Determinants of in-hospital death in patients with a thrombus straddling a patent foramen ovale: protocol of a systematic review

Background: Thrombi identified on echocardiography at the time of straddling a patent foramen ovale (PFO) constitute a medical emergency with an associated imminent risk of death. Ischemic stroke (IS) and myocardial infarction (MI) occurring in patients with a thrombus straddling a PFO (TSPFO) may be associated with increased risk of in-hospital death. Variables associated with increased risk of death in women and men may be different. We will perform a systematic review of case reports and cases series of patients with a TSPFO to assess if IS and MI are associated with increased risk of in-hospital death and we will further stratify analyses by sex. Methods: This systematic review will include all case reports and case series of adult patients (18-year-old or older) with echocardiographic or pathological (e.g. at autopsy for older reports) evidence of a TSPFO published between inception and June 30, 2020, in any language. We will search in PubMed and Embase databases. Two reviewers will independently screen titles and abstracts, retrieve full texts, and extract the data in a predesigned form. We will apply a multivariable logistic regression analysis to estimate the association of IS and MI with in-hospital mortality. We will stratify analyses by sex. Discussion: IS and MI in patients with TSPFO could potentially be associated with worse outcomes if they are not timely identified or left untreated. Both acute IS and MI require specific treatment (e.g. thrombolysis, primary coronary intervention, or mechanical thrombectomy) that may be influenced by the therapy instituted for the TSPFO. Knowing the incidence of acute IS and MI among patients diagnosed with TSPFO and whether they are associated with an increased risk of death would help to improve the management of this medical emergency. Protocol registration: CRD42020216118, PROSPERO.

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Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽

10.1136/bmjopen-2018-021793 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021793 ◽

Cited By ~ 1

Author(s):

Kathryn Bunch ◽

Nia Roberts ◽

Marian Knight ◽

Manisha Nair

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anaemia ◽

Case Reports ◽

Case Series ◽

Severe Anaemia ◽

Risk Of Bias ◽

Deficiency Anaemia ◽

Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

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Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-analysis of the Literature

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0036-1598002 ◽

2017 ◽

Vol 43 (06) ◽

pp. 614-620 ◽

Cited By ~ 16

Author(s):

Vera Gessi ◽

Rossella Marcucci ◽

Monica Gianni ◽

Anna Grandi ◽

Massimo Franchini ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Venous Thromboembolism ◽

Case Reports ◽

Random Effect ◽

Random Effect Model ◽

Case Series ◽

Lipoprotein A ◽

Increased Risk ◽

Venous Thromboembolic Events

AbstractElevated plasma levels of lipoprotein(a) (Lp(a)) are associated with increased cardiovascular risk in several clinical studies. However, there is a lack of data supporting a positive association between elevated Lp(a) levels and venous thromboembolism (VTE). Thus, we conducted a systematic review of the literature to better clarify its role as a risk factor for VTE. Medline and the Embase (up to May 2015) electronic databases were used to identify potentially eligible studies. Studies measuring Lp(a) values in adult patients with deep vein thrombosis and/or pulmonary embolism and in a population of patients without a VTE were selected. Studies on patients with major venous thromboembolic events occurring at other unusual site, case reports, and case series were excluded. The odds ratios (ORs) of the association between high values of Lp(a) and VTE and the weighted mean difference (WMD) in Lp(a) levels in cases and in controls were calculated using a random-effect model. Results were presented with 95% confidence interval (CI). Fourteen studies for a total of more than 14,000 patients were finally included in our analysis. Lp(a) was slightly but significantly associated with an increased risk of VTE (OR: 1.56, 95% CI: 1.36, 1.79; 10 studies, 13,541 patients). VTE patients had significantly higher Lp(a) values compared with controls (WMD: 14.46 mg/L, 95% CI: 12.14, 16.78; 4 studies, 470 patients). Lp(a) appeared to be significantly associated with increased risk of VTE. However, Lp(a) levels were only slightly increased in VTE patients compared with controls.

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Uneventful delivery of two pregnancies in a woman with severe factor XII deficiency: case report and systematic review

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2017-0035 ◽

2018 ◽

Vol 7 (1) ◽

Author(s):

Stamatios Petousis ◽

George Karavas ◽

Chrysoula Margioula-Siarkou ◽

Themistoklis Dagklis ◽

Paraskevi Karapavlidou ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Case Series ◽

Signs And Symptoms ◽

Factor Xii ◽

Case Presentation ◽

Severe Deficiency ◽

Pubmed Database ◽

Increased Risk

Abstract Background Deficiency of factor XII (FXII) is widely considered to have a detrimental effect on pregnancy. Several reports underline the increased risk for antenatal complications with few published case reports of uncomplicated deliveries. The main objective of our article is to perform a systematic review to highlight pregnancies with severe deficiency of FXII that have been delivered uneventfully, along with presenting our relative case of a woman with severe deficiency of FXII. Materials and methods A systematic review was performed in the Pubmed database. Inclusion criteria were considered to be case reports and case series presenting delivery of uncomplicated pregnancies in women with severe FXII deficiency. Medical records of our patient were also reviewed in terms of signs and symptoms, laboratory and imaging examinations and neonatal outcomes. Results There were 62 abstracts derived while 44 were assessed for eligibility. There were finally three case reports of women with FXII deficiency delivering live newborns and one case series of 12 women with a final outcome of 19 deliveries. Regarding our case presentation, the woman with FXII levels <12%, after a neonatal death because of extreme prematurity (24 weeks + 4 days), was set in regular follow-up and treatment with bemiparin natriate, 3.5 mg/kg and acetylsalicylic acid, 100 mg/day. She finally managed to have her second pregnancy delivered at 38 weeks + 3 days, her third pregnancy ended up as a miscarriage and her fourth pregnancy was also delivered at 37 weeks + 4 days. Conclusion Despite the increased risk for antenatal complications, appropriate follow-up of pregnancies with severe FXII pregnancy may finally lead to an uneventful delivery.

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COVID-19 in Patients with Solid Organ Transplantation: A Systematic Review

Transplantology ◽

10.3390/transplantology1010001 ◽

2020 ◽

Vol 1 (1) ◽

pp. 1-15 ◽

Cited By ~ 7

Author(s):

René Hage ◽

Carolin Steinack ◽

Christian Benden ◽

Macé M. Schuurmans

Keyword(s):

Systematic Review ◽

Social Life ◽

Case Reports ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Case Series ◽

Google Scholar ◽

Current Evidence ◽

Solid Organ ◽

Increased Risk

The novel coronavirus, SARS-CoV-2, is causing a pandemic of unknown precedent, with huge healthcare challenges and worldwide disruptions to economic and social life. Lung transplant recipients and other solid organ transplant (SOT) recipients are immunosuppressed, and therefore are generally considered at an increased risk for severe infections. Given the current gap in knowledge and evidence regarding the best management of these patients, we conducted a systematic review of studies on SARS-CoV-2 infections and Coronavirus Disease 2019 (COVID-19) in SOT recipients, to evaluate the association between immunosuppression in these patients, SARS-CoV-2 infection and COVID-19 outcomes. The focus was the severity of the disease, the need for mechanical ventilation and intensive care unit (ICU) admissions, and rate of death. The literature search was conducted repeatedly between 16 March and 8 April 2020. We searched original papers, observational studies, case reports, and meta-analyses published between 2019 and 2020 using two databases (PubMed, Google Scholar) with the search terms: [transplant OR immunosuppression] AND [COVID-19 OR SARS-CoV-2]. Further inclusion criteria were publications in English, French, German and Italian, and reference to humans. We also searched the reference lists of the studies encountered. From an initial search of PubMed and Google Scholar, 19 potential articles were retrieved, of which 14 were excluded after full-text screening (not being case reports or case series), leaving 5 studies for inclusion. No further studies were identified from the bibliographies of retrieved articles. Based on the limited research, no firm conclusions can be made concerning SOT recipients, but the current evidence suggests that immunosuppression is most likely associated with a better outcome of SARS-CoV-2 infection and COVID-19 because it prevents hyperinflammation (cytokine storm) in this particular population. There is a need for further research that would allow results to be adjusted for other factors potentially impacting COVID-19 severity and outcome.

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COVID-19 and cause of pregnancy loss during the pandemic: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0255994 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255994

Author(s):

Seyyedeh Neda Kazemi ◽

Bahareh Hajikhani ◽

Hamidreza Didar ◽

Sareh Sadat Hosseini ◽

Sara Haddadi ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Case Series ◽

Fetal Loss ◽

First Trimester ◽

Trimester Abortion ◽

Pregnant Females ◽

Increased Risk ◽

Comprehensive Search ◽

Placental Inflammation

Introduction The association between Coronavirus Disease 2019 (COVID-19) and abortion has been debated since the beginning of the COVID-19 pandemic. We aimed to conduct this systematic review to understand better the potential effects of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on fetal loss in infected mothers presented with abortion following this infection. Methods We included articles published in PubMed/Medline, Web of Science, clinicaltrials.gov, and Embase databases in 2019 and 2020 through a comprehensive search via appropriate keywords, including COVID-19 and abortion synonyms. All studies with the abortion data in COVID-19 confirmed pregnant females were collected. Results Out of 208 potentially relevant articles, 11 articles were eligible to include in the systematic review. The included reports were published because of the following reasons: (1) First-trimester miscarriage; (2) Late miscarriage; (3) complication of COVID-19 infection in pregnancy; (4) COVID-19 disease in artificial pregnancy. First-trimester abortion was found in 5 studies, and second-trimester abortion in 7 studies. Two patients acquired infection during the hospital stay while they were referred for abortion. Reports related to abortion in pregnant females with COVID-19 show that most miscarriages due to COVID-19 in the first trimester were due to placental insufficiency. Conclusions There is an increased risk of abortion in mothers with a positive test result of SARS-CoV-2, which several case reports and case series have identified during the pandemic. Placental inflammation during the viral infection may result in fetal growth retardation and induce abortion. There has not been any consistent evidence of vertical transmission of the virus from mother to fetus, which requires further investigation.

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A systematic review to assess seizure risk with chloroquine therapy in persons with epilepsy

10.1101/2020.04.09.20056358 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sandipan Pati

Keyword(s):

Systematic Review ◽

Case Reports ◽

Case Series ◽

Public Attention ◽

Significant Relation ◽

Systematic Analysis ◽

Randomized Clinical Study ◽

Increased Risk ◽

A Prospective Study ◽

Present Systematic Review

ABSTRACTBackgroundThe goal of this systematic review is to assess the published literature for seizure risk with chloroquine therapy in persons with and without epilepsy. With the COVID-19 pandemic, there is a desperate need for therapy against the SARS CoV-2 virus. Chloroquine is one proposed medication that has received substantial public attention. However, drug labeling in the package insertion states that persons with epilepsy have the risk of chloroquine provoking seizures, and this has increased questions and anxiety in the epilepsy community.MethodsPubMed (1970 to March 27, 2020) and the Embase (1970 to March 27, 2020) were searched with the terms chloroquine and seizure or epilepsy. Selected studies were reviewed, and the adverse drug reaction was classified.ResultsOnly nine out of 27 studies were deemed eligible for systematic analysis. Out of the nine studies, only one was a prospective study (N=109), two were case series (N=6), and the remaining 6 were case reports. The dose of chloroquine ranged between 100-500 mg/day, except in one patient, the seizure was after taking 1000 mg. The strength of causality for the drug causing seizures in healthy and persons with epilepsy was mostly possible or unlikely, and none were certain. The only clinical trial that evaluated seizure risk with chloroquine failed to find any significant relation.ConclusionAlthough the drug insertion label states an increased risk of seizure, the systematic review highlights that such a statement is not supported by any class I studies but by anecdotal case reports. The only randomized clinical study revealed that seizures were not associated with an increased blood level of chloroquine or its metabolite. The present systematic review should provide reassurance to busy clinicians and persons with epilepsy that chloroquine, if prescribed to treat COVID-19, lacks any substantial evidence to suggest that the medication increases the risk of seizure.

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The Association Between Periodontitis and Erectile Dysfunction: A Systematic Review and Meta-Analysis

American Journal of Men s Health ◽

10.1177/15579883211007277 ◽

2021 ◽

Vol 15 (3) ◽

pp. 155798832110072

Author(s):

Fathima Farook ◽

Azzam Al Meshrafi ◽

Nuzaim Mohamed Nizam ◽

Abdulsalam Al Shammari

Keyword(s):

Systematic Review ◽

Erectile Dysfunction ◽

Quality Assessment ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Increased Risk ◽

Statistical Heterogeneity ◽

High Degree

The objective of this study is to investigate the association between periodontitis (PD) and erectile dysfunction (ED). A systematic review and meta-analysis on data was extracted and conducted according to PRISMA. Relevant articles were selected from a literature search using MEDLINE, EMBASE, Scopus, Web of Science and CENTRAL from inception until August 2, 2020. Both randomized and nonrandomized controlled studies were included. Case reports, case series, nonsystematic reviews and trials published as abstract were excluded. Odds ratios (ORs) and corresponding 95% conﬁdence intervals (CIs) were used to estimate the association between PD and the risk of ED. The meta-analysis was conducted with RevMan 5.3. Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale and the quality of evidence was assessed using the GRADE approach. Six articles (215008 subjects) were included for analysis. Of the participants, 38,675 cases were compared to 1,76,333 healthy controls. Based on the random effects model, periodontitis was associated with an increased risk of ED (OR = 2.56, 95% CI: 1.70–3.85) as compared with the non-periodontitis individuals. The findings were statistically significant with a p < .0001. The statistical heterogeneity was high across all studies ( I2 = 98%, p < .00001). Estimates of total effects were generally consistent with the sensitivity and subgroup analyses. Within the limits of the available evidence, our review and meta-analysis showed that a significant association exists between the PD and ED. The results should be interpreted with caution due to high degree of inconsistency across all the studies.

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Cannabis-associated arteritis

VASA ◽

10.1024/0301-1526/a000004 ◽

2010 ◽

Vol 39 (1) ◽

pp. 43-53 ◽

Cited By ~ 17

Author(s):

Grotenhermen

Keyword(s):

Systematic Review ◽

Case Reports ◽

Case Series ◽

Cardiovascular Effects ◽

Causative Factor ◽

Cannabis Use ◽

Thromboangiitis Obliterans ◽

Pathological Features ◽

Scientific Support ◽

Clinical And Pathological Features

Background: To investigate the hypothesis that cases of arteritis similar to thromboangiitis obliterans (TAO) and associated with the use of cannabis were caused by cannabis or THC (dronabinol), or that cannabis use is a co-factor of TAO. Patients and methods: A systematic review on case reports and the literature on so-called cannabis arteritis, TAO, and cardiovascular effects of cannabinoids was conducted. Results: Fifteen reports with 57 cases of an arteritis associated with the use of cannabis and two additional case series of TAO, in which some patients also used cannabis, were identified. Clinical and pathological features of cannabis-associated arteritis do not differ from TAO and the major risk factor of TAO, tobacco use, was present in most, if not in all of these cases. The proposed pathophysiological mechanisms for the development of an arteritis by cannabis use are not substantiated. Conclusions: The hypothesis of cannabis being a causative factor or co-factor of TAO or an arteritis similar to TAO is not supported by the available evidence. The use of the term cannabis arteritis should be avoided until or unless more convincing scientific support is forthcoming.

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Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00351 ◽

2020 ◽

Author(s):

Judd Sher ◽

Kate Kirkham-Ali ◽

Denny Luo ◽

Catherine Miller ◽

Dileep Sharma

Keyword(s):

Systematic Review ◽

At Risk ◽

Drug Therapy ◽

Dental Implant ◽

Case Series ◽

Cochrane Central Register ◽

Bisphosphonate Treatment ◽

Implant Placement ◽

Increased Risk ◽

History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

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Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.5.peds19126 ◽

2019 ◽

Vol 24 (5) ◽

pp. 558-571 ◽

Cited By ~ 3

Author(s):

Kartik Bhatia ◽

Hans Kortman ◽

Christopher Blair ◽

Geoffrey Parker ◽

David Brunacci ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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