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Clinics in Dermatology 2023Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving primarily intertriginous skin areas. Ectopic HS lesions are a reported phenomenon that is not...
Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving primarily intertriginous skin areas. Ectopic HS lesions are a reported phenomenon that is not fully understood. We present a case report of a 66-year-old patient with painful symmetric ulcerated plaques on the posterior surface of the ankles and lower lip. In addition, we performed a systematic review on ectopic HS by conducting an electronic literature search to identify relevant contributions. Inclusion criteria included English-language and full texts only using PubMed, Embase, and the Cochrane Database. We found 22 eligible contributions reporting on a total of 58 patients. Most of the patients were men who had lesions on the head and neck region. The reviewed cases share common features with HS and may be considered disorders of follicular occlusion.
Topics: Male; Humans; Aged; Female; Hidradenitis Suppurativa; Skin; Pain
PubMed: 37661025
DOI: 10.1016/j.clindermatol.2023.08.019 -
International Wound Journal Oct 2023The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1,... (Review)
Review
The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1, 2023, a comprehensive search was conducted in international and Persian electronic databases such as Web of Science, PubMed, Scopus, Iranmedex, and Scientific information database (SID). The keywords obtained from Medical Subject Headings, including "Attitude", "Nursing students", and "Pressure ulcer" were used in this search. The quality assessment of the present studies in this systematic review was based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 6454 nursing students participated in ten cross-sectional studies. All students were studying at the undergraduate level and 81.20% of them were female. Nursing students were in the first (39.27%), second (28.19%), and third and fourth (32.54%) academic years. Among the participants, 49.86% have completed at least 2 clinical units. The mean scores of attitudes toward PU prevention in nursing students based on attitude toward PU prevention (APuP) and researcher-made questionnaires were 75.01% and 68.82%, respectively. The attitude of nursing students was influenced by various factors, including age, sex, academic year, clinical experience, number of clinical units, experience in caring for PU patients, previous courses on PU in the curriculum, and contribution of training to knowledge. Also, in the present study, the positive relationship between the attitude and knowledge of nursing students was shown as the only significant correlation. In sum, the attitude of the majority of nursing students toward the prevention of PUs was at a satisfactory level. Therefore, it is expected to transfer the necessary knowledge to them with proper planning so that preventive actions can be carried out by following the guidelines.
Topics: Humans; Female; Male; Ulcer; Students, Nursing; Cross-Sectional Studies; Surveys and Questionnaires; Pressure Ulcer; Health Knowledge, Attitudes, Practice; Suppuration; Attitude of Health Personnel
PubMed: 37434034
DOI: 10.1111/iwj.14191 -
Academic Emergency Medicine : Official... Aug 2023Distinguishing peritonsillar abscess (PTA) from peritonsillar cellulitis using clinical assessment is challenging as many features overlap for both conditions, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Distinguishing peritonsillar abscess (PTA) from peritonsillar cellulitis using clinical assessment is challenging as many features overlap for both conditions, and physical examination is only about 75% sensitive and 50% specific for diagnosing PTA. The primary objective of this systematic review was to determine the test characteristics of ultrasound for diagnosing PTA when compared to a reference standard of computed tomography or acquisition of pus via needle aspiration or incision and drainage.
METHODS
This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) guidelines. We searched seven databases from 1960 to November 2022. Two independent reviewers completed study selection, data extraction, and QUADAS-2 risk-of-bias assessment. We used a bivariate random-effects model to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-). We also conducted subgroup analyses on radiology ultrasound compared to point-of-care ultrasound (POCUS) and intraoral compared to transcervical scanning techniques.
RESULTS
From 339 citations, we identified 18 studies for inclusion. Because one study only reported positive cases of PTA (thereby preventing the calculation of specificity), it was excluded from the analysis, so the analysis included a total of 17 studies with 812 patients, of whom 541 had PTA. Pooled bivariate sensitivity was 86% (95% confidence interval [CI] 78%-91%), specificity 76% (95% CI 67%-82%), LR+ 3.51 (95% CI 2.59-4.89), and LR- 0.19 (95% CI 0.12-0.30). On subgroup analysis, radiology-performed ultrasound had a sensitivity and specificity of 89% and 71%, compared to POCUS, which had a sensitivity and specificity of 74% and 79%. Comparing the two different techniques, intraoral had a sensitivity and specificity of 91% and 75% while transcervical had a sensitivity and specificity of 80% and 81%.
CONCLUSIONS
Ultrasound demonstrates high sensitivity for ruling out PTA, but it only has moderate specificity for ruling in the diagnosis.
Topics: Humans; Peritonsillar Abscess; Ultrasonography; Tomography, X-Ray Computed; Sensitivity and Specificity; Physical Examination
PubMed: 36625850
DOI: 10.1111/acem.14660 -
Journal of the European Academy of... Sep 2023
Meta-Analysis
Topics: Humans; Hidradenitis Suppurativa; Neoplasms
PubMed: 37143377
DOI: 10.1111/jdv.19136 -
Actas Dermo-sifiliograficas May 2024Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their...
BACKGROUND AND OBJECTIVE
Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS.
MATERIALS AND METHODS
We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study.
RESULTS
We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs.
CONCLUSION
The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
Topics: Hidradenitis Suppurativa; Humans; Injections, Intralesional; Administration, Topical; Photochemotherapy; Treatment Outcome; Female; Randomized Controlled Trials as Topic; Male
PubMed: 38423507
DOI: 10.1016/j.ad.2024.02.024 -
International Journal of Pediatric... Jan 2024Traditional uvulectomy is a harmful procedure in which the entire or a portion of the uvula is removed by traditional practitioners. It causes complications like... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Traditional uvulectomy is a harmful procedure in which the entire or a portion of the uvula is removed by traditional practitioners. It causes complications like septicemia, transmission of infectious diseases, anemia, excessive bleeding, infection, tetanus, meningitis, and death. A summary of national data was lacking, thus, the study aimed to determine the pooled national burden and determinants of traditional uvulectomy in Ethiopia.
METHODS
Studies were retrieved from PubMed, EMBASE, CINHAL (EBSCO), Google Scholar, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, and Google databases. Finally, 19 studies were included. The methodological quality of the included studies was assessed using the JBI checklist. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled and summarized with random-effects meta-analysis models.
RESULTS
Totally 19 articles with 23,559 study participants were included in this systematic review and meta-analysis. The overall pooled prevalence of uvulectomy in Ethiopia was 44 % (95 % CI: 31%-57 %). The highest prevalence was observed among studies conducted in the Tigray region (63 % (95 % CI: 34%-94 %), between the year 2011-2014 (58 % (95 % CI: 29%-87 %)) and, community setting (57 % (95 % CI: 36%-78 %). Mothers' educational status (AOR: 1.66, 95 % CI: 1.31-2.01) and residence (AOR: 1.70, 95 % CI: 1.16-2.23) were found to be significantly associated with traditional uvulectomy in Ethiopia. Frequently cited reasons for traditional uvulectomy were to prevent swelling, pus, and rupture of the uvula, for better care, prevention of sore throats and coughs, religion, and culture.
CONCLUSION
The pooled result revealed that almost half of children are still subjected to traditional uvulectomy in Ethiopia. There is a need to intensify awareness creation campaigns against the practice by giving special attention to rural residents and uneducated ones.
Topics: Child; Humans; Ethiopia; Prevalence; Uvula
PubMed: 38171120
DOI: 10.1016/j.ijporl.2023.111835 -
International Immunopharmacology Jan 2024Hidradenitis suppurativa (HS) is a challenging skin disease with an underlying inflammatory process. Substantial progress has been made in our understanding of HS over... (Review)
Review
BACKGROUNDS AND AIMS
Hidradenitis suppurativa (HS) is a challenging skin disease with an underlying inflammatory process. Substantial progress has been made in our understanding of HS over the last few years, with the advancement of novel treatment approaches. The current systematic review aims to evaluate the safety and efficacy of Janus kinase (JAK) inhibitors and spleen tyrosine kinase (Syk) inhibitors in treating HS.
METHOD
A thorough systematic search was performed on PubMed/Medline, Web of Science, and Ovid Embase databases up to September 23th, 2023. Clinical studies published in English were included.
RESULTS
Our search yielded ten articles with a total of 165 patients treated with four types of JAK inhibitors (upadacitinib, povorcitinib, tofacitinib, and baricitinib) and one Syk inhibitor (fostamatinib). Upadacitinib, povorcitinib, and tofacitinib improved clinical outcomes, with a significant reduction in hidradenitis suppurativa clinical response (HiSCR) and abscess and inflammatory nodule count (AN count) during the treatment period. Also, these drugs are well tolerated in most HS patients with minimal adverse events (AEs). Moreover, baricitinib depicted an amelioration in signs and symptoms of HS in one case report. Also, fostamatinib exhibited favorable tolerability throughout a 12-week in moderate-to-severe HS patients. The remarkable clinical improvement, as assessed through HiSCR and hidradenitis suppurativa severity (IHS4), corresponded closely with serological indicators of inflammation following fostamatinib administration was achieved.
CONCLUSION
JAK and Syk inhibitors are potentially efficacious in managing moderate-to-severe HS since the proinflammatory cytokines are mediated by JAK and Syk signaling pathways. However, further research with a more rigorous examination is mandatory to evaluate such medication's long-term safety and efficacy.
Topics: Humans; Hidradenitis Suppurativa; Adalimumab; Janus Kinase Inhibitors; Tyrosine Kinase Inhibitors; Spleen; Syk Kinase; Treatment Outcome; Severity of Illness Index; Aminopyridines; Pyrazoles; Sulfonamides; Azetidines; Purines; Pyrimidines; Morpholines
PubMed: 38150881
DOI: 10.1016/j.intimp.2023.111435 -
Journal of Endodontics Aug 2023The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT).
METHODS
Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by 2 reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors.
RESULTS
Fourteen sources reporting on 2877 teeth (489 with VRF and 2388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR = 4.87; 95% confidence interval [CI], 1.58-15.0), increased periodontal probing depths (OR = 13.24; 95% CI, 5.44-32.22), swelling/abscess (OR = 2.86; 95% CI, 1.74-4.70), and tenderness to percussion (OR = 1.76; 95% CI, 1.18-2.61) were significantly associated with the presence of a VRF (P value < .05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, and apical extension of the root canal filling) were found to be significantly associated with the presence of a VRF (P value > .05).
CONCLUSIONS
Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, and tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF.
REGISTRATION
CRD42022354108 (PROSPERO).
Topics: Humans; Tooth Root; Root Canal Therapy; Tooth Fractures; Tooth, Nonvital; Abscess; Risk Factors
PubMed: 37307871
DOI: 10.1016/j.joen.2023.06.004 -
Clinical Otolaryngology : Official... Jan 2024Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children.
DESIGN AND SETTING
Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022.
PARTICIPANTS
Children 16 years old and below.
MAIN OUTCOME MEASURES
Clinical diagnosis of CSOM.
RESULTS
In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies).
CONCLUSION
Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.
Topics: Child; Humans; Male; Adolescent; Female; Otitis Media, Suppurative; Chronic Disease; Otitis Media; Hearing Loss; Risk Factors
PubMed: 37794685
DOI: 10.1111/coa.14102 -
Surgery Today Apr 2024Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review... (Review)
Review
Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review aims to provide a critical overview of the most recent literature about IUI prevention techniques in colorectal surgery. We performed a comprehensive and systematic review of studies published from 2000 to 2022 and assessed the use of techniques for ureteral injury prevention and intraoperative localization. 26 publications were included, divided into stent-based (prophylactic/lighted ureteral stent and near-infrared fluorescent ureteral catheter [PUS/LUS/NIRFUC]) and fluorescent dye (FD) groups. Costs, the percentage and number of IUIs detected, reported limitations, complication rates and other outcome points were compared. The IUI incidence rate ranged from 0 to 1.9% (mean 0.5%) and 0 to 1.2% (mean 0.3%) in the PUS/LUS/NIRFUC and FD groups, respectively. The acute kidney injury (AKI) and urinary tact infection (UTI) incidence rate ranged from 0.4 to 32.6% and 0 to 17.3%, respectively, in the PUS/LUS/NIRFUC group and 0-15% and 0-6.3%, respectively, in the FD group. Many other complications were also compared and descriptively analyzed (length-of-stay, mortality, etc.). These techniques appear to be feasible and safe in select patients with a high risk of IUI, but the delineation of reliable guidelines for preventing IUI will require more randomized controlled trials.
Topics: Humans; Colorectal Surgery; Digestive System Surgical Procedures; Ureter; Incidence; Stents; Fluorescent Dyes; Iatrogenic Disease
PubMed: 36593285
DOI: 10.1007/s00595-022-02639-9