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Journal of Nephrology Apr 2019Achievement of sodium and fluid balance is considered a major determinant of dialysis adequacy in peritoneal dialysis (PD). However, the contribution of different PD... (Meta-Analysis)
Meta-Analysis
Achievement of sodium and fluid balance is considered a major determinant of dialysis adequacy in peritoneal dialysis (PD). However, the contribution of different PD modalities to dialytic sodium removal (DSR) remains ill-defined. We performed a systematic review and meta-analysis to compare DSR by manual (continuous ambulatory PD, CAPD) versus automated PD (APD). Alternative PD strategies to remove sodium were also analyzed. Seven cohort studies, including 683 patients, 406 in CAPD and 277 in APD, were meta-analyzed out of the 30 studies selected based on DSR data availability. Overall, the unstandardized mean difference between CAPD and APD was significant [- 56 mmol/day (95% CI - 106, - 6), p = 0.027]. Heterogeneity was high (I 87.2%; p < 0.001). Meta-regression showed a strict correlation of DSR difference with creatinine dialysate/plasma ratio (D/P) (p = 0.04). DSR was significantly lower in APD than CAPD [86.2 (57.3-115.1) vs. 141.3 (107.6-174.9) mmol/day, p = 0.015]. Conversely, ultrafiltration (UF) did not differ [1122.6 (891.2-1354.0) in CAPD and 893.6 (823.0-964.2) ml/day in APD, p = 0.064]. A very strong correlation between DSR and achieved UF was found in CAPD (R = 0.94; p < 0001) while no relationship was detected in APD (R = - 0.07; p = 0.85). CAPD allows a higher DSR than APD, even though UF is not different. APD removes more water than sodium; therefore, DSR should be measured rather than estimated from the achieved UF. The difference in DSR between the two modalities decreases in high transporters. Novel strategies proposed to increase DSR, e.g. lower sodium dialysate or adapted-APD, are promising, but ad hoc studies are necessary.
Topics: Aged; Female; Humans; Kidney Diseases; Male; Middle Aged; Natriuresis; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Renal Elimination; Treatment Outcome; Water-Electrolyte Balance
PubMed: 29978446
DOI: 10.1007/s40620-018-0507-1 -
Archives of Dermatology Jun 2010To clarify clinicopathologic features and reconcile discrepancies in previous studies of folliculotropic mycosis fungoides (FMF). (Comparative Study)
Comparative Study
OBJECTIVES
To clarify clinicopathologic features and reconcile discrepancies in previous studies of folliculotropic mycosis fungoides (FMF).
DESIGN
A single-center retrospective clinicopathologic study and a systematic review of FMF.
SETTING
Tertiary referral center in the midwestern United States.
PATIENTS
Patients with clinical and histopathologic evidence of FMF seen at the tertiary referral center during a 12(1/2)-year period.
MAIN OUTCOME MEASURES
Clinicopathologic features of FMF.
RESULTS
Fifty patients (32 male [64%] and 18 female [36%]) met study criteria for the clinicopathologic review. Pruritic patches, plaques, and folliculocentric lesions (milia, cysts, and alopecia) on the head, neck, and trunk were common clinical findings. The mean time to diagnosis of FMF was 5.0 years. Diagnostic latency did not affect risk of death. One-year and 5-year overall survival rates were 96% and 62%, respectively. Frequent microscopic features were follicular mucinosis (74%) and epidermotropism (54%). Systematic review of 186 additional patients confirmed male predominance (ratio of men to women, 3.2:1.0), prevalent pruritus (73%), frequent follicular mucinosis (69%) and epidermotropism (37%) microscopically, and common head, neck, and trunk involvement. Combined data demonstrated that 6% of patients with FMF had concurrent non-mycosis fungoides hematologic malignant neoplasms and that the 5-year overall survival rate was 62% to 64%.
CONCLUSION
Folliculotropic mycosis fungoides has distinct clinical and microscopic features and is associated with a poor 5-year overall survival rate.
Topics: Adult; Biopsy; Diagnosis, Differential; Female; Flow Cytometry; Follow-Up Studies; Humans; Male; Middle Aged; Mycosis Fungoides; Prognosis; Retrospective Studies; Skin; Skin Neoplasms; Survival Rate; United States
PubMed: 20566923
DOI: 10.1001/archdermatol.2010.101 -
Orphanet Journal of Rare Diseases Apr 2021Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic collagen disorder characterized by skin fragility leading to blistering, wounds, and scarring. There are... (Review)
Review
BACKGROUND/OBJECTIVE
Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic collagen disorder characterized by skin fragility leading to blistering, wounds, and scarring. There are currently no approved curative therapies. The objective of this manuscript is to provide a comprehensive literature review of the disease burden caused by RDEB.
METHODS
A systematic literature review was conducted in MEDLINE and Embase in accordance with PRISMA guidelines. Observational and interventional studies on the economic, clinical, or humanistic burden of RDEB were included.
RESULTS
Sixty-five studies were included in the review. Patients had considerable wound burden, with 60% reporting wounds covering more than 30% of their body. Increases in pain and itch were seen with larger wound size. Chronic wounds were larger and more painful than recurrent wounds. Commonly reported symptoms and complications included lesions and blistering, anemia, nail dystrophy and loss, milia, infections, musculoskeletal contractures, strictures or stenoses, constipation, malnutrition/nutritional problems, pseudosyndactyly, ocular manifestations, and dental caries. Many patients underwent esophageal dilation (29-74%; median dilations, 2-6) and gastrostomy tube placement (8-58%). In the severely affected population, risk of squamous cell carcinoma (SCC) was 76% and mortality from SCC reached 84% by age 40. Patients with RDEB experienced worsened quality of life (QOL), decreased functioning and social activities, and increased pain and itch when compared to other EB subtypes, other skin diseases, and the general population. Families of patients reported experiencing high rates of burden including financial burden (50-54%) and negative impact on private life (79%). Direct medical costs were high, though reported in few studies; annual payer-borne total medical costs in Ireland were $84,534 and annual patient-borne medical costs in Korea were $7392. Estimated annual US costs for wound dressings ranged from $4000 to $245,000. Patients spent considerable time changing dressings: often daily (13-54% of patients) with up to three hours per change (15-40%).
CONCLUSION
Patients with RDEB and their families/caregivers experience significant economic, humanistic, and clinical burden. Further research is needed to better understand the costs of disease, how the burden of disease changes over the patient lifetime and to better characterize QOL impact, and how RDEB compares with other chronic, debilitating disorders.
Topics: Adult; Cost of Illness; Dental Caries; Epidermolysis Bullosa; Epidermolysis Bullosa Dystrophica; Humans; Quality of Life; Republic of Korea
PubMed: 33849616
DOI: 10.1186/s13023-021-01811-7 -
Frontiers in Immunology 2019The many clinical aspects of anti-p200 pemphigoid are not well-characterized. We aimed to analyze and correlate known existing data on the epidemiological, clinical,...
The many clinical aspects of anti-p200 pemphigoid are not well-characterized. We aimed to analyze and correlate known existing data on the epidemiological, clinical, histological, and immunological features of anti-p200 pemphigoid. We performed a review using Medline, Embase, and Web of Science databases (1900-2018). Case reports and series of patients were included. A total of 68 eligible studies that comprised 113 anti-p200 pemphigoid patients were included in the qualitative analysis, where there was a mean age of onset of 65.5 years. All patients presented with bullae/vesicles, and 54.3% had urticarial plaques. A similarity to bullous pemphigoid was reported in 66.1% of cases, but palmoplantar (51.4%), cephalic (40.3%), and mucosal (38.5%) involvement, besides frequent development of scars/milia (15.7%), were reported. Autoantibodies against recombinant laminin γ1 were detected in the sera of 73.1% of patients. Psoriasis was present in 28.3% of anti-p200 pemphigoid patients, particularly among Japanese patients (56.4%). The incidence of pustular psoriasis in this subgroup, was significantly greater than in the normal population. In conclusion, the diagnosis of anti-p200 pemphigoid may be suspected when a subepidermal autoimmune blistering disease develops in a younger age group, along with significant acral and cephalic distribution and mucosal involvement.
Topics: Age of Onset; Aged; Autoantibodies; Female; Humans; Laminin; Male; Pemphigoid, Bullous; Psoriasis
PubMed: 31695695
DOI: 10.3389/fimmu.2019.02466 -
The British Journal of Dermatology Oct 2013Vitiligo is a disfiguring disease, characterized frequently by the presence of de-pigmented macules and/or patches. Traditional therapies are essentially medical and are... (Review)
Review
BACKGROUND
Vitiligo is a disfiguring disease, characterized frequently by the presence of de-pigmented macules and/or patches. Traditional therapies are essentially medical and are most preferred by dermatologists. Surgical therapies, however, are amongst the most effective interventions for vitiligo but are limited by their invasive nature, as well as the training and expertise needed to perform specific procedures.
OBJECTIVES
To assess the evidence for the effectiveness, safety and applicability of the various surgical methods in the treatment of vitiligo.
METHODS
For this systematic review of vitiligo surgical therapies, our searches included: PubMed, MEDLINE and Cochrane databases.
RESULTS
We reviewed research studies reporting on split thickness skin grafts (STSG), punch/mini-graft, blister roof grafting, cultured and non-cultured cellular transplantation (MKTP). While all methods vary in their repigmentation outcomes, STSG is found to have the highest repigmentation success rate. Overall, post-operative complications included milia, scarring, cobblestone appearance or hyperpigmentation of treated areas.
CONCLUSION
This review highlights the need for more randomized controlled trials in this field, underpinned by a more standardized objective approach to the assessment of repigmentation following surgical interventions.
Topics: Cells, Cultured; Epidemiologic Methods; Humans; Postoperative Complications; Recurrence; Skin Transplantation; Treatment Outcome; Vitiligo
PubMed: 24098901
DOI: 10.1111/bjd.12532 -
Australian Dental Journal Sep 2015Carious affected dentine (CAD) represents a very common substrate in adhesive dentistry. Despite its ability to interact with adhesive systems, the intrinsic character... (Review)
Review
BACKGROUND
Carious affected dentine (CAD) represents a very common substrate in adhesive dentistry. Despite its ability to interact with adhesive systems, the intrinsic character of CAD leads to lower bonding compared with sound dentine, regardless of the adhesive systems used. This low bonding may be more susceptible to leakage and hydrolysis of the interface by matrix metalloproteinases (MMPs). This systematic review aimed to determine current knowledge of CAD bonding, together with bond strength and MMP inhibitors' ability to prevent hybrid layer instability.
METHODS
MEDLINE/Pubmed, Scopus and The Cochrane Library databases were electronically searched for articles published from 1 January 1960 to 31 August 2014. Two reviewers independently screened and included papers according to predefined selection criteria.
RESULTS
The electronic searches identified 320 studies. After title, abstract and full-text examinations, 139 articles met the inclusion criteria. Data highlighted that a poor resin saturation of the already demineralized collagen matrix in CAD is strictly related to nanoleakage in interdiffusion and is the basis of the progressive decrease in strength with hydrolysis by MMPs. The use of mild self-etching systems seems to be the more accredited method to establish bonding in CAD. Inhibitors of MMPs may ensure better performance of CAD bonding, allowing undisturbed remineralization of the affected matrix.
CONCLUSIONS
CAD bonding needs further understanding and improvement, particularly to enhance the strength and durability of the hybrid layer.
Topics: Dental Bonding; Dental Caries; Dental Cements; Dental Leakage; Dentin; Humans; Matrix Metalloproteinase Inhibitors; Stress, Mechanical
PubMed: 25790344
DOI: 10.1111/adj.12309 -
Experimental Gerontology Feb 2018This systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social...
This systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons. A search of PubMed, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases was performed. The terminology combined all possible alternatives of the following keywords: social isolation, loneliness, old people, intervention and effectiveness. Eligible studies were published between January 2011 and February 2016 in English or Italian language and regarded the implementation of loneliness/social isolation interventions among the older generations. Outcome measures in terms of the intervention effects needed to be reported. In total, 15 quantitative and five qualitative studies were ultimately included in this review. Eighteen interventions were reported across the quantitative studies. Six out of 11 group interventions (55%), one out of four mixed interventions (25%) and all three individual interventions reported at least one significant finding related to loneliness or social isolation. Our review suggested that new technologies and community engaged arts might be seen as a promising tool for tackling social isolation and loneliness among the older individuals. Future studies need to work on methodological quality and take into consideration the suggestions of the present literature in order to provide firm evidence.
Topics: Adaptation, Psychological; Age Factors; Aged; Aged, 80 and over; Aging; Community Health Services; Female; Health Services for the Aged; Humans; Interpersonal Relations; Loneliness; Male; Middle Aged; Quality of Life; Social Isolation
PubMed: 29199121
DOI: 10.1016/j.exger.2017.11.017 -
BMC Health Services Research Sep 2016Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and... (Review)
Review
BACKGROUND
Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and productive is a key goal of European labor policy and health promotion is a key to achieve this result. Previous studies about workplace health promotion (WHP) programs are usually focused on the entire workforce or to a specific topic. Within the framework of the EU-CHAFEA ProHealth65+ project, this paper aims to systematically review the literature on WHP interventions specifically targeted to older workers (OWs).
METHODS
This systematic review was conducted by making a comprehensive search of MEDLINE, ISI Web of Science, SCOPUS, The Cochrane Library, CINAHL and PsychINFO databases. Search terms included ageing (and synonyms), worker (and synonyms), intervention (and synonyms), and health (and synonyms). The search was limited to papers in English or Italian published between January, 1(st) 2000 and May, 31(st) 2015. Relevant references in the selected articles were also analyzed.
RESULTS
Of the 299 articles initially identified as relating to the topic, 18 articles met the inclusion criteria. The type, methods and outcome of interventions in the WHP programs retrieved were heterogenous, as was the definition of the age at which a worker is considered to be 'older'. Most of the available studies had been conducted on small samples for a limited period of time.
CONCLUSION
Our review shows that, although this issue is of great importance, studies addressing WHP actions for OWs are few and generally of poor quality. Current evidence fails to show that WHP programs improve the work ability, productivity or job retention of older workers. In addition, there is limited evidence that WHP programs are effective in improving lifestyles and concur to maintain the health and well-being of older workers. There is a need for future WHP programs to be well-designed so that the effectiveness and cost-benefit of workplace interventions can be properly investigated.
Topics: Adult; Aged; Cost-Benefit Analysis; Epidemiologic Methods; Health Promotion; Health Services for the Aged; Healthy Lifestyle; Humans; Middle Aged; Occupational Health Services; Workplace
PubMed: 27609070
DOI: 10.1186/s12913-016-1518-z -
Journal of the American Academy of... Jan 2016Organochlorine exposure is an important cause of cutaneous and systemic toxicity. Exposure has been associated with industrial accidents, intentional poisoning, and the... (Review)
Review
Organochlorine exposure is an important cause of cutaneous and systemic toxicity. Exposure has been associated with industrial accidents, intentional poisoning, and the use of defoliants, such as Agent Orange in the Vietnam War. Although long-term health effects are systematically reviewed by the Institute of Medicine, skin diseases are not comprehensively assessed. This represents an important practice gap as patients can present with cutaneous findings. This article provides a systematic review of the cutaneous manifestations of known mass organochlorine exposures in military and industrial settings with the goal of providing clinically useful recommendations for dermatologists seeing patients inquiring about organochlorine effects. Patients with a new diagnosis of chloracne, porphyria cutanea tarda, cutaneous lymphomas (non-Hodgkin lymphoma), and soft-tissue sarcomas including dermatofibrosarcoma protuberans and leiomyosarcomas should be screened for a history of Vietnam service or industrial exposure. Inconclusive evidence exists for an increased risk of other skin diseases in Vietnam veterans exposed to Agent Orange including benign fatty tumors, melanomas, nonmelanoma skin cancers, milia, eczema, dyschromias, disturbance of skin sensation, and rashes not otherwise specified. Affected veterans should be informed of the uncertain data in those cases. Referral to Department of Veterans Affairs for disability assessment is indicated for conditions with established associations.
Topics: 2,4,5-Trichlorophenoxyacetic Acid; 2,4-Dichlorophenoxyacetic Acid; Agent Orange; Environmental Exposure; Female; Follow-Up Studies; Humans; Hydrocarbons, Chlorinated; Incidence; Male; Military Personnel; Polychlorinated Dibenzodioxins; Risk Assessment; Skin Diseases; United States; Vietnam
PubMed: 26210237
DOI: 10.1016/j.jaad.2015.05.006 -
Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis.Sleep & Breathing = Schlaf & Atmung Jun 2020Only a limited amount of data is available from lower-income countries regarding the prevalence of poor quality of sleep. This meta-analysis of the scientific literature... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Only a limited amount of data is available from lower-income countries regarding the prevalence of poor quality of sleep. This meta-analysis of the scientific literature was performed to estimate the pooled prevalence of poor sleep quality in the Ethiopian population.
METHODS
The study protocol followed was the Preferred Reporting of Items for Systematic Review and meta-analysis (PRISMA) statement.
RESULTS
The nine studies which met the inclusion criteria provided data based on a total of 9103 participants who were studied at various health and academic institutions. The incidences of self-reported poor sleep quality ranged from 26 to 66.2%. The pooled estimate of poor sleep quality was 53%.There was a high prevalence of reported poor quality of sleep among younger subjects and among those who were studied in community (noninstitutional) settings.
CONCLUSION
The pooled prevalence of poor sleep quality is quite high among Ethiopians.
Topics: Adult; Age Factors; Aged; Cross-Sectional Studies; Developing Countries; Ethiopia; Humans; Middle Aged; Poverty; Sleep Wake Disorders; Surveys and Questionnaires
PubMed: 31183743
DOI: 10.1007/s11325-019-01871-x