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The American Journal of the Medical... Aug 2023Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It has been traditionally administered through a central venous catheter (CVC). The avoidance of peripheral intravenous infusion of 3% HTS stems theoretically from the concern about the ability of the peripheral veins to tolerate hyperosmolar infusions. The aim of this systematic review and meta-analysis is to assess the rate of complications associated with the infusion of 3% HTS using peripheral intravenous access.
METHODS
We conducted a systematic review and meta-analysis to assess the rate of complications related to the peripheral infusion of 3% HTS. We searched several databases for available studies that met the criteria until February 24th, 2022. We included ten studies conducted across three countries examining the incidence of infiltration, phlebitis, venous thrombosis, erythema, and edema. The overall event rate was calculated and transformed using the Freeman-Tukey arcsine method and pooled using the DerSimonian and Laird random-effects model. I was used to evaluate heterogeneity. Selected items from Newcastle-Ottawa Scale were used to assess the risk of bias in each included study.
RESULTS
A total of 1200 patients were reported to have received peripheral infusion of 3% HTS. The analysis showed that peripherally administered 3% HTS has a low rate of complications. The overall incidence of each of the complications was as follows: infiltration 3.3%, (95% C.I. = 1.8-5.1%), phlebitis 6.2% (95% C.I. = 1.1-14.3%), erythema 2.3% (95% C.I. = 0.3-5.4%), edema 1.8% (95% C.I. = 0.0-6.2%), and venous thrombosis 1% (95% C.I. = 0.0-4.8%). There was one incident of venous thrombosis preceded by infiltration resulting from peripheral infusion of 3% HTS.
CONCLUSIONS
Peripheral administration of 3% HTS is considered a safe and possibly preferred option as it carries a low risk of complications and is a less invasive procedure compared to CVC.
Topics: Humans; Infusions, Intravenous; Saline Solution, Hypertonic; Phlebitis; Edema; Erythema
PubMed: 37192695
DOI: 10.1016/j.amjms.2023.04.025 -
Medical Ultrasonography Feb 2018This study aimed to determine the sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema by meta-analysis. (Meta-Analysis)
Meta-Analysis Review
AIMS
This study aimed to determine the sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema by meta-analysis.
MATERIALS AND METHODS
A systematic search was conducted through the following databases: Cochrane, PubMed, EMBASE and Ovid MEDLINE. Prospective cohort and prospective case-control studies that reported sensitivity and specificity of lung ultrasound in diagnosis of acute pulmonary edema were selected. An independent review of citations was carried out for inclusion and data extraction. Quality assessment was conducted using the QUADAS-2 tool. Sensitivity and specificity were taken from the studied articles and then calculated with the contingency tables. A total of 984 articles were identified but only eight studies (1301 patients) were included in this meta-analysis. One study was a case-control study and seven studies were prospective cohort study.
RESULTS
The overall sensitivity of ultrasound for the diagnosis of acute pulmonary edema is 97% (95% CI: 96%-98%) and the overall specificity was 98% (95% CI: 97%-99%).
CONCLUSION
The diagnostic test accuracy suggests that lung ultrasound using B-lines is a useful and reliable diagnostic tool for critically illpatients with acute pulmonary edema.
Topics: Acute Disease; Humans; Lung; Pulmonary Edema; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography
PubMed: 29400365
DOI: 10.11152/mu-1223 -
The British Journal of Oral &... Oct 2016Hilotherapy is the application of cold compression at a regulated temperature through a face mask. Studies that have evaluated its efficacy have focused on postoperative... (Meta-Analysis)
Meta-Analysis Review
Hilotherapy is the application of cold compression at a regulated temperature through a face mask. Studies that have evaluated its efficacy have focused on postoperative oedema, pain, and the patient's comfort. However, there is no clear consensus in favour of its use, so we have made a systematic review and meta-analysis to evaluate relevant published reports. We searched PubMed, EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials to identify studies. Sixty-one records were screened, six of which met the inclusion criteria and four of which were suitable for meta-analysis. All data suitable for meta-analysis were derived from studies of elective and traumatic facial skeletal surgery. Hilotherapy was associated with significant reductions in facial pain on postoperative day 2 (p<0.00001), and facial oedema on days 2 (p=0.0004) and 3 (p=0.02). Patients reported more comfort and satisfaction with hilotherapy than with cold compression (p<0.00001). The effect of hilotherapy on ecchymosis and formation of haematomas remains uncertain. Well-designed, randomised, controlled trials of its use after aesthetic facial surgery are required.
Topics: Ecchymosis; Edema; Face; Facial Pain; Humans; Pain Measurement; Pain, Postoperative
PubMed: 27516162
DOI: 10.1016/j.bjoms.2016.07.003 -
Children (Basel, Switzerland) Feb 2022Acute hemorrhagic edema of young children, a benign skin-limited vasculitis, predominantly affects children 2 years of age or younger. The prevalence and clinical... (Review)
Review
Acute hemorrhagic edema of young children, a benign skin-limited vasculitis, predominantly affects children 2 years of age or younger. The prevalence and clinical features of the Köbner and Pastia signs have never been systematically investigated in this vasculitis. To address this issue, we analyzed the data contained in the Acute Hemorrhagic Edema Bibliographic Database, which incorporates all reports on hemorrhagic edema published after 1969. A total of 339 cases (236 males and 103 females; 11 (8-18) months of age; median and interquartile range) were documented with at least 1 photograph and therefore included in this analysis. The Köbner sign occurred in 24 cases (14 males and 10 females; 11 (7-17) months of age), the Pastia sign in 51 cases (39 males and 12 females; 11 (8-15) months of age), and both Köbner and Pastia signs in 8 cases (7 males and 1 female; 11 (7-17) months of age). The lower legs, thighs, waistline, and groin were the regions that were most commonly affected with the Köbner sign, while the ankle, feet, cubital fossa, and elbow were most affected with the Pastia sign. The Köbner and Pastia signs are clinically relevant; they occur in about every fourth child affected with hemorrhagic edema and do not influence the disease progression.
PubMed: 35204985
DOI: 10.3390/children9020265 -
Survey of Ophthalmology 2021Radiation maculopathy and radiation-induced macular edema are common, sight-threatening complications after radiotherapy, especially that used for uveal melanoma. While... (Review)
Review
Radiation maculopathy and radiation-induced macular edema are common, sight-threatening complications after radiotherapy, especially that used for uveal melanoma. While many treatment and preventive strategies have been proposed, management of these conditions is still challenging. Initially, treatments were based on the use of retinal laser, but the outcomes were poor. Subsequently, management has shifted toward injection of intravitreal antivascular endothelial growth factor or corticosteroids. We reviewed current clinical evidence, which mostly relies on small sample-sized and retrospective studies, for the management of radiation maculopathy and, in particular, radiation-induced macular edema. At present, the first-line approach is usually intravitreal antivascular endothelial growth factor. Intravitreal dexamethasone implantation may be an option for those with suboptimal response or contraindications to antivascular endothelial growth factor agents. Possible preventive treatments that require future study are intravitreal bevacizumab and ranibizumab, peripheral laser photocoagulation, and subtenon triamcinolone acetonide.
Topics: Angiogenesis Inhibitors; Bevacizumab; Glucocorticoids; Humans; Intravitreal Injections; Macular Edema; Retrospective Studies; Triamcinolone Acetonide; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 32918934
DOI: 10.1016/j.survophthal.2020.08.007 -
Physical Therapy Feb 2021Hand swelling may result from injury or trauma. Various physical assessment tools and measurement methods can be used to quantify the volume or size of the hand or...
OBJECTIVE
Hand swelling may result from injury or trauma. Various physical assessment tools and measurement methods can be used to quantify the volume or size of the hand or fingers; however, the reliability and validity of each tool and measurement method have not been evaluated. The purpose of this study was to evaluate the reliability and validity of physical assessment tools and methods used to quantify hand and finger volume orsize.
METHODS
MEDLINE, CINAHL, EMBASE, Web of Science, and Scopus were searched using key terms related to swelling, edema, volume, size, hand, measures, reliability, and validity. Cross-sectional or longitudinal studies that assessed reliability and/or validity of physical assessment tools or measurement methods to quantify hand swelling were included. Two examiners independently extracted data from the included articles and appraised the articles' quality using the Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Data extracted from studies analyzing reliability and validity were grouped by type of assessment tool and measurement method.
RESULTS
Five physical assessment tools used for quantification of hand swelling were evaluated, including tape measure, water volumeter, bioimpedance spectroscopy, ring gauge, 3-dimensional techniques. All assessment tools had good to excellent reliability (ICC = 0.74 - 0.99), and moderate to high validity (Pearson coefficient = 0.58 - 0.99), for quantification of the volume or size of the hand or fingers.
CONCLUSION
All measurement methods with these tools had good to excellent reliability and moderate to high validity. The evidence underpinning the figure-of-eight technique, which uses a tape measure, was the highest. Because these physical assessment tools and measurement methods assess different aspects and regions of the hand, which one is selected depends on the region of interest for assessment and the availability of tools.
IMPACT
Reliable tools and measurement methods are available to measure the size or volume of the hand and fingers, either together or separately. The best tool will depend on the aim of assessment and tool availability.
LAY SUMMARY
Hand swelling can occur with injuries, burns, or lymphedema. This review shows that tools are available to accurately measure swelling in any part of thehand.
Topics: Body Weights and Measures; Edema; Hand; Humans; Reproducibility of Results
PubMed: 33313914
DOI: 10.1093/ptj/pzaa206 -
PloS One 2023Intracerebral hemorrhage (ICH) is a devastating stroke with many mechanisms of injury. Edema worsens outcome and can lead to mortality after ICH. Glibenclamide (GLC), a...
Intracerebral hemorrhage (ICH) is a devastating stroke with many mechanisms of injury. Edema worsens outcome and can lead to mortality after ICH. Glibenclamide (GLC), a sulfonylurea 1- transient receptor potential melastatin 4 (Sur1-Trpm4) channel blocker, has been shown to attenuate edema in ischemic stroke models, raising the possibility of benefit in ICH. This meta-analysis synthesizes current pre-clinical (rodent) literature regarding the efficacy of post-ICH GLC administration (vs. vehicle controls) on behaviour (i.e., neurological deficit, motor, and memory outcomes), edema, hematoma volume, and injury volume. Six studies (5 in rats and 1 in mice) were included in our meta-analysis (PROSPERO registration = CRD42021283614). GLC significantly improved behaviour (standardized mean difference (SMD) = -0.63, [-1.16, -0.09], n = 70-74) and reduced edema (SMD = -0.91, [-1.64, -0.18], n = 70), but did not affect hematoma volume (SMD = 0.0788, [-0.5631, 0.7207], n = 18-20), or injury volume (SMD = 0.2892, [-0.4950, 1.0734], n = 24). However, these results should be interpreted cautiously. Findings were conflicted with 2 negative and 4 positive reports, and Egger regressions indicated missing negative edema data (p = 0.0001), and possible missing negative behavioural data (p = 0.0766). Experimental quality assessed via the SYRCLE and CAMARADES checklists was concerning, as most studies demonstrated high risks of bias. Studies were generally low-powered (e.g., average n = 14.4 for behaviour), and future studies should employ sample sizes of 41 to detect our observed effect size in behaviour and 33 to detect our observed effect in edema. Overall, missing negative studies, low study quality, high risk of bias, and incomplete attention to key recommendations (e.g., investigating female, aged, and co-morbid animals) suggest that further high-powered confirmatory studies are needed before conclusive statements about GLC's efficacy in ICH can be made, and before further clinical trials are performed.
PubMed: 37756302
DOI: 10.1371/journal.pone.0292033 -
Plastic and Reconstructive Surgery May 2016Today, minimally invasive procedures are becoming more popular because of the fast recovery. Rhinoplasty is a common facial plastic surgery procedure that can be... (Review)
Review
BACKGROUND
Today, minimally invasive procedures are becoming more popular because of the fast recovery. Rhinoplasty is a common facial plastic surgery procedure that can be associated with significant postoperative morbidities, especially periorbital edema and ecchymosis. The aim of this review is to summarize the results of published literature that studied interventions that decrease postoperative edema and ecchymosis after rhinoplasty, and provide evidence-based strategies for surgeons to incorporate into practice.
METHODS
A systematic review of the PubMed, Scopus, and EMBASE databases was performed to investigate interventions studied to decrease postoperative edema and ecchymosis after rhinoplasty. After inclusion and exclusion criteria were applied, articles were grouped into one of the following categories: corticosteroids, other medications and herbal supplements, interventions to decrease intraoperative bleeding, other postoperative interventions, and surgical techniques.
RESULTS
A total of 50 articles were included for review. Fourteen articles studied corticosteroids exclusively, whereas another 10 articles reviewed other medications and herbal supplements. Nine articles evaluated methods to decrease intraoperative bleeding during rhinoplasty, and four articles studied postoperative interventions to decrease edema and ecchymosis. Thirteen articles studied various surgical techniques to decrease postoperative morbidities.
CONCLUSIONS
There was a consensus within the literature that steroids, intraoperative hypotension, intraoperative cooling, and head elevation postoperatively decrease postoperative edema and ecchymosis, whereas nasal packing and periosteal elevation before osteotomy increased these postoperative morbidities. Studies of herbal supplements may be incorporated into practice with minimal risk to the patient. More studies must be performed before recommending an external or internal approach to lateral osteotomy.
Topics: Adrenal Cortex Hormones; Blood Loss, Surgical; Ecchymosis; Edema; Fibrin Tissue Adhesive; Humans; Hypotension; Intraoperative Complications; Lidocaine; Osteotomy; Phytotherapy; Plant Preparations; Postoperative Complications; Randomized Controlled Trials as Topic; Rhinoplasty
PubMed: 27119920
DOI: 10.1097/PRS.0000000000002101 -
Indian Journal of Psychological Medicine 2016A number of atypical antipsychotics have been associated with peripheral edema. The exact cause is not known. We report two cases of olanzapine-induced edema and a brief... (Review)
Review
A number of atypical antipsychotics have been associated with peripheral edema. The exact cause is not known. We report two cases of olanzapine-induced edema and a brief review of atypical antipsychotic-induced edema, possible risk factors, etiology, and clinical features. The recommendation is given on different methods of managing this side effect.
PubMed: 27335511
DOI: 10.4103/0253-7176.183089 -
Journal of Orthopaedic Surgery and... Jun 2021Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may be favourable in the treatment of BME. Therefore, the aim of this systematic review was to assess the efficacy of ESWT for the treatment of BME.
METHODS
MEDLINE was searched for relevant literature with no time constraints. Both randomized and non-randomized trials were included. Case reports and conference abstracts were excluded. Titles and abstracts were screened and full-text articles of included studies were retrieved. Data on the effect of ESWT on pain, function, and the BME area on magnet resonance imaging were extracted.
RESULTS
Pain, function, and magnet resonance imaging results all improved across the studies - regardless of whether it was a randomized or non-randomized study. This effect was consistent across multiple pathologies such as osteonecrosis of the femoral head, BME associated with knee osteoarthritis, Kienböck's disease, and osteitis pubis. The meta-analysis showed that pain (after 1 month: weighted mean difference (WMD) = - 2.23, 95% CI - 2.58 to - 1.88, P < 0.0001; after 3-6 month: WMD = - 1.72, 95% CI - 2.52 to - 0.92, P < 0.00001) and function (after 1 month: WMD = - 1.59, 95% CI - 2.04 to - 1.14, P < 0.0001; after 3-6 month: WMD = - 2.06, 95% CI - 3.16 to - 0.96, P = 0.0002; after ≥ 12 month: WMD = - 1.20, 95% CI - 1.83 to - 0.56, P = 0.0002) was reduced in terms of ESWT treatment compared to a control group.
CONCLUSIONS
Based on the available evidence, ESWT may be an adequate option for conservative therapy in pathologies involving BME.
TRIAL REGISTRATION
PROSPERO, CRD42021201719 . Registered 23 December 2020.
Topics: Bone Diseases; Bone Marrow; Conservative Treatment; Edema; Extracorporeal Shockwave Therapy; Female; Femur Head Necrosis; Humans; Male; Osteoarthritis, Knee; Treatment Outcome
PubMed: 34107978
DOI: 10.1186/s13018-021-02484-5