Diagnosis of Anosmia and Hyposmia: A Systematic Review

Background Anosmia and hyposmia have many etiologies, including trauma, chronic sinusitis, neoplasms, and respiratory viral infections such as rhinovirus and SARS-CoV-2. We aimed to systematically review the literature on the diagnostic evaluation of anosmia/hyposmia. Methods PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating diagnostic modalities for anosmia, written in the English language, used original data, and had two or more patients. Results A total of 2065 unique titles were returned upon the initial search. Of these, 226 abstracts were examined, yielding 27 full-text articles meeting inclusion criteria (Level of evidence ranging from 1 to 4; most level 2). The studies included a total of 13,577 patients. The most utilized diagnostic tools were orthonasal smell tests (such as the Sniffin’ Sticks and the UPSIT, along with validated abridged smell tests). Though various imaging modalities (including MRI and CT) were frequently mentioned in the workup of olfactory dysfunction, routine imaging was not used to primarily diagnose smell loss. Conclusion The literature includes several studies on validity and reliability for various smell tests in diagnosing anosmia. Along with a thorough history and physical, validated orthonasal smell tests should be part of the workup of the patient with suspected olfactory dysfunction. The most widely studied modality was MRI, but criteria for the timing and sequence of imaging modalities was heterogenous.

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Systematic Review of the Surgical Outcomes of Elbow Plicae

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120955162 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095516

Author(s):

In-Ho Jeon ◽

Hua Liu ◽

Akriti Nanda ◽

Hyojune Kim ◽

Dong Min Kim ◽

...

Keyword(s):

Systematic Review ◽

Radial Head ◽

Surgical Outcomes ◽

English Language ◽

Cochrane Library ◽

Medical Subject Headings ◽

Level Of Evidence ◽

Residual Symptoms ◽

Language Studies ◽

Meta Analyses

Background: Surgical resection is usually required for symptomatic elbow plicae that have failed nonoperative therapy. However, evidence of surgical outcomes has not been presented. Purpose: To review the surgical outcomes for the treatment of synovial plicae in the radiocapitellar joint. Study Design: Systematic review; Level of evidence, 4. Methods: We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, and Embase databases using keywords as well as Medical Subject Headings terms and Emtree ([(elbow OR humeroradial joint OR radiohumeral joint) AND (meniscus OR plica)] OR snapping elbow OR snapping triceps OR synovial fold syndrome OR synovial fringe) for English-language studies. We conducted a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: A total of 14 articles comprising four level 5 and ten level 4 studies were identified, including 279 patients (284 elbows). The triggering factors reported for 58 patients were heavy labor (29 patients; 50.0%), sporting activities (17 patients; 29.3%), and nonspecific trauma (12 patients; 20.7%). Overall, 92 patients (33.0%) were administered a steroid injection before surgery. Arthroscopic plica resection was performed in 266 patients (95.3%). Intraoperatively, plicae were mostly found in the posterior (44.0%) and posterolateral (28.6%) sites, and chondromalacia of the radial head was observed in 25 patients (9.2%). Of the reported surgical outcomes, 67.7% showed a resolution of symptoms. However, 9.3% of patients had residual symptoms, which were likely associated with pre-existing radial head chondromalacia. The complication rate was reported as 1.8%. Conclusion: Symptomatic elbow plicae were mostly treated arthroscopically, with most of the results being favorable. Pre-existing chondromalacia and the underestimation of concomitant intra-articular abnormalities may yield an inferior outcome.

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99 Approaches to Eating and Drinking with Acknowledged Risk: A Systematic Review

Age and Ageing ◽

10.1093/ageing/afz196.01 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i34-i36

Author(s):

N Soar ◽

J Birns ◽

P Sommerville ◽

A Lang ◽

S Archer

Keyword(s):

English Language ◽

Systematic Approach ◽

Meta Analysis ◽

Original Data ◽

Best Interests ◽

Capacity Assessment ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Future Work ◽

The Impact

Abstract Introduction Patients with dysphagia may consider eating and drinking with acknowledged risk (EDAR) instead of artificial hydration/nutrition. Timely consideration of complex issues is required including dysphagia reversibility, prognosis, risk/benefit discussions, patient wishes, their capacity, best interests and advanced care planning. This study aimed to ascertain if EDAR protocols improve care through a systematic literature review. Methods PUBMED, MEDLINE, CINAHL and EMBASE were searched for English language articles to May ‘19 with terms related to EDAR, dysphagia and end of life. Articles and conference abstracts with original data were agreed for inclusion by two independent reviewers. Levels of evidence were assessed using the Sackett scale (Cook et al, Chest. 1995; 4: 227–230). Study themes were identified and discussed. Results 12 articles met the inclusion criteria with varied methodology. The highest level of evidence was III (cohort study) and most were limited to patients with dementia, stroke, in older person’s wards or residential homes. 4 articles described a systematic approach to EDAR for in-patients and reported reductions in days nil-by-mouth until feeding plans are made and improvements in documentation of decision making, nutrition plans and capacity assessment. Other major themes included the need for an EDAR protocol, staff, patient and carer/family knowledge of EDAR, development of a protocol and the language of “risk feeding”. Formal meta-analysis was not possible due to the level and mix of methodology. Conclusions There is a paucity of evidence to determine if EDAR protocols improve care. However support is emerging for a coordinated approach to managing EDAR. Findings suggest having a protocol is not enough; education, training and communication within teams and with patients and carers is essential and this justifies further work. The lack of research into the impact of EDAR protocols on patient and carer experience means they must be central to any future work.

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Systematic review of immunosuppressant guidelines in the COVID-19 pandemic

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620985687 ◽

2021 ◽

Vol 12 ◽

pp. 204209862098568

Author(s):

Fenella Barlow-Pay ◽

Thura Win Htut ◽

Mina Khezrian ◽

Phyo Kyaw Myint

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

English Language ◽

Viral Infections ◽

Evidence Base ◽

The Novel ◽

Level Of Evidence ◽

High Doses

Aims: Individuals taking immunosuppressants are at increased susceptibility to viral infections in general. However, due to the novel nature of the COVID-19, there is a lack of evidence about the specific risks of the disease in this patient group. This systematic review aims to summarize the current international clinical guidelines to highlight areas where research is needed through critical appraisal of the evidence base of these guidelines. Methods: We conducted a systematic review of clinical practice guidelines about the usage of immunosuppressants during the COVID-19 pandemic. Electronic databases including MEDLINE and the websites of relevant professional bodies were searched for English language guidelines that were published or updated between March 2020 and May 2020 in this area. We assessed the quality and consistency of guidelines. The evidence base underpinning these guidelines was critically appraised using GRADE criteria. Results: Twenty-three guidelines were included. Most guidelines ( n = 15, 65.2%) informed and updated evidence based on expert opinion. The methodological quality of the guidelines varied, ranging from ‘very low’ to ‘moderate’. Guidelines consistently recommended that high-risk patients, including those who are taking high doses of steroids for more than a month, or a combination of two or more immunosuppressants, should be shielding during the outbreak. Most guidelines stated that steroids usage should not be stopped abruptly and advised on individualized risk–benefit analysis considering the risk of the effect of COVID-19 infection and the relapse of the autoimmune condition in patients. Discussion: Clinical practice guidelines on taking immunosuppressants during the COVID-19 outbreak vary in quality. The level of evidence informing the available guidelines was generally low. Given the novel nature of COVID-19, the guidelines draw on existing knowledge and data, refer to the use of immunosuppressants and risks of serious infections of other aetiologies and have extrapolated these to form their evidence base.

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630. A 5-mRNA host response whole-blood classifier trained using patients with non-COVID-19 viral infections accurately predicts severity of COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.824 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S375-S376

Author(s):

ljubomir Buturovic ◽

Purvesh Khatri ◽

Benjamin Tang ◽

Kevin Lai ◽

Win Sen Kuan ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Failure ◽

Viral Infections ◽

Lamp Assay ◽

Training Data ◽

Diagnostic Tools ◽

Severe Respiratory Failure ◽

Proof Of Concept ◽

Risk Of Death ◽

Qpcr Platform

Abstract Background While major progress has been made to establish diagnostic tools for the diagnosis of SARS-CoV-2 infection, determining the severity of COVID-19 remains an unmet medical need. With limited hospital resources, gauging severity would allow for some patients to safely recover in home quarantine while ensuring sicker patients get needed care. We discovered a 5 host mRNA-based classifier for the severity of influenza and other acute viral infections and validated the classifier in COVID-19 patients from Greece. Methods We used training data (N=705) from 21 retrospective clinical studies of influenza and other viral illnesses. Five host mRNAs from a preselected panel were applied to train a logistic regression classifier for predicting 30-day mortality in influenza and other viral illnesses. We then applied this classifier, with fixed weights, to an independent cohort of subjects with confirmed COVID-19 from Athens, Greece (N=71) using NanoString nCounter. Finally, we developed a proof-of-concept rapid, isothermal qRT-LAMP assay for the 5-mRNA host signature using the QuantStudio 6 qPCR platform. Results In 71 patients with COVID-19, the 5 mRNA classifier had an AUROC of 0.88 (95% CI 0.80-0.97) for identifying patients with severe respiratory failure and/or 30-day mortality (Figure 1). Applying a preset cutoff based on training data, the 5-mRNA classifier had 100% sensitivity and 46% specificity for identifying mortality, and 88% sensitivity and 68% specificity for identifying severe respiratory failure. Finally, our proof-of-concept qRT-LAMP assay showed high correlation with the reference NanoString 5-mRNA classifier (r=0.95). Figure 1. Validation of the 5-mRNA classifier in the COVID-19 cohort. (A) Expression of the 5 genes used in the logistic regression model in patients with (red) and without (blue) mortality. (B) The 5-mRNA classifier accurately distinguishes non-severe and severe patients with COVID-19 as well as those at risk of death. Conclusion Our 5-mRNA classifier demonstrated very high accuracy for the prediction of COVID-19 severity and could assist in the rapid, point-of-impact assessment of patients with confirmed COVID-19 to determine level of care thereby improving patient management and healthcare burden. Disclosures ljubomir Buturovic, PhD, Inflammatix Inc. (Employee, Shareholder) Purvesh Khatri, PhD, Inflammatix Inc. (Shareholder) Oliver Liesenfeld, MD, Inflammatix Inc. (Employee, Shareholder) James Wacker, n/a, Inflammatix Inc. (Employee, Shareholder) Uros Midic, PhD, Inflammatix Inc. (Employee, Shareholder) Roland Luethy, PhD, Inflammatix Inc. (Employee, Shareholder) David C. Rawling, PhD, Inflammatix Inc. (Employee, Shareholder) Timothy Sweeney, MD, Inflammatix, Inc. (Employee)

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Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

World Journal of Surgery ◽

10.1007/s00268-021-05994-9 ◽

2021 ◽

Author(s):

Carol J. Peden ◽

Geeta Aggarwal ◽

Robert J. Aitken ◽

Iain D. Anderson ◽

Nicolai Bang Foss ◽

...

Keyword(s):

High Risk ◽

English Language ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Preoperative Care ◽

Surgical Patient ◽

Emergency Laparotomy ◽

Emergency General Surgery ◽

Optimal Care ◽

Level Of Evidence

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. Methods Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1. Results Twelve components of preoperative care were considered. Consensus was reached after three rounds. Conclusions These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

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Foot and Ankle Injections in Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211003619 ◽

2021 ◽

pp. 194173812110036

Author(s):

Jonathan K. Ochoa ◽

Christopher E. Gross ◽

Robert B. Anderson ◽

Andrew R. Hsu

Keyword(s):

English Language ◽

Platelet Rich Plasma ◽

Empirical Studies ◽

Autologous Blood ◽

Case Series ◽

Placental Tissue ◽

Ankle Injuries ◽

Extensive Literature ◽

Foot And Ankle ◽

Level Of Evidence

Context: Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. Evidence Acquisition: An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Study Design: Clinical review. Level of Evidence: Level 4. Results: Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Conclusions: Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

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Current status of wet lab and cadaveric simulation in urological training: A systematic review

Canadian Urological Association Journal ◽

10.5489/cuaj.6520 ◽

2020 ◽

Vol 14 (11) ◽

Author(s):

Ahmed Al-Jabir ◽

Abdullatif Aydin ◽

Hussain Al-Jabir ◽

M. Shamim Khan ◽

Prokar Dasgupta ◽

...

Keyword(s):

Systematic Review ◽

English Language ◽

In Vivo Studies ◽

Current Status ◽

Level Of Evidence ◽

Cadaveric Simulation ◽

Randomized Controlled Studies ◽

Wet Lab ◽

Urological Training

Introduction: We undertook a systematic review of the use of wet lab (animal and cadaveric) simulation models in urological training, with an aim to establishing a level of evidence (LoE) for studies and level of recommendation (LoR) for models, as well as evaluating types of validation. Methods: Medline, EMBASE, and Cochrane databases were searched for English-language studies using search terms including a combination of surgery, surgical training, and medical education. These results were combined with wet lab, animal model, cadaveric, and in-vivo. Studies were then assigned a LoE and LoR if appropriate as per the education-modified Oxford Centre for Evidence-Based Medicine classification. Results: A total of 43 articles met the inclusion criteria. There was a mean of 23.1 (±19.2) participants per study with a median of 20. Overall, the studies were largely of low quality, with 90.7% of studies being lower than 2a LoE (n=26 for LoE 2b and n=13 for LoE 3). The majority (72.1%, n=31) of studies were in animal models and 27.9% (n=12) were in cadaveric models. Conclusions: Simulation in urological education is becoming more prevalent in the literature, however, there is a focus on animal rather than cadaveric simulation, possibly due to cost and ethical considerations. Studies are also predominately of a low LoE; more higher LoEs, especially randomized controlled studies, are needed.

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Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review

Cartilage ◽

10.1177/19476035211063862 ◽

2021 ◽

Vol 13 (2_suppl) ◽

pp. 1790S-1801S

Author(s):

Guglielmo Schiavon ◽

Gianluigi Capone ◽

Monique Frize ◽

Stefano Zaffagnini ◽

Christian Candrian ◽

...

Keyword(s):

Systematic Review ◽

Disease Progression ◽

Infrared Thermography ◽

Rheumatic Diseases ◽

English Language ◽

Response To Treatment ◽

Cochrane Library ◽

Joint Diseases ◽

Level Of Evidence ◽

Post Evaluation

Objective Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies. Design A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review. Results Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis. Conclusions The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.

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Consensus-based recommendations for the use of biosimilars to treat rheumatological diseases

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211937 ◽

2017 ◽

Vol 77 (2) ◽

pp. 165-174 ◽

Cited By ~ 91

Author(s):

Jonathan Kay ◽

Monika M Schoels ◽

Thomas Dörner ◽

Paul Emery ◽

Tore K Kvien ◽

...

Keyword(s):

English Language ◽

Task Force ◽

Level Of Evidence ◽

Conference Abstract ◽

Consensus Recommendations ◽

American College Of Rheumatology ◽

Published Evidence ◽

Grade Of Recommendation ◽

Scientific Meetings ◽

Rheumatological Diseases

The study aimed to develop evidence-based recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases. The task force comprised an expert group of specialists in rheumatology, dermatology and gastroenterology, and pharmacologists, patients and a regulator from ten countries. Four key topics regarding biosimilars were identified through a process of discussion and consensus. Using a Delphi process, specific questions were then formulated to guide a systematic literature review. Relevant English-language publications through November 2016 were searched systematically for each topic using Medline; selected papers and pertinent reviews were examined for additional relevant references; and abstracts presented at the 2015 and 2016 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual scientific meetings were searched for those about biosimilars. The experts used evidence obtained from these studies to develop a set of overarching principles and consensus recommendations. The level of evidence and grade of recommendation were determined for each. By the search strategy, 490 references were identified. Of these, 29 full-text papers were included in the systematic review. Additionally, 20 abstracts were retrieved from the ACR and EULAR conference abstract databases. Five overarching principles and eight consensus recommendations were generated, encompassing considerations regarding clinical trials, immunogenicity, extrapolation of indications, switching between bio-originators and biosimilars and among biosimilars, and cost. The level of evidence and grade of recommendation for each varied according to available published evidence. Five overarching principles and eight consensus recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases were developed using research-based evidence and expert opinion.

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Imaging of Fibrosis in Chronic Pancreatitis

Frontiers in Physiology ◽

10.3389/fphys.2021.800516 ◽

2022 ◽

Vol 12 ◽

Author(s):

Yasunobu Yamashita ◽

Reiko Ashida ◽

Masayuki Kitano

Keyword(s):

Chronic Pancreatitis ◽

Magnetic Resonance ◽

Imaging Modality ◽

Magnetic Resonance Cholangiopancreatography ◽

Imaging Modalities ◽

Diagnostic Tools ◽

Diagnostic Modality ◽

Magnetic Resonance Imaging Mri ◽

Initial Imaging ◽

Eus Elastography

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

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