scholarly journals Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

2021 ◽  
Vol 11 ◽  
Author(s):  
Antonio Piras ◽  
Luca Boldrini ◽  
Sebastiano Menna ◽  
Valeria Venuti ◽  
Gianfranco Pernice ◽  
...  
Keyword(s):  
Head And Neck ◽  
Older Patients ◽  
Case Reports ◽  
Performance Status ◽  
Case Series ◽  
Number Of Patients ◽  
Complex Decision ◽  
Meta Analyses ◽  
Systematic Database ◽  
Strong Agreement

ObjectiveRadiotherapy (RT) in the head and neck (H&N) site are undoubtedly the most challenging treatments for patients. Older and frail patients are not always able to tolerate it, and there are still no clear guidelines on the type of treatments to be preferred for them. The recommendations for Risk-Adapted H&N Cancer Radiation Therapy during the coronavirus disease 2019 (COVID-19) pandemic provided by the ASTRO-ESTRO consensus statement achieved a strong agreement about hypofractionated RT (HFRT). A systematic literature review was conducted in order to evaluate the feasibility and safety of HFRT for older patients affected by H&N malignancies.Materials and MethodsA systematic database search was performed on PubMed and Embase according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Original studies, case series, and case reports describing the use of HFRT (with at least 2.2 Gy fractions) in patients with mean age ≥65 years were included. The analysis was based on the type of study, number of patients, mean age, tumor site, histology, performance status (PS), RT details, concomitant chemotherapy (CT), and described clinical outcomes. All the reported doses have been calculated in equivalent dose in 2 Gy fractions (EQD2) and biologically effective dose (BED) using α/β = 10 Gy or α/β = 12 Gy.ResultsWe selected 17 papers that met the inclusion criteria and divided them in 4 categories: 6 articles analyze HFRT performed twice daily in repeated cycles, 3 once a day in repeated cycles, 4 in alternative days, and the last 4 in consecutive days.ConclusionHFRT seems to be a good treatment with an acceptable prolonged disease control. In older patients fit for radical treatments, a 55 Gy in 20 fractions regimen can be proposed as a valid alternative to the standard fractionated RT, but there are a multitude of hypofractionated regimens, ranging from single fraction, quad shot, and 1-, 2-, 3-, 4-, and 5-week schedules that all may be appropriate. The correct regimen for a patient depends on many factors, and it represents the result of a more specific and complex decision.

scholarly journals Repeated SARS-CoV-2 Positivity: Analysis of 123 Cases

Viruses ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 512
Author(s):  
Szilárd Váncsa ◽  
Fanni Dembrovszky ◽  
Nelli Farkas ◽  
Lajos Szakó ◽  
Brigitta Teutsch ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Case Reports ◽  
Severe Disease ◽  
Descriptive Analysis ◽  
Case Series ◽  
Disease Course ◽  
Chain Reaction ◽  
Baseline Characteristics ◽  
Polymerase Chain ◽  
Meta Analyses

Repeated positivity and reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a significant concern. Our study aimed to evaluate the clinical significance of repeatedly positive testing after coronavirus disease 2019 (COVID-19) recovery. We performed a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. With available individual patient data reporting on repeatedly SARS-CoV-2 positive (RSP) patients, case reports, and case series were included in this analysis. We performed a descriptive analysis of baseline characteristics of repeatedly positive cases. We assessed the cases according to the length of their polymerase chain reaction (PCR) negative interval between the two episodes. Risk factors for the severity of second episodes were evaluated. Overall, we included 123 patients with repeated positivity from 56 publications, with a mean repeated positivity length of 47.8 ± 29.9 days. Younger patients were predominant in the delayed (>90 days) recurrent positive group. Furthermore, comparing patients with RSP intervals of below 60 and above 60 days, we found that a more severe disease course can be expected if the repeated positivity interval is shorter. Severe and critical disease courses might predict future repeatedly positive severe and critical COVID-19 episodes. In conclusion, our results show that the second episode of SARS-CoV-2 positivity is more severe if it happens within 60 days after the first positive PCR. On the other hand, the second episode’s severity correlates with the first.

Abstract P101: Mechanical Thrombectomy in COVID-19 Positive Patients With Large Vessel Occlusion: Pooled Review of Individual Case Series

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Z Memon ◽  
Taha Nisar ◽  
Amit Singla ◽  
Anil Nanda ◽  
Gaurav Gupta ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Historic Data ◽  
Meta Analyses

Background: COVID-19 has been shown to induce a hypercoagulable state thereby increasing the risk of arterial thrombosis resulting in Large Vessel Occlusion Stroke (LVOs) Objective: We performed a systematic review of published reports to study the clinical characteristics, and outcomes of COVID-19 acute ischemic stroke (AIS) patients with LVO treated with mechanical thrombectomy (MT) and compared them with historical controls. Methods: We conducted a systematic literature search from December 2019 to July 2020 using multiple combinations of keywords from PubMed and Ovid databases according to the PRISMA meta-analyses and systemic reviews guidelines and then pooled data from individual case series. We included studies where COVID -19 associated LVO cases were treated with MT and their clinical outcomes were reported. We then compared these findings with the historic patient data from the five landmark randomized MT trials, the Hermes collaborators (HC). Results: An initial search generated 12 studies but after excluding case reports and multiple reports comprising of the same series of patients, a total of five reports consisting of 51 patients were analyzed. The mean age of patients was 59 years (IQR 36-75), and 40 (78 %) were men. Median NIHSS on presentation was 20 (IQR 10-29). AIS with LVO was the presenting manifestation of COVID-19 in 16 (20%) of patients. Intracranial ICA was the most common site of occlusion found in 27 (53%) of patients with multi-territory occlusion in 10 (20 %). Final recanalization TICI ≥ 2b was achieved in 33 (64%) of patients but reocclusion was noted in 7 (14 %). Modified Rankin score (mRS) 0-2 was reported in 12 (23 %) of patients with 40 % in-hospital mortality. When compared to historic data from HC, COVID -19 patients were younger (59 vs 69 years), presented with a higher median NIHSS score (20 vs 17), and had a higher prevalence of ICA terminus occlusion (53% vs 21% ). Similarly, patient outcomes were poor in the COVID -19 group with mRs 0-2 in (23 % versus 46 %) and mortality (40 % vs 15 %) compared to Hermes group. Conclusion: COVID -19 AIS patients with LVO who underwent MT were younger, had multiple territory occlusions with a propensity for ICA terminus location, and had poor angiographic and clinical outcomes as compared to historic data.

scholarly journals Oral White Lesions: An Updated Clinical Diagnostic Decision Tree

2019 ◽  
Vol 7 (1) ◽  
pp. 15 ◽  
Author(s):  
Hamed Mortazavi ◽  
Yaser Safi ◽  
Maryam Baharvand ◽  
Soudeh Jafari ◽  
Fahimeh Anbari ◽  
...  
Keyword(s):  
Decision Tree ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Oral Diseases ◽  
Diagnostic Decision ◽  
General Search ◽  
Retrospective Cohort Studies ◽  
Special Pattern ◽  
Meta Analyses

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease”, “oral keratosis”, “oral leukokeratosis”, and “oral leukoplakia”. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

Cholinesterase Inhibitors and Memantine: Best Practices

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S16) ◽  
pp. 34-35 ◽  
Author(s):  
Rachelle S. Doody
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Best Practices ◽  
Cholinesterase Inhibitors ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Case Series ◽  
Added Value ◽  
Case Control Studies ◽  
Number Of Patients

Today’s therapies must be put in the context of both currently available treatments as well as treatment trials with exciting potential for use in the near future. Current clinical trial methodologies do not allow for clear separation of symptomatic treatments from disease-modifying therapies; it may be unproductive to maintain this distinction given the current range of treatments available. A more currently relevant focus is added value. Therapies should aim to provide added value through incremental benefits above and beyond existing treatments, as well as enduring benefits.Alzheimer’s disease (AD) treatment guidelines are not used by physicians only. Healthcare payers often make use of these guidelines to delimit coverage. Cost concerns will also impact AD treatments after generic cholinesterase inhibitors are made available; it is widely believed that a great number of patients will switch to generics. Therefore, treatment guidelines must account for the possible adverse effects of switching therapies as well as the desirability of persistent treatment. There are many AD treatment guidelines, among them the American Academy of Neurology (AAN) Management of Dementia Guidelines, which are currently being revised. The Institute for the Study on Aging (ISOA) Management of Alzheimer’s Disease in Managed Care Guideline also presents a different approach for a different audience.The first step to creating evidence-based best practices guidelines is to determine what is meant by “evidence.” A system of classification exists for examining forms of evidence: Class I evidence is provided by one or more well-designed, randomized, controlled clinical trials, including overviews or meta-analyses of such trials. Class II evidence is provided by well-designed observational studies with concurrent controls; for example, case-control studies that generate hypotheses about epidemiologic associations. Class III evidence is provided by expert opinion, case series, case reports, and studies with historical controls.

scholarly journals The Involvement of Hypothalamus–Pituitary–Adrenal (HPA) Axis in Suicide Risk

2020 ◽  
Vol 10 (9) ◽  
pp. 653 ◽  
Author(s):  
Isabella Berardelli ◽  
Gianluca Serafini ◽  
Natalia Cortese ◽  
Federica Fiaschè ◽  
Rory C O’Connor ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Systematic Reviews ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Case Reports ◽  
Number Of Patients ◽  
Hpa Axis Dysregulation ◽  
New Treatment ◽  
Meta Analyses ◽  
Hpa Axis Activity

Stress and Hypothalamic–Pituitary–Adrenal (HPA) axis dysregulation play a major role in various pathophysiological processes associated with both mood disorders and suicidal behavior. We conducted a systematic review with the primary aim of clarifying the nature and extent of HPA axis activity and suicidal behavior. The second aim of this review was to investigate whether potential biomarkers related to HPA axis abnormalities act as individual susceptibility factors for suicide. The PRISMA statement for reporting systematic reviews was used. Only articles published in English peer-reviewed journals were considered for possible inclusion; we excluded case reports, meta-analyses, and systematic reviews, and studies that did not clearly report statistical analysis, diagnostic criteria, or the number of patients included. Overall, 36 articles on HPA axis and suicide risk met inclusion criteria and were reviewed. Studies that investigated tests detecting biomarkers and the role of early life stressors in suicide risk were also included. We found that HPA axis activity is involved in suicide risk, regardless of the presence or absence of psychiatric conditions. The HPA axis abnormalities, mainly characterized by hyperactivity of the HPA axis, may exert an important modulatory influence on suicide risk. Impaired stress response mechanisms contribute to suicide risk. Targeting HPA axis dysregulation might represent a fruitful strategy for identifying new treatment targets and improving suicide risk prediction.

Care of the Cocaine User with Nasal Deformity

2017 ◽  
Vol 33 (04) ◽  
pp. 411-418 ◽  
Author(s):  
Anil Joshi ◽  
Alwyn D'Souza ◽  
Abigail Walker
Keyword(s):  
Surgical Approach ◽  
Case Reports ◽  
Case Series ◽  
Careful Consideration ◽  
Western World ◽  
Free Text ◽  
Nasal Deformity ◽  
Psychiatric Comorbidities ◽  
Operative Care ◽  
Number Of Patients

AbstractCocaine is the most commonly used stimulant in the Western world, and its use is increasing not only in young people but also in people older than 40 years. Intranasal use is associated with several pathologies, ranging from crusting and blockage, to fibrosis and scarring, to destruction of the osteocartilaginous structures of the midface. As its use becomes more prevalent in society, the reconstructive surgeon can accordingly expect to be faced with an increasing number of patients with cocaine-related nasal deformity. However, the use of cocaine adds a significant layer of complexity to the perioperative and operative care that requires careful consideration by the whole health care team. We present a practical evidence-based guide to management of reconstruction of the cocaine nose, taking in all aspects of periprocedural care. Finally, we present a model for surgical approach based on best evidence and the experience of the senior author. A search was performed of the Medline, Embase, and Cochrane Collection database using both MeSH keywords and free text words, identifying key articles on the epidemiology, pathophysiology, and medical and psychiatric comorbidities of cocaine users. Both case series and case reports reporting cocaine-associated defects and their reconstruction were reviewed together with the senior authors (A.D.S., A.J.), and a series of recommendations synthesized based on these recommendations. The nasal deformities associated with cocaine use represent only the tip of the iceberg of underlying associated pathology. The surgeon who embarks upon reconstruction of the cocaine nose should be aware of possible coexisting medical and psychiatric comorbidities that may complicate both the patient's motivations for surgery and their fitness to undergo anesthesia. Ultimately, successful reconstructive outcomes are critically dependent on holistic perioperative care and the surgeon's ability to be flexible in their surgical approach.

A scoping review of the evidence for efficacy of acupuncture in companion animals

2017 ◽  
Vol 18 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Wesley J. Rose ◽  
Jan M. Sargeant ◽  
W. J. Brad Hanna ◽  
David Kelton ◽  
Dianna M. Wolfe ◽  
...  
Keyword(s):  
Scoping Review ◽  
Case Reports ◽  
Companion Animals ◽  
Experimental Studies ◽  
Case Series ◽  
Complex Nature ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Experimental Trials

AbstractAcupuncture has become increasingly popular in veterinary medicine. Within the scientific literature there is debate regarding its efficacy. Due to the complex nature of acupuncture, a scoping review was undertaken to identify and categorize the evidence related to acupuncture in companion animals (dogs, cats, and horses). Our search identified 843 relevant citations. Narrative reviews represented the largest proportion of studies (43%). We identified 179 experimental studies and 175 case reports/case series that examined the efficacy of acupuncture. Dogs were the most common subjects in the experimental trials. The most common indication for use was musculoskeletal conditions, and the most commonly evaluated outcome categories among experimental trials were pain and cardiovascular parameters. The limited number of controlled trials and the breadth of indications for use, outcome categories, and types of acupuncture evaluated present challenges for future systematic reviews or meta-analyses. There is a need for high-quality randomized controlled trials addressing the most common clinical uses of acupuncture, and using consistent and clinically relevant outcomes, to inform conclusions regarding the efficacy of acupuncture in companion animals.

scholarly journals Vasculitis induced by biological agents used in rheumatology practice: A systematic review

2021 ◽  
Author(s):  
Camila da Silva Cendon Duran ◽  
Adriane Souza da Paz ◽  
Mittermayer Barreto Santiago
Keyword(s):  
Systematic Review ◽  
Leukocytoclastic Vasculitis ◽  
Case Reports ◽  
Case Series ◽  
Final Analysis ◽  
Infusion Reaction ◽  
Biological Agents ◽  
Necrosis Factor Alpha ◽  
Pubmed Database ◽  
Meta Analyses

Objectives: Biological medications have been used with an increasing frequency to treat rheumatological diseases. Autoimmune events can be induced by these drugs, such as psoriasiform lesions, alopecia, lupus and, vasculitis, which more often affects the skin (small-sized vessels) and eventually other organs. In this review, we describe the clinical profile of patients with vasculitis induced by the main biological agents used in rheumatology. Patients and methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed database was used for searching eligible articles. We included case reports, case series, and letter to the editor of patients on anti-tumor necrosis factor-alpha (anti-TNF-a) molecules, as well as tocilizumab, ustekinumab, secukinumab, rituximab, and abatacept, who had vasculitis induced by these agents. Results: Eighty-one articles were included for final analysis (n=89). Twenty-seven patients were using infliximab, 20 adalimumab, 18 etanercept, seven secukinumab, four certolizumab, four rituximab, three golimumab, three ustekinumab, two abatacept, and one tocilizumab. Unspecific leukocytoclastic vasculitis (LCV) was the most common type of vasculitis (n=37), followed by anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (n=16). The medication was replaced with another biological molecule in 23 cases, with only four relapses. In six cases, the biological was maintained, but vasculitis worsened/persisted in one case, being necessary drug removal. Conclusion: Infections, infusion reaction, cancer, and autoimmune events are well-known side effects of biological therapy. This review demonstrates that vasculitis is another adverse effect of this type of therapy, particularly the anti-TNF-a molecules, and LCV the most reported type of vasculitis.

scholarly journals 18 Years of Medication-Related Osteonecrosis of the Jaw (MRONJ) Research: Where Are We Now?—An Umbrella Review

2021 ◽  
Vol 11 (19) ◽  
pp. 8818
Author(s):  
Roberto Sacco ◽  
Monica Diuana Calasans-Maia ◽  
Julian Woolley ◽  
Oladapo Akintola ◽  
Carlos Fernando de Almeida Barros Mourão ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Case Reports ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Umbrella Review ◽  
Severe Condition ◽  
Manual Search ◽  
Number Of Patients ◽  
Retrospective Cohort Studies ◽  
Study Designs

Background: Osteonecrosis of the jaw (ONJ) is a condition affecting patients exposed to medications used to treat benign and malignant conditions of bone tissue. Many studies have highlighted that ONJ is a severe condition, which is very challenging to manage, especially in individuals with oncologic disease. The aim of this umbrella review is to analyze all available interventional and non-interventional systematic reviews published on medication-related osteonecrosis of the jaw (MRONJ) and summarize this evidence. Material and methods: A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until June 2021. An additional manual search was also performed in systematic review registries (PROSPERO, INPLASY, JBI and OFS) to identify possible missing reviews. Data were extracted from relevant papers and analyzed according to the outcomes selected in this review. Results: The search generated 25 systematic reviews eligible for the analysis. The total number of patients included in the analysis was 80,840. Of the reviews, 64% (n = 16) were non-interventional and 36% (n = 9) were interventional. Study designs included case series 20.50% (n = 140), retrospective cohort studies 12.30% (n = 84) and case reports 12.20% (n = 83). It was unclear what study design was used for 277 studies included in the 25 systematic reviews. Conclusions: The data reviewed confirmed that the knowledge underpinning MRONJ in the last 20 years is still based on weak evidence. This umbrella review highlighted a widespread low-level quality of studies and many poorly designed reviews.

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

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