scholarly journals Efficacy and safety of urate-lowering therapy in people with kidney impairment: a GCAN-initiated literature review

2021 ◽  
Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Case Reports ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Studies ◽  
Kidney Impairment ◽  
The Cochrane Library ◽  
Study Designs ◽  
Different Levels

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate <6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of < 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of < 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.

scholarly journals Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Nikita Mohan ◽  
Muhammad Ali Fayyaz ◽  
Christopher del Rio ◽  
Navpreet Kaur Rajinder Singh Khurana ◽  
Sampada Sandip Vaidya ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Case Reports ◽  
Healthcare Providers ◽  
Case Series ◽  
Altered Mental Status ◽  
Common Finding ◽  
Cochrane Library ◽  
Neurological Manifestations ◽  
The Cochrane Library ◽  
Ct And Mri

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

scholarly journals A Systematic Review of the Literature on Early Vocalizations and Babbling Patterns in Young Children

2018 ◽  
Vol 40 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Lydia Morgan ◽  
Yvonne E. Wren
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Speech Development ◽  
Cochrane Library ◽  
Bibliographic Databases ◽  
Review Of The Literature ◽  
Phonological Acquisition ◽  
Future Studies ◽  
The Cochrane Library ◽  
Children's Speech

Children’s speech development begins in infancy. The pattern of this development has been explored in studies over a number of years using a range of research methodology and approaches to investigation. A systematic review of the existing literature was carried out to determine the collective contribution of this literature to our understanding of early vocalizations and babbling through the period 9 to 18 months. Eight bibliographic databases were searched as well as the Cochrane library. Thirteen studies were identified for inclusion, which were mostly longitudinal observational case series. The review identified progressive increases in the complexity and volume of infants’ early vocalizations through the period. It also found a broad order of phonological acquisition. Although the studies in this review demonstrated marked individual variation, the review provides indicative patterns of development which can be used as a basis to explore relationships with later speech development in future studies.

scholarly journals Trochanteric pain in patients undergoing total hip arthroplasty: A protocol for a systematic review

2018 ◽  
Author(s):  
Daniel Axelrod ◽  
Kim Madden ◽  
Laura Banfield ◽  
Mitchell Winemaker ◽  
Justin deBeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Future Research ◽  
Total Hip ◽  
Review Management ◽  
The Cochrane Library ◽  
Study Designs

Background: Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. Unfortunately, there remains little high quality and reproducible evidence surrounding this disorder, especially following total hip replacement. The objectives of this review are to describe, among pre-operative or post-operative primary THA patients the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain. Methods: This is a protocol for a descriptive systematic review of trochanteric pain among THA patients. We will include studies of all study designs, with the exception of non-systematic reviews and expert opinion, with no date limits. We will search Medline, Embase, CINAHL, and the Cochrane Library using the Ovid search interface. We will also search the reference lists of included studies for possible missed studies. We will use the systematic review management software Rayyan to assist with study screening. Two reviewers will independently review studies for inclusion and extract data into a study-specific database. Discussion: This study will add to the literature by comprehensively and systematically evaluating the available literature on trochanteric pain after THA. Previous studies have been conducted on the topic but they were not comprehensive or did not review the literature systematically. Additionally, our study will critically evaluate the methodological quality of the included studies, adding an evidence-based component to the review. This review will help orthopaedic surgeons better care for patients with trochanteric pain after THA, and will identify knowledge gaps for future research. Registration: This protocol will be registered on PROSPERO

scholarly journals Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xuefeng Ma ◽  
Shousheng Liu ◽  
Jie Zhang ◽  
Mengzhen Dong ◽  
Yifen Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Method ◽  
Case Reports ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Model ◽  
Hepatic Inflammation ◽  
Normal Alt ◽  
Study Type ◽  
The Cochrane Library

Abstract Background: ALT value is often used to reflect the hepatic inflammation and injury in NAFLD patients, but many studies proved that ALT values were normal in many NAFLD patients. The aim of this study was to identify the summarized proportion of NAFLD patients with normal ALT value in the overall NAFLD patients. Methods: Electronic databases PubMed, EMBASE, Ovid, and the Cochrane Library were searched for potential studies published from January 1, 2000 to September 30, 2019. Studies that have reported the number of NAFLD or NASH patients with normal and abnormal ALT value were included and analyzed. Abstracts, reviews, case reports, and letters were excluded. Results: A total of 11 studies with 4084 patients were included for assessing the summarized proportion of NAFLD patients with normal ALT in overall NAFLD patients. As the results shown, the summarized proportion of NAFLD patients with normal ALT value in overall NAFLD patients was 25% (95%CI: 20%-31%) which was calculated by the random-effects model. The summarized proportion of NASH patients with normal ALT value in overall NASH patients was 19% (95%CI: 13%-27%). Subgroup analysis includes region, study type, diagnostic method, and group size were conducted to investigate the resource of heterogeneity in the summarized proportion of NAFLD and NASH patients with normal ALT value. Conclusions: 25% NAFLD patients and 19% NASH patients possess the normal ALT value in the clinical manifestation. The value of ALT in the clinical diagnosis of NAFLD and NASH remains need be further testified.

scholarly journals Trochanteric pain in patients undergoing total hip arthroplasty: A protocol for a systematic review

2018 ◽  
Author(s):  
Daniel Axelrod ◽  
Kim Madden ◽  
Laura Banfield ◽  
Mitchell Winemaker ◽  
Justin deBeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Future Research ◽  
Total Hip ◽  
Review Management ◽  
The Cochrane Library ◽  
Study Designs

Background: Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. Unfortunately, there remains little high quality and reproducible evidence surrounding this disorder, especially following total hip replacement. The objectives of this review are to describe, among pre-operative or post-operative primary THA patients the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain. Methods: This is a protocol for a descriptive systematic review of trochanteric pain among THA patients. We will include studies of all study designs, with the exception of non-systematic reviews and expert opinion, with no date limits. We will search Medline, Embase, CINAHL, and the Cochrane Library using the Ovid search interface. We will also search the reference lists of included studies for possible missed studies. We will use the systematic review management software Rayyan to assist with study screening. Two reviewers will independently review studies for inclusion and extract data into a study-specific database. Discussion: This study will add to the literature by comprehensively and systematically evaluating the available literature on trochanteric pain after THA. Previous studies have been conducted on the topic but they were not comprehensive or did not review the literature systematically. Additionally, our study will critically evaluate the methodological quality of the included studies, adding an evidence-based component to the review. This review will help orthopaedic surgeons better care for patients with trochanteric pain after THA, and will identify knowledge gaps for future research. Registration: This protocol will be registered on PROSPERO

scholarly journals Tophaceous Gout and Renal Insufficiency: A New Solution for an Old Therapeutic Dilemma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Anne-Kathrin Tausche ◽  
Carsten Wunderlich ◽  
Martin Aringer
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Life Expectancy ◽  
Renal Impairment ◽  
Gouty Arthritis ◽  
Serum Urate ◽  
Oxidase Inhibitor ◽  
The Novel ◽  
Tophaceous Gout ◽  
Rapid Control

The prevalence of gout is increasing with increased life expectancy. Approximately half of the patients with gout have some degree of renal impairment. If both conditions persistently coexist, and in severe tophaceous gout, in particular, treatment has been difficult. We here report on the case of an 87-year-old woman, who had been suffering from recurrent gouty arthritis over 4 years. Monthly polyarthritis attacks were accompanied by subcutaneous tophi. Serum uric acid levels were constantly above 600 μmol/L (10 mg/dL). Allopurinol was no option because of intolerance, while benzbromarone was ineffective because of renal impairment. Therefore, the novel xanthin oxidase inhibitor febuxostat was started, achieving rapid control of serum urate levels (<360 μmol/L). After initial worsening of inflammation in the first weeks, gouty attacks stopped and all tophi resolved within the following 10 months. Renal function remained stable.

scholarly journals Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases

2021 ◽  
pp. rapm-2020-102154
Author(s):  
Elke ME Bos ◽  
Koen van der Lee ◽  
Johan Haumann ◽  
Marcel de Quelerij ◽  
W Peter Vandertop ◽  
...  
Keyword(s):  
Single Case ◽  
Case Reports ◽  
Cochrane Library ◽  
Cerebrospinal Fluid Leakage ◽  
Intracranial Hematoma ◽  
Epidural Catheter Placement ◽  
Neuraxial Block ◽  
Blood Patch ◽  
Intracranial Complications ◽  
The Cochrane Library

BackgroundBesides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear.ObjectiveThis review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block.Evidence reviewWe systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie.FindingsWe analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found.ConclusionDiagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.

scholarly journals Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis

2016 ◽  
Vol 19 (3) ◽  
pp. 207-216 ◽  
Author(s):  
Asma Khalil ◽  
Emily Cooper ◽  
Rosemary Townsend ◽  
Basky Thilaganathan
Keyword(s):  
Laser Surgery ◽  
Case Reports ◽  
Meta Analysis ◽  
Survival Rates ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Definitive Answer ◽  
Registration Number ◽  
The Cochrane Library ◽  
Stage 1

Objectives: The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies.Methods: MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS. Randomized controlled trials, cohort and case-control studies were included. Case reports, studies including three or fewer cases of stage 1 TTTS, and editorials were excluded. Proportion meta-analysis was used for analysis (Registration number: CRD42016036190).Results: The search yielded 3,085 citations; 18 studies were included in the review (172 pregnancies to assess progression and 433 pregnancies to assess the survival). The pooled incidence of progression in stage 1 TTTS was 27% [95% CI 16–39%]. The pooled overall survival, double survival and at least one survival in the pregnancies managed expectantly were 79% [95% CI 62–92%], 70% [95% CI 54–84%] and 87% [95% CI 69–98%], respectively. In those undergoing amnioreduction, the corresponding figures were 77% [95% CI 68–85%], 67% [95% CI 57–76%] and 86% [95% CI 76–94%], respectively. The survival rates were 68% [95% CI 54–81%], 54% [95% CI 36–72%], and 81% [95% CI 69–90%], when laser surgery was performed.Conclusions: The optimal initial management of stage 1 TTTS remains in equipoise. The ongoing randomized trial comparing immediate laser surgery versus conservative management should provide a definitive answer.

SAFETY OF LAMOTRIGINE IN PAEDIATRICS: A SYSTEMIC REVIEW

2015 ◽  
Vol 101 (1) ◽  
pp. e1.68-e1
Author(s):  
Oluwaseun Egunsola ◽  
Imti Choonara ◽  
Helen Sammons
Keyword(s):  
Case Reports ◽  
Treatment Discontinuation ◽  
Common Reason ◽  
Systemic Review ◽  
Cochrane Library ◽  
Original Research ◽  
Paediatric Patients ◽  
Randomised Controlled ◽  
The Uk ◽  
The Cochrane Library

BackgroundLamotrigine has been increasingly used for the treatment of paediatric epilepsy. It is the most commonly prescribed new generation antiepileptic drug in the UK.ObjectivesTo identify adverse drug reactions associated with lamotrigine in children, compare the safety profile with other antiepileptic drugs and identify all clinical studies and case reports involving lamotrigine safety in children.MethodsDatabases EMBASE (1974-November 2013), Medline (1946-November 2013), PubMed and the Cochrane library for randomised controlled trials were searched for original research or reports in which paediatric patients received at least a single dose of lamotrigine for the treatment of epilepsy, with safety as an outcome measure.ResultsA total of 76 articles involving 2,184 paediatric patients were identified. There were 1,952 adverse events (AEs) reported. Fifty two of these AEs were from 49 case reports. Rash was most commonly reported, with a risk of 8.96 per 100 patients. Other common AEs included headache, fever, somnolence, vomiting, seizure aggravation, dizziness, cough, aggression, ataxia and insomnia. There were significantly higher risks of dizziness [RR 4.57, 95% CI: 1.88–11.12, p<0.001], abdominal pain [RR: 2.53, 95% CI: 1.12–5.70, p=0.03] and nausea [RR: 5.94, 95% CI: 1.59–22.13, p=0.008] with lamotrigine than placebo. When compared with valproic acid, the risk of somnolence and vomiting was significantly lower for lamotrigine [RR: 0.35, 95% CI: 0.13–0.89, p=0.04] and [RR: 0.20, 95% CI: 0.04–0.89, p=0.03]. Discontinuation due to an adverse drug reaction was recorded in 72 children (3.2% of all treated patients). Rash was the most common reason, with 58% of treatment discontinuation attributed to different forms of rash.ConclusionRash is the most common adverse reaction of lamotrigine, seen in around 9% of patients, and it is the most common reason for treatment discontinuation.

scholarly journals Dental Bulk-Fill Resin Composites Polymerization Efficiency: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 5 (6) ◽  
pp. 149
Author(s):  
Reem A. Ajaj ◽  
Nada J. Farsi ◽  
Lama Alzain ◽  
Nour Nuwaylati ◽  
Raneem Ghurab ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Relevant Information ◽  
Cochrane Library ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Medical Subject Headings ◽  
Future Studies ◽  
Comprehensive Search ◽  
The Cochrane Library

Dental Bulk-Fill Composites (BFCs) and Bulk-Fill Flowables (BFFs) were introduced in the market to facilitate efficient bulk filling of cavities up to 5 mm. The aim of this study was to synthesize the literature investigating their polymerization efficiency. A comprehensive search of PubMed and the Cochrane Library from 2010 to January 2019 was performed using the medical subject headings. Screening of the titles, abstracts and full text was performed. Data extraction for relevant information was done on the included studies. Clinically relevant parameters were selected to present the study estimates (meta-analysis) using a random effects model for polymerization efficiency (Degree of Conversion (DC) and Depth of Cure (DoC)). Twenty one studies fulfilled the inclusion criteria and were included in the analysis reporting seven BFCs and nine BFFs. Ten materials reported acceptable DC values of above 55% and ten materials reported adequate DoC values. Most of the stated materials reported adequate DC and DoC values in at least one investigation with BFFs showing higher and more acceptable values compared to packable BFCs. It is suggested that future studies be carried out using a standard methodology following the ISO 4049 standard and manufacturer’s instructions to compare results.

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