109 Vascular Composite Allotransplantation in Burn Reconstruction: Systematic Review and Meta-analysis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S72-S73
Author(s):  
Joshua Peterson ◽  
Pablo Padilla ◽  
Kelsey Gray ◽  
Ramón Zapata-Sirvent ◽  
William Norbury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Senior Author ◽  
Fisher Exact Test ◽  
Burn Patients ◽  
Exact Test ◽  
Relative Safety ◽  
Significant Difference

Abstract Introduction The first vascular composite allotransplantation (VCA) was performed in 1998, with the first post-burn VCA in 2003. Since then, 21 burn patients have been recipients of VCAs. Controversy exists regarding safety of VCA in burn patients due to high levels of immunologic sensitization attributed to use of cadaver allograft. We seek to understand unique considerations of VCA in burn reconstruction and its relative safety compared to VCA in non-burn reconstruction. Methods A systematic review of VCA in burn reconstruction was conducted using the PubMed, Media and EBSCO database to retrieve all articles and news stories studying VCA from Jan. 2000 to May 2019. Only articles containing composite tissue allotransplantation, VCA, and reconstructive surgery were included. Articles that did not report outcomes or patient information were excluded. Reported cases were grouped according to injury and tissue (face vs. upper extremity) with mortality as a dependent variable. Statistical analysis was performed with the Fisher exact test. Results Of 63 articles obtained, 21 met criteria. After secondary review by the senior author, 6 more articles were included. To date, 147 VCAs are reported in 112 patients, including 40 face VCAs and 107 upper extremity VCAs. Of these, 30 (20%) were performed for post-burn deformities, and 117 (80%) for non-burn deformities. A total of 21 post-burn patients received VCAs with 4 subsequent deaths (19%). Post-burn recipients of upper extremity VCAs had significantly higher mortality than non-burn recipients of the same (p = 0.01), but there was no significant difference in face VCA mortality (p = 1.0) or overall mortality (p = 0.06) between groups. Conclusions VCA is a forefront procedure employed worldwide for reconstruction of devastating injuries. Presently, burn patients are at greater risk of mortality after upper extremity VCA, but not face VCA. Burn patients will benefit from focused investigation of unique post-burn risk factors of VCA mortality. Applicability of Research to Practice Disparities between post-burn and non-burn VCA outcomes suggest the presence of unique risk factors in burn patients. Investigation of unique risk factors will improve safety of VCA for burn patients.

scholarly journals Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Durray Shahwar A. Khan ◽  
La-Raib Hamid ◽  
Anna Ali ◽  
Rehana A. Salam ◽  
Nadeem Zuberi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Pregnant Women ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Respiratory Disorder ◽  
Significant Difference ◽  
The Mean ◽  
In Pregnancy

Abstract Background There is dearth of information on COVID-19’s impact on pregnant women. However, literature reported trends of COVID-19 differ, depending on the presence of clinical features upon presentation. Objective This systematic review aimed to assess differences in risk factors, management, complications, and pregnancy and perinatal outcomes in symptomatic vs. asymptomatic pregnant women with confirmed SARS-CoV-2 infection. Methods A search was run on electronic databases to identify studies reporting COVID-19 in pregnancy. Meta-analysis was performed and odds ratios and mean difference with 95% confidence intervals were calculated using Review Manager 5.4. Review Prospero registration number CRD42020204662. Results We included ten articles reporting data from 3158 pregnancies; with 1900 symptomatic and 1258 asymptomatic pregnant women. There was no significant difference in the mean age, gestational age, and body mass index between the two groups. The meta-analysis suggested that pregnant women who were obese (OR:1.37;95%CI:1.15 to 1.62), hypertensive (OR:2.07;95%CI:1.38 to 3.10) or had a respiratory disorder (OR:1.64;95%CI:1.25 to 2.16), were more likely to be symptomatic when infected with SARS-CoV-2. Pregnant women with Black (OR:1.48;95%CI:1.19 to 1.85) or Asian (OR:1.64;95%CI:1.23 to 2.18) ethnicity were more likely to be symptomatic while those with White ethnicity (OR:0.63;95%CI:0.52 to 0.76) were more likely to be asymptomatic. Cesarean-section delivery (OR:1.40;95%CI:1.17 to 1.67) was more likely amongst symptomatic pregnant women. The mean birthweight(g) (MD:240.51;95%CI:188.42 to 293.51), was significantly lower, while the odds of low birthweight (OR:1.85;95%CI:1.06 to 3.24) and preterm birth (< 37 weeks) (OR:2.10;95%CI:1.04 to 4.23) was higher amongst symptomatic pregnant women. Symptomatic pregnant women had a greater requirement for maternal ICU admission (OR:13.25;95%CI:5.60 to 31.34) and mechanical ventilation (OR:15.56;95%CI:2.96 to 81.70) while their neonates had a higher likelihood for Neonatal Intensive Care Unit admission (OR:1.96;95%CI:1.59 to 2.43). The management strategies in the included studies were poorly discussed, hence could not be analyzed. Conclusion The evidence suggests that the presence of risk factors (co-morbidities and ethnicity) increased the likelihood of pregnant women being symptomatic. Higher odds of complications were also observed amongst symptomatic pregnant women. However, more adequately conducted studies with adjusted analysis and parallel comparison groups are required to reach conclusive findings.

Tapered and non-tapered prosthetic grafts in upper extremity dialysis access: A systematic review and meta-analysis

2020 ◽  
pp. 112972982097417
Author(s):  
Venkata Sai Jasty ◽  
David Haddad ◽  
Babu Mohan ◽  
Wei Zhou ◽  
Jeffrey J Siracuse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Significant Difference ◽  
Arteriovenous Grafts ◽  
Meta Analyses ◽  
Steal Syndrome

Objective: It is unclear whether tapered arteriovenous grafts (AVGs) are superior to non-tapered AVGs when it comes to preventing upper extremity ischemic steal syndrome. We aimed to evaluate the outcomes of tapered and non-tapered AVGs using systematic review and meta-analysis. Methods: A literature search was systemically performed to identify all English publications from 1999 to 2019 that directly compared the outcomes of upper extremity tapered and non-tapered AVGs. Outcomes evaluated were the primary patency at 1-year (number of studies ( n) = 4), secondary patency at 1-year ( n = 3), and risk of ischemic steal ( n = 5) and infection ( n = 4). Effect sizes of individual studies were pooled using random-effects model, and between-study variability was assessed using the I2 statistic. Results: Of 5808 studies screened, five studies involving 4397 patients have met the inclusion criteria and included in the analysis. Meta-analyses revealed no significant difference for the risk of ischemic steal syndrome (pooled odds ratio (OR) 0.92, 95% Confidence Incidence (CI) 0.29–2.91, p = 0.89, I2 = 48%) between the tapered and non-tapered upper extremity AVG. The primary patency (OR 1.33, 95% CI 0.93–1.90, p = 0.12, I2 = 10%) and secondary patency at 1-year (OR 1.49, 95% CI 0.84–2.63, p = 0.17, I2 = 13%), and rate of infection (OR 0.62, 95% CI 0.30–1.27, p = 0.19, I2 = 29%) were also similar between the tapered and non-tapered AVG. Conclusions: The risk of ischemic steal syndrome and patency rate are comparable for upper extremity tapered and non-tapered AVGs. This meta-analysis does not support the routine use of tapered graft over non-tapered graft to prevent ischemic steal syndrome in upper extremity dialysis access. However, due to small number of studies and sample sizes as well as limited stratification of outcomes based on risk factors, future studies should take such limitations into account while designing more robust protocols to elucidate this issue.

scholarly journals Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

2019 ◽  
Vol 89 (10) ◽  
pp. 1256-1260 ◽  
Author(s):  
Mark L. Vickers ◽  
Eva Malacova ◽  
Gabriel J. Milinovich ◽  
Patrick Harris ◽  
Lars Eriksson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Modifiable Risk Factors ◽  
Burn Patients ◽  
Gram Negative

scholarly journals Predictors for sexual dysfunction in the first year postpartum: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Laura Cattani ◽  
Liza De Maeyer ◽  
Jan Verbakel ◽  
Jan Bosteels ◽  
Jan Deprest
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Sexual Dysfunction ◽  
Search Strategy ◽  
Meta Analysis ◽  
Pelvic Floor Dysfunction ◽  
First Year ◽  
Vaginal Dryness ◽  
Significant Difference ◽  
Spontaneous Delivery

Background Pregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role, remain unclear. Objectives In this systematic review of literature, we aimed to determine the risk factors for sexual dysfunction in the first year after delivery. Search Strategy We searched MEDLINE, Embase and CENTRAL using the search strategy: Sexual dysfunction AND Obstetric events. Selection Criteria We included original English, comparative studies that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness. Data Collection and Analysis We assessed the quality and the risk of bias of the included studies with the Newcastle Ottawa Scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary Odds Ratios (OR) with 95% Confidence Intervals. Heterogeneity across studies was assessed using the I2 statistic. Main Results We found no significant difference in the odds for both sexual dysfunction and dyspareunia between cesarean section and spontaneous delivery (OR:1.17[0.88-1.57] and OR:0.75[0.53-1.07]) and between operative delivery and spontaneous delivery (OR:1.56[0.87-2.79] and OR:1.35[0.75-2.42]). Anal sphincter injury was associated with increased odds for both sexual dysfunction (OR:3.00[1.28-7.03]) and dyspareunia (OR:1.71[1.09-2.67]). Episiotomy was associated with dyspareunia (OR:1.65[1.20-2.29]) but not with sexual dysfunction (OR:1.90[0.94-3.84]). We retrieved one study of low quality which reported on vaginal dryness and found no significant association with obstetric events.

scholarly journals The prevalence of and risk factors for dysphagia among elderly residents in nursing homes: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Zhao Hu ◽  
Baohua Zheng ◽  
Atipatsa Chiwanda Kaminga ◽  
Huilan Xu
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Nursing Homes ◽  
English Language ◽  
Meta Analysis ◽  
Functional Limitation ◽  
Significant Risk ◽  
Assessment Tools ◽  
Significant Difference ◽  
Prevalence Estimates

Abstract Background Elderly residents in nursing homes are at high risk for dysphagia. However, the prevalence estimates of this condition and its risk factors among this population were inconsistent. Objective To estimate the prevalence of dysphagia and examine its risk factors among the elderly in nursing homes. Methods Electronic database of PubMed, Web of science, Embase for English language, Wangfang, VIP and CNKI for Chinese language were systematically searched to identify relevant observational studies published not later than July 4, 2021. Studies conducted in nursing homes and reported dysphagia assessment methods were included. Results In total, 43 studies involving 56,746 participants were included in this systematic review and meta-Analysis. The overall pooled crude prevalence of dysphagia was 35.9% (95%CI: 29.0%, 43.4%), with high heterogeneity (I2 = 99.5%). There was a statistically significant difference in prevalence estimates with respect to study locations, methods of assessment of dysphagia, dysphagia assessment staff, representativeness of samples, and validity of assessment tools. Pooled estimates indicated that male (OR = 1.13, 95%CI: 1.00, 1.27), cognitive impairment (OR = 2.47, 95%CI: 1.59, 3.84), functional limitation (OR = 2.59, 95% CI: 1.75, 3.84), cerebrovascular disease (OR = 2.90, 95%CI: 1.73,4.87), dementia (OR = 1.50, 95%CI: 1.15, 1.96) and Parkinson’s disease (OR = 1.81, 95%CI: 1.06, 3.08) were significant risk factors for dysphagia. Conclusions The prevalence of dysphagia in nursing homes is relatively high, and with high heterogeneity. Also, many factors were associated with the risk of dysphagia. Further research is needed to identify strategies for management and interventions targeted at these disorders in this population.

scholarly journals Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036086
Author(s):  
Sohail Akhtar ◽  
Jamal Abdul Nasir ◽  
Aqsa Sarwar ◽  
Nida Nasr ◽  
Amara Javed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
General Population ◽  
Rural Areas ◽  
Urban Areas ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Significant Difference ◽  
Associated Risk Factors

ObjectiveThe purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh.DesignSystematic review and meta-analysis.ParticipantsGeneral population of Bangladesh.Data sourcesPubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed.ResultsOut of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4–9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7–14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference.ConclusionsThis meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population.PROSPERO registration numberCRD42019148205.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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