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Dermatology (Basel, Switzerland) 2024Chronic prurigo (CPG) is an inflammatory skin disease. Comorbidities including dermatological, cardiovascular, and psychiatric diseases have been reported in patients... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic prurigo (CPG) is an inflammatory skin disease. Comorbidities including dermatological, cardiovascular, and psychiatric diseases have been reported in patients with CPG; however, the evidence has not been systematically evaluated. We aim to summarize the comorbidities, discuss underlying pathogenesis, and highlight the evaluation of CPG patients.
METHODS
We performed a systematic search using PubMed, Embase, and Web of Science databases for all articles reporting possible associated diseases with CPG. Pooled random-effects odds ratios (ORs) with 95% CI were calculated.
RESULTS
A total of 17 studies were included in this systematic review. Statistically significant association (p <0.05) with CPG has been demonstrated with atopic diseases: atopic dermatitis (pooled OR, 10.91; 95% CI, 3.65-32.67), allergic rhinitis (2.66; 1.12-6.27), asthma (3.23; 1.55-6.74); infectious diseases: hepatitis B (pooled OR, 2.15; 95% CI, 1.11-4.14); endocrine diseases: diabetes (pooled OR, 4.93; 95% CI, 1.13-21.56), type 1 diabetes (2.46; 2.16-2.81), type 2 diabetes (1.89; 1.34-2.68), hyperlipoproteinemia (2.90; 1.61-5.22); cardiovascular diseases: heart failure (pooled OR, 4.13; 95% CI, 1.15-14.91), hypertension (3.17; 1.56-6.45); respiratory system diseases: chronic obstructive pulmonary disease (pooled OR, 3.19; 95% CI, 1.42-7.16); urinary system diseases: chronic kidney disease (pooled OR, 4.16; 95% CI, 1.79-9.66); digestive system disease: inflammatory bowel disease (pooled OR, 2.06; 95% CI, 1.26-3.36); and others: osteoporosis (pooled OR, 3.08; 95% CI, 1.70-5.59), thyroid disease (1.70; 1.17-2.47).
CONCLUSION
CPG is associated with various systemic disorders. Recognition of comorbidities is critical to the appropriate management of affected patients.
Topics: Humans; Diabetes Mellitus, Type 2; Prurigo; Comorbidity; Asthma; Dermatitis, Atopic
PubMed: 37883943
DOI: 10.1159/000534660 -
Infection Oct 2023Currently, there are no standardized guidelines for the diagnosis or management of the complications of urogenital schistosomiasis (UGS). This systematic review of the... (Review)
Review
BACKGROUND
Currently, there are no standardized guidelines for the diagnosis or management of the complications of urogenital schistosomiasis (UGS). This systematic review of the literature aims to investigate the state of the art in reference to diagnostic approaches and the clinical management of this condition.
METHODS
A systematic review of literature published between January 1990 and January 2021 was conducted in the MEDLINE database, scoping for articles regarding diagnostic means or therapeutic options for the complications of UGS, namely obstructive uropathy, bladder cancer, abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures. Relevant data were then extracted from the articles deemed eligible according to the inclusion criteria.
MAIN RESULTS
In total, 3052 articles were identified by the research query, of which 167 articles fulfilling inclusion criteria after title/abstract screening and full-text evaluation were included, 35% on both diagnostic and therapeutic aspects, and 51% on diagnosis and 14% on therapy. Ultrasound was the most frequently tool employed for the diagnosis of UGS complications showing a good performance. Concerning the management of hydronephrosis, the majority of available evidences came from community-based studies where universal treatment with praziquantel was used leading to decrease of prevalence of obstructive uropathy. Concerning studies on surgical procedures, laser endoureterotomy followed by stenting was mostly employed in adult patients leading to a crude cure rate of 60% (43 of 71 patients). In the case of severe hydronephrosis, surgery consisting of ureteral re-implantation showed excellent results with a crude cure rate of 98% (157 cured patients of 160 treated). Concerning bladder cancer, data on 93 patients with a clear diagnosis of UGS-related bladder were available reporting a variable and sometime combined approach based on disease stage. Available data on diagnosis and management of abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures due to UGS are also presented.
CONCLUSIONS
The review produced a complete picture of the diagnostic and therapeutic options currently available for complicated UGS. These results can be useful both for guiding clinicians towards correct management and for tracing the direction of future research.
Topics: Female; Pregnancy; Adult; Humans; Schistosomiasis haematobia; Hydronephrosis; Infertility; Pregnancy, Ectopic; Renal Insufficiency; Urinary Bladder Neoplasms; Urolithiasis
PubMed: 37466786
DOI: 10.1007/s15010-023-02060-5 -
Current Problems in Cardiology Nov 2023Transcatheter aortic valve replacement (TAVR) is indicated for high-risk patients with severe degenerative aortic stenosis (AS). Given the shared risk factors and... (Meta-Analysis)
Meta-Analysis Review
Transcatheter aortic valve replacement (TAVR) is indicated for high-risk patients with severe degenerative aortic stenosis (AS). Given the shared risk factors and coexistence of obstructive coronary artery disease (CAD) and AS, there is inconsistent clinical data regarding potential survival benefits of paired percutaneous coronary intervention (PCI) with TAVR procedures. We performed a literature search using PubMed, Embase, and Cochrane Library from inception through June 2023 assessing the impact of concomitant PCI in patients with obstructive CAD undergoing TAVR. The primary outcomes were 30-day all-cause mortality, 30-day cardiovascular mortality, and 6 months-1 year all-cause mortality. Secondary outcomes included 30-day myocardial infarction, stroke, major bleeding complications, and acute kidney injury (AKI). A total of 11 studies involving 2804 patients were included in the final analysis. Compared to patients undergoing TAVR alone, the TAVR+PCI group showed no significant difference in 30-day all-cause mortality (RR 0.90, CI 0.66, 1.22, P = 0.49), 30-day cardiovascular mortality (RR 0.71 CI 0.44, 1.14, P = 0.16), or 6 months-1 year all-cause mortality (RR 0.94, CI 0.75, 1.18, P = 0.57). Regarding secondary outcomes, 30-day myocardial infarction was higher in the TAVR+PCI group (RR 3.09, CI 1.26, 7.57, P = 0.01), with no significant differences noted in rates of 30-day stroke (RR 1.14, CI 0.56, 2.33, P = 0.72), major bleeding/vascular complications (RR 1.11, CI 0.79, 1.56, P = 0.55), and AKI (RR 1.07, CI 0.75, 1.54, P = 0.71). Concomitant PCI does not confer any mortality benefit in patients with obstructive CAD and high-grade AS undergoing TAVR. Further trials are needed to confirm our findings.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Percutaneous Coronary Intervention; Aortic Valve; Coronary Artery Disease; Risk Factors; Myocardial Infarction; Stroke; Treatment Outcome; Acute Kidney Injury; Hemorrhage
PubMed: 37473936
DOI: 10.1016/j.cpcardiol.2023.101980 -
The Cochrane Database of Systematic... Nov 2023Kidney stones (also called renal stones) can be a source of pain, obstruction, and infection. Depending on size, location, composition, and other patient factors, the... (Review)
Review
BACKGROUND
Kidney stones (also called renal stones) can be a source of pain, obstruction, and infection. Depending on size, location, composition, and other patient factors, the treatment of kidney stones can involve observation, shock wave lithotripsy, retrograde intrarenal surgery (RIRS; i.e. ureteroscopic approaches), percutaneous nephrolithotomy (PCNL), or a combination of these approaches.
OBJECTIVES
To assess the effects of percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.
SEARCH METHODS
We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, Scopus, and two trials registries up to 23 March 2023. We applied no restrictions on publication language or status.
SELECTION CRITERIA
We included randomized controlled trials that evaluated PCNL (grouped by access size in French gauge [Fr] into three groups: ≥ 24 Fr [standard PCNL], 15-23 Fr [mini-PCNL and minimally invasive PCNL], and < 15 Fr [ultra-mini-, mini-micro-, super-mini-, and micro-PCNL]) versus RIRS.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies and extracted data from the included studies. Our primary outcomes were stone-free rate, major complications, and need for secondary interventions. Our main secondary outcomes were unplanned medical visits to emergency/urgent care or outpatient clinic, length of hospital stay, ureteral stricture or injury, and quality of life. We performed statistical analyses using a random-effects model. We rated the certainty of evidence using GRADE criteria. We adopted a minimally contextualized approach with predefined thresholds for minimal clinically important differences (MCIDs).
MAIN RESULTS
We included 42 trials assessing the effects of PCNL versus RIRS in 4571 randomized participants. Twenty-two studies were published as full-text articles, and 20 were published as abstract proceedings. The average size of stones ranged from 10.1 mm to 39.1 mm. Most studies did not report sources of funding or conflicts of interest. The main results for the most important outcomes are summarized below. Stone-free rate PCNL compared with RIRS may improve stone-free rates (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08 to 1.18; I = 71%; 39 studies, 4088 participants; low-certainty evidence). Based on 770 participants per 1000 being stone-free with RIRS, this corresponds to 100 more (62 more to 139 more) stone-free participants per 1000 with PCNL (an absolute difference of 10%, where the predefined MCID was 5%). Major complications PCNL compared with RIRS probably has little or no effect on major complications (RR 0.86, 95% CI 0.59 to 1.25; I = 15%; 34 studies, 3649 participants; moderate-certainty evidence). Based on 31 complications in the RIRS group, this corresponds to six fewer (13 fewer to six more) major complications per 1000 with PCNL (an absolute difference of 0.6%, where the predefined MCID was 2%). Need for secondary interventions PCNL compared with RIRS may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17 to 0.55; I = 61%; 21 studies, 2005 participants; low-certainty evidence). Based on 222 secondary interventions in the RIRS group, this corresponds to 153 fewer (185 fewer to 100 fewer) secondary interventions per 1000 with PCNL (an absolute difference of 15.3%, where the predefined MCID was 5%). Unplanned medical visits No studies reported unplanned medical visits. Length of hospital stay PCNL compared with RIRS may extend length of hospital stay (mean difference 1.04 days more, 95% CI 0.27 more to 1.81 more; I = 100%; 26 studies, 2804 participants; low-certainty evidence). This effect size is greater than the predefined MCID of one day. Ureteral stricture or injury PCNL compared with RIRS may have little or no effect on the occurrence of ureteral strictures (RR 0.93, 95% CI 0.39 to 2.21; I = 0%; 13 studies, 1574 participants; low-certainty evidence). Based on 14 ureteral strictures in the RIRS group, this corresponds to one fewer (nine fewer to 17 more) ureteral strictures per 1000 with PCNL (an absolute difference of 0.1%, where the predefined MCID was 2%). Quality of life No studies reported quality of life.
AUTHORS' CONCLUSIONS
Based on a large body of evidence from 42 trials, we found that PCNL compared with RIRS may improve stone-free rates and may reduce the need for secondary interventions, but probably has little or no effect on major complications. PCNL compared with RIRS may have little or no effect on ureteral stricture rates and may increase length of hospital stay. We found no evidence on unplanned medical visits or participant quality of life. Because of the considerable shortcomings of the included trials, the evidence for most outcomes was of low certainty. Access size for PCNL was less than 24 Fr in most studies that provided this information. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.
Topics: Adult; Humans; Nephrolithotomy, Percutaneous; Constriction, Pathologic; Quality of Life; Kidney Calculi; Lithotripsy; Ureteral Obstruction
PubMed: 37955353
DOI: 10.1002/14651858.CD013445.pub2 -
Sleep & Breathing = Schlaf & Atmung Oct 2023Obstructive sleep apnea (OSA) is frequently reported among patients with chronic kidney disease resulting in considerable morbidity and mortality. OSA may cause... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Obstructive sleep apnea (OSA) is frequently reported among patients with chronic kidney disease resulting in considerable morbidity and mortality. OSA may cause repetitive stimulation of the sympathetic nervous system and elevations in pulmonary artery pressure leading to an elevated risk of cardiac and vascular complications in patients with chronic kidney disease. Furthermore, OSA is associated with progressive worsening of kidney injury and loss of renal function.
METHODS
In this systematic review and meta-analysis, we evaluated the effect of renal transplantation on the progression of OSA in patients with end-stage kidney disease.
RESULTS
The meta-analysis included eight studies with a total of 401 patients. Findings showed that kidney transplantation does not lead to a statistically significant effect on the apnea-hypopnea index (MD 2.6 events/hr, 95% CI -3.2 to 8.3, p = 0.21), total sleep time (MD 14.7 min/night, 95% CI -8.4 to 37.8, p = 0.76), sleep efficiency (MD 2.5%, 95% CI -1.4 to 6.3, p = 0.57), slow wave sleep (MD 0.4% of total sleep time, 95% CI -7.5 to 8.4, p = 0.05), and rapid eye movement sleep (MD 0.6% of total sleep time, 95% CI -2.2 to 3.3, p = 0.98). There was no statistically significant effect of kidney transplantation on OSA in patients with chronic renal disease.
Topics: Humans; Kidney Transplantation; Kidney Failure, Chronic; Sleep Apnea, Obstructive; Renal Insufficiency, Chronic; Kidney
PubMed: 36928547
DOI: 10.1007/s11325-023-02803-6 -
Current Urology Reports Dec 2023In this study, we describe a rare case of a male with a duplex renal collecting system with ectopic ureter insertion into the prostate who presented with sepsis and... (Review)
Review
PURPOSE OF REVIEW
In this study, we describe a rare case of a male with a duplex renal collecting system with ectopic ureter insertion into the prostate who presented with sepsis and required urgent laparoscopic radical nephrectomy. This study offers urologists and emergency care practitioners a great overview of the variety of manifestations, anatomic differences, and therapeutic approaches for similar patients.
RECENT FINDINGS
modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters. There is a spectrum of acute presentations and management strategies in adult patients with duplex collecting systems. The majority of patients presenting with obstruction and infection are managed surgically with hemi-nephrectomy; stable patients who present with less extensive anomalies were managed conservatively or with ureteral dilatation or deroofing.
Topics: Adult; Humans; Male; Infant; Kidney; Ureter; Kidney Diseases; Kidney Pelvis; Ureteral Obstruction
PubMed: 37943428
DOI: 10.1007/s11934-023-01190-5 -
Renal Failure Jan 2024Currently, there is no consensus on the optimal timing for the initiation of peritoneal dialysis (PD) after catheter placement. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Currently, there is no consensus on the optimal timing for the initiation of peritoneal dialysis (PD) after catheter placement.
DESIGN
Systematic review and meta-analysis.
EXACT DATE OF DATA COLLECTION
From inception till July 31, 2023.
MAIN OUTCOME MEASURES
To assess the outcomes and safety of unplanned PD initiation (<14/7 days after catheter insertion) in cohort studies.
RESULTS
Fifteen studies involving 3054 participants were included. (1) The risk of unplanned initiation of leakage and Obstruction was no difference in both the break-in period (BI) <14 and BI < 7 groups. (2) Catheter displacement was more likely to occur in the emergency initiation group with BI < 7. (3) No significant differences were observed between the two groups regarding infectious complications. (4) There was no difference in transition to HD between patients with BI < 7 and BI < 14 d.
CONCLUSION
Infectious complications of unplanned initiation of peritoneal dialysis did not differ from planned initiation. Emergency initiation in the BI < 7 group had higher catheter displacement, but heterogeneity was higher. There were no differences in leakage or obstruction in either group. Catheter survival was the same for emergency initiation of peritoneal dialysis compared with planned initiation of peritoneal dialysis and did not increase the risk of conversion to hemodialysis.
REGISTRATION
This meta-analysis was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023431369).
Topics: Humans; Cohort Studies; Kidney Failure, Chronic; Peritoneal Dialysis; Prognosis; Renal Dialysis
PubMed: 38391179
DOI: 10.1080/0886022X.2024.2312533 -
Panminerva Medica Sep 2023Statins produce significant hypolipidemic effects and reduce C-reactive protein (CRP) in patients with chronic obstructive pulmonary disease (COPD). It has been reported... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Statins produce significant hypolipidemic effects and reduce C-reactive protein (CRP) in patients with chronic obstructive pulmonary disease (COPD). It has been reported that statins did not prevent the acute exacerbation of COPD or improve clinical outcomes. Therefore, we analyzed the actual therapeutic effects of statins on COPD therapy during long-term clinical trials.
EVIDENCE ACQUISITION
Relevant studies were retrieved from various databases from 2008 to 2019. For each study, Odds Ratios (ORs), mean difference (MD) and 95% confidence interval (95% CI) were assessed.
EVIDENCE SYNTHESIS
Thirty-two studies were retrieved with 3137 patients receiving statin therapy and 3140 controls. Satins significantly increased exercise capacity (47.21, 95% CI: 20.79-73.63), lung FEV1 (4.02, 95% CI: 2.28-5.75), forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) (3.56, 95% CI: 2.01-5.10) and high-density lipoproteins (HDL) (5.573, 95% CI: 1.74-9.41). In addition, statins downregulated CRP function (W=-1.60, 95% CI: -2.45-0.76), IL-6 (-3.35, 95% CI: -4.94 to -1.76), St George's breath questionnaire (SGRQ) scores (-9.96, 95% CI: -12.83 to -7.10), COPD assessment test (CAT) (-3.49, 95% CI: -4.70 to 2.29) and systolic blood pressure (-4.992, 95% CI: -5.17 to -4.818). Total cholesterol (TC) (-37.84, 95% CI: -46.10 to 29.58) low-density lipoproteins (LDL) (-26.601, 95% CI: -26.688 to 26.514) and triglycerides (TG) (-42.914, 95% CI: -61.809 to 24.02) were also decreased.
CONCLUSIONS
Clinical trials conducted over a 10-year period revealed beneficial advantages of statin therapy in COPD patients, permitting increased exercise capacity, FEV1/FVC and HDL. In addition, CRP, IL-6, systolic blood pressure, SGRQ scores and CAT were significantly decreased as well as lipid levels.
Topics: Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Interleukin-6; Quality of Life; Pulmonary Disease, Chronic Obstructive; Lung
PubMed: 32343509
DOI: 10.23736/S0031-0808.20.03932-4 -
Sleep Medicine Jul 2024Obstructive sleep apnea (OSA) is a common sleep disorder among chronic kidney disease (CKD) patients, associated with considerable morbidity. Various studies from around... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnea (OSA) is a common sleep disorder among chronic kidney disease (CKD) patients, associated with considerable morbidity. Various studies from around the globe have reported different prevalence rates.
OBJECTIVE
This systematic review and meta-analysis aimed to determine the prevalence of OSA and quantify the relationship between OSA and mortality risk in patients with CKD.
METHODS
Four databases were systematically searched, and additional references to relevant articles were manually searched. The prevalence of OSA and the mortality risk based on random-effects models were assessed using percentages and hazard ratio (HR) with a 95 % confidence interval (95 % CI). In addition, the heterogeneity between studies was assessed using I statistics.
RESULTS
A total of 44 literature (47 studies with 223,967 participants) met the eligibility criteria for the meta-analysis. The results showed that the prevalence of OSA in CKD patients was reported to be 39.3 % (95 % CI, 32.3-46.7). Among study participants in different age groups, the highest prevalence of OSA was found in CKD respondents aged 60 years or older, at 47.1 % (95 % CI 34.4-60.3). Of the eight literature (10 cohorts) that provided survival data, the pooled estimates indicated a 26.5 % (HR: 1.265; 95 % CI 1.021-1.568) higher mortality risk in subjects with OSA than CKD patients without OSA.
CONCLUSIONS
This systematic review and meta-analysis found that more than 1/3 of CKD patients have comorbid OSA, which increases the risk of early death in CKD patients. These results should help policymakers to provide adequate healthcare for this population.
PROSPERO REGISTRATION ID
CRD42023465497.
Topics: Humans; Sleep Apnea, Obstructive; Renal Insufficiency, Chronic; Prevalence; Risk Factors
PubMed: 38805860
DOI: 10.1016/j.sleep.2024.05.047 -
Renal Failure Dec 2024To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis.
METHODS
The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model.
RESULTS
Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%-43%), and the prevalence according to CKD status were 31% (95% CI: 20%-42%) for CKD (I-V), 39% (95% CI: 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%-50%) for ESKD (hemodialysis), and 26% (95% CI: 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18-1.63; < 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; < 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05-2.51; = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18-2.46; = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38-2.55; < 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88-4.87; < 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18-9.98; < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death.
CONCLUSION
This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.
Topics: Humans; Hypertension, Pulmonary; Renal Insufficiency, Chronic; Prevalence; Prognosis; Risk Factors; Renal Dialysis; Observational Studies as Topic
PubMed: 38938193
DOI: 10.1080/0886022X.2024.2368082