Search

BACKGROUND: The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively. OBJECTIVE: This systematic review and meta-analysis were designed to investigate the presence of sublingual microcirculatory flow alterations during the immediate and early postoperative period and their correlation with complications and survival. METHODS: A systematic search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was conducted for relevant articles from January 2000 to March 2021. Eligibility criteria were randomized controlled and non-randomized trials. Case reports, case series, review papers, animal studies and non-English literature were excluded. The primary outcome was the assessment of sublingual microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing surgery. Risk of bias was assessed with the Ottawa-Newcastle scale. Standard meta-analysis methods (random-effects models) were used to assess the difference in microcirculation variables. RESULTS: Thirteen studies were included. No statistically significant difference was found between preoperative and postoperative total vessel density (p = 0.084; Standardized Mean Difference (SMD): –0.029; 95%CI: –0.31 to 0.26; I2 = 22.55%). Perfused vessel density significantly decreased postoperatively (p = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2 = 65.66%), while perfused boundary region significantly increased postoperatively (p = 0.031; SMD: –0.415; 95%CI: –0.79 to –0.03; I2 = 37.21%). Microvascular flow index significantly decreased postoperatively (p = 0.028; SMD: 0.587; 95%CI: 0.06 to 1.11; I2 = 86.09%), while no statistically significant difference was found between preoperative and postoperative proportion of perfused vessels (p = 0.089; SMD: 0.53; 95%CI: –0.08 to 1.14; I2 = 70.71%). The results of the non-cardiac surgery post-hoc analysis were comparable except that no statistically significant difference in perfused vessel density was found (p = 0.69; SMD: 0.07; 95%CI: –0.26 to 0.39; I2 = 0%). LIMITATIONS: The included studies investigate heterogeneous groups of surgical patients. There were no randomized controlled trials. CONCLUSIONS: Significant sublingual microcirculatory flow alterations are present during the immediate and early postoperative period. Further research is required to estimate the correlation of sublingual microcirculatory flow impairment with complications and survival.

Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); Pz = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.

Background It is unclear whether Peripherally Inserted Central Catheter (PICC) lines are associated with lower complication rates as compared to conventional Central Venous Catheters (CVCs), especially in high risk patients. Objective To compare Central Line Associated Bloodstream Infection (CLABSI) and catheter-related thrombosis rates in Intensive Care Unit (ICU) and onco-hematologic patients with PICC lines and CVCs. Methods We systematically reviewed the PubMed, Cochrane and Google Scholar databases to identify relevant studies. Study quality was evaluated using appropriate assessment tools and the pooled odds ratio (OR) and confidence interval (CI) were calculated. Sensitivity analyses were performed based on meta-analysis method, type of study and prophylaxis implementation. Results Thirteen studies were included in our meta-analysis. PICC lines were associated with a significantly higher rate of thrombosis in ICU [OR (95%CI): 2.58(1.80,3.70); Pz Conclusions PICC lines are associated with higher rates of thrombotic events. However, they might be suitable for onco-hematologic patients due to lower CLABSI rates.

The formation of intracranial aneurysms (IAs) has been associated with genetic polymorphisms. A few genome-wide (GWAS) and candidate gene association studies (CGAS) have reported that single nucleotide polymorphisms (SNPs) in locus 9p21 have been associated with the formation of IAs.We performed a meta-analysis of case-control studies to investigate the association of two SNPs (rs1333040, rs10757278), located at the 9p21 locus, with the formation of IAs. MEDLINE, EMBASE, Google Scholar and CENTRAL databases were comprehensively searched.For the rs1333040 (C T) polymorphism, a significant association with IA was observed in the dominant [OR (95% CI): 1.39 (1.24, 1.56); Pz0.00001], recessive [OR (95% CI): 1.38 (1.28, 1.49); Pz0.00001] and over-dominant [OR (95% CI): 0.85 (0.79, 0.91); Pz0.00001] models. For the rs10757278(A G) SNP, we observed a statistically significant association with IAs in the dominant [OR (95% CI): 1.41 (1.28, 1.56); Pz0.01] and recessive [OR (95% CI): 1.42 (1.29, 1.56); Pz0.01] models, while statistical significance was not revealed in the over-dominant model [OR (95% CI): 1.01 (0.93, 1.10); PA possible association between the two SNPs and IAs was indicated. The associations reported by our meta-analysis need to be further studied and validated by larger CGAS and GWAS.

Background In the present study we performed a systematic review and meta-analysis regarding the initial management of perforations following endoscopic retrograde cholangiopancreatography (ERCP). Method A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Result In total, 10 comparative studies and 223 patients with post-ERCP perforations were included in the present study. In type I and II perforations, the success rate of initial surgical management was higher compared to the non-operative management (NOM) group (P=0.09 and P=0.02, respectively). There was no statistically significant difference in mortality rates or length of hospital stay between initial surgical and NOM management for any type of perforation. Conclusions The current meta-analysis demonstrated the significance of the initial management of patients with post-ERCP perforations. Whether a surgical or an endoscopic approach is chosen, the patient should immediately be evaluated by an experienced surgeon or endoscopist.

AimTo estimate the incidence of in-hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID-19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non-ICU patients with COVID-19.MethodsWe systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies.ResultsEleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID-19 patients was 7% [95% CI: 4 – 11%; P < 0.0001] and 44% [95% CI: 30 – 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42 – 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow-up was 59% [95% CI: 37 – 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards.ConclusionThe incidence of IHCA amongst hospitalized COVID-19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.What this paper addsSection 1: What is already known on this subjectMortality in COVID-19 patients ranges between 20% and 40%.it has been reported that patients with COVID-19 have a high incidence of IHCA and higher mortality.This paper aimed to calculate the proportion of COVID-19 patients who experience IHCA and their outcome, as well as compare the outcome of IHCA between ICU and non-ICU patients.Section 2: What this study addsApproximately 7% of hospitalized COVID-19 patients suffer from IHCA and 44% of those achieve ROSC.The rate of ROSC was higher in ICU patients, but the rate of mortality did not differe between ICU and non-ICU patients.

Study objectiveTo systematically review the literature regarding the presence of sublingual microcirculatory alterations during the immediate and early postoperative period.DesignSystematic review and meta-analysis searching PubMed, Scopus, and Google Scholar.Patients/interventionsStudies comparing sublingual microcirculation before and after surgery.MeasurementThe primary outcome was to investigate the severity of microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing non-cardiac and cardiac surgery.Main resultsAmong 17 eligible studies, 13 were finally analyzed. A non-statistically significant difference was found between preoperative and postoperative total vessel density (p=0.084; estimate: −0.029; 95% CI: −0.31 to 0.26; I2 = 22.55%, Q = 10.23, p=0.24). Perfused vessel density significantly decreased postoperatively (p=0.035; estimate: 0.344; 95% CI: 0.02 to 0.66; I2 = 65.66%, Q = 41.77, p2 = 37.21%, Q = 6.56, p=0.16). Microvascular flow index significantly decreased postoperatively (p=0.028; estimate: 0. 587; 95% CI: 0.06 to 1.11; I2 = 86.09%, Q = 96.28, p2 = 70.71%, Q = 18.99, p=0.002). The results in the non-cardiac surgery subgroup were comparable with the full group except that a statistically non-significant difference in PVD was found in the remaining seven studies (p=0.19; estimate: 0.26; 95% CI: −0.13 to 0.66; I2 = 71.94%, Q = 33.42, p=0.002). The other parameters did not differ significantly from their respective full group results.ConclusionsSignificant sublingual microcirculatory alterations are present during the immediate and early postoperative period.

Introduction: There is an ongoing debate whether Decompressive Craniectomy (DC) serves as an independent risk factor for the development of Post-traumatic Hydrocephalus (PTH). Research question: The aim of this systematic review and meta-analysis was to compare the incidence of PTH in TBI patients that underwent DC versus those that were managed without DC. Materials and methods: The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) Randomized Controlled Trials and observational studies with more than 10 patients in each study arm, (2) comparing the incidence of PTH, (3) in patients aged ≥15 years old, (4) that either underwent DC or received other treatment (non-DC). (5) Only studies in English were included and (6) no restrictions were applied on publication date. The pooled Odds Ratio (OR) and Confidence Interval (CI) were calculated. The quality of the included studies was assessed using the ROBINS and RoB 2.0 tools. Results: Evidence from six articles was synthesized, incorporating data from 2522 patients. A statistically significant higher occurrence of PTH [OR (95% CI): 4.84 (2.51, 9.31); Pz ​