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Sleep Medicine Nov 2020While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information on its association with neuromuscular and spinal pathologies that may be of interest to a musculoskeletal (MSK) medicine or pain management clinician. The objective of this study was to perform a systematic literature review to examine the association between OSA and cervical spine pathologies, postural changes, and pain.
DESIGN
We systematically reviewed PubMed and Embase databases up to 4/15/2019. We included studies that explored associations between OSA and a) pain, b) postural characteristics or changes, or c) cervical spine morphology. Systematic reviews, meta-analysis, randomized control trials, cohort studies, and case-control studies were included. Case reports, narrative reviews or expert opinion papers were excluded. From the articles that met selection criteria, information regarding type, direction and magnitude of such associations was extracted. The OSA-pain association studies were further divided into 3 subgroups: neuropathic, temporomandibular, and chronic pain.
RESULTS
21 articles that met our study criteria were selected for this review. Two studies were on cervical spine pathologies, eight on postural changes, and eleven on pain associated with OSA. Exploring the association between OSA and cervical spine pathologies, postural changes, and pain in this systematic review we found: (1) Cervical spine lesions, fusions, and abnormalities that reduce retropharyngeal space are associated with OSA, likely by way of worsening posture and decreasing range of motion. (2) Head extension and anteriorization are associated with OSA likely as a compensatory mechanism. Extension may improve airway function, while anteriorization helps to maintain visual sense. (3) Head-of-bed-elevation may improve OSA symptoms and can possibly supplement other conservative treatment measures. (4) Neuropathic pain is associated with OSA, likely by way of inflammatory pathways. (5) Oral appliance use (eg mandibular advancement/protruding device) in OSA likely contributes to transient temporomandibular pain. (6) There is little association between OSA and chronic pain prevalence. (7) Increased pain intensity and decreased pain tolerance are somewhat associated with OSA, likely by way of hypoxemia and sleep fragmentation.
CONCLUSIONS
Clinicians in MSK and pain medicine need to consider these associations and consider obtaining imaging studies and/or making referrals for management of their OSA to better provide appropriate care to these patients.
Topics: Cervical Vertebrae; Chronic Pain; Humans; Posture; Respiratory System; Sleep Apnea, Obstructive
PubMed: 33007717
DOI: 10.1016/j.sleep.2020.09.008 -
The British Journal of Ophthalmology Nov 2021Optic neuritis (ON) is the primary ophthalmic manifestation of myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD), but numerous reports have expanded...
BACKGROUND/AIMS
Optic neuritis (ON) is the primary ophthalmic manifestation of myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD), but numerous reports have expanded the visual manifestations of this condition. The goal of this study was to synthesise the extensive literature on this topic to help ophthalmologists understand when testing for MOG-IgG should be considered.
METHOD
A systematic review of the English-language literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searches were conducted using Ovid MEDLINE (from January 1, 1948 to April 1, 2020) and Ovid EMBASE (from January 1, 1947 to April 1, 2020). Inclusion criteria included studies describing non-isolated ON ophthalmic manifestations where cell-based assays were used for the detection of MOG antibodies.
RESULTS
Fifty-one articles representing 62 patients with a median age of 32.0 (range 2-65), female gender (51%) and follow-up of 20.0 months (range: 1-240) were included. Twenty-nine patients had non-isolated ON afferent visual manifestations: uveitis, peripheral ulcerative keratitis, acute macular neuroretinopathy, neuroretinitis, venous stasis retinopathy, large preretinal macular haemorrhage, orbital inflammatory syndrome, orbital apex syndrome, optic perineuritis, papilloedema and homonymous visual field defects. Incomplete recovery of ON was associated with a case of Leber's hereditary optic neuropathy. Efferent ophthalmic manifestations included cranial neuropathies, internuclear ophthalmoplegia, central nystagmus, saccadic intrusions and ocular flutter. Cranial nerve involvement was secondary to enhancement of the cisternal portion or brainstem involvement. All included cases were treated with corticosteroids with 31% of cases requiring additional immunosuppressive therapy.
CONCLUSIONS
MOGAD has been associated with various afferent and efferent ophthalmic manifestations apart from isolated ON. Awareness of these findings may result in earlier diagnosis and treatment.
Topics: Autoantibodies; Female; Humans; Immunoglobulin G; Myelin-Oligodendrocyte Glycoprotein; Optic Neuritis; Papilledema; Vision Disorders
PubMed: 32998905
DOI: 10.1136/bjophthalmol-2020-317267 -
The Cochrane Database of Systematic... Sep 2020The diagnosis of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents major challenges. Reverse transcriptase polymerase chain reaction... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The diagnosis of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents major challenges. Reverse transcriptase polymerase chain reaction (RT-PCR) testing is used to diagnose a current infection, but its utility as a reference standard is constrained by sampling errors, limited sensitivity (71% to 98%), and dependence on the timing of specimen collection. Chest imaging tests are being used in the diagnosis of COVID-19 disease, or when RT-PCR testing is unavailable.
OBJECTIVES
To determine the diagnostic accuracy of chest imaging (computed tomography (CT), X-ray and ultrasound) in people with suspected or confirmed COVID-19.
SEARCH METHODS
We searched the COVID-19 Living Evidence Database from the University of Bern, the Cochrane COVID-19 Study Register, and The Stephen B. Thacker CDC Library. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. We conducted searches for this review iteration up to 5 May 2020.
SELECTION CRITERIA
We included studies of all designs that produce estimates of test accuracy or provide data from which estimates can be computed. We included two types of cross-sectional designs: a) where all patients suspected of the target condition enter the study through the same route and b) where it is not clear up front who has and who does not have the target condition, or where the patients with the target condition are recruited in a different way or from a different population from the patients without the target condition. When studies used a variety of reference standards, we included all of them.
DATA COLLECTION AND ANALYSIS
We screened studies and extracted data independently, in duplicate. We also assessed the risk of bias and applicability concerns independently, in duplicate, using the QUADAS-2 checklist and presented the results of estimated sensitivity and specificity, using paired forest plots, and summarised in tables. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs).
MAIN RESULTS
We included 84 studies, falling into two categories: studies with participants with confirmed diagnoses of COVID-19 at the time of recruitment (71 studies with 6331 participants) and studies with participants suspected of COVID-19 (13 studies with 1948 participants, including three case-control studies with 549 cases and controls). Chest CT was evaluated in 78 studies (8105 participants), chest X-ray in nine studies (682 COVID-19 cases), and chest ultrasound in two studies (32 COVID-19 cases). All evaluations of chest X-ray and ultrasound were conducted in studies with confirmed diagnoses only. Twenty-five per cent (21/84) of all studies were available only as preprints, 15/71 studies in the confirmed cases group and 6/13 of the studies in the suspected group. Among 71 studies that included confirmed cases, 41 studies had included symptomatic cases only, 25 studies had included cases regardless of their symptoms, five studies had included asymptomatic cases only, three of which included a combination of confirmed and suspected cases. Seventy studies were conducted in Asia, 2 in Europe, 2 in North America and one in South America. Fifty-one studies included inpatients while the remaining 24 studies were conducted in mixed or unclear settings. Risk of bias was high in most studies, mainly due to concerns about selection of participants and applicability. Among the 13 studies that included suspected cases, nine studies were conducted in Asia, and one in Europe. Seven studies included inpatients while the remaining three studies were conducted in mixed or unclear settings. In studies that included confirmed cases the pooled sensitivity of chest CT was 93.1% (95%CI: 90.2 - 95.0 (65 studies, 5759 cases); and for X-ray 82.1% (95%CI: 62.5 to 92.7 (9 studies, 682 cases). Heterogeneity judged by visual assessment of the ROC plots was considerable. Two studies evaluated the diagnostic accuracy of point-of-care ultrasound and both reported zero false negatives (with 10 and 22 participants having undergone ultrasound, respectively). These studies only reported True Positive and False Negative data, therefore it was not possible to pool and derive estimates of specificity. In studies that included suspected cases, the pooled sensitivity of CT was 86.2% (95%CI: 71.9 to 93.8 (13 studies, 2346 participants) and specificity was 18.1% (95%CI: 3.71 to 55.8). Heterogeneity judged by visual assessment of the forest plots was high. Chest CT may give approximately the same proportion of positive results for patients with and without a SARS-CoV-2 infection: the chances of getting a positive CT result are 86% (95% CI: 72 to 94) in patient with a SARS-CoV-2 infection and 82% (95% CI: 44 to 96) in patients without.
AUTHORS' CONCLUSIONS
The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results. Our findings indicate that chest CT is sensitive but not specific for the diagnosis of COVID-19 in suspected patients, meaning that CT may not be capable of differentiating SARS-CoV-2 infection from other causes of respiratory illness. This low specificity could also be the result of the poor sensitivity of the reference standard (RT-PCR), as CT could potentially be more sensitive than RT-PCR in some cases. Because of limited data, accuracy estimates of chest X-ray and ultrasound of the lungs for the diagnosis of COVID-19 should be carefully interpreted. Future diagnostic accuracy studies should avoid cases-only studies and pre-define positive imaging findings. Planned updates of this review will aim to: increase precision around the accuracy estimates for CT (ideally with low risk of bias studies); obtain further data to inform accuracy of chest X rays and ultrasound; and continue to search for studies that fulfil secondary objectives to inform the utility of imaging along different diagnostic pathways.
Topics: Adult; Betacoronavirus; COVID-19; COVID-19 Testing; Child; Clinical Laboratory Techniques; Coronavirus Infections; Humans; Lung; Pandemics; Pneumonia, Viral; Radiography, Thoracic; SARS-CoV-2; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography
PubMed: 32997361
DOI: 10.1002/14651858.CD013639.pub2 -
Frontiers in Neuroscience 2020Macular degeneration (MD) is one of the most frequent causes of visual deficit, resulting in alterations affecting not only the retina but also the entire visual pathway... (Review)
Review
BACKGROUND
Macular degeneration (MD) is one of the most frequent causes of visual deficit, resulting in alterations affecting not only the retina but also the entire visual pathway up to the brain areas. This would seem related not just to signal deprivation but also to a compensatory neuronal reorganization, having significant implications in terms of potential rehabilitation of the patient and therapeutic perspectives.
OBJECTIVE
This paper aimed to outline, by analyzing the existing literature, the current understanding of brain structural and functional changes detected with neuroimaging techniques in subjects affected by juvenile and age-related maculopathy.
METHODS
Articles using various typologies of central nervous system (CNS) imaging in at least six patients affected by juvenile or age-related maculopathy were considered. A total of 142 were initially screened. Non-pertinent articles and duplicates were rejected. Finally, 19 articles, including 649 patients, were identified.
RESULTS
In these sources, both structural and functional modifications were found in MD subjects' CNS. Changes in visual cortex gray matter volume were observed in both age-related MD (AMD) and juvenile MD (JMD); in particular, an involvement of not only its posterior part but also the anterior one suggests further causes besides an input-deprivation mechanism only. White matter degeneration was also found, more severe in JMD than in AMD. Moreover, functional analysis revealed differences in cortical activation patterns between MD and controls, suggesting neuronal circuit reorganization. Interestingly, attention and oculomotor training allowed better visual performances and correlated to a stronger cortical activation, even of the area normally receiving inputs from lesioned macula.
CONCLUSION
In MD, structural and functional changes in cerebral circuits and visual pathway can happen, involving both cerebral volume and activation patterns. These modifications, possibly due to neuronal plasticity (already observed and described for several brain areas), can allow patients to compensate for macular damage and gives therapeutic perspectives which could be achievable through an association between oculomotor training and biochemical stimulation of neuronal plasticity.
PubMed: 32973424
DOI: 10.3389/fnins.2020.00755 -
Pain Physician Sep 2020Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the...
BACKGROUND
Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the central sensitization process, modulating the pain experience. However, there is still a gap in its efficacy compared with another hands-on approach because manual therapy has nonspecific effects, such as placebo.
OBJECTIVES
This systematic review aims to review the scientific literature for an overview of the efficacy of manual therapy in pain, disease impact, and quality of life in patients with FM compared with control or other treatments through randomized clinical trials.
STUDY DESIGN
This study involved systematic review of published randomized controlled trials (RCTs).
SETTING
This study examined all RCTs evaluating the effect of manual therapy on pain, impact of disease, and quality of life for patients with FM.
METHODS
Systematic review. The research was performed in 9 databases: MEDLINE/PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Lilacs, SciELO, PEDro, and Cochrane. Searches were carried out from the end of the project until September 2019, with no language and year restrictions. Randomized controlled clinical trials that used the following outcome measures were included: Visual Analog Scale, Fibromyalgia Impact Questionnaire, and SF-36 Quality of Life Questionnaire. The risk of bias and quality of studies was assessed using the PEDro scale; the Cochrane risk-of-bias tool; and Grading of Recommendations Assessment, Development, and Evaluation System.
RESULTS
Seven studies were included (368 patients). The quantitative analysis was performed on 4 studies because of the lack of data in the others. Myofascial release was the most used modality. The level of evidence ranged from very low to moderate, mainly because of the inconsistency and inaccuracy of results.
LIMITATIONS
The present systematic review presented limitations because of the heterogeneity of the included studies and only a short-term analysis of the intervention results. It was observed that other information, such as pressure, repetition, and/or sustaining manual therapy techniques, could be better described in future protocols, aiming at a better comparison between the techniques and their subsequent reproducibility.
CONCLUSIONS
Current evidence of manual therapy in patients with FM, based on a very low to moderate quality of evidence, was inconclusive and insufficient to support and recommend the use of manual therapy in this population. To date, only general osteopathic treatment has achieved clinically relevant pain improvement when compared with control.
Topics: Fibromyalgia; Humans; Musculoskeletal Manipulations; Pain; Pain Management; Quality of Life; Treatment Outcome
PubMed: 32967389
DOI: No ID Found -
The Laryngoscope May 2021The main aim was to assess the misperception of visual verticality (VV) in patients with peripheral vestibular disorders (PVD) in comparison with healthy controls. As... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The main aim was to assess the misperception of visual verticality (VV) in patients with peripheral vestibular disorders (PVD) in comparison with healthy controls. As secondary objectives, we checked if vestibular, visual, and somatosensory postural pathways can be affected in patients with PVD as well as the characteristics of PVD that could influence on the VV perception.
METHODS
A systematic review with meta-analysis was carried out. The bibliographic search was performed in January, 2020 in PubMed, Scopus, Web of Science (WOS), CINAHL, SciELO. Two reviewers selected the studies that met the inclusion criteria, extracted data, and assessed the methodological quality using the Newcastle-Ottawa Scale (NOS). The VV perception was assessed in two meta-analysis according the used test: The Subjective Visual Vertical test (SVV) or the Rod and Frame Test (RFT) in comparison with healthy subjects. The Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI) was used to estimate the pooled effect. Publication bias was assessed using the Egger's test and Trim and Fill Method.
RESULTS
Thirty-four studies were included reporting 3,524 participants. PVD patients showed a misperception of the VV with SVV (SMD = 1.510; 95%CI: 1.190-1.830) and the RFT (SMD = 0.816; 95% CI: 0.234-1.398) respect healthy controls. A subgroup of patients in the acute phase (SMD = 2.5; 95%CI: 2.022-2.978) and who underwent a vestibular surgery (SMD = 2.241; 95%CI: 1.471-3.011) had the greater misperception of VV.
CONCLUSION
Patients with PVD show an alteration in the perception of VV, being greater in the acute phase and after a vestibular surgery. Laryngoscope, 131:1110-1121, 2021.
Topics: Case-Control Studies; Healthy Volunteers; Humans; Otologic Surgical Procedures; Posture; Vestibular Diseases; Vestibule, Labyrinth; Visual Perception
PubMed: 32965689
DOI: 10.1002/lary.29124 -
Aging & Mental Health Oct 2021Visual impairment and cognitive disorders are common among older people in Low-and Middle-Income Countries (LMIC). Several recent studies performed in High-Income...
OBJECTIVES
Visual impairment and cognitive disorders are common among older people in Low-and Middle-Income Countries (LMIC). Several recent studies performed in High-Income Countries suggested that visual impairment is associated with cognitive disorders. However, no synthesis of current knowledge exists for LMIC.
METHODS
We have conducted an extensive literature search combining six databases and two grey literature databases. We searched for studies assessing the link between visual and cognitive impairments carried out in LMIC. The systematic search was performed up to 14th February 2019.
RESULTS
Overall, eight studies were included in this review. Among them, five studies were performed in Asia and seven studies had a cross-sectional design. Mean age of the participants varied from 64.2 to 76.2 years. Participants were most often females. Only three studies were specifically focused on the association between visual impairment and cognitive disorders. Out of the eight studies included, four reported a significant association; two showed a possible association and two did not retrieve any statistically significant effect. Heterogeneity in assessments of visual and cognitive impairments was high.
CONCLUSION
In LMIC, very few studies explored the association between visual and cognitive impairments among older people. The current review seems to suggest that visual impairment is associated with cognitive disorders in LMIC. However, further studies are required to improve the knowledge on this relationship. Improving vision, in particular through optical correction and cataract surgery, could potentially be easy pathways to reduce cognitive disorders incidence and to improve quality of life of people affected by this disorder.
Topics: Aged; Cognition; Cross-Sectional Studies; Developing Countries; Female; Humans; Quality of Life; Vision Disorders
PubMed: 32896159
DOI: 10.1080/13607863.2020.1808878 -
Disability and Rehabilitation Apr 2022To systematically review the evidence for effectiveness of rehabilitation interventions in people who are visually impaired, living in low- and middle-income countries.
OBJECTIVE
To systematically review the evidence for effectiveness of rehabilitation interventions in people who are visually impaired, living in low- and middle-income countries.
METHODS
Fifteen databases and the grey literature were searched up until February 2020; papers were identified according to eligibility criteria, and assessed for risk of bias. Eligible studies were controlled trials (randomised or non-randomised) of rehabilitation interventions for blind or visually impaired adults or children from low- and middle-income countries. Possible outcomes included visual acuity, activities of daily living, safety, quality of life and psychological status.
RESULTS
Fifteen eligible studies were identified from India, Turkey, Nigeria, Croatia and Iran. Six studies were randomised, seven were non-randomised trials, and in two the method of allocation was not clear. Participants were adults, children and both adults and children. Seven studies were small ( ≤ 65) and examined the effect of training programmes. Remaining studies compared the effect of low vision aids, economic rehabilitation, goalball, rehabilitation compliance and service delivery methods, including one large four-arm randomised trial ( = 436). Studies measured a variety of outcomes, and mostly showed a positive effect of interventions for pre- and post-intervention assessment, although between intervention group comparisons were often inconclusive. Overall, only four studies had a low risk of bias.
CONCLUSIONS
A lack of high-quality evidence for rehabilitation interventions is a barrier to provision of low vision services in low- and middle-income countries. Future research should focus on establishing effectiveness and cost-effectiveness of devices and models of vision rehabilitation appropriate for low-resource settings.IMPLICATIONS FOR REHABILITATIONThe systematic review found a lack of high-quality evidence for rehabilitation interventions is a barrier to provision of low vision services in low- and middle-income countries.Consider how visual rehabilitation interventions which have been shown to be effective can be delivered by non-specialists.Ensure that service providers for people who are visually impaired are trained in recognising depression and anxiety and have pathways for referral to mental health services, as appropriate.
Topics: Activities of Daily Living; Adult; Blindness; Child; Developing Countries; Humans; Quality of Life; Vision, Low; Visually Impaired Persons
PubMed: 32726142
DOI: 10.1080/09638288.2020.1794063 -
Frontiers in Cellular Neuroscience 2020The maintenance of the excitability of neurons and circuits is a fundamental process for healthy brain functions. One of the main homeostatic mechanisms responsible for...
The maintenance of the excitability of neurons and circuits is a fundamental process for healthy brain functions. One of the main homeostatic mechanisms responsible for such regulation is synaptic scaling. While this type of plasticity is well-characterized through a robust body of literature, there are no systematic evaluations of the methodological and reporting features from these studies. Our review yielded 168 articles directly investigating synaptic scaling mechanisms, which display relatively high impact, with a median impact factor of 7.76 for the publishing journals. Our methodological analysis identified that 86% of the articles made use of inhibitory interventions to induce synaptic scaling, while only 41% of those studies contain excitatory manipulations. To verify the effects of synaptic scaling, the most assessed outcome was miniature excitatory postsynaptic current (mEPSC) recordings, performed in 71% of the articles. We could also observe that the field is mostly focused on mechanistic studies of the synaptic scaling pathways (70%), rather than the interaction with other types of plasticity, such as Hebbian processes (4%). We found that more than half of the articles failed to describe simple features, such as regulatory compliance statements, ethics committee approval, or statements of conflict of interests. In light of these results, we discuss the strengths and pitfalls existing in synaptic scaling literature.
PubMed: 32612512
DOI: 10.3389/fncel.2020.00164 -
Child's Nervous System : ChNS :... Sep 2020Optic pathway gliomas (OPGs), also known as Visual Pathway Gliomas, are insidious, debilitating tumours. They are most commonly WHO grade 1 pilocytic astrocytomas and... (Review)
Review
INTRODUCTION
Optic pathway gliomas (OPGs), also known as Visual Pathway Gliomas, are insidious, debilitating tumours. They are most commonly WHO grade 1 pilocytic astrocytomas and frequently occur in patients with neurofibromatosis type 1. The location of OPGs within the optic pathway typically precludes complete resection or optimal radiation dosing, hence outcomes remain poor compared to many other low-grade gliomas. The aim of this systematic review was to formulate a comprehensive list of all current ongoing clinical trials that are specifically looking at clinical care of OPGs in order to identify trends in current research and provide an overview to guide future research efforts.
METHODS
This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Cochrane Controlled Register of Trials (CENTRAL) and ClinicalTrials.gov were searched. Inclusion and exclusion criteria were applied and final results were reviewed.
RESULTS
501 clinical trials were identified with the search strategy. All were screened and eligible studies extracted and reviewed. This yielded 36 ongoing clinical trials, 27 of which were pharmacological agents in phase I-III. The remaining trials were a mixture of biological agents, radiation optimisation, diagnostic imaging, surgical intervention, and a social function analysis.
CONCLUSION
OPG is a complex multifaceted disease, and advances in care require ongoing research efforts across a spectrum of different research fields. This review provides an update on the current state of research in OPG and summarises ongoing trials.
Topics: Astrocytoma; Humans; Neurofibromatosis 1; Optic Nerve Glioma
PubMed: 32556546
DOI: 10.1007/s00381-020-04724-1