Orocutaneous Fistula After Oral Cavity Resection and Reconstruction: Systematic Review and Meta-Analysis

2021 ◽  
pp. 000348942110474
Author(s):  
Patrick Tassone ◽  
Tabitha Galloway ◽  
Laura Dooley ◽  
Robert Zitsch
Keyword(s):  
Radiation Therapy ◽  
Oral Cavity ◽  
English Language ◽  
Meta Analysis ◽  
Primary Objective ◽  
Preoperative Radiation ◽  
Cutaneous Fistula ◽  
Language Studies ◽  
Oral Cavity Reconstruction ◽  
Segmental Mandibulectomy

Objective: Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction. Data Sources: Scopus 1960—database was searched for terms: “orocutaneous fistula,” “oro cutaneous fistula,” “oral cutaneous fistula,” “orocervical fistula,” “oral cavity salivary fistula.” Review Methods: English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy. Results: Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection. Conclusion: Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation.

Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta-analysis

2019 ◽  
Vol 161 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Eric L. Wu ◽  
William C. Harris ◽  
Casey M. Babcock ◽  
Bailin H. Alexander ◽  
Charles A. Riley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Relative Risk ◽  
English Language ◽  
Meta Analysis ◽  
Included Study ◽  
Pubmed Central ◽  
Intranasal Corticosteroids ◽  
Language Studies ◽  
Increased Risk

Objective Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs. Data Sources Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases. Review Methods Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS. Results Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity. Conclusions While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.

Assessing risk of neurodevelopmental disorders after birth with oxytocin: a systematic review and meta-analysis

2018 ◽  
Vol 49 (6) ◽  
pp. 881-890 ◽  
Author(s):  
Nicole N. Lønfeldt ◽  
Frank C. Verhulst ◽  
Katrine Strandberg-Larsen ◽  
Kerstin J. Plessen ◽  
Eli R. Lebowitz
Keyword(s):  
Cognitive Impairment ◽  
English Language ◽  
Psychiatric Symptoms ◽  
Meta Analysis ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Risk Estimate ◽  
Current Evidence ◽  
Language Studies ◽  
Meta Analyses

AbstractExperts have raised concerns that oxytocin for labor induction and augmentation may have detrimental effects on the neurodevelopment of children. To investigate whether there is the reason for concern, we reviewed and evaluated the available evidence by searching databases with no language or date restrictions up to 9 September 2018. We included English-language studies reporting results on the association between perinatal oxytocin exposure and any cognitive impairment, psychiatric symptoms or disorders in childhood. We assessed the quality of studies using the Newcastle–Ottawa Quality Assessment Scales. Independent risk estimates were pooled using random-effects meta-analyses when at least two independent datasets provided data on the same symptom or disorder. Otherwise, we provided narrative summaries. Two studies examined cognitive impairment, one examined problem behavior, three examined attention-deficit/hyperactivity disorder (ADHD) and seven focused on autism spectrum disorders (ASD). We provided narrative summaries of the studies on cognitive impairment. For ADHD, the pooled risk estimate was 1.17; 95% confidence interval (CI) 0.77–1.78, based on a pooled sample size of 5 47 278 offspring. For ASD, the pooled risk estimate was 1.10; 95% CI 1.04–1.17, based on 8 87 470 offspring. Conclusions that perinatal oxytocin increases the risks of neurodevelopmental problems are premature. Observational studies of low to high quality comprise the evidence-base, and confounding, especially by the genetic or environmental vulnerability, remains an issue. Current evidence is insufficient to justify modifying obstetric guidelines for the use of oxytocin, which state that it should only be used when clinically indicated.

scholarly journals Pre-, Pro-, and Synbiotics: Do They Have a Role in Reducing Uremic Toxins? A Systematic Review and Meta-Analysis

2012 ◽  
Vol 2012 ◽  
pp. 1-20 ◽  
Author(s):  
Megan Rossi ◽  
Kerenaftali Klein ◽  
David W. Johnson ◽  
Katrina L. Campbell
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Uremic Toxins ◽  
Population Estimates ◽  
Inclusion Criteria ◽  
Language Studies ◽  
Human Adults ◽  
Meta Analyses ◽  
Grade Approach

Objective. This paper assessed the effectiveness of pre-, pro-, and synbiotics on reducing two protein-bound uremic toxins, p-cresyl sulphate (PCS) and indoxyl sulphate (IS).Methods. English language studies reporting serum, urinary, or fecal PCS and/or IS (or their precursors) following pre-, pro-, or synbiotic interventions (>1 day) in human adults were included. Population estimates of differences in the outcomes between the pre- and the postintervention were estimated for subgroups of studies using four meta-analyses. Quality was determined using the GRADE approach.Results. 19 studies met the inclusion criteria, 14 in healthy adults and five in haemodialysis patients. Eight studies investigated prebiotics, six probiotics, one synbiotics, one both pre- and probiotics, and three studies trialled all three interventions. The quality of the studies ranged frommoderatetovery low. 12 studies were included in the meta-analyses with all four meta-analyses reporting statistically significant reductions in IS and PCS with pre- and probiotic therapy.Conclusion. There is a limited but supportive evidence for the effectiveness of pre- and probiotics on reducing PCS and IS in the chronic kidney disease population. Further studies are needed to provide more definitive findings before routine clinical use can be recommended.

scholarly journals Olfactory and gustatory dysfunction in 2019 novel coronavirus: An updated systematic review and meta-analysis

2020 ◽  
Author(s):  
Marzieh Esmaeili ◽  
Fatemeh Abdi ◽  
Gita Shafiee ◽  
Hadis Rastad ◽  
Hamid Asayesh ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Random Effect ◽  
Eligibility Criteria ◽  
Language Studies ◽  
Pooled Prevalence ◽  
Comprehensive Search ◽  
Novel Coronavirus

Abstract BackgroundEvidence showed that partial or complete loss of smell and taste might be a possible primary symptom of the 2019 novel coronavirus (COVID-19). This study aimed to systematically review and pool all available evidence on the olfactory and gustatory dysfunction in COVID-19 patients. MethodsIn this systematic review, a comprehensive search was carried out systematically through e-databases including PubMed, EMBASE, Scopus, and Web of Science (WoS); that was limited to English-language studies published from 2019 up to 6th May 2020. Afterward, all studies reported the taste and smell dysfunction in the COVID-19 patients were included. The quality of the studies was assessed by the Mixed Methods Appraisal Tool (MMAT). The pooled prevalence of olfactory and gustatory dysfunction was estimated using the random effects meta-analysis method.ResultsAmong 28 eligible included studies in this systematic review, finally, 22 studies met the eligibility criteria and were included in the meta-analysis. According to the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of any olfactory dysfunction, anosmia, and hyposmia was 55% (40%-70%), 40% (22%-57%), and 40% (20%-61%) respectively. The pooled estimated prevalence of any gustatory dysfunction, ageusia, and dysgeusia was 41% (23%-59%), 31% (3%-59%), and 34% (19%-48%) respectively. ConclusionOlfactory and gustatory dysfunction is prevalent among COVID-19 patients. Therefore, olfactory and gustatory dysfunction seems to be part of important symptoms and notify for the diagnosis of COVID-19, especially in the early phase of the infection.

scholarly journals Dietary Polyphenol Intake, Blood Pressure, and Hypertension: A Systematic Review and Meta-Analysis of Observational Studies

Antioxidants ◽  
2019 ◽  
Vol 8 (6) ◽  
pp. 152 ◽  
Author(s):  
Justyna Godos ◽  
Marilena Vitale ◽  
Agnieszka Micek ◽  
Sumantra Ray ◽  
Daniela Martini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
English Language ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Dietary Polyphenols ◽  
Beneficial Effects ◽  
Language Studies ◽  
Prospective Cohorts ◽  
Polyphenol Intake ◽  
Selection Of

Background: Dietary polyphenols, including flavonoids, have been the focus of major recent attentions due to their wide content in a variety of foods commonly consumed and the findings from numerous studies showing evidence of an association with positive outcomes on human health. Methods: A systematic search using electronic databases PubMed and EMBASE was performed to retrieve English language studies published from the earliest indexing year of each database to April 2019, reporting on the association between dietary flavonoids intake and hypertension. Results: The search strategy resulted in the final selection of 20 studies including 15 cross-sectional investigations and 7 prospective cohorts (1 study reported on 3 prospective cohorts). 5 prospective cohorts, comprising 200,256 individuals and 45,732 cases of hypertension were included in the quantitative analysis. Analysis by extreme quantiles of intake of flavonoid showed a non-significant association with decreased risk of hypertension (RR (risk ratio): 0.96, 95% CI (confidence interval): 0.89, 1.03). Taking into consideration individual flavonoid subclasses, dietary anthocyanins intake was associated with 8% reduction in risk of hypertension, when comparing highest vs. lowest exposure (RR: 0.92, 95% CI: 0.88, 0.97). Conclusions: Further studies are needed to strengthen the retrieved association between anthocyanins consumption and decreased risk of hypertension and clarify whether total flavonoids or rather individual subclasses may exert beneficial effects on blood pressure.

Asthma medication use in obese and healthy weight asthma: systematic review/meta-analysis

2020 ◽  
pp. 2000612
Author(s):  
Cherry A. Thompson ◽  
Shaun R. Eslick ◽  
Bronwyn S. Berthon ◽  
Lisa G. Wood
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Medication Use ◽  
Mean Difference ◽  
Asthma Medication ◽  
Healthy Weight ◽  
Language Studies ◽  
Methodologic Quality ◽  
Co Morbidity ◽  
Obese Subjects

BackgroundObesity is a common co-morbidity in asthma and associated with poorer asthma control, more frequent/severe exacerbations, and reduced response to asthma pharmacotherapy.ObjectiveThis review aims to compare use of all classes of asthma medications in obese (BMI≥30 kg·m−2) versus healthy weight (BMI<25 kg·m−2) subjects with asthma.DesignDatabases including CINAHL, Cochrane, EMBASE, and MEDLINE were searched for English language studies up to July 2019 that recorded medication use or dose in obese and healthy weight adults with asthma. A critical appraisal checklist was utilised for scrutinising methodologic quality of eligible studies. Meta-analysis was performed and heterogeneity was examined with the use of the χ2 test. This review was conducted based on a published protocol (PROSPERO: CRD42020148671).ResultsMeta-analysis showed that obese subjects are more likely to use asthma medications including; short-acting β2-agonists [odds ratio (OR)=1.75; 95% CI:1.17, 2.60; p=0.006, I2=41%] and maintenance oral corticosteroids (OR=1.86; 95% CI:1.49, 2.31; p<0.001, I2=0%) compared to healthy weight subjects. Inhaled corticosteroid dose (µg·day−1) was significantly higher in obese subjects (mean difference=208.14; 95% CI:107.01, 309.27; p<0.001, I2=74%). FEV1% predicted was significantly lower in obese subjects (mean difference=−5.32%; 95% CI:−6.75, −3.89; p<0.001, I2=42%), however, no significant differences were observed in FEV1/FVC% between groups.ConclusionsWe found that obese subjects with asthma have higher use of all included asthma medication classes and higher ICS doses than healthy weight asthma subjects, despite lower FEV1 and a similar FEV1/FVC%. A better understanding of the factors driving increased medication use is required to improve outcomes in this subgroup of asthmatics.

scholarly journals Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
pp. e001776
Author(s):  
Unjali P Gujral ◽  
Ram Jagannathan ◽  
Siran He ◽  
Minxuan Huang ◽  
Lisa R Staimez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
English Language ◽  
Meta Analysis ◽  
Glycosylated Hemoglobin ◽  
Language Studies ◽  
Risk Of Mortality ◽  
Cochrane Database ◽  
Design And Methods

IntroductionWe conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.Research design and methodsWe identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.ResultsImpaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110–125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100–125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%–6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%–6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).ConclusionPrediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.

scholarly journals Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Natasha Wehner-Hewson ◽  
Paul Watts ◽  
Richard Buscombe ◽  
Nicholas Bourne ◽  
David Hewson
Keyword(s):  
Systematic Review ◽  
Ethnic Groups ◽  
English Language ◽  
Meta Analysis ◽  
Community Dwelling ◽  
Racial And Ethnic Differences ◽  
Use Of Resources ◽  
Language Studies ◽  
Risk Of Falls ◽  
Meta Analyses

Abstract The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.

Surface Sensibility of the Floor of the Mouth and Tongue in Healthy Controls and in Radiated Patients

1992 ◽  
Vol 107 (3) ◽  
pp. 418-423 ◽  
Author(s):  
Jonathan E. Aviv ◽  
Craig Hecht ◽  
Hubert Weinberg ◽  
Jack F. Dalton ◽  
Mark L. Urken
Keyword(s):  
Radiation Therapy ◽  
Oral Cavity ◽  
Age Groups ◽  
Sensory Nerve ◽  
Free Flaps ◽  
Sensory Loss ◽  
Sensory Discrimination ◽  
Oral Function ◽  
Floor Of Mouth ◽  
Oral Cavity Reconstruction

Increased areas of anesthesia in the oral cavity have been shown to significantly impair oral function in normal individuals. In patients who undergo oral cavity reconstruction, loss of sensation plays a major role in producing disturbances in postoperative oral function. Free tissue transfer techniques have permitted the problem of sensory loss to be addressed through the use of sensate cutaneous free flaps, in which microneural anastomoses are performed between a sensory nerve supplying the flap and a recipient nerve in the head and neck. To critically assess the results of such reconstructions, the effect of sensory restoration on oral cavity rehabilitation must be studied. As a first step toward this goal, normal values for sensory discrimination of the floor of mouth and tongue are needed. Previous studies of oral sensation failed to examine the ventral tongue and floor of mouth. The purpose of this study is to determine the surface sensibility of these regions in healthy patients and in patients who received radiation therapy to the oral cavity. Sensation was evaluated using static and moving two-point discrimination in 90 healthy subjects divided equally into three age groups: 20 to 40 years, 41 to 60 years, and 61 to 80 years. In addition, 20 patients who received radiation therapy were studied. The mucosa of the dorsal and ventral aspects of the lateral tongue, tongue tip, and floor of mouth was examined. The tongue tip is the most sensitive area, followed by the dorsal lateral tongue, ventral lateral tongue, and floor of mouth. The effects of age and radiation therapy on sensory discrimination are discussed. We propose that patients undergoing reconstruction of the floor of mouth and tongue with sensate cutaneous free flaps undergo both preoperative and postoperative sensory testing. The control data obtained in this study can be applied for objective analysis of the results of the reconstruction. Current techniques for assessment of sensory discrimination are reviewed.

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