scholarly journals Timing of Mycobacterium tuberculosis exposure explains variation in BCG effectiveness: a systematic review and meta-analysis

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216794
Author(s):  
James M Trauer ◽  
Andrew Kawai ◽  
Anna K Coussens ◽  
Manjula Datta ◽  
Bridget M Williams ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Search Strategy ◽  
Latitudinal Gradient ◽  
Meta Analysis ◽  
Early Exposure ◽  
Exclusion Criteria ◽  
High Burden ◽  
Bcg Vaccination ◽  
Explanatory Hypothesis

RationaleThe heterogeneity in efficacy observed in studies of BCG vaccination is not fully explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure.MethodsWe updated previous systematic reviews of the effectiveness of BCG vaccination to 31 December 2020. We employed an identical search strategy and inclusion/exclusion criteria to these earlier reviews, but reclassified several studies, developed an alternative classification system and considered study demography, diagnostic approach and tuberculosis (TB)-related epidemiological context.Main resultsOf 21 included trials, those recruiting neonates and children aged under 5 were consistent in demonstrating considerable protection against TB for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period.ConclusionsThe most plausible explanatory hypothesis for these results is that BCG protects against TB that results from exposure shortly after vaccination. However, we found no evidence of protection when exposure occurs later from vaccination, which would be of greater importance in trials in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection observed for many years thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines with repeated exposure to Mycobacterium tuberculosis or other pathogens.

scholarly journals Timing of M. tuberculosis exposure explains variation in BCG effectiveness: A systematic review and meta-analysis

2020 ◽  
Author(s):  
James M Trauer ◽  
Andrew Kawai ◽  
Anna Coussens ◽  
Manjula Datta ◽  
Bridget M Williams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Search Strategy ◽  
Latitudinal Gradient ◽  
Meta Analysis ◽  
Early Exposure ◽  
Exclusion Criteria ◽  
High Burden ◽  
Bcg Vaccination ◽  
Explanatory Hypothesis

AbstractBackgroundThe variable efficacy observed in studies of BCG vaccination is incompletely explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure. We investigated heterogeneity in BCG vaccination in the context of participant demography, diagnostic approach and TB-related epidemiological context.MethodsWe updated previous systematic reviews of the effectiveness of BCG vaccination to 31st December 2018. We employed an identical search strategy and inclusion/exclusion criteria to past reviews, but reclassified several studies and developed an alternative classification system.ResultsOf 21 included trials, those recruiting neonates and children aged under five were consistent in demonstrating considerable protection for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period.ConclusionsThe most plausible explanatory hypothesis is that BCG protects against TB that results from exposure shortly after vaccination. However, risk is equivalent or increased when exposure occurs later from vaccination, a phenomenon which is predominantly observed in adults in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines due to repeated exposure to M. tuberculosis or other pathogens.

scholarly journals Cuidado de enfermagem ao recém-nascido em fototerapia, o que as evidências revelam: revisão integrativa

2020 ◽  
Vol 10 (32) ◽  
pp. 259-268
Author(s):  
Karla Brandão de Araújo ◽  
Erika Oliveira Abinader ◽  
Anete Leda de Oliveira Martins ◽  
Gláucia Alvarenga de Araújo ◽  
Karem De Souza Brandão ◽  
...  
Keyword(s):  
Literature Review ◽  
Nursing Care ◽  
Clinical Condition ◽  
Search Strategy ◽  
Scientific Evidence ◽  
Neonatal Hyperbilirubinemia ◽  
Exclusion Criteria ◽  
Specific Care

A Hiperbilirrubinemia neonatal é uma condição clínica caraterizada pelo acúmulo de bilirrubina no organismo do neonato podendo acarretar graves sequelas quando não tratada. Um dos meios terapêuticos consiste fototerapia, um tratamento que demanda cuidados específicos para prevenir iatrogenias. A enfermagem desempenha relevante papel nesses cuidados, pois permanece 24 horas no seguimento dos casos prevenindo complicações e contribuindo para a eficácia da terapêutica. Portanto, nesse estudo o objetivo foi investigar, através de revisão integrativa da literatura, as evidências científicas sobre os cuidados de enfermagem ao recém nascido em fototerapia. Para tal, foram pesquisadas as bases de dados: BDENF, LILACS, MEDLINE e SCIELO. Na formulação da estratégia de busca foram utilizados os descritores em saúde combinados entre si através dos operadores booleanos AND e OR. Foram encontrados quarenta artigos que após uso de critérios de inclusão e exclusão pré-definidos, permaneceram quatro que compuseram a amostra. A revisão revelou que os cuidados de enfermagem influenciam positivamente na adesão e resultado do tratamento.Descritores: Assistência de Enfermagem, Hiperbilirrubinemia Neonatal, Fototerapia. Nursing care for newborn in phototherapy, what the evidence reveals: integrative reviewAbstract: Neonatal hyperbilirubinemia is a clinical condition characterized by the accumulation of bilirubin in the neonate's organism and can cause serious sequelae when not treated. One of the therapeutic means consists of phototherapy, a treatment that requires specific care to prevent iatrogenesis. Nursing plays an important role in this care, as it remains 24 hours in the follow-up of cases, preventing complications and contributing to the effectiveness of therapy. Therefore, in this study the objective was to investigate, through an integrative literature review, the scientific evidence on nursing care for newborns undergoing phototherapy. For this, the databases were searched: BDENF, LILACS, MEDLINE and SCIELO. In the formulation of the search strategy, health descriptors combined with each other through the Boolean operators AND and OR were used. Forty articles were found that, after using pre-defined inclusion and exclusion criteria, four remained in the sample. The review revealed that nursing care positively influences adherence and treatment results.Descriptors: Nursing Care, Neonatal Hyperbilirubinemia, Phototherapy. Cuidado de enfermería para lo recién nacida en fototerapia, lo que revelan la evidencia: revisión integrativaResumen: La hiperbilirrubinemia neonatal es una condición clínica caracterizada por la acumulación de bilirrubina en el organismo del recién nacido y puede causar secuelas graves cuando no se trata. Uno de los medios terapéuticos consiste en la fototerapia, un tratamiento que requiere atención específica para prevenir la iatrogénesis. La enfermería desempeña un papel importante en esta atención, ya que permanece 24 horas en el seguimiento de los casos, previniendo complicaciones y contribuyendo a la efectividad de la terapia. Por lo tanto, en este estudio el objetivo fue investigar, a través de una revisión bibliográfica integradora, la evidencia científica sobre el cuidado de enfermería para los recién nacidos sometidos a fototerapia. Para esto, se realizaron búsquedas en las bases de datos: BDENF, LILACS, MEDLINE y SCIELO. En la formulación de la estrategia de búsqueda, se utilizaron descriptores de salud combinados entre sí a través de los operadores booleanos AND y OR. Cuarenta artículos se encontraron que, después de utilizar criterios de inclusión y exclusión predefinidos, cuatro permanecieron en la muestra. La revisión reveló que la atención de enfermería influye positivamente en la adherencia y los resultados del tratamiento.Descriptores: Cuidados de Enfermería, Hiperbilirrubinemia Neonatal, Fototerapia.

scholarly journals Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

BMJ ◽  
2014 ◽  
Vol 349 (aug04 5) ◽  
pp. g4643-g4643 ◽  
Author(s):  
A. Roy ◽  
M. Eisenhut ◽  
R. J. Harris ◽  
L. C. Rodrigues ◽  
S. Sridhar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mycobacterium Tuberculosis ◽  
Meta Analysis ◽  
Tuberculosis Infection ◽  
Mycobacterium Tuberculosis Infection ◽  
Bcg Vaccination

Rituximab in the treatment of systemic sclerosis–related interstitial lung disease: a systematic review and meta-analysis

Rheumatology ◽  
2020 ◽  
Author(s):  
Rudra P Goswami ◽  
Animesh Ray ◽  
Moumita Chatterjee ◽  
Arindam Mukherjee ◽  
Geetabali Sircar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Vital Capacity ◽  
Meta Analysis ◽  
First Year ◽  
Exclusion Criteria ◽  
Diffusion Capacity ◽  
And Diffusion

Abstract Objectives To assess the effect of rituximab (RTX) on the lung function parameters in SSc interstitial lung disease (SSc-ILD) patients. Methods PubMed and Embase were searched to identify studies on SSc-ILD treated with RTX, confined to a predefined inclusion and exclusion criteria. A systematic review and meta-analysis were performed on the included studies on changes in forced vital capacity (FVC) and diffusion capacity of carbon monoxide (DLCO) from baseline to 6 and 12 months of follow-up. Results A total of 20 studies (2 randomized controlled trials, 6 prospective studies, 5 retrospective studies and 7 conference abstracts) were included (n = 575). RTX improved FVC from baseline by 4.49% (95% CI 0.25, 8.73) at 6 months and by 7.03% (95% CI 4.37, 9.7) at 12 months. Similarly, RTX improved DLCO by 3.47% (95% CI 0.99, 5.96) at 6 months and 4.08% (95% CI 1.51, 6.65) at 12 months. In the two studies comparing RTX with other immunosuppressants, improvement of FVC by 6 months in the RTX group was 1.03% (95% CI 0.11, 1.94) greater than controls. At the 12 month follow-up, RTX treatment was similar to controls in terms of both FVC and DLCO. Patients treated with RTX had a lower chance of developing infections compared with controls [odds ratio 0.256 (95% CI 0.104, 0.626), I2 = 0%, P = 0.47). Conclusions Treatment with RTX in SSc-ILD was associated with a significant improvement of both FVC and DLCO during the first year of treatment. RTX use was associated with lower infectious adverse events.

Ambient air pollution and multiple sclerosis: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mohammad Amin Farahmandfard ◽  
Ahmad Naghibzadeh-Tahami ◽  
Narges Khanjani
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Air Pollution ◽  
Search Strategy ◽  
Meta Analysis ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Significant Relation ◽  
Exclusion Criteria ◽  
Key Word

Abstract Objectives Some studies have shown that environmental risk factors, including air pollution, might be related to the incidence or recurrence of multiple sclerosis (MS). This systematic review was conducted to investigate the relation between air pollution and MS. Methods A systematic search was conducted in PubMed, Scopus, Science Direct, Embase, and Web of Science; until January 2020 with no restrictions. The search strategy was conducted with air pollution key words such as CO, PM2.5, PM10, SO2, and NO2, for exposure and the key word “Multiple sclerosis” as the outcome. Results Eventually, after applying the inclusion and exclusion criteria, 17 articles were included. The methodologies and outcomes reported were heterogeneous and different metrics had been used in the results; therefore conducting a meta-analysis was not possible. Eight studies had analyzed the relation between particulate matter (PM) and the prevalence or relapse of MS and had observed a significant relation. NO2 and NOx were associated with recurrence or prevalence of MS in three studies. But, in three cohort studies, no association was observed between air pollution and recurrence or occurrence of MS. Conclusions The results of this systematic review show that outdoor air pollution, especially PM and nitrogen oxides might be related to the prevalence or relapse of MS.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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