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American Journal of Otolaryngology 2024To evaluate pre- and post-operative resonance, surgical technique, revision rate, and revision indication among syndromic and non-syndromic children with velopharyngeal... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate pre- and post-operative resonance, surgical technique, revision rate, and revision indication among syndromic and non-syndromic children with velopharyngeal insufficiency (VPI).
MATERIALS AND METHODS
A systematic review was conducted through July 2022. Children surgically treated for VPI were included. A meta-analysis of single means, proportions, comparison of proportions, and mean differences with 95 % confidence interval [CI] was conducted.
RESULTS
Twenty-three articles (n = 1437) were included in the analysis. The most common surgery was Sphincter Pharyngoplasty (SP), 62.6 % [31.3-88.9] for syndromic and 76.3 % [37.5-98.9] for non-syndromic children. Among all surgical techniques, for syndromic and non-syndromic children, 54.8 % [30.9-77.5] and 73.9 % [61.3-84.6] obtained normal resonance post-operatively, respectively. Syndromic patients obtained normal resonance post-operatively in 83.3 % [57.7-96.6] of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty (CPSP), 72.6 % [54.5-87.5] of Pharyngeal Flap (PF), and 45.1 % [13.2-79.8] of Sphincter Pharyngoplasty (SP) surgeries. Non-syndromic patients obtained normal resonance post-operatively in 79.2 % [66.4-88.8] of PF and 75.2 % [61.8-86.5] of SP surgeries. The revision rate for syndromic and non-syndromic patients was 19.9 % [15.0-25.6] and 11.3 % [5.8-18.3], respectively. The difference was statistically significant, 8.6 % [2.9-15.0, p = 0.003]. Syndromic patients who underwent PF were least likely to undergo revision surgery as compared to SP and CPSP, 7.7 % [2.3-17.9] vs. 23.7 % [15.5-33.1] and 15.3 % [2.8-40.7], respectively.
CONCLUSIONS
Syndromic children had higher revision rates and were significantly less likely to obtain normal resonance following primary surgery than non-syndromic patients. Among syndromic children, PF and CPSP have been shown to improve resonance and reduce revision rates more so than SP alone.
Topics: Humans; Velopharyngeal Insufficiency; Reoperation; Child; Treatment Outcome; Plastic Surgery Procedures; Female; Male; Child, Preschool; Syndrome; Otorhinolaryngologic Surgical Procedures; Pharynx
PubMed: 38754293
DOI: 10.1016/j.amjoto.2024.104341 -
Acta Otorhinolaryngologica Italica :... Jun 2024Studies have demonstrated that tonsillectomy may alter the risk of oropharyngeal cancer (OPC). We systematically reviewed the evidence and pooled data to examine such an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Studies have demonstrated that tonsillectomy may alter the risk of oropharyngeal cancer (OPC). We systematically reviewed the evidence and pooled data to examine such an association.
METHODS
PubMed, Embase, and Scopus were searched up to 25 April 2023. Studies reporting an association between tonsillectomy and oropharyngeal cancer risk at any site were included.
RESULTS
Five studies were eligible. All examined the risk of tonsillar and base of the tongue (BOT) cancer with prior history of tonsillectomy. On meta-analysis of the data, prior history of tonsillectomy was associated with a significantly decreased risk of tonsillar cancer. The second meta-analysis showed that history of tonsillectomy did not significantly alter the risk of BOT cancer. However, after exclusion of one study, the results showed an increased risk of BOT cancer with a history of tonsillectomy.
CONCLUSIONS
The scarce data available in the literature suggests that tonsillectomy may reduce the risk of tonsillar cancer but does not alter the risk of BOT cancer. Further studies are needed to explore the association between tonsillectomy and the risk of OPC.
Topics: Humans; Oropharyngeal Neoplasms; Risk Assessment; Risk Factors; Tonsillar Neoplasms; Tonsillectomy
PubMed: 38712770
DOI: 10.14639/0392-100X-N2790 -
AIDS (London, England) Jun 2024To evaluate the effect of preexposure prophylaxis (PrEP) initiation on bacterial sexually transmitted infection (STI) occurrence (overall; chlamydia; gonorrhea;... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effect of preexposure prophylaxis (PrEP) initiation on bacterial sexually transmitted infection (STI) occurrence (overall; chlamydia; gonorrhea; syphilis), in MSM.
DESIGN
Systematic review and meta-analysis.
METHODS
Systematic searches were performed in PubMed, Embase, and Scopus without language restrictions until 1 February 2023. We sought studies reporting data for the estimation of incidence rate ratios (IRR), prevalence ratios or cumulative incidence ratios (the latter in equal time periods before and after PrEP initiation) regarding bacterial STI occurrence. Separate analyses were performed overall for any STI, syphilis, chlamydia and gonorrhea (overall; rectal; urethral; pharyngeal for the two latter conditions); ratios greater than unity denoted increase in STI occurrence after PrEP initiation.
RESULTS
Twenty-three eligible studies with 11 776 participants (age range: 18-71 years) with a median follow-up of 12 months were included. Overall, PrEP initiation was associated with a significant increase in the occurrence of any STI (pooled effect size: 1.15, 95% confidence interval (CI): 1.04-1.26), any gonorrhea (pooled effect size: 1.17, 95% CI: 1.02-1.34), any chlamydia (pooled effect size: 1.31, 95% CI: 1.09-1.58) and rectal chlamydia (pooled effect size: 1.31, 95% CI: 1.05-1.64), whereas a borderline increase was found in urethral chlamydia (pooled effect size: 1.25, 95% CI: 0.99-1.60, P = 0.064). Changes in pharyngeal chlamydia and site-specific gonorrhea occurrence did not reach statistical significance. Syphilis showed virtually no change after PrEP initiation (pooled effect size: 0.99, 95% CI: 0.72-1.37).
CONCLUSION
These results highlight the need for more comprehensive, accessible STI testing to tackle bacterial STI infections in PrEP users.
Topics: Adolescent; Adult; Aged; Humans; Middle Aged; Young Adult; Chlamydia Infections; Gonorrhea; HIV Infections; Homosexuality, Male; Incidence; Pre-Exposure Prophylaxis; Prevalence; Sexually Transmitted Diseases, Bacterial; Syphilis
PubMed: 38669203
DOI: 10.1097/QAD.0000000000003837 -
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 -
Minerva Surgery Jun 2024Nowadays, robotic surgery finds application in the field of head and neck in the treatment of oropharyngeal tumors. The aim of this work is to examine the efficacy of...
INTRODUCTION
Nowadays, robotic surgery finds application in the field of head and neck in the treatment of oropharyngeal tumors. The aim of this work is to examine the efficacy of transoral robotic surgery (TORS) in performing safe oncological resections of oropharyngeal squamous cell carcinoma (OPSCC), with particular attention to the status of margins.
EVIDENCE ACQUISITION
Literature search of English-language studies focused on TORS through PubMed, the Cochrane Library and EMBASE databases. A total of 431 papers returned to search, but only 24 met the inclusion criteria. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines.
EVIDENCE SYNTHESIS
Within the selected studies, the overall rate of OPSCC positive margins following TORS is minimal, especially when patient selection is adequate and when TORS is used by high volume centers.
CONCLUSIONS
TORS is a very precise and viable therapeutic tool that provides good results in terms of surgical radicality with low positive margin rates and good results in terms of overall survival and disease-free survival; however, there is still a great heterogeneity in margins definition within the available literature. Consequently, even if this surgical approach is very promising, it is still challenging to draw firm conclusions nowadays.
Topics: Humans; Oropharyngeal Neoplasms; Robotic Surgical Procedures; Margins of Excision; Carcinoma, Squamous Cell; Treatment Outcome; Disease-Free Survival
PubMed: 38618712
DOI: 10.23736/S2724-5691.24.10235-3 -
Oral Oncology May 2024Recurrent/Metastatic Nasopharyngeal Carcinoma (RM-NPC) remains difficult to treat and contributes to considerable mortality. The first-line treatment for RM-NPC is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recurrent/Metastatic Nasopharyngeal Carcinoma (RM-NPC) remains difficult to treat and contributes to considerable mortality. The first-line treatment for RM-NPC is Gemcitabine and Cisplatin and second-line treatment options differ. The endemic variant of NPC is associated with Epstein-Barr Virus (EBV). Therefore, Cell-based Immunotherapy (CBI) targeting EBV-specific RM-NPC may be effective.
METHODS
We systematically searched PubMed, Embase and the Cochrane Library for randomised or observational studies investigating the efficacy and safety of CBI in the treatment of RM-NPC. We performed all meta-analyses using the random-effects model. Studies were further stratified by endemicity, nature of disease and drug type to investigate for potential between-study heterogeneity and additional pre-specified tests were employed to assess for publication bias.
RESULTS
We screened 1,671 studies and included 13 studies with 403 participants in the systematic review, of which nine studies were eligible for meta-analysis. The use of CBI monotherapy as second or subsequent line treatment for EBV-positive RM-NPC revealed an ORR of 10 % (95 %CI = 3 %-29 %), median PFS of 2.37 months (95 %CI = 1.23-3.51) and median OS of 10.16 months (95 %CI = 0.67-19.65). For EBV-specific Cytotoxic T-Lymphocyte monotherapy, the pooled PD rate was 54 % (95 %CI = 9 %-93 %), SD rate was 22 % (95 %CI = 2 %-75 %) and incidence rate of any grade adverse events was 45 %. For Dendritic Cell monotherapy, a PD rate of 80 % (95 % CI = 29 %-98 %), SD rate of 11 % (95 % CI = 0 %-82 %) and incidence rate of any grade adverse events of 29 % was achieved.
CONCLUSION
CBI monotherapy demonstrates some activity in pre-treated RM-NPC. More trials are needed to better understand how to integrate CBI into RM-NPC care.
Topics: Humans; Cell- and Tissue-Based Therapy; Herpesvirus 4, Human; Immunotherapy; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Neoplasm Metastasis; Neoplasm Recurrence, Local; Treatment Outcome
PubMed: 38615584
DOI: 10.1016/j.oraloncology.2024.106786 -
Curationis Mar 2024Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in... (Review)
Review
BACKGROUND
Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in identifying symptoms of post-stroke dysphagia.
OBJECTIVE
To explore existing literature regarding nurses' practices and knowledge in the identification and management of post-stroke oropharyngeal dysphagia (OPD) in low- and middle income countries (LMICs).
METHOD
A scoping review was conducted according to the PRISMA-ScR guidelines. Studies were retrieved from PubMed, Scopus, EBSCOhost (CINAHL and Health source: Nursing and Academic edition), Web of Science Core collection, and Cochrane libraries. No time frame was applied, and all included studies were screened according to predefined eligibility criteria.
RESULTS
Eight studies were included from 1 792 initial hits. Studies described nursing practices in acute care pertaining to identification and management of stroke-related dysphagia in LMICs. Increased knowledge was reported in nurses who had greater clinical experience in managing patients with dysphagia. Needs for training relating to dysphagia management and opportunities for interprofessional collaboration with speech-language therapists (SLTs) were identified. Contextual barriers specific to LMICs impacting on optimal nursing management of dysphagia included heavy workloads, staff-shortages and time constraints.Conclusion and contribution: Eight studies described nurses' practices and identified needs for the improvement of nurses' dysphagia care in LMICs. This scoping review highlighted the urgency for further research in dysphagia management that provides creative, contextually relevant solutions for improved protocols and training of health care professionals. Findings may be valuable for the multidisciplinary team involved in post-stroke dysphagia care.
Topics: Humans; Developing Countries; Deglutition Disorders; Health Personnel; Allied Health Personnel; Nurses
PubMed: 38572844
DOI: 10.4102/curationis.v47i1.2499 -
Radiotherapy and Oncology : Journal of... Jun 2024This systematic review examines the role of dosimetric parameters in predicting temporal lobe necrosis (TLN) risk in nasopharyngeal carcinoma (NPC) patients treated with... (Meta-Analysis)
Meta-Analysis Review
This systematic review examines the role of dosimetric parameters in predicting temporal lobe necrosis (TLN) risk in nasopharyngeal carcinoma (NPC) patients treated with three-dimensional conformal RT (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). TLN is a serious late complication that can adversely affect the quality of life of NPC patients. Understanding the relationship between dosimetric parameters and TLN can guide treatment planning and minimize radiation-related complications. A comprehensive search identified relevant studies published up to July 2023. Studies reporting on dosimetric parameters and TLN in NPC patients undergoing 3D-CRT, IMRT, and VMAT were included. TLN incidence, follow-up duration, and correlation with dosimetric parameters of the temporal lobe were analyzed. The review included 30 studies with median follow-up durations ranging from 28 to 110 months. The crude incidence of TLN varied from 2.3 % to 47.3 % and the average crude incidence of TLN is approximately 14 %. Dmax and D1cc emerged as potential predictors of TLN in 3D-CRT and IMRT-treated NPC patients. Threshold values of >72 Gy for Dmax and >62 Gy for D1cc were associated with increased TLN risk. However, other factors should also be considered, including host characteristics, tumor-specific features and therapeutic factors. In conclusion, this systematic review highlights the significance of dosimetric parameters, particularly Dmax and D1cc, in predicting TLN risk in NPC patients undergoing 3D-CRT, IMRT, and VMAT. The findings provide valuable insights that can help in developing optimal treatment planning strategies and contribute to the development of clinical guidelines in this field.
Topics: Humans; Nasopharyngeal Carcinoma; Temporal Lobe; Necrosis; Radiation Injuries; Nasopharyngeal Neoplasms; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Radiotherapy, Conformal
PubMed: 38537680
DOI: 10.1016/j.radonc.2024.110258 -
Orvosi Hetilap Mar 2024
Topics: Humans; Deglutition; Deglutition Disorders; Saliva
PubMed: 38522050
DOI: 10.1556/650.2024.32999 -
The Journal of Nursing Research : JNR Apr 2024Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors.
PURPOSE
In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy.
METHODS
The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopy were considered eligible for inclusion. The search terms used included "dysphagia," "questionnaire," and "videofluoroscopy." Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions.
RESULTS
The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy ( r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis ( r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies ( p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy ( r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy ( r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups.
CONCLUSIONS
These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients.
Topics: Humans; Deglutition Disorders; Head and Neck Neoplasms; Surveys and Questionnaires
PubMed: 38506593
DOI: 10.1097/jnr.0000000000000608