Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). Methods: A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. Results: The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33–2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45–2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. Conclusion: There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.

De Novo Vesicoureteral Reflux Following Ureterocele Decompression in Children: A Systematic Review and Meta-Analysis Comparing Laser Puncture versus Electrosurgical Incision Techniques

Background: The available endoscopic techniques for ureterocele decompression include laser puncture (LP), electrosurgical incision (ES), and cold-knife incision. This systematic review was performed to compare the efficacy of LP versus ES techniques with special emphasis on de novo VUR. Methods: Four databases were systematically searched by the authors. The inclusion criteria were all comparative studies in which ureterocele decompression was performed by either LP or ES endoscopic techniques. Outcomes including the incidence of de novo VUR, the need for endoscopic retreatment of the ureterocele, and the need for secondary surgical procedures were studied. Risk ratios (RR) were calculated for all outcomes and the Mantel-Haenszel method was utilized for the estimation of pooled RR. The methodological quality was assessed by the Downs and Black scale. Results: Five studies were considered for systematic review, while four of them were included in the meta-analysis. Out of 202 children, 67 developed de novo VUR. Significantly lower rates of reflux were observed in the LP group vis-a-vis ES group (RR = 0.17, 95% CI 0.09 to 0.32, p < 0.00001). Endoscopic retreatment rates (n = 20) demonstrated no significant difference among the two patient groups (RR = 0.66, 95% CI 0.26–1.68, p = 0.38). A total of 46 secondary procedures were performed in 170 children, mostly ureteral re-implantations, with a significantly lower need of secondary surgeries following LP versus ES (RR = 0.26, 95% CI 0.13–0.49, p < 0.0001). The risk of bias in the included studies was low-to-moderate. Conclusions: When compared to the ES technique, the LP technique is associated with a significantly low incidence of de novo VUR and requirement for secondary surgeries (particularly anti-reflux surgeries). Endoscopic retreatment rates showed no significant difference between the two techniques. However, due to the moderate risk of bias in two out of four included studies, randomized controlled trials are needed in the future.

Changes in Muscle Oxygen Saturation Measured Using Wireless Near-Infrared Spectroscopy in Resistance Training: A Systematic Review

Background: This study aimed to report, through a systematic review of the literature, the baseline and final reference values obtained by near-infrared spectroscopy (NIRS) of muscle oxygen saturation (SmO2) during resistance training in healthy adults. Methods: Original research studies were searched from four databases (Scopus, PubMed, WOS, and SportDiscus). Subsequently, three independent reviewers screened the titles and abstracts, followed by full-text reviews to assess the studies’ eligibility. Results: Four studies met the inclusion criteria, data were extracted and methodological quality was assessed using the Downs and Black scale. Muscle oxygen saturation (% SmO2) during reported muscle strength exercises showed a decreasing trend after a muscle strength protocol; that is, before the protocol (range = 68.07–77.9%) and after (range = 9.50–46.09%). Conclusions: The trend of the SmO2 variables is to decrease after a muscle strength protocol. Studies are lacking that allow expanding the use of these devices during this type of training.

The Role of Sensor Based Insole as a Rehabilitation Tool in Improving Walking among the Patients with Lower Limb Arthroplasty: A Protocol for Systematic Review

Objectives: The purpose of this review protocol is to assess the role of sensor based insole in improving walking in patients with lower limb arthroplasty and to rule out the demand and advantage of sensor based insole in utilizing such types of problems at clinical setup. Methodology: A systematic review will be conducted by two independent reviewers who will search articles using electronic search for publications in seven databases: Google Scholar, Index Copernicus, JSTOR, PubMed/Medline, Science Direct, Scopus and Web of Science. After applying the selection criteria, study papers published between the years 2001 to 2019 will be selected. Studies of human participants of 45-75 years of age having history of lower limb arthroplasty will be eligible. All the study papers will be analyzed using Modified Downs and Black scale and scores will be awarded for the items selected on a 27 point scale. Findings: The findings of this review will be disseminated through presentations and peer-reviewed publication. The systematic review will direct the attention of the physiotherapists to assess and evaluate the patient’s walking pattern, as alterations in the biomechanics of joints of lower limb can produce far-reaching effects in the ideal or normal gait. The results of this review will provide evidence regarding changes in gait parameters in patients with lower limb arthroplasty and this information will be useful in planning for rehabilitation in improving walking of patients after lower limb arthroplasty. Novelty: Many studies have been carried on sensor insole technology for monitoring gait. However, there is scarcity of literature based on the systematic reviews on the use of smart sensor insole in improving walking among patients with lower limb arthroplasty.

Determining the biomechanical changes in lumbar spine among patients with injuries around the knee joint: a systematic review protocol

The knee is one of the body's more complicated joints and is susceptible to various injuries. A closed kinetic relationship exists between the lumbar spine and knee joint and any dysfunction in knee or lumbar region may result in compensation, joint dysfunction and pain in either one or both the regions. Therefore, the above stated reason highlights the need of analyzing the spine biomechanically. So, that a new physiotherapeutic assessment and treatment approach can be developed in future to prevent permanent adaptive changes in the posture in patients with knee injuries. This systematic review protocol has been conducted by two independent reviewers who searched the articles using electronic search for publications in several databases: Google Scholar, Index Copernicus, JSTOR, PubMed/Medline, ScienceDirect, Scopus and Web of Science. After applying the selection criteria, study papers published between the years 2001 to 2019 have been selected. Studies of human participants of any age having injuries around knee joint have been eligible, and there was no restriction on type of injuries. All the study papers have been analyzed using modified Downs and Black scale and scores have been awarded for the items selected on a 27 point scale. This review has collected secondary data only; hence no ethical approval was required. The results of this review protocol will provide evidence regarding changes in lumbar spine in patients with injuries around knee and this information will be useful in planning for rehabilitation in knee and around knee injury.

Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis

The aim of this study was to systematize the scientific evidence that assessed the prevalence of urinary incontinence in female athletes and determine which modality is most predisposed to stress urinary incontinence. From September to December 2018, a systematic literature search of current interventional studies of stress urinary incontinence of the last ten years was performed using PubMed, EMBASE, Scopus and Web of Science databases. The methodological quality was assessed by the Downs and Black scale, while the data collected from the studies were analyzed through meta-analysis. Nine studies met the eligibility criteria, meaning they included reports of urinary incontinence in different sports. The meta-analysis showed 25.9% prevalence of urinary incontinence in female athletes in different sports, as well as 20.7% prevalence of stress urinary incontinence. The most prevalent high impact sport was volleyball, with the value of 75.6%. The prevalence of urinary incontinence can be high in female athletes, with high-impact sports potentially increasing the risk for stress urinary incontinence. Further research is needed regarding the potential risk factors related to the onset of urinary incontinence.

The Use of Vitamin D in The Infectious Process in The Hospital Period in Childhood Effective?

Goals: To verify whether the use of Vitamin D as parallel therapy to hospital and drug treatment can be effective in the process of infectious reduction in hospitalized children. Data source: This study is a systematic review and meta-analysis of randomized controlled trials, published between 2011 and the first quarter of 2019, in the Cochrane Library, Medline, US National Library of Medicine and the National Institute of Health (PubMed), Literature databases. Latin American and Caribbean Health Sciences (Lilacs), Scopus and Web of Science. The studies were scored by the Down and Black scale associated with the quality assessment method according to the Cochrane criteria (RCT). Summary of the data: Of the 1475 studies, 09 were included. There is a direct relationship between Vitamin D level and mortality rate in hospitalized children with infections. Conclusion: This study highlighted that the vitamin D deficiency in children under serum analysis during hospitalization triggers severe immunological changes.