scholarly journals Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

2020 ◽  
Vol 9 (11) ◽  
pp. 3622
Author(s):  
Christian Heise ◽  
Einas Abou Ali ◽  
Dirk Hasenclever ◽  
Francesco Auriemma ◽  
Aiste Gulla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Significant Risk ◽  
Significant Heterogeneity ◽  
Incomplete Resection ◽  
Quality Of Data ◽  
Surgical Interventions ◽  
Random Effects Models ◽  
Fixed And Random Effects

Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I2 = 91.38%) for EA, 96.4% (93.6–99.2%, I2 = 37.8%) for SA and 98.9% (98.0–99.7%, I2 = 0%) for PD. AEs were 24.7% (19.8–29.6%, I2 = 86.4%), 28.3% (19.0–37.7%, I2 = 76.8%) and 44.7% (37.9–51.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I2 = 91.3%), 9.4% (4.8–14%, I2 = 57.3%) and 14.2% (9.5–18.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.

scholarly journals Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paddy Ssentongo ◽  
Emily S. Heilbrunn ◽  
Anna E. Ssentongo ◽  
Shailesh Advani ◽  
Vernon M. Chinchilli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Beneficial Effects ◽  
Risk Of Mortality ◽  
Immunodeficiency Syndrome ◽  
Hiv Negative

AbstractSusceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of mortality among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) is largely unknown. PLWHA are unique due to their altered immune system from their history of chronic HIV infection and their use of antiretroviral therapy, some of which have been used experimentally to treat coronavirus disease 2019 (COVID-19). Therefore, we conducted a systematic review and meta-analysis to assess the epidemiology of SARS-COV-2/HIV coinfection and estimate associated mortality from COVID-19 (Prospero Registration ID: CRD42020187980). PubMed, SCOPUS, OVID and Cochrane Library databases, and medRxiv preprint repositories were searched from January 1, 2020, to December 12, 2020. Data were extracted from studies reporting COVID-19 attack and mortality rates in PLWHA compared to their HIV-negative counterparts. Pooled attack and mortality risks were quantified using random-effects models. We identified 22 studies that included 20,982,498 participants across North America, Africa, Europe, and Asia. The median age was 56 years, and 50% were male. HIV-positive persons had a significantly higher risk of SARS-CoV-2 infection [risk ratio (RR) 1.24, 95% CI 1.05–1.46)] and mortality from COVID-19 (RR 1.78, 95% CI 1.21–2.60) than HIV-negative individuals. The beneficial effects of tenofovir and protease-inhibitors in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in PLWHA remain inconclusive. HIV remains a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19. In support of the current Centers for Disease Control and Prevention (CDC) guidelines, persons with HIV need priority consideration for the SARS-CoV-2 vaccine.

scholarly journals Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eric Chong ◽  
Chathura Bathiya Ratnayake ◽  
Samantha Saikia ◽  
Manu Nayar ◽  
Kofi Oppong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Duct ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Significant Heterogeneity ◽  
Success Rates ◽  
Surgical Interventions ◽  
Transmural Drainage ◽  
Transpapillary Drainage ◽  
Duct Syndrome

Abstract Background Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

Surgical treatment of rectovaginal fistulas (systematic literature review)

2021 ◽  
pp. 30-48
Author(s):  
Andrei Anatolevich Mudrov ◽  
Aleksandr Yur’evich Titov ◽  
Mariyam Magomedovna Omarova ◽  
Sergei Alekseevich Frolov ◽  
Ivan Vasilevich Kostarev ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
High Recurrence Rate ◽  
Surgical Interventions ◽  
Rectovaginal Fistulas ◽  
Surgical Treatments

Despite the large number of available surgical interventions aimed at the treatment of rectovaginal fistulas, the results of their use remain extremely disappointing, associated with the high recurrence rate of the disease reaching 80 %, as well as the lack of a single tactic to minimize the risk of anal incontinence and the need for colostomy. Objective: to conduct a systematic literature review in order to summarize information related to the rectovaginal fistulas surgery. The systematic review includes the results of an analysis of 97 clinical trials selected from 756 publications found in databases. Inclusion criteria: a full-text article, the presence of at least 5 patients in the study, as well as data on the outcome of surgery. Clinical trials with different surgical treatments were identified and classified into the following categories: elimination of the rectovaginal septal defect with a displaced flap (rectal and vaginal); Martius surgery; gracilis muscle transposition; transperineal procedure; abdominal procedure including endoscopic and laparoscopic methods; use of biological or biocompatible materials. Treatment outcomes vary significantly from 0 % to > 80 %. None of the studies were randomized. Due to the low quality of the identified studies, comparison of results and meta-analysis conduction were not possible. Conclusion: as a result of the systematic review, data for the analysis and development of any strategic and tactical algorithms for the treatment of RVF were not obtained. The most important questions still remain open: what and when surgical method to choose, is it necessary to form a disconnecting stoma?

scholarly journals Pregnancy-related complications and incidence of atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Al Bahhawi ◽  
A Aqeeli ◽  
S L Harrison ◽  
D A Lane ◽  
I Buchan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cohort Studies ◽  
Observational Studies ◽  
Large Scale ◽  
Data Extraction ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Random Effects Models ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Pregnancy-related complications have been previously associated with incident cardiovascular disease. However, data are scarce on the association between pregnancy-related complications and incident atrial fibrillation (AF). This systematic review examines associations between pregnancy-related complications and incident AF. Methods A systematic search of the literature utilising MEDLINE and EMBASE (Ovid) was conducted from 1990 to 6 April 2020. Observational studies examining the association between pregnancy-related complications including hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, low birth weight, small-for-gestational-age and stillbirth, and incidence of AF were included. Screening and data extraction were conducted independently by two reviewers. Inverse-variance random-effects models were used to pool hazard ratios. Results: Six observational studies met the inclusion criteria one case-control study and five retrospective cohort studies, with four studies eligible for meta-analysis.  Sample sizes ranged from 1,839-1,303,365. Mean/median follow-up for the cohort studies ranged from 7-36 years. Most studies reported an increased risk of incident AF associated with pregnancy-related complications. The pooled summary statistic from four studies reflected a greater risk of incident AF for HDP (hazard ratio (HR) 1.47, 95% confidence intervals (CI) 1.18-1.84; I2 = 84%) and from three studies for pre-eclampsia (HR 1.71, 95% CI 1.41-2.06; I2 = 64%; Figure). Conclusions The results of this review suggest that pregnancy-related complications particularly pre-eclampsia appear to be associated with higher risk of incident AF. The small number of included studies and the significant heterogeneity in the pooled results suggest further large-scale prospective studies are required to confirm the association between pregnancy-related complications and AF. Abstract Figure.

Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis

2020 ◽  
Vol 48 (4) ◽  
pp. 437-454
Author(s):  
Tomas Lindegaard ◽  
Matilda Berg ◽  
Gerhard Andersson
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Psychodynamic Therapy ◽  
Significant Heterogeneity ◽  
Psychodynamic Treatment ◽  
Literature Searches ◽  
Treatment Models ◽  
Promising Treatment

Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32–0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.

scholarly journals Anxiety disorders and risk of stroke: A systematic review and meta-analysis

2017 ◽  
Vol 41 (1) ◽  
pp. 102-108 ◽  
Author(s):  
M. Pérez-Piñar ◽  
L. Ayerbe ◽  
E. González ◽  
R. Mathur ◽  
Q. Foguet-Boreu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Critical Appraisal ◽  
Web Of Science ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Explanatory Factors ◽  
Increased Risk ◽  
Severe Anxiety

AbstractBackgroundAnxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke.MethodsCohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders.ResultsEight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09–1.41), P = 0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety.ConclusionsAnxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.

Prevalence of idiopathic REM behavior disorder: a systematic review and meta-analysis

SLEEP ◽  
2021 ◽  
Author(s):  
Calogero Edoardo Cicero ◽  
Loretta Giuliano ◽  
Jaime Luna ◽  
Mario Zappia ◽  
Pierre-Marie Preux ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Behavior Disorder ◽  
Significant Heterogeneity ◽  
Pooled Prevalence ◽  
Screening Questionnaires ◽  
Meta Regression

Abstract Study Objectives To provide an overall estimate of the prevalence of idiopathic REM Sleep Behavior Disorder (iRBD). Methods Two investigators have independently searched the PubMed and Scopus databases for population-based studies assessing the prevalence of iRBD. Data about type of diagnosis (polysomnographic diagnosis, defined iRBD [dRBD]; clinical diagnosis, probable RBD [pRBD]), continent, age range of the screened population, quality of the studies, sample size, screening questionnaires and strategies have been gathered. A random effect model was used to estimate the pooled prevalence. Heterogeneity was investigated with subgroup analysis and meta-regression. Results From 857 articles found in the databases, 19 articles were selected for the systematic review and meta-analysis. According to the type of diagnosis, five studies identified dRBD cases given a pooled prevalence of 0.68% (95%CI 0.38-1.05) without significant heterogeneity (Cochran’s Q p=0.11; I 2 = 46.43%). Fourteen studies assessed the prevalence of pRBD with a pooled estimate of 5.65% (95%CI 4.29-7.18) and a significant heterogeneity among the studies (Cochran’s Q p<0.001; I 2 = 98.21%). At the subgroup analysis, significant differences in terms of prevalence were present according to the quality of the studies and, after removing two outlaying studies, according to the continents and the screening questionnaire used. Meta-regression did not identify any significant effect of the covariates on the pooled estimates. Conclusion Prevalence estimates of iRBD are significantly impacted by diagnostic level of certainty. Variations in pRBD prevalence are due to methodological differences in study design and screening questionnaires employed.

The incidence of military training-related injuries in Chinese new recruits: a systematic review and meta-analysis

2017 ◽  
Vol 164 (4) ◽  
pp. 309-313 ◽  
Author(s):  
Wei Hua ◽  
Q Chen ◽  
M Wan ◽  
J Lu ◽  
L Xiong
Keyword(s):  
Systematic Review ◽  
Military Service ◽  
Meta Analysis ◽  
Military Training ◽  
Inclusion Criteria ◽  
Random Effects Models ◽  
Premature Discharge ◽  
New Recruits

IntroductionTraining-related injuries are the main reason for disability, long-term rehabilitation, functional impairment and premature discharge from military service. The aim of this study was to identify the incidence of injuries in the training of Chinese new recruits via a systematic review of the literature.MethodA systematic review and meta-analysis was conducted to evaluate the combined incidence of military training-related injuries in Chinese new recruits. The electronic databases of full-text journals were searched, and the Loney criteria were used to assess the quality of eligible articles. Summary estimates were obtained using random-effects models. Subgroup analyses and publication bias tests were performed.ResultsFifty-five eligible articles representing 109 611 Chinese new recruits met the inclusion criteria, of which 21 253 recruits were clinically diagnosed with military training-related injuries. The combined incidence of military training-related injuries in Chinese new recruits was found to be 21.04%.ConclusionsAn increased incidence of training injuries was found in more recent years, underscoring the need for further research on the risk factors associated with their causation.

scholarly journals Incidence Trend of Breast Cancer and its Risk Factors in Women of Eastern Mediterranean Region Countries between 1998 and 2018: A Systematic Review and Meta-Analysis

2019 ◽  
Author(s):  
Razieh Zahedi ◽  
Hossein Molavi Vardanjani ◽  
Mohammad Reza Baneshi ◽  
Ali Akbar Haghdoost ◽  
Reza Malekpour Afshar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Eastern Mediterranean Region ◽  
Quality Data ◽  
Current Status ◽  
Quality Of Data ◽  
Incidence Trend

Abstract Abstract Background This study was conducted to provide evidence on the current status of breast cancer (BC) and its incidence trend in EMR during 1998-2018. Also, this study aimed to investigate the association between the incidence of BC and HDI and some factors related to this index, including total fertility rate (TFR), and obesity, using a meta-analysis. Method Data on incidence of BC were collected from various sources, including PubMed, Embase, Web of Science, and WHO, from 1998 to 2018 using systematic review and meta-analysis. Pooled ASR (age standardized rate) was calculated based on study duration and quality of data using a subgroup analysis and random effect meta-analysis. Results A total of 76 studies (499 data points) were analyzed. Pooled ASR of BC for EMR was 39.8 per 100 000 person-year (95% confidence interval [CI], 36.01, 43.9) during 2011-2018. ASR of BC had an upward trend in EMR from 2005 to 2018. However, the increasing trend was found to be slightly different in various regions based on quality of data. Moreover, pooled ASR had a significant association with Human Development Index (HDI) [-6.6 (95% CI, -8.9, -4.3)] and obesity [0.1 (95% CI, 0.07, 0.1)]. Conclusion Pooled ASR of BC in EMR was lower than the global average. Also, the ASR value and its incremental trend have been higher in countries with low-quality data than in other countries of this region in recent years. Data quality or physiological factors, such as increase in obesity rates, could be the reasons for this incremental trend.

scholarly journals Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Sanjay Pandanaboyana ◽  
Eric Chong Jing Fu ◽  
Chathura Bathiya Ratnayake ◽  
Samantha Saikia ◽  
Manu Nayar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Duct ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Significant Heterogeneity ◽  
Success Rates ◽  
Surgical Interventions ◽  
Transmural Drainage ◽  
Transpapillary Drainage ◽  
Duct Syndrome

Abstract BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aim to review the definitions, clinical presentation, intervention, and outcomes for DPDS. MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.2%, 918/964), followed by chronic pancreatitis (3.1%, 30/964). DPDS commonly presented with PFC (77.3%,728/942) and EPF (18.6%, 175/942). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI: 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P=0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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