Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.

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Abstract 181: A Systematic Review of Interventions to Increase tPA Administration

Stroke ◽

10.1161/str.47.suppl_1.181 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Mollie McDermott ◽

Lesli E Skolarus ◽

James F Burke

Keyword(s):

Systematic Review ◽

Public Education ◽

Small Sample Size ◽

Case Reports ◽

Meta Analysis ◽

Experimental Studies ◽

Fixed Effect Model ◽

Small Sample ◽

Eligibility Criteria ◽

Design Elements

Introduction: Rates of tPA administration remain low nationally and globally despite its demonstrated efficacy. We performed a systematic review and meta-analysis of interventions to increase the rate of tPA administration. Methods: We searched PubMed and EMBASE to identify all studies (excluding case reports) published between 1995 and January 8, 2015 documenting interventions to increase the utilization of tPA. We screened each study with pre-specified inclusion and exclusion criteria. Design elements and study data were extracted from eligible studies. The principal summary measure was the percentage change in rate of tPA administration. Fixed and random effects meta-analytic models were built to summarize the effect of intervention compared to control as well as intervention subtypes. Results: Our search yielded 1457 results of which 25 met eligibility criteria. We identified 13 pre-post studies and 11 randomized or quasi-experimental studies. Included studies utilized EMS (n=14), telemedicine (n=6), and public education (n=5). Intervention settings included urban (n=13), rural (n=4), and combined (n=4). In a fixed effect model, tPA administration was significantly higher in the intervention arm across all studies that limited enrollment to ischemic stroke patients (n=14) with a risk ratio (RR) of 1.71. Interventions involving EMS were associated with an increased rate of tPA administration with a RR of 1.51, (95% CI: 1.43-1.59, p<0.0001); promoting public education RR = 2.62, (95% CI: 1.54-4.43, p<0.01); and utilizing telemedicine RR = 2.97, (95% CI: 2.61-3.39, p<0.0001). Conclusions: Interventions to increase tPA use appear to have considerable efficacy. Comparative inferences between intervention types are limited by small sample size and intervention heterogeneity.

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

10.1101/2020.06.07.20124677 ◽

2020 ◽

Cited By ~ 1

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)

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Agreement between results of meta-analyses from case reports and clinical studies, regarding efficacy and safety of idursulfase therapy in patients with mucopolysaccharidosis type II (MPS-II). A new tool for evidence-based medicine in rare diseases

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-019-1202-6 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 5

Author(s):

Miguel Sampayo-Cordero ◽

Bernat Miguel-Huguet ◽

Almudena Pardo-Mateos ◽

Andrea Malfettone ◽

José Pérez-García ◽

...

Keyword(s):

Rare Diseases ◽

Clinical Studies ◽

Case Reports ◽

Meta Analysis ◽

Type I ◽

Mucopolysaccharidosis Type ◽

Type Ii ◽

Mucopolysaccharidosis Type Ii ◽

Mps Ii ◽

Meta Analyses

Abstract Background A preliminary exploratory study shows solid agreement between the results of case reports and clinical study meta-analyses in mucopolysaccharidosis Type I (MPS-I) adult patients. The aim of the present study is to confirm previous results in another patient population, suffering from mucopolysaccharidosis Type II (MPS-II). Methods A systematic review and meta-analysis of case reports published by April 2018 was conducted for MPS-II patients treated with enzyme replacement therapy (ERT). The study is reported in accordance with PRISMA and MOOSE guidelines (PROSPERO database code CRD42018093408). The assessed population and outcomes were the same as previously analyzed in a meta-analysis of MPS-II clinical studies. The primary endpoint was the percent of clinical cases showing improvement in efficacy outcome, or no harm in safety outcome after ERT initiation. A restrictive procedure to aggregate case reports, by selecting standardized and well-defined outcomes, was proposed. Different sensitivity analyses were able to evaluate the robustness of results. Results Every outcome classified as “acceptable evidence group” in our case report meta-analysis had been graded as “moderate strength of evidence” in the aforementioned meta-analysis of clinical studies. Sensitivity, specificity, and positive-negative predictive values for results of both meta-analyses reached 100%, and were deemed equivalent. Conclusions Aggregating case reports quantitatively, rather than analyzing them qualitatively, may improve conclusions in rare diseases and personalized medicine. Additionally, we propose some methods to evaluate publication bias and heterogeneity of the included studies in a meta-analysis of case reports.

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Four-Rooted Maxillary First Molars: A Systematic Review and Meta-Analysis

International Journal of Dentistry ◽

10.1155/2021/8845442 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Gabriel Magnucki ◽

Sven V. K. Mietling

Keyword(s):

Case Reports ◽

Meta Analysis ◽

Population Based ◽

Occurrence Rate ◽

Type I ◽

Root Canals ◽

Anatomical Anomaly ◽

Maxillary Molars ◽

Significant Difference ◽

Dental Professionals

Objectives. The majority of human maxillary first molars is usually described as having three roots, but different morphologies were documented in several studies and case reports. One very rare and less investigated anatomical anomaly is the occurrence of four radicular structures in the upper first molars. This communication aimed to define the prevalence of four-rooted maxillary first molars on a meta-analytical basis. The external and internal morphology of these teeth was described by the collection of published case reports. Materials and Methods. Six electronic databases were accessed to collect case reports dealing with four-rooted maxillary first molars, as well as population-based cone-beam computed tomography (CBCT) studies. Afterward, the publications were selected according to predefined inclusion/exclusion criteria and evaluated using the Joanna Briggs Institute Critical Appraisal tool. The teeth of the chosen case reports were then independently analyzed by two dental professionals according to different dental classifications. Furthermore, the population studies were meta-analyzed to calculate the global and regional prevalence of four-rooted maxillary molars. Results. Included were forty-nine population-based CBCT studies containing 26663 maxillary first molars. Upon these data, the global incidence of four-rooted maxillary molars was meta-analytically determined as 0.047% (95%-CI:0.011–0.103%). In combination with the case reports, it was pointed out that this anomaly is distributed worldwide. Furthermore, forty-eight case reports were included containing fifty-three maxillary molars with four roots. The analyzed teeth exhibited Versiani´s pulpal chamber floor Types A and B. The majority of four-rooted maxillary first molars were classified as Type I regarding Christie's configuration. But, also 7.54% of the altered teeth could not be described by this classification. 62.34% exhibited four root canals, but also variations with five, six, or seven canals were identified. Furthermore, a significant difference was found in the occurrence rate between male and female patients. Conclusion. Due to the worldwide occurrence, dental professionals should be aware of this rare anomaly to avoid treatment errors, especially during endodontic or surgical therapies.

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Presentation and Management of Liraglutide-Related Pancreatitis: Systematic Review of Case Reports

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.853 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A418-A418

Author(s):

Som P Singh ◽

Fahad Qureshi

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Systematic Reviews ◽

Serum Amylase ◽

Age Of Onset ◽

Case Reports ◽

Meta Analysis ◽

Elevated Serum ◽

Duration Of Treatment ◽

Significant Difference

Abstract Background: Liraglutide is a glucagon-like peptide-1 (GLP-1 agonist) aimed towards promoting glucose-dependent insulin secretions. This medication is an emerging treatment option for the management of obesity through promoting satiety. However, there are a growing number of cases noting adverse effects of liraglutide. Of note, liraglutide has been seen to elevate serum amylase and lipase levels among users, and therefore promoting acute pancreatitis. Moreover, the overall presentation of liraglutide-related acute pancreatitis can be variable. The aim of this study is to determine qualitative patterns of presentation and meta-analysis of lab changes among acute pancreatitis patients on liraglutide. Methodology: Systematic review of the literature was performed on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for liraglutide-related acute pancreatitis case studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Meta-Analysis performed using Stata. Results: Twenty-one patient cases were identified then contingently evaluated for acute pancreatitis based on presentation, labs, and treatment outcomes. Within the pancreatitis cases, the average age of onset was 59 ± 16.5 (male = 58 ± 24.5; female = 56 ± 24.6). Upon qualitative review, 14.3% of patients were asymptomatic but showed elevated serum amylase and lipase levels following liraglutide administration (p < 0.05). Among the symptomatic group, there was variation in the duration of liraglutide administration and reported compliance. There was no significant difference among treatment regimes between symptomatic and asymptomatic groups. Conclusion: Longer duration of liraglutide treatment without dose adjustment was notable to show elevated rises in both serum amylase and lipase. However, the variation of patient symptoms cannot be determined through the duration of treatment. Patient demographics do not seem to play a role in acute pancreatitis episodes. Future studies ought to focus on larger patient samples to further develop an understanding of treatment duration, presentation, and management of acute pancreatitis management after liraglutide administration.

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Emergency room closed reductionversus in situsplinting in the treatment of paediatric supracondylar humerus fractures

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190018 ◽

2019 ◽

Vol 13 (3) ◽

pp. 334-339 ◽

Cited By ~ 1

Author(s):

S. M. Sylvia ◽

K. J. Maguire ◽

D. A. Molho ◽

B. J. Levens ◽

M. E. Jr. Stone ◽

...

Keyword(s):

Closed Reduction ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Type Ii ◽

Continuous Variables ◽

Level Of Evidence ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Humerus Fractures

PurposeDisplaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods.MethodsPatients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables.ResultsIn all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005).ConclusionNo difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.Level of EvidenceLevel III, retrospective comparative study

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Pediatric asthma control during the COVID-19 pandemic: a systematic review and meta-analysis

10.22541/au.162699252.29324612/v1 ◽

2021 ◽

Author(s):

Ze Yang ◽

Xiang Wang ◽

Xigang Wan ◽

Menglei Wang ◽

Zonghua Qiu ◽

...

Keyword(s):

Systematic Review ◽

Asthma Control ◽

Inhaled Corticosteroids ◽

Case Reports ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Significant Difference ◽

The Impact

Background: During the current ongoing COVID-19 pandemic, studies had reported that patients with asthma would experience increased asthma-associated morbidity because of the respiratory virus SARS-CoV-2 infection, based on experience with other respiratory viral infections. However, some studies suggested that there was no apparent increase in asthma related morbidity in children with asthma, it is even possible that due to reduced exposures due to confinement, such children may have improved outcomes. In order to understand the impact of Covid-19 on asthma control in children, we performed this systematic review and meta-analysis. Methods: We searched PubMed, Embase, and Cochrane Library to find literature from December 2019 to June 2021 related to Covid-19 and children’s asthma control, among which results such as abstracts, comments, letters, reviews and case reports were excluded. The level of asthma control during the COVID-19 pandemic was synthesized and discussed. Results: A total of 20456 subjects were included in 7 studies. Random effect model is used to account for the data. Compared to the same period before the COVID-19 pandemic, asthma exacerbation, asthma admission, emergency room visit reduced a lot. The outcome of use of inhaled corticosteroids and Beta-2 agonists shows no significant difference. Conclusion: Compared to the same period before the COVID-19 pandemic and the measures in response to it, the level of asthma control has been significantly improved. We need to understand the exact factors leading to these improvements and find methods to sustain it.

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The Use of Tocilizumab in Patients with COVID-19: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Studies

Journal of Clinical Medicine ◽

10.3390/jcm10214935 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4935

Author(s):

Alberto Enrico Maraolo ◽

Anna Crispo ◽

Michela Piezzo ◽

Piergiacomo Di Di Gennaro ◽

Maria Grazia Vitale ◽

...

Keyword(s):

Systematic Review ◽

Sequential Analysis ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Severe Disease ◽

Fixed Effect Model ◽

Severe Form ◽

Trial Sequential Analysis ◽

Type I ◽

Randomized Controlled Studies

Background: Among the several therapeutic options assessed for the treatment of coronavirus disease 2019 (COVID-19), tocilizumab (TCZ), an antagonist of the interleukine-6 receptor, has emerged as a promising therapeutic choice, especially for the severe form of the disease. Proper synthesis of the available randomized clinical trials (RCTs) is needed to inform clinical practice. Methods: A systematic review with a meta-analysis of RCTs investigating the efficacy of TCZ in COVID-19 patients was conducted. PubMed, EMBASE, and the Cochrane COVID-19 Study Register were searched up until 30 April 2021. Results: The database search yielded 2885 records; 11 studies were considered eligible for full-text review, and nine met the inclusion criteria. Overall, 3358 patients composed the TCZ arm, and 3131 the comparator group. The main outcome was all-cause mortality at 28–30 days. Subgroup analyses according to trials’ and patients’ features were performed. A trial sequential analysis (TSA) was also carried out to minimize type I and type II errors. According to the fixed-effect model approach, TCZ was associated with a better survival odds ratio (OR) (0.84; 95% confidence interval (CI): 0.75–0.94; Iˆ2: 24% (low heterogeneity)). The result was consistent in the subgroup of severe disease (OR: 0.83; 95% CI: 0.74–0.93; I2: 53% (moderate heterogeneity)). However, the TSA illustrated that the required information size was not met unless the study that was the major source of heterogeneity was omitted. Conclusions: TCZ may represent an important weapon against severe COVID-19. Further studies are needed to consolidate this finding.

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Gartland Type II Supracondylar Humerus Fractures, Their Operative Treatment and Lateral Pinning Are Increasing: A Population-Based Epidemiologic Study of Extension-Type Supracondylar Humerus Fractures in Children

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1597270 ◽

2016 ◽

Vol 27 (05) ◽

pp. 455-461 ◽

Cited By ~ 11

Author(s):

Tytti Pokka ◽

Minna Sirviö ◽

Willy Serlo ◽

Juha-Jaakko Sinikumpu

Keyword(s):

Epidemiologic Study ◽

Geographic Area ◽

Population Based ◽

Type I ◽

Type Ii ◽

Fractures In Children ◽

Operative Care ◽

Pin Fixation ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

Background Supracondylar humerus fractures are usual in children but their recent trends are unclear. Material and Methods A population-based study was performed to determine the epidemiology of childhood supracondylar humerus fractures during the decade, 2000 to 2009, in a geographic area of Oulu, Finland. Altogether, 565 extension-type supracondylar humerus fractures were included. The fractures and their treatment were analyzed according to the Gartland classification. Results Fracture incidence increased by 28%, from 50.9 to 65.2 per 100,000 during 2000 to 2009 (β = 1.03, p < 0.001). The increase was from 41.3 to 57.6 per 100,000 in girls (β = 1.9, p < 0.001). Trampoline-related fractures in particular increased in girls. Type II fractures increased twofold from 7.1 to 16.3 per 100,000 (β = 1.1, p < 0.001), whereas type I fractures decreased from 22.4 to 20.9 per 100,000 (β = −0.3, p = 0.026).Surgical treatment increased during the 10 years study period from 32.6 to 51.8% (p = 0.022); it was in particular due to increase of operative care of type II fractures (from 5.9% in 2000–2001 to 37.1% in 2008–2009; p = 0.011). Lateral pin fixation increased from nil to six (10.7%) (p < 0.001). Conclusion The incidence and surgical stabilization of type II fractures in particular are increasing. There is a trend toward lateral pin fixation.

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The Efficacy of Conbercept in Polypoidal Choroidal Vasculopathy: A Systematic Review

Journal of Ophthalmology ◽

10.1155/2020/4924053 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yimin Wang ◽

Mengxi Shen ◽

Jinwei Cheng ◽

Xiaodong Sun ◽

Peter K. Kaiser

Keyword(s):

Systematic Review ◽

Polypoidal Choroidal Vasculopathy ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Random Effect ◽

Fixed Effect Model ◽

Age Related Macular Degeneration ◽

Age Related ◽

Significant Difference ◽

Choroidal Vasculopathy

Topic. The aim of this study is to evaluate the efficacy of conbercept in PCV, which will optimize the management for PCV patients. Clinical Relevance. The use of antivascular endothelial growth factor (VEGF) therapy in polypoidal choroidal vasculopathy (PCV), a subtype of neovascular age-related macular degeneration (nAMD), has been well established in randomized clinical trials. This meta-analysis has evaluated the efficacy of a novel anti-VEGF agent, conbercept, in the management of PCV using ranibizumab and aflibercept as the reference agents. Methods. Thirty studies with 1308 eyes were identified and included in this study. The primary outcome measures were best-corrected visual acuity (BCVA), and secondary outcomes were optical coherence tomography characteristics and polyp regression rates. The pooled results were calculated by the random-effect or fixed-effect model according to the heterogeneity of the data. Results. Despite a large standard deviation in means (SMD) improvement for BCVA and central retinal thickness (CRT) in the conbercept group, there was no statistically significant difference in the other outcomes compared to ranibizumab and aflibercept. However, there was a greater polyp regression rate in the conbercept group at 12 months. Conclusions. This systematic review indicates that conbercept may achieve similar BCVA and CRT improvements as ranibizumab and aflibercept, with a superior rate of polyp regression at 12 months.

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