Latest diagnostic performance of different ultrasonic features for biliary atresia

2021 ◽  
pp. 028418512110558
Author(s):  
Pan Yang ◽  
Yajie Tang ◽  
Hongying Wang ◽  
Xiangxiang Zhang ◽  
Boyang Yang

Background Early diagnosis of biliary atresia (BA) is an important clinical challenge. Purpose To summarize the latest diagnostic performance of different ultrasonic (US) features for BA. Material and Methods MeSH terms “biliary atresia” and “ultrasonography” and related hyponyms were used to search PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible articles were included and data were retrieved. The methodologic quality was assessed by version 2 of the Quality Assessment of Diagnostic Accuracy Studies tool. Estimated sensitivity and specificity of each US feature were calculated by Stata 14.0. Results Fifty eligible studies on 5622 patients were included. Respective summary sensitivity and specificity were 77% (95% CI=69–84) and 98% (95% CI=96–99) for triangular cord sign (TCS) in 32 studies, 86% (95% CI=78–92) and 86% (95% CI=72–94) for shear wave elastography (SWE) in seven studies, 75% (95% CI=65–83) and 92% (95% CI=86–95) for gallbladder and biliary system abnormality (GBA) in 25 studies, and 81% (95% CI=69–90) and 79% (95% CI=67–87) for hepatic artery (HA) enlargement in seven studies. The overall US features from 11 studies yielded a summary sensitivity of 84% (95% CI=72–92) and specificity of 86% (95% CI=77–92). Conclusion TCS and GBA were the two most widely accepted US features currently used for differential diagnosis of BA. The newly developed SWE was an objective and convenient method with good diagnostic performance. HA enlargement can be used as an auxiliary sign.

2017 ◽  
Vol 22 (12) ◽  
pp. 4001-4012 ◽  
Author(s):  
Maria Ines Rosa ◽  
Maria Fernandes dos Reis ◽  
Carla Simon ◽  
Eduardo Dondossola ◽  
Maria Cecília Alexandre ◽  
...  

Abstract A systematic review with meta-analysis was performed to estimate the accuracy of IgM ELISA for Leptospirosis diagnosis. A search of Medline, Lilacs, Embase, Cochrane Central Register of Controlled Trials and Grey literature (Google Scholar and British Library) was conducted. The medical subject headings (MeSHs) and the words “leptospirosis”, “human leptospirosis” and “IgM ELISA” were used. Fifty-two studies were analyzed, which included 10,775 samples. The pooled sensitivity of all the studies was 86% (CI 95%, 85%-87%) and specificity was 90% (CI 95%, 89%-91%). In studies of the acute phase, the sensitivity and specificity were 84% (CI 95%, 82%-85%) and 91% (CI 95%, 90%-91%), respectively. In conclusion, IgM ELISA is sensitive for use as an initial screen for leptospiral infections.


2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Xingxing Duan ◽  
Ya Peng ◽  
Wengang Liu ◽  
Liu Yang ◽  
Jie Zhang

Purpose. To investigate the diagnostic performance of shear wave elastography (SWE) for measuring liver stiffness to identify and differentiate biliary atresia (BA) from cholestatic hepatitis in infants younger than 90 days. Methods. A total of 138 infants younger than 90 days with cholestatic hepatitis were examined by SWE. The infants were subclassified into BA and nonbiliary atresia (non-BA) groups. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of hepatic Young’s modulus measurements, the ultrasonic findings in the differential diagnosis of suspected BA, and the cut-off value to diagnose BA. Results. In all infants with cholestatic hepatitis, the cut-off value of hepatic Young’s modulus to differentiate the BA group from the non-BA group was 12.35 kPa and the area under the ROC curve (AUC) was 0.937, with a sensitivity of 84.3% and a specificity of 89.7%; nevertheless the AUC of the abnormal gallbladder (AbGB) was 0.940, with a sensitivity of 96.1% and a specificity of 92.0%. In the parallel test, triangular cord (TC) sign combined with AbGB had the best diagnostic performance and the AUC was 0.960, with a sensitivity of 100% and a specificity of 92.0%. In the serial test, SWE combined with AbGB achieved the best diagnostic performance; the AUC was 0.902, the sensitivity and specificity were 80.4% and 100%, respectively. Conclusions. SWE could not only help differentiate BA from cholestatic hepatic diseases but also increase the diagnostic specificity when combined with grey-scale ultrasound in the serial test.


2021 ◽  
pp. 175857322110190
Author(s):  
Morissa F Livett ◽  
Deborah Williams ◽  
Hayley Potter ◽  
Melinda Cairns

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.


2016 ◽  
pp. 33-42
Author(s):  
Débora Wanderley ◽  
Joaquim José de Souza Costa Neto ◽  
Marcelo Moraes Valença ◽  
Daniella Araújo de Oliveira

A intolerância aos movimentos, incapacidade do pescoço e alterações nos músculos pericranianos são aspectos que podem interferir durante as crises de migrânea. A presença destes achados tornou a fisioterapia uma modalidade terapêutica alternativa para as cefaleias. Assim, as desordens estruturais e comportamentais musculares podem promover modificações na biomecânica da cabeça e região cervical, bem como limitações na mobilidade cervical no paciente com cefaleia, as quais podem ser tratadas por meio de diferentes modalidades fisioterapêuticas. O objetivo deste estudo foi revisar as publicações mais relevantes sobre o papel da fisioterapia no tratamento das cefaleias, a fim de fundamentar e direcionar o tratamento não farmacológico destes pacientes. Foi feito um levantamento da literatura, entre setembro/2015 e maio/2016, nas bases de dados MEDLINE/ PubMed, LILACS e Cochrane Central Register of Controlled Trials - CENTRAL, buscando ensaios clínicos randomizados e quasi randomizados sobre o tema. Os descritores do MeSH/DeCS utilizados foram: 'cefaleia', 'modalidades de fisioterapia', e seus equivalentes em inglês. Foram identificados 589 artigos, dos quais 19 foram incluídos, segundo os critérios de elegibilidade. De acordo com os resultados dos estudos avaliados, a fisioterapia promove melhora da cefaleia, dos sintomas associados e das disfunções musculoesqueléticas relacionadas. Entre as modalidades utilizadas estão correção postural, mobilização da coluna, alongamento muscular, técnicas de relaxamento, massagem, exercícios ativos ou passivos, entre outras. Devido à baixa qualidade metodológica da maioria dos estudos, são necessários novos ensaios controlados e randomizados, baseados nos critérios diagnósticos da ICHD, utilizando protocolos descritos de maneira mais detalhada e reprodutível, incluindo a avaliação de efeitos adversos.


10.52011/0097 ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maritza Auxiliadora Torres Valdez ◽  
Lorena Alexandra Muñoz Avila ◽  
Carlos Enrique Ortega Espinoza ◽  
Franklin Geovany Mora Bravo ◽  
Diego Fernando Barzallo Zeas

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico dominante que produce hipercolesterolemia y desarrollo prematuro de enfermedades cardiovasculares. Las estatinas han sido el medicamento de elección en estos pacientes, sin embargo, un buen porcentaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas recomendadas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado primarias: 1. Niveles de LDL, HDL pos tratamiento. 2. Presencia de eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). La evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspección visual del diagrama de embudo. La evaluación de la calidad de la evidencia se realizará usando la evaluación GRADE.


2021 ◽  
Vol 12 ◽  
Author(s):  
Wei Zhao ◽  
Chuantao Peng ◽  
Hafiz Arbab Sakandar ◽  
Lai-Yu Kwok ◽  
Wenyi Zhang

Lactobacillus (L.) plantarum strains, belong to lactic acid bacteria group, are considered indispensable probiotics. Here, we performed meta-analysis to evaluate the regulatory effects of L. plantarum on the immunity during clinical trials. This meta-analysis was conducted by searching across four most common literature databases, namely, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PubMed. Clinical trial articles that met the inclusion and exclusion criteria were analyzed by Review Manager (version 5.3). p-value < 0.05 of the total effect was considered statistically significant. Finally, total of 677 references were retrieved, among which six references and 18 randomized controlled trials were included in the meta-analysis. The mean differences observed at 95% confidence interval: interleukin (IL)-4, −0.48 pg/mL (−0.79 to −0.17; p < 0.05); IL-10, 9.88 pg/mL (6.52 to 13.2; p < 0.05); tumor necrosis factor (TNF)-α, −2.34 pg/mL (−3.5 to −1.19; p < 0.05); interferon (IFN)-γ, −0.99 pg/mL (−1.56 to −0.41; p < 0.05). Therefore, meta-analysis results suggested that L. plantarum could promote host immunity by regulating pro-inflammatory and anti-inflammatory cytokines.


2021 ◽  
Author(s):  
Luis Ayerbe ◽  
Ivo Forgnone ◽  
Carlos Risco-Risco ◽  
Maria Perez-Pinar ◽  
Salma Ayis

Background: Azithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the studies on the beneficial and adverse effect of AZM in patients with Covid-19. Methods: The PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. Results: The initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. Conclusions: These results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs


2021 ◽  
Author(s):  
Rabiu Ibrahim ◽  
Isa Usman Lawal ◽  
Conran Joseph

Abstract Background This study aimed to describe and present detailed protocol of a systematic review aimed at determining available research evidence regarding the intensity, and frequency of task-specific training ( TST ) that can best result in improved motor function and mobility outcomes in both upper and lower extremities in acute, sub-acute and chronic stroke survivors. Methods Literature search strategies were developed using Medical Subject Headings (MeSH) terms and text key words related to stroke rehabilitation and the use of TST to search for relevant randomized controlled trials (RCTs). The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed search engine), Excerpta Medica dataBASE (EMBASE), Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar were searched for eligible articles published from inception to date. Two reviewers independently screened the titles, selected appropriate abstract/studies and extracted relevant data as yielded by the search based on the study inclusion criteria. Assessment of the study risk of bias and quality of included studies were appraised using the Cochrane’s tool for assessing risk of bias or other appropriate tools. Discussion This paper presented the description of the systematic review methods, and it is expected to guide researchers in conducting systematic review in similar fields of research. Sources of literature search terms and reviewers have been determined. Systematic review registration The study protocol has been registered with PROSPERO (130991)


2019 ◽  
Vol 11 (16) ◽  
pp. e1417
Author(s):  
Adriana Souza Szpalher

Objetivo: Avaliar o desenvolvimento de transtornos psicológicos relacionados à presença de úlcera venosa de perna (UVP). Métodos: revisão sistemática em julho de 2019 com metodologia de Donato H e Donato M (2019) e Recomendação PRISMA para responder à questão: há desenvolvimento de transtornos psicológicos relacionados à UVP? Incluídos estudos originais, sem delimitação temporal, em português, inglês e espanhol, nas Bases US National Library of Medicine (PubMed), Biblioteca Virtual de Saúde (BVS), The Cochrane Central Register of Controlled Trials (CENTRAL) abrangendo a Base eletrônica editora Elsevier (EMBASE), Scientific Electronic Library Online (SciELO) e Health Evidence. Resultados: A busca retornou 256 estudos, após análise completa foram excluídos 248 por não atenderem a metodologia e objetivo, resultando em 8 estudos, prevalecendo em inglês. 816 indivíduos foram avaliados, predominando como transtorno mental a depressão. Houve diversidade quanto ao Tipo de estudo. Considerações finais: há pouca produção relacionada à temática e não foi encontrada revisão sistemática. Sugerem-se estudos que aprofundem o impacto dos transtornos psicológicos na UVP, enfatizando os níveis citológico e histológico. Acredita-se que pesquisas futuras trarão reflexões acerca da importância do atendimento psicológico e psiquiátrico, associado à promoção de atividades de bem-estar e do convívio social.


2018 ◽  
Vol 104 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Christopher Stutchfield ◽  
Anna Davies ◽  
Amber Young

BackgroundOptimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation.ObjectivesTo identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome.DesignSystematic review.MethodsMedline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed.ResultsFollowing screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5–1.0 mL/kg/hour to 2–3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome.ConclusionsFew studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns.


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