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Cureus Jun 2023There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with... (Review)
Review
There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with neurotoxicity. We conducted a systematic review using online data to explore the trend of cefepime-induced neurotoxicity over the last 10 years. Forty-six articles met our inclusion criteria, including 73 cases of cefepime-induced neurotoxicity. We noticed a steady increase in the reports of cefepime-induced neurotoxicity, from one case in 2013 to 11 cases in 2022. Individuals aged 65 and older accounted for most cefepime-induced neurotoxicity cases (52%). The top three indications for cefepime administration included bone and joint infections (25%), urinary tract infections (22.7%), and pneumonia (22.7%). Most patients with renal impairment have never had a renal adjustment of their cefepime dosage (either 2 g 12 hours a day or 2 g eight hours a day). Most cases of cefepime-induced neurotoxicity occurred between days two and five (n=29, 71%), while most resolution occurred between days one and five (n=29, 85%). While cefepime continues to be a popularly used and effective antibiotic against gram-negative bacteria like , its dosage needs to be adjusted in patients with renal impairment to avoid neurotoxicity.
PubMed: 37503476
DOI: 10.7759/cureus.40980 -
AJR. American Journal of Roentgenology Nov 2015Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom,... (Review)
Review
OBJECTIVE
Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom, by whom, and how these potential risks should be discussed with patients. We aimed to provide a review of the literature regarding awareness and communication of potential radiation-induced cancer risks from medical imaging procedures in hopes of providing guidance for communicating these potential risks with patients.
MATERIALS AND METHODS
We performed a systematic literature review on the topics of radiation dose and radiation-induced cancer risk awareness, informed consent regarding radiation dose, and communication of radiation-induced cancer risks with patients undergoing medical imaging. We included original research articles from North America and Europe published between 1995 and 2014.
RESULTS
From more than 1200 identified references, a total of 22 original research articles met our inclusion criteria. Overall, we found that there is insufficient knowledge regarding radiation-induced cancer risks and the magnitude of radiation dose associated with CT examinations among patients and physicians. Moreover, there is minimal sharing of information before nonacute imaging studies between patients and physicians about potential long-term radiation risks.
CONCLUSION
Despite growing concerns regarding medical radiation exposure, there is still limited awareness of radiation-induced cancer risks among patients and physicians. There is also no consensus regarding who should provide patients with relevant information, as well as in what specific situations and exactly what information should be communicated. Radiologists should prioritize development of consensus statements and novel educational initiatives with regard to radiation-induced cancer risk awareness and communication.
Topics: Communication; Diagnostic Imaging; Humans; Informed Consent; Neoplasms, Radiation-Induced; Physician-Patient Relations; Radiation Dosage
PubMed: 26295534
DOI: 10.2214/AJR.15.15057 -
La Radiologia Medica Oct 2018Radiation-induced health risks are broadly questioned in the literature. As cone beam computed tomography (CBCT) is increasingly used in non-dental examinations, its... (Review)
Review
BACKGROUND
Radiation-induced health risks are broadly questioned in the literature. As cone beam computed tomography (CBCT) is increasingly used in non-dental examinations, its effective dose needs to be known. This study aimed to review the published evidence on effective dose of non-dental CBCT for diagnostic use by focusing on dosimetry system used to estimate dose.
MATERIALS AND METHODS
A systematic review of the literature was performed on 12 November 2017. All the literature up to this date was included. The PubMed and web of science databases were searched. Studies were screened for inclusion based on defined inclusion and exclusion criteria according to the preferred reporting items for systematic reviews.
RESULTS
Fifteen studies met the inclusion criteria and were included in our review. Thirteen and two of them examined one and two anatomical areas, respectively. The anatomical areas were: ear (6), paranasal sinuses (4), ankle (3), wrist (2), knee (1), and cervical spine (1). Effective dose was estimated by different methods: (i) RANDO phantom associated with thermoluminescent dosimeters (6), metal oxide semiconductor field-effect transistor dosimeters (3), and optically stimulated luminescent dosimeters (1). (ii) Scanner outputs, namely computed tomography dose index (1) and dose area product (2). (iii) Monte Carlo simulations (2).
CONCLUSION
CBCT of extremities, cervical spine, ears and paranasal sinuses was found to be a low-dose volumetric imaging technique. Effective doses varied significantly because of different exposure settings of CBCT-units and different dosimetry systems used to estimate dose.
Topics: Cone-Beam Computed Tomography; Head; Humans; Neck; Radiation Dosage
PubMed: 29869227
DOI: 10.1007/s11547-018-0910-7 -
Radiotherapy and Oncology : Journal of... Mar 2023Compare the efficacy and safety of high vs standard radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Compare the efficacy and safety of high vs standard radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC).
METHODS AND MATERIALS
This meta-analysis is registered in PROSPERO, and it was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Eligible randomized clinical trials (RCTs) comparing high dose (HD;≥59.4 Gy/1.8 Gy) and standard doses (SD; 50 Gy/2Gy or 50.4 Gy/1.8 Gy) were identified on electronic databases. STATA16.0 was used for statistical analysis. A meta-analysis was performed to compare treatment effect and toxicity.
RESULTS
Four articles with a total of 1014 patients were finally included. The results showed that the two groups had similar 1-, 2-, and 3-year OS rates (RR = 1.08, 95 % CI = 0.90-1.30, P = 0.395; RR = 1.07, 95 % CI = 0.95-1.20, P = 0.272; RR = 1.06, 95 % CI = 0.97-1.17, P = 0.184; respectively) and 2-, and 3-year locoregional progression-free survival (LRPFS) (RR = 0.95, 95 % CI = 0.81-1.10, P = 0.478; RR = 0.97, 95 % CI = 0.85-1.11, P = 0.674; respectively). The HD-RT group had higher grade ≥ 3 treatment-related toxicities (OR = 1.35, 95 % CI = 1.03-1.77, P = 0.029) and treatment-related deaths rates (OR = 1.85, 95 % CI = 1.04-3.28, P = 0.036) compared with the SD-RT group. Results of subgroup analysis also indicated that HD could not bring benefit compared to SD, even with modern radiotherapy techniques.
CONCLUSION
SD-RT had similar treatment effect but lower Grade ≥ 3 treatment-related toxicities rates compared with the HD-RT. Therefore, SD (50 Gy/2Gy or 50.4 Gy/1.8 Gy) should be considered as the recommended dose in dCCRT for EC. Further RCTs are needed to verify our conclusions.
Topics: Humans; Randomized Controlled Trials as Topic; Esophageal Neoplasms; Chemoradiotherapy; Radiotherapy Dosage; Radiation Dosage
PubMed: 36642387
DOI: 10.1016/j.radonc.2023.109463 -
Cancer Biology & Therapy Dec 2023To investigate the impact of radiation dose on the efficacy of definitive chemoradiotherapy(dCCRT) in patients with locally advanced esophageal carcinoma. PubMed,... (Meta-Analysis)
Meta-Analysis
The impact of radiation dose on the efficacy of definitive chemoradiotherapy in patients with locally advanced esophageal carcinoma: a systematic review and meta-analysis.
To investigate the impact of radiation dose on the efficacy of definitive chemoradiotherapy(dCCRT) in patients with locally advanced esophageal carcinoma. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Wanfang, and Chinese National Knowledge Infrastructure(CNKI) were searched for eligible studies. Studies that compared high-dose radiation(HD-RT) group with low-dose radiation(LD-RT) group using modern radiotherapy techniques for locally advanced esophageal carcinoma patients in dCCRT were identified. The hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and the odds ratios (OR) for clinical complete response (cCR), local-regional failure (LRF), distant metastasis (DM), and grade≥3 AEs. Meta-analysis was performed when relevant data were available. Eleven studies involving 1943 patients were included for analyses. The results showed that the HD-RT group had better OS (pooled HR 0.78 [0.70, 0.87], p < .00001), PFS (pooled HR 0.72 [0.55, 0.94], p = .01), cCR (OR 1.52 [1.13, 2.05], p = .005), and LRF (OR 0.60 [0.45, 0.80], p = .0004). In addition, there were no significant differences between the two groups in terms of DM (OR 1.43 [1.00, 2.04], p = .05), grade 3-5 radiation pneumonitis (OR 1.38 [0.71, 2.68], p = .35), grade 3-5 radiation esophagitis (OR 1.36 [0.88, 2.10], p = .17), grade 3-5 other esophageal toxicities(stenosis/fistula/hemorrhage) (OR 1.22 [0.75, 2.00], p = .43), and treatment-related death (OR 1.40 [0.73, 2.68], p = .31). High-dose radiotherapy in definitive CCRT for patients with locally advanced esophageal carcinoma is associated with improved PFS, OS, cCR, and LC with no increase of grade≥3AEs. Simultaneously, we await the preliminary and final results of several ongoing dose-escalation randomized trials. Furthermore, future studies should provide personalized radiotherapy doses for these patients.
Topics: Humans; Chemoradiotherapy; Esophageal Neoplasms; Carcinoma; Progression-Free Survival; Radiation Dosage
PubMed: 36519807
DOI: 10.1080/15384047.2022.2156246 -
Pediatric Radiology Jan 2021Ionizing radiation use for medical diagnostic purposes has substantially increased over the last three decades. Moderate to high doses of radiation are well established... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ionizing radiation use for medical diagnostic purposes has substantially increased over the last three decades. Moderate to high doses of radiation are well established causes of cancer, especially for exposure at young ages. However, cancer risk from low-dose medical imaging is debated.
OBJECTIVE
To review the literature on cancer risks associated with prenatal and postnatal medical diagnostic ionizing radiation exposure among children and to assess this risk through a meta-analysis.
MATERIALS AND METHODS
A literature search of five electronic databases supplemented by a hand search was performed to retrieve relevant epidemiological studies published from 2000 to 2019, including patients younger than 22 years of age exposed to medical imaging ionizing radiation. Pooled odds ratio (OR) and pooled excess relative risk (ERR) representing the excess of risk per unit of organ dose were estimated with a random effect model.
RESULTS
Twenty-four studies were included. For prenatal exposure (radiographs or CT), no significant increased risk was reported for all cancers, leukemia and brain tumors. For postnatal exposure, increased risk was observed only for CT, mostly for leukemia (ERR=26.9 Gy; 95% confidence interval [CI]: 2.7-57.1) and brain tumors (ERR=9.1 Gy; 95% CI: 5.2-13.1).
CONCLUSION
CT exposure in childhood appears to be associated with increased risk of cancer while no significant association was observed with diagnostic radiographs.
Topics: Brain Neoplasms; Child; Female; Humans; Neoplasms, Radiation-Induced; Pregnancy; Radiation Dosage; Radiation Exposure; Radiation, Ionizing; Radiography
PubMed: 32910229
DOI: 10.1007/s00247-020-04803-0 -
International Journal of Dermatology Sep 2017Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies.... (Review)
Review
Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies. However, none have shown effective and sustained results, with incomplete clearance and frequent recurrences. There has been increasing interest recently in oral medications and dietary supplements in improving melasma. We sought to evaluate the efficacy and safety/tolerability of oral medications and dietary supplements for the treatment of melasma. Multiple databases were systematically searched for randomized clinical trials (RCTs) evaluating the use of oral medication for treatment of melasma alone or in combination with other treatments. A total of eight RCTs met inclusion criteria. Oral medications and dietary supplements evaluated include tranexamic acid, Polypodium leucotomos extract, beta-carotenoid, melatonin, and procyanidin. These agents appear to have a beneficial effect on melasma improvement. In conclusion, oral medications have a role in melasma treatment and have been shown to be efficacious and tolerable with a minimal number and severity of adverse events. Therefore, dermatologists should keep oral medications and dietary supplements in their armamentarium for the treatment of melasma.
Topics: Administration, Oral; Antifibrinolytic Agents; Antioxidants; Biflavonoids; Carotenoids; Catechin; Dietary Supplements; Humans; Melanosis; Melatonin; Phytotherapy; Plant Extracts; Polypodium; Proanthocyanidins; Randomized Controlled Trials as Topic; Tranexamic Acid
PubMed: 28239840
DOI: 10.1111/ijd.13578 -
Aviation, Space, and Environmental... Nov 2014Some commercial spaceflight participants (SFPs) may have medical conditions that require implanted medical devices (IMDs), such as cardiac pacemakers, defibrillators,... (Review)
Review
INTRODUCTION
Some commercial spaceflight participants (SFPs) may have medical conditions that require implanted medical devices (IMDs), such as cardiac pacemakers, defibrillators, insulin pumps, or similar electronic devices. The effect of space radiation on the function of IMDs is unknown. This review will identify known effects of terrestrial and aviation electromagnetic interference (EMI) and radiation on IMDs in order to provide insight into the potential effects of radiation exposures in the space environment.
METHODS
A systematic literature review was conducted on available literature on human studies involving the effects of EMI as well as diagnostic and therapeutic radiation on IMDs.
RESULTS
The literature review identified potential transient effects from EMI and diagnostic radiation levels as low as 10 mGy on IMDs. High-energy, therapeutic, ionizing radiation can cause more permanent device malfunctions at doses as low as 40 mGy. Radiation doses from suborbital flight altitudes and durations are anticipated to be less than those experienced during an average round-trip, cross-country airline flight and are unlikely to result in significant detriment, though longer, orbital flights may expose SFPs to doses potentially harmful to IMD function.
DISCUSSION
Individuals with IMDs should experience few, if any, radiation-related device malfunctions during suborbital flight, but could have problems with radiation exposures associated with longer, orbital flights.
Topics: Defibrillators, Implantable; Electromagnetic Radiation; Humans; Pacemaker, Artificial; Radiation Dosage; Radiation, Ionizing; Space Flight
PubMed: 25329943
DOI: 10.3357/ASEM.4104.2014 -
Journal of Vascular Surgery Sep 2015Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is... (Review)
Review
BACKGROUND
Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is less invasive compared with the classic open approach, related to a decreased immediate postoperative morbidity and mortality. Those beneficial characteristics of EVAR do not come without a cost, since EVAR requires that the patient will be exposed to a significant amount of radiation during preoperative planning, graft placement, and consecutive follow-up. This systematic review examines the periprocedural radiation exposure to patients and staff as well as ways to ameliorate it.
METHODS
A systematic literature search was conducted using the MEDLINE electronic database. All articles reporting radiation exposure to alive humans during EVAR were eligible for review. Only studies publishing numerical data regarding radiation exposure were included in the Results section. Other relevant articles were used for further discussion.
RESULTS
Twenty-four studies, both prospective and retrospective in nature, were included. These studies revealed that the radiation exposure depends on the specific type of procedure, with more complex procedures carrying greater radiation burden. Variations in the positioning and operating of the fluoroscopic unit may significantly alter radiation dose to both patients and staff. There was an apparent lack of education among vascular specialists and trainees in terms of radiation safety awareness. At follow-up, a significant number of patients needed additional procedures, and all required radiographic imaging, further increasing the radiation exposure to alarming levels.
CONCLUSIONS
Every effort should be made to decrease radiation exposure related to endovascular aortic procedures. Attempts must be directed towards maximizing the operator's awareness, welcoming new imaging technology emitting less radiation, and shifting to follow-up strategies that require minimal or no radiation.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortography; Endovascular Procedures; Humans; Occupational Exposure; Radiation Dosage; Radiation Injuries; Radiation Monitoring; Radiation Protection; Radiography, Interventional; Risk Assessment; Risk Factors
PubMed: 26169014
DOI: 10.1016/j.jvs.2015.05.033 -
ANZ Journal of Surgery Mar 2015There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a general consensus among reconstructive surgeons that preoperative radiotherapy is associated with a higher risk of flap failure and complications in head and neck surgery. Opinion is also divided regarding the effects of radiation dose on free flap outcomes and timing of preoperative radiation to minimize adverse outcomes. Our meta-analysis will attempt to address these issues.
METHOD
A systematic review of the literature was conducted in concordance to PRISMA protocol. Data were combined using STATA 12 and Open Meta-Analyst software programmes.
RESULTS
Twenty-four studies were included comparing 2842 flaps performed in irradiated fields and 3491 flaps performed in non-irradiated fields. Meta-analysis yielded statistically significant risk ratios for flap failure (RR 1.48, P = 0.004), complications (RR 1.84, P < 0.001), reoperation (RR 2.06, P < 0.001) and fistula (RR 2.05, P < 0.001). Mean radiation dose demonstrated a trend towards increased risk of flap failure, but this was not statistically significant. On subgroup analysis, flaps with >60 Gy radiation had a non-statistically significant higher risk of flap failure (RR 1.61, P = 0.145).
CONCLUSION
Preoperative radiation is associated with a statistically significant increased risk of flap complications, failure and fistula. Preoperative radiation in excess of 60 Gy after radiotherapy represents a potential risk factor for increased flap loss and should be avoided where possible.
Topics: Free Tissue Flaps; Graft Survival; Head and Neck Neoplasms; Humans; Models, Statistical; Neoadjuvant Therapy; Postoperative Complications; Radiotherapy Dosage; Radiotherapy, Adjuvant; Plastic Surgery Procedures; Reoperation; Risk Factors; Treatment Outcome
PubMed: 25345755
DOI: 10.1111/ans.12888