Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review

Objectives: COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients. Methods: The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion. Results: A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients’ death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001). Conclusion: With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn’t find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies’ design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes› incidence, risk factors, and outcomes in COVID-19 patients. doi: https://doi.org/10.12669/pjms.38.3.5529 How to cite this:Shahsavarinia K, Rahvar G, Soleimanpour H, Saadati M, Vahedi L, Mahmoodpoor A. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5529 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Risk Factors for Acute Kidney Injury in Critically Ill Neonates: A Systematic Review and Meta-Analysis

Frontiers in Pediatrics ◽

10.3389/fped.2021.666507 ◽

2021 ◽

Vol 9 ◽

Author(s):

Qian Hu ◽

Shao-Jun Li ◽

Qian-Ling Chen ◽

Han Chen ◽

Qiu Li ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Kidney Injury ◽

Critically Ill ◽

Apgar Score ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Increased Risk ◽

Critically Ill Neonates

Background and Objective: Acute kidney injury (AKI) is recognized as an independent risk factor for mortality and long-term poor prognosis in neonates. The objective of the study was to identify the risk factors for AKI in critically ill neonates to provide an important basis for follow-up research studies and early prevention.Methods: The PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang Med, SinoMed, and VIP Data were searched for studies of risk factors in critically ill neonates. Studies published from the initiation of the database to November 19, 2020, were included. The quality of studies was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) checklist. The meta-analysis was conducted with Stata 15 and drafted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.Results: Seventeen studies (five cohort studies, ten case-control studies, and two cross-sectional studies) were included in meta-analysis, with 1,627 cases in the case group and 5,220 cases in the control group. The incidence of AKI fluctuated from 8.4 to 63.3%. Fifteen risk factors were included, nine of which were significantly associated with an increased risk of AKI in critically ill neonates: gestational age [standardized mean difference (SMD) = −0.31, 95%CI = (−0.51, −0.12), P = 0.002], birthweight [SMD = −0.37, 95%CI = (−0.67, −0.07), P = 0.015], 1-min Apgar score [SMD = −0.61, 95%CI = (−0.78, −0.43), P = 0.000], 5-min Apgar score [SMD = −0.71, 95%CI = (−1.00, −0.41), P = 0.000], congenital heart disease (CHD) [odds ratio (OR) = 2.94, 95%CI = (2.08, 4.15), P = 0.000], hyperbilirubinemia [OR = 2.26, 95%CI = (1.40, 3.65), P = 0.001], necrotizing enterocolitis (NEC) [OR = 6.32, 95%CI = (2.98, 13.42), P = 0.000], sepsis [OR = 2.21, 95%CI = (1.25, 3.89), P = 0.006], and mechanical ventilation [OR = 2.37, 95%CI = (1.50, 3.75), P = 0.000]. Six of them were not significantly associated with AKI in critically ill neonates: age [SMD = −0.25, 95%CI = (−0.54, 0.04), P = 0.095], male sex [OR = 1.10, 95%CI =(0.97, 1.24), P = 0.147], prematurity [OR = 0.90, 95%CI(0.52, 1.56), P = 0.716], cesarean section [OR = 1.52, 95%CI(0.77, 3.01), P = 0.234], prenatal hemorrhage [OR = 1.41, 95%CI = (0.86, 2.33), P = 0.171], and vancomycin [OR = 1.16, 95%CI = (0.71, 1.89), P = 0.555].Conclusions: This meta-analysis provides a preliminary exploration of risk factors in critically ill neonatal AKI, which may be useful for the prediction of AKI.Systematic Review Registration: PROSPERO (CRD42020188032).

Download Full-text

Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01308-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Vikisha Hazariwala ◽

Hind Hadid ◽

Denise Kirsch ◽

Cecilia Big

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Subcutaneous Emphysema ◽

Positive Pressure Ventilation ◽

Laboratory Data ◽

Positive Pressure ◽

Case Presentation ◽

Spontaneous Pneumomediastinum ◽

Important Complication ◽

Underlying Pathophysiology

Abstract Background Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. Case presentation We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. Conclusions Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.

Download Full-text

Unravelling Genetic Factors Underlying Corticobasal Syndrome: A Systematic Review

Cells ◽

10.3390/cells10010171 ◽

2021 ◽

Vol 10 (1) ◽

pp. 171

Author(s):

Federica Arienti ◽

Giulia Lazzeri ◽

Maria Vizziello ◽

Edoardo Monfrini ◽

Nereo Bresolin ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Genetic Risk ◽

Genetic Factors ◽

Diagnostic Algorithm ◽

Behavioral Changes ◽

Corticobasal Syndrome ◽

Cochrane Library ◽

Radiological Features ◽

Genetically Determined

Corticobasal syndrome (CBS) is an atypical parkinsonian presentation characterized by heterogeneous clinical features and different underlying neuropathology. Most CBS cases are sporadic; nevertheless, reports of families and isolated individuals with genetically determined CBS have been reported. In this systematic review, we analyze the demographical, clinical, radiological, and anatomopathological features of genetically confirmed cases of CBS. A systematic search was performed using the PubMed, EMBASE, and Cochrane Library databases, included all publications in English from 1 January 1999 through 1 August 2020. We found forty publications with fifty-eight eligible cases. A second search for publications dealing with genetic risk factors for CBS led to the review of eight additional articles. GRN was the most common gene involved in CBS, representing 28 out of 58 cases, followed by MAPT, C9ORF72, and PRNP. A set of symptoms was shown to be significantly more common in GRN-CBS patients, including visuospatial impairment, behavioral changes, aphasia, and language alterations. In addition, specific demographical, clinical, biochemical, and radiological features may suggest mutations in other genes. We suggest a diagnostic algorithm to help in identifying potential genetic cases of CBS in order to improve the diagnostic accuracy and to better understand the still poorly defined underlying pathogenetic process.

Download Full-text

Pancreas-Preserving Total Duodenectomy: A Systematic Review

Digestive Surgery ◽

10.1159/000515718 ◽

2021 ◽

pp. 1-12

Author(s):

Miguel Cantalejo-Díaz ◽

José Manuel Ramia-Ángel ◽

Ana Palomares-Cano ◽

Mario Serradilla-Martín

Keyword(s):

Systematic Review ◽

Postoperative Morbidity ◽

Operating Time ◽

Pancreatic Head ◽

Cochrane Library ◽

Morbidity Rate ◽

Intraoperative Bleeding ◽

Risks And Benefits ◽

Duodenal Lesions ◽

The Mean

Background: The management of the pancreas in patients with duodenal trauma or duodenal tumors remains a controversial issue. Pancreas-preserving total duodenectomy (PPTD) requires a meticulous surgical technique. The most common indication is familial duodenal adenomatous polyposis (FAP). The aims of this study are to carry out a systematic review of the literature on the indications for PPTD and to highlight the risks and benefits compared with other more aggressive procedures. Summary: A systematic literature review was performed following PRISMA recommendations of studies published in PubMed, Embase, and Cochrane library until May 2019. Thirty articles describing 211 patients were chosen. The mean age was 48 years. The surgical indication in 75% of patients was FAP. The mean operating time was 329 min and mean intraoperative bleeding 412 mL. Postoperative morbidity rate was 49.7% (76% Clavien-Dindo <IIIa), and mortality rate was 1.4%. The mean hospital stay was 22 days. Overall survival at 1–3–5 years was >97.8%. Key Messages: PPTD is indicated for patients with benign and premalignant duodenal lesions without involvement of the pancreatic head. It is a feasible procedure offering an alternative to other more aggressive procedures in selected patients. Mortality is below 1.5%.

Download Full-text

Natural history and treatment options of radiation-induced brain cavernomas: a systematic review

Neurosurgical Review ◽

10.1007/s10143-021-01598-y ◽

2021 ◽

Author(s):

Gildas Patet ◽

Andrea Bartoli ◽

Torstein R. Meling

Keyword(s):

Systematic Review ◽

Natural History ◽

Radiation Treatment ◽

Neurological Deficits ◽

Cochrane Library ◽

Average Dose ◽

Cavernous Malformations ◽

Radiation Induced ◽

The Mean

AbstractRadiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.

Download Full-text

Incidence and risk factors of delirium after percutaneous coronary intervention in individuals hospitalised for acute myocardial infarction: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044564 ◽

2020 ◽

Vol 10 (12) ◽

pp. e044564

Author(s):

Kaizhuang Huang ◽

Jiaying Lu ◽

Yaoli Zhu ◽

Tao Cheng ◽

Dahao Du ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Risk Factor ◽

Meta Analysis ◽

Coronary Intervention ◽

Cochrane Library ◽

Percutaneous Coronary

IntroductionDelirium in the postoperative period is a wide-reaching problem that affects important clinical outcomes. The incidence and risk factors of delirium in individuals with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) has not been completely determined and no relevant systematic review and meta-analysis of incidence or risk factors exists. Hence, we aim to conduct a systematic review and meta-analysis to ascertain the incidence and risk factors of delirium among AMI patients undergoing PCI.Methods and analysesWe will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL and Google Scholar from their inception to the search date. Prospective cohort and cross-sectional studies that described the incidence or at least one risk factor of delirium will be eligible for inclusion. The primary outcome will be the incidence of postoperative delirium. The quality of included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence and risk factors associated with delirium will be extracted. Incidence data will be pooled. Each risk factor reported in the included studies will be recorded together with its statistical significance; narrative and meta-analytical approaches will be employed. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence and risk factors of delirium after PCI among patients with AMI, which is necessary for future research in this area. The findings of this study will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020184388.

Download Full-text

Prevalence and Risk Factors of Relapse in Patients with ANCA-Associated Vasculitis Receiving Cyclophosphamide Induction: A Systematic Review and Meta-analysis of Large Observational Studies

Rheumatology ◽

10.1093/rheumatology/keaa667 ◽

2020 ◽

Author(s):

Peng He ◽

Jin-ping Hu ◽

Xiu-juan Tian ◽

Li-jie He ◽

Shi-ren Sun ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Cochrane Library ◽

Baseline Serum ◽

Anca Associated Vasculitis ◽

Hazard Ratios ◽

Post Hoc ◽

Cumulative Probabilities ◽

Relapse Rates

Abstract Background Clinical relapses are common in patients with ANCA-associated vasculitis (AAV). The aim of this systematic review was to estimate time-point prevalence and risk factors of relapse. Methods We searched PubMed, Embase, and Cochrane Library databases from their inception to March 30, 2020. Cohorts and post-hoc studies were included for the estimation of summary cumulative relapse rates (CRRs) and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Sensitivity and meta-regression analyses were also performed. Results Of the 42 eligible studies, 24 studies with 6236 participants were used for the pooled analyses of CRRs. The summary 1-year, 3-year, and 5-year CRRs were 0.12 (95% CI, 0.10–0.14), 0.33 (0.29–0.38), and 0.47 (0.42–0.52), respectively. In meta-regressions, the baseline age was positively associated with 1-year CRR. The proportion of granulomatosis with polyangiitis was positively associated with 5-year CRR. Twenty-eight studies with 5390 participants were used for the meta-analysis of risk factors for relapse, including a lower level of baseline serum creatine, proteinase 3 (PR3)-ANCA positivity at diagnosis, an ANCA rise, extrarenal organ involvement (including lung, cardiovascular, upper respiratory, and gastrointestinal involvement), intravenous (vs oral) cyclophosphamide induction, a shorter course of immunosuppressant maintenance, and maintenance with mycophenolate mofetil (vs azathioprine). Conclusions Our systematic review demonstrated that the 1-year, 3-year, and 5-year cumulative probabilities of relapse were ∼12%, 33%, and 47% in AAV patients receiving cyclophosphamide induction, respectively. Early identification of risk factors for relapse is helpful to the risk stratification of patients so as to achieve personalized treatment.

Download Full-text

The prevalence of diabetes in Afghanistan: a systematic review and meta-analysis

BMC Public Health ◽

10.1186/s12889-021-10993-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sohail Akhtar ◽

Jamal Abdul Nasir ◽

Amara Javed ◽

Mariyam Saleem ◽

Sundas Sajjad ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Methodological Quality ◽

Meta Analysis ◽

Population Based ◽

Included Study ◽

Cochrane Library ◽

Or Education ◽

Meta Regression

Abstract Background The aim of this paper is to investigate the prevalence of diabetes and its associated risk factors in Afghanistan through a systematic review and meta–analysis. Methods A comprehensive literature search was conducted using EMBASE, PubMed, Web of Sciences, Google Scholar and the Cochrane library, carried out from inception to April 312,020, without language restriction. Meta–analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. The existence of publication bias was initially assessed by visual inspection of a funnel plot and then tested by the Egger regression test. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity. This systematic review was reported by following the PRISMA guidelines and the methodological quality of each included study was evaluated using the STROBE guidelines. Results Out of 64 potentially relevant studies, only 06 studies fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of diabetes in the general population based on population-based studies were 12.13% (95% CI: 8.86–16.24%), based on a pooled sample of 7071 individuals. Results of univariate meta-regression analysis revealed that the prevalence of diabetes increased with mean age, hypertension and obesity. There was no significant association between sex (male vs female), smoking, the methodological quality of included articles or education (illiterate vs literate) and the prevalence of diabetes. Conclusions This meta-analysis reports the 12.13% prevalence of diabetes in Afghanistan,with the highest prevalence in Kandahar and the lowest in Balkh province. The main risk factors include increasing age, obesity and hypertension. Community-based care and preventive training programmes are recommended. Trial registration This review was registered on PROSPERO (registration number CRD42020172624).

Download Full-text

Seroprevalence of SARS CoV-2 infection in Low and Middle-Income Countries and risk classification in the context of rolling out vaccine candidate across these countries : Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-578481/v1 ◽

2021 ◽

Author(s):

Martin Ackah ◽

Louise Ameyaw ◽

Kwadwo Owusu Akuffo ◽

Cynthia Osei Yeboah ◽

Nana Esi Wood ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaccine Candidate ◽

Meta Analysis ◽

Cochrane Library ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

Abstract Background Seroprevalence of SARS Cov-2 provides a good indication of the extent of exposure and spread in the population, as well as those likely to benefit from a vaccine candidate. To date, there is no published or ongoing systematic review on the seroprevalence of COVID-19 in Low- and Middle-Income Countries (LMICs). This systematic review and meta-analysis will estimate SARS Cov-2 seroprevalence and the risk factors for SARS Cov-2 infection in LMICs.Methods We will search PubMed, EMBASE, WHO COVID-19 Global research database, Google Scholar, the African Journals Online, LILAC, HINARI, medRxiv, bioRxiv and Cochrane Library for potentially useful studies on seroprevalence of COVID-19 in LMICs from December 2019 to December 2020 without language restriction. Two authors will independently screen all the articles, select studies based on pre-specified eligibility criteria and extract data using a pre-tested data extraction form. Any disagreements will be resolved through discussion between the authors. The pooled seroprevalence of SARS CoV-2 for people from LMICs will be calculated. Random effects model will be used in case of substantial heterogeneity in the included studies, otherwise fixed-effect model will be used. A planned subgroup, sensitivity and meta-regression analyses will be performed. For comparative studies, the analyses will be performed using Review Manager v 5.4; otherwise, STATA 16 will be used. All effect estimates will be presented with their confidence intervals.Discussion The study will explore and systematically review empirical evidence on SARS Cov-2 seroprevalence in LMICs, and to assess the risk factors for SARS Cov-2 infection in Low Middle Income Countries in the context of rolling out vaccines in these countries. Finally, explore risk classifications to help with the rolling out of vaccines in LMICs.Systematic review registration: The protocol for this review has been registered in PROSPERO (CRD422020221548).

Download Full-text