Purpose: In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). Methods: We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). Results: Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. Conclusion: Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.
Background:
Levetiracetam, a novel antiepileptic drug, has shown antidyskinetic effects in
experimental animal models of Parkinson's disease (PD). The tolerability and efficacy of levetiracetam
in reducing the levodopa-induced dyskinesia (LID) in PD patients have not been established. Therefore,
this study aims to synthesize evidence from published prospective clinical trials about the efficacy
of levetiracetam for the management of LID in PD patients.
Methods:
We followed the PRISMA statement guidelines during the preparation of this systematic review.
A computer literature search of PubMed, EBSCO, Scopus, MEDLINE, and the web of science
was carried out. We selected prospective clinical trials assessing the anti-dyskinetic efficacy of
levetiracetam for treating LID in patients with PD. The Abnormal Involuntary Movement Scale
(AIMS), Clinical Global Impression Score (GCI), UPDRS III, and UPDRS IV were considered as the
primary outcome measures; their data were extracted and reviewed.
Results:
Our review included seven clinical trials with a total of 150 patients. Of them, three studies
were randomized controlled trials, and the remaining were open-label single arm trials. Four studies
reported poor tolerability of the levetiracetam with mild anti-dyskinetic effects. Levetiracetam slightly
improved the UPDRS-IV and AIMS scores with small effect size. In the remaining three studies,
levetiracetam failed to exhibit any anti-dyskinetic effects.
Conclusion:
Current evidence does not support the efficacy of the levetiracetam for treating LID in
PD patients, however, due to the limited number of published randomized control trials (RCTs), further
RCTs are required.
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