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Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation. Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool. Results: A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%). Conclusion: While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients' vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs.
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Predictive scoring systems are tools that assess the magnitude of a patient's illness and forecast disease prognosis, usually in the form of mortality, in the ICU. We aimed to determine the mortality rate among patients admitted to ICU using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system correlating with lengths of stay in the ICU. Methodology: A cohort study using team approach to care was conducted from July 2021 through July 2022 at KRL Hospital. Five hundred fifty-two patients aged 18-40 years, admitted for medical or surgical reasons (other than cardiac) who stayed in the ICU for more than 24 h were included. The APACHE II score was determined using 12 physiological variables at the end of the first 24 h of ICU admission. Data were analyzed using IBM Corp. released in 2015 (IBM SPSS Statistics for Windows, Version 23.0, Armonk, New York). Results: The average age of study participants was 36.34±2.77, ranging from 18 to 40 years. Three hundred fifteen participants were males and 237 were females. Patients were categorized into four separate groups as per their respective APACHE II scores. Patients with an APACHE II score of 31-40 were assigned to group 1. Patients with an APACHE II score of 21-30 were assigned to group 2. Patients with an APACHE II score of 11-20 were assigned to group 3. Lastly, patients with an APACHE II score of 3-10 were assigned to group 4. All patients in group 1 and group 2 died and none survived. Groups 1 and 2 contained a sum of 228 patients. A total of 123 patients were assigned to group 3, out of which 88 patients (71.54%) survived and 35 patients (28.45%) died. From these observations, it is evident that a higher APACHE II score is correlated with increased mortality. Conclusion: APACHE II scoring serves as an early warning indication of death and prompts clinicians to upgrade their treatment protocol. This makes it a useful tool for the clinical prediction of ICU mortality.
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INTRODUCTION: The association between fluoroquinolone use and the risk of aortic aneurysm as well as the risk of aortic dissections remains uncertain, primarily due to conflicting findings from observational studies. We sought to conduct a double-systematic review and meta-analysis of all observational studies to assess the existence and extent of both these associations. The aim of our study is to assess the role of Fluoroquinolone on aortic aneurysm and aortic dissection in comparison to other antibiotics. EVIDENCE ACQUISITION: MEDLINE and Cochrane CENTRAL were systematically searched up till June 2021 for observational studies studying the correlation between fluoroquinolone usage and aortic aneurysms and dissections. Random-effects pooling was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CI). To assess publication bias, propensity score matching was conducted, and heterogeneity was evaluated by using I2 statistics. EVIDENCE SYNTHESIS: Of 688 potentially relevant articles, 635 titles were screened. Ten studies were included in the systematic review, and 4 observational studies with 53,651,283 participants were eligible to be included in the meta-analysis. Pooled estimates showed that fluoroquinolone use was associated with a higher risk of aortic aneurysm when compared to other Antibiotics (HR 1.84, 95% CI 1.10-2.48; P<0.00001). However, fluoroquinolones had no significant effect on the risk of developing aortic dissection (HR 1.09, 95% CI 0.96-1.25; P=0.19). CONCLUSIONS: The present analysis suggests that fluoroquinolone usage is more strongly linked to aortic aneurysm than other antibiotics. However, there was no statistically significant link between fluoroquinolone and aortic dissection. As a result, clinicians should exercise caution when administering fluoroquinolone to patients who have a history of or are at risk of aortic disease.
