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The British Journal of Oral &... Nov 2022The main purpose of this study was to identify an algorithm for the surgical management of fibrous dysplasia in syndromic (McCune-Albright syndrome) and non-syndromic... (Meta-Analysis)
Meta-Analysis Review
The main purpose of this study was to identify an algorithm for the surgical management of fibrous dysplasia in syndromic (McCune-Albright syndrome) and non-syndromic patients (monostotic and polyostotic subtypes). The secondary objectives were to assess the prevalence of affected craniofacial bones and the main clinical presentation. The authors performed a systematic review and meta-analysis by conducting a comprehensive electronic search from 1 January 2000 to 31 December 2019. A total of 1260 patients were included. The maxilla was the most affected facial bone (41%) (p<0.001, CI 38.3 to 43.8) and facial asymmetry was the chief complaint (p<0.001, CI 31.7 to 37.1). Conservative surgery registered higher recurrence rates than radical resection in both syndromic (84%) (p<0.001, CI 70.9 to 92.8) and non-syndromic patients (26%) (p<0.001, CI 21.8 to 30.6). Compared with prophylactic decompression, therapeutic optic nerve decompression (OND) showed better postoperative outcomes in both syndromic (p=0.9, CI 18.6 to 55.9) and non-syndromic patients (p=0.09, CI 9.3 to 28.4). Watchful waiting showed excellent results in both subgroups when asymptomatic (p<0.001). Syndromic and non-syndromic patients share the same treatment strategies. Radical resection is the preferred surgical technique to eradicate the disease, but it is often difficult to perform due to the extent and location of the disease. Furthermore, the authors advise early therapeutic over prophylactic OND to prevent optic nerve atrophy. Asymptomatic patients should be managed expectantly. Finally, medical management helps reduce the symptoms of bone pain (p=0.02 in non-syndromic and p<0.001 in syndromic patients).
Topics: Humans; Craniofacial Fibrous Dysplasia; Skull; Fibrous Dysplasia, Polyostotic; Orbit; Maxilla; Fibrous Dysplasia of Bone
PubMed: 35817637
DOI: 10.1016/j.bjoms.2022.06.002 -
Pediatric Pulmonology Nov 2022In adults, permissive hypercapnia reduces mortality and ventilation duration. However, in preterm infants, the findings from past research regarding the efficacy and... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
In adults, permissive hypercapnia reduces mortality and ventilation duration. However, in preterm infants, the findings from past research regarding the efficacy and safety of permissive hypercapnia are controversial.
OBJECTIVE
To evaluate the efficacy and safety of permissive hypercapnia versus normocapnia in preterm infants on mechanical ventilation.
DATA SOURCES
MEDLINE, EMBASE, CENTRAL, and CINAHL STUDY SELECTION: Published randomized controlled trials (RCTs), non-RCTs, interrupted time series, cohort studies, case-control studies, and controlled before-and-after studies were included.
DATA EXTRACTION
Two reviewers independently screened the title, abstract, and full text, extracted data, assessed the risk of bias, and evaluated certainty of evidence (CoE) according to the Grading of Recommendations Assessment and Development and Evaluation approach. A meta-analysis of RCTs was performed using the random-effects model.
RESULTS
Four RCTs (693 infants) and one cohort study (371 infants) were included. No significant differences existed between the permissive hypercapnia and normocapnia groups for bronchopulmonary dysplasia (BPD) (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.74-1.18; very low CoE) and a composite outcome of death or BPD (RR, 1.05; 95% CI, 0.90-1.23; very low CoE). Permissive hypercapnia may increase necrotizing enterocolitis (RR, 1.69; 95% CI, 0.98-2.91; very low CoE), but the null or trivial effect cannot be excluded. No significant differences existed between the two groups for any other outcome assessed (very low-to-low CoE).
LIMITATIONS
The sample sizes were less than the optimal sizes for all outcomes assessed, indicating the need for further trials.
CONCLUSIONS
Permissive hypercapnia did not have any significant benefit or harm in preterm infants.
Topics: Bronchopulmonary Dysplasia; Enterocolitis, Necrotizing; Humans; Hypercapnia; Infant; Infant, Newborn; Infant, Premature; Respiration, Artificial
PubMed: 35945674
DOI: 10.1002/ppul.26108 -
Frontiers in Pediatrics 2023We aimed to determine the association between red blood cell transfusions (RBCT) and bronchopulmonary dysplasia (BPD) in neonates. (Review)
Review
BACKGROUND
We aimed to determine the association between red blood cell transfusions (RBCT) and bronchopulmonary dysplasia (BPD) in neonates.
METHODS
A systematic review and meta-analysis were conducted using data obtained from literature search of PubMed, Embase, and Web of Science from their inception till May 1, 2022. Two reviewers independently selected potentially relevant studies, and after data extraction, they assessed the methodological quality of the included studies using the Newcastle-Ottawa scale. Data were pooled using random-effects models in Review Manager 5.3. Subgroup-analysis was performed based on the number of transfusions and adjusted results.
RESULTS
Of the 1,011 identified records, 21 total case-control, cross-sectional, and cohort studies were selected, which included a total of 6,567 healthy controls and 1,476 patients with BPD. The pooled unadjusted odds ratio ([OR], 4.01; 95% confidence interval [CI] 2.31-6.97) and adjusted OR (5.11; 95% CI 3.11-8.4) showed significant association between RBCT and BPD. A substantial heterogeneity was noted, which could be due to different variables controlled for in each study. The subgroup analysis showed that heterogeneity may be partially explained by the extent of transfusion.
CONCLUSION
The association between BPD and RBCT remains unclear based on the current data due to the substantial heterogeneity among the results. Well-designed studies are still needed in the future.
PubMed: 37325359
DOI: 10.3389/fped.2023.1095889 -
Archives of Oral Biology Mar 2023This systematic review aims to investigate possible connections between the oral microbiome and the onset and carcinogenesis of oral epithelial dysplasia (OED). (Review)
Review
OBJECTIVE
This systematic review aims to investigate possible connections between the oral microbiome and the onset and carcinogenesis of oral epithelial dysplasia (OED).
METHODS
A systematic search was performed on PubMed, Embase, Cochrane Database, and SCOPUS by two authors independently, addressing the focused question- "Has oral microbiome dysbiosis been involved in the onset and carcinogenesis of oral epithelial dysplasia?" We used the Newcastle-Ottawa scale to assess the quality of studies included in the review.
RESULTS
Out of 580 references screened, ten studies were found eligible for inclusion. All studies were case-control studies, and only qualitative analysis was conducted due to heterogeneous characteristics. The overall risk of bias in the eligible studies was considered as high. Microbiome diversity indices showed inconsistent evidence among studies. A significant increase of phylum Bacteroidetes in OED patients was reported in five studies. Five studies reported an increase of genus Fusobacterium in both the OED and oral squamous cell carcinoma (OSCC) patients and six different studies respectively reported a reduction of genus Streptococcus in both the OED and OSCC groups when compared to normal controls. Other predominant bacteria that were specific to different patient groups varied in each study.
CONCLUSIONS
The results of the included studies showed that the composition of the oral microbiome in patients with OED compared to healthy controls and OSCC patients was inconsistent. However, all ten studies showed non-negligible heterogeneity in the type and size of the sample, and the comparability between groups, which strongly limited the external validity of results. Further studies are strongly recommended.
Topics: Humans; Carcinoma, Squamous Cell; Mouth Neoplasms; Precancerous Conditions; Dysbiosis; Biomarkers, Tumor; Squamous Cell Carcinoma of Head and Neck; Carcinogenesis; Head and Neck Neoplasms
PubMed: 36709626
DOI: 10.1016/j.archoralbio.2023.105630 -
Gastroenterology Research and Practice 2021Colorectal cancer (CRC) and inflammatory bowel disease (IBD) are closely interrelated. However, the effect of having a family history of one disease on the risk of... (Review)
Review
BACKGROUND
Colorectal cancer (CRC) and inflammatory bowel disease (IBD) are closely interrelated. However, the effect of having a family history of one disease on the risk of another remains undetermined.
AIM
The purpose of this meta-analysis was to estimate the prevalence of a family history of CRC among patients with IBD, as well as the prevalence of a family history of IBD among patients with CRC.
METHODS
PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to identify studies reporting the prevalence of family history of IBD among patients with CRC, in addition to the prevalence of family history of CRC among IBD patients. Criteria for study inclusion consisted of the following: (1) studies that evaluated either IBD or CRC and dysplasia, (2) included all age groups, and (3) evaluated the family history effects for IBD or CRC. The total number of IBD patients and IBD patients with a family history of CRC and the total number of CRC patients and CRC patients with a family history of IBD were reviewed. The pooled prevalence of diseases was also estimated according to degree of relatives and geographical area. Random-effects models were used for estimating pooled prevalence.
RESULTS
A total of 27 studies were included with 26,576 IBD and 9,181 CRC or dysplasia patients. Eligible studies included 13 case-control, 10 cohort, and 4 cross-sectional types. The pooled prevalence of a family history of CRC among patients with IBD was 6% (95% CI: 4-9%). The pooled prevalence for first- and second-degree relatives (11%, 95% CI: 0-37%) was more than that for the other relative subgroups of relatedness degree. The prevalence in the American regions (8% (95% CI: 5-13%)) was higher than that in the others. The pooled prevalence for a family history of IBD among CRC or dysplasia patients was 11% (95% CI: 6-16%). The pooled prevalence for first-degree relatives (13% (95% CI: 3-28%) was higher than that for the other relative subgroups of relatedness degree; it was also greater in American countries (15%, 95% CI: 8-23%).
CONCLUSION
This study emphasizes the relationship between a family history of IBD and CRC development. Additionally, there was notable prevalence for a family history of CRC among IBD patients. American countries and first-degree relatives were identified to have a higher prevalence for both disease processes.
PubMed: 34725546
DOI: 10.1155/2021/4874459 -
Clinical Gastroenterology and... Feb 2022Identification of postendoscopy esophageal adenocarcinoma (PEEC) among Barrett's esophagus (BE) patients presents an opportunity to improve survival of esophageal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Identification of postendoscopy esophageal adenocarcinoma (PEEC) among Barrett's esophagus (BE) patients presents an opportunity to improve survival of esophageal adenocarcinoma (EAC). We aimed to estimate the proportion of PEEC within the first year after BE diagnosis.
METHODS
Multiple databases (Medline, Embase, Scopus, and Cochrane databases) were searched until September 2020 for original studies with at least 1-year follow-up evaluation that reported EAC and/or high-grade dysplasia (HGD) in the first year after index endoscopy in nondysplastic BE, low-grade dysplasia, or indefinite dysplasia. The proportions of PEEC defined using EAC alone and EAC+HGD were calculated by dividing EAC or EAC+HGD in the first year over the total number of EAC or EAC+HGD, respectively.
RESULTS
We included 52 studies with 145,726 patients and a median follow-up period of 4.8 years. The proportion of PEEC (EAC) was 21% (95% CI, 13-31) and PEEC (EAC+HGD) was 26% (95% CI, 19-34). Among studies with nondysplastic BE only, the PEEC (EAC) proportion was 17% (95% CI, 11-23) and PEEC (EAC+HGD) was 14% (95% CI, 8-19). Among studies with 5 or more years of follow-up evaluation, the PEEC (EAC) proportion was 10% and PEEC (EAC+HGD) was 19%. Meta-regression analysis showed a strong inverse relationship between PEEC and incident EAC (P < .001). The PEEC (EAC) proportion increased from 5% in studies published before 2000 to 30% after 2015. Substantial heterogeneity was observed for most analyses.
CONCLUSIONS
PEEC accounts for a high proportion of HGD/EACs and is proportional to reduction in incident EAC. Using best endoscopic techniques now and performing future research on improving neoplasia detection through implementation of quality measures and educational tools is needed to reduce PEEC.
Topics: Adenocarcinoma; Barrett Esophagus; Disease Progression; Endoscopy; Esophageal Neoplasms; Humans; Hyperplasia; Precancerous Conditions
PubMed: 33901662
DOI: 10.1016/j.cgh.2021.04.032 -
Sultan Qaboos University Medical Journal Feb 2023This systematic review and meta-analysis aimed to assess the cytotoxic and genotoxic impacts of waterpipe smoking on oral health. The databases MEDLINE, Cochrane Library... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to assess the cytotoxic and genotoxic impacts of waterpipe smoking on oral health. The databases MEDLINE, Cochrane Library and Dimensions were searched to find studies evaluating whether waterpipe smokers exhibited any cytotoxic or genotoxic effects on their oral cells compared to non-smokers, with regard to mouth neoplasms. Particularly, changes in DNA methylation and p53 expression were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted for the systematic review. Review Manager was utilised for statistical analysis with a significance level at <0.05. To assess the grades of the included articles, a risk of bias analysis was summarised. A forest plot, including some of the included articles included, was created regarding the different grades. A total of 20 studies were included in this review. The results showed that waterpipe smoking has cytotoxic and genotoxic effects on oral cells, with a risk difference of 0.16. Although the published articles are few in number, all confirm the devastating effects of waterpipe smoking related to the carcinogenicity. Waterpipe smoking is harmful to oral health. It causes a series of detrimental cellular and genetic modifications such as acanthosis, epithelial dysplasia and hyperparakeratosis. In addition, waterpipe smoke contains several carcinogenic compounds. As it releases many harmful organic compounds, waterpipe smoking increases the incidence of oral cancer.
Topics: Humans; Oral Health; Water Pipe Smoking; Antineoplastic Agents; Mouth Neoplasms; DNA Damage
PubMed: 36865434
DOI: 10.18295/squmj.6.2022.043 -
Surgical Endoscopy Apr 2021This systematic review and meta-analysis aims to evaluate efficacy and safety of endoscopic treatment for the non-polypoid dysplasia in patients with long-standing IBD. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aims to evaluate efficacy and safety of endoscopic treatment for the non-polypoid dysplasia in patients with long-standing IBD.
METHODS
Medline, Embase, Cochrane, and clinicaltrials.gov registry were comprehensively searched. Pooled estimates of curative, R0, en-bloc resection rates, CRC, metachronous dysplasia, and local recurrence rates were calculated. Subgroup analysis according to areas, lesion size, endoscopic resection techniques, and grades of dysplasia were conducted. Data synthesis was completed in R using the package "meta".
RESULTS
Of the 973 studies initially identified, 7 met the inclusion/exclusion criteria. These were all single-arm cohorts and included a total of 202 patients with IBD and non-polypoid dysplasia. The combined R0 and en-bloc resection rate were 0.70 (95% CI 0.55-0.81) and 0.86 (95% CI 0.65-0.95), respectively, with a recurrence rate of 0.08 (95% CI 0.05-0.13). CRC and metachronous dysplasia incidences were pooled as 32.53 (95% CI 12.21-86.67) and 90.24 (95% CI 44.91-181.33) per 1000 patient years.
CONCLUSIONS
Non-polypoid dysplasia associated with IBD can be resected endoscopically, especially by ESD. However, these patients have higher CRC and metachronous dysplasia incidence rates than patients with polypoid dysplasia, indicating a closer endoscopic surveillance.
Topics: Aged; Endoscopic Mucosal Resection; Humans; Inflammatory Bowel Diseases; Middle Aged
PubMed: 33523273
DOI: 10.1007/s00464-020-08225-9 -
European Journal of Orthopaedic Surgery... May 2022The primary aim of the study is to compare the patient outcome in medial patellofemoral ligament reconstruction (MPFLR) or MPFLR concurrent with trochleoplasty... (Review)
Review
Medial patellofemoral ligament reconstruction with and without trochleoplasty for patients with patella instability-correlation of trochlear dysplasia and patient outcome, classification and outcome measure in the past decade-a systematic review.
PURPOSE
The primary aim of the study is to compare the patient outcome in medial patellofemoral ligament reconstruction (MPFLR) or MPFLR concurrent with trochleoplasty (MPFLR + TP) and correlate it with the degree of trochlear dysplasia (TD). The secondary aim is to review TD classification, outcome measure, chronological and geographical trend of such studies in the past decade.
METHODS
A systemic review of the literature in the past decade on studies of patients with patella instability and underwent either a MPFLR or MPFLR + TP. The degree of TD with the patient outcome was correlated and compared between the 2 groups. The TD classification, outcome measures, chronological and geographical trends of these studies were documented.
RESULTS
There is no statistical difference in the overall improvement in the compared outcome scores between the 2 groups. However, the MPFLR studies reported a total of 16 re-dislocation in contrast to none in the MPFLR + TP studies. The 24 selected studies in the current review utilized different TD classification as well as outcome measures. A more homogeneous subgroup of 12 studies utilized Dejour classification as well as Kujala score that enabled comparison and showed no significant difference in outcome. The highest number of MPFLR publications was in 2019 and was from North and South Americas, Asia and Europe. The MPFLR + TP studies were from Europe during 2013 to 2017.
CONCLUSION
Though there is an overall improvement in post-operative outcomes scores with no statistical significance between MPFLR and MPFLR + TP, the documented re-dislocations in the MPFLR studies suggested an undetermined zone where the choice of procedure could result in a different outcome. The current review did not show correlation between the degree of TD with the patient outcome to provide a clear indication for either procedure according to the degree of TD. The diverse TD classifications and varied outcome measures indicated the need for standardization and consistency in documentation to guide the treating clinician in the choice of procedure. MPFLR was more commonly performed and studied than MPFLR + TP in the past decade.
Topics: Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Outcome Assessment, Health Care; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34120236
DOI: 10.1007/s00590-021-03030-z -
Indian Journal of Orthopaedics Dec 2021Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern,... (Review)
Review
BACKGROUND
Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern, many children with DDH are not picked early and present late at walking age. In our country, it is presumed to be due to absence of a national policy for screening of DDH. Screening programmes including the combination of clinical and radiological methods in different ways have been suggested. However, the exact method of screening is controversial.
PURPOSE
To analyze effectiveness and cost-effectiveness of various screening methods for DDH.
STUDY DESIGN
Systematic review.
METHODS
This review was conducted in accordance with PRISMA guidelines. Medline database was explored for original case series and randomized clinical trials. Inclusion criteria were English language, screening for DDH in neonates, sample size more than 500, and studies with minimum duration of one year.
RESULTS
Thirty-four studies were selected to write the manuscript. This included 23 studies looking for effectiveness of a screening programme and 11 studies comparing various outcomes of different screening strategies. A trend favoring universal ultrasound screening was observed.
CONCLUSION
The literature supports universal ultrasound screening and has proved its cost-effectiveness. However, considering the logistic and financial challenges in our country, immediate implementation of universal ultrasound screening seems impractical. In the absence of any current guidelines for screening for DDH in India, we suggest professional organizations involved in the care of children and public health policy-makers to come together to develop national screening guidelines for DDH.
PubMed: 35003532
DOI: 10.1007/s43465-021-00409-2