RESUMO
BACKGROUND: The management of vestibular schwannomas (VS) encompasses a choice between conservative "wait-and-scan" (WAS) approach, stereotactic radiosurgery (SRS) or open microsurgical resection. Currently, there is no consensus on the optimal management approach for small to medium sized VS. This study aims to compared outcomes related to hearing in patients with small and medium sized VS who underwent initial treatment with WAS versus SRS. METHODS: A systematic review of the available literature was conducted using PubMed/MEDLINE, Embase, and Cochrane up December 08, 2023. Meta-analysis was performed using a random-effect model to calculate mean difference (MD) and relative risk (RR). A leave-one-out analysis was conducted. The risk of bias was assessed via the Risk of Bias in Non-randomized Studies-Interventions (ROBINS-I) and Cochrane Risk of Bias assessment tool (RoB-2). Ultimately, the certainty of evidence was evaluated using the GRADE assessment. The primary outcomes were serviceable hearing, and pure-tone average (PTA). The secondary outcome was the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) total score. RESULTS: Nine studies were eligible for inclusion, comprising a total of 1,275 patients. Among these, 674 (52.86%) underwent WAS, while 601 patients (47.14%) received SRS. Follow-up duration ranged from two to eight years. The meta-analysis indicated that WAS had a better outcome for serviceable hearing (0.47; 95% CI: 0.32 - 0.68; p < 0.001), as well as for postoperative functional measures including PTA score (MD 13.48; 95% CI 3.83 - 23.13; p < 0.01), and PANQOL total score (MD 3.83; 95% CI 0.42 - 7.25; p = 0.03). The overall certainty of evidence ranged from "very low" to "moderate". CONCLUSIONS: Treating small to medium sized VS with WAS increases the likelihood of preserving serviceable hearing and optimized PANQOL overall postoperative score compared to SRS. Nevertheless, the limited availability of literature and the methodological weakness observed in existing studies outline the need for higher-quality studies.
Assuntos
Neuroma Acústico , Qualidade de Vida , Radiocirurgia , Humanos , Audição/fisiologia , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Perda Auditiva/prevenção & controle , Neuroma Acústico/complicações , Neuroma Acústico/fisiopatologia , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Resultado do Tratamento , Conduta Expectante/métodosRESUMO
OBJECTIVE: To identify predictors of adverse events after PTCA during hospitalization and after hospital discharge in a private hospital in Puerto Rico. BACKGROUND: A review of the literature shows limited information about predictors of adverse events associated to percutaneous transluminal coronary angioplasty (PTCA) in Hispanic patients. METHODS: This is a non-concurrent prospective study. Baseline variables were analyzed using multivariate logistic regression to identify predictors of adverse events. Data were collected from medical charts and telephone reports from referring physicians. RESULTS: Data from 197 subjects undergoing PTCA were analyzed for this study. Median age of patients was 65 years, and 62.9 of patients were male. Angiographic success rate was 81.6. A total of 8.1 of patients had at least one in-hospital adverse event, and 39.8 had at least one adverse event after hospital discharge. After multivariate analysis, a statistically significant association was found between the presence of at least one lesion with residual stenosis of 50 or greater and the risk of developing adverse events in-hospital (RO 11.75; 95 CI 4.32-31.97). A marginally significant association was found between family history of heart disease (RO 2.75; 95 CI 0.93-8.11) and the risk of adverse events during hospitalization. Family history of heart disease (RO 1.41; 95 CI 0.98-2.04) and the presence of at least one lesion with residual stenosis of 50 or greater (RO 2.87; 95 CI 0.82-10.01) showed marginally significant associations with increased risk for adverse events after discharge. CONCLUSIONS: These findings suggest that the presence of at least one lesion with residual stenosis of 50 or greater and family history of heart disease may be risk factors for adverse events after PTCA during hospitalization and after discharge.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Angioplastia Coronária com Balão/efeitos adversos , Doença das Coronárias , Idoso de 80 Anos ou mais , Doença das Coronárias , Hispânico ou Latino , Análise Multivariada , Estudos Prospectivos , Porto Rico , RecidivaRESUMO
A total of 91 nursing home patients were evaluated to determine the prevalence of tuberculous infection and the prevalence of risk factors for active TB in those with positive tuberculin reactions. Overall prevalence rate for positive PPD was 42.9 percent No association was found between revalence of positive PPD and time since admission to the nursing home. The most prevalent risk factors for active TB among PPD positive patients were diabetes mellitus (38.5percent), being 10 percent below ideal body weight (25.6 percent), chest X ray with fibrotic changes (13.2 percent), and carcinoma of oropharynx (5.1 percent). Twenty-one patients (53.8 percent) of patients with positive test) met criteria for prophylactic treatment with isoniazid. This study detected a high prevalence of positive PPD reactions in this nursing home population and a high prevalence of risk factors for the development of active TB in the group with positive reaction to PPD. Due to the high risk for the development of active tuberculosis in this population, aggressive screening and preventive therapy are mandatory