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Cureus Mar 2024Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine... (Review)
Review
Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.
PubMed: 38681338
DOI: 10.7759/cureus.57077 -
Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature.Journal of Personalized Medicine Mar 2024The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are... (Review)
Review
BACKGROUND
The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients.
MATERIALS AND METHODS
We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery.
RESULTS
Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges.
CONCLUSIONS
ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
PubMed: 38672962
DOI: 10.3390/jpm14040335 -
Clinical Oral Investigations Apr 2024This study aims to determine the association between severe mental disorders and oral health among individuals over 18 years of age. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aims to determine the association between severe mental disorders and oral health among individuals over 18 years of age.
METHODS
An electronic search was conducted in six electronic databases and gray literature. Qualitative and quantitative analyses were performed on studies that met the inclusion criteria. The methodology of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis of proportions with a random effect was carried out. The certainty of evidence was evaluated using the GRADE tool.
RESULTS
After searching the databases, 5,734 references were retrieved, and twenty articles were selected for synthesis. Considering the DMFT index between the groups with mental disorders and the control group, the values of the DMFT index were higher among individuals with schizophrenia [MD = 5.27; 95% CI = 4.13 - 6.42; I = 35%] and bipolar disorder [MD = 1.90; 95% CI = 0.87 - 2.93]. Values were lower among individuals with obsessive-compulsive disorder [MD = -0.85; 95% CI = -1.46-0.24]. The risk of bias was considered low for 16 studies, and four were classified with a moderate risk of bias. The certainty of evidence was very low.
CONCLUSION
Patients with schizophrenia and bipolar disorder exhibit increased frequency in the number of decayed, missing, or filled teeth. There was no effect in relation to periodontal probing depth, plaque index, and TMD, but the evidence is still uncertain for this outcome.
CLINICAL RELEVANCE
These findings underscore the need for a comprehensive health approach.
Topics: Humans; Oral Health; DMF Index; Mental Disorders; Dental Caries
PubMed: 38664259
DOI: 10.1007/s00784-024-05642-1 -
Clinical Oncology (Royal College of... Jul 2024Approximately 55% of patients diagnosed with primary or metastatic cancer endure pain directly attributable to the disease. Consequently, it becomes imperative to... (Meta-Analysis)
Meta-Analysis Comparative Study
AIMS
Approximately 55% of patients diagnosed with primary or metastatic cancer endure pain directly attributable to the disease. Consequently, it becomes imperative to address pain management through a comparative analysis of stereotactic radiotherapy (SRT) and conventional radiation therapy (CRT), especially in light of the less efficacious improvement achieved solely through pharmacological interventions.
MATERIALS AND METHODS
A systematic exploration was undertaken on PubMed, the Cochrane Library, and Elsevier's ScienceDirect databases to identify studies that compare Stereotactic Radiotherapy to Conventional radiation therapy for pain management in individuals with metastatic bone cancer. The analyses were executed utilizing the random-effects model.
RESULTS
A cohort of 1152 participants with metastatic bone cancer was analyzed, demonstrating significantly higher complete pain relief in the Stereotactic Radiotherapy group during both early and late follow-up (RR: 1.61; 95% CI: 1.17, 2.23, p-value: 0.004; I2: 0%). Stereotactic Radiotherapy also showed a non-significant increase in the incidence of partial pain relief (RR: 1.07; 95% CI: 0.85, 1.34, p-value: 0.56; I2: 18%). Furthermore, Stereotactic Radiotherapy was associated with a significantly reduced risk of stationary pain throughout follow-up (RR: 0.61; 95%CI: 0.48, 0.76, p-value: <0.0001; I2: 0. The incidence of progressive pain was non-significantly reduced with Stereotactic Radiotherapy during both early and late follow-up (RR: 0.77; 95% CI: 0.50, 1.17, p-value: 0.22; I2: 0%). Secondary outcomes exhibited a non-significant trend favoring Stereotactic Radiotherapy for dysphagia, esophagitis, pain, and radiodermatitis, while a non-significant increase was observed for nausea, fatigue, and vertebral compression fracture.
CONCLUSION
In summary, stereotactic radiation therapy (SRT) has improved in achieving complete pain relief while exhibiting a decreased probability of delivering stationary pain compared to conventional radiation therapy (CRT). Nevertheless, it is crucial in future research to address a noteworthy limitation, specifically, the risk of vertebral compression fracture.
Topics: Humans; Radiosurgery; Cancer Pain; Pain Management; Bone Neoplasms
PubMed: 38664177
DOI: 10.1016/j.clon.2024.04.004 -
Dysphagia Apr 2024Dysphagia or swallowing dysfunction is common in patients with acute or critical illness, and diverse methods of dysphagia rehabilitation are provided worldwide. We...
Dysphagia or swallowing dysfunction is common in patients with acute or critical illness, and diverse methods of dysphagia rehabilitation are provided worldwide. We aimed to examine the efficacy of rehabilitation to treat dysphagia in patients with acute or critical illness. We searched PubMed, ICHUSHI, and Cochrane Central Register of Controlled Trials databases from inception to November 22, 2023 for relevant randomized controlled trials. We focused on dysphagic patients with acute or critical illness who were not orotracheally intubated. Our target intervention included conventional rehabilitation and nerve stimulation/neuromodulation techniques as dysphagia rehabilitation. Comparators were conventional or standard care or no dysphagia interventions. Primary outcomes included mortality, incidence of pneumonia during the study period, and health-related quality of life (HRQoL) scores within 90 days of hospital discharge. We pooled the data using a random-effects model, and classified the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation system. Nineteen randomized controlled trials involving 1,096 participants were included. Dysphagia rehabilitation was associated with a reduced incidence of pneumonia (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.54-0.81; moderate certainty), but not with reduced mortality (RR, 0.92; 95% CI, 0.61-1.39; very low certainty) or improved HRQoL scores (mean difference, -0.20; 95% CI, -20.34 to 19.94; very low certainty). Based on the available moderate- or very low- quality evidence, while dysphagia rehabilitation had no impact on mortality or HRQoL, they might reduce the incidence of pneumonia in dysphagic patients with acute or critical illness.
PubMed: 38662217
DOI: 10.1007/s00455-024-10700-7 -
Diseases of the Esophagus : Official... Apr 2024Esophageal manometry is utilized for the evaluation and classification of esophageal motility disorders. EndoFlip has been introduced as an adjunctive test to evaluate...
Esophageal manometry is utilized for the evaluation and classification of esophageal motility disorders. EndoFlip has been introduced as an adjunctive test to evaluate esophagogastric junction (EGJ) distensibility. Treatment options for achalasia and EGJ outflow obstruction (EGJOO) include pneumatic dilation, myotomy, and botulinum toxin. Recently, a therapeutic 30 mm hydrostatic balloon dilator (EsoFLIP, Medtronic, Minneapolis, MN, USA) has been introduced, which uses impedance planimetry technology like EndoFlip. We performed a systematic review to evaluate the safety and efficacy of EsoFLIP in the management of esophageal motility disorders. A systematic literature search was performed with Medline, Embase, Web of science, and Cochrane library databases from inception to November 2022 to identify studies utilizing EsoFLIP for management of esophageal motility disorders. Our primary outcome was clinical success, and secondary outcomes were adverse events. Eight observational studies including 222 patients met inclusion criteria. Diagnoses included achalasia (158), EGJOO (48), post-reflux surgery dysphagia (8), and achalasia-like disorder (8). All studies used 30 mm maximum balloon dilation except one which used 25 mm. The clinical success rate was 68.7%. Follow-up duration ranged from 1 week to a mean of 5.7 months. Perforation or tear occurred in four patients. EsoFLIP is a new therapeutic option for the management of achalasia and EGJOO and appears to be effective and safe. Future comparative studies with other therapeutic modalities are needed to understand its role in the management of esophageal motility disorders.
PubMed: 38659256
DOI: 10.1093/dote/doae036 -
Archives of Gerontology and Geriatrics Sep 2024To characterize mouth-opening muscular performance (MOMP) in adults and elderly individuals with dysphagia and healthy controls. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To characterize mouth-opening muscular performance (MOMP) in adults and elderly individuals with dysphagia and healthy controls.
METHODS
We searched the PubMed, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science databases from inception to Jan. 26, 2023. Two independent researchers considered the titles, abstracts, and full texts of potentially eligible papers from 1451 search results. Twenty-five studies that evaluated mouth-opening maximal strength (MOMS) in healthy adults, elderly individuals, and patients with dysphagia met the inclusion criteria.
RESULTS
We found comparable, reliable values with significant sex differences in maximal mouth opening strength (MMOS) in the meta-analysis for healthy elderly patients (females 5.31 ± 0.47 kg vs. males 7.04 ± 0.70 kg; mean difference of 0.84 kg). Age has also emerged as an essential factor in reducing strength. There was a significant reduction in the MMOS score in the only study that compared dysphagic individuals to healthy elderly individuals. In another study, the MMOS score was comparable to the meta-analysis of healthy elderly individuals.
CONCLUSIONS
Both sex and age play significant roles in the MMOS. There is no reliable data on the normal mouth-opening strength and endurance of healthy adults, patients with dysphagia, or individuals with other relevant clinical problems.
Topics: Humans; Deglutition Disorders; Muscle Strength; Aged; Mouth; Male; Female; Adult; Sex Factors; Age Factors
PubMed: 38653018
DOI: 10.1016/j.archger.2024.105448 -
PeerJ 2024Gastroesophageal reflux disease (GERD) and sleep problems are highly prevalent among the general population. Both them are associated with a variety of psychiatric... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Gastroesophageal reflux disease (GERD) and sleep problems are highly prevalent among the general population. Both them are associated with a variety of psychiatric disorders such as depression and anxiety, which is highlighting an underexplored connection between them. This meta-analysis aims to explore the association between sleep problems and GERD.
METHODS
We conducted a comprehensive search on PubMed, Cochrane Library, Embase, and Web of Science, using Medical Subject Headings (MeSH) and keywords, covering articles from the inception of the databases until August 2023. Stata statistical software, version 14.0, was utilized for all statistical analyses. A fixed-effects model was applied when > 0.1 and I2 ≤ 50%, while a random-effects model was employed for high heterogeneity ( < 0.1 and I2 > 50%). Funnel plots and Egger's test were used to assess publication bias.
RESULTS
Involving 22 studies, our meta-analysis revealed that insomnia, sleep disturbance, or short sleep duration significantly increased the risk of GERD (OR = 2.02, 95% CI [1.64-2.49], < 0.001; I = 66.4%; OR = 1.98, 95% CI [1.58-2.50], < 0.001, I = 50.1%; OR = 2.66, 95% CI [2.02-3.15], < 0.001; I = 62.5%, respectively). GERD was associated with an elevated risk of poor sleep quality (OR = 1.47, 95% CI [1.47-1.79], < 0.001, I = 72.4%), sleep disturbance (OR = 1.47, 95% CI [1.24-1.74], < 0.001, I = 71.6%), or short sleep duration (OR = 1.17, 95% CI [1.12-1.21], < 0.001, I = 0).
CONCLUSION
This meta-analysis establishes a bidirectional relationship between four distinct types of sleep problems and GERD. The findings offer insights for the development of innovative approaches in the treatment of both GERD and sleep problems.
Topics: Gastroesophageal Reflux; Humans; Sleep Wake Disorders; Risk Factors
PubMed: 38646475
DOI: 10.7717/peerj.17202 -
Cerebrovascular Diseases (Basel,... Apr 2024In patients with stroke, poststroke dysphagia (PSD) is a common complication that plays an important role in morbidity and mortality. The aim of this paper was to assess...
INTRODUCTION
In patients with stroke, poststroke dysphagia (PSD) is a common complication that plays an important role in morbidity and mortality. The aim of this paper was to assess the prevalence and risk factors of PSD using a systemic review and meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for potentially eligible studies published until September 2023. Further, the pooled incidence and risk factors for PSD were determined using a random-effects model. Overall, 58 studies involving 37,404 patients with acute stroke were selected for the meta-analysis.
RESULTS
The pooled incidence of PSD in patients with acute stroke was 42% (95% confidence interval [CI]: 36-48%), which is the highest in South America (47%) and lowest in Asia (37%). Notably, older age (odds ratio [OR]: 2.13; 95% CI: 1.53-2.97; p < 0.001), hypertension (OR: 1.23; 95% CI: 1.06-1.44; p = 0.007), diabetes mellitus (OR: 1.22; 95% CI: 1.04-1.44; p = 0.014), stroke history (OR: 1.26; 95% CI: 1.04-1.53; p = 0.019), and atrial fibrillation (OR: 1.58; 95% CI: 1.02-2.44; p = 0.039) were found to be associated with an increased risk of PSD. Conversely, sex differences, smoking, alcoholism, obesity, hyperlipidemia, ischemic heart disease, stroke type, and the hemisphere affected were not associated with the risk of PSD.
CONCLUSION
The abstract reports the prevalence of PSD in patients with acute stroke and identified potential risk factors for PSD, including older age, hypertension, diabetes mellitus, stroke history, and atrial fibrillation.
PubMed: 38643757
DOI: 10.1159/000538218 -
Surgical Endoscopy Jun 2024The surgical management of hiatal hernia remains controversial. We aimed to compare outcomes of mesh versus no mesh and fundoplication versus no fundoplication in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The surgical management of hiatal hernia remains controversial. We aimed to compare outcomes of mesh versus no mesh and fundoplication versus no fundoplication in symptomatic patients; surgery versus observation in asymptomatic patients; and redo hernia repair versus conversion to Roux-en-Y reconstruction in recurrent hiatal hernia.
METHODS
We searched PubMed, Embase, CINAHL, Cochrane Library and the ClinicalTrials.gov databases between 2000 and 2022 for randomized controlled trials (RCTs), observational studies, and case series (asymptomatic and recurrent hernias). Screening was performed by two trained independent reviewers. Pooled analyses were performed on comparative data. Risk of bias was assessed using the Cochrane Risk of Bias tool and Newcastle Ottawa Scale for randomized and non-randomized studies, respectively.
RESULTS
We included 45 studies from 5152 retrieved records. Only six RCTs had low risk of bias. Mesh was associated with a lower recurrence risk (RR = 0.50, 95%CI 0.28, 0.88; I = 57%) in observational studies but not RCTs (RR = 0.98, 95%CI 0.47, 2.02; I = 34%), and higher total early dysphagia based on five observational studies (RR = 1.44, 95%CI 1.10, 1.89; I = 40%) but was not statistically significant in RCTs (RR = 3.00, 95%CI 0.64, 14.16). There was no difference in complications, reintervention, heartburn, reflux, or quality of life. There were no appropriate studies comparing surgery to observation in asymptomatic patients. Fundoplication resulted in higher early dysphagia in both observational studies and RCTs ([RR = 2.08, 95%CI 1.16, 3.76] and [RR = 20.58, 95%CI 1.34, 316.69]) but lower reflux in RCTs (RR = 0.31, 95%CI 0.17, 0.56, I = 0%). Conversion to Roux-en-Y was associated with a lower reintervention risk after 30 days compared to redo surgery.
CONCLUSIONS
The evidence for optimal management of symptomatic and recurrent hiatal hernia remains controversial, underpinned by studies with a high risk of bias. Shared decision making between surgeon and patient is essential for optimal outcomes.
Topics: Hernia, Hiatal; Humans; Recurrence; Fundoplication; Herniorrhaphy; Surgical Mesh; Asymptomatic Diseases; Reoperation
PubMed: 38630179
DOI: 10.1007/s00464-024-10816-9