-
Oral Surgery, Oral Medicine, Oral... Feb 2024This systematic review aimed to determine the clinical and epidemiologic profile of patients with burning mouth syndrome (BMS) following the current classification of... (Meta-Analysis)
Meta-Analysis Review
Clinical and epidemiological profile of burning mouth syndrome patients following the International Headache Society classification: a systematic review and meta-analysis.
OBJECTIVE
This systematic review aimed to determine the clinical and epidemiologic profile of patients with burning mouth syndrome (BMS) following the current classification of the International Headache Society (IHS)-the International Classification of Headache Disorders (ICHD-3) and the International Classification of Orofacial Pain (ICOP).
STUDY DESIGN
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and involved a comprehensive search on PubMed, Scopus, EMBASE, Web of Science, LILACS, and the gray literature.
RESULTS
Of the 4,252 studies identified, 41 were included. In general, there were no differences between the clinical and epidemiologic profiles of patients with BMS classified based on ICHD-3 or ICOP. Studies were pooled in meta-analyses and showed a significant prevalence of female patients between the sixth and seventh decade of life. The burning sensation and the tongue were the most prevalent descriptors and affected location. Significant associations were demonstrated between BMS and anxiety (P = .0006), depression (P = .004), and poor oral hygiene (P = .00001).
CONCLUSIONS
Under the existing contemporary classification systems, patients with BMS were found to be mostly females in the sixth and seventh decade of life with a burning sensation on the tongue. Experiencing depression and anxiety was a commonly existing comorbidity.
Topics: Humans; Female; Male; Burning Mouth Syndrome; Headache; Comorbidity; Facial Pain; Anxiety; Paresthesia
PubMed: 38155008
DOI: 10.1016/j.oooo.2023.10.002 -
Cephalalgia : An International Journal... Apr 2023Headache with neurologic deficits and cerebrospinal fluid lymphocytosis, previously also termed pseudomigraine with temporary neurologic symptoms and lymphocytic... (Review)
Review
BACKGROUND
Headache with neurologic deficits and cerebrospinal fluid lymphocytosis, previously also termed pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis, is a self-limiting syndrome characterized by moderate to severe headache associated with focal neurological deficits occurring in the context of lymphocytosis in the cerebrospinal fluid. As a consequence of its rarity, data regarding headache with neurologic deficits and cerebrospinal fluid lymphocytosis is sparse. Therefore, we conducted this review to analyze data related to 93 patients of headache with neurologic deficits and cerebrospinal fluid lymphocytosis, to characterize their demographics, clinical manifestations, investigations and treatment options.
METHODS
We performed a systematic review of cases reported through PubMed and Google scholar database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Keywords used were 'Headache with Neurologic Deficits and cerebrospinal fluid lymphocytosis', 'Headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome'. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.
RESULTS
We analyzed a total of 93 cases of headache with neurologic deficits and cerebrospinal fluid lymphocytosis with a mean age of 28.8 years at onset. Seventy patients (75.2%) were adults, while 23 (24.7%) belonged to the pediatric age group. Comparing these groups, mean age at onset was 32.5 years and 14.3 years, respectively. The average duration of follow-up was 11.08 months. Thirty percent of patients experienced relapsing episodes of headache with neurologic deficits and cerebrospinal fluid lymphocytosis symptoms. The most common type of headache reported was unilateral severe throbbing episodic headache. Other associated symptoms included sensory deficit (60%) and motor deficits (54.8%). The least common symptoms were nystagmus and agraphia, which were reported in one patient each. Antiviral agents were a common treatment option in the acute phase (n = 23 patients [23.6%]), while Flunarizine was the most commonly used agent in the chronic setting (n = 3 patients [3.2%]). While most of the patients had normal brain magnetic resonance imaging, 20 patients had magnetic resonance imaging abnormalities, including (but not limited to) non-specific white matter lesions (eight patients) and meningeal enhancement (six patients). The most common electroencephalographic findings included diffuse and focal slowing. The mean cerebrospinal fluid opening-pressure was 240.5 mmHO. Cerebrospinal fluid protein was elevated in 59 (63.4%) patients, with a mean value of 114 mg/dL. Two patients in our cohort were found to have cerebrospinal fluid oligoclonal bands.
CONCLUSION
Headache with neurologic deficits and cerebrospinal fluid lymphocytosis tends to affect young individuals with a slight male predominance. Unilateral severe throbbing episodic headache with associated hemi-paresthesia and hemiparesis were the most common symptoms based on our review. Elevated cerebrospinal fluid opening-pressure can be seen in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome. Early recognition of the syndrome is paramount. Antivirals were found to be among the most widely used treatments in the acute setting. Magnetic resonance imaging of the brain is mostly normal. Diffuse and focal slowing were among the most common electroencephalographic findings. Cerebral flow abnormalities on perfusion scans are not uncommon in headache with neurologic deficits and cerebrospinal fluid lymphocytosis. Prospective studies with a larger sample size are needed to validate our findings and guide the clinical care of these patients.
Topics: Adult; Humans; Male; Child; Female; Lymphocytosis; Prospective Studies; Headache; Cerebrospinal Fluid Pressure; Brain
PubMed: 36856002
DOI: 10.1177/03331024231157694 -
Cureus Oct 2022Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy. The disease initially manifests as a sensory disorder in the form of paresthesia, numbness,... (Review)
Review
A Comparative Analysis Between Ultrasound and Electromyographic and Nerve Conduction Studies in Diagnosing Carpal Tunnel Syndrome (CTS): A Systematic Review and Meta-Analysis.
Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy. The disease initially manifests as a sensory disorder in the form of paresthesia, numbness, or tingling of the fingers. The diagnosis is usually made based on history and clinical symptoms, which are confirmed using nerve conduction studies (NCS) and electromyography. More recently, ultrasound has gained more use in CTS diagnosis due to its advantages, which include patients' comfort during diagnosis, better visualization of anatomy and nerve forms directly, and cost-effectiveness. However, a literature review shows that the diagnostic accuracy of ultrasound over NCS is still in question; therefore, the present systematic review was carried out to compare the diagnostic accuracy of ultrasound to NCS and electromyography. A systematic literature search was performed on five electronic databases: PubMed, Medline, Web of Science, Embase, and Google Scholar. The search strategy limited the retrieval of literature published between 2000 and 2022. Of the 1098 articles retrieved from the electronic databases, only 12 met the inclusion criteria. A meta-analysis of outcomes from the included studies showed that the pooled sensitivity and specificity of the ultrasound were 0.80 (95% CI: 0.73, 0.88) and 0.90 (0.83, 0.96), respectively. On the other hand, combing the outcomes of electromyography and NCS resulted in sensitivity and specificity values of 0.89 (95% CI: 0.84, 0.95) and 0.77 (95% CI; 0.64, 0.90), respectively. The results show that ultrasound has comparable sensitivity and slightly higher specificity than NCS and electromyography; therefore, ultrasound can be used as an alternative diagnostic test for CTS. However, it cannot replace NCS and electromyography since more research needs to be done on doubtful and secondary cases of CTS.
PubMed: 36415360
DOI: 10.7759/cureus.30476 -
The Journal of Manual & Manipulative... Aug 2011Systematic review of randomized clinical trials.
STUDY DESIGN
Systematic review of randomized clinical trials.
OBJECTIVE
Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy.
BACKGROUND
Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100 000 and an increased prevalence in the fifth decade of life among the general population.
RESULTS
Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ⩾5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising.
CONCLUSION
Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR.
PubMed: 22851876
DOI: 10.1179/2042618611Y.0000000011 -
Journal of Infection and Public Health Aug 2022Several studies have reported prolonged symptoms especially neurological symptoms following acute infection in patients with COVID-19, known as long COVID-19. There are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have reported prolonged symptoms especially neurological symptoms following acute infection in patients with COVID-19, known as long COVID-19. There are only few studies investigating this population and relatively less known, including nervous system involvement. A systematic review and meta-analysis of these studies are required to understanding the prevalence of persistent neurological manifestations after COVID-19.
OBJECTIVE
To conduct a systematic review and meta-analysis on the persistent neurological manifestations in COVID-19 survivors.
METHODS
Authors conducted a literature search through PubMed and MedRxiv from January 1st, 2020 to October 2021 according to PRISMA guideline. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of long COVID-19 patients in their data were included. Case reports and case series also included in this review. The quality of the studies was assessed based on the Oxford Centre for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and heterogeneity test.
FINDINGS
From 128 identified studies, 36 were eligible, with 9944 participants included. Most of the included studies had mean duration of follow-up after COVID-19 onset of less than 6 months. Fatigue was the most common (52.8%, 95%CI 19.9 - 84.4) symptoms of long COVID, followed by cognitive disorder (35.4%, 95%CI 2.1 - 81.7); paresthesia (33.3%, 95%CI 2.7 - 76.6); sleep disorder (32.9%, 95%CI 6.5 - 67.4); musculoskeletal pain (27.8%, 95%CI 12.7 - 46); and dizziness (26.4%, 95%CI 4.6 - 57.9).
CONCLUSION
Neurological manifestations are prevalent and persisting in patients with long COVID. The duration of the symptoms are vary among literatures. However, the frequency are mostly observed during the first six months after the illness onset.
Topics: COVID-19; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; Post-Acute COVID-19 Syndrome
PubMed: 35785594
DOI: 10.1016/j.jiph.2022.06.013 -
Phlebology Apr 2022To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence.
METHODS
A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications.
RESULTS
The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur.
CONCLUSION
Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.
Topics: Humans; Laser Therapy; Quality of Life; Saphenous Vein; Sclerotherapy; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 34965757
DOI: 10.1177/02683555211060998 -
JPRAS Open Jun 2022Age-related changes to the dorsum of the hand present as dyschromia, soft-tissue atrophy, and volume loss, resulting in wrinkles and prominent deep structures. Volume... (Review)
Review
BACKGROUND
Age-related changes to the dorsum of the hand present as dyschromia, soft-tissue atrophy, and volume loss, resulting in wrinkles and prominent deep structures. Volume augmentation by means of autologous fat transfer (AFT) is one of the options to rejuvenate the hand; theoretically, autologous fat is the ideal filler because of durability and biocompatibility.
OBJECTIVE
This systematic review aims to summarize and describe the current evidence on the technique, effectiveness, and safety of AFT in hand rejuvenation.
METHODS
Three major databases, PubMed, Embase, and Web of Science, were systematically searched up to November 2020 for studies reporting on AFT and hand rejuvenation.
RESULTS
A total of 10 articles were included, reporting on a total of 320 patients treated by AFT to improve the aesthetic appearance of the dorsum of the hand. Some degree of postoperative oedema was present in nearly all patients. Other complications were infection (0.67%), cysts/irregularities (1.3%), temporary dysesthesia (5.3%), and ecchymosis (7%). There were no major complications. Of all patients, 97.6% self-reported to be satisfied with the result.
CONCLUSIONS
Overall, by combining the current evidence, AFT is considered a promising and safe technique to rejuvenate the aging hand with very high patient satisfaction. Future research, using validated patient questionnaires, objective volumetric measurements, and longer follow-up, is needed to confirm these results.
LEVEL OF EVIDENCE
3.
PubMed: 35449731
DOI: 10.1016/j.jpra.2022.03.001 -
Journal of General Internal Medicine Nov 2013To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH).
METHODS
We searched major databases and related conference proceedings through June 30, 2012. Two reviewers independently selected studies and extracted data. Random-effects meta-analysis was used to pool the outcome measures across studies.
RESULTS
Seven trials were included in the efficacy analysis (enrolling 325 patients, mean age 53 years) and two additional trials were included in the safety analysis. Compared to placebo, the mean change in systolic blood pressure was 4.9 mmHg (p = 0.65) and the mean change in mean arterial pressure from supine to standing was -1.7 mmHg (p = 0.45). The change in standing systolic blood pressure before and after giving midodrine was 21.5 mmHg (p < 0.001). A significant improvement was seen in patients' and investigators' global assessment symptoms scale (a mean difference of 0.70 [95 % CI 0.30-1.09; p < 0.001] and 0.80 [95 % CI 0.76-0.85; p < 0.001], respectively). There was a significant increase in risk of piloerection, scalp pruritis, urinary hesitancy/retention, supine hypertension and scalp paresthesia after giving midodrine. The quality of evidence was limited by imprecision, heterogeneity and increased risk of bias.
CONCLUSION
There is insufficient and low quality evidence to support the use of midodrine for OH.
Topics: Blood Pressure; Clinical Trials as Topic; Humans; Hypotension, Orthostatic; Midodrine; Vasoconstrictor Agents
PubMed: 23775146
DOI: 10.1007/s11606-013-2520-3 -
Therapeutic Advances in Neurological... 2023Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an innovative therapeutical approach for medically refractory tremor. It is currently under investigation for... (Review)
Review
BACKGROUND
Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an innovative therapeutical approach for medically refractory tremor. It is currently under investigation for other neurological diseases including refractory neuropathic pain (NP).
OBJECTIVE
The objective of this systematic review is to analyze available evidence about the effectiveness and safety profile of MRgFUS in the treatment of refractory NP.
METHODS
Eligible studies were identified by searching published studies in PubMed and Scopus databases from inception to December 2022 and by identifying ongoing studies registered on the clinicaltrials.gov website. The study was registered in PROSPERO (ID: CRD42021277154).
RESULTS
We found three published observational studies and nine ongoing studies. In published studies, the involved population ranged from 8 to 46 patients with overall 66 patients being included with NP or trigeminal neuralgia. The target lesion was in the posterior part of the central lateral nucleus of the thalamus, bilaterally. Outcomes were assessed at different times through the Visual Analog Scale, showing a variable degree of improvement. Adverse events were rare, mild, and transient (vertigo, paresthesias, and dysesthesias) with intracerebral bleeding being reported as major adverse event in one case only. Among ongoing studies, we found three prospective, randomized, sham-controlled, crossover trials (RCTs) and six observational studies. Inclusion criteria are previous failure of more than three pharmacological treatments and NP duration longer than 6 months. The thalamus is the main proposed target and measured outcomes are accuracy of the procedure and pain relief, with a follow-up period ranging from 1 week to 1 year.
CONCLUSION
This systematic review suggests that, although high-quality studies are lacking, available evidence endorses the effectiveness and safety of MRgFUS in the management of NP. Ongoing RCTs will provide more robust data to understand benefits and risks of the procedure.
REGISTRATION
PROSPERO (ID: CRD42021277154).
PubMed: 37363184
DOI: 10.1177/17562864231180729 -
Neuromodulation : Journal of the... Apr 2022To compare the short- and long-term efficacies as well as tolerability of vagus nerve stimulation (VNS) for the patients with drug-resistant epilepsy (DRE) in comparison... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the short- and long-term efficacies as well as tolerability of vagus nerve stimulation (VNS) for the patients with drug-resistant epilepsy (DRE) in comparison with status at baseline.
MATERIALS AND METHODS
We conducted a specific and systematic search in online data bases for relevant literature published prior to December 2020. The literature retrieved, including randomized clinical trials (RCTs) and observational studies, were then reviewed and analyzed. A fixed-effect model was used to evaluate the pooled odds ratio (OR) of responder rates and complications associated with RCTs. A random-effect model was used to generate overall responder rates and overall incidences of complication.
RESULTS
A total of 61 studies, featuring 5223 patients, were included in our study. The pooled ORs of responder rates, hoarseness/voice change, throat pain, coughing, dyspnea, paresthesia, muscle pain, and headache during the short-term phase were 2.195 (p = 0.001), 5.527 (p = 0.0001), 0.935 (p = 0.883), 1.119 (p = 0.655), 2.901 (p = 0.005), 1.775 (p = 0.061), 3.606 (p = 0.123), and 0.928 (p = 0.806), respectively. The overall responder rates in 3, 6, 12, 24, 36, 48, and 60 months postoperatively were 0.421, 0.455, 0.401, 0.451, 0.482, 0.502, and 0.508, respectively. The overall incidences of complication were 0.274 for hoarseness/voice change, 0.099 for throat pain, 0.133 for coughing, 0.099 for dyspnea, 0.102 for paresthesia, 0.062 for muscle pain, 0.101 for headache, 0.015 for dysphagia, 0.013 for neck pain, 0.040 for infection, 0.030 for lead fracture, 0.019 for vocal cord palsy, and 0.020 for device malfunction, respectively.
CONCLUSIONS
The estimating of efficacy and tolerability, using data from the existing literature, indicated VNS therapy is a safe and effective treatment option for patients with DRE.
Topics: Drug Resistant Epilepsy; Dyspnea; Headache; Hoarseness; Humans; Myalgia; Paresthesia; Treatment Outcome; Vagus Nerve; Vagus Nerve Stimulation
PubMed: 35396068
DOI: 10.1111/ner.13509