ABSTRACT
Abstract Background Ankylosing Spondylitis (AS) patients face several challenges due to the nature of the disease and its physical and psychological complications. Sleep disorders are among the most important concerns. Sleep disorders can aggravate the signs and symptoms of the disease and ultimately reduce the quality of patients' lives. This study uses a systematic review and meta-analysis to pool the reported prevalence of sleep disorders among AS patients. Methods To find related studies, the WoS, PubMed, ScienceDirect, Scopus, Embase, and Google Scholar databases were systematically searched without a lower time limit. Heterogeneity among the identified studies was checked using the I2 index, and the Begg and Mazumdar correlation test examined the existence of published bias. Comprehensive Meta-Analysis (v.2) software was adopted to analyze the data. Results In the review of 18 studies with a sample size of 5,840, the overall pooled prevalence of sleep disorders among AS patients based on the random effects method was found to be 53% (95% CI: 44.9-61). The highest and lowest prevalence was in Egypt at 90% and Australia at 19.2%, respectively. Our meta-regression results show that with the increase in 'sample size' and 'year of publication', the overall prevalence of sleep disorders in patients with AS decreases (p < 0.05). Conclusion The results of the present study indicate a high and significant prevalence of sleep disorders among AS patients. Thus, health policymakers and healthcare providers must focus on timely diagnosis and effective educational and therapeutic interventions for the prevention and proper treatment of sleep disorders in this population of patients.
ABSTRACT
Abstract Background: High-risk basal cell carcinoma involves a significant rate of basal cell carcinoma that requires Mohs micrographic surgery for definitive treatment. Staged excision with pathologic margin control is a simple, accessible, and curative procedure suggested for the treatment of high-risk basal cell carcinoma. Objective: To evaluate the results of staged excision of high-risk basal cell carcinoma in the head region. Methods: This interventional study was performed on patients with high-risk basal cell carcinoma, who underwent staged excision until the margins were free of tumor. Results: A total of 122 patients (47 females and 75 males) with mean age of 57.66 ± 9.13 years were recruited in this study. Nasal and nodular types were the most common of both clinical and pathologic forms, respectively. Further, 89.3 % of cases were cured by staged excision after four years of follow-up. There was a significant relationship between treatment outcomes and recurrent lesions, multiplicity of risk factors, long-standing disease, and pathologic type. There was also a significant association between the number of surgical excisions and multiplicity of risk factors, as well as recurrence, location, and size of basal cell carcinoma. Study limitations: Lack of magnetic resonance imaging assessment in cases of suspected perineural invasion. Conclusions: High-risk basal cell carcinoma had a high cure rate by staged excision. Patients with more risk factors and those with nasal and recurrent basal cell carcinoma required more staged excisions. Failure of treatment is more probable in patients with more risk factors, long-standing lesions, and high-risk pathologic and recurrent basal cell carcinomas.