A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19.

BACKGROUND: Several meta-analysis studies have been reported in the literature on the incidence of psychopathological conditions resulting from the COVID-19 pandemic. This investigation aims to compile and analyze the findings of previously published meta-analysis research, as shown by the present meta-analysis of previous meta-analysis studies. METHODS: The PubMed and Scopus databases were searched from 1 January 2019 to 30 May 2022. The procedure was carried out according to the PRISMA flow chart and the qualities of the identified studies were analyzed using AMSTAR 2. Heterogeneities and risk of bias were assessed using the Meta-MUMS tool. The corresponding results, forest and funnel plots of the psychological consequences of COVID-19 were synthesized. RESULTS: Eleven meta-analysis studies were included. Random-effects meta-analysis of anxiety and depression showed (ER = 0.318 p-value < 0.001, ER = 0.295 p-value < 0.001) high heterogeneities (I2 = 99.70%, I2 = 99.75) between studies. Random-effects meta-analyses of sleep difficulties and insomnia were shown (ER = 0.347 p-value < 0.001, ER = 0.265, p-value < 0.001) along with heterogeneities (I2 = 99.89, I2 = 99.64). According to the random meta-analysis of post-traumatic stress syndrome (PTSS) and post-traumatic stress disorder (PTSD) (ER = 0.246, p-value = 0.001, ER = 0.223 p-value < 0.001) with heterogeneities (I2 = 99.75, I2 = 99.17). Random-effects meta-analyses of somatic and fear symptoms have been shown (ER = 0.16 p-value < 0.001, ER = 0.41, p-value = 0.089) with high heterogeneities (I2 = 99.62, I2 = 98.63). Random-effects meta-analysis of obsessive-compulsive symptoms and distress (ER = 0.297 p-value = 0.103; ER = 0.428, p-value = 0.013) with high heterogeneity, as I2 = 99.38%. Subgroup analysis of all symptoms and Egger's tests for detecting publication bias were also assessed. CONCLUSION: The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings.

A systematic review and meta-analysis on the outcomes of extracorporeal shock wave compared to ureteroscopic lithotripsy for the treatment of ureteral stones.

Objectives: In this systematic review and meta-analysis, we sought to identify whether extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL) is the most appropriate method for treating ureteral stones. Methods: We identified relevant literature by searching the Google Scholar and PubMed databases in accordance with PRISMA guidelines. We focused on the outcomes of extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy. For each method, we compared complications, hematuria, perforation, failure, stone clearance, initial stone-free, operating time, stone size, auxiliary procedures, and overall stone-free outcomes. Our analysis involved meta-analysis, heterogeneity testing, subgroup analysis, meta-regression sensitivity analyses, Egger's tests, Smoothed Variance Egger's (SVE) testing, and Smoothed Variance Thomson (SVT) testing. In addition, we detected publication bias for all outcomes related to the two procedures. Results: Based on ten eligible studies, we conducted a meta-analysis on a total of 1509 patients. Extracorporeal shockwave lithotripsy was used to treat 677 patients; the remaining 832 patients were treated by the ureteroscopic lithotripsy procedure. Considering the meta-analysis statistical parameters including odds ratio (OR), standardized mean difference (SMD), Q, I2 and their p-values, the overall stone-free, operating time, stone size outcomes were identified with significant OR, SMD, and Q values. The hematuria, failure, and stone clearance outcomes were determined to have significant Q values. The perforation and initial stone free outcomes had significant OR values. And, complications and auxiliary urinary procedures were not significant in terms of OR and Q values. Conclusions: Analysis indicated that ESWL and URSL procedures are essential for the treatment of ureteral stones, even though the perforation rate is higher for URSL than for ESWL. Overall stone-free rates were better for the URSL procedure.

Comparative Global Epidemiological Investigation of SARS-CoV-2 and SARS-CoV Diseases Using Meta-MUMS Tool Through Incidence, Mortality, and Recovery Rates.

COVID-19 is a novel coronavirus that was reported by the world health organization in late December 2019. As an unexplained respiratory disease epidemic, which is similar to respiratory syndrome coronavirus SARS-CoV, it rapidly spread all over the world. The study aims to compare several parameters of COVID-19 and SARS-CoV infectious diseases in terms of incidence, mortality, and recovery rates. The publicly available dataset Worldometer (extracted on April 5, 2020) confirmed by WHO report was available for meta-analysis purposes using the Meta-MUMS tool. And, the reported outcomes of the analysis used a random-effects model to evaluate the event rate, and risk ratios thorough subgroup analysis forest plots. Seventeen countries for COVID-19 and eight countries of SARS infections, including COVID-19 group n = 1124243, and SARS-CoV group n = 8346, were analyzed. In this meta-analysis, a random effect model of relations of incidence, mortality, and recovery rates of COVID-19 and SARS world infections were determined. The meta-analysis and forest plots of two viral world infections showed that the incidence rate of COVID-19 infection is more than SARS infections, while recovery and mortality event rates of SARS-CoV are more than COVID-19 infection. And subgroup analysis showed that the mortality and recovery rates were higher in both SARS-CoV wand COVID-19 in comparison to incidence and mortality rates, respectively. In conclusion, the meta-analysis approach on the abovementioned dataset revealed the epidemiological and statistical analyses for comparing COVID-19 and SARS-CoV outbreaks.

Treating empyema thoracis using video-assisted thoracoscopic surgery and open decortication procedures: a systematic review and meta-analysis by meta-mums tool.

INTRODUCTION: The optimal treatment of empyema thoracis is still debatable between academics and surgeons. This study reviews advantages and disadvantages of video-assisted thoracoscopic surgery (VATS) and open thoracotomy decortication (OTD) considering outcomes of empyema thoracis. MATERIALS AND METHODS: A descriptive Boolean query was used for searching three databases to extract the published studies up to 27 March 2017. The outcomes of VATS and OTD were extracted and assessed by random-effects model of meta-analysis. The Egger's test and trim-and-fill method were used for analyzing publication bias, and, meta-regression and subgroup analyses were done for determining heterogeneity. RESULTS: A total of 2219 patients, from 13 studies, meeting the inclusion criteria were selected and subjected to further analyses. Of 2219 patients, 1120 were treated by VATS and the remaining were subjected to OTD. During VATS, 252 patients were converted to OTD. Forest plots showed that VATS was far superior in terms of incidence of duration of hospital stay and operative time (SMDs = 1.189, 1.565; p < 0.001, < 0.001) compared to OTD. Mortality, prolonged air leakage, wound infection, and recurrence rates (ORs = 1.234, 2.564, 1.363, 1.962; p = 0.576, 0.077, 0.0692, 0.4) had no advantages for both procedures while failure or conversion rate (OR = 0.198, p < 0.001) of VATS was more than those of OTD. CONCLUSIONS: The results of the current research suggest no trends of superior outcomes with VATS in the treatment of empyema thoracis. Hence, VATS and OTD could be recommended as treatments for empyema thoracis.

A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures.

INTRODUCTION: There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. MATERIAL AND METHODS: We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. RESULTS: Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed. CONCLUSIONS: This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.

Surgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study.

BACKGROUND: There are several studies reporting high success rates for surgical and nonsurgical treatments of empyema separately. The aim of current retrospective cohort study is to find the best treatment in low socio-economic areas. MATERIAL AND METHODS: A total of 149 patients were treated in the referring hospital from January 2002 to December 2008. The current retrospective cohort study was carried out by nonsurgical (medically & thoracenthesis & chest tube drainage with or without fibrinolytic agents) and surgical (VATS &open thoracotomy decortication methods) procedures in single center performed in thoracic and respiratory medicine wards. The independent t-test on demographic data was the statistical test tool. RESULTS: The complete cure and mortality rates for 130 patients were 27% (35 out of 130 patients) and 0.3% (1 out of 130 patients), respectively. Thirteen out of 149 patients that were estimated to be at stage II underwent VATS decortication. The results showed zero success rates for this procedure which was then converted to open thoracotomy decortication. And, 113 patients who underwent thoracotomy decortication had a cure rate of 96.4% (109 patients) and mortality rate of 1.8% (2 patients). Four (3.5%) patients needed thoracoplasty, 2 died and 2 (1.8%) needed open window thoracostomy resulted in empyema necessitans that remained uncured. Total hospitalization lengths for the patients treated by tube thoracostomy and thoracotomy decortication were (15.4 ± 2.1) and (6.2 ± 1.8) days (P < 0.001), respectively. The success rates between surgical and nonsurgical treatments were 98.2% and 27.1%. And, the difference between them was significant (P < 0.001). CONCLUSION: Because of the advanced stages of empyema in our patients, thoracotomy decortication procedure is often the first rank choice with success rates higher than nonsurgical techniques. However, nowadays, the success rates of nonsurgical and VATS management of empyema thoracis are mostly reported in the literature.

A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries.

BACKGROUND AND STUDY AIMS: There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts. METHODS: Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process. RESULTS: Six studies totally consisting of 1028 patients [open surgery group=816 (+7 converted to lap) and laparoscopic group=212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR=0.852, LL=0.469, UL=1.546, Z=-0.526, p=0.599 (for post-operative complications); OR=0.849, LL=0.141, UL=5.105, Z=-0.179, p=0.858 (for mortality); OR=0.903, LL=0.166, UL=4.906, Z=-0.119, p=0.906 (for recurrence); and OR=0.459, LL=0.129, UL=1.637, Z=-1.201, p=0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q=8.083, df=5, p=0.152, I2=38.142% for post-operative complications; Q=0.127, df=2, p=0.938, I2=0% for mortality; Q=4.984, df=2, p=0.083, I2=59.874% for recurrence; and Q=10.639, df=5, p=0.059, I2=53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures. CONCLUSION: The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.

Chest Tube Insertion in the Delayed Esophageal Perforation Phenomenon: A Tragic or Beneficial Outcome?

A 53-year-old woman with foreign body esophageal perforation, was first misdiagnosed as pulmonary thromboembolism. In referral hospital her chest computed tomography was reported as giant hiatal hernia or giant pulmonary abscess. She was treated for abscess, after several days, right hemithorax tube thoracostomy was performed. After that, she developed necrotizing fasciitis on the chest wall. After a 19-day delay, we found a 5-cm mid-thoracic esophageal tearing during thoracotomy and repaired it. After 2 years follow up the patient condition is good. This report describes a unique case of mid-thoracic foreign body esophageal perforation and rupture with a delay in diagnosis with a tragic course.

Multi-vesicular pulmonary hydatid cyst, the potent underestimated factor in the formation of daughter cysts of pulmonary hydatid disease.

Pulmonary multi-vesicular hydatid disease (HD) with Echinococcus granulosus is rare. A 28-year-old woman presented to our center with cough and respiratory distress. Chest x-ray and computerized tomography scan revealed bilateral giant cysts with water-lily sign (ruptured hydatid cysts). The left cyst was in vicinity of heart. With thoracotomy cysts of both lungs were removed. Thousands of translucent, homogenized small daughter cysts were discovered from the left side cyst. Pathologic examinations revealed the ruptured hydatid cysts of both lungs with daughter cysts on the left lung cyst. To best of our knowledge probably this is the first report of multi-vesicular HD in lung. We suppose that the heart pulsation was effective in the formation of daughter cysts.

Giant Pulmonary Hydatid Cyst and Trauma in a 9 Year-Old Child: A Case Report.

Herein, we report a case of giant lung hydatid cyst in a nine-year-old boy. For four years, he experienced mild chest pain and chronic nonproductive cough. He had a trauma resulted from a fall two days before admission. Chest X-ray showed misdiagnosed massive pleural effusion, and was aspirated in the other hospital. However, after admission, the computed tomography revealed a giant lung hydatid cyst filling the right hemithorax completely. Being considered by the diagnosis of ruptured lung hydatid cyst, he was treated surgically by right-thoracotomy. The existing hydatid cyst, (e.g., with a dimension of 30*22*20cm) filled all cavity of hemithorax extended from the right diaphragm to the apex of the lung situated in the right lower lobe. After evacuation of the hydatid fluid and laminated membrane, right lower lobectomy was carried out due to remaining no salvageable parenchyma without any complications. Also, the pathologic examination have confirmed hydatid cyst. In conclusion, giant hydatid cysts are probably misdiagnosed with massive pleural effusion in the endemic area. And, because of the risk of allergic reactions, anaphylactic shock and dissemination, it should not be aspirated.

A huge lymphangioma mimicking pleural effusion with extension to both chest cavities: a case report and review of literature.

Mediastinal lymphangioma is primarily a benign lesion and the majority of the cases are found incidentally. These lesions account for approximately 1% of all mediastinal tumors. Here we present a giant mediastinal cystic mass in a 35-year-old female who was presented with severe respiratory distress. On the plain chest radiography and CT scan, a massive left pleural effusion with large parasternal and mediastinal lymphadenopathy was seen. Thoracentesis was performed and 400 cm³ of clear fluid was drained from the left hemithorax. However, a subsequent CT scan with contrast and the same technique 40 days later showed a large cystic mass in the mediastinum protruding to the right and left hemi thoraces. The giant cystic mass was resected via right and left anterior thoracotomies. Histopathological examination revealed a diagnosis of lymphangioma. The patient has been alive and without tumor recurrence and has been followed for 2 years.

Pericyst: the outermost layer of hydatid cyst.

Hydatid disease, caused by the parasite Echinococcus granulosus, mostly affects the liver and the lungs with hydatid cysts which consist of three layers: (1) the outer pericyst; (2) the middle laminated membrane; and (3) the inner germinal layer. Pericyst, as the outermost layer of the hydatid cyst, is made by host cells encasing the hydatid cyst. An extremely close interaction exists between this host tissue and the parasite, and any degenerative changes of the pericyst would result in hydatid cyst degeneration or rupture. The pericyst plays an undeniably important role in the development and survival of the hydatid cyst.

The Role of Esophagogastric Anastomotic Technique in DecreasingBenign Stricture Formation in the Surgery of Esophageal Carcinoma.

INTRODUCTION: Postoperative stenosis and dysphagia after esophageal carcinoma resection is the major problem. The aim of this study is to compare two types cervical esophagogastric anastomosis in reduction of stricture formation in esophageal cancer surgery. METHODS: The subjects of this study were 223 patients undergoing esophageal carcinoma resection during 1998 to 2007. Twenty two patients were excluded from the study because of recurrent malignancy of anastomosis, mortality and losing in follow up period. Two hundred and one patients remained by the end of study were classified into two groups: 98 patients were treated by routinely transverse hand-sewn cervical esophagogastric anastomosis (group 1); and 103 patients were treated by the proposed oblique hand-sewn esophagogastric anastomotic technique (group 2). All the operations were with high abdominal and left cervical incisions (Transhiatal esophagectomy). All patients of both groups were followed up at least 6-month for detection of anastomotic strictures. RESULTS: Postoperative dysphagia occurred in 20 patients of group 1 versus 5 patients of group 2. In working up by rigid esophagoscopy, two patients of group 2 and four patients of group 1 had not true strictures. Anastomotic strictures occurred in 16 cases of group 1, versus 3 cases of group 2. Statistical comparative analysis results of two groups about stricture formation were significant (3% versus 16% P= 0.003). CONCLUSION: The oblique hand-sewn esophagogastric anastomostic techniques reduce markedly the rate of stricture formation after esophagectomy.