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

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.

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Cryptococcosis complicating diabetes mellitus: a scoping review

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211014769 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110147

Author(s):

Lauryn Nsenga ◽

Jonathan Kajjimu ◽

Ronald Olum ◽

Sandra Ninsiima ◽

Andrew Peter Kyazze ◽

...

Keyword(s):

Diabetes Mellitus ◽

Single Case ◽

Wide Spectrum ◽

Case Reports ◽

Case Series ◽

Cochrane Library ◽

Cryptococcal Disease ◽

Language Restriction ◽

Antigen Tests ◽

The Cochrane Library

Background: A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. Objective: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( n = 18). Among those with meningitis mortality was 36.2%. Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.

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

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa073 ◽

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.

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

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00322-3 ◽

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.

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

10.21203/rs.2.17842/v2 ◽

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.

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

Twin Research and Human Genetics ◽

10.1017/thg.2016.33 ◽

2016 ◽

Vol 19 (3) ◽

pp. 207-216 ◽

Cited By ~ 15

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.

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SAFETY OF LAMOTRIGINE IN PAEDIATRICS: A SYSTEMIC REVIEW

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.70 ◽

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.

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Urethral Diverticulum following Polypropylene Mesh Midurethral Slings: A Literature Review

BioMed Research International ◽

10.1155/2020/6761581 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Elizabeth Pacer ◽

Omar Felipe Duenas-Garcia ◽

Lekha Hota ◽

Kristan Hornsby ◽

Robert Shapiro

Keyword(s):

Polypropylene Mesh ◽

Case Reports ◽

Urethral Diverticulum ◽

Cochrane Library ◽

Midurethral Slings ◽

Autoimmune Conditions ◽

Urethral Diverticula ◽

Sling Placement ◽

Tract Infections ◽

The Cochrane Library

Aims. It is currently unknown whether an association exists between polypropylene mesh and urethral diverticulum formation following placement of polypropylene midurethral slings (MUS) for the treatment of stress urinary incontinence (SUI). We aimed to examine the literature associating MUS with the occurrence of urethral diverticula. Methods. Multiple online research databases, including PubMed, Google Scholar, EBSCOhost, and the Cochrane Library, were searched, from January 2019 to February 2019, for evidence related to the occurrence of urethral diverticula following polypropylene MUS procedures. Results. Four case reports were published demonstrating the occurrence of urethral diverticula following the use of polypropylene mesh for surgical treatment of SUI. Subjects of these cases were menopausal and had an elevated body mass index (BMI), recurrent urinary tract infections (UTIs), autoimmune conditions, or prior pelvic floor surgeries. A thorough urologic workup, including imaging prior to sling placement, was not always performed. Conclusion. No clear association exists between polypropylene MUS placement and subsequent urethral diverticulum formation. Factors that diminish polypropylene mesh biocompatibility include elevated BMI, menopause, recurrent UTIs, prior pelvic surgeries, and preexisting medical conditions. Symptoms associated with urethral diverticula should prompt a complete urologic workup prior to MUS placement.

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Sport-Related Concussion in Female Athletes: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120932306 ◽

2020 ◽

Vol 8 (7) ◽

pp. 232596712093230

Author(s):

Neil K. McGroarty ◽

Symone M. Brown ◽

Mary K. Mulcahey

Keyword(s):

Systematic Review ◽

Female Athletes ◽

Treatment Guidelines ◽

Single Case ◽

Case Reports ◽

Specific Treatment ◽

Cochrane Library ◽

Cross Sectional ◽

Male Athletes ◽

Head Impacts

Background: Female athletes are more susceptible to sport-related concussions (SRCs) and experience worse outcomes compared with male athletes. Although numerous studies on SRC have compared the outcomes of concussions in male and female athletes after injury, research pertaining to why female athletes have worse outcomes is limited. Purpose: To determine the factors that predispose female athletes to more severe concussions than their male counterparts. Study Design: Systematic review; Level or evidence, 3. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. The MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane Library databases were systematically searched on July 5 to July 20, 2018. Included were cohort, case-control, and cross-sectional studies that examined the effects of concussive and subconcussive head impacts in only female athletes of all ages, regardless of competition level. These studies were further supplemented with epidemiologic studies. Exclusion criteria included narrative reviews, single case reports, abstracts and letters to the editor, and studies related to chronic traumatic brain injury. Results: A total of 25 studies met the inclusion criteria. Female athletes appear to sustain more severe concussions than male athletes, due in part to a lower biomechanical threshold tolerance for head impacts. Additionally, concussions may alter the hypothalamic-pituitary-ovarian axis, resulting in worse symptoms and amenorrhea. Although females are more likely to report concussions than males, underreporting still exists and may result in concussions going untreated. Conclusion: This systematic review demonstrates that female athletes may be more susceptible to concussion, have prolonged symptoms after a concussion, and are more likely to report a concussion than their male counterparts. However, underreporting still exists among female athletes. Possible factors that put female athletes at a higher risk for concussions include biomechanical differences and hormonal differences. To effectively prevent, diagnose, and treat concussions in female athletes, more research is required to determine when and how such injuries are sustained. Despite sex-based differences in the clinical incidence, reporting behavior, and outcomes of SRCs, female athletes remain an understudied population, resulting in lack of sex-specific treatment guidelines for female athletes postinjury.

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Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review

American Journal of Rhinology and Allergy ◽

10.1177/1945892420976766 ◽

2020 ◽

pp. 194589242097676

Author(s):

Fabiana Allevi ◽

Gian Luca Fadda ◽

Cecilia Rosso ◽

Federica Martino ◽

Carlotta Pipolo ◽

...

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Diagnostic Criteria ◽

Single Case ◽

Case Reports ◽

Significant Proportion ◽

Case Series ◽

Assessment Tools ◽

Cochrane Library ◽

Odontogenic Sinusitis

Background Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. Objective The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. Methods Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. Results Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. Conclusions Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.

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Intracranial microhemorrhages in the setting of COVID-19: what we know so far

The Neuroradiology Journal ◽

10.1177/19714009211004144 ◽

2021 ◽

pp. 197140092110041

Author(s):

John C Benson ◽

Christopher H Hunt ◽

James P Klaas ◽

David F Kallmes

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Case Reports ◽

Severity Of Illness ◽

Cochrane Library ◽

Resonance Imaging ◽

Patient Demographics ◽

Characteristic Features ◽

The Cochrane Library ◽

Multiple Patients

Background Diffuse intracranial susceptibility abnormalities have recently been described among patients with coronavirus disease 2019 (COVID-19), although prior studies have consisted of case reports and/or series. This brief literature review seeks to compile and catalogue the available data to elucidate characteristic features of such findings. Materials and methods Scientific articles and studies on intracranial microhemorrhages in the setting of COVID-19 were searched on PubMed, Google Scholar, and the Cochrane Library. Included studies described intracranial microbleed(s) on magnetic resonance imaging in patients with COVID-19. If multiple patients were described, only patients with intracranial microhemorrhage on magnetic resonance imaging were included for analysis. Patient demographics, severity of illness (e.g. intensive care unit admission and/or intubation), time from diagnosis of COVID-19 to magnetic resonance imaging, and location(s) of any observed microhemorrhages were noted. Results A total of 39 patients with suspected intracranial microhemorrhages have been described in prior studies. The average age of patients was 64.7 years; 21.9% were women. The average time between COVID-19 diagnosis and magnetic resonance imaging was 31.7 days. All patients in the cohort were admitted to critical care and were either intubated or treated with extracorporeal membrane oxygenation during their clinical course. Microhemorrhages were most commonly located in the subcortical/juxtacortical white matter and corpus callosum. Conclusions Intracranial microbleeds are a well-documented finding in patients with severe COVID-19, and are most commonly callosal and subcortical/juxtacortical in location.

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