scholarly journals MINIMALLY INVASIVE LUMBAR ARTHRODESIS AND PERCUTANEOUS PEDICLE SCREWS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 19 (4) ◽  
pp. 249-254
Author(s):  
VINICIUS DE MELDAU BENITES ◽  
FABIO VEIGA DE CASTRO SPARAPANI ◽  
EDUARDO AUGUSTO IUNES ◽  
FRANZ JOOJI ONISHI ◽  
THIAGO SALATI ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Case Reports ◽  
Surgical Techniques ◽  
Case Series ◽  
Pedicle Screws ◽  
Invasive Procedure ◽  
Cochrane Library ◽  
Disc Disease ◽  
Level Of Evidence

ABSTRACT A systematic review of the literature was performed in order to organize, evaluate, and select evidences available about the safety and efficacy of minimally invasive percutaneous arthrodesis with percutaneous pedicle screws in the treatment of patients with degenerative disc disease (and other spinal pathologies) as compared to conventional arthrodesis. PubMed, EMBASE and Cochrane Library databases were consulted to locate clinical trials and case reports/case series published in English between 2014 and 2019. After selection according to the inclusion/exclusion criteria, 21 of the 197 articles identified were chosen for a complete reading and used for the present review. Although the level of evidence of most of the studies included made the demonstration of efficacy and superiority among the surgical techniques reviewed difficult, the findings related to the minimally invasive procedure indicate a safe and reliable approach for the treatment of lumbar diseases. Level of evidence II; Systematic review of literature.

Treatment of Sagittal Band Injuries and Extensor Tendon Subluxation: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894471989562
Author(s):  
Kitty Wu ◽  
Geoffrey Masschelein ◽  
Nina Suh
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Surgical Management ◽  
Nonoperative Management ◽  
Case Reports ◽  
Surgical Techniques ◽  
Case Series ◽  
Extensor Tendon ◽  
Retrospective Case ◽  
Level Of Evidence

Background: This systematic review assesses the current literature and reviews the clinical outcomes of treatment for sagittal band injuries and extensor tendon instability. Materials: A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed for English-language articles on the treatment of nonrheumatoid adult sagittal band injuries between 1969 and 2019. Two independent reviewers were involved in screening, data extraction, and critical appraisal. The level of evidence was assigned using the Sackett scale, and the methodological quality of the studies was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Outcome measures were persistent pain, extensor lag, and recurrent tendon subluxation. Results: In all, 1653 abstracts were identified, with 43 articles reviewed in full text and 17 articles (429 treated digits) included in the final systematic review. There were 10 studies on surgical management, 3 on nonoperative management, and 4 on both. There were 4 retrospective case series and 13 retrospective case reports (Sackett level 4) with an average SEQES score of 15 (low quality). Studies on nonoperative management had on average more digits per study and higher SEQES scores (n = 27.7, SEQES = 19) compared with studies on surgical management (n = 11.8, SEQES = 13.8). Variability in reported outcome measures precluded meta-analysis. Conclusion: Qualitative synthesis of available literature suggests that acute sagittal band injuries can be successfully treated by splinting the injured digit in neutral or hyperextension. Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration. A lack of consistent outcome measures precluded comparison of surgical techniques.

scholarly journals Use of Self-Expandable Prosthesis for the Treatment of Colon and Rectal Benign Stenosis. Systematic Review

2018 ◽  
Vol 1 (1) ◽  
pp. 45-50
Author(s):  
C. Manterola ◽  
S. Urrutia
Keyword(s):  
Systematic Review ◽  
Intestinal Perforation ◽  
Case Reports ◽  
Case Series ◽  
Cochrane Library ◽  
Use Of Self ◽  
Level Of Evidence ◽  
Mesh Terms ◽  
Colon And Rectum ◽  
Benign Stenosis

he main reason for the use of self-expandable prosthesis (SEP) is for the treatment of malignant colonic obstructions. The objective of this study is to determine the understanding with regard to results of applying SEP in benign stenosis of colon and rectum, measured in terms of numbers, etiology, and results. Systematic review. A search on MEDLINE, Cochrane Library CENTRAL, DARE, HTA, NHSEED, EMBASE and CINAHL and TRIP database was conducted. We considered all studies published since 1990 for this report. Search strategies were applied to each database using MesH terms, truncated, free words and Booleans. The results and level of evidence of the studies were summarized in tables summarizing efficacy, safety and complications. We obtained 19 related articles. All of these were case series and case reports (evidence level 4), totaling less than 150 cases treated with SEP. The observed results were adequate in terms of symptom reduction, however, a considerable percentage of complications were observed (intestinal perforation, migration, re-obstruction and pain). Published experience concerning the results of the installation of SEP in benign strictures of colon and rectum is scarce and evidence is limited. Therefore, further studies and articles with improved methodological qualities are required.

scholarly journals Does the Type of Sport Influence Morphology of the Hip? A Systematic Review

2021 ◽  
pp. 036354652110235
Author(s):  
Chantelle Doran ◽  
Matthew Pettit ◽  
Yash Singh ◽  
Karadi Hari Sunil Kumar ◽  
Vikas Khanduja
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Alpha Angle ◽  
Case Series ◽  
Activity Level ◽  
Ice Hockey ◽  
Cochrane Library ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Hip Morphology

Background: Femoroacetabular impingement (FAI) has been extensively investigated and is strongly associated with athletic participation. Purpose: To assess (1) the prevalence of cam-type FAI across various sports; (2) whether kinematic variation among sports influences hip morphology; and (3) whether performance level, duration, and frequency of participation or other factors influence hip morphology in a sporting population. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of Embase, PubMed, and the Cochrane Library was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Prospective and retrospective case series, case reports, and review articles published after 1999 were screened, and those that met the inclusion criteria decided a priori were included for analysis. Results: The literature search identified 58 relevant articles involving 5683 participants. A total of 49 articles described a higher prevalence of FAI across various “hip-heavy” sports, including soccer, basketball, baseball, ice hockey, skiing, golf, and ballet. In studies including nonathlete controls, a greater prevalence of FAI was reported in 66.7% of studies (n = 8/12). The highest alpha angle was identified at the 1-o’clock position (n = 9/9) in football, skiing, golf, ice hockey, and basketball. The maximum alpha angle was located in a more lateral position in goalkeepers versus positional players in ice hockey (1 vs 1:45 o’clock). A positive correlation was also identified between the alpha angle and both age and activity level (n = 5/8 and n = 2/3, respectively) and between prevalence of FAI and both age and activity level (n = 2/2 and n = 4/5). Conclusion: Hip-heavy sports show an increased prevalence of FAI, with specific sporting activities influencing hip morphology. There is some evidence to suggest that a longer duration and higher level of training also result in an increased prevalence of FAI. Registration: CRD4202018001 (PROSPERO).

scholarly journals Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Avascular Necrosis ◽  
Proximal Humerus ◽  
Constant Score ◽  
Surgical Techniques ◽  
Case Series ◽  
Cochrane Library ◽  
Operation Rate ◽  
Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

Dental implants survival after nasal floor elevation: a systematic review

2021 ◽  
Author(s):  
Eduardo Anitua ◽  
Beatriz Anitua ◽  
Mohammad Hamdan Alkhraisat ◽  
Laura Piñas ◽  
Asier Eguia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Case Reports ◽  
Meta Analysis ◽  
Lateral Approach ◽  
Cochrane Library ◽  
Good Survival ◽  
Quality Level ◽  
Level Of Evidence ◽  
Nasal Floor

Purpose The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. Methods A systematic review was conducted using four electronic databases; Medline (Pubmed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)?. The study was pre-registered in PROSPERO (CRD42021229479). Included articles quality was assessed using the “NIH quality assessment tool”, “The Newcastle-Ottawa scale” and “JBI critical appraisal tools for case reports''. Results Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range 89.2-100%). No statistical differences could be inferred between the treatments performed in one-stage or two-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusion Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE system and based on the study quality level, the strength of evidence attending the SORT taxonomy was B.

Rituximab for Eosinophilic Granulomatosis with Polyangiitis: a Systematic Review of Observational Studies

Rheumatology ◽  
2021 ◽  
Author(s):  
Vincenzo G Menditto ◽  
Giulia Rossetti ◽  
Diletta Olivari ◽  
Alessia Angeletti ◽  
Marco Rocchi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Granulomatosis With Polyangiitis ◽  
Case Reports ◽  
Case Series ◽  
Biologic Agents ◽  
Cochrane Library ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Extensive Literature ◽  
Eosinophilic Granulomatosis

Abstract Objective to analyze the available evidence about the use of rituximab (RTX) and other biologic agents in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients and to provide useful findings to inform the design of future, reliable clinical trials. Methods A systematic review was performed. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane library databases and an extensive literature search on other biologic agents. Results 45 papers pertinent to our questions were found: 16 retrospective cohort studies, 8 case series, 3 prospective cohort studies and 18 single case reports, for a total of 368 EGPA patients. More than 80% of evaluable patients achieved complete or partial remission with a tendency towards a higher rate of complete response in pANCA positive subgroup. Conclusion Although the majority of the evaluable EGPA patients treated with RTX appears to achieve complete remission, we strongly believe that a number of sources of heterogeneity impairs a clear interpretation of results and limits their transferability in clinical practice. Differences in design, enrollment criteria, outcome definition and measurement make a comparison among data obtained from studies on RTX and other biologic agents unreliable.

Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

2018 ◽  
Vol 12 (2) ◽  
pp. 134-144
Author(s):  
Thomas Ahn ◽  
Matthew J Roberts ◽  
Anojan Navaratnam ◽  
Eric Chung ◽  
Simon T Wood
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Case Reports ◽  
Contemporary Literature ◽  
Case Series ◽  
Artery Aneurysm ◽  
Well Being ◽  
Renal Neoplasm ◽  
Level Of Evidence ◽  
Meta Analyses

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

scholarly journals Repurposing of drugs for Covid-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Pinky Kotecha ◽  
Alexander Light ◽  
Enrico Checcucci ◽  
Daniele Amparore ◽  
Cristian Fiori ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Adverse Events ◽  
Clinical Improvement ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Control Group ◽  
Significant Difference

AbstractObjectiveThe aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or placebo.MethodsWe searched Ovid-MEDLINE, EMBASE, Cochrane library, clinical trial registration site in the UK(NIHR), Europe (clinicaltrialsregister.eu), US (ClinicalTrials.gov) and internationally (isrctn.com), and reviewed the reference lists of articles for eligible articles published up to April 22, 2020. All studies in English that evaluated the efficacy of the listed drugs were included. Cochrane RoB 2.0 and ROBINS-I tool were used to assess study quality. This systematic review adheres to the PRISMA guidelines. The protocol is available at PROSPERO (CRD42020180915).ResultsFrom 708 identified studies or clinical trials, 16 studies and 16 case reports met our eligibility criteria. Of these, 6 were randomized controlled trials (763 patients), 7 cohort studies (321 patients) and 3 case series (191 patients). Chloroquine (CQ) had a 100% discharge rate compared to 50% with lopinavir-ritonavir at day 14, however a trial has recommended against a high dosage due to cardiotoxic events. Hydroxychloroquine (HCQ) has shown no significant improvement in negative seroconversion rate which is also seen in our meta-analysis (p=0.68). Adverse events with HCQ have a significant difference compared to the control group (p=0.001). Lopinavir-ritonavir has shown no improvement in time to clinical improvement which is seen in our meta-analyses (p=0.1). Remdesivir has shown no significant improvement in time to clinical improvement but this trial had insufficient power.DiscussionDue to the paucity in evidence, it is difficult to establish the efficacy of these drugs in the treatment of Covid-19 as currently there is no significant clinical effectiveness of the repurposed drugs. Further large clinical trials are required to achieve more reliable findings. A risk-benefit analysis is required on an individual basis to weigh out the potential improvement in clinical outcome and viral load reduction compared to the risks of the adverse events. (1-16)

625 EFFICACY OF MYOTOMY IN PATIENTS WITH SIGMOID MEGAESOPHAGUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Marina Orlandini ◽  
Maria Carolina Serafim ◽  
Letícia Datrino ◽  
Clara Santos ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heller Myotomy ◽  
Selection Process ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Manual Search ◽  
The Mean

Abstract   Megaesophagus progress to sigmoid megaesophagus (SM) in 10–15% of patients, presenting tortuosity and sigmoid colon aspect. Esophagectomy is the choice treatment but is associated with high complications and mortality rates. To avoid the esophagectomy inherent morbidity, several authors recommend Heller myotomy (HM) with pull-down technique for SM, mainly for patients with comorbidities and the elderly. This systematic review and meta-analysis is the first to analyze the effectiveness of HM for treating SM. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, Lilacs (BVS), and manual search of references. Inclusion criteria were: a) clinical trials, cohort studies, case series; b) patients with SM and esophageal diameter ≥ 6 cm; and c) patients undergoing primary myotomy. The exclusion criteria were: a) reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; b) animal studies, c) previous surgical treatment for achalasia; and d) pediatric studies. There were no restrictions on language or date of publication, and no filters were applied for the selection process. Random model and a 95% confidence interval (CI) were used. Results Sixteen articles were selected, encompassing 231 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. The analyzed outcomes include mortality, complications (pneumonia, pneumothorax, gastroesophageal reflux), need for reintervention (remyotomy, dilation and esophagectomy), and results classified as ‘good’ and ‘excellent’. Mortality rate was 0.035 (CI: 0.017–0.07; p < 0.01). Complications rate was 0.08 (CI: 0.04–0.153; p = 0.01). Need for retreatment rate was 0.161 (CI: 0.053–0.399; p < 0.01). Probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.693–0.819; p < 0,01). Conclusion Heller myotomy is an option for avoiding esophagectomy in achalasia, with a low morbimortality rate and good results. It is effective for most patients but will fail in a minority of patients and demand retreatment, be it a remyotomy, endoscopic treatment or esophagectomy.

scholarly journals The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

2016 ◽  
Vol 44 (2) ◽  
pp. 152-160 ◽  
Author(s):  
Marcelo Lannes ◽  
Frederick Zeiler ◽  
Céline Guichon ◽  
Jeanne Teitelbaum
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Case Reports ◽  
Randomized Study ◽  
Delayed Cerebral Ischemia ◽  
Case Series ◽  
Cochrane Library ◽  
York Academy ◽  
Randomized Controlled Studies

AbstractObjective:The purpose of this article is to provide a systematic review of the evidence supporting the use of milrinone for the management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH).Design:Primary outcomes were functional neurological status and the incidence of cerebral infarction. Search strategies adapted to the different databases were developed by a professional librarian. Medline, EMBASE, the Cochrane Library database, Web of Science, SCOPUS, BIOSIS, Global Health, Health Star, Open SIGLE, Google Scholar and the New York Academy of Medicine Gray Literature were searched as well as clinical trials databases and the proceedings of several scientific meetings. Quality of the evidence for these outcomes across studies was adjudicated using the GRADE Working Group criteria.Results:The search resulted in 284 citations after elimination of duplicates. Of those 9 conference proceedings and 15 studies met inclusion criteria and consisted of case reports, case series and two comparative studies: one non-randomized study with physiological outcomes only and a case series with historical controls. There was considerable variation in dosing and in co-interventions and no case control or randomized controlled studies were found.Conclusion:There is currently only very low quality evidence to support the use of milrinone to improve important outcomes in patients with delayed cerebral ischemia secondary to subarachnoid hemorrhage. Further research is needed to clarify the value and risks of this medication in patients with SAH.

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