-
Respiratory Medicine Aug 2018Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and... (Review)
Review
BACKGROUND
Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and afferent autonomic nerves. As a consequence, patients develop neurogenic dysphagia with frequent aspiration, chronic lung disease, and chemoreflex failure leading to severe sleep disordered breathing. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of respiratory disorders in familial dysautonomia.
METHODS
We performed a systematic review to summarize the evidence related to our questions. When evidence was not sufficient, we used data from the New York University Familial Dysautonomia Patient Registry, a database containing ongoing prospective comprehensive clinical data from 670 cases. The evidence was summarized and discussed by a multidisciplinary panel of experts. Evidence-based and expert recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
RESULTS
Recommendations were formulated for or against specific diagnostic tests and clinical interventions. Diagnostic tests reviewed included radiological evaluation, dysphagia evaluation, gastroesophageal evaluation, bronchoscopy and bronchoalveolar lavage, pulmonary function tests, laryngoscopy and polysomnography. Clinical interventions and therapies reviewed included prevention and management of aspiration, airway mucus clearance and chest physical therapy, viral respiratory infections, precautions during high altitude or air-flight travel, non-invasive ventilation during sleep, antibiotic therapy, steroid therapy, oxygen therapy, gastrostomy tube placement, Nissen fundoplication surgery, scoliosis surgery, tracheostomy and lung lobectomy.
CONCLUSIONS
Expert recommendations for the diagnosis and management of respiratory disease in patients with familial dysautonomia are provided. Frequent reassessment and updating will be needed.
Topics: Bronchoalveolar Lavage; Bronchoscopy; Brugada Syndrome; Consensus; Deglutition Disorders; Dysautonomia, Familial; Evidence-Based Practice; Humans; New York; Pneumonia, Aspiration; Polysomnography; Prospective Studies; Respiration Disorders; Respiratory Function Tests
PubMed: 30053970
DOI: 10.1016/j.rmed.2018.06.017 -
Clinical Otolaryngology : Official... Jul 2023To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS). (Review)
Review
OBJECTIVE
To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS).
DATA SOURCES
PubMed, Cochrane Library and Scopus.
REVIEW METHODS
Three investigators searched the specified databases for studies investigating the relationship between LPR, GERD and recalcitrant CRS with or without polyposis. The following outcomes were investigated with PRISMA criteria: age; gender; reflux and CRS diagnosis; association outcomes and potential treatment outcomes. The authors performed a bias analysis of papers and provided recommendations for future studies.
RESULTS
A total of 17 studies investigated the association between reflux and recalcitrant CRS. According to pharyngeal pH monitoring, 54% of patients with recalcitrant CRS reported hypo or nasopharyngeal acid reflux events. The number of hypo- and nasopharyngeal acid reflux events was significantly higher in patients compared to healthy individuals in 4 and 2 studies, respectively. Only one study did not report intergroup differences. The proportion of GERD was significantly higher in CRS patients compared to controls, with a prevalence ranging from 32% to 91% of cases. No author considered nonacid reflux events. There was significant heterogeneity in the inclusion criteria; definition of reflux and association outcomes, limiting the ability to draw clear conclusions. Pepsin was found in sinonasal secretions more frequently in CRS patients than controls.
CONCLUSION
Laryngopharyngeal reflux and GERD may be contributing factors of CRS therapeutic resistance, but future studies are needed to confirm the association considering nonacid reflux events.
Topics: Humans; Laryngopharyngeal Reflux; Esophagitis, Peptic; Pepsin A; Sinusitis
PubMed: 36895147
DOI: 10.1111/coa.14047 -
Iranian Journal of Public Health Jan 2021Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of... (Review)
Review
BACKGROUND
Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of cancer studies in Iran.
METHODS
This systematic review examined the types of direct medical and non-medical costs and indirect costs in cancer patients and includes studies in English and Persian that were reviewed in Scopus, Web of science, SID, Iranmedex, Magiran and databases of Medline, etc., from 1995-2019.
RESULTS
Twenty-one articles were included. Most studies have examined the direct costs of all types of cancers. The articles reviewed different types of cancer, such as prostate cancer (n=2), colorectal cancer (n=2), breast cancer (n=4), gastric cancer (n=2), oral and pharyngeal cancer (n=1), lung cancer (n=3), and blood cancer (n=4). The great number of studies were related to the gastrointestinal, breast and blood cancers. The gastrointestinal (gastric and colorectal) and breast cancer had the major economic burden than others.
CONCLUSION
It is necessary that special attention to patients, supportive measures to reduce the share of costs, and more budget allocation for prevention, screening and early detection being at priorities in the health system planning.
PubMed: 34178762
DOI: 10.18502/ijph.v50i1.5070 -
Strahlentherapie Und Onkologie : Organ... Sep 2023Reirradiation is a potentially useful option for many patients with recurrent cancer, aiming at cure or symptom palliation, depending on disease/recurrence type and... (Review)
Review
BACKGROUND
Reirradiation is a potentially useful option for many patients with recurrent cancer, aiming at cure or symptom palliation, depending on disease/recurrence type and stage. The purpose of this follow-up study to a previous review from 2016 was to summarize all recently published randomized trials. Points of interest again included identifcation of methodological strengths and weaknesses, practice-changing results, and open questions.
MATERIAL AND METHODS
Systematic review of trials published between 2015 and February 2023.
RESULTS
We reviewed 7 additional trials, most of which addressed reirradiation of head and neck or brain tumours. The median number of patients was 60. Mirroring the previous review, trial design, primary endpoints and statistical hypotheses varied widely. The updated results only impact on decision making for reirradiation of nasopharynx cancer and glioma. Patients with one of these diseases, as well as other head and neck cancers, may benefit from reirradiation-induced local control, e.g. in terms of progression-free survival. For the first time, hyperfractionated radiotherapy emerged as preferred option for recurrent, inoperable nasopharynx cancer. Despite better therapeutic ratio with hyperfractionation, serious toxicity remains a concern after high cumulative total doses. Randomized trials are still lacking for prostate cancer and other sites.
CONCLUSION
Multicentric randomized trials on reirradiation are feasible and continue to refine the current standard of care for recurrent disease after previous radiotherapy. Ongoing prospective studies such as the European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer (ESTRO-EORTC) observational cohort ReCare (NCT: NCT03818503) will further shape the clinical practice of reirradiation.
Topics: Male; Humans; Re-Irradiation; Prospective Studies; Follow-Up Studies; Neoplasm Recurrence, Local; Head and Neck Neoplasms; Nasopharyngeal Neoplasms
PubMed: 37500926
DOI: 10.1007/s00066-023-02118-1 -
The Cochrane Database of Systematic... Jul 2015Antibiotics are sometimes used to prevent recurrent sore throat, despite concern about resistance. However, there is conflicting primary evidence regarding their... (Review)
Review
BACKGROUND
Antibiotics are sometimes used to prevent recurrent sore throat, despite concern about resistance. However, there is conflicting primary evidence regarding their effectiveness.
OBJECTIVES
To assess the effects of antibiotics in patients with recurrent sore throat.
SEARCH METHODS
The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 25 June 2015.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of antibiotics in adults and children suffering from pre-existing recurrent sore throat, defined as three or more sore throats in a year, examining the incidence of sore throat recurrence, with follow-up of at least 12 months post-antibiotic therapy.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. Multiple attempts to contact the authors of one study yielded no response.
MAIN RESULTS
We identified no trials that met the inclusion criteria for the review. We discarded the majority of the references retrieved from our search following screening of the title and abstract. We formally excluded four studies following review of the full-text report.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine the effectiveness of antibiotics for preventing recurrent sore throat. This finding must be balanced against the known adverse effects and cost of antibiotic therapy, when considering antibiotics for this purpose. There is a need for high quality RCTs that compare the effects of antibiotics versus placebo in adults and children with pre-existing recurrent sore throat on the following outcomes: incidence of sore throat recurrence, adverse effects, days off work and absence from school, and the incidence of complications. Future studies should be conducted and reported according to the CONSORT statement.
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Pharyngitis; Recurrence; Secondary Prevention
PubMed: 26171901
DOI: 10.1002/14651858.CD008911.pub2 -
Cancer Treatment and Research... 2023Radiation-induced oral mucositis (RIOM) is one of the common toxic reactions from ionizing radiation and normal tissue injuries as a complication of radiation therapy... (Review)
Review
Radiation-induced oral mucositis (RIOM) is one of the common toxic reactions from ionizing radiation and normal tissue injuries as a complication of radiation therapy and chemotherapy. Radiation therapy is an option for the treatment of head and neck cancer (HNC). The use of natural products is an alternative therapy for RIOM. This review aimed to describe the effectiveness of natural-based products (NBPs) in reducing the severity, pain score, incidence, oral lesion size, and other symptoms such as dysphagia, dysarthria, and odynophagia. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Pubmed, ScienceDirect, and Ebscohost-CINAHL Plus databases were used for article searches. The inclusion criteria were studies published from 2012 to 2022 with full text available, in English, a study in humans, and a Randomized Clinical Trial (RCT) that evaluate the effect of NBPs therapy in RIOM patients diagnosed with HNC. This study's population was HNC patients who had oral mucositis after receiving radiation or chemical therapy. The NBPs were manuka honey, thyme honey, aloe vera, calendula, zataria multiflora, Plantago major L., and turmeric. Eight of the twelve included articles showed significant effectiveness against RIOM in various parameters, such as a decrease in severity, incidence rate, pain score, oral lesion size, and the other symptoms of oral mucositis such as dysphagia and burning mouth syndrome. This review concludes that NBPs therapy is effective for RIOM in HNC patients.
Topics: Humans; Deglutition Disorders; Head and Neck Neoplasms; Radiation Injuries; Randomized Controlled Trials as Topic; Stomatitis
PubMed: 37209466
DOI: 10.1016/j.ctarc.2023.100720 -
Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis.European Journal of Medical Research Aug 2016Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries and neurosurgical procedures performed to treat a variety of disorders in the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries and neurosurgical procedures performed to treat a variety of disorders in the cervical spine. Over the last several years, ACDF has been done in the outpatient setting for less invasive approaches and exposures, as well as modified anesthetic and pain management techniques. Despite the fact that it may be innocuous in other parts of the body, complications in the spine can literally be fatal. The objective of this article is to evaluate the safety of outpatient surgery compared with inpatient surgery in the cervical spine for adult patients.
METHODS
The multiple databases including Pubmed, Springer, EMBASE, EBSCO and China Journal Full-text Database were adopted to search for the relevant studies in English or Chinese. Full-text articles involving to the safety of outpatient cervical spine surgery were selected. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Chi-square tests were conducted with SPSS 20.0 software.
RESULTS
Finally, 12 articles were included. The results of meta-analysis suggested that in the articles included, no death occurred, and compared with inpatient surgery, outpatient surgery has a similar risk (RR = 0.99, 95 % CI [0.98, 1.00], P = 0.02; P for heterogeneity = 0.47, I (2) = 0 %). An I (2) value of 0 % indicates no heterogeneity observed. All complications were occurred in both outpatients and inpatients. Among the studies selected, after the outpatient spine surgery, the highest incidences of complication were dysphagia (18/29) and hematoma (4/29). Compared with the overall complication rate in inpatient group, no significant difference was observed (x (2) = 1.820, P = 0.177).
CONCLUSION
In this study, outpatient surgery has a similar risk with inpatient surgery, and no difference of morbidity between outpatient and inpatient was found. Because of short operative time and moderate postoperative pain, we believe that outpatient cervical spine surgery is a safe and convenient alternative procedure, which also decrease the cost of care. Besides, postoperative complications including dysphagia and hematoma should be noticed.
Topics: Adult; Cervical Vertebrae; Deglutition Disorders; Diskectomy; Humans; Postoperative Hemorrhage; Spinal Fusion
PubMed: 27582129
DOI: 10.1186/s40001-016-0229-6 -
European Journal of Pediatrics May 2023to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11-63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11-63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%). Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae.
WHAT IS KNOWN
• Survival rates of esophageal atresia patients is now more than 90% thanks to the improvements in surgical techniques and intensive care, therefore patients' needs throughout adolescence and adulthood must be taken into account.
WHAT IS NEW
• This review, by summarizing recent literature concerning long term sequelae of esophageal atresia, may contribute to raise awareness on the importance of defining standardized protocols of transitional and adulthood care for esophageal atresia patients.
Topics: Adolescent; Adult; Child; Humans; Middle Aged; Young Adult; Barrett Esophagus; Deglutition Disorders; Disease Progression; Esophageal Atresia; Follow-Up Studies; Gastroesophageal Reflux; Quality of Life; Transitional Care
PubMed: 36905437
DOI: 10.1007/s00431-023-04893-6 -
Dysphagia Feb 2023Oropharyngeal dysphagia (OD) is a high impact morbidity in head-and-neck cancer (HNC) patients. A wide variety of instruments are developed to screen for affective... (Review)
Review
Oropharyngeal dysphagia (OD) is a high impact morbidity in head-and-neck cancer (HNC) patients. A wide variety of instruments are developed to screen for affective symptoms and OD. The current paper aims to systematically review and appraise the literature to obtain insight into the prevalence, strength, and causal direction of the relationship between affective symptoms and OD in HNC patients. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed, PsycINFO, Cochrane, and Embase. All available publications reporting on the relationship between affective conditions and swallowing function in HNC patients were included. Conference papers, tutorials, reviews, and studies with less than 5 patients were excluded. Fifteen studies met the inclusion criteria. The level of evidence and methodological quality were assessed using the ABC-rating scale and QualSyst critical appraisal tool. Eleven studies reported a positive relationship between affective symptoms and OD. The findings of this paper highlight the importance of affective symptom screening in dysphagic HNC patients as clinically relevant affective symptoms and OD seems to be prevalent and coincident in this population. Considering the impact of affective symptoms and OD on patients' daily life, early detection and an integrated interdisciplinary approach are recommended. However, due to the heterogeneity of study designs, outcomes, and outcome measures, the generalization of study results is limited.
Topics: Humans; Deglutition Disorders; Affective Symptoms; Deglutition; Head and Neck Neoplasms; Prevalence
PubMed: 35796877
DOI: 10.1007/s00455-022-10484-8 -
Frontiers in Endocrinology 2023The safety results of different recommended doses of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) for patients with type 2 diabetes mellitus (T2DM) remain... (Comparative Study)
Comparative Study Meta-Analysis
Comparative safety of different recommended doses of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis of randomized clinical trials.
OBJECTIVE
The safety results of different recommended doses of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) for patients with type 2 diabetes mellitus (T2DM) remain uncertain. This study aims to comprehensively estimate and rank the relative safety outcomes with different doses of SGLT-2i for T2DM.
METHODS
PubMed, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, WanFang database, and SinoMed database were searched from the inception to 31 May 2023. We included double-blind randomized controlled trials (RCTs) comparing SGLT-2i with placebo or another antihyperglycemic as oral monotherapy in the adults with a diagnosis of T2DM.
RESULTS
Twenty-five RCTs with 12,990 patients randomly assigned to 10 pharmacological interventions and placebo were included. Regarding genital infections (GI), all SGLT-2i, except for ertugliflozin and ipragliflozin, were associated with a higher risk of GI compared to placebo. Empagliflozin 10mg/d (88.2%, odds ratio [OR] 7.90, 95% credible interval [CrI] 3.39 to 22.08) may be the riskiest, followed by empagliflozin 25mg/d (83.4%, OR 7.22, 95%CrI 3.11 to 20.04)) and canagliflozin 300mg/d (70.8%, OR 5.33, 95%CrI 2.25 to 13.83) based on probability rankings. Additionally, dapagliflozin 10mg/d ranked highest for urinary tract infections (UTI, OR 2.11, 95%CrI 1.20 to 3.79, 87.2%), renal impairment (80.7%), and nasopharyngitis (81.6%) when compared to placebo and other treatments. No increased risk of harm was observed with different doses of SGLT-2i regarding hypoglycemia, acute kidney injury, diabetic ketoacidosis, or fracture. Further subgroup analysis by gender revealed no significantly increased risk of UTI. Dapagliflozin 10mg/d (91.9%) and canagliflozin 300mg/d (88.8%) ranked first in the female and male subgroups, respectively, according to the probability rankings for GI.
CONCLUSION
Current evidence indicated that SGLT-2i did not significantly increase the risk of harm when comparing different doses, except for dapagliflozin 10mg/d, which showed an increased risk of UTI and may be associated with a higher risk of renal impairment and nasopharyngitis. Additionally, compared with placebo and metformin, the risk of GI was notably elevated for empagliflozin 10mg/d, canagliflozin 300mg/d, and dapagliflozin 10mg/d. However, it is important to note that further well-designed RCTs with larger sample sizes are necessary to verify and optimize the current body of evidence.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023396023.
Topics: Female; Humans; Male; Canagliflozin; Diabetes Mellitus, Type 2; Glucose; Nasopharyngitis; Network Meta-Analysis; Randomized Controlled Trials as Topic; Sodium; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 38027214
DOI: 10.3389/fendo.2023.1256548