scholarly journals Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review

2008 ◽  
Vol 136 (11) ◽  
pp. 1441-1447 ◽  
Author(s):  
M. R. HOEK ◽  
H. CHRISTENSEN ◽  
W. HELLENBRAND ◽  
P. STEFANOFF ◽  
M. HOWITZ ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meningococcal Disease ◽  
Attack Rate ◽  
Meta Analysis ◽  
Weighted Average ◽  
Inclusion Criteria ◽  
Primary Case ◽  
Household Contacts ◽  
Unpublished Report

SUMMARYWe performed a systematic review to estimate the effectiveness of vaccination, in addition to chemoprophylaxis, in preventing meningococcal disease among household contacts. Medline, EMBASE, EMGM, and EUIBIS were used for data collection. Studies reporting on at least 100 primary cases and on subsequent cases in household settings with follow-up of more than 2 weeks after onset of disease in the primary case were reviewed. A meta-analysis was used to calculate the average attack rate in household contacts given chemoprophylaxis 14–365 days after onset of disease in the primary case. In total, 652 studies were identified, five studies and one unpublished report met the inclusion criteria. The weighted average attack rate was 1·1/1000 household contacts (95% CI 0·7–1·7). This review supports vaccination of household contacts in addition to chemoprophylaxis to reduce the risk of meningococcal disease among household contacts of a case caused by a vaccine-preventable serogroup.

scholarly journals Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis and Severe Hindfoot Deformity: A Systematic Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Amanda N. Fletcher ◽  
Jordan L. Liles ◽  
Gregory F. Pereira ◽  
John Steele ◽  
Samuel B. Adams
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Weighted Average ◽  
Wound Complications ◽  
Bone Block ◽  
Inclusion Criteria ◽  
Operative Techniques ◽  
Radiographic Outcomes ◽  
Subtalar Arthritis

Category: Hindfoot; Trauma Introduction/Purpose: Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objectives of this study were (1) to conduct a systematic review of clinical outcomes following SDA, (2) to assess the demographics, indications, and surgical technique used, (3) to assess the clinical and radiographic outcomes of this procedure and its role in improving function, (4) to provide treatment recommendations based on the best available literature, and (5) to identify knowledge deficits that require further investigation. Methods: MEDLINE and EMBASE were queried with an end date of January 1, 2018 using the keywords The keywords used for this search included ‘‘subtalar,’’ ‘‘talar,’’ ‘‘talus,’’ ‘‘bone,’’ ‘‘block,’’ ‘distraction,’ ‘arthrodesis,’ ‘fusion,’ ‘arthritis,’ ‘arthrosis,’ ‘calcaneus,’ ‘calcaneal,’ ‘fracture,’ ‘malunion,’ ‘deformity,’ and ‘‘clinical outcome,’’ alone and in various combinations using the Boolean operator ‘‘AND.’’ Data abstraction was performed by two independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least five patients, (4) reporting clinical and/or radiographic outcomes of SDA. Data collected included: demographics, operative techniques, radiographic measures, clinical and functional outcomes, and complications. The level of evidence for each study was assessed according to the method described by Wright et al. Methods followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle hindfoot scores with a weighted average of 33 points of improvement. Conclusion: Subtalar bone block arthrodesis provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. These consistent clinical outcomes throughout the literature, despite different lengths of followup periods, suggest that the functional results do not deteriorate with time. Higher confidence recommendations for SDA require longer follow-up, clear indications and treatment protocols, standardized clinical and radiographic outcome measures, and direct comparison or stratification of results based on graft type and other operative techniques. [Table: see text]

Abstract WP117: Therapeutic Hypothermia in Patients With Malignant Ischemic Stroke and Hemicraniectomy: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Andrea Kuczynski ◽  
Andrew Demchuk ◽  
Mohammed Almekhlafi
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Therapeutic Hypothermia ◽  
English Language ◽  
Meta Analysis ◽  
Cardiac Complications ◽  
Target Temperature ◽  
Inclusion Criteria ◽  
Surface Cooling

Introduction: Numerous animal models have demonstrated the efficacy of mild to moderate therapeutic hypothermia (TH) in reducing cerebral edema and conferring protection after ischemic injury. We investigated whether TH had a beneficial effect in stroke patients after hemicraniectomy (HC). Methods: A MEDLINE systematic review was performed. Inclusion criteria included: ≥10 patients with acute malignant ischemic stroke having undergone HC, studies published in full in the English language, and studies reporting on clinical outcome and complications. Results: Thirty-four studies met our search criteria. Six studies with 302 patients with malignant ischemic stroke (TH: n=146, HC alone: n=156) were included. Age, and initial median NIHSS were comparable between the two groups. All studies used systemic TH; four utilized combined TH (venous endovascular and surface cooling), while one study used systemic surface and one used systemic venous endovascular TH. TH was initiated within 37.2 hours (range 24-42 hours) from onset for a median target temperature of TH was 33.6°C (range 33-35°C) and maintained for a median of 72 hours (range 48-96 hours). Target temperature was achieved within 4.5 hours (range 2-36 hours). All studies used rewarming (3 active rewarming). Clinical outcomes at follow-up were not different (follow-up modified Rankin’s 0-2; RR 1.04, 95% CI 0.60-1.80, p=0.9; Figure 1). Cardiac complications were greater in TH (RR 1.79, 95% CI 1.16-2.76, p<0.01). A suggestion of greater mortality was seen with TH (RR 1.43, 95% CI 0.97-2.10, p=0.07), and was significantly greater in studies that did not actively rewarm patients (RR 1.65, 95% CI 1.04-2.60, p<0.05). Conclusions: Clinical and functional outcomes were comparable between patients undergoing systemic TH vs. normothermia following HC despite higher complications associated with TH.

scholarly journals Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 (10) ◽  
pp. 2016
Author(s):  
Mariachiara Ippolito ◽  
Barbara Simone ◽  
Carlotta Filisina ◽  
Francesca Romana Catalanotto ◽  
Giulia Catalisano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Web Of Science ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Inclusion Criteria ◽  
Clinical Consequences

Background: Little is known about the occurrence of bloodstream infections in hospitalized patients with COVID-19 and the related clinical consequences. The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of BSIs among hospitalized patients with COVID-19 and mortality of this patient population. Methods: A systematic search was performed on PubMed, EMBASE, and Web of Science from inception to 19 April 2021. The primary outcome was the occurrence of BSIs among hospitalized patients with COVID-19. The secondary outcome was mortality at the longest available follow-up. Results: Forty-six studies met the inclusion criteria, with a total of 42,694 patients evaluated. The estimated occurrence of BSIs was 7.3% (95% CI 4.7–1.1%) among hospitalized patients with COVID-19, with a mortality rate of 41% (95% CI 30%–52.8%). The subgroup analysis conducted on patients admitted to ICU provided an estimated occurrence of 29.6% (95% CI 21.7%–38.8%). A higher occurrence of BSI was observed in patients with COVID-19, in comparison with patients without COVID-19 (OR 2.77; 95% CI 1.53–5.02; p < 0.001). Conclusions: Our analysis estimated the occurrence of BSIs among hospitalized patients with COVID-19 at around 7%. A four-times higher occurrence was estimated among patients admitted to ICU.

scholarly journals Orbital Paraganglioma: A Systematic Review

2017 ◽  
Vol 79 (04) ◽  
pp. 407-412 ◽  
Author(s):  
Natalie Huang ◽  
Hani Rayess ◽  
Peter Svider ◽  
Nadim Rayess ◽  
Adam Folbe ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Clinical Presentation ◽  
Human Subjects ◽  
Meta Analysis ◽  
Adjuvant Radiation ◽  
Inclusion Criteria ◽  
Presenting Symptoms ◽  
The Mean

Purpose The purpose of this study was to perform a systematic review of the literature on orbital paragangliomas, evaluating clinical presentation, diagnosis, management patterns, and prognosis. Methods The systematic review was conducted based on the principles described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Cochrane databases, Embase, and Web of Science were searched for articles related to orbital paragangliomas. Inclusion criteria included English language articles with original reports on human subjects. Data on clinical presentation, diagnosis, treatment, and prognosis were collected. Results Twenty-seven articles met inclusion criteria (28 total patients). The mean patient age was 37.1 years (range, 3–75 years); 13 (46.4%) patients were male. The most common presenting symptoms were proptosis (89.2%), visual acuity changes (67.9%), and extraocular muscle restriction (64.2%). Lesions were most commonly intraconal (92.9%). Single modality therapy was employed in 19 patients (67.9%), including excision in 12 patients (42.9%) and exenteration in 5 patients (17.9%). Ten patients (35.7%) developed recurrence, and there was a 92.9% survival rate (mean follow-up, 29 months). Conclusion Orbital paragangliomas are rare tumors with an excellent prognosis. These lesions commonly present with proptosis, and are primarily managed surgically with simple excision, although exenteration and adjuvant radiation may be necessary for invasive tumors. This series is the largest and most comprehensive systematic review of orbital paragangliomas conducted to date.

scholarly journals Hydroxicloroquine, What is the Role of the Drug in the Treatment of COVID-19? A Review

2020 ◽  
pp. 7-22
Author(s):  
Eliza Miranda Ramos ◽  
Francisco José Mendes dos Reis ◽  
Gilberto Gonçalves Facco ◽  
Emerson Luiz Lima Araújo ◽  
Igor Domingos de Souza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Meta Analysis ◽  
Clinical Signs ◽  
Inclusion Criteria ◽  
Emerging Virus ◽  
Severe Respiratory Infection ◽  
The Ideal

Introduction: Coronaviruses (COVID-19) is an emerging virus with severe respiratory infection. Despite several efforts, so far there is no medicine to fight it and use it as the ideal treatment. OBJECTIVES: This study aims to describe the role of hydroxychloroquine in the treatment of patients with COVID-19 and thus present its benefits in the respective doses. Methodology: The methodology used was the systematic review with meta-analysis. Results: From the reading of the 75 papers found, only three articles were excluded for not presenting a complete abstract, 65 were excluded for not presenting eligibility according to the inclusion criteria, 01 was excluded for reaching a methodological score below 20 points in Down and Black (1998) and ending the process of inclusion of the articles, only 06 articles were included and included 894 patients. Conclusion: Despite the small number of published articles, this meta-analysis found that the use of hydroxychloroquine as an adjunct therapy in the follow-up of COVID-19 in patients with mild to severe clinical signs brings benefits and avoids hospitalization in intensive care.

scholarly journals Tracheotomy in COVID-19 Patients: A Systematic Review and Meta-analysis of Weaning, Decannulation, and Survival

2021 ◽  
pp. 019459982098478
Author(s):  
Daniel A. Benito ◽  
Daniel E. Bestourous ◽  
Jane Y. Tong ◽  
Luke J. Pasick ◽  
Robert T. Sataloff
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Weighted Average ◽  
Cochrane Library ◽  
Current State ◽  
Ventilation Weaning ◽  
The Cochrane Library ◽  
Mechanical Ventilation Weaning

Objectives A systematic review and meta-analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID-19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means. Data Sources PubMed, SCOPUS, CINAHL, and the Cochrane library. Review Methods Studies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies including patients with COVID-19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random-effects model. Results After identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta-analysis, with a weighted mean follow-up time of 28.6 ± 6.2 days after tracheotomy. Meta-analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%-62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID-19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy. Conclusion At the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID-19 reported in the literature have undergone successful decannulation.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (13) ◽  
pp. 2873
Author(s):  
Cornelia Melinda Adi Santoso ◽  
Fera Ketti ◽  
Taufan Bramantoro ◽  
Judit Zsuga ◽  
Attila Nagy
Keyword(s):  
Systematic Review ◽  
Metabolic Syndrome ◽  
Oral Hygiene ◽  
Reference Lists ◽  
Meta Analysis ◽  
Tooth Brushing ◽  
Inclusion Criteria ◽  
Poor Oral Hygiene ◽  
Dental Visits ◽  
Substantial Heterogeneity

Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to March 17, 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13–0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58–0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81–0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77–1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.

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