Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) for the management of adults with DRE. A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print, Embase, and the Cochrane library databases. Outcomes examined included reduction in seizure frequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs). Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy. Four RCTs and six comparative observational studies were identified for inclusion. Against comparators, individuals treated with VNS had a significantly better odds of experiencing a ≥ 50% reduction in seizure frequency (OR: 2.27 [95% CI 1.47, 3.51]; p = 0.0002), a ≥ 75% reduction in seizure frequency (OR: 3.56 [95% CI 1.59, 7.98]; p = 0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI 0.21, 0.62]; p = 0.0002). There was no difference in the odds of discontinuation or the rate of SAEs between VNS versus comparators. This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which included improvement in seizure frequency without an increase in the rate of SAEs or discontinuations, thereby supporting the consideration of VNS Therapy for people who are not responding to ASMs and those unsuitable or unwilling to undergo surgery.

Efficacy and Safety of Ocriplasmin Use for Vitreomacular Adhesion and Its Predictive Factors: A Systematic Review and Meta-Analysis

Symptomatic vitreomacular adhesion (sVMA) impedes visual acuity and quality. Ocriplasmin is a recombinant protease, which may be injected into the vitreous cavity to treat this condition, yet controversy remains with respect to its effectiveness and safety, particularly its patient selection standard. In this systematic review, the PubMed, Embase, and the Cochrane Library were searched to identify studies published prior to August 2020 on the impact of ocriplasmin treatment on VMA release, macular hole (MH) closure, and/or related adverse events (AEs). Data were pooled using a random-effects model. Risk ratios (RRs) with 95% CIs were calculated. Of 1,186 articles reviewed, 5 randomized controlled trials and 50 cohort studies were ultimately included, representing 4,159 patients. Ocriplasmin significantly increased the rate of VMA release (RR, 3.61; 95% CI, 1.99–6.53; 28 days after treatment) and MH closure (RR, 3.84; 95% CI, 1.62–9.08; 28 days after treatment) and was associated with visual function improvement. No increased risk for overall AEs was seen in ocriplasmin treatment. The proportion of VMA release and MH closure in patients was 0.50 and 0.36, respectively. VMA release was more likely in patients with absence of epiretinal membrane (ERM). Patients with smaller MH diameter were more likely to achieve MH closure. Evidence from included studies suggests that ocriplasmin is a suitable and safe approach for treating sVMA. ERM and MH status are important factors when considering ocriplasmin treatment.

The Genetic Polymorphism of TNF-α Associated with the Anti-TNF-α Therapy Used for COVID-19 Patients – Another Possible Approach

Objective: This work aimed of to review the implications of anti-TNF-α therapy in COVID-19 patients associated with the genetic polymorphism (TNF-α polymorphisms in the region-308) of this pertinent cytokine Methodology: Electronic searches were carried out on PUBMED Central, BVS/BIREME, Web of Science and The Cochrane Library with the aid of key-words. Results: Twenty-six articles were collected. Anti-TNF-α therapy was interpreted and evaluated. Conclusions: Although scarce information is available in the current literature, anti- TNF-α therapy seems to be a viable clinical approach for hospitalized COVID-19 patients who do not need oxygen supply. The genetic polymorphisms, although relevant, may be useful for further researched to assess the clinical response in different research groups.

Heart failure in cancer patients

The purpose of the study was to conduct a systematic review of data on the role of heart failure (HF) in the development of cancer, as well as to discuss problems dealing with diagnosis and treatment of heart failure in cancer patients. Material and methods. A literature search was conducted using the Cochrane library, elibrary, medline, and embase databases over the past 7 years. The general mechanisms of heart failure and cancer, cardiotoxicity risk factors, and some aspects of the diagnosis and treatment of HF in cancer patients were analyzed. Results. The literature analysis indicates that cardiovascular disease and cancer have common risk factors. Several common pathophysiological mechanisms that associate HF with cancer have been identified. They include inflammation, oxidative stress, and neurohomonal activation. HF is known to be a common complication of aggressive cardiotoxic cancer therapy that can aggravate or trigger existing HF. Recent epidemiological studies have shown that the development of cancer is more common among patients with pre-existing HF. Although the reason for this relationship has not yet been identified, it is assumed that HF may be a pro-oncogenic condition. There are several strategies to prevent and treat toxicity of various chemotherapeutic drugs. They are all based on accurate patient selection, short- and longterm follow-up, and therapies that can prevent and delay cardiac dysfunction. Conclusion. The main goal of cardio-oncology is to prevent and treat of cardiotoxic effects of chemotherapy drugs. In this context, elucidation of the underlying mechanisms plays an important role in the development of strategies for the prevention of chemotherapy-associated cardiomyopathy. It is necessary to pay attention to the fact that there is more and more evidence that patients with HF have high risks of developing cancer, thereby requiring more attention. In general, understanding the direct and indirect mechanisms of the relationship between HF and cancer can help in the prevention and early diagnosis of these diseases.

Incidences of Adverse Reactions in BNT162b2: A Meta-analysis

Review question / Objective: This study searched PubMed, Cochrane Library, Web of Science, Embase Electronics, and other databases to collect healthy adults aged 16 and older, subjects with no previous history of COVID-19 infection, A randomized controlled trial of Pfizer's vaccine BNT162b2 versus placebo. Using RevMan5.4 software, meta-analysis was conducted to compare the effects of injection of BNT162b2 and placebo on the incidence of adverse reactions in healthy adults over 16 years of age. Main indexes include total incidence of adverse reactions, the incidence of local adverse reactions at the injection site (including red hot accessories), the incidence of systemic adverse reactions, including fever, headache, rash, urticaria, joint pain, muscle pain, gastrointestinal tract reaction, fatigue, cough, etc.), death rate, so as to provide a reference for clinical practice. Information sources: The following electronic databases will be searched from January 2020 to November 2021: PubMed, the Cochrane Library, Web of Science, Embase Electronics. In addition, reference lists of the included studies were manually searched to identify additional relevant studies.

The use of non-pharmacological adjuvant therapies for cancer pain: a narrative review in the context of dance

Cancer is one of the leading causes of morbidity in the globe, with more than half of patients reporting pain as a result of the disease. By reducing cancer-related pain, dance has the potential to redefine the life of patients independently of their cure prognosis. This review investigated the benefits of dance as adjuvant, non-pharmacological therapy for cancer treatment. To identify studies related to this topic, we searched the Cochrane Library, PUBMED, Scielo, BVS, Embase, CINAHL, and PsycINFO databases. However, we found few published systematic reports investigating the effects of dance in cancer treatment. The numbers are even smaller when we considered the relationship between dance and cancer pain. Although there is a small number of publications on this theme, we reviewed studies that indicate that there is a positive relationship between dance practice and cancer pain management. Moreover, we found that the decline of pain contributed to the better life quality of patients with cancer. We concluded that dance is a physical practice that may improve patients’ quality of life. Regarding the estimations of cancer diagnosis and pain during disease development and therapy, it is fundamental new studies and clinical trials that integrate dance as adjuvant therapy for improving cancer pain and patient’s life quality.

Endometrial sampling tests for the diagnosis of endometrial carcinoma: a protocol of a diagnostic test accuracy systematic review

Background: Endometrial cancer ranks as the most common gynecological cancer. An accurate detection can dramatically improve patient relevant outcomes.Objectives: To determine the diagnostic accuracy of different endometrial sampling methods for detecting endometrial carcinoma and its precursors.Search strategy: we will search the Cochrane library, Pubmed/MEDLINE, Web of Science, and Scopus. We will search references of relevant studies.Selection criteria: We will include diagnostic test accuracy studies if women had an endometrial sampling followed by verification with histopathology in hysterectomy specimens. The primary target is endometrial carcinoma.Data collection and analysis: Two authors will independently screen studies, extract data, and assess methodological quality. We will use bivariate diagnostic random-effects meta-analysis.Results: This is a protocol of a diagnostic test accuracy systematic review.Conclusions: Evidence will aid in making well-informed decisions for diagnosing endometrial carcinoma. Implications for research will be outlined for future studies.

Key concepts for searching evidence: an introduction for healthcare professionals

The currently abundant bibliography on healthcare can make the search process an exhausting and frustrating experience. For this reason, it is essential to learn the basic concepts of research question formulation, information sources, and search strategies to make this process more efficient and user-friendly. The search strategy is an iterative process that allows the incorporation of tools and terms in the strategy design to optimize evidence retrieval. Each strategy varies according to the questions, the language used, the source of information accessed, and the available tools. This article is part of a methodological series of narrative reviews on biostatistics and clinical epidemiology. This narrative review describes the essential elements for developing a literature search strategy and identifying the relevant evidence concerning a clinical question through familiar and accessible sources (such as Google and Google Scholar), as well as search interfaces and technical-scientific databases focused on biomedical knowledge (PubMed and The Cochrane Library).

Effect of electric stimulation on patients with facial paralysis: A systematic review and Meta-analysis of randomized controlled trials

Review question / Objective: To investigate the effectiveness of electric stimulation on patients with facial paralysis through a systematic review and meta-analysis. Condition being studied: P: facial paralysis; I: electric stimulation; C: clinical routine treatment; O: total clinical effectiveness, House-Brackmann scale (HBN) and Portmann scale; S:RCT. Information sources: PubMed; the Cochrane Library; Embase; SinoMed; WanFang Data; Vip; China National Knowledge Infrastructure databases.

Efficacy and Safety of VNS Therapy or Continued Medication Management for Treatment of Adults with Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people withdrug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessfulsurgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted todetermine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) forthe management of adults with DRE.A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print,Embase, and the Cochrane library databases. Outcomes examined included reduction in seizurefrequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs).Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy.Four RCTs and six comparative observational studies were identified for inclusion. Against comparators,individuals treated with VNS had a significantly better odds of experiencing a ≥50% reduction in seizurefrequency (OR: 2.27 [95% CI: 1.47, 3.51]; p=0.0002), a ≥75% reduction in seizure frequency (OR: 3.56[95% CI: 1.59, 7.98]; p=0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI: 0.21,0.62]; p=0.0002). There was no difference in the odds of discontinuation or the rate of SAEs betweenVNS versus comparators.This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which includedimprovement in seizure frequency without an increase in the rate of SAEs or discontinuations, therebysupporting the consideration of VNS Therapy for people who are not responding to ASMs and thoseunsuitable or unwilling to undergo surgery.