Risultati per: Il dolore neuropatico: review

This narrative review summarizes current evidence on the pathogenesis, epidemiology, clinical manifestations, diagnosis, and treatment of axial spondyloarthritis.

Introduction
Pregnant women and their babies are a highly vulnerable population to health effects from air pollution. This scoping review aims to understand the extent and type of evidence concerning the mediating and moderating factors between air pollution and birth outcomes. By gathering and synthesising this evidence, this review aims to identify key concepts, themes and knowledge gaps. In turn, these findings will serve as a valuable resource for researchers and policymakers by highlighting potential pathways and gaps in evidence.

Methods and analysis
This scoping review protocol is based on the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported in full with a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) flow diagram. This review will search eight databases: Web of Science, Scopus, PubMed, Embase, GreenFILE, CINAHL Ultimate, APA PsycINFO and MIDIRS. Results will be limited to those written or translated into English and peer-reviewed studies with no restriction on publication date. The study selection and data extraction will be completed within the software Covidence by two or more independent reviewers, with conflicts solved by group discussion. The data extracted from this process will include publication details, study characteristics and population characteristics.

Ethics and dissemination
This study will not collect primary data; therefore, no formal ethical approval is required. The findings will be disseminated to academic and non-academic audiences through conferences, publications and focus groups.

Trail registration number
Open Science Framework (https://doi.org/10.17605/OSF.IO/6Y2D9).

Circulation, Ahead of Print. BACKGROUND:Dilated cardiomyopathy (DCM) appears to be diagnosed twice as often in male than in female patients. This could be attributed to underdiagnosis in female patients or sex differences in susceptibility. Up to 30% of cases have an autosomal dominant monogenic cause, where equal sex prevalence would be expected. The aim of this systematic review, meta-analysis, and population study was to assess the sex ratio in patients with DCM, stratified by genetic status, and evaluate whether this is influenced by diagnostic bias.METHODS:A literature search identified DCM patient cohorts with discernible sex ratios. Exclusion criteria were studies with a small (n

Introduction
Fine motor skill (FMS) development during childhood is essential to many learning processes, especially in school. FMS impairment can have a major impact on children’s quality of life. Developing effective and engaging rehabilitation solutions to train FMS that engage children in the abundant practice required for motor learning can be challenging. Virtual reality (VR) is a promising intervention option offering engaging FMS training tasks and environments that align with evidence-based motor learning principles. Other potential advantages of VR for rehabilitation include accessibility for home-based use and adaptability to individual needs. The objective of this scoping review is to map the extent, range and nature of VR applications focused on FMS training in paediatric rehabilitation, including hardware, software and interventional parameters.

Methods and analysis
We are following methodological guidelines for scoping review conduct and reporting from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews recommendations. We will search four databases (Pubmed, Web of Science, PsycInfo and Scopus) for articles that meet inclusion criteria defined by the Population, Concept, Context method; specifically studies focused on development or evaluation of immersive or non-immersive VR applications to deliver FMS training in paediatric rehabilitation. Different populations of children with FMS impairments will be included (such as children with cerebral palsy, children with developmental coordination disorder or attention deficit hyperactivity disorder). The first search took place in December 2023, and a second is planned for February 2025. One reviewer will complete title, abstract and full paper screening, with consultation by a second reviewer in case of uncertainty. A data extraction framework will be tested by two reviewers on five randomly selected studies to ensure inter-rater reliability, and one reviewer will complete data extraction. Quantitative and qualitative extraction will follow JBI guideline recommendations. Results will be presented in a descriptive and tabular format, including a narrative summary. Results will enhance understanding of the potential of FMS training in VR and inform subsequent directions for research and clinical practice.

Ethics and dissemination
Data for this review will be collected from the published literature. Ethical approval is not required. We will present our findings at scientific conferences and submit this review to a peer-reviewed journal for publication.

Introduction
Postpartum haemorrhage (PPH) negatively impacts women’s health. Preventing and managing PPH is important, and nurse-led interventions are needed. However, no systematic review has evaluated the effectiveness of non-invasive uterine massage for PPH prevention. Therefore, this systematic review aims to assess the efficacy of midwife/nurse-led intervention in managing PPH, serving as the best available evidence to develop further guidelines and recommendations in practice and policy-making.

Methods and analysis
This systematic review will follow the JBI methodology for systematic reviews of effectiveness. The search will be conducted in the MEDLINE (PubMed), CINAHL (EBSCO), BENTHUM Science, JBI, Cochrane, ThaiJo and Google Scholar databases. Studies will be included in English and Thai and published between 2015 and 2024. Two independent reviewers will conduct the review, with data extraction and quality evaluation. Studies will be pooled in a statistical meta-analysis using JBI System for the Unified Management, Assessment and Review of Information or other software where possible.

Ethics and dissemination
This systematic review does not require formal ethical approval because all data will be analysed anonymously. The results will provide an overall review and evidence of midwife/nurse-led non-invasive uterine massage intervention in preventing PPH. These findings will be disseminated through peer-reviewed publications.

PROSPERO registration number
CRD42024566382

Introduction
Inappropriate antibiotic use in (primary healthcare, PHC) settings fuels antimicrobial resistance (AMR), threatens patient safety and burdens healthcare systems. Patients’ knowledge, attitudes, motivations and expectations play a crucial role in antibiotic use behaviour, especially in low-income and middle-income countries including South Africa. There is a need to ensure measures of antibiotic use, interventions and future guidance reflect cultural, community and demographic issues associated with patient views to reduce inappropriate use of antibiotics and associated AMR. The objective of this scoping review is to identify key themes surrounding knowledge, attitudes, motivations and expectations among patients and community members regarding antimicrobial use in PHC settings especially in low-income and middle-income countries.

Methods and analysis
This scoping review employs a comprehensive search strategy across multiple electronic databases, including OVID, Medline, PubMed and CINHAL, to identify studies addressing patients or community members seeking care at PHC facilities and exploring key drivers of antimicrobial use. The Covidence web-based platform will be used for literature screening and data extraction and the Critical Appraisal Skills Programme qualitative checklist will assess the quality of qualitative papers. Anticipated results will provide an overview of the current evidence base, enabling identification of knowledge gaps. A narrative synthesis of findings will summarise key themes and patterns in patients’ knowledge, attitudes, motivations and expectations related to antibiotic use across studies while considering methodological diversity and limitations.

Ethics and dissemination
Ethics approval is not required for this scoping review. The findings of this scoping review will be disseminated through publication in a peer-reviewed journal, presentation at relevant conferences and workshops, and collaboration with policy-makers and healthcare stakeholders.

ICIs are associated with a significant improvement in OS and PFS compared to chemotherapy in elderly patients with advanced NSCLC. Nevertheless, some patient characteristics such as aged ≥ 75 years, ECOG score ≥ 2, and PD-L1 < 1% seem to have a negative impact on the efficacy of ICIs, while these findings require further validation in large RCTs.

Objective
This study examined real-world treatment patterns and outcomes in patients with melanoma brain metastasis (MBM) treated with first-line immunotherapy consisting of nivolumab plus ipilimumab or anti-programmed death-1 (PD-1) monotherapy (nivolumab or pembrolizumab) or targeted therapy consisting of BRAF/MEK inhibitors.

Design
Retrospective chart review study.

Setting
Academic medical centres, community hospitals and private practice offices.

Participants
Included patients diagnosed with melanoma with brain metastasis in the USA.

Outcome measures
The statistical analysis was descriptive in nature. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared between treatments in a univariate Cox proportional hazards model.

Results
In total, 472 patients with MBM who received first-line nivolumab plus ipilimumab (n=246), anti-PD-1 monotherapy (n=112) or BRAF/MEK inhibitors (n=114) were identified. Patients receiving nivolumab plus ipilimumab, compared with patients receiving anti-PD-1 monotherapy or BRAF/MEK inhibitors, had favourable baseline prognostic factors, such as younger age, fewer or smaller brain metastases, better Eastern Cooperative Oncology Group performance status and less frequently elevated lactate dehydrogenase. Median follow-up times were 15.4 months (range 0.1 to 37.0), 13.3 months (range 0.3 to 36.6) and 13.9 months (range 1.9 to 36.5), respectively. Numerically longer OS was observed with nivolumab plus ipilimumab versus anti-PD-1 monotherapy (HR 0.47, 95% CI 0.34 to 0.67) or BRAF/MEK inhibitors (HR 0.72, 95% CI 0.50 to 1.04) and numerically longer PFS was observed with nivolumab plus ipilimumab versus anti-PD-1 monotherapy (HR 0.74, 95% CI 0.53 to 1.02) or BRAF/MEK inhibitors (HR 0.82, 95% CI 0.60 to 1.12). With nivolumab plus ipilimumab, anti-PD-1 monotherapy and BRAF/MEK inhibitors, 1-year OS rates were 79%, 60% and 72%, respectively; 1-year PFS rates were 68%, 58% and 59%.

Conclusions
In this real-world study, first-line nivolumab plus ipilimumab appeared to provide benefit versus anti-PD-1 monotherapy and BRAF/MEK inhibitors in patients with MBM, consistent with pivotal trial data. However, the observed benefit may have been due to confounding and selection bias, given that patients receiving nivolumab plus ipilimumab had favourable baseline prognostic factors compared with patients receiving anti-PD-1 monotherapy or BRAF/MEK inhibitors.

Objectives
To provide an overview of research, policies and programmes related to the sexual and reproductive health (SRH) needs of adolescents and youth (AY) in South Sudan in order to identify the gaps and potential areas of focus for researchers, policymakers and local and global SRH actors.

Design
Systematic scoping review following the Joanna Briggs Institute criteria for evidence synthesis.

Data sources
Medline, Embase and Global Health were searched for articles dated between 9 July 2011 and 13 July 2023. A grey literature search was conducted using Google search engine and on the websites of key stakeholders.

Eligibility criteria for selecting studies
We included all types of studies, policies, reports and programmes that pertained to any aspect of the SRH AY (ages 10–35) in South Sudan.

Data extraction and synthesis
All articles were screened by the first author using the predetermined eligibility criteria. A secondary review was conducted on all selected articles to ensure alignment with criteria. Data were extracted from all eligible articles using an established data extraction tool. The authors identified overarching themes from the extracted data and results were synthesised based on those themes.

Results
We screened 728 articles, resulting in 52 articles included in the review (19 peer-reviewed, 33 grey literature). Results were mapped across South Sudan and synthesised by key AYSRH thematic areas. The results were largely focused on the experiences of adolescent girls and young women and the sociocultural norms and economic challenges that contribute to their lack of access to SRH services and increased risk of experiencing various forms of gender-based violence. Vulnerable populations were excluded from research, policies and programmes, including very young adolescents, LGBTQ youth and youth with disabilities.

Conclusions
Quality research has been done on AYSRH in South Sudan; however, there are many key areas that have not been addressed such as maternal mortality and morbidities, safe abortion and tailored interventions for specific subgroups. While some policies and programmes were identified that address AYSRH, robust programme evaluation processes or evidence of follow-through or implementation of government strategies are lacking.

Introduction
Infant mortality in low or middle-income countries (LoMICs) is still triple that of high-income countries (HICs), and the high mortality burden regions are also weighed down by a triple or quadruple burden of disease such as HIV and tuberculosis; chronic illness; mental health; injury and violence; and maternal, neonatal and child mortality. Emerging data suggest that the sudden unexpected death in infancy (SUDI) burden in LoMICs is at least 10-fold that in HICs. While ending preventable deaths in the neonatal period has received some global attention, the postnatal period where SUDIs occur is a poorly understood and data-poor area in LoMICs. We propose conducting a systematic review to evaluate the burden and trends of SUDIs in LoMICs since 2004.

Methods and analysis
We will systematically search PubMed, Web of Science, Scopus, African Index Medicus, EBSCOHost, Google Scholar, WHOIS and WHO database to identify studies published from July 2004 until October 2024. Two reviewers will screen titles and abstracts and select full-text articles independently for review. We will use the tool developed by the South African Medical Research Council—Burden of Disease Review Manager (BODRevMan)—to assess the risk of bias for each included study. Risk of bias will be assessed for each included study. Information on the prevalence and/or incidence of SUDI and its subcategories and case definitions will be extracted from each article. Where possible, data on prevalence, incidence and subcategories will be pooled using a random effects meta-analysis to account for variability between estimates. The I2 statistic will establish the level of heterogeneity due to variation in estimates rather than chance. Results will be presented in tables and graphs. The systematic review will be reported according to the PRISMA 2020 checklist.

Ethics and dissemination
Ethical approval is not required as this is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO registration number
CRD42023466162.

Objectives
Population ageing and the rise in chronic diseases place continual stress on healthcare systems. Scarce resources often impede equitable access to healthcare, particularly in rural areas, resulting in prolonged waiting times and heightened risks of morbidity and mortality. Telemedicine has emerged as a promising solution, offering remote and equitable care that could potentially bridge access gaps and enhance health outcomes. This systematic review aims to quantitatively examine the impact of telemedicine implementation on waiting times, defined as the time passed from the booking of a visit for an outpatient to the administration of the service.

Design
A systematic review was conducted using studies on telemedicine interventions that specifically addressed waiting times. Bias assessment was performed with three tools: ROBINS-I (“Risk of Bias In Non-Randomized Studies of Interventions”), AXIS (“Appraisal tool for Cross-Sectional Studies”) and RoB-2 (“Risk of Bias-2”). A weighted mean approach was used to synthesise results, with medians synthesised using a median approach.

Data sources
Articles in English were retrieved from the PubMed and Scopus databases.

Eligibility criteria
Studies were excluded if they did not specifically address waiting times related to telemedicine interventions. Only studies that considered waiting times defined as the time passed from the booking of a visit for an outpatient to the administration of the service and any telemedicine intervention were included.

Data extraction and synthesis
A total of 53 records were included, encompassing 270 388 patients in both the experimental and control groups. The weighted mean reduction in waiting times was calculated, and bias was assessed. No record was evaluated to be at high risk of bias, with 69.8% of studies evaluated at low risk and 26.4% at moderate risk (3.8% were surveys). Results were synthesised using a weighted mean approach for studies reporting means, and a median approach for studies reporting medians.

Results
Overall, a weighted mean reduction of 25.4 days in waiting times was observed. Focusing on clinical specialties (n=114 042), the weighted mean reduction amounted to 34.7 days, while in surgical patients (n=156 346), telemedicine was associated with a weighted mean of 17.3 days saved.

Conclusions
The implementation of telemedicine solutions may significantly improve waiting times, potentially leading to more efficient and equitable healthcare systems.

PROSPERO registration number
CRD42023490822.

Stroke, Volume 56, Issue Suppl_1, Page ATMP35-ATMP35, February 1, 2025. Introduction:Studies have suggested efficacy of glycoprotein IIb/IIIa antagonists such as tirofiban for patients with acute ischemic stroke (AIS). However, neurological deterioration is still common in many of the recommended antiplatelet regimens. We aimed to evaluate the efficacy and safety of tirofiban versus dual antiplatelet therapy (DAPT) or aspirin in patients with AIS.Methods:Following PRISMA guidelines, we searched Pubmed, Embase, Scopus and Cochrane databases for studies comparing effects of tirofiban versus DAPT or aspirin alone in patients with AIS. Main outcomes were increase in NIHSS score, Modified Rankin Scale (mRS) scores at 90 days (0 to 2), intracranial hemorrhage (ICH) and mortality. Statistics analysis was performed using Review Manager 5.4.1 software. Heterogeneity was assessed with I2statistics.Results:We included 5 RCT and 5 non-RCT studies covering 1,857 patients, of whom 926 were treated with Tirofiban. Neurological deterioration, assessed by changes in NIHSS scores from baseline across four studies, was less pronounced in the Tirofiban group (MD -0.32; 9% CI -0.83-0.19; p

Stroke, Volume 56, Issue Suppl_1, Page ATMP23-ATMP23, February 1, 2025. Background:Swift intervention is crucial to achieving optimal outcomes in patients presenting with an acute ischemic stroke due to large vessel occlusion (LVO). The goal of this real-world, retrospective, records-based study was to assess process components driving door-to-reperfusion times across 16 facilities.Methods:A total of 1,362 patient records from a large healthcare system between August 2020 to December 2021 were reviewed retrospectively across 16 facilities throughout the United States. Each facility (n=16) completed a 196-question care pathway survey with clear differentiation between direct arrival and interfacility transfer modes of arrival. Elastic Net Regularization was used to account for patient-level characteristics in a subsequent multi-variable linear regression, revealing care pathway indicators associated with decreased door-to-reperfusion times. Actionable indicators were categorized and ranked using statistically significant coefficients and p-values. Confounders, (e.g. facility-related volume, level of stroke certification) were accounted for in the analysis and, subsequently, results were interpreted by a 16-member Nurse Working Group and an 8-member Physician Working Group. Preferred practice recommendations for thrombectomy-capable facilities were generated.Results:Overall, mean reperfusion rate (TICI 2B or higher) was 90.3% and mean door-to-reperfusion time was 116 minutes (SD ± 56, 108 mins (71, 152)). Mean door-to-puncture time was 83 minutes (74 min, (43,109)). Significant and highly-ranked care pathway indicators were classified into three categories: people, process, and technology. Programs with evidence of (1) full integration of CT techs into stroke alerts; (2) neuro-dedicated personnel prior to and at time of arrival; (3) standardized intake and communication protocols from door to puncture; (4) remote access for rapid imaging interpretation; and (5) established protocols for baseline imaging and anesthesia were associated with significantly higher time efficiencies across the continuum-of-care.Conclusions:Establishing evidence-based, preferred practices for mechanical thrombectomy across each care segment from door to recanalization can enhance stroke care pathway tactics to optimize patient outcomes. Future work will be to evaluate changes in time to reperfusion post-implementation of these preferred practices and to assess impact on patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP320-ATP320, February 1, 2025. Background:The kynurenine (KYN) pathway serves as the primary route for tryptophan (TRP) metabolism and plays a crucial role in the occurrence and development of several nervous diseases. The alterations in this pathway have been confirmed in psychiatric disorders, but their role in stroke remains unclear. This review aims to investigate whether metabolites in the TRP-KYN pathway change in patients with stroke.Methods:We searched PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases for studies that compare the levels of KYN pathway metabolites between stroke and healthy volunteers. The primary outcome of this study was KYN, and the secondary outcome were TRP, kynurenine/tryptophan ratio (KYN/TRP), and kynurenic acid (KYNA). The Stata software was utilized for data synthesis.Results:Seven full-length articles with a total of 1080 participants (767 with stroke and 313 healthy volunteers) were included. The results indicated that compared to the control group, stroke patients had significantly lower levels of TRP (standardized mean difference (SMD)=-1.64; 95% CI [-2.36, -0.93];P

Stroke, Volume 56, Issue Suppl_1, Page AWP9-AWP9, February 1, 2025. Background:Acute ischemic stroke can result from extracranial arterial dissection. The effectiveness and safety of intravenous thrombolysis (IVT) for acute ischemic stroke in these cases, particularly those involving large vessel occlusions, are debated. We conducted a systematic review and metanalysis to assess the efficacy and safety of IVT in patients with acute ischemic stroke attributed to extracranial arterial dissection.Methods:This systematic review was registered in PROSPERO (CRD42024499774). We searched MEDLINE (OVID), EMBASE, web of Science, and SCOPUS from inception to 03/03/2024. Search terms included a combination of keywords and controlled vocabulary terms for carotid or vertebral artery dissection and fibrinolysis or alteplase or tenecteplase. We included randomized controlled trials, observational studies, case series that compared IV thrombolysis and standard management with at least 10 patients in each group in patients with cervical or vertebral artery dissection. Where studies were sufficiently similar, we performed metanalyses for benefits (excellent (0-1) and good (0-2) modified Rankin scale at 90 days), safety (symptomatic intracerebral hemorrhage (sICH)), and mortality outcomes, using relative risks (RR). Given the impact of NIHSS on 90-day modified Rankin Scale, we pooled adjusted ORs (adjusting for NIHSS) when exploring 90-day functional outcomes.Results:Our search identified 418 records, we screened 12 studies as potentially eligible. Four studies (all retrospective cohort, 3 studies adjusted for NIHSS variable, one study addressed LVO cohort) met our inclusion criteria. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. Two studies had serious risk of bias while the other two had a moderate bias risk. When compared no IVT, IVT was associated with comparable risk of sICH (RR, 0.91 [95% CI, 0.11-7.94]) and mortality (RR, 0.63 [95% CI, 0.29-1.37]). However, IVT was associated with a significantly higher odds of good functional outcome at 90-days (aOR, 1.53 [95% CI, 1.14-2.05]) and a non-significantly lower chance of excellent functional outcome at 90-days (aOR 2.16 [95% CI 0.72-6.51]).Conclusion:Our metanalysis suggests that in patients with acute ischemic stroke secondary to extracranial artery dissection, IVT may have improved efficacy but comparable safety and mortality. Our findings should be interpreted with caution until supported by randomized controlled trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP106-ATP106, February 1, 2025. Background:Post-stroke cognitive impairment is especially devastating for young adult patients, who are in their most productive years. Despite its significant impact, this remains under-studied in this growing and clinically distinct patient group.Methods:We systematically searched PubMed, Embase, Scopus, and Cochrane CENTRAL for studies including ischemic stroke patients aged 18-50 years from January 2000 to July 2024. This meta-analysis evaluated the pooled prevalence of post-stroke cognitive impairment (CogI) and specific cognitive domains, as well as the associations between baseline characteristics and CogI.Results:A total of 4 studies with 1060 patients were included in this systematic review and meta-analysis. Overall, 35.9% (95% CI 27.2-45.5; Figure 1) of patients experienced post-stroke CogI with a mean follow-up time of 11.7 months (95% CI 8.00-15.4). One study was not included in the meta-analysis of proportions of overall cognition as this information was not available. The prevalence for individual domains was: visuospatial construction (23.1%; 95% CI 14.7-34.4), episodic memory (18.5%; 95% CI 9.7- 32.5), delayed memory (16.0%; 95% CI 13.5-18.9), working memory (18.8%; 95%CI 11.8-28.6), and attention (9.3%; 95%CI 3.2-24.0) with a mean follow-up time of 8.11 months (95% CI 3.50-12.7). Male patients had significantly higher odds of CogI (OR 1.58, 95% CI 1.05-2.38, p=0.030; Figure 2). Hypertension, diabetes mellitus, current smoking and dyslipidaemia were not significantly associated with CogI.Conclusions:A significant proportion of young adult ischemic stroke survivors experience CogI. Longitudinal prospective cohort studies are needed to better characterise the post-stroke cognitive trajectory in this important group of patients.