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Vector Borne and Zoonotic Diseases... Apr 2022Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients...
Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients occasionally present with buboes formed in deep lymph nodes, which are difficult to detect and can lead to delays in diagnosis and treatment. To better characterize this phenomenon, we conducted a review of the published literature to identify reports of occult buboes among patients with plague. Articles were identified from two sources: a systematic review on plague treatment, and a search of the PubMed Central database. Articles were eligible if they described a patient with plague who had (1) no evidence of lymphadenopathy on examination; and (2) at least one bubo discovered during surgery or autopsy. Six patients with occult buboes were identified among 5120 articles screened. The majority were male ( = 4/6) and three were <15 years of age. Fever ( = 6/6), leukocytosis ( = 5/6), and abdominal pain or distention ( = 4/6) were the most common signs and symptoms. Initial diagnoses included other bacterial infections, appendicitis, or acute abdomen. Four patients received at least one antimicrobial effective against ; however, some experienced delayed treatment due to late diagnosis of plague. Occult buboes were discovered in retroperitoneal ( = 2), inguinal/femoral ( = 2), mesenteric ( = 2), axillary ( = 1), and mediastinal ( = 1) regions. Four of the six patients died. Patients with occult buboes experienced delays in the diagnosis of plague and a high fatality rate. Clinicians in plague-endemic areas should consider the presence of occult buboes among patients with compatible symptoms and exposure history.
Topics: Animals; Autopsy; Female; Fever; Male; Plague; Strigiformes; Yersinia pestis
PubMed: 35404104
DOI: 10.1089/vbz.2022.0012 -
Pediatric Surgery International Apr 2022Hirschsprung's disease (HD) is a rare occurrence in premature infants, and the exact prevalence varying across studies. Thus, we conducted this study to determine the... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hirschsprung's disease (HD) is a rare occurrence in premature infants, and the exact prevalence varying across studies. Thus, we conducted this study to determine the prevalence of and clinical presentation of HD in preterm infants.
METHODS
The PubMed, EmBase, and Cochrane library databases were searched for eligible studies throughout May 2021. The pooled incidence with 95% confidence interval (CI) was calculated using the random-effects model.
RESULTS
Thirty studies involved 4,557 children with HD were included. The pooled proportion of HD patients who were preterm infants was 7% (95% CI 5-8%; P < 0.001); the sensitivity analysis indicated that the pooled prevalence of preterm infants with HD ranged from 5.0% to 5.6%. Moreover, the pooled incidence of abdominal distention in HD patients was 83% (P < 0.001), that of vomiting was 61% (P < 0.001), that of bilious vomiting was 54% (P < 0.001), that of delayed meconium passage was 48% (P < 0.001), that of constipation was 44% (P < 0.001), and that of enterocolitis was 13% (P < 0.001).
CONCLUSIONS
This study reported the prevalence of HD patients who were preterm infants, and the most common presentations were abdominal distention, vomiting, bilious vomiting, delayed meconium passage, constipation, and enterocolitis.
Topics: Child; Constipation; Enterocolitis; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Infant, Premature; Prevalence
PubMed: 35142873
DOI: 10.1007/s00383-021-05054-2 -
International Journal of Colorectal... Mar 2022Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition.
METHODS
Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively.
RESULTS
Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study.
CONCLUSIONS
The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.
Topics: Colostomy; Enterostomy; Hernia, Ventral; Humans; Risk Factors; Surgical Mesh; Surgical Stomas
PubMed: 35028686
DOI: 10.1007/s00384-021-04068-5 -
Annals of Palliative Medicine Dec 2021The purpose of this study was to evaluate the clinical effects and safety of neostigmine for the postoperative recovery of gastrointestinal function. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The purpose of this study was to evaluate the clinical effects and safety of neostigmine for the postoperative recovery of gastrointestinal function.
METHODS
We performed a literature search of multiple databases [PubMed, Web of Science, Cochrane Library and China National Knowledge Internet (CNKI)] to retrieve studies comparing the postoperative gastrointestinal function of neostigmine and control groups. Review Manager 5.2 was applied for the analysis of heterogeneity, sensitivity, and bias.
RESULTS
After screening the articles, 17 trials involving 1,589 postoperative patients that met the eligibility criteria were included. The results suggested that neostigmine improved the first passage of flatus [standard mean difference (SMD) =-3.00; 95% confidence interval (CI): (-4.03, -1.97); P<0.001), first defecation [SMD =-3.75; 95% CI: (-5.25, -2.24); P<0.001], time of bowel sound recovery [SMD =-3.42; 95% CI: (-4.49, -2.36), P<0.001], and gastrointestinal function recovery [risk ratio (RR) =1.84; 95% CI: (1.19, 2.86); P=0.007]. Compared to the control group, the neostigmine group had lower rates of abdominal distention [RR =0.39; 95% CI: (0.18, 0.87); P=0.02; I2=76%] and overall adverse events [RR =0.49; 95% CI: (0.29, 0.82); P=0.007]. However, two groups had no difference in postoperative nausea and vomiting (PONV) [RR =0.50; 95% CI: (0.21, 1.23); P=0.13], and respiratory complications [RR =0.96; 95% CI: (0.20, 4.53); P=0.96]. Sensitivity and publication bias analyses showed that these results were robust and exhibited little publication bias.
DISCUSSION
Small doses of neostigmine may promote the recovery of postoperative gastrointestinal function without obvious side effects.
Topics: China; Humans; Neostigmine; Postoperative Nausea and Vomiting
PubMed: 35016456
DOI: 10.21037/apm-21-3291 -
Archives of Disease in Childhood. Fetal... Jul 2022We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomes DATA SOURCES: PubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome.
RESULTS
Thirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively.
CONCLUSION
Prenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.
Topics: Dilatation, Pathologic; Female; Gastroschisis; Humans; Infant, Newborn; Polyhydramnios; Predictive Value of Tests; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34607856
DOI: 10.1136/archdischild-2021-322612 -
Journal of Pediatric Surgery Aug 2022Postoperative feeding practices are not uniform in children undergoing bowel anastomosis surgery. Primary aim of this review was to evaluate the safety and efficacy of... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of safety and efficacy of early enteral nutrition as an isolated component of Enhanced Recovery After Surgery [ERAS] in children after bowel anastomosis surgery.
BACKGROUND
Postoperative feeding practices are not uniform in children undergoing bowel anastomosis surgery. Primary aim of this review was to evaluate the safety and efficacy of early enteral nutrition (EEN) as an isolated component of enhanced recovery in children undergoing bowel anastomosis surgery.
METHODS
Medical search engines (PubMed, CENTRAL, Google scholar) were accessed from inception to January 2021. Randomized Controlled Trials (RCT)s, non-randomized controlled trials, observational studies and retrospective studies comparing EEN, initiated within 48 h vs late enteral nutrition (LEN), initiated after 48 h in children ≤ 18 years undergoing bowel anastomosis surgery were included. Primary outcome measure was the incidence of postoperative complications (anastomotic leak, abdominal distension, surgical site infection, wound dehiscence, vomiting and septic complications). Secondary outcome measures were the time to passage of first feces and the length of hospital stay.
RESULTS
Twelve hundred and eighty-six children from 10 studies were included in this review. No difference was seen between the EEN and LEN groups in the incidence of anastomotic leak (1.69% vs 4.13%; p = 0.06), abdominal distention (13.87% vs 12.31%; p = 0.57), wound dehiscence (3.07% vs 2.69%; p = 0.69) or vomiting (8.11% vs 8.67%; p = 0.98). The incidence of surgical site infections (7.51% vs 11.72%; p = 0.04), septic complications (14.02% vs 26.22%; p = 0.02) as well as pooled overall complications (8.11% vs 11.27%; RR 0.71; 95% CI = 0.56 to 0.89; p = 0.003; I = 33%) were significantly lower in the EEN group. The time to passage of first feces (MD - 17.23 h; 95% CI -23.13 to -11.34; p < 0.00001; I = 49%) and the length of hospital stay (MD -2.95 days; 95% CI -3.73 to -2.17; p < 0.00001; I = 93%) were significantly less in the EEN group.
CONCLUSION
EEN is safe and effective in children following bowel anastomosis surgery and is associated with a lower overall incidence of complications as compared to LEN. EEN also promotes early bowel recovery and hospital discharge. However, further well designed RCTs are required to validate these findings.
LEVEL OF EVIDENCE
V.
Topics: Anastomosis, Surgical; Anastomotic Leak; Child; Enhanced Recovery After Surgery; Enteral Nutrition; Humans; Length of Stay; Postoperative Complications; Vomiting
PubMed: 34417055
DOI: 10.1016/j.jpedsurg.2021.07.020 -
World Journal of Gastrointestinal... Jun 2021Chylous ascites is a rare complication in colorectal surgery with limited evidence.
BACKGROUND
Chylous ascites is a rare complication in colorectal surgery with limited evidence.
AIM
To systematically review all available evidence to describe the incidence, clinical presentation, risk factors and management strategies.
METHODS
The systematic review was performed through PubMed, MEDLINE, EMBASE and Cochrane and cross-checked up to November 2020. The data collated included: Demographics, indications (benign malignant), site of disease, surgical approach, extent of lymphadenectomy, day to and method of diagnosis of chylous ascites and management strategies.
RESULTS
A total of 28 studies were included in the final analysis (426 cases). Patient age ranged from 31 to 89 years. All except one case were performed for malignancy. Of the 426 cases, 195 were right-colonic, 121 left-colonic, 103 pelvic surgeries and 7 others. The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume. Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis. Most cases were managed successfully non-operatively (fasting with prolonged drainage, total parenteral nutrition, somatostatin analogues or a combination of these). Only three cases required surgical intervention after failing conservative management and subsequently resolved completely. Risk factors identified include: Right-colonic surgery/ tumour location, extent of lymphadenectomy and number of lymph nodes harvested.
CONCLUSION
Chylous ascites after colorectal surgery is a relatively rare complication. Whilst the majority of cases resolved without surgical intervention, preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.
PubMed: 34194616
DOI: 10.4240/wjgs.v13.i6.585 -
Minerva Obstetrics and Gynecology Aug 2022Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for about 1-2% of the total. The rarity of KT is at least in part responsible for the lack of a precise clinic-pathological characterization of these tumors. Clinically, KT may have a subtle clinical presentation, with few symptomatic manifestations and nonspecific clinical signs, even though in literature there is disagreement about the clinical presentation of these patients; such difficulties in the diagnostic framework often leads to a delayed diagnosis with serious consequences on the patient outcome. We aimed to provide a clinico-pathological characterization of Krukenberg Tumor (KT) through a systematic review and meta-analysis to improve the diagnosis and management of KT.
EVIDENCE ACQUISITION
Electronic databases were searched for all studies assessing clinico-pathological features of KT series. Pooled prevalence of each clinical or pathological factor was calculated according to the random-effect model.
EVIDENCE SYNTHESIS
Forty-eight studies with 3025 KT patients were included; 39.7% of patients were ≥50 and 39.8% were postmenopausal. The most common primary tumor sites were stomach (42.5%), colon-rectum (26.1%), breast (9.3%), and appendix (5%); 48.7% of KTs were synchronous with the primary tumor, 64.3% were bilateral, 40.5% had a diameter ≥10 cm; 55.3% showed extraovarian extent and 49% showed peritoneal involvement. The most common presenting symptoms were ascites (51.7%), palpable mass (31.3%), pain (29.3%), abdominal distention (28.7%), irregular bleeding (9.1%), asymptomatic (11.2%).
CONCLUSIONS
KT shows a highly variable presentation. Understanding the prevalence of clinico-pathological factors may be helpful to improve the diagnosis and management of KT.
Topics: Female; Humans; Krukenberg Tumor; Ovarian Neoplasms
PubMed: 33944524
DOI: 10.23736/S2724-606X.21.04797-7 -
Annals of Palliative Medicine Apr 2021Moxibustion is widely used in the recovery of gastrointestinal function in East Asian countries, especially in China. This systematic review aims to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Moxibustion is widely used in the recovery of gastrointestinal function in East Asian countries, especially in China. This systematic review aims to evaluate the recovery effects of moxibustion on gastrointestinal function in preventing early postoperative small-bowel obstruction (EPSBO).
METHODS
The Medline, Embase, PubMed, and the other seven databases were searched independently by two authors. Randomized controlled trials (RCTs) were selected using the PICOS method. The methodological quality was appraised with the Cochrane's risk of bias tool, and the reporting quality of included studies was evaluated by Consolidated Standards of Reporting Trials (CONSORT) and STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM), respectively. Revman 5.2.0 was used for statistical analysis, and the mean difference (MD) with 95% confidence interval (CI) was performed for effect estimation. Random effects model (REM) and fixed effects model (FEM) were used for pooling data.
RESULTS
A total of 8 RCTs with 693 participants were included. Meta-analysis showed that moxibustion combined with usual care had favorable effects on the time to first flatus (MD -15.15 h, 95% CI: -19.14 to -11.15, 8 studies, I2=85%, P<0.00001, REM), the time to bowel sound recovery (MD -10.35 h, 95% CI: -11.65 to -9.06, 7 studies, I2=0%, P=0.91, FEM), the time to first defecation (MD -18.94 h, 95% CI: -24.53 to -13.36, 3 studies, I2=45%, P=0.16, FEM), and the duration time to abdominal distention (MD -11.7 h, 95% CI: -15.32 to -8.09, 3 studies, I2=0%, P=0.70, FEM) when compared to the controls. No adverse events were reported in the included studies.
CONCLUSIONS
Moxibustion may have a beneficial effect on the recovery of gastrointestinal function in preventing EPSBO. However, positive findings should be treated carefully. And rigorous studies with high quality and large samples are warranted.
Topics: China; Humans; Moxibustion; Postoperative Complications; Recovery of Function
PubMed: 33691449
DOI: 10.21037/apm-20-1266 -
Frontiers in Pediatrics 2021Carbon dioxide (CO) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not...
Carbon dioxide (CO) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not known. The current review aimed to compare the efficacy of CO vs. air insufflation for GI endoscopic procedures in pediatric patients. The electronic databases of PubMed, Embase, Scopus, and CENTRAL were searched from the inception of databases to 15th August 2020. All randomized controlled trials (RCTs) comparing CO vs. air insufflation for GI endoscopic procedures in pediatric patients were eligible for inclusion. Five RCTs were identified. Pooled analysis of data from 226 patients in the CO group and 224 patients in the air group revealed that patients receiving CO insufflation were at a lower odds of experiencing postoperative pain as compared to those undergoing the procedure with air (OR: 0.40; 95% CI: 0.19, 0.87; = 62%; = 0.02). Descriptive analysis indicated no difference in the two groups for abdominal distention after the procedure. Two trials reported elevated CO in the study group but without any pulmonary complications. Bloating was reported by two studies and both reported significantly less bloating in the CO group. Our study indicates that the incidence of pain may be reduced with the use of CO insufflation in pediatric GI endoscopies without a significant risk of adverse events. However, current evidence is from a limited number of trials and not strong to recommend a routine of CO in pediatric gastroenterology practice. Further high-quality RCTs are required to supplement current evidence.
PubMed: 33634056
DOI: 10.3389/fped.2021.610066