Dopamine, Serotonin, and Structure/Function Brain Defects as Biological Bases for Treatment Response in Delusional Disorder: A Systematic Review of Cases and Cohort Studies

Although blockade of dopamine receptors D2 and D3 appears to be the main mechanism of antipsychotic action, treatment response variability calls for an examination of other biological systems. Our aim is to systematically review reports of treatment response in delusional disorder (DD) in order to help determine its biological bases. Computerized searches of ClinicalTrials.gov, PubMed, and Scopus databases (from 1999 to September 2021) were systematically reviewed, in keeping with PRISMA directives. We used the search terms: (treat * OR therap * AND (delusional disorder)). We included all studies that explored the biological mechanisms of treatment response in DD, as diagnosed by ICD or DSM criteria. A total of 4344 records were initially retrieved, from which 14 papers were included: case reports, case series, and cohort studies. Findings point to (1) dopaminergic dysfunction (based on biochemical and genetic studies), (2) serotonergic dysfunction (based on partial agonism/antagonism of drugs), and (3) brain structure/function impairment, especially in the temporal and parietal lobes, as crucial factors in treatment response. Further studies with higher levels of evidence are needed to help clinicians determine treatment.

Download Full-text

Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Breast Care ◽

10.1159/000485023 ◽

2018 ◽

Vol 13 (2) ◽

pp. 129-132 ◽

Cited By ~ 6

Author(s):

Susan R. Harris

Keyword(s):

Breast Cancer ◽

Cohort Studies ◽

Systematic Reviews ◽

Nurse Practitioners ◽

Case Reports ◽

Case Series ◽

Diagnosis And Management ◽

Oncology Nurse ◽

Management Interventions ◽

Axillary Web Syndrome

The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

Download Full-text

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

Rheumatology ◽

10.1093/rheumatology/keab046 ◽

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.

Download Full-text

Quality of Modern Total Ankle Arthroplasty Research

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00160 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Daniel Bohl ◽

Emily Vafek ◽

Simon Lee ◽

Johnny Lin ◽

George Holmes ◽

...

Keyword(s):

Cohort Studies ◽

Case Reports ◽

Case Series ◽

The United States ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

End Stage

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is gaining popularity as an alternative to ankle arthrodesis in the setting of end-stage ankle arthritis. However, compared to hip and knee arthroplasty, there is a relative dearth of evidence to support its use. This study assesses the quality of literature surrounding modern TAA designs. Methods: A search of all peer-reviewed, English-language journals was conducted to identify publications involving TAA. The initial search identified 444 articles published during 2006-2016. Of these, 182 were excluded because they were not clinical outcomes studies, 46 because the TAA implant was no longer available, and 15 because the primary outcome of the study was not related to TAA, leaving 201 articles for analysis. Results: No Level I studies were identified. Seventeen (8%) studies were Level II, 48 (24%) Level III, 128 (64%) Level IV, and 8 (4%) Level V. One hundred forty-three studies (71%) were retrospective in nature. Stratification by study design revealed 128 (64%) case series, 33 (16%) experimental cohort studies, 19 (10%) case-control studies, 13 (6%) observational cohort studies, and 8 (4%) case reports. The number of studies published each year steadily increased from 2006 to 2016. A total of 51% of TAA research was published in only two journals: Foot and Ankle International and the Journal of Bone and Joint Surgery. Publications from the United States accounted for 36% of total publications. The most published implant was the Scandinavian Total Ankle Replacement (Figure 1). Conclusion: While the number of TAA studies published each year has steadily increased since 2006, the quality of this research as measured by level of evidence remains suboptimal. This analysis highlights the need for continued improvement in methodology and development of robust prospective registries to advance our knowledge of TAA as a treatment for end-stage ankle arthritis.

Download Full-text

Helminthic infections mimicking malignancy: a review of published case reports

The Journal of Infection in Developing Countries ◽

10.3855/jidc.840 ◽

2010 ◽

Vol 4 (07) ◽

pp. 425-429 ◽

Cited By ~ 7

Author(s):

Florian H. Pilsczek

Keyword(s):

Infectious Diseases ◽

English Language ◽

Fasciola Hepatica ◽

Case Reports ◽

Case Series ◽

Angiostrongylus Cantonensis ◽

Paragonimus Westermani ◽

Helminthic Infections ◽

Review Reports ◽

Toxocara Species

Background: Infectious diseases, including infections with helminths, can initially present similarly to malignancies. The goal of the article is to review reports of helminthic infections that are initially diagnosed as malignancy. Methodology: The database PubMed was searched for English language references published as of July 2009. Results: The following published case reports and case series, mainly from Asia and Africa, were identified: Nematodes: 8 publications (1 patient with Angiostrongylus cantonensis, 2 Stronglyloides stercoralis, 1 Toxocara species, 1 Dioctophyma renale, 1 Ascaris species, 1 Gnathostoma spinigerum, 1 Dirofilaria repens); Trematodes: 7 publications (46 patients with Schistosoma species, 2 Fasciola hepatica, 1 Paragonimus westermani); Cestodes: 6 publications (10 patients with Echinococcus species, 1 Sparganum mansoni). Conclusion: To avoid unnecessary investigations and treatment, physicians should be aware when diagnosing patients from Asia or Africa that a large number of helminthic infections can present similar to malignancies.

Download Full-text

Neonates with Asymptomatic Central Venous Catheter-Related Thrombosis - a Systematic Review

Blood ◽

10.1182/blood-2020-133646 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 8-9

Author(s):

Bader Allahyani ◽

Abdullah Alanazi ◽

Joshua Feder ◽

Ewurabena Simpson

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Conflicts Of Interest ◽

Umbilical Vein ◽

Case Reports ◽

Anticoagulation Therapy ◽

Case Series ◽

Current Guideline ◽

Central Venous ◽

Randomized Controlled Studies

Background: Central venous catheters (CVCs) are the most frequent cause of thrombosis in acutely unwell neonates. The natural history CVC-RT remains unclear. The current guideline for symptomatic CVC-related thrombus suggests that anticoagulation likely leads to minimizing complications while the recommendation for pediatric patients with asymptomatic deep vein thrombosis (DVT) is equivocal. Objective: This systematic review was undertaken to summarize evidence from the pediatric literature on the prevalence of asymptomatic CVC-RT in the neonate and whether anticoagulation therapy (ACT) improves the outcomes of asymptomatic CVC-RT in the neonate. Methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, the Web of Science, and clinical trial databases. We considered data from retrospective and prospective cohort studies, case series, and randomized controlled studies evaluating the prevalence and outcomes of CVC-RT following the use or non-use of ACT. Data were analyzed using Fisher exact and Chi-square statistics. Results: In total 762 articles were identified and screened, of which 16 articles included (1 RCT, 4 prospective studies and 8 retrospective cohort studies, and 3 case reports) that met inclusion criteria and contained extracted case data; these studies reported on a total of 1909 neonates with CVC have been screened for thrombosis. All studies were considered at moderate or high risk of bias. Tau2 and I2 suggested a high degree of heterogeneity. Ultimately, 309 cases were identified with the prevalence of asymptomatic CVC-RT was 16%. Notably, only 6.5% of neonates with symptomatic CVC-RT had undergone ultrasound (US) screening. The majority of the cases were premature neonates. 45% of the neonate had Umbilical Vein Catcher (UVC). 114 (41%) of the cases received ACT, of which none complicated with major bleeding. Overall there was no difference following the use or nonuse of ACT in patency of the asymptomatic CVC-RT, recurrence, and thrombosis related mortality. The frequency of each outcome according to therapy is shown in Table1. CONCLOSION: This systematic review has provided additional evidence supporting the favorable outcome of asymptomatic CVC-RT in the neonate regardless of the use of ACT. Further well-designed, prospective, multi-center clinical trials are needed to establish evidence-based treatment recommendations for neonates with asymptomatic CVC-RT. Figure Disclosures No relevant conflicts of interest to declare.

Download Full-text

Spectrum of Neurologic Complications after Allogeneic Hematopoietic Cell Transplantation for Hematologic Diseases in Adults: Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood-2019-128641 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5692-5692

Author(s):

Maria Gavriilaki ◽

Maria Mainou ◽

Eleni Gavriilaki ◽

Anna-Bettina Haidich ◽

Sotirios Papagiannopoulos ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Hematopoietic Cell Transplantation ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Neurologic Complications ◽

Hematologic Diseases ◽

Immune Mediated ◽

Impact On Survival

Introduction: Neurologic adverse events remain challenging complications with poor morbidity and mortality post adult allogeneic hematopoietic cell transplantation (alloHCT) for hematologic diseases. We conducted a systematic review and meta-analysis to determine their spectrum, incidence and impact on survival. Methods: We searched MEDLINE, COCHRANE, EMBASE through March 2019 for studies published in English. We deemed eligible all types of primary studies including randomized controlled trials (RCTs), controlled observational studies (both cohort and case control), case series and case reports. The eligibility criteria were: (a) adult population specified as patients fifteen years old or older, (b) alloHCT for hematologic diseases, (c) neurologic disorders' diagnosis. Two independent reviewers screened, extracted data and assessed risk of bias (RoB). The primary outcome being the incidence of neurologic complications was assessed in a form of a proportion of adult patients with the neurologic manifestation (n) from the total group of patients that received alloHCT for hematologic diseases (N). We performed a random-effects meta-analysis of proportions using the Freeman-Tukey double arcsine transformation, including only cohort studies. Secondary outcome was impact of neurologic complications on overall survival of patients presented with symptoms after allo-HCT. Pre-planned sensitivity analysis integrating the risk of bias assessment by excluding studies evaluated as high risk was performed as well as prespecified subgroup analyses according to the type of neurologic event. Results: We identified 552 eligible studies describing 57.972 patients; one randomized controlled trial, two case-control, 17 prospective, 86 retrospective cohort studies, 21 case-series and 425 case-reports (PRISMA flow diagram). RoB ranged from fair to high although case-series were of low-risk. The majority of studies traced infectious or drug-related neurologic manifestations. Incidence rates of neurologic complications varied, according to type of complications and studies, from 0.6% for immune-mediated disorders in retrospective cohorts to 13% for drug-related events in prospective cohorts. In meta-analysis of proportions, we included only cohort studies, retrospective or prospective, with homogenous population to estimate a proportion. Neurologic clinical signs or symptoms were detected in 1415 out of 37450 [6.2% (95%CI 4.8-7.7), Ι2= 96.1% (p<0.001)] patients described in 78 included cohort studies. Heterogeneity of results remained high, even after sensitivity analysis excluding studies of high RoB. Infectious complications were present in 2.7% (95%CI 1.9-3.6) and 3.3% (95%CI 0.8-7.1) of patients in retrospective and prospective cohort studies respectively. In retrospective studies, 3.4% (95%CI 2.1-4.9) of patients suffered from drug-related neurologic events. In prospective cohorts, the equivalent incidence was 13% (95%CI 4.2-24.8). Other neurologic complications included cerebrovascular events, thrombotic microangiopathy, immune-mediated complications, relapse and metabolic events. Regarding the severity of neurologic complications and death rate in patients with outcome of interest, data were too diverse to provide any safe conclusion. Neurologic complications had a detrimental impact on survival depending on type of complication in various studies. Based on study type, high RoB in most of the included studies, as well as significant heterogeneity in results from observational data, high imprecision and suspected publication bias, quality of evidence was very low applying the GRADE tool. Conclusion: Our study highlights the wide spectrum and significant impact of neurologic complications on survival post alloHCT. This systematic review summarizes existing data and provides the necessary background information for every physician involved in the management of these patients. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Endocrine tumors: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases.

Acta Endocrinologica ◽

10.1530/eje-21-0162 ◽

2021 ◽

Author(s):

Carlien de Herdt ◽

Eva Philipse ◽

Christophe De Block

Keyword(s):

Pituitary Adenoma ◽

Cohort Studies ◽

Case Reports ◽

Case Series ◽

Postoperative Treatment ◽

Visual Field Defects ◽

Somatostatin Analogue ◽

Endocrine Tumors ◽

Residual Tumour ◽

Mesh Terms

Background and Aims: Thyrotropin-stimulating pituitary adenoma (TSHoma) are a rare entity, occurring in 1 per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discuss the current guidelines for diagnosis and treatment. Methods A structured research was conducted using Pubmed with the following MeSH terms: “thyrotropin secreting pituitary adenoma” OR “TSHoma” OR “thyrotropinoma”. Results Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. Mean age at diagnosis was 46 years. At presentation 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. Median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean fT4 of 41.5±15.3 pmol/L. The majority (76.9%) of the TSHoma were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% patients of which 33.5% had residual pituitary adenoma. Postoperative treatment with a somatostatin analogue led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r=0.490, p<0.001). However, in patients pre-operatively treated with somatostatin analogue this correlation was absent. Conclusion TSHoma are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHoma are macroadenoma being diagnosed in the 5-6th decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one third of TSHoma. Treatment consists of neurosurgical resection and SSA in case of surgical failure.

Download Full-text

The Use of tPA in the Treatment of Frostbite: A Systematic Review

Hand ◽

10.1177/1558944718800731 ◽

2018 ◽

Vol 14 (1) ◽

pp. 13-18 ◽

Cited By ~ 8

Author(s):

Richard L. Hutchison ◽

Hannah M. Miller ◽

Spencer K. Michalke

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Case Reports ◽

Case Series ◽

Scientific Quality ◽

Complication Rates ◽

Outcomes Measures ◽

Study Results

Background: The use of tissue plasminogen activator (tPA) for the treatment of frostbite has been reported and advocated, but its efficacy has not been well established. We conducted a systematic review to guide physicians on the role of tPA in the treatment of frostbite. Our hypothesis was that the use of tPA improves clinical outcomes, as measured by amputation rate. Methods: We searched MEDLINE (PubMed) and EMBASE for primary research articles on the use of tPA for the treatment of extremity frostbite. Information related to study design, outcomes, and complications was extracted. A total of 204 citations were screened, and then 35 abstracts and 24 reports were reviewed. Fifteen studies met the standard for final review. Results: One randomized, prospective study; 3 cohort studies; 8 case series; and 3 case reports were found. A total of 208 patients were treated. Differences in protocols, inclusion criteria, and outcomes measures prevented combining the study results. In all the studies, the authors reported that the use of tPA was or may have been useful in reducing amputation rates or increasing tissue salvage. Complication rates ranged from 0% to 100%, with a combined rate of 13%. The quality of the evidence was low. Conclusions: Due to the low scientific quality of the studies, the efficacy of tPA in reducing amputation rates cannot currently be established. Randomized, prospective trials or well-controlled cohort studies are needed to better assess the role of tPA. Consideration should be given to limiting its use to research protocols.

Download Full-text

Is the Simplicity of the Evidence Pyramid Actually Detrimental for Understanding Evidence?

Veterinary Evidence ◽

10.18849/ve.v2i1.100 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Annette O'Connor

Keyword(s):

Cohort Studies ◽

Real World ◽

Disease Risk ◽

Case Reports ◽

Meta Analysis ◽

Information Source ◽

Case Series ◽

Case Control ◽

Current Evidence ◽

Case Control Studies

The evidence pyramid for assessing the efficacy of interventions under real world conditions has been used in various forms for many years, and to a lesser extent the pyramid has been used for assessing evidence for disease risk factors. While acknowledging minor differences, many pyramids list the following information sources for interventions in decreasing order of “validity”: systematic review and meta-analysis of randomised control trials, randomised controlled trials, cohort studies, case control studies, case series and case reports. The evidence pyramid is often used as a teaching aid to help clinicians and students visualise the concept that all studies might not have equal evidentiary value when evaluating real world efficacy.The rationale for the hierarchy of the pyramid is partially based on the potential for bias in some designs and partially based on the external validity of the information source. Designs with greater potential for bias “on average” are placed lower on the pyramid. The greater risk of bias means a greater risk that effect size estimates from studies lower on the pyramid may be systematically incorrect (overestimated or underestimated). As such, the evidence pyramid makes very broad statements about the design “on average”. Of course, for any particular study or topic, the pyramid may not be correct. Regardless, the generalisations described in the evidence pyramid have over the years been considered useful and use of the tool continues likely because of its simplicity. However, the validity of most pyramids that we have seen (and used ourselves, and published ourselves) is predicated on two potentially false concepts. The first potentially false concept conveyed by most evidence pyramids, is that there is only one case-control design and it is of lesser evidentiary value than cohort studies. The second potentially false concept conveyed by evidence pyramids is that the terms cohort, case control, and case series can be used to “filter” out studies of lower evidentiary value.In this presentation Annette discusses the validity of the evidence pyramid on the interpretation of evidence from primary research. She proposes a new way to think about evidence from primary studies using the framework for classifying epidemiologic studies proposed by Pearce (2012) based on incident and prevalent cases. This would also result in a rethinking of the current evidence pyramid.

Download Full-text

Types of trials

10.1093/med/9780198765875.003.0059 ◽

2017 ◽

Author(s):

Mark Harrison

Keyword(s):

Emergency Medicine ◽

Cohort Studies ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Case Control ◽

Controlled Trials ◽

Case Control Studies ◽

Advantages And Disadvantages ◽

Randomized Controlled

This chapter describes types of trials as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details and advantages and disadvantages of case reports, case series, cohort studies, case–control studies, randomized controlled trials, crossover trials, systematic reviews, and meta-analysis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.

Download Full-text