Endometriosis and Ectopic Pregnancy: A Meta-analysis.

OBJECTIVE: To systematically review and perform a meta-analysis of the risk of ectopic pregnancy in endometriosis. DATA SOURCES: MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and Cochrane Library to April 1, 2019. Inclusion criteria were cohort or case-control studies from 1990 onward. Exclusion criteria were cohort studies without controls, case reports or series, or no English full-text. METHODS OF STUDY SELECTION: A total of 1361 titles/abstracts were screened after removal of duplicates, 39 full-texts were requested, and, after 24 studies were excluded, there were 15 studies in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Data were extracted using standardized spreadsheets with 2 independent reviewers, and conflicts were resolved by a third reviewer. We performed random effects calculation of weighted estimated average odds ratio (OR). Heterogeneity and publication bias were assessed with the I2 metric and funnel plots/Egger's test, respectively. The Ottawa-Newcastle Quality Assessment Scale was used with a cutoff of ≥7 for higher quality. There were 10 case-control studies (17 972 ectopic pregnancy cases and 485 266 nonectopic pregnancy controls) and 5 cohort studies (30 609 women with endometriosis and 107 321 women without endometriosis). For case-control studies, endometriosis was associated with increased risk of ectopic pregnancy with an OR of 2.66 (95% confidence interval [CI] = 1.14-6.21, p = .02). For cohort studies, the OR was 0.95 (95% CI = 0.29-3.11, p = .94), but after post hoc analysis of the studies with a Ottawa-Newcastle score ≥7, the OR was 2.16 (95% CI = 1.67-2.79, p <.001). For both case-control and cohort studies, there was high heterogeneity among studies (I2 = 93.9% and I2 = 96.6%, Q test p <.001) but no obvious evidence of systematic bias in the funnel plot, and Egger's test results were not significant (p = .35, p = .70), suggesting no strong publication bias. There were insufficient data to make any conclusions with respect to anatomic characteristics of endometriosis (e.g., stage) or mode of conception (e.g., assisted reproductive technology vs spontaneous). CONCLUSION: Possible evidence of an association between endometriosis and ectopic pregnancy was observed (OR = 2.16-2.66). However, these results should be considered with caution, owing to high heterogeneity among studies. Continued research is needed to delineate the pregnancy implications of endometriosis.

Complications of PORT-A-CATH® in patients with sickle cell disease.

BACKGROUND: Red cell exchange/transfusion is frequently used in the management of patients with medical complications related to acute severe sickle cell disease (SCD). However, peripheral venous access is often difficult without central venous catheters (CVCs) in adult patients with moderate or severe SCD. AIMS: To review our experience with the use of the PORT-A-CATH(®) device in sixteen patients with SCD undergoing exchange or simple transfusions. METHODS: Among a cohort of 550 patients who frequently visited the inpatient service, sixteen SCD patients required the insertion of a PORT-A-CATH(®) device. These patients included 3 males and 13 females, aged 25-44 years [31.1 ± 2.3; mean ± SD]. A total of 24 PORT-A-CATH(®) devices were implanted in these 16 patients during the study period. Eleven patients had 1 device implanted, three patients had 2 devices, one patient had 3 devices, and one patient had 4 devices implanted. RESULTS: Out of the 24 devices implanted, 17 required removal, due to either infection associated with sepsis and/or thrombosis. The organisms involved were Candida spp. (3), C. Parapsilosis (2), C. albicans (1), C. famata (1), C. lusitanice (1), Staphylococcus spp. (6), and S. aureus (3), as well as the coagulase-negative Staphylococcus (2), alpha hemolytic Streptococcus (1), Diphtheroid bacilli (2), Pseudomonas aeruginosa (2), Ps. Spp. (3), Escherichia coli (3), Klebsiella oxytoca (1), Klebsiella pneumoniae (1), Klebsiella spp. (1), Serratia liquefaciens (1), Serratia fanticola (1), Achromobacter spp. (2) Chromobacterium violaceum (1), Delftia acidovirans (1), Stenotrophomonas maltophile (1), Alcaligenes faecalis (1), and Enterobacter cloacae (1). Two episodes of documented thrombosis were observed. One case presented with right atrial thrombosis/SVC syndrome and the other case presented with left upper arm thrombosis. Two patients died with ports in situ, while five patients had ports in place at the time of this study. The median working life of the ports was 688.5 days (range: 39-3925). The rate of infective complications was 2.63 infections per 1000 catheter days, and the number of infections was significantly correlated with the number of ports [Pearson's r=0.66; p<0.01]. DISCUSSION: Our results suggest that patients with SCD suffer infective complications associated with the PORT-A-CATH(®), which often necessitate its removal. Although these devices are extremely useful, their optimal beneficial potential is only realized if the patients receive proper care at special centers well-versed in the maintenance of such devices by experienced staff.