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Endocrinology and Metabolism (Seoul,... Feb 2023There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of...
BACKGRUOUND
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
METHODS
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
RESULTS
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
CONCLUSION
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.
Topics: Humans; Thyroid Nodule; Biopsy, Fine-Needle; Thyroid Neoplasms; Cohort Studies; Pain
PubMed: 36891657
DOI: 10.3803/EnM.2023.1669 -
Frontiers in Pediatrics 2021This study was designed to assess the efficacy of increased salt and water intake in the treatment of pediatric vasovagal syncope (VVS) based on a meta-analysis of...
This study was designed to assess the efficacy of increased salt and water intake in the treatment of pediatric vasovagal syncope (VVS) based on a meta-analysis of global data. Following the established inclusion criteria, seven databases, Cochrane Library, EMBASE, PubMed, Web of Science, VIP, Wanfang, and China National Knowledge Infrastructure (CNKI), were searched using specific terms. The Cochrane Bias risk assessment tool was used as a quality assessment tool of the included studies, and publication bias was assessed by funnel plots. Review Manager 5.4 software was used to analyze the efficacy of the included studies, taking the negative changing rate of the head-up tilt test (HUTT) and recurrence rate of syncope or presyncope as therapeutic efficacy evaluations. In total, 5 randomized controlled trials (RCTs) were finally obtained, using the negative changing rate of the HUTT as an efficacy evaluation, while in 4 of the studies, the recurrence rate of syncope or presyncope was also evaluated. A total of 233 children with VVS were included in the salt and water intervention group. The cases in the control group were treated with non-medicinal conventional therapy. The results revealed that the negative changing rate of the HUTT in the intervention group (144/233, 61.8%) was higher than that in the control group (48/179, 26.8%), and the difference was significant ( < 0.00001). The recurrence rate of syncope or presyncope in the intervention group (85/195, 43.6%) was lower than that in the control group (86/144, 59.7%), and the difference was significant ( = 0.002). The current findings suggest that increased salt and water intake may increase the negative changing rates of the HUTT and reduce syncope or presyncope recurrence rates in pediatric patients with VVS.
PubMed: 34055695
DOI: 10.3389/fped.2021.663016 -
Frontiers in Physiology 2019The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and...
The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and stroke volume (SV) measured during head-up tilt table test (HUTT) in patients with positive and negative HUT test outcome. Pubmed and Clinical Key databases were searched for English-only articles presenting results of biosignals measurements during tilt test in patients suffering from syncope. From 3,289 articles 13 articles published between 1997 and 2015 investigating 892 patients (467 with positive HUTT outcome and 401 with negative one) were selected. There were not statistically significant differences observed between the parameters measured in supine position in patients with positive and negative test outcome [HR ( = 0.86), sBP ( = 0.32), dBP ( = 0.21), SV ( = 0.71)]. In tilt position the parameters HR and SV were significantly different when compared between the two groups of patients [HR ( = 0.02), sBP ( = 0.10), dBP ( = 0.59), SV ( = 0.0004)]. Changes in HR and SV parameters in response to tilt test turned out to be statistically significant. In supine position the differences between patients with positive and negative test outcome were not significant, hence tilt test can be considered as necessary in the diagnosis of vasovagal syndrome.
PubMed: 30899228
DOI: 10.3389/fphys.2019.00184 -
Open Heart Jun 2024Neurocardiogenic syncope is a common condition with significant associated psychological and physical morbidity. The effectiveness of therapeutic options for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neurocardiogenic syncope is a common condition with significant associated psychological and physical morbidity. The effectiveness of therapeutic options for neurocardiogenic syncope beyond placebo remains uncertain.
METHODS
The primary endpoint was the risk ratio (RR) of spontaneously recurring syncope following any therapeutic intervention. We also examined the effect of blinding on treatment efficacy. We identified all randomised trials which evaluated the effect of any pharmacological, device-based or supportive intervention on patients with a history of syncope. A systematic search was conducted on Medline, Embase, PubMed databases and Cochrane Central Register for Controlled Trials from 1950 to 25 April 2023. Event rates, their RRs and 95% CIs were calculated, and a random-effects meta-analysis was conducted for each intervention. Data analysis was performed in R using RStudio.
RESULTS
We identified 47 eligible trials randomising 3518 patients. Blinded trials assessing syncope recurrence were neutral for beta blockers, fludrocortisone and conventional dual-chamber pacing but were favourable for selective serotonin reuptake inhibitors (SSRIs) (RR 0.40, 95% CI 0.26 to 0.63, p<0.001), midodrine (RR 0.70, 95% CI 0.53 to 0.94, p=0.016) and closed-loop stimulation (CLS) pacing (RR 0.15, 95% CI 0.07 to 0.35, p<0.001). Unblinded trials reported significant benefits for all therapy categories other than beta blockers and consistently showed larger benefits than blinded trials.
CONCLUSIONS
Under blinded conditions, SSRIs, midodrine and CLS pacing significantly reduced syncope recurrence. Future trials for syncope should be blinded to avoid overestimating treatment effects.
PROSPERO REGISTRATION NUMBER
CRD42022330148.
Topics: Humans; Syncope, Vasovagal; Randomized Controlled Trials as Topic; Treatment Outcome; Recurrence
PubMed: 38890128
DOI: 10.1136/openhrt-2024-002669