To assess the safety of pregnancy in ventriculoperitoneal (VP) shunt-dependent women.
Three electronic databases MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched to identify studies published in English between 1950 and 2019. We additionally searched Web of Science, Google Scholar, and ClinicalTrials.gov.
Among the 38 cases of pregnant VP shunt-dependent women, median age was 25.5 years and shunting duration was 15.5 years with 11 women being shunted at birth or soon after. Congenital diseases were the most common reason for shunting, present in 63.2% of women. The antepartum complications were reported in 50% of cases with the symptoms of increased ICP being the most commonly reported (73.7%). In the majority of cases the complications were resolved with cerebrospinal fluid aspiration (26.3%). Eight women (42.1%) had spontaneous vaginal delivery, 4 had assisted vaginal delivery, while 7 women underwent cesarian section. There was one fetal demise occurred in a woman that was diagnosed with tuberous sclerosis and presented with status epilepticus during the pregnancy.
A multidisciplinary approach is needed in managing the VP shunts during the pregnancy and post-partum periods to ensure the best pregnancy outcome for both mothers and the fetus. Based on our findings, VP shunt appears not to be a contraindication for pregnancy. The routine use of prophylactic antibiotics to prevent shunt infection is not recommended. Vaginal delivery should be attempted unless a cesarean section is inevitably required for obstetrics reasons.

Safety of Pregnancy in Ventriculoperitoneal Shunt Dependent Women: Meta-analysis and Systematic Review of the Literature.

Antimicrobial resistance (AMR) is a global public health threat for both human and veterinary medicine. Increasing evidence suggests that animals are important sources of AMR to humans; however, most of these studies focus on production animals. In order to determine the pattern of AMR in pets, mainly in dogs in Africa, a meta-analysis was performed with AMR studies conducted in African countries and published between January 2000 and January 2021 in four databases: Medline (PubMed), Scopus, Cab abstract and Google Scholar. Seven bacterial strains, namely Staphylococcus aureus, Escherichia coli, Salmonella spp., Pseudomonas aeruginosa, Streptococcus pyogenes, coagulase-negative Staphylococcus (SNC) and Staphylococcus pseudintermedius were included in this study. A total of 18 out of 234 indexed articles met the study criteria. The results revealed that multiple bacteria were resistant to various commonly used antibiotics including enrofloxacin, ciprofloxacin, gentamicin, amoxicillin, clavulanic acid, cotrimoxazole, streptomycin, tetracycline and chloramphenicol. Concerning multidrug resistance, E. coli strains came first with the highest prevalence of 98%, followed by P. aeroginosa (92%) and Salmonella spp. (53%). In contrast, the overall prevalence of multidrug resistance was low for S. aureus (18%) and S. pseudintermedius (25%). It is therefore urgent to find, as soon as possible, alternatives to replace these antibiotics, which have become ineffective in controlling these bacteria in dogs in Africa. Moreover, further metagenomic studies are needed to describe the full resistome and mobilome in dogs regardless of the bacteria.

Prevalence of antibiotic-resistant bacteria amongst dogs in Africa: A meta-analysis review.

To comprehensively compare the vision improvement rate in patients with traumatic optic neuropathy with different surgical timing and other different preoperative conditions.
PubMed, Embase, and MEDLINE Ovid were searched to identify studies. We performed subgroup analyses for differences in the surgical timing, surgical approach, optic canal fractures, state of consciousness after trauma, time of visual loss development, incision of the optic nerve sheath, and treatment methods.
A total of 74 studies involving 6084 patients were included in the final analysis. In the groups of patients with early (≤3 days), middle (4-7 days), and late (>7 days) surgical interventions, 58.4%, 53.2%, and 45.4% demonstrated visual improvements, respectively. The results of the statistical analysis revealed that patients with early surgical intervention had a higher improvement rate than patients with late surgical intervention (P = 0.00953). The improvement rate was significantly lower for patients who presented with no light perception before surgery than for patients whose vision was better than no light perception (relative risk, 0.498; 95% confidence interval [CI], 0.443-0.561; P = 0.001) and lower for patients with immediate visual loss after trauma than for those with secondary visual loss (relative risk, 0.639; 95% CI, 0.498-0.819; P = 0.001).
We recommend that patients seek medical treatment as soon as possible after traumatic optic nerve injury, and patients with secondary injuries can have a good recovery effect while still living with light perception or more. The option of treatment and whether to incise the optic nerve sheath still remains controversial.

Selection and Prognosis of Optic Canal Decompression for Traumatic Optic Neuropathy.

To examine the effects and safety of oxytocin administered intramuscularly or intravenously for preventing postpartum hemorrhage (PPH) in the third stage of labor after vaginal deliveries.
Before data extraction, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration No. CRD42019145912). We searched the published electronic databases, including Medline, EMBASE, PubMed, Web of Science, CNKI, VIP, Wanfang, the Cochrane Library, clinicaltrial.gov and PROSPERO database, from their inception until February 2019. We included all randomized controlled trials (RCTs) comparing intramuscular and intravenous oxytocin administered just after the birth of the anterior shoulder or soon after the birth of the baby during a vaginal delivery. The primary outcomes were the incidence of PPH and severe PPH. PPH was defined as a blood loss ≥500 ml within 24 hours after vaginal birth. Severe PPH refers to a clinically estimated blood loss equal to or greater than 1000 mL within 24 hours after vaginal birth. Statistical heterogeneity was assessed by the I
Six RCTs, including 7320 women undergoing vaginal delivery, were identified in the meta-analysis. Women who were randomized to have intravenous oxytocin for the third stage of labor had a significantly lower incidence of PPH (relative risk 1.35, 95% CI 1.11-1.64, p = 0.003), severe PPH (relative risk 1.61, 95% CI 1.05-2.46, p = 0.03) and blood transfusion (relative risk 2.50, 95% CI 1.37-4.59, p = 0.003) compared with those who were randomized to have intramuscular oxytocin during the third stage of labor after vaginal delivery. There was no significant difference with regard to changes in hemoglobin level, third stage of labor duration, mean postpartum blood loss, or the incidences of a need for additional uterotonics and of retained placenta or manual removal of placenta between groups.
For women in the third stage of labor who are undergoing a vaginal delivery, the use of intravenous oxytocin reduces the incidence of PPH, severe PPH and blood transfusion and does not increase the risk of adverse effects compared with intramuscular oxytocin.

Intramuscular versus intravenous oxytocin for the third stage of labor after vaginal delivery to prevent postpartum hemorrhage: a meta-analysis of randomized controlled trials.

Several treatment strategies for avoiding post-operative ileus have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different therapeutic interventions on ileus outcome measures.
A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing treatments for post-operative ileus following colorectal surgery. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method. Direct and indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis.
A total of 48 randomised controlled trials were included in this network meta-analysis reporting on 3614 participants. Early feeding was found to be the best treatment for time to solid diet tolerance and length of hospital stay with a probability of P = 0.96 and P = 0.47, respectively. Early feeding resulted in significantly shorter time to solid diet tolerance (Mean Difference (MD) 58.85 h; 95% Credible Interval (CrI) -73.41, -43.15) and shorter length of hospital stay (MD 2.33 days; CrI -3.51, -1.18) compared to no treatment. Epidural analgesia was ranked best treatment for time to flatus (P = 0.29) and time to stool (P = 0.268). Epidural analgesia resulted in significantly shorter time to flatus (MD -18.88 h; CrI -33.67, -3.44) and shorter time to stool (MD -26.05 h; 95% CrI -66.42, 15.65) compared to no intervention. Gastrograffin was ranked best treatment to avoid the requirement for post-operative nasogastric tube insertion (P = 0.61) however demonstrated limited efficacy (OR 0.50; CrI 0.143, 1.621) compared to no intervention. Nasogastric and nasointestinal tube insertion, probiotics, and acupuncture were found to be least efficacious as interventions to reduce ileus.
This network meta-analysis identified early feeding as the most efficacious therapeutic intervention to reduce post-operative ileus in patients undergoing colorectal surgery, in addition to highlighting other therapies that require further investigation by high quality study. In patients undergoing colorectal surgery, emphasis should be placed on early feeding as soon as can be appropriately initiated to support the return of gastrointestinal motility.

Reducing ileus after colorectal surgery: A network meta-analysis of therapeutic interventions.

The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome-coronavirus-2 infection during pregnancy.
Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language.
Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related-illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19.
We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score <7 at 5 minutes, neonatal asphyxia, admission to a neonatal intensive care unit, perinatal death, and evidence of vertical transmission.
Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth <37 weeks was 24.3% (14/56; 95% confidence interval, 12.5-38.6); premature prelabor rupture of membranes occurred in 20.7% (6/34; 95% confidence interval, 9.5-34.9), preeclampsia in 16.2% (2/19; 95% confidence interval, 4.2-34.1), and fetal growth restriction in 11.7% (2/29; 95% confidence interval, 3.2-24.4), although reported only for women affected by SARS; 84% (50/58) were delivered by cesarean; the pooled proportion of perinatal death was 11.1% (5/60; 95% confidence interval, 84.8-19.6), and 57.2% of newborns (3/12; 95% confidence interval, 3.6-99.8) were admitted to the neonatal intensive care unit. When focusing on COVID-19, the most common adverse pregnancy outcome was preterm birth <37 weeks, occurring in 41.1% of cases (14/32; 95% confidence interval, 25.6-57.6), while the pooled proportion of perinatal death was 7.0% (2/41; 95% confidence interval, 1.4-16.3). None of the 41 newborns assessed showed clinical signs of vertical transmission.
In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.

Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.

Prediction of outcomes in severe COVID-19 patients using chest computed tomography severity score (CTSS) may enable more effective clinical management and early, timely ICU admission. We conducted a systematic review and meta-analysis to determine the predictive accuracy of the CTSS for disease severity and mortality in severe COVID-19 subjects.
The electronic databases PubMed, Google Scholar, Web of Science, and the Cochrane Library were searched to find eligible studies that investigated the impact of CTSS on disease severity and mortality in COVID-19 patients between 7 January 2020 and 15 June 2021. Two independent authors looked into the risk of bias using the Quality in Prognosis Studies (QUIPS) tool.
Seventeen studies involving 2788 patients reported the predictive value of CTSS for disease severity. The pooled sensitivity, specificity, and summary area under the curve (sAUC) of CTSS were 0.85 (95% CI 0.78-0.90, I
Early prediction of prognosis is needed to deliver the better care to patients and stratify them as soon as possible. Because different CTSS thresholds have been reported in various studies, clinicians are still determining whether CTSS thresholds should be used to define disease severity and predict prognosis.
Early prediction of prognosis is needed to deliver optimal care and timely stratification of patients.  CTSS has strong discriminating power for the prediction of disease severity and mortality in patients with COVID-19.
La prédiction des résultats chez les patients atteints de COVID-19 grave à l'aide du score de gravité de la tomographie thoracique (CTSS) peut permettre une gestion clinique plus efficace et une admission précoce et opportune en soins intensifs. Nous avons effectué une revue systématique et une méta-analyze pour déterminer la précision prédictive du CTSS pour la gravité de la maladie et la mortalité chez les sujets atteints de COVID-19 grave.
Les bases de données électroniques PubMed, Google Scholar, Web of Science et la Cochrane Library ont été consultées pour trouver des études éligibles qui ont examiné l'incidence du CTSS sur la gravité de la maladie et la mortalité chez les patients atteints de COVID-19 entre le 7 janvier 2020 et le 15 juin 2021. Deux auteurs indépendants ont examiné le risque de biais à l'aide de l'outil QUIPS (Quality in Prognosis Studies).
Dix-sept études portant sur 2788 patients ont rapporté la valeur prédictive du CTSS pour la gravité de la maladie. La sensibilité, la spécificité et l'aire synthétique sous la courbe (sAUC) regroupées du CTSS étaient respectivement de 0,85 (IC 95% : 0,78–0,90, I2 = 83), 0,86 (IC 95% : 0,76–0,92, I2 = 96) et 0,91 (IC 95% : 0,89–0,94). Six études portant sur 1403 patients ont rapporté les valeurs prédictives du CTSS pour la mortalité de la COVID-19. La sensibilité, la spécificité et le sAUC regroupés du CTSS étaient respectivement de 0,77 (IC 95% : 0,69–0,83, I2 = 41), 0,79 (IC 95% : 0,72–0,85, I2 = 88) et 0,84 (IC 95% : 0,81–0,87).
La prédiction précoce du pronostic est nécessaire pour fournir les meilleurs soins aux patients et les stratifier le plus tôt possible. Étant donné que différents seuils de CTSS ont été rapportés dans diverses études, les cliniciens sont encore en train de déterminer si les seuils de CTSS devraient être utilisés pour définir la gravité de la maladie et prédire le pronostic.
La prédiction précoce du pronostic est nécessaire pour fournir des soins optimaux et une stratification opportune des patients. Le CTSS a un fort pouvoir discriminant pour la prédiction de la gravité de la maladie et de la mortalité chez les patients atteints de COVID-19.

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