Multisystemic Inflammatory Syndrome in Neonates: A Systematic Review
Shaiba LA, More K, Hadid A, Almaghrabi R, Al Marri M, Alnamnakani M, Shah P
INTRODUCTION Multisystem inflammatory syndrome in neonates (MIS-N) related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has increasingly been reported worldwide amid the spread of the SARS-CoV-2 pandemic. METHODS We searched PubMed, EMBASE, and CINAHL and preprint servers (BioRxiv.org and MedRxiv.org) using a specified strategy integrating Medical Subject Headings terms and keywords until October 20, 2021. Our aim was to systematically review demographic profiles, clinical features, laboratory parameters, complications, treatments, and outcomes of neonates with MIS-N. Studies were selected when fulfilling the inclusion criteria. Articles were included if they fulfilled the World Health Organization (WHO), Centers for Disease Control (CDC) definitions of MIS-C, or our proposed definition. RESULTS Sixteen reports of MIS-N including 47 neonates meeting MIS-N criteria were identified. Presentation included cardiovascular compromise (77%), respiratory involvement (55%), and fever in (36%). Eighty-three percent of patients received steroids, and 76% received immunoglobulin. Respiratory support was provided to 60% of patients and inotropes to 45% of patients. Five (11%) neonates died. CONCLUSION The common presentation of MIS-N included cardiorespiratory compromise with the possibility of high mortality. Neonates with MIS-N related to SARS-CoV-2 may be at higher risk of adverse outcomes.
Economic Analyses of Pathogen-Reduction Technologies in Blood Transfusion: A Systematic Literature Review
LaFontaine PR, Yuan J, Prioli KM, Shah P, Herman JH, Pizzi LT
Applied health economics and health policy. 2021
BACKGROUND Technologies used in the processing of whole blood and blood component products, including pathogen reduction, are continuously being adopted into blood transfusion workflows to improve process efficiencies. However, the economic implications of these technologies are not well understood. With the advent of these new technologies and regulatory guidance on bacterial risk-control strategies, an updated systematic literature review on this topic was warranted. OBJECTIVE The objective of this systematic literature review was to summarize the current literature on the economic analyses of pathogen-reduction technologies (PRTs). METHODS A systematic literature review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify newly published articles in PubMed, MEDLINE Complete, and EconLit from 1 January 2000 to 17 July 2019 related to economic evaluations of PRTs. Only full-text studies in humans published in English were included in the review. Both budget-impact and cost-effectiveness studies were included; common outcomes included cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The initial searches identified 433 original abstracts, of which 16 articles were included in the final data extraction and reporting. Seven articles presented cost-effectiveness analyses and nine assessed budget impact. The introduction of PRT increased overall costs, and ICER values ranged widely across cost-effectiveness studies, from below $US150,000/QALY to upwards of $US20,000,000/QALY. This wide range of results was due to a multitude of factors, including comparator selection, target patient population, and scenario analyses included. CONCLUSIONS Overall, the results of economic evaluations of bacterial risk-control strategies, regardless of mechanism, were highly dependent on the current screening protocols in place. The optimization of blood transfusion safety may not result in decisions made at the willingness-to-pay thresholds commonly seen in pharmaceutical evaluations. Given the critical public health role of blood products, and the potential safety benefits introduced by advancements, it is important to continue building this body of evidence with more transparency and data source heterogeneity. This updated literature review provides global context when making local decisions for the coverage of new and emerging bacterial risk-control strategies.
Effect of blood transfusions on cognitive development in very low birth weight infants
Whole blood and blood component products (16 studies).
Systematic review to summarize the current literature on the economic implications of pathogen-reduction technologies (PRTs).
The introduction of PRT increased overall costs, and incremental cost-effectiveness ratios values ranged widely across cost-effectiveness studies, from below $US150,000/quality-adjusted life-years (QALY), to upwards of $US20,000,000/QALY. This wide range of results was due to a multitude of factors, including comparator selection, target patient population, and scenario analyses.
Shah P, Cannon DC, Lowe JR, Phillips J, Christensen RD, Kamath-Rayne B, Rosenberg A, Wiedmeier S, Patel S, Winter S, et al
Journal of perinatology : official journal of the California Perinatal Association. 2021
OBJECTIVE Preterm infants frequently receive red cell transfusions; however, the effect of transfusions on cognition is unclear. We evaluated the relationship between transfusions and cognitive outcomes in preterm infants enrolled in a randomized trial of erythropoiesis stimulating agents (ESAs). STUDY DESIGN Preterm infants were randomized to ESAs or placebo during initial hospitalization, and transfusions recorded. Children were evaluated using standard developmental tests of cognition at 18-22 months (56 ESA, 24 placebo) and 3.5-4 years (39 ESA, 14 placebo). RESULTS Cognitive scores at 18-22 months were inversely correlated with transfusion volume (p = 0.02). Among those receiving ≥1 transfusion, cognitive scores were significantly higher in the ESA-treated group (p = 0.003). At 3.5-4 years, transfusions were not correlated with cognitive scores. CONCLUSIONS In the placebo group, transfused children had lower cognitive scores than did non-transfused children at 18-22 months. In the ESA group, cognitive scores did not differ by transfusion status, suggesting ESAs might provide neuroprotection.
Clinical Success of Platelet-rich Fibrin and Mineral Trioxide Aggregate (MTA) or MTA-like Agents in Healing of Periapical Lesion in Nonsurgically Treated Pulpless Immature Permanent Teeth: A Systematic Review
Joshi SR, Palekar AU, Pendyala GS, Mopagar V, Padmawar N, Shah P
Journal of International Society of Preventive & Community Dentistry. 2020;10(4):379-383
BACKGROUND The chances of extrusion of mineral trioxide aggregate (MTA) are quite high if apical barrier is not present in immature pulpless permanent teeth. Platelet-rich fibrin (PRF) enriched with platelets and growth factors serves to accelerate the wound healing of periapical lesion in immature pulpless permanent teeth and also serves as internal matrix to condense MTA. AIM: The aim of the present study was to comprehensively review the clinical success of MTA+PRF in healing of periapical lesions in immature pulpless permanent teeth. MATERIALS AND METHODS An electronic search for systematic review was conducted in Pubmed/Medline (www.ncbi.nlm.nih.gov), Cochrane (www.cochrane.org), Scopus (www.scopus.com) databases upto 15th January 2020 related to the healing of periapical lesions in permanent teeth with immature apices when combination of MTA+PRF was used. A sample of 10 relevant studies and case reports were identified in our search out of 65. The sampling method was simple random technique. The studies and case reports with Randomised Controlled Trials(RCTs), Invitro studies, Case reports and animal studies in healing of periapical lesion were included in our comprehensive systematic review. RESULTS The search showed that the combination of MTA+PRF showed faster and definite periapical lesion healing in immature permanent teeth. The follow-up period was also recorded in all the relevant studies and case reports. CONCLUSION Acclerated bone filling was seen in healing of periapical leions when MTA+PRF was used.