scholarly journals Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Syed Arsalan A. Zaidi ◽  
Kainat Saleem
Keyword(s):  
Risk Ratio ◽  
Meta Analysis ◽  
Survival Rates ◽  
Final Analysis ◽  
Total Sample ◽  
Sample Population ◽  
Obese Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Nonobese Patients

Purpose. Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods. We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m2 (obese) and BMI < 30 kg/m2 (nonobese). Results. In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi2 = 7.44, df = 4 ( p = 0.11 ), I2 = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau2 0.03, chi2 = 14.61, df = 5 ( p = 0.01 ), I2 = 66%). Conclusion. Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.

scholarly journals The Use of Oseltamivir as Adjunctive Therapy for the Treatment of Hand-Food-and-Mouth Disease: A Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Yijing Zhao ◽  
Yangyang Sun ◽  
Raphael N. Alolga ◽  
Gaoxiang Ma ◽  
Fan Wang
Keyword(s):  
Clinical Trials ◽  
Adjunctive Therapy ◽  
Adverse Reactions ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Final Analysis ◽  
Mouth Disease ◽  
Increased Risk ◽  
Fever Clearance Time ◽  
Significant Difference

Background: Hand-foot-and-mouth disease (HFMD) is a common childhood illness caused by enteroviruses. Oseltamivir (OS), a neuraminidase inhibitor, has been frequently used as an adjunctive therapy for the treatment of HFMD. Solid evidence, however, is lacking regarding the efficacy of such adjunctive therapy. This work is to conduct a meta-analysis of randomized clinical trials (RCTs) to assess the efficacy of oseltamivir for HFMD in children.Methods: Eligible studies from inception to October 10, 2020 were identified by searching six databases (PubMed, Embase, CENTRAL, CNKI, Wanfang, and VIP database). Quality of evidence was assessed using the Cochrane Collaboration tool.Results: Of a total of 91 entries, 11 RCTs involving 977 HFMD children were included in the final analysis. The results showed that the therapy combined with oseltamivir was more effective, with higher effective rate (RR, 0.84; 95% CI, 0.80 to 0.87; p &lt; 0.01), shorter fever clearance time (days) (SMD, −0.74; 95% CI, −1.12 to −0.35; p &lt; 0.01), shorter rash regression time (days) (MD, −0.89; 95% CI, −1.05 to −0.72; p &lt; 0.01) and shorter clinical cure time (SMD, −1.08; 95% CI, −1.55 to −0.61; p &lt; 0.01). No significant difference was observed in the risk of adverse reactions between the groups with and without oseltamivir.Conclusion: The use of oseltamivir as adjunctive therapy shows effectiveness and no increased risk of adverse reactions for the treatment of HFMD in children.

scholarly journals Obesity Is Associated with Severe Disease and Mortality in Patients with Coronavirus Disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Zixin Cai ◽  
Yan Yang ◽  
Jingjing Zhang
Keyword(s):  
Fixed Effects ◽  
Web Of Science ◽  
Meta Analysis ◽  
Severe Disease ◽  
Cochrane Library ◽  
Obese Patients ◽  
Risk Of Infection ◽  
Fixed Effects Models ◽  
Increased Risk ◽  
Nonobese Patients

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has led to global research with the aim of predicting which people are at greatest risk of developing severe disease and dying. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods: We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19 . Odd risks (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Results: Thirty-eight studies involving 621502 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection (OR 3.19, 95% CI 1.45-7.03; I2 = 98.3%), hospitalization (OR 1.77, 95% CI 1.61-1.95; I2 = 43.8%), clinically severe disease (OR 2.88, 95% CI 1.99-4.16; I2 = 49.9%), mechanical ventilation (OR 1.66, 95% CI1.42-1.94; I2 = 41.3%), intensive care unit (ICU) (OR 2.06, 95% CI1.49-2.85; I2 = 71.4%), and mortality (OR 1.48, 95% CI 1.18-1.85; I2 = 80.8%). Conclusion: Patients with obesity may have a greater risk of developing severe COVID-19 and dying. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients.

Interpersonal Violence and Substance Use Among Female Sexual Minorities

2019 ◽  
Author(s):  
Cort M. Dorn-Medeiros ◽  
Cass Dykeman ◽  
Timothy Bergquist
Keyword(s):  
New York ◽  
Tobacco Use ◽  
Interpersonal Violence ◽  
Sexual Minorities ◽  
Sample Population ◽  
Life Outcomes ◽  
City Community ◽  
Increased Risk ◽  
Significant Difference ◽  
Community Health Survey

This archived data study used results from the New York City Community Health Survey to explore the relationship between interpersonal violence among female sexual minorities (FSM) and their levels of alcohol and tobacco use. A total of 92 FSM were included in the sample population. There was a significant difference in the mean number of alcoholic drinks consumed between FSM who reported past experience of interpersonal violence and those who did not. No difference was found in levels of tobacco use between FSM who reported interpersonal violence and those who did not. Results of the present study support current research indicating FSM may be at increased risk for elevated alcohol use and respective negative life outcomes related to the experience of interpersonal violence.

scholarly journals Simultaneous implant placement with autogenous onlay bone grafts: a systematic review and meta-analysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Guoqiang Ma ◽  
Chaoan Wu ◽  
Miaoting Shao
Keyword(s):  
Meta Analysis ◽  
Survival Rates ◽  
Bone Grafts ◽  
Implant Survival ◽  
Analysis Model ◽  
Implant Placement ◽  
Significant Difference ◽  
Delayed Implant Placement ◽  
Onlay Grafts

AbstractSeveral authors have suggested that implants can be placed simultaneously with onlay bone grafts without affecting outcomes. Therefore, the purpose of this study was to answer the following clinical questions: (1) What are the outcomes of implants placed simultaneously with autogenous onlay bone grafts? And (2) is there a difference in outcomes between simultaneous vs delayed placement of implants with autogenous onlay bone grafts? Databases of PubMed, Embase, and Google Scholar were searched up to 15 November 2020. Data on implant survival was extracted from all the included studies (single arm and comparative) to calculate point estimates with 95% confidence intervals (CI) and pooled using the DerSimonian–Laird meta-analysis model. We also compared implant survival rates between the simultaneous and delayed placement of implants with data from comparative studies. Nineteen studies were included. Five of them compared simultaneous and delayed placement of implants. Dividing the studies based on follow-up duration, the pooled survival of implant placed simultaneously with onlay grafts after <2.5 years of follow-up was 93.1% (95% CI 82.6 to 97.4%) and after 2.5–5 years was 86% (95% CI 78.6 to 91.1%). Implant survival was found to be 85.8% (95% CI 79.6 to 90.3%) with iliac crest grafts and 95.7% (95% CI 83.9 to 93.0%) with intra-oral grafts. Our results indicated no statistically significant difference in implant survival between simultaneous and delayed placement (OR 0.43, 95% 0.07, 2.49, I2=59.04%). Data on implant success and bone loss were limited. Data indicates that implants placed simultaneously with autogenous onlay grafts have a survival rate of 93.1% and 86% after a follow-up of <2.5 years and 2.5–5years respectively. A limited number of studies indicate no significant difference in implant survival between the simultaneous and delayed placement of implants with onlay bone grafts. There is a need for randomized controlled trials comparing simultaneous and delayed implant placement to provide robust evidence.

A Meta-Analysis of Extracorporeal Anticoagulants in Pediatric Continuous Kidney Replacement Therapy

2021 ◽  
pp. 088506662199275
Author(s):  
Rupesh Raina ◽  
Nirav Agrawal ◽  
Kirsten Kusumi ◽  
Avisha Pandey ◽  
Abhishek Tibrewal ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Electrolyte Imbalance ◽  
Therapeutic Modality ◽  
Regional Citrate Anticoagulation ◽  
Increased Risk ◽  
Study Results ◽  
Significant Difference ◽  
Kidney Replacement Therapy

Objective: Continuous kidney replacement therapy (CKRT) is the primary therapeutic modality utilized in hemodynamically unstable patients with severe acute kidney injury. As the circuit is extracorporeal, it poses an increased risk of blood clotting and circuit loss; frequent circuit losses affect the provider’s ability to provide optimal treatment. The objective of this meta-analysis is to evaluate the safety and efficacy of the extracorporeal anticoagulants in the pediatric CKRT population. Data Sources: We conducted a literature search on PubMed/Medline and Embase for relevant citations. Study Selection: Studies were included if they involved patients under the age of 18 years undergoing CKRT, with the use of anticoagulation (heparin, citrate, or prostacyclin) as a part of therapy. Only English articles were included in the study. Data Extraction: Initial search yielded 58 articles and a total of 24 articles were included and reviewed. A meta-analysis was performed focusing on the safety and effectiveness of regional citrate anticoagulation (RCA) vs unfractionated heparin (UFH) anticoagulants in children. Data Synthesis: RCA had statistically significantly longer circuit life of 50.65 hours vs. UFH of 42.10 hours. Two major adverse effects metabolic alkalosis and electrolyte imbalance seen more commonly in RCA compared to UFH. There was not a significant difference in the risk of systemic bleeding when comparing RCA vs. UFH. Conclusion: RCA is the preferred anticoagulant over UFH due to its significantly longer circuit life, although vigilant circuit monitoring is required due to the increased risk of electrolyte disturbances. Prostacyclin was not included in the meta-analysis due to the lack of data in pediatric patients. Additional studies are needed to strengthen the study results further.

scholarly journals Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

2021 ◽  
pp. svn-2020-000534
Author(s):  
Zhentang Cao ◽  
Xinmin Liu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yingyu Jiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Intracerebral Haemorrhage ◽  
Final Analysis ◽  
Normal Weight ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Leah B Kosyakovsky ◽  
Federico Angriman ◽  
Emma Katz ◽  
Neill Adhikari ◽  
Lucas C Godoy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cumulative Incidence ◽  
Meta Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
Sepsis Survivors ◽  
Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis

2021 ◽  
pp. neurintsurg-2021-018032
Author(s):  
Derrek Schartz ◽  
Sajal Medha K Akkipeddi ◽  
Nathaniel Ellens ◽  
Redi Rahmani ◽  
Gurkirat Singh Kohli ◽  
...  
Keyword(s):  
Literature Review ◽  
Meta Analysis ◽  
Final Analysis ◽  
Case Control ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Access Site ◽  
Lower Odds ◽  
Significant Difference ◽  
Study Heterogeneity

BackgroundTransradial access (TRA) has gained increased usage among neurointerventionalists. However, the overall safety profile of access site complications (ASCs) and non-access site complications (NASCs) of TRA versus transfemoral access (TFA) for neuroendovascular procedures remains unclear.MethodsA systematic literature review and meta-analysis using a random effects model was conducted to investigate the pooled odds ratios (OR) of ASCs and NASCs. Randomized, case–control, and cohort studies comparing access-related complications were analyzed. An assessment of study heterogeneity and publication bias was also completed.ResultsSeventeen comparative studies met the inclusion criteria for final analysis. Overall, there was a composite ASC rate of 1.8% (49/2767) versus 3.2% (168/5222) for TRA and TFA, respectively (P<0.001). TRA was associated with a lower odds of ASC compared with TFA (OR 0.42; 95% CI 0.25 to 0.68, P<0.001, I2=31%). There was significantly lower odds of complications within the intervention and diagnostic subgroups. For NASC, TRA had a lower composite incidence of complications than TFA at 1.2% (31/2586) versus 4.2% (207/4909), P<0.001). However, on meta-analysis, we found no significant difference overall between TRA and TFA for NASCs (OR 0.79; 95% CI 0.51 to 1.22, P=0.28, I2=0%), which was also the case on subgroup analysis.ConclusionOn meta-analysis, the current literature indicates that TRA is associated with a lower incidence of ASCs compared with TFA, but is not associated with a lower rate of NASCs.

Association of VEGF and p53 Polymorphisms and Spiral Artery Remodelling in Recurrent Pregnancy Loss: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Tamilmani Subi ◽  
Vinodhini Krishnakumar ◽  
Chandreswara Raju Kataru ◽  
Inusha Panigrahi ◽  
Meganathan Kannan
Keyword(s):  
Risk Factor ◽  
Risk Ratio ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Mixed Population ◽  
Relative Risk Ratio ◽  
Spiral Artery ◽  
Prevalence Odds Ratio ◽  
Increased Risk

Many studies have reported the association of VEGF-1154G/A, VEGF 936C/T and p53 Arg72Pro polymorphisms with Recurrent Pregnancy Loss (RPL), but the outcomes are inconsistent. We have used meta-analysis to associate these polymorphisms with RPL, having the spiral artery remodelling as a major risk factor. The studies were identified from three different reputed databases, namely Science direct, PubMed/Medline and Scopus. The eligible studies of VEGF-1154G/A, VEGF 936C/T and p53Arg72Pro polymorphisms associated with the RPL were selected for the analysis. They were segregated into three different ethnic groups as Asians, Caucasians and mixed population. For the analysis, the overall prevalence, Odds ratio, Risk ratio, Relative risk ratio and P values were calculated. A total of 3241 RPL cases and 3205 healthy controls from 21 different case-control studies were analysed. RPL was highly prevalent in mixed population with VEGF-1154G/A and p53 Arg72Pro polymorphisms (70.04% and 66.46% respectively) and in Asian population with VEGF 936C/T polymorphism (53.58%). The homozygous recessive genotypes of VEGF and p53 exhibited significant association between the respective polymorphisms and RPL along with the increased risk of outcome. The current analysis conclusively reports the geographic distribution of the different genetic polymorphisms which shows high association with the progression of RPL. Understanding the spectrum of polymorphisms on different population with the spiral artery remodelling as a risk factor encloses the importance of the vasculature during the pregnancy.

scholarly journals Suicidality: Once Again, Don’t Blame the Drug Class

2021 ◽  
pp. 153575972110531
Author(s):  
Faught Edward
Keyword(s):  
Clinical Trials ◽  
Suicidal Ideation ◽  
Risk Ratio ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Meta Analysis ◽  
Adjunctive Treatment ◽  
Current Evidence ◽  
Phase 2 ◽  
Increased Risk

Importance Mostantiseizure medications (ASMs) carry a US Food and Drug Administration–mandated class label warning of increased suicidality risk, based on a meta-analysis comparing suicidality between individuals treated with medications vs placebo in randomized clinical trials done before 2008. ASMs approved since then carry this warning although they were not similarly studied. Objective To review all placebo-controlled phase 2 and 3 studies of 10 ASMs approved since 2008 to evaluate the risk of suicidality of these drugs compared with placebo. Data Sources Primary publications and secondary safety analyses in PubMed of all phase 2 and 3 randomized placebo-controlled epilepsy trials of ASMs approved since 2008, using keywords epilepsy, antiepileptic drugs, seizures, suicidality, suicidal ideation, and the names of individual drugs. Study Selection All phase 2 and 3 randomized clinical trials of adjunctive treatment of drug-resistant epilepsy and their secondary safety analyses. Data Extraction and Synthesis Articles were reviewed for frequency of suicidality (ideation, attempts, and completed suicides). Mode of suicidality ascertainment included treatment-emergent adverse event reports, Standardized Medical Dictionary for Regulatory Activities queries for events in prespecified categories including suicidal ideation and behavior, prospective collection of suicidality data as a prespecified safety outcome using the Columbia-Suicide Severity Rating Scale, and retrospective evaluation by blinded review using the Columbia-Classification Algorithm of Suicide Assessment. A meta-analysis compared risk for drugs vs placebo of each outcome for all drugs overall and by individual drugs and trials. Main Outcomes and Measures Suicidality (total and by ideation), attempts, and completed suicides. Results Excluding studies that did not evaluate suicidality (everolimus and fenfluramine) or did not evaluate it prospectively (lacosamide, ezogabine, and clobazam), 5 drugs were analyzed: eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate. Suicidality was evaluated in 17 randomized clinical trials of these drugs, involving 5996 patients, of whom 4000 patients were treated with ASMs and 1996 with placebo. There was no evidence of increased risk of suicidal ideation (drugs vs placebo overall risk ratio, .75; 95% CI, .35–1.60) or attempt (risk ratio, .75; 95% CI, .30–1.87) overall or for any individual drug. Suicidal ideation occurred in 12 of 4000 patients treated with ASMs (.30%) vs 7 of 1996 patients treated with placebo (.35%) ( P  =  .74). Three patients treated with ASMs and no patients treated with placebo attempted suicide ( P  =  .22). There were no completed suicides. Conclusions and Relevance There is no current evidence that the 5 ASMs evaluated in this study increase suicidality in epilepsy and merit a suicidality class warning

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