A Meta-Analysis of Mid-Term Outcomes of Endovascular Aneurysm Sealing

BACKGROUND-AIM

Several studies have been published showing conflicting results on the outcome after endovascular aneurysm sealing (EVAS). The aim of the present study is to conduct a systematic review and meta-analysis of published evidence to assess the efficacy of EVAS in the management of patients with abdominal aortic aneurysm (AAA).

METHODS

An electronic search of the English medical literature, from 2010 to March 2021, was conducted using MEDLINE, EMBASE, and Cochrane databases to find studies relevant to outcome after EVAS.

RESULTS

The final analysis included 12 articles published between 2011 and 2021, including 1440 patients. In total, 79.3% of the included patients underwent aneurysm treatment according to the instructions for use. Technical success was 98.8%. Overall, 30-day mortality was 1.3%. Procedure-related complications were reported in 4% of the cohort. During median follow-up of 28.1 months (range 9-72 months), the pooled estimate of endoleak type I, migration and reinterventions was 16% (95% confidence interval [CI]=7-25), 16% (95% CI=9-23), and 19% (95% CI=11-28), respectively. In a sub-analysis, 7 studies (703 patients) reported outcome with a mean follow-up of more than 2 years (range 24-72 months). In these studies, the pooled estimate of endoleak type I, migration, and reinterventions was 25% (95% CI=13-38), 22% (95% CI=19-26), and 27% (95% CI=21-33), respectively.

CONCLUSION

Patients who have been treated with EVAS are in high risk for reintervention especially beyond 2 years following implantation. Close surveillance for patients treated with EVAS is mandatory.

Surveillance for avian influenza and Newcastle disease in backyard poultry flocks in Côte d'Ivoire, 2007-2009

Between 2007 and 2009, active surveys were conducted on backyard poultry (chickens, guinea fowls and ducks) in four areas of Côte d'Ivoire, including two areas where avian influenza H5N1 outbreaks occurred in 2006. Each bird underwent clinical examination. In total, 5,578 sera, 4,580 tracheal swabs and 5,120 cloacal swabs were collected, plus tissues from 35 sick chickens. Using the haemagglutination inhibition (HI) test, 277 and 36 serum samples were positive for H5 and H7, respectively; all were negative for H9. All samples were negative by reverse transcription polymerase chain reaction. These results confirm the circulation of H5 and H7 influenza subtypes in backyard poultry in Côte d'Ivoire. Given that the seropositive birds were healthy, the circulating subtypes may be low pathogenicity avian influenza strains. Half (2,680) of the sera collected from chickens were tested by HI for Newcastle disease virus (NDV) antibody: 531 were positive. The seroprevalence of 19.8% confirms the endemic status of NDV, but may underestimate its true prevalence in Côte d'Ivoire.

Acute and sub-chronic oral toxicity studies of an aqueous stem bark extract of Pterocarpus soyauxii Taub (Papilionaceae) in rodents

Pterocarpus soyauxii Taub (Papilionaceae) is used in Cameroonian traditional medicine and pharmacopoeia to treat hypertension, diabetes, gastrointestinal parasitizes and cutaneous diseases.

AIM OF THE STUDY

The present investigation was carried out to evaluate the safety of an aqueous stem bark extract of Pterocarpus soyauxii by determining toxicity after acute and sub-chronic oral administration in male and female rodents.

MATERIALS AND METHODS

The acute toxicity test was conducted in mice. An aqueous extract of barks was administrated by gavage in single doses of 2.5-12.5 g/kg. General behaviour and mortality were examined for up to 7 days. The sub-chronic toxicity test was performed in rats. The plant extract was administered by daily gavage of 150-600 mg/kg for 42 days. Body weight, food and water intakes were followed weekly. Haematological, biochemical and organ parameters were determined at the end of the 42-day administration.

RESULTS

In the acute study in mice, oral administration of the aqueous extract of Pterocarpus soyauxii caused dose-dependent general behaviour adverse effects and mortality. The no-observed adverse effect level (NOAEL) of the extract was 5.0 g/kg. The lowest-observed adverse effect level (LOAEL) was 7.5 mg/kg. Mortality increased with the dose, LD(50) was>10.75 g/kg for the mouse. In the sub-chronic study in rats, daily oral administration of the aqueous extract of Pterocarpus soyauxii did not result in death or significant changes in haematological or biochemical parameters, excepted increased hepatic catalase activity (P<0.05) at the dose of 600 mg/kg. No alteration was observed in body weight, food and water intake. Liver, kidney, lung and pancreas histopathology did not reveal morphological alteration.

CONCLUSIONS

The results showed that the aqueous stem bark extract of Pterocarpus soyauxii Taub had very low toxicity in oral acute high dose administration and no toxicity in oral sub-chronic low dose administration and indicate that the plant could be considered safe for oral medication.

Maternal and developmental toxicity evaluation of Acanthus montanus leaves extract administered orally to Wistar pregnant rats during organogenesis

Acanthus montanus is a plant used in Cameroon to treat pains and threatened abortion. The aim of this study was to evaluate the influence of methanol/methylene chlorides leaves extract from Acanthus montanus on Wistar pregnant rats and identify the substance(s) essential for these actions. Dams were treated orally from days 6 to 15 of the pregnancy at the dose levels of 0, 250, 500 and 1000 mg/(kgday). They were sacrificed on day 20 or allowed to deliver and wean. Various parameters were assessed. The F(1) generation offsprings were allowed to give birth to F(2) generation and a number of parameters assessed. The results showed that there was no maternal or organs toxicity. Embryotoxicity was observed during organogenesis manifested by reduction in foetal body weight, crown-rump and tail lengths and reduced ossification of extremities bones. However after delivery, these signs of growth retardation were seen before day 5, and henceforth, the treated pups regained all their parameters to normality. All others parameters for F(1) and F(2) generations were insignificant. beta-Sitosterol was the major chemical component of the extract and its role on these results could not be ignored. The MeOH/CH(2)Cl(2) extract of this plant is embryotoxic peri-natally at high doses but this failed to manifest after 5 days of post-natal survival. beta-Sitosterol may be central in the observed effects of the extract. This extract can be tolerated by pregnant patients.

Analgesic and anticonvulsant effects of extracts from the leaves of Kalanchoe crenata (Andrews) Haworth (Crassulaceae)

Kalanchoe crenata Andr. (Crassulaceae) is a fleshy herbaceous plant used in the African traditional medicine as remedies against otitis, headache, inflammations, convulsions and general debility. In the present work, the analgesic effects of methylene chloride/methanol (1:1) (CH(2)Cl(2)/CH(3)OH) extract and its hexane, methylene chloride (CH(2)Cl(2)), ethyl acetate, n-butanol fractions and aqueous residue have been evaluated using acetic acid, formalin and pressure test. The anticonvulsant effects of the CH(2)Cl(2)/CH(3)OH extract were also investigated on seizures induced by pentylenetetrazol (PTZ 70 mg/kg), strychnine sulphate (STN 2.5 mg/kg) and thiosemicarbazide (TSC 50 mg/kg). CH(2)Cl(2)/CH(3)OH extract and its fractions, administered orally at the doses of 150 and 300 mg/kg, exhibited protective effect of at least 30% on the pain induced by acetic acid. The CH(2)Cl(2) fraction at 300 mg/kg showed a maximal effect of 78.49%. The CH(2)Cl(2)/CH(3)OH extract and its CH(2)Cl(2) fraction at the doses of 150 and 300 mg/kg significantly reduced the first phase of pain induced by formalin while the second phase was completely inhibited. The CH(2)Cl(2) fraction produced more than 45% reduction in the sensitivity to pain induced by pressure. The CH(2)Cl(2)/CH(3)OH extract of Kalanchoe crenata significantly increased the latency period in seizures induced by PTZ and significantly reduced the duration of seizures induced by the three convulsant agents. The extract protected 20% of animals against death in seizures induced by TSC and STN. These results suggest a peripheral and central analgesic activities as well as an anticonvulsant effect of the leaves of Kalanchoe crenata.