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Irish Journal of Medical Science May 2020In the management of bilateral fetal hydrothorax where the fetus is non-hydropic and apparently otherwise normal, we wished to determine if pleural-amniotic shunt...
OBJECTIVE
In the management of bilateral fetal hydrothorax where the fetus is non-hydropic and apparently otherwise normal, we wished to determine if pleural-amniotic shunt insertion was better than conservative management in terms of mortality.
METHODS
A systematic review was conducted between 1992 and 2017. Data extracted was inspected for heterogeneity. Where there was comparative data available, the odds ratio (OR) and confidence interval (CI) were calculated.
RESULTS
Seven studies were included in this systematic review. There was a paucity of comparative data where only 2 studies (28 cases) allowed for direct comparison. Within the limitations of the study, there was no difference between shunt insertion vs. conservative management in terms of stillbirth or miscarriage (OR = 1.00, 95% CI 0.12-8.34, heterogeneity I = 0%, p = 1.00).
CONCLUSION
There is insufficient data available to determine whether the outcome is improved by pleural-amniotic shunt insertion compared with conservative management in cases of bilateral fetal hydrothorax where the fetus is non-hydropic and otherwise normal.
Topics: Conservative Treatment; Female; Fetus; Humans; Hydrothorax; Pregnancy; Thoracentesis
PubMed: 31745722
DOI: 10.1007/s11845-019-02094-5 -
Current Hepatology Reports Jun 2020Ascites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium-restriction and high-protein diet are considered standard of care....
PURPOSE OF REVIEW
Ascites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium-restriction and high-protein diet are considered standard of care. However, their evidence base is limited. We performed a systematic review of randomized trials of nutritional interventions for ascites.
RECENT FINDINGS
Increasing consumption of calories and protein alone was ineffective. Studies reached contradictory conclusions regarding sodium restriction in patients taking combination diuretics. Intravenous amino acid infusion alone did not improve outcomes, peripheral parenteral nutrition did not improve outcomes except alone but reduced mortality in conjunction with branched-chain amino acid evening snack.
SUMMARY
Patients may benefit from sodium restriction and a protein-rich evening snack. Future trials should prioritize standardizing nutritional targets and tailoring interventions to the specific needs of patients including the socioeconomic factors impacting adherence.
PubMed: 33473347
DOI: 10.1007/s11901-020-00513-1 -
BMJ Supportive & Palliative Care Mar 2020Malignant pleural effusion (MPE) results in breathlessness and impairment of health-related quality of life (HRQOL). This study reviews the existing literature on HRQOL...
BACKGROUND
Malignant pleural effusion (MPE) results in breathlessness and impairment of health-related quality of life (HRQOL). This study reviews the existing literature on HRQOL following invasive interventions in MPE.
METHODS
Five electronic databases were systematically searched and assessed three times during the review process and last completed on 15 June 2018. We included all studies evaluating HRQOL outcomes for the following interventions: therapeutic thoracocentesis, talc slurry (TS) pleurodesis, indwelling pleural catheter (IPC) insertion and thoracoscopic talc poudrage (TTP) pleurodesis. Meta-analysis was not performed due to substantial heterogeneity in the published data.
RESULTS
17 studies were included in the review reporting HRQOL outcomes in 2515 patients. TTP, TS and IPC were associated with modest but inconsistent improvements in HRQOL up to 12 weeks. No intervention was significantly different from another in HRQOL outcomes at any time point. The attrition to follow-up was 48.3% (664/1374) at 3 months. The overall quality of studies was inadequate.
CONCLUSION
TTP, TS and IPC seem to improve HRQOL in MPE over 4-12 weeks, but there are insufficient longer term data due to high attrition rates. Evidence on the most effective treatment strategy is limited by the small number of randomised or comparative studies.
TRIAL REGISTRATION NUMBER
CRD42016051003.
Topics: Aged; Catheterization; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Quality of Life; Talc; Thoracentesis; Thoracoscopy; Treatment Outcome
PubMed: 31243020
DOI: 10.1136/bmjspcare-2018-001610 -
Journal of Stomatology, Oral and... Apr 2024We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis.
METHODS
A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included.
RESULTS
Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively.
CONCLUSION
Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.
Topics: Humans; Hyaluronic Acid; Arthrocentesis; Treatment Outcome; Injections, Intra-Articular; Platelet-Rich Plasma
PubMed: 37923134
DOI: 10.1016/j.jormas.2023.101676 -
Cardiovascular Revascularization... Nov 2019Hemorrhagic cardiac tamponade (HCT) is characterized by rapid accumulation of blood in the pericardium causing hemodynamic collapse. We report a case of HCT due to...
BACKGROUND
Hemorrhagic cardiac tamponade (HCT) is characterized by rapid accumulation of blood in the pericardium causing hemodynamic collapse. We report a case of HCT due to Apixaban use in a patient with renal cell carcinoma, supplemented with a systematic review of pericardial tamponade associated with the use of direct oral anticoagulants (DOACs).
CASE REPORT
A 62-year-old African American male with a history of metastatic renal cell carcinoma presented with dyspnea while taking Apixaban. He was diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion was drained. The pericardial fluid analysis was negative for malignancy and suggestive of HCT. He had a complicated hospital course and died several days later.
METHODS
We searched MEDLINE, EMBASE and other sources for published cases of pericardial tamponade associated with DOACs. Our outcomes of interest included patient characteristics, risk factors, timing from the start of anticoagulation to tamponade, treatment and mortality. Simple descriptive statistics using percentages for categorical variables were used to describe the included cases.
RESULTS
A total of 26 cases were included in the final systematic review after searching MEDLINE, EMBASE and other sources. The mean age was 70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine. Only 2 patients died but 24 had to undergo pericardiocentesis.
CONCLUSION
Cardiac tamponade is rarely associated with DOACs and elderly male patients with renal and coagulation abnormalities appear to have the highest risk.
Topics: Adult; Aged; Aged, 80 and over; Cardiac Tamponade; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Pyrazoles; Pyridones; Risk Factors; Treatment Outcome
PubMed: 31088720
DOI: 10.1016/j.carrev.2019.04.002 -
Pulmonary Medicine 2024Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of...
BACKGROUND
Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of >1.
METHODS
The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis.
RESULTS
Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid-to-serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty-two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax.
CONCLUSION
Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.
Topics: Female; Humans; Bile; Bilirubin; Pleural Effusion; Thoracentesis; Thoracostomy; Aged
PubMed: 38947176
DOI: 10.1155/2024/3973056 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Sep 2020To sysetematically evaluate the efficacy, compliance and collaborative operation of Balloon Eustachian tuboplasty(BET) for treatment of Eustachian tube dysfunction... (Meta-Analysis)
Meta-Analysis
To sysetematically evaluate the efficacy, compliance and collaborative operation of Balloon Eustachian tuboplasty(BET) for treatment of Eustachian tube dysfunction via Meta-analysis. The PubMed, OVID, Embase, Cochrane Library, ProQuest, Web of Science, Chinese biomedical literature database, VIP database, WanFang database, CNKI were searched for papers on autoinflation for treatment of chronic otitis media with effusion in children(up to March 2020). Statistical analysis was performed by using Cochrane tools and RevMan5.2. A total of 14 articles were included. The results of Meta-analysis showed that the effective rate of the BET was 86%(95%: 0.79-0.94), and had statistical significance. The tubomanometry, ETS, ETDQ-7 of postoperative BET was better than that of the control group, and had statistical significance. Heterogeneity of tubomanometry,ETS was relatively small, which is ²=51%(OR 3.57, 95% :1.95 - 6.55) and ²=59%( 1.33, 95% :0.98-1.67) respectively. There was no statistical significance between BET plus tympanic paracentesis compared with those treated with BET alone. The recurrence rate of the included literature was 5.37% and the complication rate was only 0.33%. Balloon Eustachian tuboplastycan be a safe and effective treatment for adult Eustachian tube dysfunction. However, in terms of collaborative surgery and evaluation methods, we still need more homogeneous, multi-center randomized controlled studies to obtain more accurate conclusions to guide clinical practice.
Topics: Adult; Child; Ear Diseases; Eustachian Tube; Humans; Otitis Media; Treatment Outcome; Tympanoplasty
PubMed: 33040509
DOI: 10.13201/j.issn.2096-7993.2020.09.014 -
Clinical Neurology and Neurosurgery Mar 2021
Topics: Albumins; Alpha-Globulins; Ascites; Cerebrospinal Fluid Proteins; Cerebrospinal Fluid Shunts; Female; Heart Atria; Humans; Hydrocephalus; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasms, Multiple Primary; Paracentesis; Postoperative Complications; Prealbumin; Reoperation; Ventriculoperitoneal Shunt
PubMed: 33540175
DOI: 10.1016/j.clineuro.2021.106519 -
Cranio : the Journal of... Mar 2024To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a...
OBJECTIVE
To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders.
METHODS
An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: "In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?"
RESULTS
Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group.
CONCLUSION
Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).
Topics: Humans; Arthrocentesis; Hyaluronic Acid; Arthroscopy; Temporomandibular Joint Disorders; Temporomandibular Joint; Injections, Intra-Articular; Treatment Outcome
PubMed: 34027829
DOI: 10.1080/08869634.2021.1925029