scholarly journals Rate and Predictors of Failure in the Conservative Management of Stable Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110312
Author(s):  
Terence Tan ◽  
Milly S. Huang ◽  
Joost Rutges ◽  
Travis E. Marion ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Predictive Factors ◽  
Conservative Management ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Kyphotic Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Neurologically Intact

Study Design: Systematic review. Objectives: Management of stable traumatic thoracolumbar burst fractures in neurologically-intact patients remains controversial. Conservative management fails in a subset of patients who require subsequent surgical fixation. The aim of this review is to (1) determine the rate of conservative management failure, and (2) analyze predictive factors at admission influencing conservative management failure. Methods: A systematic review adhering to PRISMA guidelines was performed. Studies with data pertaining to traumatic thoracolumbar burst fractures without posterior osteoligamentous injury (e.g. AO Type A3/A4) and/or the rate and predictive factors of conservative management failure were included. Risk of bias appraisal was performed. Pooled analysis of rates of failure was performed with qualitative analysis of predictors of conservative management failure. Results: 16 articles were included in this review (11 pertaining to rate of conservative management failure, 5 pertaining to predictive risk factors). Rate of failure of conservative management from a pooled analysis of 601 patients is 9.2% (95% CI: 4.5%-13.9%). Admission factors predictive of conservative management failure include age, greater initial kyphotic angle, greater initial interpedicular distance, smaller initial residual canal size, greater Load Sharing Classification (LSC) score and greater admission Visual Analog Scale (VAS) pain scores. Conclusion: A proportion (9.2%) of conservatively managed, neurologically-intact thoracolumbar burst fractures fail conservative management. Among other factors, age, kyphotic angle, residual canal area and interpedicular distance should be investigated in prospective studies to identify the subset of patients prone to failure of conservative management. Surgical management should be carefully considered in patients with the above risk factors.

scholarly journals Preterm birth and its associated factors in Ethiopia: a systematic review and meta- analysis

2021 ◽  
Vol 21 (3) ◽  
pp. 1321-1333
Author(s):  
Fikadu Waltengus Sendeku ◽  
Fentahun Yenealem Beyene ◽  
Azimeraw Arega Tesfu ◽  
Simachew Animen Bante ◽  
Getnet Gedefaw Azeze
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Preterm Birth ◽  
Meta Analysis ◽  
Preterm Births ◽  
Pooled Analysis ◽  
Health Concern ◽  
Middle Income ◽  
Quality Healthcare ◽  
Associated Risk Factors

Background: Preterm birth is a public health concern globally. In low- and middle-income countries, like Ethiopia, preterm birth is under reported and underestimated. Therefore, this systematic review and meta-analysis assessed the pooled preva- lence and associated risk factors for preterm birth in Ethiopia. Methods: In this review the databases used were PubMed, Google scholar, EMBASE, HINARI and African journal online. Publication bias was checked using a funnel plot and Eggers test. Results: A total of 30 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of preterm birth in Ethiopia was 11.4% (95% CI; 9.04, 13.76). On pooled analysis, preterm birth was associated with pregnan- cy-induced hypertension being HIV-positive, premature rupture of membrane, rural residence, the mother having a history of abortion, multiple pregnancies, and anemia during pregnancy. Conclusion: The national prevalence of preterm birth in Ethiopia was low. Early identifying those pregnant women who are at risk of the above determinants and proving quality healthcare and counsel them how to prevent preterm births, which decrease the rate of preterm birth and its consequences. So, both governmental and non-governmental health sectors work on the minimization of these risk factors. Keywords: Prevalence; pre-term birth; determinants; systematic review; meta-analysis; Ethiopia.

scholarly journals Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches

2021 ◽  
Author(s):  
Andres Roblesgil-Medrano ◽  
Eduardo Tellez-Garcia ◽  
Luis Carlos Bueno-Gutierrez ◽  
Juan Bernardo Villarreal-Espinosa ◽  
Cecilia Anabell Galindo-Garza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

scholarly journals Effect of Dietary and Supplemental Lycopene on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 11 (6) ◽  
pp. 1453-1488 ◽  
Author(s):  
Audrey C Tierney ◽  
Chloe E Rumble ◽  
Lauren M Billings ◽  
Elena S George
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Hdl Cholesterol ◽  
Pooled Analysis ◽  
Total Risk ◽  
Meta Analyses

ABSTRACT Cardiovascular disease (CVD) is the leading cause of death globally and the presence of ≥1 cardiovascular risk factors elevates total risk. Lycopene, a carotenoid with high antioxidant capacity, may be protective. The aim of this systematic review and meta-analyses is to determine the efficacy of consuming dietary and/or supplemental lycopene on cardiovascular risk factors. Using the PRISMA guidelines, 4 databases were systematically searched from inception: Medline, Cinahl, Proquest, and Scopus. Intervention trials assessing dietary or supplemental lycopene on CVD outcomes were included. The Cochrane Risk-of-Bias tool was used to assess the quality of the included papers. Pooled analysis was conducted using outcomes with available data. Forty-three studies were included. Lycopene interventions were highly variable (supplement with or without food, based as tomato juice/paste/raw product, or combined with olive oil), the dose ranged from 1.44 to 75 mg lycopene/d and was not reported in 11 of 43 included studies. Studies reported conflicting findings for the effect of lycopene on cardiovascular risk factors, This was supported by meta-analyses where there were no significant differences between lycopene intervention and control groups for blood pressure and lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides). This was observed for overall groups and in subgroup analyses for individuals with elevated risk factor concentrations at baseline. Lycopene interventions for cardiovascular risk factors were highly variable across studies in both the dosage provided and the mode of delivery (supplement or food based). As such, there are conflicting findings regarding the efficacy of lycopene to improve cardiovascular risk factors. This systematic review was registered with PROSPERO as CRD42018112174.

Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit: A systematic review and meta-analysis v1

2021 ◽  
Author(s):  
Tzu-Yi Chou ◽  
Fon-yih Tsuang ◽  
Chung Liang Chai
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Neurological Deficit ◽  
Meta Analysis ◽  
Burst Fracture ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Non Surgical Treatment

The aim of this systematic review is to compare the outcomes of burst fracture between non-operative treatments and operative treatments.

scholarly journals Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management

2014 ◽  
Vol 37 (1) ◽  
pp. E1 ◽  
Author(s):  
Joshua Bakhsheshian ◽  
Nader S. Dahdaleh ◽  
Shayan Fakurnejad ◽  
Justin K. Scheer ◽  
Zachary A. Smith
Keyword(s):  
Conservative Treatment ◽  
Conservative Management ◽  
Nonoperative Management ◽  
Neurological Deficits ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
High Level ◽  
Neurologically Intact

Object The overall evidence for nonoperative management of patients with traumatic thoracolumbar burst fractures is unknown. There is no agreement on the optimal method of conservative treatment. Recent randomized controlled trials that have compared nonoperative to operative treatment of thoracolumbar burst fractures without neurological deficits yielded conflicting results. By assessing the level of evidence on conservative management through validated methodologies, clinicians can assess the availability of critically appraised literature. The purpose of this study was to examine the level of evidence for the use of conservative management in traumatic thoracolumbar burst fractures. Methods A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of burst fractures resulting from a traumatic mechanism, and fractures of the thoracic or lumbar spine. The exclusion criteria consisted of osteoporotic burst fractures, pathological burst fractures, and fractures located in the cervical spine. Of the studies meeting the inclusion/exclusion criteria, any study in which nonoperative treatment was used was included in this review. Results One thousand ninety-eight abstracts were reviewed and 447 papers met inclusion/exclusion criteria, of which 45 were included in this review. In total, there were 2 Level-I, 7 Level-II, 9 Level-III, 25 Level-IV, and 2 Level-V studies. Of the 45 studies, 16 investigated conservative management techniques, 20 studies compared operative to nonoperative treatments, and 9 papers investigated the prognosis of conservative management. Conclusions There are 9 high-level studies (Levels I–II) that have investigated the conservative management of traumatic thoracolumbar burst fractures. In neurologically intact patients, there is no superior conservative management technique over another as supported by a high level of evidence. The conservative technique can be based on patient and surgeon preference, comfort, and access to resources. A high level of evidence demonstrated similar functional outcomes with conservative management when compared with open surgical operative management in patients who were neurologically intact. The presence of a neurological deficit is not an absolute contraindication for conservative treatment as supported by a high level of evidence. However, the majority of the literature excluded patients with neurological deficits. More evidence is needed to further classify the appropriate burst fractures for conservative management to decrease variables that may impact the prognosis.

Omega-6 fatty acids and risk of cardiovascular disease: insight from systematic review and meta-analysis of randomized controlled trials and a mendelian randomization study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mazidi ◽  
N Shekoohi ◽  
N Katsiki ◽  
M Banach
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Fatty Acids ◽  
Sequential Analysis ◽  
Mendelian Randomization ◽  
Meta Analysis ◽  
Serum Levels ◽  
Pooled Analysis ◽  
Trial Sequential Analysis ◽  
Omega 6

Abstract Background Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in the Western countries. Their effects on several cardiovascular (CV) risk factors are still controversial. Purpose We performed a systematic review and meta-analysis of randomized control trials (RCTs) as well as a Mendelian randomization (MR) analysis to evaluate the links (or possible causality) between supplementation or serum levels of omega-6 PUFA, CV disease (CVD) and cardiometabolic risk factors. Methods Selected databases were searched until 31 August 2019 to identify prospective studies investigating the effects of omega-6 PUFAs supplementation on CVD events/mortality. Random-effects model meta-analysis was performed for quantitative data synthesis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 20% reduction in outcomes after administration of omega-6 PUFAs. Inverse variance weighted method (IVW), weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied for MR. Results In the meta-analysis of 9 studies with 4,433 participants we showed that omega-6 PUFAs supplementation was not associated with CVD event risk - RR 0.94 (95% CI: 0.77–1.15, heterogeneity p=0.031; I2=66.2%, n=4 studies). The pooled estimate (RR) of the effect of omega-6 PUFAs supplementation on CVD death was 1.06 (95% C:I 0.73–1.55, heterogeneity p=0.011; I2=66.2%, n=6 studies), on CHD events 0.84 (95% CI: 0.61–1.16, heterogeneity p=0.001; I2=79.4%), on MI 0.87 (95% CI: 0.74–1.01, heterogeneity p=0.381; I2=2.3%) (Figure), and on stroke 1.36 (95% CI: 0.45–4.07, heterogeneity p=0.082; I2=55.3%). In MR analysis we showed that individuals with genetically higher serum adrenic acid (AA; 22:4, n-6) levels had a greater risk of CHD events (IVW=Beta: 0.526, p=0.007), MI (IVW=Beta: 0.606, p=0.017) and stroke (IVW=Beta: 1.694, p=0.009), as well as higher levels of FBG (IVW=Beta: 0.417, p=1.0x10–3), LDL-C (IVW=Beta: 0.806, p=4.9x10–5), HDL-C (IVW=Beta: −0.820, p=4.3x10–17), whereas lower levels of TG (IVW=Beta: −1.064, p=1.2x10–12) and TC (IVW=Beta: −1.064, p=1.2x10–12). Conclusions In the pooled analysis different omega-6 PUFAs supplementation did not affect the risk of MI, stroke and CHD event/mortality or the serum concentration of cardiometabolic parameters (data not presented), however in MR analysis, higher AA levels significantly associated with the risk of CHD, MI and stroke, as well as with elevated levels of FBG, LDL-C and HDL-C and reduced levels of TC and TG. There is probably lack of class effect for omega-6 PUFAs, therefore further studies are needed to assess the effects of omega-6 PUFAs on cardiometabolic outcomes. Funding Acknowledgement Type of funding source: None

scholarly journals THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis

2016 ◽  
Vol 175 (6) ◽  
pp. R283-R295 ◽  
Author(s):  
Irina Bancos ◽  
Fares Alahdab ◽  
Rachel K Crowley ◽  
Vasileios Chortis ◽  
Danae A Delivanis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Conservative Management ◽  
Meta Analysis ◽  
Cushing's Syndrome ◽  
Adrenal Tumors ◽  
Subclinical Cushing’S Syndrome

Objective Beneficial effects of adrenalectomy on cardiovascular risk factors in patients with subclinical Cushing’s syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on cardiovascular risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on cardiovascular risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor. Methods MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial were searched on 17 November 2015. Reviewers extracted data and assessed methodological quality in duplicate. Results We included 26 studies reporting on 584 patients with SCS and 457 patients with NF adrenal tumors. Studies used different definitions of SCS. Patients with SCS undergoing adrenalectomy demonstrated an overall improvement in cardiovascular risk factors (61% for hypertension, 52% for diabetes mellitus, 45% for obesity and 24% for dyslipidemia). When compared with conservative management, patients with SCS undergoing adrenalectomy experienced improvement in hypertension (RR 11, 95% CI: 4.3–27.8) and diabetes mellitus (RR 3.9, 95% CI: 1.5–9.9), but not dyslipidemia (RR 2.6, 95% CI: 0.97–7.2) or obesity (RR 3.4, 95% CI: 0.95–12). Patients with NF adrenal tumors experienced improvement in hypertension (21/54 patients); however, insufficient data exist for comparison to patients with SCS. Conclusions Available low-to-moderate-quality evidence from heterogeneous studies suggests a beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS overall and compared with conservative management.

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