scholarly journals Intralesional cryotherapy for hypertrophic scars and keloids: a review

2017 ◽  
Vol 3 ◽  
pp. 205951311770216 ◽  
Author(s):  
Ciaran P O’Boyle ◽  
Holleh Shayan-Arani ◽  
Maha Wagdy Hamada
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Hypertrophic Scars ◽  
Published Evidence ◽  
Keloid Scarring ◽  
Comparative Trials ◽  
Scar Reduction

Introduction: Hypertrophic and keloid scarring remain notoriously troublesome for patients to tolerate and frustratingly difficult for clinicians to treat. Many different treatment modalities exist, signifying the failure of any method to achieve consistently excellent results. Intralesional cryotherapy is a relatively recent development that uses a double lumen needle, placed through the core of a keloid or hypertrophic scar, to deliver nitrogen vapour, which freezes the scar from its core, outwards. Methods: This article provides a comprehensive review of the literature on intralesional cryotherapy for hypertrophic scars and keloids. A systematic review or meta-analysis was not possible, since the existing articles did not permit this. Results: A search of English language, peer-reviewed literature was carried out. The evidence base was found to be low (level 4). In addition, much of the published evidence comes from a very few groups. Despite this, consistent findings from case series suggest that the technique is safe and achieves good scar reduction with very few treatments. Adverse effects include depigmentation, recurrence and pain. Pain and recurrence appear to be uncommon and depigmentation may be temporary. Discussion: Well-constructed, prospectively recruited comparative trials are absent from the literature. These are strongly encouraged, in order to strengthen general confidence in this technique and in the repeatability of outcomes reported thus far.

scholarly journals 628 Management of Chyle Leaks Following Oesophagectomy: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Power ◽  
P Smyth ◽  
N E Donlon ◽  
T Nugent ◽  
C L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Optimal Management ◽  
Retrospective Case ◽  
High Quality ◽  
Chyle Leakage

Abstract Aim Chyle leakage is a rare but potentially life-threatening complication following oesophageal resection. The optimal management strategy is not clear. Method Searches were conducted up to 31/12/2020 on MEDLINE, Embase and Web of Science for randomised trials or retrospective studies that evaluated the management of chyle leakage following oesophageal resection. Two authors independently screened studies extracted data and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with PRISMA guidelines. Results A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including 2 low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leaks was 3.2% but no consistent risk factors were found across studies. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, and 6 described percutaneous lymphangiography with thoracic duct embolisation (TDE) or disruption (TDD). There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity, but lower efficacy compared to surgery. Conclusions The evidence-base for optimal management of chyle leakage post-oesophagectomy is lacking, which may be related to its low incidence. Further high quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.

scholarly journals Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis

2020 ◽  
pp. flgastro-2020-101529 ◽  
Author(s):  
Anthony K Akobeng ◽  
Ciaran Grafton-Clarke ◽  
Ibtihal Abdelgadir ◽  
Erica Twum-Barimah ◽  
Morris Gordon
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Case Reports ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Risk Of Bias ◽  
Gastrointestinal Manifestations ◽  
Published Evidence ◽  
Pooled Prevalence

ObjectivesTo summarise the published evidence on the gastrointestinal manifestations of COVID-19 in children and to determine the prevalence of gastrointestinal symptoms.MethodsIn this systematic review and meta-analysis, we searched PubMed, Embase, CINAHL and the WHO’s database of publications on novel coronavirus. We included English language studies that had described original demographic and clinical characteristics of children diagnosed with COVID-19 and reported on the presence or absence of gastrointestinal symptoms. Meta-analysis was conducted using the random-effects model. The pooled prevalence of gastrointestinal symptoms was expressed as proportion and 95% CI.ResultsThe search identified 269 citations. Thirteen studies (nine case series and four case reports) comprising data for 284 patients were included. Overall, we rated four studies as having a low risk of bias, eight studies as moderate and one study as high risk of bias. In a meta-analysis of nine studies, comprising 280 patients, the pooled prevalence of all gastrointestinal symptoms was 22.8% (95% CI 13.1% to 35.2%; I2=54%). Diarrhoea was the most commonly reported gastrointestinal symptom followed by vomiting and abdominal pain.ConclusionsNearly a quarter of children with COVID-19 have gastrointestinal symptoms. It is important for clinicians to be aware of the gastrointestinal manifestation of COVID-19.PROSPERO registration numberCRD42020177569.

scholarly journals Management of chyle leaks following esophageal resection: a systematic review

2021 ◽  
Author(s):  
Robert Power ◽  
Philip Smyth ◽  
Noel E Donlon ◽  
Timothy Nugent ◽  
Claire L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Prospective Studies ◽  
Case Series ◽  
Esophageal Resection ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Optimal Management ◽  
Retrospective Case ◽  
High Quality ◽  
Chyle Leakage

Summary Background Chyle leakage is an uncommon but potentially life-threatening complication following esophageal resections. The optimal management strategy is not clear, with a limited evidence base. Methods Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web of Science for randomized trials or retrospective studies that evaluated the management of chyle leakage following esophageal resection. Two authors independently screened studies, extracted data, and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Results A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. Conclusions The evidence base for optimal management of chyle leakage postesophagectomy is lacking, which may be related to its low incidence. There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity but lower efficacy compared with surgery. Further high-quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.

scholarly journals Epidemiology of Microsatellite Instability High (MSI-H) and Deficient Mismatch Repair (dMMR) in Solid Tumors: A Structured Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-17 ◽  
Author(s):  
Maria Lorenzi ◽  
Mayur Amonkar ◽  
Jacky Zhang ◽  
Shivani Mehta ◽  
Kai-Li Liaw
Keyword(s):  
Literature Review ◽  
Solid Tumors ◽  
English Language ◽  
Meta Analysis ◽  
Evidence Base ◽  
Published Data ◽  
Cancer Type ◽  
Pooled Prevalence ◽  
Tumor Types ◽  
Structured Literature Review

Background. Given limited data on the epidemiology of MSI-H and dMMR across solid tumors (except colorectal cancer (CRC)), the current study was designed to estimate their prevalence. Materials and Methods. A structured literature review identified English language publications that used immunohistochemistry (IHC) or polymerase chain replication (PCR) techniques. Publications were selected for all tumors except CRC using MEDLINE, EMBASE, and Cochrane databases and key congresses; CRC and pan-tumor genomic publications were selected through a targeted review. Meta-analysis was performed to estimate pooled prevalence of MSI-H/dMMR across all solid tumors and for selected tumor types. Where possible, prevalence within tumor types was estimated by disease stages. Results. Of 1,176 citations retrieved, 103 and 48 publications reported prevalence of MSI-H and dMMR, respectively. Five pan-tumor genomic studies supplemented the evidence base. Tumor types with at least 5 publications included gastric (n = 39), ovarian (n = 23), colorectal (n = 20), endometrial (n = 53), esophageal (n = 6), and renal cancer (n = 8). Overall MSI-H prevalence (with 95% CI) across 25 tumors was based on 90 papers (28,213 patients) and estimated at 14% (10%–19%). MSI-H prevalence among Stage 1/2 cancers was estimated at 15% (8%–23%); Stages 3 and 4 prevalence was estimated at 9% (3%–17%) and 3% (1%–7%), respectively. Overall, dMMR prevalence across 13 tumor types (based on 54 papers and 20,383 patients) was estimated at 16% (11%–22%). Endometrial cancer had the highest pooled MSI-H and dMMR prevalence (26% and 25% all stages, respectively). Conclusions. This is the first comprehensive attempt to report pooled prevalence estimates of MSI-H/dMMR across solid tumors based on published data. Prevalence determined by IHC and PCR was generally comparable, with some variations by cancer type. Late-stage prevalence was lower than that in earlier stages.

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 Comparison of Treatment Modalities in Frontline Therapy of Stages I/IE Extranodal NK/T-Cell Lymphoma-Nasal Type (ENKTL-N): An up-to-Date Network Meta-Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4538-4538
Author(s):  
Philip A Haddad ◽  
Dalia Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Comparative Studies ◽  
English Language ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Stage I ◽  
Treatment Modalities ◽  
Direct Head

Abstract Introduction: Despite many studies reporting on the optimal therapies for early stage ENKTL-N in the front-line setting, this area continues to be subject to a significant controversy regarding single modalities versus combination or sequential approaches. All these comparative studies were small non-randomized studies that combined stages I & II. The results were often inconclusive and occasionally conflicting. In the absence of direct head-to-head randomized controlled trials in this clinical setting, a network meta-analysis was conducted to compare these therapeutic approaches and their respective impact on 5-year survival in stage I/IE ENKTL-N. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language, diagnosis of stage I/IE ENKTL-N, treatment with chemotherapy (CT), radiation (RT), sequential CT and RT (SEQ), and chemoradiotherapy (CRT), comparative studies that reported predominantly (>70%) I/IE 5-year overall survival (OS) and disease-free survival (DFS) rates. Studies that reported on mixed samples of early and advanced ENKTL were excluded. A frequentist network meta-analysis was conducted using the netmeta package and random-effects model. Results: Seven studies comprising a total of 397 participants were included. Our network meta-analysis revealed that upfront RT tended to have better 5-year OS and DFS than CRT, SEQ, though it did not reach statistical significance. However, RT had a significantly superior 5-year OS when compared to CT (RR=0.43, 0.19-0.97). Based on the pair-wise and network meta-analyses, RT was ranked as the most effective first-line treatment approach followed by CRT, SEQ, and CT in decreasing order. Analysis of the 5-year DFS yielded similar findings. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusion: This is the first network meta-analysis to compare all commonly utilized upfront treatment modalities in stages I/IE ENKTL-N. It indicates that upfront RT alone may be sufficient as there was no signal that chemotherapy added any OS or DFS advantages. Adequately powered randomized trials are warranted. Disclosures No relevant conflicts of interest to declare.

scholarly journals Fetal and maternal outcomes after maternal biologic use during conception and pregnancy: a systematic review and meta-analysis.

2021 ◽  
Author(s):  
Laura O'Byrne ◽  
Safi Alqatari ◽  
Gillian Maher ◽  
Aoife O'Sullivan ◽  
Ali Khashan ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
English Language ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Neonatal Infection ◽  
Chronic Inflammatory Disease ◽  
Cross Sectional ◽  
In Pregnancy

Background: Biologic medications, specifically the TNF-α inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy. Objective: To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy. Search strategy: PubMed and EMBASE databases were searched through January 1998-July 2021. Selection criteria: Peer reviewed, English language cohort, case-control, cross-sectional studies, and case series which contained original data. Data collection and analysis: Two authors independently conducted data extraction and assessed study quality. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the ‘treated’ group as the reference category. All studies were evaluated using an appropriate quality assessment tool described by McDonald et al. Main Results: 35 studies, 11172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations: treated 4%(95% CI 0.03-0.4) vs disease matched 4%(0.03-0.05).Preterm delivery treated 12%(0.10-0.14) vs disease matched 10%(0.09-0.12) Severe neonatal infection: treated 5%(0.03-0.07) vs disease matched 5%(0.02-0.07) Low birth weight: treated 10%(0.07-0.12) vs disease matched 8%(0.07-0.09) The pooled Miscarriage: treated 13%(0.10-0.15) vs disease matched 8%(0.04-0.11) Pre-eclampsia; treated 1%(0.01-0.02) vs disease matched 1%(0.00-0.01). No statistical differences in proportions were observed. Conclusion: We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease matched controls and CID free pregnancies. Overall, women receiving biologics in pregnancy may be reassured regarding their safety.

scholarly journals Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

2020 ◽  
Vol 11 ◽  
pp. 94 ◽  
Author(s):  
Davide Nasi ◽  
Mauro Dobran
Keyword(s):  
Decompressive Craniectomy ◽  
Lower Incidence ◽  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Cerebrospinal Fluid Dynamics ◽  
Inclusion Criteria ◽  
Postoperative Hydrocephalus ◽  
Meta Analyses ◽  
Early Cranioplasty

Background: Do alterations of cerebrospinal fluid dynamics secondary to decompressive craniectomy (DC) lead to hydrocephalus, and can this effect be mitigated by early cranioplasty (CP)? In this meta-analysis, we evaluated whether the timing of CP decreased the incidence of postoperative hydrocephalus. Methods: We performed a systematic search of PubMed/MEDLINE, Scopus, and the Cochrane databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for English language articles (1990–2020). We included case series, case–control, and cohort studies, and clinical trials assessing the incidence of hydrocephalus in adult patients undergoing early CP (within 3 months) versus late CP (after 3 months) after DC. Results: Eleven studies matched the inclusion criteria. The rate of postoperative hydrocephalus was not significantly different between the early (=96/1063; 9.03%) and late CP (=65/966; 6.72%) group (P = 0.09). Only in the three studies specifically reporting on the rate of hydrocephalus after DC performed to address traumatic brain injury (TBI) alone was there a significantly lower incidence of hydrocephalus with early CP (P = 0.01). Conclusion: Early CP (within 90 days) after DC performed in TBI patients alone was associated with a lower incidence of hydrocephalus. However, this finding was not corroborated in the remaining eight studies involving CP for pathology exclusive of TBI.

Knowledge Gaps among Patients and Providers in HPV-Related Oropharyngeal Cancer: A Systematic Review

2020 ◽  
Vol 162 (5) ◽  
pp. 612-621 ◽  
Author(s):  
Sean M. Parsel ◽  
Blair M. Barton ◽  
Sydney Beatty ◽  
Paul L. Friedlander
Keyword(s):  
Health Care ◽  
General Population ◽  
Health Care Providers ◽  
English Language ◽  
Human Subjects ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Case Series ◽  
Primary Outcome Measure ◽  
Care Providers

Objective To describe the level of knowledge of human papillomavirus (HPV) and HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) among the general population and health care providers. Data Sources Systematic search was performed on December 20, 2018, using MEDLINE (1966 to December 2018), EMBASE (1975 to December 2018), Web of Science (1900 to December 2018), and CENTRAL (1996 to December 2018) databases. English-language literature involving human subjects was used, and studies were limited to case series, case-control, cohort, and randomized controlled trial designs. Review Methods Studies were included if they assessed knowledge of HPV and HPV-associated OPSCC. The primary outcome measure was the knowledge of HPV-associated OPSCC among the general population and with health care providers. Meta-analysis of proportions was attempted using random-effects model. The PRISMA guidelines were used for accuracy of reporting. Results Thirty-two studies were included with 17,288 participants. There was a high degree of heterogeneity preventing completion of a meta-analysis. Knowledge of HPV and HPV-associated OPSCC varied between the general population and health care providers. The proportion of the general population and health care providers with knowledge of HPV ranged from 16% to 75% and 21% to 84%, respectively. Knowledge of HPV-associated OPSCC was greater in health care providers and ranged from 22% to 100% compared with the general population, which ranged from 7% to 57%. Conclusion There is a knowledge gap of HPV-associated OPSCC for both the general population and health care providers. Additional education may not only increase awareness but may also result in prevention and earlier detection.

scholarly journals Role of maternal mental health disorders on stillbirth and infant mortality risk: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036280
Author(s):  
Akilew A. Adane ◽  
Helen D. Bailey ◽  
Rhonda Marriott ◽  
Brad M. Farrant ◽  
Scott W. White ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Infant Mortality ◽  
Systematic Reviews ◽  
English Language ◽  
Maternal Mental Health ◽  
Meta Analysis ◽  
Mental Health Disorders ◽  
Published Evidence ◽  
Health Disorders

IntroductionMaternal mental health disorders such as anxiety and depression are major public health concerns. Evidence shows a link between maternal mental health disorders and preterm birth and low birth weight. However, the impacts of maternal mental health disorders on stillbirth and infant mortality have been less investigated and inconsistent findings have been reported. Thus, using the available literature, we plan to examine whether prenatal maternal mental health disorders impact the risk of stillbirth and infant mortality.Methods and analysisThis systematic review and meta-analysis will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews. Systematic searches will be conducted (from database inception to December 2019) in Medline, Embase, PsycINFO and Scopus for studies examining the association of prenatal mental health disorders and stillbirth and infant mortality. The search will be limited to studies published in English language and in humans only, with no restriction on the year of publication. Two independent reviewers will evaluate records and assess the quality of individual studies. The Newcastle–Ottawa scales and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to assess the methodological quality and bias of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess between-study heterogeneity in the estimated effect size.Ethics and disseminationAs it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.PROSPERO registration number159834.

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