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Age and Ageing Feb 2024Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence of this condition varies significantly across studies. We aimed to determine the prevalence of PPH in older adults.
METHODS
Web of Science, PubMed, Cochrane Library, Embase and CINAHL were searched from their inception until February 2023. Search terms included 'postprandial period', 'hypotension' and 'postprandial hypotension'. Eligible studies were assessed using the Joanna Briggs Institute tool. Meta-analyses were performed among similar selected studies.
RESULTS
Thirteen eligible studies were included, and data from 3,021 participants were pooled. The meta-analysis revealed a PPH prevalence of 40.5% [95% confidence interval (CI): 0.290-0.519] in older adults, and this was prevalent in the community (32.8%, 95% CI: 0.078-0.647, n = 1,594), long-term healthcare facility (39.4%, 95% CI: 0.254-0.610, n = 1,062) and geriatrics department of hospitals (49.3%, 95% CI: 0.357-0.630, n = 365). The pooled results showed significant heterogeneity (I2 > 90%), partially related to the different ages, sex, pre-prandial systolic blood pressure levels of participants, or the different criteria and methodology used to diagnose PPH.
CONCLUSIONS
PPH is a prevalent condition in older adults. Further research is needed to confirm this result, and priority should be given to establishing international consensus on PPH diagnostic criteria and designing its diagnostic procedure.
Topics: Humans; Aged; Prevalence; Hypotension; Cardiovascular Diseases; Consensus; Hospitals
PubMed: 38411408
DOI: 10.1093/ageing/afae022 -
The Journal of Evidence-based Dental... Jan 2024Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review...
OBJECTIVES
Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals.
METHODS
The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review.
RESULTS
After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60.
CONCLUSIONS
This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.
Topics: Humans; Oral Health; Quality of Life; Oral Hygiene; Health Personnel; Surveys and Questionnaires; Facial Pain
PubMed: 38401949
DOI: 10.1016/j.jebdp.2023.101949 -
Journal of the European Academy of... Jul 2024Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease... (Review)
Review
Prevalence of dermatitis including allergic contact dermatitis from medical devices used by children and adults with Type 1 diabetes mellitus: A systematic review and questionnaire study.
Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease control. Adverse skin reactions from these MDs may however hamper compliance. The objective of this study was to systematically review and analyse studies assessing the prevalence and incidence of dermatitis, including allergic contact dermatitis (ACD) related to MDs used in patients with T1D and to compare referral routes and the clinical investigation routines between clinics being part of the European Environmental and Contact Dermatitis Research Group (EECDRG). A systematic search of PubMed, EMBASE, CINAHL and Cochrane databases of full-text studies reporting incidence and prevalence of dermatitis in persons with T1D using MDs was conducted until December 2021. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at EECRDG clinics focused on referral routes, patient numbers and the diagnostic process. Among the 3145 screened abstracts, 39 studies fulfilled the inclusion criteria. Sixteen studies included data on children only, 14 studies were on adults and nine studies reported data on both children and adults. Participants were exposed to a broad range of devices. Skin reactions were rarely specified. It was found that both the diagnostic process and referral routes differ in different centres. Further data on the prevalence of skin reactions related to MDs in individuals with T1D is needed and particularly studies where the skin reactions are correctly diagnosed. A correct diagnosis is delayed or hampered by the fact that, at present, the actual substances within the MDs are not declared, are changed without notice and the commercially available test materials are not adequately updated. Within Europe, routines for referral should be made more standardized to improve the diagnostic procedure when investigating patients with possible ACD from MDs.
Topics: Humans; Diabetes Mellitus, Type 1; Prevalence; Dermatitis, Allergic Contact; Child; Adult; Blood Glucose Self-Monitoring; Insulin Infusion Systems; Surveys and Questionnaires; Incidence
PubMed: 38400603
DOI: 10.1111/jdv.19908 -
International Journal of Cardiology May 2024To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12‑lead ECG in detecting ACO across any coronary artery, challenging the current... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12‑lead ECG in detecting ACO across any coronary artery, challenging the current STEMI-NSTEMI paradigm.
METHODS
Studies from MEDLINE and Scopus (2012-2023) comparing ECG findings with coronary angiograms were systematically reviewed and analyzed following PRISMA-DTA guidelines. QUADAS-2 assessed the risk of bias.
STUDY SELECTION
Studies included focused on AMI patients and provided data enabling the construction of contingency tables for sensitivity and specificity calculation, excluding those with non-ACS conditions, outdated STEMI criteria, or a specific focus on bundle branch blocks or other complex diagnoses. Data were extracted systematically and pooled test accuracy estimates were computed using MetaDTA software, employing bivariate analyses for within- and between-study variation. The primary outcomes measured were the sensitivity and specificity of ST-segment elevation in detecting ACO.
RESULTS
Three studies with 23,704 participants were included. The pooled sensitivity of ST-segment elevation for detecting ACO was 43.6% (95% CI: 34.7%-52.9%), indicating that over half of ACO cases may not exhibit ST-segment elevation. The specificity was 96.5% (95% CI: 91.2%-98.7%). Additional analysis using the OMI-NOMI strategy showed improved sensitivity (78.1%, 95% CI: 62.7%-88.3%) while maintaining similar specificity (94.4%, 95% CI: 88.6%-97.3%).
CONCLUSION
The findings reveal a significant diagnostic gap in the current STEMI-NSTEMI paradigm, with over half of ACO cases potentially lacking ST-segment elevation. The OMI-NOMI strategy could offer an improved diagnostic approach. The high heterogeneity and limited number of studies necessitate cautious interpretation and further research in diverse settings.
Topics: Humans; Coronary Occlusion; ST Elevation Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Heart; Electrocardiography; Diagnostic Tests, Routine
PubMed: 38382857
DOI: 10.1016/j.ijcard.2024.131889 -
Stereotactic and Functional Neurosurgery 2024MRI-guided focused ultrasound (FUS) is an incisionless thermo-ablative procedure that may be used to treat medication-refractory movement disorders, with a growing...
INTRODUCTION
MRI-guided focused ultrasound (FUS) is an incisionless thermo-ablative procedure that may be used to treat medication-refractory movement disorders, with a growing number of potential anatomic targets and clinical applications. As of this article's publication, the only US Food and Drug Administration (FDA)-approved uses of FUS for movement disorders are thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's Disease (PD), and pallidotomy for other cardinal symptoms of PD. We present a state-of-the-art review on all non-FDA approved indications of FUS for movement disorders, beyond the most well-described indications of ET and PD. Our objective was to summarize the safety and efficacy of FUS in this setting and provide a roadmap for future directions of FUS for movement disorders.
METHODS
A state-of-the-art review was conducted on use of FUS for non-FDA approved movement disorders. All movement disorders excluding FDA-approved uses for ET and PD were included.
RESULTS
A total of 25 studies on 172 patients were included. In patients with tremor plus dystonia syndromes (n = 6), ventralis intermediate nucleus of the thalamus (VIM)-FUS gave >50% tremor reduction, with no improvement in dystonia and worsened dystonia in 2/6 patients. Ventral-oralis complex (VO)-FUS gave >50% improvement for focal hand dystonia (n = 6) and 100% return to musical performance in musician's dystonia (n = 6). In patients with multiple sclerosis (MS) and tremor (n = 3), improvement in tremor was seen in 2 patients with a favorable skull density ratio; no MS disease change was noted after VIM-FUS. In patients with tremor and comorbid ataxia syndromes (n = 3), none were found to have worsened ataxia after VIM-FUS; all had clinically significant tremor improvement. Subthalamic nucleus (STN)-FUS for PD (n = 49) gave approximately 50% improvement in PD motor symptoms, with dystonia and mild dyskinesias as possible adverse effects. Cerebellothalamic tract (CTT-FUS) for ET (n = 42) gave 55-90% tremor improvement, with gait dysfunction as a rare persistent adverse effect. Pallidothalamic tract (PTT-FUS) for PD (n = 50) gave approximately 50% improvement in motor symptoms, with mild speech dysfunction as a possible adverse effect.
CONCLUSION
VIM-FUS appeared safe and effective for heterogenous tremor etiologies, and VO-FUS appeared most effective for isolated segmental dystonia. STN-FUS was effective for PD symptom reduction; postoperative dystonia and mild on-medication dyskinesias required medical management. Tractography-based targeting with CTT-FUS for ET and PTT-FUS for PD demonstrated promising early results. Larger prospective trials with long-term follow-up are needed to the evaluate the safety and efficacy non-FDA approved indications for FUS.
Topics: United States; Humans; Tremor; Dystonia; Prospective Studies; United States Food and Drug Administration; Thalamus; Essential Tremor; Parkinson Disease; Ataxia; Dyskinesias; Treatment Outcome; Dystonic Disorders
PubMed: 38368868
DOI: 10.1159/000535621 -
Neuropediatrics Jun 2024is involved in posttranslational modification and is known to have a role in physiological functions such as cell signaling, DNA repair, gene control, cell death, and... (Review)
Review
is involved in posttranslational modification and is known to have a role in physiological functions such as cell signaling, DNA repair, gene control, cell death, and response to stress. Recently, a group of neurological disorders due to variants is described, characterized by childhood-onset, stress-induced variable movement disorders, neuropathy, seizures, and neurodegenerative course. We present the diagnostic pathway of two pediatric patients with episodic dystonia and ataxia, who later had a neurodegenerative course complicated by central hypoventilation syndrome due to the same homozygous variant. We conducted a systematic literature search and data extraction procedure following the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 statement in terms of patients with variants, from 2018 up to 3 February, 2023. In total, 12 articles describing 47 patients were included in the final analysis. Median age at symptom onset was 2 (0.7-25) years, with the most common presenting symptoms being gait problems ( = 19, 40.4%), seizures ( = 16, 34%), ataxia ( = 13, 27.6%), and weakness ( = 10, 21.2%). Triggering factors (28/47; 59.5%) and regression (28/43; 60.4%), axonal polyneuropathy (9/23; 39.1%), and cerebral and cerebellar atrophy with white matter changes (28/36; 77.7%) were the other clues. The fatality rate and median age of death were 44.6% ( = 21) and 7 (2-34) years, respectively. variants should be considered in the context of episodic, stress-induced pediatric and adult-onset movement disorders and seizures.
Topics: Humans; Male; Child; Female; Child, Preschool; Adolescent; Young Adult; Ataxia; Adult; Infant; Hypoventilation
PubMed: 38365196
DOI: 10.1055/s-0044-1779618 -
Gastrointestinal Endoscopy Jun 2024Obtaining adequate tissue samples in subepithelial lesions (SELs) remains challenging. Several biopsy techniques are available, but a systematic review including all... (Review)
Review
BACKGROUND AND AIMS
Obtaining adequate tissue samples in subepithelial lesions (SELs) remains challenging. Several biopsy techniques are available, but a systematic review including all available techniques to obtain a histologic diagnosis of SEL is lacking. The aim of this study was to evaluate the diagnostic yield and adverse event rates of endoscopic biopsies, EUS-guided FNA (EUS-FNA), EUS-guided fine-needle biopsy (FNB) (EUS-FNB), and mucosal incision-assisted biopsy (MIAB) for SELs in the upper GI tract.
METHODS
A search strategy in multiple databases was performed. The primary outcome was diagnostic yield, defined as the percentage of procedures in which histology was obtained and resulted in a definitive histopathologic diagnosis. Secondary outcome measures included reported procedure-related adverse events, which were graded according to the AGREE (Adverse Events in Gastrointestinal Endoscopy) classification.
RESULTS
A total of 94 original articles were included. Studies were classified per endoscopic technique to obtain histopathology. This resulted in 8 included studies for endoscopic biopsy methods, 55 studies for EUS-FNA, 33 studies for EUS-FNB, and 26 studies for MIAB. Pooled rates for diagnostic yield were 40.6% (95% confidence interval [CI], 30.8-51.2) for endoscopic biopsy, 74.6% (95% CI, 69.9-78.7) for EUS-FNA, 84.2% (95% CI, 80.7-87.2) for EUS-FNB, and 88.2% (95% CI, 84.7-91.1) for MIAB. Reported procedure-related adverse events graded AGREE II or higher were 2.8% to 3.9% for endoscopic biopsies, 1.0% to 4.5% for EUS-FNA, .9% to 7.7% for EUS-FNB, and 1.9% to 7.9% for MIAB.
CONCLUSIONS
Based on the available evidence, MIAB and EUS-FNB seem to be most effective in terms of achieving a high diagnostic yield, with similar rates of adverse events.
Topics: Humans; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Endoscopy, Gastrointestinal; Gastrointestinal Neoplasms; Stomach Neoplasms; Upper Gastrointestinal Tract; Image-Guided Biopsy; Esophageal Neoplasms
PubMed: 38360118
DOI: 10.1016/j.gie.2024.02.003 -
Journal of Obstetrics and Gynaecology :... Dec 2024The diagnosis of endometriomas in patients with endometriosis is of primary importance because it influences the management and prognosis of infertility and pain.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The diagnosis of endometriomas in patients with endometriosis is of primary importance because it influences the management and prognosis of infertility and pain. Imaging techniques are evolving constantly. This study aimed to systematically assess the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) in detecting endometrioma using the surgical visualisation of lesions with or without histopathological confirmation as reference standards in patients of reproductive age with suspected endometriosis.
METHODS
PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov databases were searched from their inception to 12 October 2022, using a manual search for additional articles. Two authors independently performed title, abstract and full-text screening of the identified records, extracted study details and quantitative data and assessed the quality of the studies using the 'Quality Assessment of Diagnostic Accuracy Study 2' tool. Bivariate random-effects models were used to determine the pooled sensitivity and specificity, compare the two imaging modalities and evaluate the sources of heterogeneity.
RESULTS
Sixteen prospective studies (10 assessing TVUS, 4 assessing MRI and 2 assessing both TVUS and MRI) were included, representing 1976 participants. Pooled TVUS and MRI sensitivities for endometrioma were 0.89 (95% confidence interval 'CI', 0.86-0.92) and 0.94 (95% CI, 0.74-0.99), respectively (indirect comparison -value of 0.47). Pooled TVUS and MRI specificities for endometrioma were 0.95 (95% CI, 0.92-0.97) and 0.94 (95% CI, 0.89-0.97), respectively (indirect comparison p-value of 0.51). These studies had a high or unclear risk of bias. A direct comparison (all participants undergoing TVUS and MRI) of the modalities was available in only two studies.
CONCLUSION
TVUS and MRI have high accuracy for diagnosing endometriomas; however, high-quality studies comparing the two modalities are lacking.
Topics: Female; Humans; Endometriosis; Prospective Studies; Ultrasonography; Magnetic Resonance Imaging; Sensitivity and Specificity; Diagnostic Tests, Routine
PubMed: 38348799
DOI: 10.1080/01443615.2024.2311664 -
World Neurosurgery Apr 2024To assess the efficacy and surgical outcomes of the simultaneous single-trajectory endoscopic biopsy and third ventriculostomy (ETV) in pineal region tumors. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the efficacy and surgical outcomes of the simultaneous single-trajectory endoscopic biopsy and third ventriculostomy (ETV) in pineal region tumors.
METHODS
A systematic review and meta-analysis adhering to Cochrane Standards and PRISMA framework were conducted. PubMed, Embase, and Web Of Science databases were searched until December 2023. Outcomes included rate of histopathologic diagnosis success, ETV success, complications, required VPS, and mortality.
RESULTS
Seventeen studies (N = 388) met inclusion criteria. Histopathologic diagnosis success rate was 90% for general population (95% CI: 86%-95%; I = 42%) and 94% for pediatric patients (95% CI: 89%-98%; I = 19%). ETV Success rate was 93% (95% CI: 88%-97%; I = 60%). An estimated risk of postoperative ETV complications was found to be 16% for the general population (95% CI: 5%-28%; I = 90%) and 5% for pediatric patients (95% CI: 0%-13%; I = 51%). The risk of requiring VPS was estimated as 2% (95% CI: 0%-4%; I = 39%) and for the pediatric population it was 7% (95% CI: 0%-16%; I = 69%). Mortality risk was found to be 1% (95% CI: 0%-3%; I = 0%).
CONCLUSIONS
Simultaneous endoscopic biopsy and ETV demonstrated high diagnostic and therapeutic success rates. The procedure's safety profile, with low mortality and complications, supports its role in treating hydrocephalus associated to pineal region tumors. Subgroup analyses revealed higher diagnostic success rates and required VPS in the pediatric population, whilst it had lower complication rates.
Topics: Child; Humans; Ventriculostomy; Neuroendoscopy; Third Ventricle; Pinealoma; Biopsy; Postoperative Complications; Hydrocephalus; Brain Neoplasms; Pineal Gland; Treatment Outcome; Retrospective Studies
PubMed: 38340795
DOI: 10.1016/j.wneu.2024.02.015 -
Clinical Neuroradiology Jun 2024Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs.
PURPOSE
To determine whether specific EVTs are superior to alternatives.
DATA SOURCES
CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact.
STUDY SELECTION
All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded.
DATA ANALYSIS
Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation.
DATA SYNTHESIS
In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes.
LIMITATIONS
The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details.
CONCLUSION
Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
Topics: Adult; Female; Humans; Male; Middle Aged; Mechanical Thrombolysis; Sinus Thrombosis, Intracranial; Thrombectomy; Treatment Outcome
PubMed: 38329489
DOI: 10.1007/s00062-023-01373-0