EXPRESS: Comparison of Mothership versus Drip-and-Ship Models in treating patients with Acute Ischemic Stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110132
Author(s):  
Ahmed Mohamed ◽  
Nida Fatima ◽  
Ashfaq Shuaib ◽  
Maher Saqqur
Keyword(s):  
Functional Outcome ◽  
Meta Analysis ◽  
Critical Time ◽  
Functional Independence ◽  
Models Of Care ◽  
Randomized Control Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control

Introduction There is controversy if direct to comprehensive center “mothership” (MS) or stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and- ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared. Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care. Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

scholarly journals Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

2021 ◽  
Vol 9 (3) ◽  
pp. 166-176
Author(s):  
Jia Feng ◽  
Zhihan Zhu ◽  
Ahmed Waqas ◽  
Lukui Chen
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Objective:To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.Methods:A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.Results:As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).Conclusion:Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.

scholarly journals The Effectiveness and Safety of Metronomic Chemotherapy in Patients with Head and Neck Carcinoma: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xingli Li ◽  
Jianjian Wang ◽  
Ting Zhang ◽  
Jiabin Wang ◽  
Zhangcai Zheng ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Metronomic Chemotherapy ◽  
Head And Neck Carcinoma ◽  
Randomized Control Trials ◽  
Neck Carcinoma ◽  
Significant Difference ◽  
Randomized Control

Abstract Background: Head and neck carcinoma, usually begins in the squamous cells, not only seriously endangers the quality of life, but brings a heavy financial burden for families and countries. Metronomic chemotherapy, a frequent administration of chemotherapeutic agents at a non-toxic dose, gives an alternative low-cost and tolerated approach for patients. We conducted a systematic review to find the effectiveness and safety of metronomic chemotherapy for head and neck cancer.Methods: We searched seven databases and Clinical.gov from the inception to July 14, 2021. The patients diagnosed head and neck cancer and older than 18 were included. Metronomic chemotherapy was defined as intervention. Randomized and non-randomized trials were all included. Quality assessment of included randomized control trials was performed using the Cochrane Risk-of-Bias criteria, cohort studies using The Newcastle-Ottawa Scale (NOS), single arm trials using the checklist recommended by The Agency for Healthcare Research and Quality (AHRQ). Studies were synthetized using a narrative approach. The indicators used for meta-analysis was hazard ratio (HR).Results: 310 Literatures were potentially eligible from 7 databases, finally 13 records were included. Five studies were of high quality, while eight were of moderate quality. The overall effect of HR for death of five trials reported had no statistically significant (HR=0.89, 95%CI 0.71-1.10). Subgroup analysis by different design showed a statistically significant HR (0.73, 95%CI 0.60-0.90) in randomized control trials while no significant difference in subgroup of prospective study design (HR=1.23, 95%CI 0.72-2.10). As for HR for PFS, there was no significant difference in overall effect of four studies. HR for PFS was 0.84 (95%CI 0.55-1.31). Subgroup analysis of study design showed that randomized control trials produced a significant HR (0.54, 95%CI 0.45-0.64), while prospective studies did not (1.25, 95%CI 0.73, 2.14).Conclusions: Metronomic chemotherapy has been an optimistic option for treatment for advanced head and neck cancer, especially in low income and medical resource-restricted regions.

Abstract 664: Cerebrovascular Events in Patients Undergoing Endovascular Aortic Repair (EVAR) versus Open Aortic Repair (OAR) for Abdominal Aortic Aneurysm (AAA): A Pooled Meta-Analysis of 10,409 Patients

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Ahmed S Ansari ◽  
Francisco Y Macedo ◽  
Vu Hoang ◽  
Johanna P Contreras ◽  
Yochai Birnbaum ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effects Model ◽  
Randomized Control Trials ◽  
Inclusion Criteria ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Cerebrovascular Events ◽  
Open Aortic Repair ◽  
Significant Difference ◽  
Randomized Control

Background: EVAR is still a relatively new modality for AAA repair and there are not many studies on the complications and risks associated with this procedure. In particular, there is a paucity of data in regards to the risks of Cerebrovascular Events (CVE). The purpose of the paper is to discuss the risks of CVE in patients who have undergone EVAR versus patients that have undergone OAR. We aimed to do a systematic review and meta-analysis of the CVE rates in patients undergoing EVAR versus OAR. Methods: Studies were included if they reported CVE outcomes comparing EVAR versus OAR in patients who underwent AAA repair. Of the 51 unique citations identi[[Unable to Display Character: &#64257;]]ed after the initial literature search and supplementary hand-searches, 10 studies comparing EVAR and OAR who underwent AAA repair met our inclusion criteria. Results were independently extracted by 2 reviewers. A random effects model was applied. The primary end was the incidence of stroke. Results: A total of 10 studies and 10,409 patients were included. Of the 10,409 patients, 2,659 patients underwent EVAR and 7,750 patients underwent OAR. The incidence of CVE in patients undergoing EVAR was 1.01% and the incidence of CVE in patients undergoing OAR was 1.03%. CVE (RR 0.83; CI 0.51-1.34; P=0.44; figure 1) were not statistically significant between patients undergoing EVAR vs OAR. Conclusion: This meta-analysis found that in patients undergoing EVAR versus patients going OAR, there was not a statistically significant difference and EVAR can be as safe as OAR regarding stroke related complications. These findings need to be confirmed with larger randomized control trials.

scholarly journals Functional Outcome & Revision Rate Of Pfna Vs Dhs For Osteoporotic Intertrochanteric Femur Fracture: A Meta Analysis

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0003
Author(s):  
Sherly Desnita Savio ◽  
I Made Arya Susila ◽  
Cokorda Gde Oka Dharmayuda
Keyword(s):  
Functional Outcome ◽  
Femur Fracture ◽  
Revision Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Harris Hip Score ◽  
Significant Difference ◽  
The Mean ◽  
Intertrochanteric Femur Fracture

Objectives: Intertrochanteric femur fracture in elderly presents a challenge as the source of morbidity and mortality if not well-treated. This study investigates the functional outcome and revision rate of two of the most common treatments of choice for this condition, Proximal Femoral Nail Antirotation (PFNA) and Dynamic Hip Screw (DHS), while furthermore investigate the secondary functional outcome of the two procedures if proceeded to Conversion to Total Hip Arthroplasty (CTHA). Methods: A systematic search was conducted to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 9 studies (2.251 patients) were included, divided into 3 meta-analysis. Random effect model was used for continuous outcomes using Review Manager. Results: For primary Harris Hip Score (HHS), the mean HHS at 12-months follow-up for PFNA (n = 184) was 77.77, as for DHS (n = 187) was 78.33, indicating no significant difference (P = 0.73). The mean revision rates for PFNA (n=784) was 2.68%, as for DHS (n=766) was 2.48%, indicating no significant difference (P = 0.61). For secondary HHS after CTHA, the mean HHS 12-months postoperatively for PFNA (n =142) was 83.97, as for DHS (n = 190) was 83.65, indicating no significant difference (P = 0.59). Discussion: PFNA and DHS can both be considered in osteoporotic intertrochanter femur fracture, as the two procedures offer similar 1-year functional outcome and revision rate. However, PFNA may benefit with less blood loss and operation time. Some potential revision causes, such as peri-implant femoral fracture, infection, and implant failure should always be monitored perioperatively. Furthermore, when CTHA is indicated for revision, the two procedures offer comparable secondary functional outcome. Conclusion: Current meta-analysis suggests that PFNA and DHS both have comparable primary functional outcome, revision rate, and post-CTHA secondary functional outcome.

scholarly journals Meta-analysis of prednisone in withdrawal therapy following medication overuse headache

2021 ◽  
Vol 26 (4) ◽  
pp. 761-766
Author(s):  
Wenmiao Jie ◽  
Jianzhong Xiong ◽  
Xiaohua Yan
Keyword(s):  
Medication Overuse ◽  
Meta Analysis ◽  
Medication Overuse Headache ◽  
Control Group ◽  
Randomized Control Trials ◽  
Significant Difference ◽  
Withdrawal Therapy ◽  
Randomized Control ◽  
Experimental Group

The objective of this meta-analysis was to evaluate the therapeutic effectiveness of prednisone in withdrawal therapy following medication overuse headache. The Cochrane, PubMed, EMBASE, Web of Science, CNKI, VIP, and Wanfang data were searched to identify randomized control trials of prednisone for the treatment of medication overuse headache. Two researchers independently screened published studies according to inclusion and exclusion criteria, and evaluated the methodological quality of included studies. Revman 5.3 software was used to analyze the extracted data, and a total of six randomized control trials involving 510 patients were included in the study. Meta-analysis indicated that there was no significant difference in the ratio of taking painkillers again after withdrawal (RR=0.89, 95% CI: 0.70,1.14, P=0.36) compared with the control group. There was also no significant difference between the experimental group and the control group in the incidence of withdrawal reactions (RR=1.28, 95% CI: 0.87, 1.89, P=0.21), severity of headache (RR=1.56, 95% CI: -4.83, 7.95, P=0. 63) and the frequency of headache attacks after withdrawal (RR=0.14, 95% CI: -0.35, 0.63, P=0.58). It is concluded that prednisone does not alleviate symptoms in patients with medication overuse headache after withdrawal.

scholarly journals Lithium carbonate as add-on therapy to radioiodine in the treatment on hyperthyroidism: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed Abd-ElGawad ◽  
Mohamed Abdelmonem ◽  
Ahmed Eissa Ahmed ◽  
Omar Magdy Mohammed ◽  
Mohamed Sayed Zaazouee ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Radioactive Iodine ◽  
Meta Analysis ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Randomized Control Trials ◽  
Cure Rate ◽  
Significant Difference ◽  
Randomized Control

Abstract Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation

2021 ◽  
pp. 019459982199066
Author(s):  
Sandra Ho ◽  
Prayag Patel ◽  
Daniel Ballard ◽  
Richard Rosenfeld ◽  
Sujana Chandrasekhar
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Stapes Surgery ◽  
Chorda Tympani Nerve ◽  
Stapes Fixation ◽  
Operative Outcomes ◽  
Significant Difference ◽  
The Mean ◽  
Postoperative Vertigo ◽  
Hearing Outcomes

Objective To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources PubMed, Embase, and Web of Science. Review Methods An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.

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