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The Australian and New Zealand Journal... May 2024The 22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion in humans with over 180 phenotypic expressions. Approximately 30-40% of affected individuals... (Review)
Review
OBJECTIVE
The 22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion in humans with over 180 phenotypic expressions. Approximately 30-40% of affected individuals will develop psychosis and 25% meet the criteria for schizophrenia. Despite this, pharmacotherapy for managing psychosis in 22q11.2DS is poorly understood and 22q11.2DS psychosis is frequently labelled as treatment resistant. The objectives of this paper are to evaluate the effectiveness and tolerability of pharmacotherapy for 22q11.2DS psychosis and evaluate the evidence for treatment resistance.
METHOD
A systematic search was performed using CINAHL, The Cochrane Library (Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials and Cochrane Clinical Answers), EMBASE, PsycINFO, PubMed, Scopus and Web of Science Core Collection from inception to December 2022. It yielded 39 case reports, 6 case series and 1 retrospective study which met the inclusion criteria.
RESULTS
Based on the current literature, individuals with 22q11.2DS psychosis experience a greater rate of medical co-morbidities such as cardiac arrhythmias, seizures and movement disorders, which complicate pharmacotherapy. Poor tolerability rather than poor clinical response motivates the switching of antipsychotics, which may explain the labelling of treatment resistance in the literature.
CONCLUSION
There are insufficient data to recommend a single antipsychotic for 22q11.2DS psychosis. Nonetheless, with proactive management of co-morbidities, antipsychotic medication in 22q11.2DS psychosis is an effective treatment commonly resulting in improvement in quality of life.
Topics: Humans; DiGeorge Syndrome; Psychotic Disorders; Antipsychotic Agents
PubMed: 38383990
DOI: 10.1177/00048674241233118 -
Gland Surgery Jan 2024Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While... (Review)
Review
BACKGROUND
Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While parathyroidectomy is the standard treatment, non-operative intervention such as radiofrequency ablation (RFA) has been adopted as an alternative for the management of pHPT, as it has been utilized in other endocrine glands such as thyroid and adrenal. In this literature review, we aim to evaluate the current practice of RFA for pHPT.
METHODS
A systematic literature search using PubMed, Web of Science, and Embase through June 2022 was conducted. Studies included in the review consisted of patient cohorts who had an unequivocal diagnosis of pHPT and underwent the treatment of pHPT with RFA. When more than one study was published from a similar cohort of patients, only the study with the most number of patients was considered. Studies included were assessed for bias using the critical appraisal instruments from the Joanna Briggs Institute (JBI) System.
RESULTS
A total of 14 studies describing 167 parathyroid glands treated in 163 patients were reviewed. The overall cure rate was 91.2%, with 5 patients undergoing more than one ablation. The most common adverse effect encountered was temporary dysphonia. Incomplete ablation and missed multiglandular disease were the most common reasons for RFA treatment failure.
CONCLUSIONS
RFA may be an effective and safe alternative to parathyroidectomy in select patients with a well-localized, well-located parathyroid adenoma. Additional long-term data are needed to refine its role in the pHPT treatment algorithm.
PubMed: 38323227
DOI: 10.21037/gs-22-546 -
Updates in Surgery Jan 2024The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the... (Meta-Analysis)
Meta-Analysis
The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the efficacies of total thyroidectomy and lobectomy in patients with unilateral multifocal papillary thyroid carcinoma. A literature search of the PubMed/Medline, Embase, Web of Science, Cochrane Library, Wan Fang, and Zhi Wang databases for relevant studies, published from inception to October 31, 2022, was performed. Two researchers independently extracted data from the included studies. Lymph node metastasis, vocal fold paralysis, parathyroid injury, postoperative recurrence, and disease-free survival were evaluated. The meta-analysis included 7 studies comprising 1540 patients, of whom 496 and 1044 underwent lobectomy and total thyroidectomy, respectively. Compared with lobectomy, total thyroidectomy resulted in more vocal cord paralysis (odds ratio [OR] 0.35 [95% confidence interval (CI) 0.13 to 0.96]; P = 0.04) and parathyroid injury (OR 0.11 [95% CI 0.03-0.39]; P = 0.001) but with better disease-free survival (OR 0.21 [95% CI 0.09-0.49]; P = 0.000), although vocal cord paralysis and parathyroid injury, in large part, resolved within 1 year after surgery. In addition, there was no difference in postoperative lymph nodes metastasis (OR 0.74 [95% CI 0.13-4.21]; P = 0.737) and postoperative recurrence (OR 2.37 [95% CI 0.42-13.38]; P = 0.33). Excluding studies that deviated from the general trend, total thyroidectomy was beneficial in reducing recurrence. Compared with lobectomy, total thyroidectomy was beneficial in reducing recurrence and disease-free survival and may be considered a more optimal approach for unilateral multifocal papillary thyroid carcinoma.
Topics: Humans; Carcinoma, Papillary; Lymphatic Metastasis; Neoplasm Recurrence, Local; Retrospective Studies; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy; Vocal Cord Paralysis
PubMed: 38127193
DOI: 10.1007/s13304-023-01726-x -
International Journal of Surgery... Mar 2024Partial pancreatectomy, commonly used for chronic pancreatitis, or pancreatic lesions, has diverse impacts on endocrine and metabolism system. The study aims to... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Partial pancreatectomy, commonly used for chronic pancreatitis, or pancreatic lesions, has diverse impacts on endocrine and metabolism system. The study aims to determine the global prevalence of new-onset, worsening, and resolution of diabetes following partial pancreatectomy.
METHODS
The authors searched PubMed, Embase, Web of Science, and Cochrane Library from inception to October, 2023. DerSimonian-Laird random-effects model with Logit transformation was used. Sensitivity analysis, meta-regression, and subgroup analysis were employed to investigate determinants of the prevalence of new-onset diabetes.
RESULTS
A total of 82 studies involving 13 257 patients were included. The overall prevalence of new-onset diabetes after partial pancreatectomy was 17.1%. Univariate meta-regression indicated that study size was the cause of heterogeneity. Multivariable analysis suggested that income of country or area had the highest predictor importance (49.7%). For subgroup analysis, the prevalence of new-onset diabetes varied from 7.6% (France, 95% CI: 4.3-13.0) to 38.0% (UK, 95% CI: 28.2-48.8, P <0.01) across different countries. Patients with surgical indications for chronic pancreatitis exhibited a higher prevalence (30.7%, 95% CI: 21.8-41.3) than those with pancreatic lesions (16.4%, 95% CI: 14.3-18.7, P <0.01). The type of surgical procedure also influenced the prevalence, with distal pancreatectomy having the highest prevalence (23.7%, 95% CI: 22.2-25.3, P <0.01). Moreover, the prevalence of worsening and resolution of preoperative diabetes was 41.1 and 25.8%, respectively.
CONCLUSIONS
Postoperative diabetes has a relatively high prevalence in patients undergoing partial pancreatectomy, which calls for attention and dedicated action from primary care physicians, specialists, and health policy makers alike.
Topics: Humans; Pancreatectomy; Diabetes Mellitus; Pancreas; Pancreatitis, Chronic; Pancreatic Neoplasms
PubMed: 38126341
DOI: 10.1097/JS9.0000000000000998 -
Endocrine Practice : Official Journal... Mar 2024Apart from renal stones, primary hyperparathyroidism (PHPT) has been linked to the occurrence of gallstone disease (GSD). Nevertheless, the association is not consistent... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Apart from renal stones, primary hyperparathyroidism (PHPT) has been linked to the occurrence of gallstone disease (GSD). Nevertheless, the association is not consistent across all studies. The present systematic review and meta-analysis aims to collate the hitherto available evidence and provide a pooled estimate of the association between GSD and PHPT.
METHODS
PubMed/MEDLINE, Embase, and Web of Science databases were systematically searched from inception till May 10, 2023 for observational studies reporting the prevalence of GSD (in terms of absolute numbers) in patients with PHPT. The pooled prevalence of GSD and odds ratio with 95% CI of the occurrence of GSD in patients with PHPT as compared to age- and sex-matched controls were calculated. Subgroup analysis was performed based on patient ethnicity (Indian/Caucasian). Statistical analysis was carried out using R version 4.2.2. Random-effects model with Hartung-Knapp adjustment was used for analyses.
RESULTS
A total of 7 observational studies were included, pooling data from 15 949 patients with PHPT. The pooled prevalence of GSD in patients with PHPT was 16% (95% CI: 7%, 25%, I = 99%), being 13% (95% CI: 0%, 66%, I = 76%) in Indians, and 17% (95% CI: 4%, 31%, I = 99%) in Caucasians. Data consolidated from 3 studies showed that the pooled odds ratio of occurrence of GSD in patients with PHPT compared to controls was 1.77 (95% CI: 1.60, 1.97, P < .001, I = 0%).
CONCLUSIONS
GSD is more prevalent in patients with PHPT than in the general population. Thus, PHPT may be considered an additional risk factor for GSD.
Topics: Humans; Gallstones; Hyperparathyroidism, Primary; Risk Factors; Observational Studies as Topic
PubMed: 38086526
DOI: 10.1016/j.eprac.2023.12.002 -
International Journal of Surgery... Mar 2024This study aimed to assess the benefits and limitations of four intraoperative visualization of parathyroid gland (IVPG) strategies in the identification and functional... (Meta-Analysis)
Meta-Analysis
Intraoperative strategies in identification and functional protection of parathyroid glands for patients with thyroidectomy: a systematic review and network meta-analysis.
BACKGROUND
This study aimed to assess the benefits and limitations of four intraoperative visualization of parathyroid gland (IVPG) strategies in the identification and functional protection of parathyroid glands (PGs).
METHODS
We searched PubMed, the Cochrane Central Register of Controlled Trials, CNKI, EMBASE, Web of Science and Google Scholar databases until 30 June 2023. Four IVPG strategies were composed of the naked eyes (NE) and three imaging strategies: autofluorescence (AF), indocyanine green fluorescence (ICGF), and carbon nanoparticles (CN). We performed a pairwise meta-analysis (PMA) for direct comparisons and a Bayesian network meta-analysis (NMA) for indirect comparisons.
RESULTS
A total of 29 eligible studies were included. According to NMA and PMA, AF had significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, PG inadvertent resection, and PG auto-transplantation compared to NE, while had significantly higher rate of PG identification. CN showed significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, and PG inadvertent resection compared to NE in PMA and NMA. ICGF showed a significantly higher rate of PG auto-transplantation compared to NE in PMA and AF in NMA. According to SUCRA values, AF showed the best advantage in reducing the rate of postoperative hypocalcemia (0.85) and PG inadvertent resection (0.89), and increasing the rate of PG identification (0.80). CN had the greatest advantage in reducing the rate of postoperative hypoparathyroidism (0.95). ICGF ranked the highest in the rate of PG auto-transplantation (0.98).
CONCLUSIONS
Three imaging strategies demonstrate significant superiority over NE in the intraoperative PG identification and functional protection. AF is the best strategy in reducing the incidence of postoperative hypocalcemia, increasing the rate of PG identification, and reducing the rate of PG inadvertent resection and auto-transplantation. ICGF has great value in assessing PG viability, leading to the trend towards PG auto-transplantation. CN is the best strategy in reducing the incidence of postoperative hypoparathyroidism.
Topics: Humans; Parathyroid Glands; Hypocalcemia; Thyroidectomy; Bayes Theorem; Network Meta-Analysis; Hypoparathyroidism; Postoperative Complications
PubMed: 38079585
DOI: 10.1097/JS9.0000000000000991 -
The Laryngoscope Jun 2024To evaluate the utility of preoperative imaging before velopharyngeal dysfunction (VPD) surgery in children with 22q11 Deletion Syndrome (22qDS) in evaluating internal...
OBJECTIVE
To evaluate the utility of preoperative imaging before velopharyngeal dysfunction (VPD) surgery in children with 22q11 Deletion Syndrome (22qDS) in evaluating internal carotid artery (ICA) medialization.
DATA SOURCES
PubMed, Scopus, and CINAHL.
REVIEW METHODS
Following PRISMA guidelines, a systematic review was performed. Studies of children with 22qDS who underwent preoperative imaging (MRA or CTA) to identify ICA anomalies were included. High-risk medialized ICAs were defined as either submucosal, retropharyngeal, Pfeiffer Grade III-IV, or <3 mm from the pharyngeal mucosa. Meta-analyses of proportions were performed.
RESULTS
Eleven studies met inclusion criteria, comprising 398 patients with 22qDS (weighted mean age 7.6 years). In 372 patients with imaging, the rate of ICA medialization on imaging was 47.1% (95%CI 29.2-65.5), of which 46.3% (95%CI 27.4-65.8) were determined high risk. Operative plans were modified in 19.4% (95%CI 5.7-38.8) of 254 surgeries due to medialized ICA. In studies attempting to use nasopharyngoscopy pulsations to identify medialization for 214 patients, the true-positive rate was 53.9% (95%CI 27.5-79.2) and the false-positive rate was 16.2% (95%CI 7.9-26.8). Nine of eleven studies (81.8%) recommended universal preoperative imaging of the ICAs in children with 22qDS undergoing VPD surgery. No cases of perioperative bleeding secondary to ICA injury were identified.
CONCLUSION
Although most studies endorse routine preoperative imaging to assess for ICA medialization in children with 22qDS undergoing VPD surgery, only a minority of these cases led to surgical modification. Additional studies are needed to compare outcomes in children with and without preoperative imaging given the low rates of ICA injury in the literature.
LEVEL OF EVIDENCE
N/A Laryngoscope, 134:2551-2561, 2024.
Topics: Child; Female; Humans; Male; 22q11 Deletion Syndrome; Carotid Artery, Internal; Magnetic Resonance Imaging; Preoperative Care; Velopharyngeal Insufficiency
PubMed: 38050953
DOI: 10.1002/lary.31181 -
International Urology and Nephrology Apr 2024Parathyroidectomy (PTX) is the conclusive therapy for primary hyperparathyroidism (PHPT), but its effect on the risk of urolithiasis is inconclusive. We... (Review)
Review
OBJECTIVE
Parathyroidectomy (PTX) is the conclusive therapy for primary hyperparathyroidism (PHPT), but its effect on the risk of urolithiasis is inconclusive. We comprehensively reviewed the currently available research to investigate the impact of PTX on the likelihood of urolithiasis among individuals suffering PHPT.
METHODS
Internet-based articles in English language released on Cochrane, PubMed, Scopus, Web of knowledge, and Embase up to September, 2023 were comprehensively reviewed. Each publication in contrast to the incidence, occurrence, or recurrence of urolithiasis after PTX versus medical treatment in PHPT patients was included. The outcome with pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) was examined employing DerSimonian and Laird's model of random effects. To determine the range of the real effect size of a future study in 95% of all populations, a prediction interval (PI) was also established.
RESULTS
Finally, ten studies involving 74,190 patients were included. Results from randomized-controlled trials (RCTs) and observational studies (OSs) both revealed that PTX did not substantially lessen the vulnerability of urolithiasis among individuals with PHPT (RCTs: pooled relative risk [RR] 0.42, 95%CI 0.13-1.41, p = 0.163; OSs: pooled RR 1.37, 95%CI 0.96 to 1.97, p = 0.084). The PI (RCT: 0.03 to 5.96; OSs: 0.44-4.20) containing 1.0 suggested the possibility of consistent results in future studies. Subgroup and sensitivity analyses supported the above findings, and no evidence showed publication bias.
CONCLUSION
Our analysis from the available RCTs or OSs did not give adequate or exact proof that the average effect of PTX lowers the incidence of urolithiasis among PHPT persons based on the random-effects model. Future research shall take into account the common effect of PTX as well as the prerequisites of preventive stone procedures, which will further help us assess the effectiveness of PTX in reducing kidney calculus comorbidity and develop techniques to avoid stone sequelae in these individuals.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Urolithiasis; Kidney Calculi
PubMed: 38038823
DOI: 10.1007/s11255-023-03882-w -
International Urology and Nephrology May 2024Mineral and bone disease in children with chronic kidney disease can cause abnormalities in calcium, phosphorus, parathyroid hormone, and vitamin D and when left... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mineral and bone disease in children with chronic kidney disease can cause abnormalities in calcium, phosphorus, parathyroid hormone, and vitamin D and when left untreated can result in impaired growth, bone deformities, fractures, and vascular calcification. Cinacalcet is a calcimimetic widely used as a therapy to reduce parathyroid hormone levels in the adult population, with hypocalcemia among its side effects. The analysis of safety in the pediatric population is questioned due to the scarcity of randomized clinical trials in this group.
OBJECTIVE
To assess the onset of symptomatic hypocalcemia or other adverse events (serious or non-serious) with the use of cinacalcet in children and adolescents with mineral and bone disorder in chronic kidney disease.
DATA SOURCES AND STUDY ELIGIBILITY CRITERIA
The bibliographic search identified 2699 references from 1927 to August/2023 (57 LILACS, 44 Web of Science, 686 PubMed, 131 Cochrane, 1246 Scopus, 535 Embase). Four references were added from the bibliography of articles found and 12 references from the gray literature (Clinical Trials). Of the 77 studies analyzed in full, 68 were excluded because they did not meet the following criteria: population, types of studies, medication, publication types and 1 article that did not present results (gray literature).
PARTICIPANTS AND INTERVENTIONS
There were 149 patients aged 0-18 years old with Chronic Kidney Disease and mineral bone disorder who received cinacalcet.
STUDY APPRAISAL AND SYNTHESIS METHODS
Nine eligible studies were examined for study type, size, intervention, and reported outcomes.
RESULTS
There was an incidence of 0.2% of fatal adverse events and 16% of serious adverse events (p < 0.01 and I = 69%), in addition to 10.7% of hypocalcemia, totaling 45.7% of total adverse events.
LIMITATIONS
There was a bias in demographic information and clinical characteristics of patients in about 50% of the studies and the majority of the studies were case series.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
If used in the pediatric population, the calcimimetic cinacalcet should be carefully monitored for serum calcium levels and attention to possible adverse events, especially in children under 50 months.
SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO REGISTER)
CRD42019132809.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Bone Diseases; Calcimimetic Agents; Calcium; Chronic Kidney Disease-Mineral and Bone Disorder; Cinacalcet; Hyperparathyroidism, Secondary; Hypocalcemia; Minerals; Parathyroid Hormone; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 37964112
DOI: 10.1007/s11255-023-03844-2 -
The Laryngoscope May 2024To evaluate the accuracy of four-dimensional computerized-tomography (4DCT) for localizing parathyroid adenomas (PTAs) in cases with discordant or non-localizing... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the accuracy of four-dimensional computerized-tomography (4DCT) for localizing parathyroid adenomas (PTAs) in cases with discordant or non-localizing ultrasonography (US) and Technetium-99 sestamibi (MIBI) scans.
DATA SOURCES
Retrospective case series and systematic review.
REVIEW METHODS
A case series and meta-analysis of patients diagnosed with primary hyperparathyroidism and discordant US and MIBI scans who underwent 4DCT prior to surgery. A comprehensive search for all relevant publications in the English literature between December 2006 and March 2022 was conducted for the meta-analysis. Patients undergoing parathyroidectomy between January 2015 and December 2021 were identified from the institutional electronic database for the case series. All studies were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 4DCT adenoma localization capabilities.
RESULTS
Thirteen retrospective studies that included 379 patients and one case series that included 37 patients were identified and analyzed. A per-patient analysis revealed sensitivity for lateralization to the correct side (n = 181) ranging from 80% to 100% with a fixed effects model of 89% (95%confidence interval [CI]: 82%-93%) and a PPV for lateralization ranging from 63%-95% with a random effects model of 87% (95% CI: 77%-95%). Sensitivity of localization to the correct quadrant (n = 172) ranged from 53% to 100% with a random effects model of 90.4% (95% CI: 76%-99%), and the PPV for localization ranged from 52% to 100% with a random effects model of 82% (95% CI: 73%-89%).
CONCLUSION
4DCT enhances imaging capabilities of localizing PTAs in cases of discordant or non-localizing US and MIBI scans.
LEVEL OF EVIDENCE
NA Laryngoscope, 134:2198-2205, 2024.
Topics: Humans; Parathyroid Neoplasms; Retrospective Studies; Technetium Tc 99m Sestamibi; Hyperparathyroidism, Primary; Parathyroidectomy; Adenoma; Ultrasonography; Parathyroid Glands; Sensitivity and Specificity
PubMed: 37929814
DOI: 10.1002/lary.31142