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Journal of Neurosurgical Sciences Oct 2023Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients.
EVIDENCE ACQUISITION
We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach.
EVIDENCE SYNTHESIS
Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients.
CONCLUSIONS
Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.
Topics: Humans; Intracranial Aneurysm; Treatment Outcome; Embolization, Therapeutic; Endovascular Procedures; Vertebral Artery
PubMed: 35416457
DOI: 10.23736/S0390-5616.22.05710-1 -
Drug Testing and Analysis Aug 2022This paper presents a systematic literature review on the detection of new psychoactive substances (NPS) in prison settings. It includes the most frequently reported NPS... (Review)
Review
This paper presents a systematic literature review on the detection of new psychoactive substances (NPS) in prison settings. It includes the most frequently reported NPS classes, the routes and forms used for smuggling, and the methods employed to analyse biological and non-biological samples. The search was carried out using MEDLINE (EBSCO), Scopus (ELSEVIER), PubMed (NCBI), and Web of Science (Clarivate) databases, along with reports from the grey literature in line with the PRISMA-S guidelines. A total of 2708 records were identified, of which 50 met the inclusion criteria. Findings showed the most prevalent NPS class reported in prison was synthetic cannabinoids (SCs). The most frequently reported SCs in non-biological samples were 4F-MDMB-BINACA, MDMB-4en-PINACA, and 5F-ADB. These were smuggled mainly through the postal services deposited on paper or herbal matrices. Concentrations of SCs detected on seized paper ranged between 0.05 and 1.17 mg/cm . The SCs most frequently reported in biological specimens (i.e., urine, blood, saliva, and wastewater) were 5F-MDMB-PICA, 4F-MDMB-BINACA, and MDMB-4en-PINACA. Concentrations of SCs reported in femoral blood and serum were 0.12-0.48 ng/ml and 34-17 ng/ml, respectively. Hyphenated techniques were predominantly employed and generally successful for the detection of NPS in biological (i.e., LC-HRMS/MS) and non-biological samples (i.e., LC-HRMS/MS and GC-MS). The onsite technique IMS showed promise for detecting SCs in various forms; however, immunoassays were not recommended. Future work should focus on accurate in-field detection of SCs deposited on paper and in urine and saliva to improve real-time decision-making, as well as wastewater and air monitoring for overall drug use trends.
Topics: Cannabinoids; Chromatography, Liquid; Illicit Drugs; Prisons; Wastewater
PubMed: 35355411
DOI: 10.1002/dta.3263 -
World Neurosurgery Jun 2022The optimal treatment modality for saccular aneurysms of the posterior inferior cerebellar artery (PICA) remains unclear. A previous meta-analysis on the topic included... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The optimal treatment modality for saccular aneurysms of the posterior inferior cerebellar artery (PICA) remains unclear. A previous meta-analysis on the topic included a heterogenous study population, limiting the conclusions that can be drawn from its results. The aim of this study was to perform a systematic review and meta-analysis to compare outcomes of microsurgical and endovascular treatment (EVT) of these aneurysms.
METHODS
A search of 4 online databases was performed for studies describing the management of saccular PICA aneurysms. The primary outcome was complete aneurysm occlusion. Data were also collected on neurologic outcomes, cranial nerve palsies, and requirement for re-treatment. A random effects model was used for calculation of pooled proportions. Our protocol was registered with PROSPERO (CRD42021232784).
RESULTS
A total of 17 studies were included in the final analysis, reporting the treatment outcomes of 455 aneurysms, with a mean follow-up of 20 months. The pooled occlusion rates were 94.8% (95% confidence interval [CI] 90.6%-97.8%) for surgical treatment and 69.1% (95% CI 55.0%-81.7%) for EVT. Pooled rates of good neurologic outcome (modified Rankin scale score ≤2, Glasgow Outcome Scale score ≥4) at last follow-up were 78.1% (95% CI 67.4%-87.1%) for surgery and 77.6% (95% CI 67.9%-86.0%) for EVT.
CONCLUSIONS
This meta-analysis demonstrates that in the treatment of saccular PICA aneurysms, microsurgical clipping results in superior angiographic outcomes, similar functional outcomes, but higher rates of lower cranial nerve palsy compared with EVT. Further studies are required to assess the duration and severity of cranial nerve palsies following surgical treatment, and long-term aneurysm occlusion and the requirement for re-intervention following EVT.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Retrospective Studies; Treatment Outcome; Vertebral Artery
PubMed: 35257955
DOI: 10.1016/j.wneu.2022.02.103 -
European Spine Journal : Official... Dec 2021The presence vertebral artery (VA) abnormalities in the upper cervical may be a potential cause of catastrophic complication in the posterior approach of the upper... (Review)
Review
BACKGROUND
The presence vertebral artery (VA) abnormalities in the upper cervical may be a potential cause of catastrophic complication in the posterior approach of the upper cervical spine surgery. The aim of this study was to demonstrate the real incidence of the V3 segment anomaly in patients who need upper cervical surgery, and tried to find out the risk factors of V3 segment anomaly to evaluate the necessary of computed tomographic angiography (CTA) for upper cervical surgery.
METHOD
This systematic review was conducted following the preferred reporting items for systematic reviews and meta-Analyses (PRISMA). Retrospective studies and reports of case series involving human subjects with data on anomalies of vertebral artery in upper cervical spine were included. Data on the prevalence of persistent first intersegmental artery (PIA), fenestration of the VA (FA), posterior inferior cerebellar artery (PICA) were extracted.
RESULTS
A total of 16 articles involving 5927 subjects met the inclusion criteria. The total incidence of V3 segment anomaly in the patients with bony abnormalities was 25.9% (74/286): PIA was 17.5%, FA was 6.6% and PICA was 1.8%. The total incidence of V3 segment anomaly in the patients without bony abnormalities was 2.7% (152/5671): PIA was 1.76%, FA was 0.4% and PICA was 0.5%. The total incidence of V3 segment anomaly in Asian population without bony abnormalities was 5.8%, while in European and American population was 0.8 and 0.6%, respectively.
CONCLUSION
Patients with bone abnormalities are high risk factor for VA abnormalities, CTA is of paramount importance to evaluate the variant VA anatomy. However, regarding to the low incidence of V3 variation in normal population, we do not recommend preoperative CT angiography as mandatory part of preoperative.
Topics: Cervical Vertebrae; Humans; Prevalence; Retrospective Studies; Spinal Diseases; Vertebral Artery
PubMed: 34601625
DOI: 10.1007/s00586-021-07015-8 -
British Journal of Neurosurgery Jun 2024Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon...
BACKGROUND
Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon and present unique treatment challenges. Giant distal PICA aneurysms are exceedingly rare and have traditionally been managed via open surgical approaches.
METHODS
A total of 207 studies were assessed, identifying 26 cases of giant distal PICA aneurysms from 26 separate publications. One additional case is described followed by a review of presentation, anatomical characteristics, treatment and outcome.
RESULTS
Presentation was due to local mass effect in 19 (70%), hydrocephalus in 4 (15%) and acute haemorrhage in 5 (19%). All reported cases were partially (86%) or completely (14%) thrombosed. The telovelotonsillar segment was involved in 18/24 (75%) cases. Two cases (7%) were associated with an arteriovenous malformation. Twenty-two (81%) were managed surgically and 5 (19%) managed endovascularly. Outcome was good in 22 (85%) and poor in one (4%).
CONCLUSIONS
Giant distal PICA aneurysms can be managed effectively through a variety of open surgical and endovascular techniques.
Topics: Humans; Intracranial Aneurysm; Cerebellum; Treatment Outcome; Endovascular Procedures; Female; Middle Aged; Male; Adult; Neurosurgical Procedures; Aged
PubMed: 34279172
DOI: 10.1080/02688697.2021.1950631 -
World Journal of Clinical Cases Apr 2021The proton pump inhibitors (PPIs), used to reduce gastric acid secretion, represent one of the most widely used pharmaceutical classes in the world. Their consumption as...
BACKGROUND
The proton pump inhibitors (PPIs), used to reduce gastric acid secretion, represent one of the most widely used pharmaceutical classes in the world. Their consumption as a risk factor for the evolution of severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been investigated as well as the mortality of these patients. These risks also appear to be linked to the duration and the dosage. On the other hand, several studies have emerged with regard to the protective or therapeutic effects of these drugs. More and more evidence underlines the immunomodulatory and anti-fibrotic role of PPIs. In addition, their ability to alkalize the contents of endosomes and lysosomes serves as an obstacle to the entry of the virus into the host cells.
AIM
To identify studies on the relationship between the intake of PPIs and coronavirus disease 2019 (COVID-19) in patients affected by SARS-CoV-2 infection, with the main objective of evaluating the outcomes related to severity and mortality.
METHODS
A literature review was performed in November 2020. The MEDLINE/PubMed, Cochrane Library, EMBASE and Google Scholar databases were searched for all relevant articles published in English on this topic. The search terms were identified by means of controlled vocabularies, such as the National Library of Medicine's MESH (Medical Subject Headings) and keywords. The MESH terms and keywords used were as follows: "COVID-19", "proton pump inhibitors", "PPIs", "SARS-CoV-2", "outcomes", "severity" and "mortality". The inclusion criteria regarding the studies considered in our analysis were: meta-analysis, case-control, hospital-based case-control, population-based case-control, retrospective studies, online survey, as well as cohort-studies, while articles not published as full reports, such as conference abstracts, case reports and editorials were excluded. We tried to summarize and pool all the data if available.
RESULTS
A total of 9 studies were found that described the use of PPIs, of which only 5 clearly reported the severity and mortality data in SARS-CoV-2 patients. Our pooled incidence analysis of severe events did not differ between patients with and without PPIs (odds ratio 1.65, 95% confidence interval: 0.62-4.35) ( = 0.314), or for mortality (odds ratio 1.77, 95% confidence interval: 0.62-5.03) ( = 0.286).
CONCLUSION
Detailed and larger case studies are needed to accurately understand the role of PPIs in this viral infection.
PubMed: 33969059
DOI: 10.12998/wjcc.v9.i12.2763 -
Clinical Psychology & Psychotherapy Jan 2021Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on...
Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.
Topics: Adolescent; Behavior Therapy; Child; Humans; Pica; Reinforcement, Psychology; Treatment Outcome
PubMed: 32628326
DOI: 10.1002/cpp.2491 -
The Pharmacogenomics Journal Oct 2020A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in...
A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in Childhood Asthma (PiCA) consortia members was conducted. Studies were eligible if genetic polymorphisms were compared with suspected ADR(s) in a patient with asthma, as either a primary or secondary outcome. Five studies met the inclusion criteria. The ADRs and polymorphisms identified were change in lung function tests (rs1042713), adrenal suppression (rs591118), and decreased bone mineral density (rs6461639) and accretion (rs9896933, rs2074439). Two of these polymorphisms were replicated within the paper, but none had external replication. Priorities from PiCA consortia members (representing 15 institution in eight countries) for future studies were tachycardia (SABA/LABA), adrenal suppression/crisis and growth suppression (corticosteroids), sleep/behaviour disturbances (leukotriene receptor antagonists), and nausea and vomiting (theophylline). Future pharmacogenomic studies in asthma should collect relevant ADR data as well as markers of efficacy.
Topics: Adolescent; Adult; Anti-Asthmatic Agents; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Pharmacogenomic Testing; Pharmacogenomic Variants; Phenotype; Polymorphism, Single Nucleotide; Risk Assessment; Risk Factors; Young Adult
PubMed: 31949291
DOI: 10.1038/s41397-019-0140-y -
American Journal of Physical... Jan 2019Geophagy, the intentional consumption of earth, is widely practiced among humans and other mammals, but its causes are not well understood. Given the growing number of...
OBJECTIVES
Geophagy, the intentional consumption of earth, is widely practiced among humans and other mammals, but its causes are not well understood. Given the growing number of reports of geophagy among nonhuman primates (NHP), we sought to (1) advance and codify our understanding of the patterns and functional and evolutionary significance of geophagy among NHP and (2) provide a research agenda for a more unified approach to its study.
METHODS
We systematically reviewed all available literature on NHP geophagy, extracted available data on taxa, geography, climate, diet, sex, age-class, reproductive status, and the characteristics of the earth. We used these data to evaluate three major hypotheses about geophagy, that it is protective, provides mineral supplementation, and is nonadaptive.
RESULTS
We identified 287 accounts of geophagy among 136 species, adding 79 new primate species to the list of those considered in prior reviews. Nineteen percent of species were in the suborder Strepsirrhini, while 81% were in the suborder Haplorrhini. There were reports of geophagy from 9 of the 17 families and 39 of the 76 genera currently recognized by the International Union for Conservation of Nature.
DISCUSSION
The limited evidence suggests that geophagy is adaptive, and provides protection and mineral supplementation. We specify the behavioral, dietary, and soil data required to more rigorously investigate these hypotheses across representative species of all taxonomic groups, geographical regions, and dietary classification. Given the plausibility of geophagy for maintaining the health of both wild and captive populations, we urge further study and conservation of geophagy sites.
Topics: Animals; Anthropology, Physical; Female; Male; Pica; Primates
PubMed: 30508222
DOI: 10.1002/ajpa.23724 -
Neurology India 2018Experience with respect to parent vessel sacrifice (PVS) for unclippable/uncoilable ruptured aneurysms is limited.
BACKGROUND
Experience with respect to parent vessel sacrifice (PVS) for unclippable/uncoilable ruptured aneurysms is limited.
OBJECTIVE
The aim of the present systematic review was to evaluate the risk of PVS for unclippable/uncoilable ruptured aneurysms.
MATERIALS AND METHODS
The PUBMED and SCIENCEDIRECT databases were searched using "parent vessel occlusion OR parent artery occlusion" AND "acute subarachnoid hemorrhage" till December 27, 2015, and 1 journal was searched from November 1995 to April 2016 for relevant results.
RESULTS
Out of a total of 19 eligible studies, 104 patients with 104 ruptured aneurysms were treated by PVS with or without bypass surgery. Unfavorable outcome [modified Rankin Score (mRS) 4-6] was reported in 14 (13.4%) acute phase patients, with a 9.6% mortality rate. Thirty (28.8%) patients developed ischemic complications and 3 (2.9%) developed bleeding complications. The complication rate was higher for PVS in the acute phase (38.0% vs. 12.0%; P= 0.015). The unfavorable clinical outcome was found to be significant in acute phase versus chronic phase (17.7% vs. 0%; P= 0.024). The risk of morbidity associated with distal vessel [posterior cerebral artery (PCA) + superior cerebellar artery (SCA) + posterior inferior cerebellar artery (PICA)] sacrifice was not lower than that associated with major vessel [internal carotid artery (ICA) + basilar artery (BA) + vertebral artery (VA)] sacrifice (P = 0.961).
CONCLUSION
Complication and unfavorable outcome rates associated with PVS for acutely ruptured aneurysms are high. The risk of distal vessel sacrifice was not lower than major vessel sacrifice in the acute phase.
Topics: Aneurysm, Ruptured; Endovascular Procedures; Humans; Intracranial Aneurysm; Postoperative Complications
PubMed: 29766928
DOI: 10.4103/0028-3886.232310