Over the last decade, there has been a 10-fold increase in the number of published systematic reviews of prevalence. In meta-analyses of prevalence, the summary estimate represents an average ...prevalence from included studies. This estimate is truly informative only if there is no substantial heterogeneity among the different contexts being pooled. In systematic reviews, heterogeneity is usually explored with I-squared statistic (I
), but this statistic does not directly inform us about the distribution of effects and frequently systematic reviewers and readers misinterpret this result. In a sample of 134 meta-analyses of prevalence, the median I
was 96.9% (IQR 90.5-98.7). We observed larger I
in meta-analysis with higher number of studies and extreme pooled estimates (defined as <10% or >90%). Studies with high I
values were more likely to have conducted a sensitivity analysis, including subgroup analysis but only three (2%) systematic reviews reported prediction intervals. We observed that meta-analyses of prevalence often present high I
values. However, the number of studies included in the meta-analysis and the point estimate can be associated with the I
value, and a high I
value is not always synonymous with high heterogeneity. In meta-analyses of prevalence, I
statistics may not be discriminative and should be interpreted with caution, avoiding arbitrary thresholds. To discuss heterogeneity, reviewers should focus on the description of the expected range of estimates, which can be done using prediction intervals and planned sensitivity analysis.
Hydrocephalus is a common neurological condition that usually requires internal ventricular cerebrospinal fluid shunt (IVCSFS). The reported infection rate (IR) varies greatly from below 1% up to ...over 50%, but no meta-analysis to assess the overall IR has ever been performed.
To determine the IVCSFS overall IR in the adult population and search for associated factors.
Six databases were searched from January 1990 to July 2022. Only original articles reporting on adult IVCSFS IR were included. Random-effects meta-analysis with generalized linear mixed model method and logit transformation was used to assess the overall IR.
Of 1703 identified articles, 44 were selected, reporting on 57 259 patients who had IVCSFS implantation and 2546 infections. The pooled IR value and its 95% CI were 4.75%, 95% CI (3.8 to 5.92). Ninety-five percent prediction interval ranged from 1.19% to 17.1%. The patients who had IVCSFS after intracranial hemorrhage showed a higher IR (7.65%, 95% CI 5.82 to 10, P -value = .002). A meta-regression by year of publication found a decreasing IR (-0.031, 95% CI -0.06 to 0.003, P -value = .032) over the past 32 years.
IVCSF is a procedure that every neurosurgeon should be well trained to perform. However, the complication rate remains high, with an estimated overall IR of 4.75%. The IR is especially elevated for hydrocephalic patients who require IVCSFS after intracranial hemorrhage. However, decades of surgical advances may have succeeded in reducing IR over the past 32 years.
Over the last decade, there has been a 10-fold increase in the number of published systematic reviews of prevalence. In meta-analyses of prevalence, the summary estimate represents an average ...prevalence from included studies. This estimate is truly informative only if there is no substantial heterogeneity among the different contexts being pooled. In systematic reviews, heterogeneity is usually explored with "I"-squared statistic ("I"superscript 2), but this statistic does not directly inform us about the distribution of effects and frequently systematic reviewers and readers misinterpret this result. In a sample of 134 meta-analyses of prevalence, the median "I"superscript 2 was 96.9% (IQR 90.5-98.7). We observed larger "I"superscript 2 in meta-analysis with higher number of studies and extreme pooled estimates (defined as <10% or >90%). Studies with high "I"superscript 2 values were more likely to have conducted a sensitivity analysis, including subgroup analysis but only three (2%) systematic reviews reported prediction intervals. We observed that meta-analyses of prevalence often present high "I"superscript 2 values. However, the number of studies included in the meta-analysis and the point estimate can be associated with the "I"superscript 2 value, and a high "I"superscript 2 value is not always synonymous with high heterogeneity. In meta-analyses of prevalence, "I"superscript 2 statistics may not be discriminative and should be interpreted with caution, avoiding arbitrary thresholds. To discuss heterogeneity, reviewers should focus on the description of the expected range of estimates, which can be done using prediction intervals and planned sensitivity analysis. This report was written on behalf of the Prevalence Estimates Reviews--Systematic Review Methodology Group (PERSyst).
•The median age at death was 32 years (IQR, 19-46) among individuals with SCD and 69 years (IQR, 53-81) among the general population.•Individuals aged 1-9 and 10-39 with SCD had 32 and 13 times ...higher risk of death, respectively, than the general population, per modeled data.
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Sickle cell disease (SCD) is a group of hereditary chronic diseases with a substantial impact on quality of life and morbimortality. In Brazil, it is 1 of the most common hereditary diseases; however, there are sparse epidemiological data for the country. Using data from death certificates, we aimed to estimate the median age at death, years of life lost because of SCD, and the median survival. From 2015 to 2019, we identified 3320 records of deaths of individuals with SCD, from a total of 6 553 132 death records. Among individuals with SCD, the median age at death was 37 years less than that of the general population (SCD: aged 32.0 years at death, interquartile range IQR, 19.0-46.0; general population: aged 69.0 years at death; IQR, 53.0-81.0). Results were consistent when stratified by sex or race. Over the 5 years evaluated, crude death rates varied from 0.30 to 0.34 per 100 000 inhabitants (mean 0.32 per 100 000 inhabitants). We estimated a prevalence of 60 017 individuals living with SCD (29.02 cases per 100 000) and an average incidence of 1362 cases yearly. The median estimated survival was 40 years for individuals with SCD and 80 years for the general population. SCD was associated with an increased risk of mortality in most age ranges. Among individuals with SCD aged between 1 and 9 years and between 10 and 39 years, the risk of death was 32 and 13 times higher, respectively. The most common causes of death were sepsis and respiratory failure. These results highlight the burden of SCD in Brazil and the necessity of improved care for this population.
INTRODUCTION:
Chagas disease, caused by the protozoan parasite
Trypanosoma cruzi
, is a neglected chronic condition with a high burden of morbidity and mortality. It affects about 6 million people in ...twenty-one countries of Latin America, and has recently become a global health concern (1), especially due to immigration from endemic areas into the developed world. Cardiac arrhythmias are common in patients with Chagas cardiomyopathy and amiodarone has been widely used as an antiarrhythmic drug. Amiodarone has been recommended as the treatment of choice for all patients with sustained ventricular tachycardia (2). The objective of this systematic review is to evaluate the effect of amiodarone in arrhythmia patients with the cardiac form of chronic Chagas disease.
METHODS:
Searches was conducted in MEDLINE (PubMed), EMBASE and LILACS from the inception to December 2016. Studies regarding the use of amiodarone to treat arrhythmia in patients affected by Chagas disease were included, and the outcomes were arrhythmia, adverse effects and sudden death. Selection of articles and data extraction were made by two independent reviewers.
RESULTS:
The database search found 378 articles but only 9 studies with 373 subjects fulfilled the eligibility criteria. The nine studies selected were composed of case series (two), crossover clinical trials (two), and clinical trials (five). Results showed that amiodarone reduced ventricular extrasystoles in all studies and ventricular tachycardia in eight studies. During treatment with amiodarone, patients in eight studies had side effects. Corneal microdeposits and gastric discomfort were the most common adverse effects present in studies. Three studies reported sudden death during follow-up.
CONCLUSIONS:
Amiodarone seems to be an effective antiarrhythmic drug for Chagasic patients, reducing uncomfortable symptoms such as tachycardia. This information can be useful in the primary care context, supporting general practitioners to manage Chagas cardiopathy, mainly when specialized cardiologic consultants are not available.
INTRODUCTION:
Chagas disease, caused by the parasite
Trypanosoma cruzi
, affects more than seven million people worldwide and it is considered by the World Health Organization (WHO) a neglected ...tropical disease (1). About one third of Chagas patients develop gastrointestinal disorders, such as dysphagia and achalasia. Management of the disease focuses on symptom improvement and drugs that relax the lower esophageal sphincter pressure (LESP), such as isosorbide and nifedipine. However, the use of these therapies is doubtful because of their side effects and palliative approach (2). The objective of this systematic review is to assess the effectiveness of isosorbide and nifedipine on gastrointestinal manifestation of Chagas disease.
METHODS:
We searched MEDLINE, EMBASE and LILACS databases to retrieve potentially relevant articles from inception to December 2016. Inclusion criteria: clinical trials, cohorts or cross-sectional design; adults (>18 years old); assessment of effects of isosorbide or nifedipine on gastrointestinal symptoms in Chagas patients. Two reviewers independently screened titles and abstracts, selected eligible studies and extracted data from each study. PROSPERO registration number: CRD42017055143.
RESULTS:
Eight studies were included (two case series, two clinical trials and four crossovers). Three studies evaluated the effect of isosorbide in LESP and three in esophageal emptying. All of them found that isosorbide rapidly reduces LESP and increases esophageal emptying rates, improving dysphagia. However, several patients reported collateral effects, such as gastroesophageal reflux, headaches and dizziness. One study evaluated the effect of nifedipine on LESP and one on esophageal emptying. Nifedipine decreased LESP, but there was no effect on esophageal emptying.
CONCLUSIONS:
The available evidence shows isosorbide is effective in the management of gastrointestinal symptoms. Frequently health care of Chagas disease patients is delivered by primary care physicians. So, information on effectiveness of interventions can be aggregated to clinical guidelines, having an important value to inform general practitioners on the decision-making process regarding treatment of this group of patients, avoiding referencing to a specialized care.
Heart failure (HF) is a growing problem for healthcare systems worldwide. Sodium and fluid restriction are non-pharmacological treatments recommended for patients with HF by several guidelines over ...the years, even without consensus.
To evaluate the effects of sodium and fluid restriction in patients with HF.
We searched MEDLINE, Embase, and Cochrane CENTRAL databases up to June 2020 and screened the reference lists of relevant articles. We included randomized controlled trials evaluating sodium and/or fluid restriction in patients with HF. We assessed three independent comparisons: (a) sodium restriction versus control; (b) fluid restriction versus control; and (c) sodium and fluid restriction versus control. Main outcomes of interest were all-cause mortality and hospitalization. Two independent reviewers selected studies and extracted data. We pooled the results using random-effects meta-analysis. We used the RoB 2.0 and the GRADE framework to assess risk of bias and quality of evidence.
We included 16 studies totaling 3545 patients in our meta-analysis. Daily sodium intake was 1.5–2.4 g for the intervention group and >2.7 g for the control group, and daily fluid intake was 0.8–1.5 L for the intervention group and free oral fluid intake for the control group. Sodium restriction increased mortality (relative risk 1.92, 95% confidence interval 1.51 to 2.45, moderate quality of evidence) and hospitalization (relative risk 1.63, 1.11 to 2.40, low quality of evidence). Fluid restriction reduced mortality (relative risk 0.32, 0.13 to 0.82, low quality of evidence) and hospitalization (relative risk 0.46, 0.27 to 0.77, n = 331, low quality of evidence). The combination of sodium and fluid restriction did not significantly affect the risk of mortality (relative risk 0.92, 0.49 to 1.73, low quality of evidence) or the risk of hospitalization (relative risk 0.94, 0.75 to 1.19, low quality of evidence).
The combination of sodium and fluid restriction in clinical trials resulted in a null effect although results in the opposite direction were observed for each intervention independently. Combined sodium and fluid restriction are usually recommended for patients with HF. Our findings of sodium restriction harm, risk of mortality and hospitalization are consistent with publications from several clinical trial and physiologic explanations. A well-designed clinical trial nested by an implementation study is urgent for definitive sodium range recommendation, specially considering the change of currently guidelines, pushing up the cut-off of sodium restriction range.
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