Estudio primario

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An Open-label Extension Study to Evaluate the Long-term Safety of Inclacumab Administered to Participants with Sickle Cell Disease Who Have Participated in an Inclacumab Clinical Trial

Año 2022
Registro de estudios Lebanese Clinical Trials Registry
Enlaces LBCTR

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Revisión sistemática

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Epilepsy surgery outcomes in children with tuberous sclerosis complex: a systematic review and meta-analysis.

Año 2025
Revista Journal of neurosurgery. Pediatrics
Enlaces Pubmed , DOI

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OBJECTIVE:

Patients with tuberous sclerosis complex (TSC), while considered genetically homogeneous, are clinically heterogeneous and present unique challenges for epilepsy surgery evaluation and treatment. Thus, the authors' goal was to identify factors associated with seizure outcomes in children with TSC who had undergone epilepsy surgery.

METHODS:

The PubMed, MEDLINE, Embase, CINAHL, and Web of Science databases were queried for relevant articles. Patients from the TSC Alliance registry and Children's of Alabama were also included. Eligible studies were those reporting individual participant data on the seizure outcomes of pediatric patients with TSC who had undergone epilepsy surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and a meta-analysis was performed using a random-effects logistic regression model. Individual factors and seizure outcome following epilepsy surgery at the latest reported follow-up were tested for association. The primary outcome was a good seizure outcome, defined as Engel class I or II, International League Against Epilepsy class 1, 2, or 3, or ≤ 3 seizures per year following surgery.

RESULTS:

From 44 studies eligible for systematic review and 2 additional sources, there were 2058 patients. Of these, 1338 (65%) patients had available surgical outcome data and a median follow-up of 2.5 years (IQR 1.0-5.0 years). Overall, 878 (66%) patients had a good seizure outcome. Such an outcome was associated with ≤ 1 visible tuber on MRI (OR 4.8, p = 0.01, 95% CI 1.44-15.94, I2 = 0%); however, a good seizure outcome was less likely in patients with no or mild cognitive delay (OR 0.52, p = 0.02, 95% CI 0.30-0.09, I2 = 11%) or in those with no or unifocal interictal scalp EEG abnormality (OR 0.36, p = 0.01, 95% CI 0.16-0.80, I2 = 24%). Preoperative IQ (treated as a continuous variable, OR 0.98, p = 0.009, 95% CI 0.96-0.99, I2 = 0%) had little to no effect on seizure outcome. Two (5%) studies met the criteria for a low risk of bias, 28 (64%) met the criteria for a moderate risk of bias, and 14 (32%) met the criteria for a serious risk of bias.

CONCLUSIONS:

The authors identified several factors associated with seizure outcomes in TSC patients who had undergone epilepsy surgery. However, the study findings should be interpreted with caution, as they represent an aggregation of largely retrospective cohort or case studies with a high potential for bias. Systematic review registration no.: CRD42023393588 (www.crd.york.ac.uk/prospero/).

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Role of circulating tumor DNA and cell-free DNA biomarkers in diagnosis and prognosis of oral cancer - a systematic review.

Año 2025
Autores Mohammad S , Ullah I , Ali A , Jan Z , Aleem B , Khan M - Más
Revista BMC oral health
Enlaces Pubmed , DOI

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BACKGROUND:

Oral squamous cell carcinoma is the most common malignant neoplasm of the oral cavity, contributing significantly to cancer-related mortality worldwide. Circulating tumor DNA could be a promising biomarker for the early diagnosis and prognosis of oral cancer.

OBJECTIVE:

The aim of this systematic review was to consolidate the existing literature on the role of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) in the diagnosis and prognosis of oral cancer.

METHODOLOGY:

The review protocol followed PRISMA guidelines. A systematic search was conducted across PubMed, Web of Science, Google Scholar and SCOPUS. Only English-language studies were included, while narrative reviews, HPV-positive OSCC, systematic reviews, meta-analyses, abstracts, and letters to the editor were excluded. Data were extracted on study design, country, sample size, participant characteristics, assessment methods, type of oral cancer and measured outcomes. Risk of bias was evaluated using Newcastle-Ottawa Scale (NOS).

RESULTS:

A total of 3,155 records were identified, out of which 17 studies met the inclusion criteria. These comprised eleven cohort studies, one was a case series, two were descriptive studies, and three were case-control studies. The studies primarily addressed oral squamous cell carcinoma (OSCC) and head and neck squamous cell carcinoma (HNSCC). Findings revealed that elevated cfDNA levels are associated with poor prognosis, lymph node metastasis, larger tumor size and advanced disease stages. ctDNA acts as a predictive tool for monitoring cancer progression, treatment response, recurrence risk, and overall survival. Among 12 studies evaluated using NOS, 8 were of good quality, while 4 were fair quality.

CONCLUSION:

ctDNA and cfDNA exhibit promising prognostic and diagnostic potential for OSCC and HNSCC. Elevated cfDNA levels correlate with poor prognosis, while ctDNA shows potential for monitoring cancer progression and treatment response.

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The implementation of guidelines in palliative care - a scoping review.

Año 2025
Revista BMC palliative care
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BACKGROUND:

Guidelines are essential tools for ensuring high-quality healthcare. However, discrepancies exist between their availability and practical implementation. In the context of palliative care, the extent to which guidelines are implemented and the barriers and facilitators that influence this process remain unknown.

AIM:

The present study aimed at systematically reviewing the international literature on the implementation of palliative care guidelines to evaluate factors that support or hinder implementation of palliative care guidelines globally.

METHOD:

A scoping review was conducted following the methodological approach of Arksey and O'Malley (2005). After the formulation of research questions and development of a search string, relevant studies investigating the implementation of guidelines were identified and retrieved from the databases CINAHL, LIVIO, PubMed and Web of Science Core Collection on 4 January 2024. Two researchers independently selected articles for inclusion, employing a blinded process with predefined inclusion and exclusion criteria. The results were subsequently categorised deductively by the same researchers using Petermann's (2014) taxonomy of implementation outcomes. The results were summarised and presented in tabular form.

RESULTS:

The search yielded 2,086 records, of which 1,252 were included in the title and abstract screening. Subsequently, 113 full-text articles were reviewed for eligibility, resulting in 29 articles deemed suitable for the final analysis. Six implementation outcomes were identified in the included literature: (1) acceptability (n = 15 articles), (2) adoption (n = 6 articles), (3) appropriateness (n = 9 articles), (4) feasibility (n = 9 articles), (5) fidelity/adherence (n = 14 articles) and (6) penetration (n = 14 articles). The majority of studies employed quantitative approaches (n = 22) and considered the perspective of healthcare professionals and their opinions regarding guideline implementation in palliative care. Only 4 articles considered patient related outcomes or the perspectives of the family caregivers. Ten articles reported on facilitators and barriers. Facilitators included healthcare professionals' motivation and managerial support, while barriers primarily referred to time constraints and limited knowledge.

CONCLUSIONS:

Guideline implementation in palliative care is highly variable. Future research should aim at comprehensively analysing facilitators of and barriers to this process, considering diverse implementation outcomes. For these evaluations, mixed-method approaches are recommended.

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A scoping review of health risks and outcomes from disasters in the Republic of Korea.

Año 2025
Autores Kim DH , Kim D , Kang H
Revista BMC public health
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BACKGROUND:

Disasters represent significant public health challenges, particularly for vulnerable populations. In the Republic of Korea, both natural and man-made disasters, exacerbated by urbanization and socioeconomic disparities, have exposed weaknesses in disaster preparedness and public health resilience. This scoping review examines health outcomes and associated risk factors from past disasters in Korea.

METHODS:

A comprehensive search was conducted in the PubMed, DBpia, KISS, and RISS databases for studies published between April 2004 and April 2022, following the PRISMA Extension for Scoping Reviews guidelines. Eighty-three studies met the inclusion criteria. Data were analyzed using a narrative synthesis approach to distinguish direct and indirect health effects. Key outcomes were categorized into socioeconomic, physical, mental, social, and environmental risk factors.

RESULTS:

Among the 83 reviewed studies, natural disasters accounted for 50.6% of the total, man-made disasters for 22.9%, and mass trauma events for 26.5%. Most studies (78.3%) focused on disaster survivors, with cross-sectional designs predominating (90.4%). Approximately half (51.8%) of the studies used primary data, with the remainder being based on secondary sources. Regression was the most common method for statistical analysis (75.9%). Frequently reported direct health outcomes included physical injuries such as fractures, burns, and respiratory issues, along with mental health conditions such as post-traumatic stress disorder and depression. Natural disasters were particularly associated with physical injuries, while both natural and man-made disasters had a significant impact on mental health. Vulnerable groups-older adults, women, unmarried individuals, and those with lower socioeconomic status-faced disproportionate higher risk for both physical and mental health. Indirect health impacts such as heightened anxiety, emotional distress, and weakened social cohesion were common in economically disadvantaged and disaster-prone communities, in which recovery was further hindered due to limited access to healthcare and support services.

CONCLUSIONS:

These findings highlight the need for strategies aimed at disaster risk reduction that prioritize health equity, integrate mental health services, and address environmental vulnerabilities. Future research should focus on longitudinal studies to track evolving health outcomes.

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How does antifungal resistance vary in Candida (Candidozyma) auris and its clades? Quantitative and qualitative analyses and their clinical implications.

Año 2025
Revista Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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BACKGROUND:

Candida auris is a multidrug-resistant yeast that emerged as a significant healthcare-associated pathogen. It is classified as an urgent threat to public health due to the high resistance to available antifungal agents. Globally six distinct clades of C. auris have been identified with varying antifungal susceptibility patterns and geographical distributions.

OBJECTIVES:

The aim of this review is investigating the (published) antifungal susceptibility profiles of different C. auris clades to identify those with a higher prevalence of resistance.

SOURCES:

A comprehensive literature review was conducted using PubMed, SciELO, Google Scholar, and MEDLINE databases to collect data on Minimum Inhibitory Concentration (MIC) distributions and clade designations of C. auris strains.

CONTENT:

A total of 1,031 C. auris strains were included. Clades I and III, which are closely related phylogenetically, displayed the highest resistance rates, particularly to fluconazole, with 94% and 96% of isolates, respectively. Clade IV also exhibited resistance to both azoles and echinocandins. In contrast, Clades II, V, and VI had lower resistance rates, with Clade VI being entirely susceptible to fluconazole. Anidulafungin demonstrated the greatest efficacy across all clades, with resistance rates ranging from 0% to 3.67%. Furthermore, Clades V and VI showed complete susceptibility to all antifungal agents evaluated.

IMPLICATIONS:

This study highlights significant variations in antifungal resistance profiles across the six C. auris clades. Clades I, III, and IV stand out due to their multidrug resistance, particularly to fluconazole and amphotericin B, posing serious challenges for treatment. Continuous global surveillance and tailored management strategies are essential for controlling C. auris infections, especially in highly resistant clades. Enhanced diagnostic capabilities and further genomic studies are critical to understanding the evolving nature of resistance in this emerging pathogen and improving therapeutic outcomes. Clade-specific antifungal resistance in C. auris requires monitoring to optimize therapy selection during outbreaks.

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Prevalence and risk factors of Babesia species in domestic herbivores in China: A systematic review and meta-analysis.

Año 2025
Autores Wei W , Lan Z , Li C , Liu X , Zhang X , Wang J - Más
Revista Acta tropica
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Babesia species are tick-transmitted hemoprotozoa that infect mammals, birds, and humans, posing a significant global threat to veterinary medicine threat. In this study, the authors systematically retrieved articles on the occurrence of Babesia species in domestic herbivores in China, including ovine, bovine, and equine species, through a search in the following six databases from their inception to 4 November 2024: PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Chinese Journal Database. A total of 94 studies (54 high-quality studies, 40 medium-quality studies) from 28 provinces were included. The pooled prevalence of Babesia infection was 11% in ovines, 12% in bovines, and 18% in equines, with significant differences observed across subgroups, including, region, species, longitude, temperature, and season. Infection prevalence was higher in East and Central China, particularly in Hunan, Fujian, and Ningxia, as well as in regions characterized by lower altitude, higher temperature, and higher humidity. Longitude and season were significantly associated with Babesia infection in equines (p < 0.05), while temperature analysis indicated a significant difference (p < 0.05) in Babesia infection in bovines. In addition, infection rates were higher in female animals than in male animals; rates were also higher in 2013 or before in comparison to later sampling years. Moreover, the infection rates of different Babesia species varied significantly in bovines. These findings highlight key epidemiological patterns and potential risk factors, including regional and environmental influences associated with Babesia infection in domestic herbivores in China; thus, the findings of this study provide a solid foundation for developing targeted prevention and control strategies that can aim to mitigate the impact of babesiosis in domestic herbivores.

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Do virtual reality interventions cause seizures in the critically ill? A rapid review.

Año 2025
Revista Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
Enlaces Pubmed , DOI

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OBJECTIVES:

The objective of this research was to investigate if the use of virtual reality, increasingly utilised within intensive care medicine due to its demonstrated benefits in improving pain and anxiety, has been reported to result in seizures.

REVIEW METHOD USED:

A rapid systematic review and synthesis of qualitative and quantitative data was performed.

DATA SOURCES:

Five databases (PubMed, Scopus, EMBASE, PsycInfo, and CINAHL) were systematically searched. An additional gray literature search was also conducted. Articles were restricted to those published on or after January 1st, 2014.

REVIEW METHODS:

The number of participants, virtual reality sessions, and length of sessions was undertaken. Subgroup analysis was undertaken for both adult and paediatric patient populations. An additional subgroup analysis was undertaken on articles which did not exclude individuals with a history of epilepsy. A tailored risk-of-bias assessment was conducted.

RESULTS:

Of the 563 articles identified through database and gray literature searching, 27 articles met inclusion criteria. A total of 886 patients have been reported within the literature with a combined 1843 virtual reality sessions, totalling more than 614.64 h of virtual reality. No seizures have been reported within intensive care patients receiving virtual reality interventions.

CONCLUSIONS:

Historically, individuals with a history of epilepsy and photosensitivity have been commonly excluded from interventions and clinical trials involving virtual reality. The results of this systematic review demonstrate that the risk of virtual reality is minimal when utilised appropriately. A history of photosensitivity or epilepsy should not constitute an absolute contraindication for the use of virtual reality. Instead, clinicians should utilise clinical judgement when evaluating a patient's risk and ensure that appropriate visual experiences are utilised which do not unnecessarily strobe the patient.

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Bioethics and hospital palliative care: a systematic review.

Año 2025
Autores Pinto KRD , Ertler LZ , Rego F , Nunes R
Revista BMJ supportive & palliative care
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BACKGROUND:

The finitude of life presents various bioethical challenges, especially when palliative care is the therapeutic option. The hospital environment for palliative care has ethical peculiarities that need to be better understood, since the literature presents research that is commonly carried out at home.

OBJECTIVES:

This study aims to investigate the fundamental bioethical perspectives for hospital palliative care and to compare these perspectives with those existing in home care.

METHODS:

A systematic review of the literature was conducted between March and April 2024. This included observational studies that addressed bioethical perspectives in hospital palliative care. No restrictions were placed on the date of publication or language of the article. This review excluded editorials, intervention studies and articles developed in a home environment.

RESULTS:

Seven databases and other sources were searched, and 3976 articles were found. Eight studies were selected for qualitative synthesis. A paired review was conducted at all stages. The results indicated that respect for cultural beliefs and values, effective communication and empathy were the most significant bioethical perspectives for hospital palliative care, among the nine other ethical aspects present in the studies. The comparison with bioethical perspectives in the home environment highlighted differences such as privacy and autonomy in the patient's home.

CONCLUSIONS:

The conclusion allows us to understand that aspects of caring for the person and understanding the illness should be the focus of bioethics in hospital palliative care.

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Effectiveness of immersive virtual reality in nursing education for nursing students and nursing staffs: A systematic review and meta-analysis.

Año 2025
Autores Hsieh JY , Lin PC , Sun WN , Lin TR , Kuo CC , Hsu HT
Revista Nurse education today
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AIM:

This study evaluates the effectiveness of immersive virtual reality (VR) in nursing education, with a focus on its impact on knowledge acquisition, skill development, and problem-solving abilities among nursing students and nursing staff. In addition, it examines the effects of different levels of VR immersion across various learner populations, as well as potential side effects.

BACKGROUND:

Traditional nursing education often lacks realistic clinical settings, leading to "reality shock" during clinical practice. VR provides a safe environment for learners to simulate clinical scenarios and practice without fear of errors. However, the effects of varying levels of VR immersion remain unclear.

DESIGN:

Systematic review and meta-analysis.

REVIEW METHODS:

A systematic search of the Cochrane Library, Embase, PubMed, CINAHL, and Airiti Library was conducted for Chinese and English studies published up to October 22, 2024, following PRISMA guidelines. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools, while evidence quality was evaluated with GRADE. Meta-analyses used standardized mean differences (SMD) and a significance threshold of p < .05.

RESULTS:

Twenty-four studies involving 1812 participants showed that VR significantly improved knowledge (small effect, SMD = 0.34, 95 % CI.: 0.06-0.62, p = .02), skills (medium effect, SMD = 0.72, 95 % CI.: 0.35-1.10, p = .0002), and problem-solving abilities (large effect, SMD = 1.46, 95 % CI.: 0.65-2.28, p = .0004). Fully immersive VR was particularly effective in enhancing nursing students' knowledge (SMD = 0.41, 95 % CI.: 0.11-0.70, p = .007), while semi-immersive VR was more effective for nursing staff (SMD = 1.34, 95 % CI.: 0.85-1.84, p < .001). Six of the 24 studies examined side effects, with four reporting adverse reactions. The most common side effect was motion sickness, manifesting as nausea, vomiting, and cold sweats.

CONCLUSIONS:

Immersive VR is an effective tool for improving knowledge, skills, and problem-solving abilities in nursing education, with fully immersive VR benefiting students and semi-immersive VR benefiting staff. Despite its advantages, potential side effects like motion sickness should be considered. VR presents a promising, realistic, and repeatable approach to nursing education.

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