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15/10/2021 | A systematic review and meta-analysis of telephone vs in-person genetic counseling in BRCA1/BRCA2 genetic testing. | Pathogenic variants in the BRCA1 and BRCA2 genes increase the risk of breast and ovarian cancer. Individuals with identified pathogenic variants in the BRCA1 or BRCA2 gene can benefit from cancer risk-reducing strategies. In the recent years, there has been an increase in the demand of genetic services. In light of the ongoing COVID19 pandemic, alternatives to face-to-face consultations have had to be considered and adopted, including telemedicine. Informed consent is necessary for genetic testing. Studies have suggested that increased levels of cancer-specific distress may impair the patient's ability to retain information, therefore, providing informed consent. This systematic review and meta-analysis aimed to answer if telephone genetic counseling for BRCA1 and BRCA2 genetic testing is non-inferior to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Databases of Medline, Embase, PsycINFO, CINAHL, SciELO, Web of Science, CENTRAL, ProQuest Dissertation & Theses Database, Clinicaltrials.gov, EU clinical trials register were accessed to identify any published or unpublished relevant literature. Random-effects models were used for the meta-analysis. Four studies were included in the qualitative synthesis of the results. Three studies were included in the quantitative synthesis of the results. Telephone genetic counseling was non-inferior compared to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Sensitivity analysis corroborated the main results. Telephone genetic counseling for BRCA1/BRCA2 genetic testing may be an alternative model of delivering genetic services in front of the increased demand/or when required by social context. However, the paucity of the evidence prevents from drawing strong conclusions regarding the generalizability of these results. Further research is needed to strengthen the conclusions. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['BRCA1 Protein', 'BRCA2 Protein', 'Breast Neoplasms', 'COVID-19', 'Female', 'Genes, BRCA1', 'Genetic Counseling', 'Genetic Predisposition to Disease', 'Genetic Testing', 'Humans', 'Mutation', 'Ovarian Neoplasms', 'SARS-CoV-2', 'Telephone'] | 33,131,182 | 0 | A systematic review and meta-analysis of telephone vs in-person genetic counseling in BRCA1/BRCA2 genetic testing. Pathogenic variants in the BRCA1 and BRCA2 genes increase the risk of breast and ovarian cancer. Individuals with identified pathogenic variants in the BRCA1 or BRCA2 gene can benefit from cancer risk-reducing strategies. In the recent years, there has been an increase in the demand of genetic services. In light of the ongoing COVID19 pandemic, alternatives to face-to-face consultations have had to be considered and adopted, including telemedicine. Informed consent is necessary for genetic testing. Studies have suggested that increased levels of cancer-specific distress may impair the patient's ability to retain information, therefore, providing informed consent. This systematic review and meta-analysis aimed to answer if telephone genetic counseling for BRCA1 and BRCA2 genetic testing is non-inferior to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Databases of Medline, Embase, PsycINFO, CINAHL, SciELO, Web of Science, CENTRAL, ProQuest Dissertation & Theses Database, Clinicaltrials.gov, EU clinical trials register were accessed to identify any published or unpublished relevant literature. Random-effects models were used for the meta-analysis. Four studies were included in the qualitative synthesis of the results. Three studies were included in the quantitative synthesis of the results. Telephone genetic counseling was non-inferior compared to in-person genetic counseling for the outcomes of cancer-specific distress and genetic knowledge. Sensitivity analysis corroborated the main results. Telephone genetic counseling for BRCA1/BRCA2 genetic testing may be an alternative model of delivering genetic services in front of the increased demand/or when required by social context. However, the paucity of the evidence prevents from drawing strong conclusions regarding the generalizability of these results. Further research is needed to strengthen the conclusions. |
29/09/2021 | One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis. | Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6-14). Among studies with longer followup (≥24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p=0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p=0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p=0.05). One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Incidence', 'Lichen Sclerosus et Atrophicus', 'Male', 'Mouth Mucosa', 'Penis', 'Plastic Surgery Procedures', 'Recurrence', 'Risk Assessment', 'Treatment Outcome', 'Urethra', 'Urethral Stricture', 'Urologic Surgical Procedures, Male'] | 34,032,494 | 0 | One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis. Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6-14). Among studies with longer followup (≥24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p=0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p=0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p=0.05). One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair. |
25/01/2022 | Simple traumatic elbow dislocations; benefit from early functional rehabilitation: A systematic review with meta-analysis including PRISMA criteria. | Elbow dislocation is the second most frequent joint dislocation after shoulder dislocation. They have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.The purpose of this systematic review and meta-analysis was to review the literature and analyze the evidence of early functional rehabilitation. A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified and evaluated in a stepwise approach. Of these publications 29 met the inclusion criteria of the authors and described simple elbow dislocations in 5765 patients.Data from the studies and subgroups included were initially categorized descriptively in conservative and surgical primary therapies, in immobilizing (immobilization lasting 2 weeks or longer) and free-functional follow-up treatments, and those data were then extracted from each subgroup in absolutes. We then pooled these numbers into descriptive statistics to ensure their comparability. We determined the success rates from the numbers of excellent and good results of the specific used outcome scores. The effect estimate of the conservative therapy's success rate was 84% and for surgical treatment 80% (P < .0001). The difference between the immobilizing treatment (78% success rate) and early-function therapy (83% success rate) was significant (P = .002).In a subgroup analysis the success rate of conservative and immobilizing therapy was 79%, of conservative and early-functional therapy 91%, of surgical and immobilizing groups' was 77% and of the surgical and early-functional therapies was 93%. The difference among the 4 treatment options was significant (P < .0001), as were differences between the 2 conservative groups (P < .0001) and between the 2 surgical groups (P = .044). Conservative therapy is the dominant therapy. Regardless of the primary therapy chosen in simple elbow dislocations: early functional follow-up care seems to be superior to immobilizing therapy with a duration more than 2 weeks. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Elbow', 'Humans', 'Joint Dislocations', 'Outcome Assessment, Health Care', 'Physical Therapy Modalities', 'Range of Motion, Articular', 'Treatment Outcome', 'Elbow Injuries'] | 34,871,203 | 0 | Simple traumatic elbow dislocations; benefit from early functional rehabilitation: A systematic review with meta-analysis including PRISMA criteria. Elbow dislocation is the second most frequent joint dislocation after shoulder dislocation. They have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.The purpose of this systematic review and meta-analysis was to review the literature and analyze the evidence of early functional rehabilitation. A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified and evaluated in a stepwise approach. Of these publications 29 met the inclusion criteria of the authors and described simple elbow dislocations in 5765 patients.Data from the studies and subgroups included were initially categorized descriptively in conservative and surgical primary therapies, in immobilizing (immobilization lasting 2 weeks or longer) and free-functional follow-up treatments, and those data were then extracted from each subgroup in absolutes. We then pooled these numbers into descriptive statistics to ensure their comparability. We determined the success rates from the numbers of excellent and good results of the specific used outcome scores. The effect estimate of the conservative therapy's success rate was 84% and for surgical treatment 80% (P < .0001). The difference between the immobilizing treatment (78% success rate) and early-function therapy (83% success rate) was significant (P = .002).In a subgroup analysis the success rate of conservative and immobilizing therapy was 79%, of conservative and early-functional therapy 91%, of surgical and immobilizing groups' was 77% and of the surgical and early-functional therapies was 93%. The difference among the 4 treatment options was significant (P < .0001), as were differences between the 2 conservative groups (P < .0001) and between the 2 surgical groups (P = .044). Conservative therapy is the dominant therapy. Regardless of the primary therapy chosen in simple elbow dislocations: early functional follow-up care seems to be superior to immobilizing therapy with a duration more than 2 weeks. |
24/01/2022 | Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review. | There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients. A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission. The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist's role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Hidradenitis Suppurativa', 'Humans'] | 32,942,279 | 0 | Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review. There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients. A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission. The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist's role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences. |
18/08/2021 | Toxoplasma gondii infection and spontaneous abortion: A systematic review and meta-analysis. | Toxoplasmosis is one of the most common parasitic infections in humans, which is caused by Toxoplasma gondii. It is usually asymptomatic but primary infection in a pregnant woman can cause severe consequences in the fetus such as miscarriage. This study aimed to estimate the global prevalence of T. gondii infection in women with spontaneous abortion. It also evaluates the possible relationship between recent Toxoplasma infection and miscarriage. Five electronic databases were reviewed. We used the random effects model and 95% confidence intervals(CI) to determine the overall prevalence and odds ratio (OR). Heterogeneity was calculated using Cochran's Q test and I<sup>2</sup> statistic. The included studies were divided into three sub-groups based on antibody class against T. gondii and the existence of parasite DNA. Based on PCR, the pooled random-effects estimates that the prevalence of T. gondii infection in women with abortion was 10% (95% CI 7-14%). The pooled random effect favored a statistically significant increased risk of latent Toxoplasma infection [OR = 1.84; 95% CI: 1.41-2.40, P < 0.001] and recent infection [OR = 3.72; 95% CI: 2.21-6.26, P < 0.001] in women with spontaneous abortions. In recent infections, significant pooled ORs of positive association were observed in women with miscarriage [OR = 4.2; 95% CI: 2.04-8.85; χ2 = 17.2; I<sup>2</sup> = 42.0%, P = 0.07]. This study demonstrates that recent T. gondii infection is associated with an elevated risk of spontaneous abortion. Further studies concerning all risk factors related to toxoplasmosis, and undertaking confirmatory tests at the time of abortion should be performed to investigate the impact of T. gondii infection and spontaneous abortion. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Abortion, Spontaneous', 'Antibodies, Protozoan', 'Female', 'Humans', 'Immunoglobulin M', 'Pregnancy', 'Risk Factors', 'Seroepidemiologic Studies', 'Toxoplasma', 'Toxoplasmosis'] | 34,186,117 | 0 | Toxoplasma gondii infection and spontaneous abortion: A systematic review and meta-analysis. Toxoplasmosis is one of the most common parasitic infections in humans, which is caused by Toxoplasma gondii. It is usually asymptomatic but primary infection in a pregnant woman can cause severe consequences in the fetus such as miscarriage. This study aimed to estimate the global prevalence of T. gondii infection in women with spontaneous abortion. It also evaluates the possible relationship between recent Toxoplasma infection and miscarriage. Five electronic databases were reviewed. We used the random effects model and 95% confidence intervals(CI) to determine the overall prevalence and odds ratio (OR). Heterogeneity was calculated using Cochran's Q test and I<sup>2</sup> statistic. The included studies were divided into three sub-groups based on antibody class against T. gondii and the existence of parasite DNA. Based on PCR, the pooled random-effects estimates that the prevalence of T. gondii infection in women with abortion was 10% (95% CI 7-14%). The pooled random effect favored a statistically significant increased risk of latent Toxoplasma infection [OR = 1.84; 95% CI: 1.41-2.40, P < 0.001] and recent infection [OR = 3.72; 95% CI: 2.21-6.26, P < 0.001] in women with spontaneous abortions. In recent infections, significant pooled ORs of positive association were observed in women with miscarriage [OR = 4.2; 95% CI: 2.04-8.85; χ2 = 17.2; I<sup>2</sup> = 42.0%, P = 0.07]. This study demonstrates that recent T. gondii infection is associated with an elevated risk of spontaneous abortion. Further studies concerning all risk factors related to toxoplasmosis, and undertaking confirmatory tests at the time of abortion should be performed to investigate the impact of T. gondii infection and spontaneous abortion. |
19/02/2024 | The application and therapeutic effect of botulinum toxin type a (BTX-A) in the treatment of patients with pain after cancer treatment: a systematic review and meta-analysis. | Botulinum toxin type A (BTX-A) is a potential treatment for cancer pain. This study aimed to analyze the effectiveness and safety of BTX-A in the treatment of pain after cancer treatment. Systematic searches of PubMed, Cochrane Library, and Embase databases were conducted. Randomized controlled trials evaluating the efficacy and safety of BTX-A compared with either placebo or active treatment in patients with pain after cancer treatment were included. The outcomes included pain intensity, quality of life, and adverse events. This systematic review included four studies of which two were included in the meta-analysis. Compared with a placebo, BTX-A injection in patients with pain after cancer treatment had a clinically meaningful reduction in self-reported pain post-treatment [mean difference=-1.79 (95% CI: -2.14--1.43), P <0.00001, I ²=0%]. This systematic review and meta-analysis demonstrated that BTX-A is safe and effective for pain relief in patients with pain after cancer treatment. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Botulinum Toxins, Type A', 'Quality of Life', 'Pain', 'Neoplasms', 'Pain Management', 'Treatment Outcome'] | 37,994,715 | 0 | The application and therapeutic effect of botulinum toxin type a (BTX-A) in the treatment of patients with pain after cancer treatment: a systematic review and meta-analysis. Botulinum toxin type A (BTX-A) is a potential treatment for cancer pain. This study aimed to analyze the effectiveness and safety of BTX-A in the treatment of pain after cancer treatment. Systematic searches of PubMed, Cochrane Library, and Embase databases were conducted. Randomized controlled trials evaluating the efficacy and safety of BTX-A compared with either placebo or active treatment in patients with pain after cancer treatment were included. The outcomes included pain intensity, quality of life, and adverse events. This systematic review included four studies of which two were included in the meta-analysis. Compared with a placebo, BTX-A injection in patients with pain after cancer treatment had a clinically meaningful reduction in self-reported pain post-treatment [mean difference=-1.79 (95% CI: -2.14--1.43), P <0.00001, I ²=0%]. This systematic review and meta-analysis demonstrated that BTX-A is safe and effective for pain relief in patients with pain after cancer treatment. |
12/07/2022 | Comparison of Efficacy and Safety of Statin-Ezetimibe Combination Therapy with Statin Monotherapy in Patients with Diabetes: A Meta-Analysis of Randomized Controlled Studies. | Dyslipidemia in diabetes mellitus is characterized by hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), and elevated low-density lipoprotein cholesterol (LDL-C). Additionally, the potentially increased risk of morbidity and mortality following atherosclerotic cardiovascular diseases should be considered in the treatment of dyslipidemia in patients with diabetes. We performed a meta-analysis of the published data to compare the effects of HMG-CoA reductase inhibitor (statin)-ezetimibe combination therapy and statin monotherapy on lipid and glucose parameters in patients with diabetes. We also compared safety based on the adverse events reported for the two groups. In total, 17 articles were included in this meta-analysis. In the efficacy assessment, the combination treatment afforded a significantly greater reduction in LDL-C than did statin monotherapy (standard difference in means 0.691; 95% confidence interval 0.534-0.847). A significantly greater improvement effect was observed in the levels of HDL-C, total cholesterol, triglyceride, and apolipoprotein B, but not apolipoprotein A1, with combination therapy than with statin monotherapy. Additionally, combination therapy reduced fasting blood glucose levels more significantly than did statin monotherapy. In terms of safety, there were no significant differences in treatment-related adverse events between the two treatments. Statin-ezetimibe combination therapy enhances levels of LDL-C and other lipids without increasing the risk of adverse events compared with statin monotherapy. The present meta-analysis presents valid evidence for appropriate drug regimens to treat dyslipidemia in patients with diabetes. PROSPERO Identifier Number CRD42021244578. | ['Meta-Analysis', 'Systematic Review'] | ['Anticholesteremic Agents', 'Cholesterol', 'Cholesterol, LDL', 'Diabetes Mellitus', 'Drug Therapy, Combination', 'Dyslipidemias', 'Ezetimibe', 'Humans', 'Hydroxymethylglutaryl-CoA Reductase Inhibitors', 'Treatment Outcome'] | 34,927,215 | 0 | Comparison of Efficacy and Safety of Statin-Ezetimibe Combination Therapy with Statin Monotherapy in Patients with Diabetes: A Meta-Analysis of Randomized Controlled Studies. Dyslipidemia in diabetes mellitus is characterized by hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), and elevated low-density lipoprotein cholesterol (LDL-C). Additionally, the potentially increased risk of morbidity and mortality following atherosclerotic cardiovascular diseases should be considered in the treatment of dyslipidemia in patients with diabetes. We performed a meta-analysis of the published data to compare the effects of HMG-CoA reductase inhibitor (statin)-ezetimibe combination therapy and statin monotherapy on lipid and glucose parameters in patients with diabetes. We also compared safety based on the adverse events reported for the two groups. In total, 17 articles were included in this meta-analysis. In the efficacy assessment, the combination treatment afforded a significantly greater reduction in LDL-C than did statin monotherapy (standard difference in means 0.691; 95% confidence interval 0.534-0.847). A significantly greater improvement effect was observed in the levels of HDL-C, total cholesterol, triglyceride, and apolipoprotein B, but not apolipoprotein A1, with combination therapy than with statin monotherapy. Additionally, combination therapy reduced fasting blood glucose levels more significantly than did statin monotherapy. In terms of safety, there were no significant differences in treatment-related adverse events between the two treatments. Statin-ezetimibe combination therapy enhances levels of LDL-C and other lipids without increasing the risk of adverse events compared with statin monotherapy. The present meta-analysis presents valid evidence for appropriate drug regimens to treat dyslipidemia in patients with diabetes. PROSPERO Identifier Number CRD42021244578. |
25/09/2023 | Epicardial fat in patients with metabolic syndrome: A systematic review and meta-analysis. | Abnormally increased epicardial fat appears to be associated with an additional risk of major adverse cardiovascular events (MACEs) in the context of metabolic syndrome (MetS). However, evidence on the relationship between epicardial fat volumes (EFVs), epicardial fat thickness (EFT) and MetS remains inconsistent. Specific searches of electronic databases from 1 January 2000 to 31 October 2022 were independently performed by two researchers. In this study, two quantification measures of epicardial fat were included: comparison of total computed tomography-based EFVs and EFT between two groups (individuals with and without MetS), estimating standardized mean difference (SMD) with corresponding 95 % confidence intervals (CIs) through a random-effects model analysis. The heterogeneity in the included studies was explored by meta-regression and subgroup analyses. The EFVs were significantly increased in MetS subjects compared with non-MetS subjects (SMD: 1.07, 95 % CI: 0.69-1.45, p < 0.001), and the EFT was also significantly larger in MetS patients than in the Non-MetS (SMD: 1.12, 95 % CI: 0.84-1.41, p < 0.001). We compared the Caucasian and American subgroups with the Asian and African subgroups, and the EFT was greater in the former subgroups (SMD: 1.32, 95 % CI: 0.44-2.20, p < 0.001). When comparing the EFT among the age subgroups, there was a significant SMD between adolescents and adults or elderly individuals (SMD: 1.21, 95 % CI: 0.84-1.52, p < 0.001). MetS patients tend to present greater EFT near the right ventricular free wall and greater total EFVs. Increased epicardial fat, an imaging biomarker, independently affects the onset of MetS. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Adolescent', 'Adult', 'Aged', 'Humans', 'Metabolic Syndrome', 'Heart', 'Adipose Tissue', 'Databases, Factual', 'Tomography, X-Ray Computed'] | 37,666,076 | 0 | Epicardial fat in patients with metabolic syndrome: A systematic review and meta-analysis. Abnormally increased epicardial fat appears to be associated with an additional risk of major adverse cardiovascular events (MACEs) in the context of metabolic syndrome (MetS). However, evidence on the relationship between epicardial fat volumes (EFVs), epicardial fat thickness (EFT) and MetS remains inconsistent. Specific searches of electronic databases from 1 January 2000 to 31 October 2022 were independently performed by two researchers. In this study, two quantification measures of epicardial fat were included: comparison of total computed tomography-based EFVs and EFT between two groups (individuals with and without MetS), estimating standardized mean difference (SMD) with corresponding 95 % confidence intervals (CIs) through a random-effects model analysis. The heterogeneity in the included studies was explored by meta-regression and subgroup analyses. The EFVs were significantly increased in MetS subjects compared with non-MetS subjects (SMD: 1.07, 95 % CI: 0.69-1.45, p < 0.001), and the EFT was also significantly larger in MetS patients than in the Non-MetS (SMD: 1.12, 95 % CI: 0.84-1.41, p < 0.001). We compared the Caucasian and American subgroups with the Asian and African subgroups, and the EFT was greater in the former subgroups (SMD: 1.32, 95 % CI: 0.44-2.20, p < 0.001). When comparing the EFT among the age subgroups, there was a significant SMD between adolescents and adults or elderly individuals (SMD: 1.21, 95 % CI: 0.84-1.52, p < 0.001). MetS patients tend to present greater EFT near the right ventricular free wall and greater total EFVs. Increased epicardial fat, an imaging biomarker, independently affects the onset of MetS. |
21/10/2021 | The role of single nucleotide polymorphisms of <i>IL-1A</i> -889C>T (rs1800587), <i>TNF-A</i> -238G>A (rs361525), and <i>VDR TaqI</i> (rs731236) on susceptibility to herniated nucleus pulposus: a systematic review and meta-analysis. | <b>Background</b>: The pathogenesis of herniated nucleus pulposus (HNP) is complex and may involve the wide variety of gene polymorphism. However, the reports from the existing studies are inconclusive. The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha ( <i>IL-1A</i>), tumor necrosis factor-alpha ( <i>TNF-A</i>), and vitamin D receptor ( <i>VDR</i>) genes on the susceptibility to herniated nucleus pulposus (HNP). <b>Methods</b>: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1 <sup>st</sup>, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of <i>IL-1A</i> -889C>T (rs1800587), <i>TNF-A</i> -238G>A (rs361525), and <i>VDR TaqI</i> (rs731236) and susceptibility to HNP were assessed using Z test. <b>Results</b>: We screened 3,067 unique studies for eligibility and three, two and nine case-control studies on <i>IL-1A</i> -889C>T, <i>TNF-A</i> -238G>A, and <i>VDR TaqI</i> were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for <i>IL-1A</i> -889C>T, 252 cases and 259 controls for <i>TNF-A</i> -238G>A and 1130 cases and 2096 controls for <i>VDR TaqI.</i> Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations. <b>Conclusion</b>: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in <i>IL-1A</i>, <i>TNF-A</i>, and <i>VDR</i>, our data indicated that <i>IL-1A</i> -889C>T, <i>TNF-A</i> -238G>A, and <i>VDR TaqI</i> had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding. | ['Meta-Analysis', 'Systematic Review'] | ['Genetic Predisposition to Disease', 'Humans', 'Interleukin-1alpha', 'Nucleus Pulposus', 'Polymorphism, Single Nucleotide', 'Receptors, Calcitriol', 'Tumor Necrosis Factor-alpha'] | 34,504,685 | 0 | The role of single nucleotide polymorphisms of <i>IL-1A</i> -889C>T (rs1800587), <i>TNF-A</i> -238G>A (rs361525), and <i>VDR TaqI</i> (rs731236) on susceptibility to herniated nucleus pulposus: a systematic review and meta-analysis. <b>Background</b>: The pathogenesis of herniated nucleus pulposus (HNP) is complex and may involve the wide variety of gene polymorphism. However, the reports from the existing studies are inconclusive. The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha ( <i>IL-1A</i>), tumor necrosis factor-alpha ( <i>TNF-A</i>), and vitamin D receptor ( <i>VDR</i>) genes on the susceptibility to herniated nucleus pulposus (HNP). <b>Methods</b>: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1 <sup>st</sup>, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of <i>IL-1A</i> -889C>T (rs1800587), <i>TNF-A</i> -238G>A (rs361525), and <i>VDR TaqI</i> (rs731236) and susceptibility to HNP were assessed using Z test. <b>Results</b>: We screened 3,067 unique studies for eligibility and three, two and nine case-control studies on <i>IL-1A</i> -889C>T, <i>TNF-A</i> -238G>A, and <i>VDR TaqI</i> were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for <i>IL-1A</i> -889C>T, 252 cases and 259 controls for <i>TNF-A</i> -238G>A and 1130 cases and 2096 controls for <i>VDR TaqI.</i> Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations. <b>Conclusion</b>: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in <i>IL-1A</i>, <i>TNF-A</i>, and <i>VDR</i>, our data indicated that <i>IL-1A</i> -889C>T, <i>TNF-A</i> -238G>A, and <i>VDR TaqI</i> had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding. |
21/07/2021 | Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors: RENAL score ≥7 or maximum tumor size >4 cm. | We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥7 or maximum clinical tumor size >4 cm). Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots. Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P=0.07) surgery, all complications (P=0.12), grade 1-2 complications (P=0.10), grade 3-5 complications (P=0.93), operative time (P=0.94), estimated blood loss (P=0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR=4.33; 95% CI: 2.01-9.33; P<0.001), a longer ischemia time (IT, P<0.001; WMD=3.02 min; 95% CI: 1.67 to 4.36), a longer length of stay (LOS, P<0.001; WMD=0.67 days; 95% CI: 0.35 to 0.99), a lower rate of positive surgical margin (P=0.03; OR=0.71; 95% CI: 0.53 to 0.96), a greater eGFR decline (P<0.001; WMD=2.41 mL/min/1.73 m<sup>2</sup>; 95% CI: 1.22 to 3.60), a higher rate of CKD upstaging (P<0.001; OR=2.44; 95% CI: 1.54 to 3.87). No obvious publication bias was observed. For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results. | ['Comparative Study', 'Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Kidney Neoplasms', 'Laparoscopy', 'Nephrectomy', 'Robotic Surgical Procedures', 'Treatment Outcome', 'Tumor Burden'] | 33,439,576 | 1 | Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors: RENAL score ≥7 or maximum tumor size >4 cm. We reviewed current studies and performed a meta-analysis to compare outcomes between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) treating complex renal tumors (RENAL score ≥7 or maximum clinical tumor size >4 cm). Using the databases of PubMed, Embase, and the Cochrane Library, a comprehensive literature search was performed in April, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was evaluated by funnel plots. Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. There was no significant difference between the two groups regarding conversion to open (P=0.07) surgery, all complications (P=0.12), grade 1-2 complications (P=0.10), grade 3-5 complications (P=0.93), operative time (P=0.94), estimated blood loss (P=0.17). Patients undergoing LPN had a significant higher rate of conversion to radical (OR=4.33; 95% CI: 2.01-9.33; P<0.001), a longer ischemia time (IT, P<0.001; WMD=3.02 min; 95% CI: 1.67 to 4.36), a longer length of stay (LOS, P<0.001; WMD=0.67 days; 95% CI: 0.35 to 0.99), a lower rate of positive surgical margin (P=0.03; OR=0.71; 95% CI: 0.53 to 0.96), a greater eGFR decline (P<0.001; WMD=2.41 mL/min/1.73 m<sup>2</sup>; 95% CI: 1.22 to 3.60), a higher rate of CKD upstaging (P<0.001; OR=2.44; 95% CI: 1.54 to 3.87). No obvious publication bias was observed. For complex renal tumors, RAPN is more favorable than LPN in terms of lower rate of conversion to radical surgery, shorter IT, shorter LOS, less eGFR decline, and lower rate of CKD upstaging. Methodological limitations of observational studies should be taken into account in interpreting these results. |
18/01/2024 | Association of air pollution and risk of chronic kidney disease: A systematic review and meta-analysis. | Although epidemiological studies have evaluated the association between ambient air pollution and chronic kidney disease (CKD), the results remain mixed. To clarify the nature of the association, we conducted a comprehensive systematic review and meta-analysis to assess the global relationship between air pollution and CKD. The Web of Science, PubMed, Embase and Cochrane Library databases systematically were searched for studies published up to July 2023 and included 32 studies that met specific criteria. The random effects model was used to derive overall risk estimates for each pollutant. The meta-analysis estimated odds ratio (ORs) of risk for CKD were 1.42 (95% confidence interval [CI]: 1.31-1.54) for each 10 μg/m<sup>3</sup> increase in PM<sub>2.5</sub> ; 1.20 (95% CI: 1.14-1.26) for each 10 μg/m<sup>3</sup> increase in PM<sub>10</sub> ; 1.07 (95% CI: 1.05-1.09) for each 10 μg/m<sup>3</sup> increase in NO<sub>2</sub> ; 1.03 (95% CI: 1.02-1.03) for each 10 μg/m<sup>3</sup> increase in NO<sub>X</sub> ; 1.07 (95% CI: 1.01-1.12) for each 1 ppb increase in SO<sub>2</sub> ; 1.03 (95% CI: 1.00-1.05) for each 0.1 ppm increase in CO. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level. Furthermore, PM<sub>2.5</sub> , PM<sub>10</sub> , and NO<sub>2</sub> had negative effects on CKD even within the World Health Organization-recommended acceptable concentrations. Our results further confirmed the adverse effect of air pollution on the risk of CKD. These findings can contribute to enhance the awareness of the importance of reducing air pollution among public health officials and policymakers. | ['Meta-Analysis', 'Systematic Review', 'Journal Article', 'Review'] | ['Humans', 'Air Pollutants', 'Particulate Matter', 'Nitrogen Dioxide', 'Environmental Exposure', 'Air Pollution', 'Renal Insufficiency, Chronic'] | 38,091,339 | 1 | Association of air pollution and risk of chronic kidney disease: A systematic review and meta-analysis. Although epidemiological studies have evaluated the association between ambient air pollution and chronic kidney disease (CKD), the results remain mixed. To clarify the nature of the association, we conducted a comprehensive systematic review and meta-analysis to assess the global relationship between air pollution and CKD. The Web of Science, PubMed, Embase and Cochrane Library databases systematically were searched for studies published up to July 2023 and included 32 studies that met specific criteria. The random effects model was used to derive overall risk estimates for each pollutant. The meta-analysis estimated odds ratio (ORs) of risk for CKD were 1.42 (95% confidence interval [CI]: 1.31-1.54) for each 10 μg/m<sup>3</sup> increase in PM<sub>2.5</sub> ; 1.20 (95% CI: 1.14-1.26) for each 10 μg/m<sup>3</sup> increase in PM<sub>10</sub> ; 1.07 (95% CI: 1.05-1.09) for each 10 μg/m<sup>3</sup> increase in NO<sub>2</sub> ; 1.03 (95% CI: 1.02-1.03) for each 10 μg/m<sup>3</sup> increase in NO<sub>X</sub> ; 1.07 (95% CI: 1.01-1.12) for each 1 ppb increase in SO<sub>2</sub> ; 1.03 (95% CI: 1.00-1.05) for each 0.1 ppm increase in CO. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level. Furthermore, PM<sub>2.5</sub> , PM<sub>10</sub> , and NO<sub>2</sub> had negative effects on CKD even within the World Health Organization-recommended acceptable concentrations. Our results further confirmed the adverse effect of air pollution on the risk of CKD. These findings can contribute to enhance the awareness of the importance of reducing air pollution among public health officials and policymakers. |
04/12/2020 | Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury - meta-analysis of randomized controlled trials. | This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2020 from several electronic databases. There were 30.522 patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p = 0.002; I<sup>2</sup>: 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p = 0.03; I<sup>2</sup>: 0%). Both TXA and control group has a similar need for neurosurgical intervention (p = 0.87) and unfavourable Glasgow Outcome Scale (GOS) (p = 0.59). The rate for vascular occlusive events (p = 0.09), and its deep vein thrombosis subgroup (p = 0.23), pulmonary embolism subgroup (p = 1), stroke subgroup (p = 0.38), and myocardial infarction subgroup (p = 0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p = 0.04; I<sup>2</sup>: 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group. TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Antifibrinolytic Agents', 'Brain Injuries, Traumatic', 'Hemorrhage', 'Humans', 'Randomized Controlled Trials as Topic', 'Tranexamic Acid'] | 32,252,661 | 0 | Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury - meta-analysis of randomized controlled trials. This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2020 from several electronic databases. There were 30.522 patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p = 0.002; I<sup>2</sup>: 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p = 0.03; I<sup>2</sup>: 0%). Both TXA and control group has a similar need for neurosurgical intervention (p = 0.87) and unfavourable Glasgow Outcome Scale (GOS) (p = 0.59). The rate for vascular occlusive events (p = 0.09), and its deep vein thrombosis subgroup (p = 0.23), pulmonary embolism subgroup (p = 1), stroke subgroup (p = 0.38), and myocardial infarction subgroup (p = 0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p = 0.04; I<sup>2</sup>: 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group. TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias. |
12/06/2024 | The Effect of Antihyperglycemic Medications on COVID-19: A Meta-analysis and Systematic Review from Observational Studies. | Diabetes, a chronic disease worldwide, may be associated with a poorer prognosis in patients with coronavirus disease 2019 (COVID-19). While some antihyperglycemic medications may be beneficial, others may increase the risk of adverse clinical outcomes of COVID-19. We aimed to analyze the effect of antihyperglycemic medications on COVID-19. We searched the Web of Science, Cochrane Library, EMBASE, PubMed, and Scopus databases from December 2019 to June 2022 to identify literature related to patients with COVID-19 and type 2 diabetes mellitus (T2DM) treated with antihyperglycemic medications. 56 studies were included in the analysis. Metformin (OR 0.66; 95% CI 0.58-0.74; p < 0.05), Glucagon-like peptide-1 receptor agonist (GLP-1ra) (OR 0.73; 95% CI 0.59-0.91; p < 0.05), and sodium-dependent glucose transporters 2 inhibitor (SGLT 2i) (OR 0.77; 95% CI 0.69-0.87; p < 0.05) were associated with lower mortality risk, while insulin was associated with increased mortality risk (OR 1.40; 95% CI 1.26-1.55; p < 0.05). Meanwhile, metformin (OR 0.65; 95% CI 0.50-0.85; p < 0.05) and GLP-1ra (OR 0.84; 95% CI 0.76-0.94; p < 0.05) were significantly associated with decreased severe manifestation risk. What's more, metformin (OR 0.77; 95% CI 0.62-0.96; p < 0.05), GLP-1ra (OR 0.86; 95% CI 0.81-0.92; p < 0.05), and SGLT 2i (OR 0.87; 95% CI 0.79-0.97; p < 0.05) were also associated with a decreased risk of hospitalization, but insulin were associated with an increased risk of hospitalization (OR 1.31; 95% CI 1.12-1.52; p < 0.05). Nevertheless, the results of the subgroup analyses showed that the effects of different glucose-lowering agents on COVID-19 may be related to in-hospital use or out-hospital use, elderly or non-elderly patients use, and different geography. Metformin, GLP-1ra, and SGLT 2i have shown a positive effect on clinical outcomes in COVID-19, particularly in non-elderly individuals. However, insulin use may pose a higher risk, especially in elderly patients, so need with caution. Meanwhile, DPP-4i, TZD, α-GLUi, and sulfonylureas appeared to have a neutral effect. These results need to be validated in future clinical studies. | ['Journal Article', 'Systematic Review', 'Meta-Analysis'] | ['Humans', 'Hypoglycemic Agents', 'Diabetes Mellitus, Type 2', 'COVID-19', 'COVID-19 Drug Treatment', 'Observational Studies as Topic', 'Metformin', 'Glucagon-Like Peptide-1 Receptor', 'SARS-CoV-2', 'Sodium-Glucose Transporter 2 Inhibitors'] | 38,683,419 | 0 | The Effect of Antihyperglycemic Medications on COVID-19: A Meta-analysis and Systematic Review from Observational Studies. Diabetes, a chronic disease worldwide, may be associated with a poorer prognosis in patients with coronavirus disease 2019 (COVID-19). While some antihyperglycemic medications may be beneficial, others may increase the risk of adverse clinical outcomes of COVID-19. We aimed to analyze the effect of antihyperglycemic medications on COVID-19. We searched the Web of Science, Cochrane Library, EMBASE, PubMed, and Scopus databases from December 2019 to June 2022 to identify literature related to patients with COVID-19 and type 2 diabetes mellitus (T2DM) treated with antihyperglycemic medications. 56 studies were included in the analysis. Metformin (OR 0.66; 95% CI 0.58-0.74; p < 0.05), Glucagon-like peptide-1 receptor agonist (GLP-1ra) (OR 0.73; 95% CI 0.59-0.91; p < 0.05), and sodium-dependent glucose transporters 2 inhibitor (SGLT 2i) (OR 0.77; 95% CI 0.69-0.87; p < 0.05) were associated with lower mortality risk, while insulin was associated with increased mortality risk (OR 1.40; 95% CI 1.26-1.55; p < 0.05). Meanwhile, metformin (OR 0.65; 95% CI 0.50-0.85; p < 0.05) and GLP-1ra (OR 0.84; 95% CI 0.76-0.94; p < 0.05) were significantly associated with decreased severe manifestation risk. What's more, metformin (OR 0.77; 95% CI 0.62-0.96; p < 0.05), GLP-1ra (OR 0.86; 95% CI 0.81-0.92; p < 0.05), and SGLT 2i (OR 0.87; 95% CI 0.79-0.97; p < 0.05) were also associated with a decreased risk of hospitalization, but insulin were associated with an increased risk of hospitalization (OR 1.31; 95% CI 1.12-1.52; p < 0.05). Nevertheless, the results of the subgroup analyses showed that the effects of different glucose-lowering agents on COVID-19 may be related to in-hospital use or out-hospital use, elderly or non-elderly patients use, and different geography. Metformin, GLP-1ra, and SGLT 2i have shown a positive effect on clinical outcomes in COVID-19, particularly in non-elderly individuals. However, insulin use may pose a higher risk, especially in elderly patients, so need with caution. Meanwhile, DPP-4i, TZD, α-GLUi, and sulfonylureas appeared to have a neutral effect. These results need to be validated in future clinical studies. |
16/12/2023 | The Impacts of COVID-19 on the Management of Ankle Fractures and their Outcomes: A Systematic Review. | The COVID-19 pandemic is still an unresolved situation in Thailand and worldwide at large. The purpose of this study was to interpret the impacts of COVID-19 on the management of ankle fractures and their outcomes. A systematic search and review were performed in accordance with the PRISMA guideline based on the PubMed database. The search terms were 'ankle fracture' and 'COVID'. From an initial search, a total of 29 abstracts were found and screened in accordance with the eligibility criteria. Then, five articles were considered eligible papers for further review. This review investigated a total of 16,813 patients with ankle fractures, including 215 patients (1.27%) who were also COVID-19-positive. According to our results, the incidence of ankle fractures showed a decrease during the pandemic. However, COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including chronic kidney disease, diabetes, hypertension, and obesity. COVID-19 infection was a factor that delayed the operation and increased the length of hospital stay and adverse effects from the surgery. COVID-19 infection affected the management of ankle fractures and their outcomes in terms of negative impacts such as delayed operation, increased length of hospital stay, and increased adverse effects from the surgery. Outpatient surgery was recommended to solve some of these problems. | ['Systematic Review', 'Journal Article'] | ['Humans', 'Ankle Fractures', 'Pandemics', 'Fracture Fixation, Internal', 'COVID-19', 'Length of Stay'] | 38,088,098 | 1 | The Impacts of COVID-19 on the Management of Ankle Fractures and their Outcomes: A Systematic Review. The COVID-19 pandemic is still an unresolved situation in Thailand and worldwide at large. The purpose of this study was to interpret the impacts of COVID-19 on the management of ankle fractures and their outcomes. A systematic search and review were performed in accordance with the PRISMA guideline based on the PubMed database. The search terms were 'ankle fracture' and 'COVID'. From an initial search, a total of 29 abstracts were found and screened in accordance with the eligibility criteria. Then, five articles were considered eligible papers for further review. This review investigated a total of 16,813 patients with ankle fractures, including 215 patients (1.27%) who were also COVID-19-positive. According to our results, the incidence of ankle fractures showed a decrease during the pandemic. However, COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including chronic kidney disease, diabetes, hypertension, and obesity. COVID-19 infection was a factor that delayed the operation and increased the length of hospital stay and adverse effects from the surgery. COVID-19 infection affected the management of ankle fractures and their outcomes in terms of negative impacts such as delayed operation, increased length of hospital stay, and increased adverse effects from the surgery. Outpatient surgery was recommended to solve some of these problems. |
15/06/2021 | Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. | To assess the effect of periodontal treatment (PT) on glomerular filtration rate (GFR), systemic inflammation, or mortality in patients with chronic kidney disease (CKD). A literature search was performed on PubMed and Web of Science databases on articles published until December 2019. The PRISMA guidelines were used throughout the manuscript. Of the total studies found, only 18 met the inclusion criteria; four retrospective and 14 prospective studies (including 3 randomized controlled trials-RCT). After PT, 3 studies investigated GFR, 2 found significant improvement; 11 (including 2 RCTs) investigated C-reactive protein levels, 9 found a significant improvement (including the 2 RCTs); 5 (including 3 RCTs) investigated Interleukine-6 level, 4 found a significant improvement (including 2 RCTs) and 2 studies evaluated mortality, one (retrospective study) found a significant difference. Within the limitations of the present study, PT seems to improve CKD status, especially by reducing the systemic inflammation. Further RCTs are needed to confirm the results and specifically assess the influence of different types of PT in CKD patients. Taking into consideration the ability of PT to prevent further tooth loss and denutrition, early management of periodontitis is extremely important in patients with impaired renal function. | ['Journal Article', 'Systematic Review'] | ['Glomerular Filtration Rate', 'Humans', 'Periodontitis', 'Renal Insufficiency, Chronic'] | 33,481,920 | 1 | Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. To assess the effect of periodontal treatment (PT) on glomerular filtration rate (GFR), systemic inflammation, or mortality in patients with chronic kidney disease (CKD). A literature search was performed on PubMed and Web of Science databases on articles published until December 2019. The PRISMA guidelines were used throughout the manuscript. Of the total studies found, only 18 met the inclusion criteria; four retrospective and 14 prospective studies (including 3 randomized controlled trials-RCT). After PT, 3 studies investigated GFR, 2 found significant improvement; 11 (including 2 RCTs) investigated C-reactive protein levels, 9 found a significant improvement (including the 2 RCTs); 5 (including 3 RCTs) investigated Interleukine-6 level, 4 found a significant improvement (including 2 RCTs) and 2 studies evaluated mortality, one (retrospective study) found a significant difference. Within the limitations of the present study, PT seems to improve CKD status, especially by reducing the systemic inflammation. Further RCTs are needed to confirm the results and specifically assess the influence of different types of PT in CKD patients. Taking into consideration the ability of PT to prevent further tooth loss and denutrition, early management of periodontitis is extremely important in patients with impaired renal function. |
19/03/2024 | The impact of sprint interval training <i>versus</i> moderate intensity continuous training on blood pressure and cardiorespiratory health in adults: a systematic review and meta-analysis. | Although aerobic exercise is the primary modality recommended for the treatment of hypertension, it remains unclear whether high-intensity all-out sprint interval training (SIT) can result in greater reductions of blood pressure (BP) and cardiorespiratory health. This systematic review aims to compare the impact of SIT <i>versus</i> Moderate-intensity continuous training (MICT) on improvements in resting systolic blood pressure (SBP), diastolic blood pressure (DBP) and maximal oxygen uptake (VO<sub>2</sub> max) among adults. We conducted a systematic search of three online databases (PubMed, Embase, and Web of Science) from January 2000 to July 2023 to identify randomized controlled trials that compared the chronic effects of SIT <i>versus</i> MICT on BP in participants with high or normal blood pressure. We extracted information on participant characteristics, exercise protocols, BP outcomes, and intervention settings. Furthermore, the changes in VO<sub>2</sub> max between the two groups were analyzed using a meta-analysis. The pooled results were presented as weighted means with 95% confidence intervals (CI). Out of the 1,874 studies initially were found, eight were included in this review, totaling 169 participants. A significant decrease in SBP (MD = -2.82 mmHg, 95% CI [-4.53 to -1.10], <i>p</i> = 0.08, <i>I</i><sup>2</sup> =45%) was observed in the SIT group compared to before the training, but no significant decrease in DBP (MD = -0.75 mmHg, 95% CI [-1.92 to 0.42], <i>p</i> = 0.16, <i>I</i><sup>2</sup> = 33%) was observed. In contrast, both SBP (MD = -3.00 mmHg, 95% CI [-5.31 to -0.69], <i>p</i> = 0.68, <i>I</i><sup>2</sup> = 0%) and DBP (MD = -2.11 mmHg, 95% CI [-3.63 to -0.60], <i>p</i> = 0.72, <i>I</i><sup>2</sup> = 0%) significantly decreased in the MICT group with low heterogeneity. No significant difference was found in resting SBP and DBP between SIT and MICT after the intervention. Both SIT and MICT significantly increased VO<sub>2</sub> peak, with SIT resulting in a mean difference (MD) of 1.75 mL/kg/min (95% CI [0.39-3.10], <i>p</i> = 0.02, <i>I</i><sup>2</sup> = 61%), and MICT resulting in a mean difference of 3.10 mL/kg/min (95% CI [1.03-5.18], <i>p</i> = 0.007, <i>I</i><sup>2</sup> = 69%). MICT was more effective in improving VO<sub>2</sub> peak (MD = -1.36 mL/kg/min, 95% CI [-2.31 to 0.40], <i>p</i> = 0.56, <i>I</i><sup>2</sup> = 0%). Subgroup analysis of duration and single sprint time showed that SIT was more effective in reducing SBP when the duration was ≥8 weeks or when the sprint time was <30 s. Our meta-analysis showed that SIT is an effective intervention in reducing BP and improving cardiorespiratory fitness among adults. Consequently, SIT can be used in combination with traditional MICT to increase the variety, utility, and time efficiency of exercise prescriptions for different populations. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Adult', 'Humans', 'Blood Pressure', 'High-Intensity Interval Training', 'Hypertension', 'Exercise Therapy', 'Exercise', 'Hypotension'] | 38,495,758 | 0 | The impact of sprint interval training <i>versus</i> moderate intensity continuous training on blood pressure and cardiorespiratory health in adults: a systematic review and meta-analysis. Although aerobic exercise is the primary modality recommended for the treatment of hypertension, it remains unclear whether high-intensity all-out sprint interval training (SIT) can result in greater reductions of blood pressure (BP) and cardiorespiratory health. This systematic review aims to compare the impact of SIT <i>versus</i> Moderate-intensity continuous training (MICT) on improvements in resting systolic blood pressure (SBP), diastolic blood pressure (DBP) and maximal oxygen uptake (VO<sub>2</sub> max) among adults. We conducted a systematic search of three online databases (PubMed, Embase, and Web of Science) from January 2000 to July 2023 to identify randomized controlled trials that compared the chronic effects of SIT <i>versus</i> MICT on BP in participants with high or normal blood pressure. We extracted information on participant characteristics, exercise protocols, BP outcomes, and intervention settings. Furthermore, the changes in VO<sub>2</sub> max between the two groups were analyzed using a meta-analysis. The pooled results were presented as weighted means with 95% confidence intervals (CI). Out of the 1,874 studies initially were found, eight were included in this review, totaling 169 participants. A significant decrease in SBP (MD = -2.82 mmHg, 95% CI [-4.53 to -1.10], <i>p</i> = 0.08, <i>I</i><sup>2</sup> =45%) was observed in the SIT group compared to before the training, but no significant decrease in DBP (MD = -0.75 mmHg, 95% CI [-1.92 to 0.42], <i>p</i> = 0.16, <i>I</i><sup>2</sup> = 33%) was observed. In contrast, both SBP (MD = -3.00 mmHg, 95% CI [-5.31 to -0.69], <i>p</i> = 0.68, <i>I</i><sup>2</sup> = 0%) and DBP (MD = -2.11 mmHg, 95% CI [-3.63 to -0.60], <i>p</i> = 0.72, <i>I</i><sup>2</sup> = 0%) significantly decreased in the MICT group with low heterogeneity. No significant difference was found in resting SBP and DBP between SIT and MICT after the intervention. Both SIT and MICT significantly increased VO<sub>2</sub> peak, with SIT resulting in a mean difference (MD) of 1.75 mL/kg/min (95% CI [0.39-3.10], <i>p</i> = 0.02, <i>I</i><sup>2</sup> = 61%), and MICT resulting in a mean difference of 3.10 mL/kg/min (95% CI [1.03-5.18], <i>p</i> = 0.007, <i>I</i><sup>2</sup> = 69%). MICT was more effective in improving VO<sub>2</sub> peak (MD = -1.36 mL/kg/min, 95% CI [-2.31 to 0.40], <i>p</i> = 0.56, <i>I</i><sup>2</sup> = 0%). Subgroup analysis of duration and single sprint time showed that SIT was more effective in reducing SBP when the duration was ≥8 weeks or when the sprint time was <30 s. Our meta-analysis showed that SIT is an effective intervention in reducing BP and improving cardiorespiratory fitness among adults. Consequently, SIT can be used in combination with traditional MICT to increase the variety, utility, and time efficiency of exercise prescriptions for different populations. |
24/12/2020 | Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis. | This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE. A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool. Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively. Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies. | ['Meta-Analysis'] | [] | 33,652,513 | 0 | Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis. This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE. A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool. Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively. Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies. |
16/12/2022 | Cardiovascular and kidney outcomes of combination therapy with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta-analysis. | Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use. We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta-analysis to indirectly compare the treatments. The primary outcome was a composite of CV events. Eight studies were selected with 36,186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]). Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Diabetes Mellitus, Type 2', 'Sodium-Glucose Transporter 2 Inhibitors', 'Mineralocorticoid Receptor Antagonists', 'Network Meta-Analysis', 'Renal Insufficiency, Chronic', 'Kidney', 'Glucose', 'Sodium', 'Cardiovascular Diseases', 'Hypoglycemic Agents'] | 36,403,681 | 1 | Cardiovascular and kidney outcomes of combination therapy with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta-analysis. Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use. We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta-analysis to indirectly compare the treatments. The primary outcome was a composite of CV events. Eight studies were selected with 36,186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]). Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD. |
04/06/2024 | A Systematic Review and Meta-Analysis of the Effects of Statin Therapy on Heart Transplantation. | Most of the mortality after Heart Transplantation (HT) is attributed to severe cardiac allograft vasculopathy (CAV) and rejection. This meta-analysis aimed to investigate the effects of postoperative statin therapy on outcomes (mortality, rejection, and CAV in HT patients). This systematic review and meta-analysis was performed on publications between 1980 and October 2023 in Web of Science, Scopus, PubMed, Cochrane, Science Direct, Google Scholar, and Embase databases. Heterogeneity was assessed using Chi-square, I2, and forest plots. Publication bias was evaluated using Begg's and Egger's tests. Analyses were performed in Stata 15 with significance at p < 0.05. This meta-analysis included 17 studies comprising 4,627 participants and conducted between 1995 to 2021. Compared to non-users, the odds of mortality were lower among statin users (OR= 0.49, 95% CI: 0.32-0.75, p < 0.001). The odds of CAV were also reduced with statin use (OR= 0.71, 95% CI: 0.53-0.96, p = 0.027). The odds of rejection were not significantly different (OR= 0.69, 95% CI: 0.41-1.15, p = 0.152). However, rejection odds were lower with statins in RCTs (OR= 0.42, 95% CI: 0.21-0.82, p = 0.012) but not in case-control studies (OR= 0.87, 95% CI: 0.49-1.52, p = 0.615). No publication bias was observed with Begg's test, but Egger's test showed possible bias. This meta-analysis found postoperative statin use associated with lower mortality and CAV, but not overall rejection, though RCT subgroup analysis showed decreased rejection with statins. Statin therapy may improve prognosis in HT patients. | ['Journal Article', 'Meta-Analysis'] | [] | 38,840,403 | 0 | A Systematic Review and Meta-Analysis of the Effects of Statin Therapy on Heart Transplantation. Most of the mortality after Heart Transplantation (HT) is attributed to severe cardiac allograft vasculopathy (CAV) and rejection. This meta-analysis aimed to investigate the effects of postoperative statin therapy on outcomes (mortality, rejection, and CAV in HT patients). This systematic review and meta-analysis was performed on publications between 1980 and October 2023 in Web of Science, Scopus, PubMed, Cochrane, Science Direct, Google Scholar, and Embase databases. Heterogeneity was assessed using Chi-square, I2, and forest plots. Publication bias was evaluated using Begg's and Egger's tests. Analyses were performed in Stata 15 with significance at p < 0.05. This meta-analysis included 17 studies comprising 4,627 participants and conducted between 1995 to 2021. Compared to non-users, the odds of mortality were lower among statin users (OR= 0.49, 95% CI: 0.32-0.75, p < 0.001). The odds of CAV were also reduced with statin use (OR= 0.71, 95% CI: 0.53-0.96, p = 0.027). The odds of rejection were not significantly different (OR= 0.69, 95% CI: 0.41-1.15, p = 0.152). However, rejection odds were lower with statins in RCTs (OR= 0.42, 95% CI: 0.21-0.82, p = 0.012) but not in case-control studies (OR= 0.87, 95% CI: 0.49-1.52, p = 0.615). No publication bias was observed with Begg's test, but Egger's test showed possible bias. This meta-analysis found postoperative statin use associated with lower mortality and CAV, but not overall rejection, though RCT subgroup analysis showed decreased rejection with statins. Statin therapy may improve prognosis in HT patients. |
19/04/2022 | Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis. | To systematically evaluate the prognostic factors for mortality in bullous pemphigoid. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc and Wanfang Database were searched to collect literature on the prognostic factors for mortality in bullous pemphigoid. The quality of studies was assessed by Newcastle-Ottawa Quality Assessment Scale. Two researchers extracted relevant data and scored study quality independently. The hazard ratio (HR) was calculated using the random effects model. Study heterogeneity was assessed using both Cochran's Q test and I2 statistics. The causes of heterogeneity were assessed by subgroup analysis and/ or sensitivity analysis when heterogeneity was significant. When ten or more studies were included as outcome indicators, publication bias was evaluated by funnel plot and Egger's test. Out of a total of 1,546 articles retrieved, 15 studies involving 2,435 patients were included. The meta-analysis showed that the mortality of patients with bullous pemphigoid increased with positive bullous pemphigoid 180 antibody (HR = 1.85, 95%CI: 1.25~2.75, P = 0.002); concomitant dementia (HR = 2.26, 95%CI: 1.43~3.59, P<0.001); stroke (HR = 2.09, 95% CI: 1.23-3.55, P = 0.007); heart disease (HR = 1.96, 95% CI: 1.41-2.73, P<0.001) and diabetes mellitus (HR = 2.39, 95% CI: 1.55-3.69, P<0.001). Sex, positive indirect immunofluorescence and hypertension were not associated with prognosis. Positive bullous pemphigoid 180 antibody, dementia, stroke, heart disease and diabetes mellitus were the prognostic factors for mortality in bullous pemphigoid. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Dementia', 'Heart Diseases', 'Humans', 'Pemphigoid, Bullous', 'Prognosis', 'Stroke'] | 35,427,358 | 0 | Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis. To systematically evaluate the prognostic factors for mortality in bullous pemphigoid. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc and Wanfang Database were searched to collect literature on the prognostic factors for mortality in bullous pemphigoid. The quality of studies was assessed by Newcastle-Ottawa Quality Assessment Scale. Two researchers extracted relevant data and scored study quality independently. The hazard ratio (HR) was calculated using the random effects model. Study heterogeneity was assessed using both Cochran's Q test and I2 statistics. The causes of heterogeneity were assessed by subgroup analysis and/ or sensitivity analysis when heterogeneity was significant. When ten or more studies were included as outcome indicators, publication bias was evaluated by funnel plot and Egger's test. Out of a total of 1,546 articles retrieved, 15 studies involving 2,435 patients were included. The meta-analysis showed that the mortality of patients with bullous pemphigoid increased with positive bullous pemphigoid 180 antibody (HR = 1.85, 95%CI: 1.25~2.75, P = 0.002); concomitant dementia (HR = 2.26, 95%CI: 1.43~3.59, P<0.001); stroke (HR = 2.09, 95% CI: 1.23-3.55, P = 0.007); heart disease (HR = 1.96, 95% CI: 1.41-2.73, P<0.001) and diabetes mellitus (HR = 2.39, 95% CI: 1.55-3.69, P<0.001). Sex, positive indirect immunofluorescence and hypertension were not associated with prognosis. Positive bullous pemphigoid 180 antibody, dementia, stroke, heart disease and diabetes mellitus were the prognostic factors for mortality in bullous pemphigoid. |
11/08/2022 | Interventions for health-related physical fitness and overweight and obesity in children with intellectual disability: Systematic review and meta-analysis. | Poor health-related physical fitness (HRPF) and overweight and obesity are common health problems for children with intellectual disability. This study aimed to review existing lifestyle intervention studies, and identify effective strategies for this population. A systematic search was undertaken in three databases. The random-effects model was used to pool the weighted results by inverse variance methods, and the I<sup>2</sup> statistic was applied to assess heterogeneity among the included studies. Most of the identified interventions (27/29) adopted physical activity (PA). For obesity-related outcomes, the results showed no significant effect of PA studies on reducing obesity. For HRPF outcomes, significant effects were found on 6-min walk distance (51.86 m, 95% CI [16.49, 87.22], p < .05). PA is the predominant intervention component adopted and may contribute to improving cardiopulmonary fitness; but the lack of research limits our ability to draw any confirmed conclusion on obesity-related outcomes and other HRPF outcomes. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Child', 'Humans', 'Intellectual Disability', 'Life Style', 'Overweight', 'Pediatric Obesity', 'Physical Fitness'] | 35,445,495 | 0 | Interventions for health-related physical fitness and overweight and obesity in children with intellectual disability: Systematic review and meta-analysis. Poor health-related physical fitness (HRPF) and overweight and obesity are common health problems for children with intellectual disability. This study aimed to review existing lifestyle intervention studies, and identify effective strategies for this population. A systematic search was undertaken in three databases. The random-effects model was used to pool the weighted results by inverse variance methods, and the I<sup>2</sup> statistic was applied to assess heterogeneity among the included studies. Most of the identified interventions (27/29) adopted physical activity (PA). For obesity-related outcomes, the results showed no significant effect of PA studies on reducing obesity. For HRPF outcomes, significant effects were found on 6-min walk distance (51.86 m, 95% CI [16.49, 87.22], p < .05). PA is the predominant intervention component adopted and may contribute to improving cardiopulmonary fitness; but the lack of research limits our ability to draw any confirmed conclusion on obesity-related outcomes and other HRPF outcomes. |
28/01/2021 | Acute kidney injury and renal replacement therapy in COVID-19 patients: A systematic review and meta-analysis. | Reported rates of acute kidney injury (AKI) have varied significantly among studies of coronavirus disease 2019 (COVID-19) published to date. The present meta-analysis was conducted to gain clarity regarding AKI incidence and renal replacement therapy (RRT) use in COVID-19 patients. The PubMed, Embase, Web of Science, medRxiv, and bioRxiv databases were systematically searched for COVID-19-related case reports published through 25 July 2020. Pooled analyses were conducted using R. The pooled incidence of AKI in 51 studies including 21,531 patients was 12.3% (95% CI 9.5-15.6%), with higher rates of 38.9% in 290 transplant patients (95% CI 27.3-51.9%), 39.0% in 565 ICU patients (95% CI 23.2-57.6%) and 42.0% among 1745 deceased patients (95% CI 30.3-54.7%). RRT usage was reported in 39 studies of 17,664 patients, with an overall pooled use of 5.4% (95% CI 4.0-7.1%), with higher rates of 15.6% in 117 transplant patients (95%CI 9.9-23.8%) and 16.3% in 776 ICU patients (95% CI 11.1-23.3%). AKI and RRT use among COVID-19 patients represent a major public health concern, and early and appropriate intervention should be called upon to improve the prognosis of patients suffering from AKI. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Acute Kidney Injury', 'COVID-19', 'China', 'Humans', 'Incidence', 'Renal Replacement Therapy', 'SARS-CoV-2'] | 33,223,467 | 1 | Acute kidney injury and renal replacement therapy in COVID-19 patients: A systematic review and meta-analysis. Reported rates of acute kidney injury (AKI) have varied significantly among studies of coronavirus disease 2019 (COVID-19) published to date. The present meta-analysis was conducted to gain clarity regarding AKI incidence and renal replacement therapy (RRT) use in COVID-19 patients. The PubMed, Embase, Web of Science, medRxiv, and bioRxiv databases were systematically searched for COVID-19-related case reports published through 25 July 2020. Pooled analyses were conducted using R. The pooled incidence of AKI in 51 studies including 21,531 patients was 12.3% (95% CI 9.5-15.6%), with higher rates of 38.9% in 290 transplant patients (95% CI 27.3-51.9%), 39.0% in 565 ICU patients (95% CI 23.2-57.6%) and 42.0% among 1745 deceased patients (95% CI 30.3-54.7%). RRT usage was reported in 39 studies of 17,664 patients, with an overall pooled use of 5.4% (95% CI 4.0-7.1%), with higher rates of 15.6% in 117 transplant patients (95%CI 9.9-23.8%) and 16.3% in 776 ICU patients (95% CI 11.1-23.3%). AKI and RRT use among COVID-19 patients represent a major public health concern, and early and appropriate intervention should be called upon to improve the prognosis of patients suffering from AKI. |
20/10/2020 | Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. | In urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute. We performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer. We searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019. We focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included. Data extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed. 28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis. Women, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers. | ['Journal Article', "Research Support, Non-U.S. Gov't", "Research Support, U.S. Gov't, Non-P.H.S.", 'Systematic Review'] | ['Critical Pathways', 'Delayed Diagnosis', 'Diagnostic Techniques, Urological', 'Guideline Adherence', 'Hematuria', 'Humans', 'Kidney Neoplasms', 'Lower Urinary Tract Symptoms', 'Practice Guidelines as Topic', 'Primary Health Care', 'Process Assessment, Health Care', 'Referral and Consultation', 'Sex Factors', 'Symptom Assessment', 'Time Factors', 'Urinary Bladder Neoplasms', 'Urinary Tract Infections', 'Urology'] | 31,585,970 | 1 | Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. In urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute. We performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer. We searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019. We focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included. Data extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed. 28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis. Women, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers. |
28/07/2020 | Prevalence of Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia trachomatis Determined by Molecular Testing in Ocular Adnexa Lymphoma Specimens. | To assess the prevalence of Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia trachomatis in ocular adnexa lymphoma (OAL) determined by molecular testing in different countries and the potential association of Chlamydia infection with mucosa-associated lymphoid tissue (MALT) histotype by performing a systematic review and meta-analysis. Electronic databases were searched for studies assessing the presence of Chlamydia in OAL. Pooled prevalence of the three Chlamydia species was calculated in each country. An odds ratio was calculated for the association between Chlamydia and MALT histotype, with a significant P < .05. Thirty-seven studies with 1,188 OALs were included. Pooled prevalence of C psittaci, C pneumoniae, and C trachomatis by country was done. Chlamydia infection was significantly associated with MALT histotype (odds ratio, 2.183; P = .027). The involvement of C psittaci in OAL is highly variable, with the highest prevalence in Italy and Korea. Chlamydia is associated with MALT histotype. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Chlamydia Infections', 'Chlamydia trachomatis', 'Chlamydophila pneumoniae', 'Chlamydophila psittaci', 'Eye Neoplasms', 'Humans', 'Lymphoma'] | 31,755,895 | 0 | Prevalence of Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia trachomatis Determined by Molecular Testing in Ocular Adnexa Lymphoma Specimens. To assess the prevalence of Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia trachomatis in ocular adnexa lymphoma (OAL) determined by molecular testing in different countries and the potential association of Chlamydia infection with mucosa-associated lymphoid tissue (MALT) histotype by performing a systematic review and meta-analysis. Electronic databases were searched for studies assessing the presence of Chlamydia in OAL. Pooled prevalence of the three Chlamydia species was calculated in each country. An odds ratio was calculated for the association between Chlamydia and MALT histotype, with a significant P < .05. Thirty-seven studies with 1,188 OALs were included. Pooled prevalence of C psittaci, C pneumoniae, and C trachomatis by country was done. Chlamydia infection was significantly associated with MALT histotype (odds ratio, 2.183; P = .027). The involvement of C psittaci in OAL is highly variable, with the highest prevalence in Italy and Korea. Chlamydia is associated with MALT histotype. |
16/10/2020 | Efficacy of Chinese Herbal Injections for the Treatment of Primary Nephrotic Syndrome: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. | Considering the adverse reactions and side effects of immunosuppressive and cytotoxic drugs for the treatment of Primary Nephrotic Syndrome (PNS) and the extensive exploration of Chinese herbal injections (CHIs), systematic evaluation of the efficacy of different CHIs in the treatment of PNS is a key imperative. In this study, we performed a network meta-analysis to investigate the efficacy of CHIs in the treatment of PNS. A systematic literature review including studies published from the establishment of each database to May 28, 2020, was conducted in PubMed, the Cochrane Library, Embase, Web of Science, the Chinese Biological Medicine Literature Service System (CBM), the China National Knowledge Infrastructure (CNKI) database, the Chinese Scientific Journal Database (VIP), and the Wanfang Database (WF).Two evaluators independently screened the literature, extracted data and the Cochrane Reviewer's Handbook 5.1 method was used to evaluate the quality of included studies. The differences in efficacy of different CHIs were compared and ranked using Stata 16.0 software. Surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Clustering analysis was performed to compare the effects of CHIs between two different outcomes. A total of 41 eligible randomized controlled trials involving 2879 patients and nine CHIs were included. Nine CHIs were Xiangdan injection (XDI), Huangqi injection (HQI), Shenkang injection (SKI), Danshen injection (DSI), Yinxingdamo injection (YXI), Dengzhanhuasu injection (DZI), Danhong injection (DHI), Shuxuetong injection (SXI), Chuanxiongqin injection (CXI). The results of the network meta-analysis showed that: with Western medical (WM) treatment as a co-intervention, in terms of improving the total clinical effectiveness and serum albumin level, DHI was the most likely to be the best choice for treatment (SUCRA = 82.2%); YXI had the highest probability of being the best option in terms of reducing 24-h urinary protein excretion (SUCRA = 97.8%); in cholesterol-lowering comparisons, the SUCRA value allows for the most likely to be the best treatment is DZI (SUCRA = 84.5%). SXI was the most effective CHIs in terms of lowering serum triglycerides (SUCRA = 85.6%), whereas on the reducing fibrinogen side, the efficacy of CXI was significant (SUCRA = 67.6%). The result cluster analysis indicated that YXI and DHI were the best interventions with respect to total clinical effectiveness, 24-h urinary protein excretion and serum albumin. CHIs were found to be superior to WM alone in the treatment of PNS and may be beneficial for patients with PNS. WM+YXI and WM+DHI had the potential to be the best CHI with respect to the total clinical effectiveness, 24-h urinary protein excretion and serum albumin. However, more well-designed randomized controlled trials are still warranted. | ['Systematic Review'] | [] | 33,178,022 | 1 | Efficacy of Chinese Herbal Injections for the Treatment of Primary Nephrotic Syndrome: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Considering the adverse reactions and side effects of immunosuppressive and cytotoxic drugs for the treatment of Primary Nephrotic Syndrome (PNS) and the extensive exploration of Chinese herbal injections (CHIs), systematic evaluation of the efficacy of different CHIs in the treatment of PNS is a key imperative. In this study, we performed a network meta-analysis to investigate the efficacy of CHIs in the treatment of PNS. A systematic literature review including studies published from the establishment of each database to May 28, 2020, was conducted in PubMed, the Cochrane Library, Embase, Web of Science, the Chinese Biological Medicine Literature Service System (CBM), the China National Knowledge Infrastructure (CNKI) database, the Chinese Scientific Journal Database (VIP), and the Wanfang Database (WF).Two evaluators independently screened the literature, extracted data and the Cochrane Reviewer's Handbook 5.1 method was used to evaluate the quality of included studies. The differences in efficacy of different CHIs were compared and ranked using Stata 16.0 software. Surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Clustering analysis was performed to compare the effects of CHIs between two different outcomes. A total of 41 eligible randomized controlled trials involving 2879 patients and nine CHIs were included. Nine CHIs were Xiangdan injection (XDI), Huangqi injection (HQI), Shenkang injection (SKI), Danshen injection (DSI), Yinxingdamo injection (YXI), Dengzhanhuasu injection (DZI), Danhong injection (DHI), Shuxuetong injection (SXI), Chuanxiongqin injection (CXI). The results of the network meta-analysis showed that: with Western medical (WM) treatment as a co-intervention, in terms of improving the total clinical effectiveness and serum albumin level, DHI was the most likely to be the best choice for treatment (SUCRA = 82.2%); YXI had the highest probability of being the best option in terms of reducing 24-h urinary protein excretion (SUCRA = 97.8%); in cholesterol-lowering comparisons, the SUCRA value allows for the most likely to be the best treatment is DZI (SUCRA = 84.5%). SXI was the most effective CHIs in terms of lowering serum triglycerides (SUCRA = 85.6%), whereas on the reducing fibrinogen side, the efficacy of CXI was significant (SUCRA = 67.6%). The result cluster analysis indicated that YXI and DHI were the best interventions with respect to total clinical effectiveness, 24-h urinary protein excretion and serum albumin. CHIs were found to be superior to WM alone in the treatment of PNS and may be beneficial for patients with PNS. WM+YXI and WM+DHI had the potential to be the best CHI with respect to the total clinical effectiveness, 24-h urinary protein excretion and serum albumin. However, more well-designed randomized controlled trials are still warranted. |
18/08/2021 | Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis. | This network meta-analysis aimed at comparing the efficacy of local control strategies after neoadjuvant chemotherapy in patients with Ewing sarcoma. Network meta-analysis was used to synthesize direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. There are three treatment options for local Ewing's sarcoma after neoadjuvant chemotherapy, namely surgery, radiotherapy and surgery plus radiotherapy (SR). Records of 2540 patients from 11 studies were analyzed. Potentially relevant studies were retrieved from PubMed and Embase, and screened according to inclusion and exclusion criteria. Hazard ratios and the associated 95% confidence intervals were used to describe the efficacy of different interventions on 5-year local recurrence rate and 5-year event-free survival rate. Surface under the cumulative ranking curve (SUCRA) was calculated for ranking probabilities of different treatment. Compared with radiotherapy, surgery had better efficacy [local recurrence, OR (95% CI) 0.48 (0.33 - 0.87)] and SR had a similar effect as surgery [local recurrence, OR (95% CI) 0.50 (0.29 - 0.82)]. There were no statistically significant differences between three different local control strategies in 5-year local recurrence rate. SUCRA values suggested that surgery was better than SR for 5-year local recurrence rate (0.79 vs 0.70) and 5-year event free survival rate (0.67 vs 0.50), respectively. Both surgery and SR were superior to radiotherapy in reducing 5-yer local recurrence of patients with Ewing sarcoma after neoadjuvant chemotherapy. Surgery had higher efficacy than SR on improving the prognosis of patients. | ['Meta-Analysis', 'Systematic Review'] | ['Antineoplastic Combined Chemotherapy Protocols', 'Bone Neoplasms', 'Humans', 'Neoadjuvant Therapy', 'Neoplasm Recurrence, Local', 'Network Meta-Analysis', 'Sarcoma, Ewing', 'Treatment Outcome'] | 32,221,054 | 0 | Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis. This network meta-analysis aimed at comparing the efficacy of local control strategies after neoadjuvant chemotherapy in patients with Ewing sarcoma. Network meta-analysis was used to synthesize direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. There are three treatment options for local Ewing's sarcoma after neoadjuvant chemotherapy, namely surgery, radiotherapy and surgery plus radiotherapy (SR). Records of 2540 patients from 11 studies were analyzed. Potentially relevant studies were retrieved from PubMed and Embase, and screened according to inclusion and exclusion criteria. Hazard ratios and the associated 95% confidence intervals were used to describe the efficacy of different interventions on 5-year local recurrence rate and 5-year event-free survival rate. Surface under the cumulative ranking curve (SUCRA) was calculated for ranking probabilities of different treatment. Compared with radiotherapy, surgery had better efficacy [local recurrence, OR (95% CI) 0.48 (0.33 - 0.87)] and SR had a similar effect as surgery [local recurrence, OR (95% CI) 0.50 (0.29 - 0.82)]. There were no statistically significant differences between three different local control strategies in 5-year local recurrence rate. SUCRA values suggested that surgery was better than SR for 5-year local recurrence rate (0.79 vs 0.70) and 5-year event free survival rate (0.67 vs 0.50), respectively. Both surgery and SR were superior to radiotherapy in reducing 5-yer local recurrence of patients with Ewing sarcoma after neoadjuvant chemotherapy. Surgery had higher efficacy than SR on improving the prognosis of patients. |
04/03/2024 | Association between urbanization and metabolic syndrome in low- and middle-income countries: A systematic review and meta-analysis. | The prevalence of metabolic syndrome (MetS) is on the rise in an increasingly urbanized world. The study aimed to review the association between urbanization and MetS in low- and middle-income countries (LMICs). A comprehensive search of five databases (MEDLINE, Web of Science, Scopus, EMBASE, and CENTRAL) was performed in January 2022 and updated in October 2022. Peer-reviewed studies that met the eligibility selection criteria were included. Search terms were used for the main concepts which are MetS, dietary patterns, and urbanization in LMICs. Study selection was done in two stages and in duplicate. Random effects models were used to calculate the overall pooled prevalence and main study-level characteristics. Out of 9,773 identified studies, nineteen were included in the systematic review and meta-analysis. The studies were done on 313,644 participants (149,616 urban and 164,028 rural). The pooled risk ratio (RR, 95% confidence interval) of MetS between urban and rural dwellers was RR = 1.24; 95%CI [1.15, 1.34] (I<sup>2</sup> = 96.0%, P < 0.0001). A relatively higher prevalence of MetS among urban than rural residents has been observed, especially with the International Diabetes Federation criteria (RR = 1.54; 95%CI [1.21, 1.96]; I<sup>2</sup> = 65.0%), and in the population in India (RR = 2.19; 95%CI = 1.24, 3.88, I<sup>2</sup> = 85%). Overall, the role of dietary patterns in the development of MetS was inconsistent, and few studies showed a lower risk of MetS with adherence to recommended healthy dietary patterns. There was an association between urbanization and the high prevalence of MetS. Interventions and policies to reduce the risk of MetS are needed. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Metabolic Syndrome', 'Urbanization', 'Developing Countries', 'Databases, Factual', 'Dietary Patterns'] | 38,182,494 | 0 | Association between urbanization and metabolic syndrome in low- and middle-income countries: A systematic review and meta-analysis. The prevalence of metabolic syndrome (MetS) is on the rise in an increasingly urbanized world. The study aimed to review the association between urbanization and MetS in low- and middle-income countries (LMICs). A comprehensive search of five databases (MEDLINE, Web of Science, Scopus, EMBASE, and CENTRAL) was performed in January 2022 and updated in October 2022. Peer-reviewed studies that met the eligibility selection criteria were included. Search terms were used for the main concepts which are MetS, dietary patterns, and urbanization in LMICs. Study selection was done in two stages and in duplicate. Random effects models were used to calculate the overall pooled prevalence and main study-level characteristics. Out of 9,773 identified studies, nineteen were included in the systematic review and meta-analysis. The studies were done on 313,644 participants (149,616 urban and 164,028 rural). The pooled risk ratio (RR, 95% confidence interval) of MetS between urban and rural dwellers was RR = 1.24; 95%CI [1.15, 1.34] (I<sup>2</sup> = 96.0%, P < 0.0001). A relatively higher prevalence of MetS among urban than rural residents has been observed, especially with the International Diabetes Federation criteria (RR = 1.54; 95%CI [1.21, 1.96]; I<sup>2</sup> = 65.0%), and in the population in India (RR = 2.19; 95%CI = 1.24, 3.88, I<sup>2</sup> = 85%). Overall, the role of dietary patterns in the development of MetS was inconsistent, and few studies showed a lower risk of MetS with adherence to recommended healthy dietary patterns. There was an association between urbanization and the high prevalence of MetS. Interventions and policies to reduce the risk of MetS are needed. |
20/03/2023 | Do phthalates and their metabolites cause poor semen quality? A systematic review and meta-analysis of epidemiological studies on risk of decline in sperm quality. | A systematic review and meta-analysis were conducted to understand the association of phthalates and their metabolites with sperm quality in humans. By June 30, 2022, relevant literature on the effects of phthalates and their metabolites on sperm quality were searched and collected using three English-language databases including PubMed, EMbase, and Web of Science. Two researchers independently screened literature, extracted data, and assessed risk of bias. Stata 11 and RevMan 5.3 were used to conduct meta-analysis, test publication bias, and sensitivity analysis. A total of 12 literature were included for meta-analysis, excluding literature with different effect sizes. The results of meta-analysis indicated that monobutyl phthalate (MBP) and monobenzyl phthalate (MBzP) in urine were negatively correlated with semen concentration, and the results were statistically significant (MBP, pooled odds ratio (OR), 95% confidence interval (CI): 2.186 (1.471, 3.248), P < 0.05) and (MBzP, pooled OR (95%CI): 1.882 (1.471, 3.248), P < 0.05). Furthermore, the level of Di-(2-ethylhexyl) phthalate (DEHP) in semen was negatively correlated with semen concentration and the combined effect size was (pooled correlation coefficients (r) (95%CI): -0.225 (-0.319, -0.192), P < 0.05). However, the associations between MBP and MBzP with sperm motility and sperm morphology were not statistically significant (P > 0.05). And there was also no significant correlation between monoethyl phthalate (MEP), monomethyl phthalate (MMP), and mono-2-ethylhexyl phthalate (MEHP) and semen parameters, including semen concentration, sperm motility, and sperm morphology (P > 0.05). In summary, this current study provides moderate-certainty evidence for the data demonstrated that is a negative correlation between urine MBP levels, urine MBzP levels, and semen DEHP levels with semen concentration. In the future, more longitudinal cohort studies are needed to help elucidate the overall association. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Male', 'Humans', 'Semen Analysis', 'Semen', 'Diethylhexyl Phthalate', 'Sperm Motility', 'Environmental Exposure', 'Spermatozoa', 'Phthalic Acids', 'Cohort Studies', 'Environmental Pollutants'] | 36,504,299 | 0 | Do phthalates and their metabolites cause poor semen quality? A systematic review and meta-analysis of epidemiological studies on risk of decline in sperm quality. A systematic review and meta-analysis were conducted to understand the association of phthalates and their metabolites with sperm quality in humans. By June 30, 2022, relevant literature on the effects of phthalates and their metabolites on sperm quality were searched and collected using three English-language databases including PubMed, EMbase, and Web of Science. Two researchers independently screened literature, extracted data, and assessed risk of bias. Stata 11 and RevMan 5.3 were used to conduct meta-analysis, test publication bias, and sensitivity analysis. A total of 12 literature were included for meta-analysis, excluding literature with different effect sizes. The results of meta-analysis indicated that monobutyl phthalate (MBP) and monobenzyl phthalate (MBzP) in urine were negatively correlated with semen concentration, and the results were statistically significant (MBP, pooled odds ratio (OR), 95% confidence interval (CI): 2.186 (1.471, 3.248), P < 0.05) and (MBzP, pooled OR (95%CI): 1.882 (1.471, 3.248), P < 0.05). Furthermore, the level of Di-(2-ethylhexyl) phthalate (DEHP) in semen was negatively correlated with semen concentration and the combined effect size was (pooled correlation coefficients (r) (95%CI): -0.225 (-0.319, -0.192), P < 0.05). However, the associations between MBP and MBzP with sperm motility and sperm morphology were not statistically significant (P > 0.05). And there was also no significant correlation between monoethyl phthalate (MEP), monomethyl phthalate (MMP), and mono-2-ethylhexyl phthalate (MEHP) and semen parameters, including semen concentration, sperm motility, and sperm morphology (P > 0.05). In summary, this current study provides moderate-certainty evidence for the data demonstrated that is a negative correlation between urine MBP levels, urine MBzP levels, and semen DEHP levels with semen concentration. In the future, more longitudinal cohort studies are needed to help elucidate the overall association. |
08/04/2022 | Mesenchymal Stromal Cells for Enhancing Hematopoietic Engraftment and Treatment of Graft-Versus-Host Disease, Hemorrhages and Acute Respiratory Distress Syndrome. | Mesenchymal stromal cells (MSCs) possess profound immunomodulatory and regenerative properties that are of clinical use in numerous clinical indications with unmet medical need. Common sources of MSCs include among others, bone marrow (BM), fat, umbilical cord, and placenta-derived decidua stromal cells (DSCs). We here summarize our more than 20-years of scientific experience in the clinical use of MSCs and DSCs in different clinical settings. BM-MSCs were first explored to enhance the engraftment of autografts in hematopoietic cell transplantation (HCT) and osteogenesis imperfecta around 30 years ago. In 2004, our group reported the first anti-inflammatory use of BM-MSCs in a child with grade IV acute graft-versus-host disease (GvHD). Subsequent studies have shown that MSCs appear to be more effective in acute than chronic GvHD. Today BM-MSC-therapy is registered for acute GvHD in Japan and for GvHD in children in Canada and New Zeeland. MSCs first home to the lung following intravenous injection and exert strong local and systemic immunomodulatory effects on the host immune system. Thus, they were studied for ameliorating the cytokine storm in acute respiratory distress syndrome (ARDS). Both, MSCs and DSCs were used to treat SARS-CoV-2 coronavirus-induced disease 2019 (COVID-19)-induced ARDS. In addition, they were also used for other novel indications, such as pneumomediastinum, colon perforation, and radiculomyelopathy. MSC and DSCs trigger coagulation and were thus explored to stop hemorrhages. DSCs appear to be more effective for acute GvHD, ARDS, and hemorrhages, but randomized studies are needed to prove superiority. Stromal cell infusion is safe, well tolerated, and only gives rise to a slight fever in a limited number of patients, but no major side effects have been reported in multiple safety studies and metaanalysis. In this review we summarize current evidence from <i>in vitro</i> studies, animal models, and importantly our clinical experience, to support stromal cell therapy in multiple clinical indications. This encloses MSC's effects on the immune system, coagulation, and their safety and efficacy, which are discussed in relation to prominent clinical trials within the field. | ['Meta-Analysis', 'Systematic Review', "Research Support, Non-U.S. Gov't"] | ['Animals', 'COVID-19', 'Female', 'Graft vs Host Disease', 'Hematopoietic Stem Cell Transplantation', 'Hemorrhage', 'Humans', 'Mesenchymal Stem Cell Transplantation', 'Mesenchymal Stem Cells', 'Pregnancy', 'Respiratory Distress Syndrome', 'SARS-CoV-2'] | 35,371,003 | 0 | Mesenchymal Stromal Cells for Enhancing Hematopoietic Engraftment and Treatment of Graft-Versus-Host Disease, Hemorrhages and Acute Respiratory Distress Syndrome. Mesenchymal stromal cells (MSCs) possess profound immunomodulatory and regenerative properties that are of clinical use in numerous clinical indications with unmet medical need. Common sources of MSCs include among others, bone marrow (BM), fat, umbilical cord, and placenta-derived decidua stromal cells (DSCs). We here summarize our more than 20-years of scientific experience in the clinical use of MSCs and DSCs in different clinical settings. BM-MSCs were first explored to enhance the engraftment of autografts in hematopoietic cell transplantation (HCT) and osteogenesis imperfecta around 30 years ago. In 2004, our group reported the first anti-inflammatory use of BM-MSCs in a child with grade IV acute graft-versus-host disease (GvHD). Subsequent studies have shown that MSCs appear to be more effective in acute than chronic GvHD. Today BM-MSC-therapy is registered for acute GvHD in Japan and for GvHD in children in Canada and New Zeeland. MSCs first home to the lung following intravenous injection and exert strong local and systemic immunomodulatory effects on the host immune system. Thus, they were studied for ameliorating the cytokine storm in acute respiratory distress syndrome (ARDS). Both, MSCs and DSCs were used to treat SARS-CoV-2 coronavirus-induced disease 2019 (COVID-19)-induced ARDS. In addition, they were also used for other novel indications, such as pneumomediastinum, colon perforation, and radiculomyelopathy. MSC and DSCs trigger coagulation and were thus explored to stop hemorrhages. DSCs appear to be more effective for acute GvHD, ARDS, and hemorrhages, but randomized studies are needed to prove superiority. Stromal cell infusion is safe, well tolerated, and only gives rise to a slight fever in a limited number of patients, but no major side effects have been reported in multiple safety studies and metaanalysis. In this review we summarize current evidence from <i>in vitro</i> studies, animal models, and importantly our clinical experience, to support stromal cell therapy in multiple clinical indications. This encloses MSC's effects on the immune system, coagulation, and their safety and efficacy, which are discussed in relation to prominent clinical trials within the field. |
14/04/2021 | Costs and Healthcare Resource Use Associated with Risk of Cardiovascular Morbidity in Patients with Chronic Kidney Disease: Evidence from a Systematic Literature Review. | The management of chronic kidney disease (CKD) costs in excess of $114 billion in the USA and £1.45 billion in the UK annually and is projected to increase alongside the increasing disease prevalence. The aim of this review was to evaluate the risks of cardiovascular (CV) morbidity, CV mortality or all-cause mortality based on KDIGO (Kidney Disease: Improving Global Outcomes) 2012 categorisations and estimate the additional costs and healthcare resource utilisation associated with CV morbidity linked to CKD severity in US and UK settings. A systematic literature review was conducted of studies reporting on the risk of CV morbidity, CV mortality or all-cause mortality characterised by CKD severity (published between January 2000 and September 2018). Additional costs and bed days associated with CKD severity in the USA and UK were estimated on the basis of median hazard ratios for CV morbidity risk at each CKD and albuminuria stage. Twenty-nine studies reported risk of adverse clinical outcomes based on KDIGO categorisations. Compared to stage 1 (or without) CKD, patients with stage 5 CKD and macroalbuminuria experienced a relative risk increase of 11.77-12.46 across all outcomes. Additional costs and bed days associated with stage 5 CKD and macroalbuminuria (versus stage 1 (or without) CKD) per 1000 patient years were US$3.93 million and 803 bed days and £435,000 and 1017 bed days, in the USA and UK, respectively. Risks of adverse clinical outcomes increase with CKD and albuminuria severity and are associated with substantial additional costs and resource utilisation. Thus, early diagnosis and proactive management of CKD and its complications should be a priority for healthcare providers to alleviate the burden of CV morbidity and its management on healthcare resources. | ['Journal Article', "Research Support, Non-U.S. Gov't", 'Review', 'Systematic Review'] | ['Cardiovascular Diseases', 'Costs and Cost Analysis', 'Delivery of Health Care', 'Disease Progression', 'Humans', 'Renal Insufficiency, Chronic'] | 33,432,542 | 1 | Costs and Healthcare Resource Use Associated with Risk of Cardiovascular Morbidity in Patients with Chronic Kidney Disease: Evidence from a Systematic Literature Review. The management of chronic kidney disease (CKD) costs in excess of $114 billion in the USA and £1.45 billion in the UK annually and is projected to increase alongside the increasing disease prevalence. The aim of this review was to evaluate the risks of cardiovascular (CV) morbidity, CV mortality or all-cause mortality based on KDIGO (Kidney Disease: Improving Global Outcomes) 2012 categorisations and estimate the additional costs and healthcare resource utilisation associated with CV morbidity linked to CKD severity in US and UK settings. A systematic literature review was conducted of studies reporting on the risk of CV morbidity, CV mortality or all-cause mortality characterised by CKD severity (published between January 2000 and September 2018). Additional costs and bed days associated with CKD severity in the USA and UK were estimated on the basis of median hazard ratios for CV morbidity risk at each CKD and albuminuria stage. Twenty-nine studies reported risk of adverse clinical outcomes based on KDIGO categorisations. Compared to stage 1 (or without) CKD, patients with stage 5 CKD and macroalbuminuria experienced a relative risk increase of 11.77-12.46 across all outcomes. Additional costs and bed days associated with stage 5 CKD and macroalbuminuria (versus stage 1 (or without) CKD) per 1000 patient years were US$3.93 million and 803 bed days and £435,000 and 1017 bed days, in the USA and UK, respectively. Risks of adverse clinical outcomes increase with CKD and albuminuria severity and are associated with substantial additional costs and resource utilisation. Thus, early diagnosis and proactive management of CKD and its complications should be a priority for healthcare providers to alleviate the burden of CV morbidity and its management on healthcare resources. |
18/03/2024 | Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of 14 cohort studies. | Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB. A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings. Herein, 14 observational studies involving 77 250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates. Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Male', 'Gastric Bypass', 'Obesity', 'Peptic Ulcer', 'Risk Factors', 'Diabetes Mellitus, Type 2', 'Cohort Studies', 'Steroids', 'Obesity, Morbid', 'Postoperative Complications', 'Retrospective Studies'] | 38,320,087 | 0 | Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of 14 cohort studies. Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB. A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings. Herein, 14 observational studies involving 77 250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates. Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB. |
06/01/2022 | The effect of statins on all-cause and cardiovascular mortality in patients with non-dialysis chronic kidney disease, patients on dialysis, and kidney transplanted recipients: an umbrella review of meta-analyses. | Although some previous meta-analyses have demonstrated a relationship between statin therapy and all-cause mortality in patients with chronic kidney disease (CKD), conflicting results have been reported. Thus, we performed an umbrella review to understand the strength of evidence and validity of the claimed associations between statin use and all cause and cardiovascular mortality in CKD patients, including patients on dialysis (CKD stage 5D) and transplant recipients. We comprehensively re-analyzed the data of 14 meta-analyses of observational studies and randomized controlled trials on associations between statin use and different CKD groups - CKD, CKD stage 5D, and kidney transplant recipients. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria, including the statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval. For CKD patients, statin use showed suggestive evidence for an association with reduced all-cause mortality [relative risk (RR) 0.77, 95% confidence interval (0.69-0.87)]. For kidney transplant recipients, statin use showed suggestive evidence for an association with reduced cardiovascular mortality [RR 0.67, 95% CI (0.50-0.90)]. However, for patients on dialysis, statins showed neither cardiovascular [RR 0.93, 95% CI (0.86-1.01)] nor all-cause mortality [RR 0.98, 95% CI (0.89-1.08)] benefits. Our finding indicates that statin could improve all-cause and cardiovascular mortality in patients with non-dialysis CKD. | ['Journal Article', 'Meta-Analysis', 'Review'] | ['Cardiovascular Diseases', 'Humans', 'Observational Studies as Topic', 'Randomized Controlled Trials as Topic', 'Renal Dialysis', 'Renal Insufficiency, Chronic', 'Transplant Recipients'] | 33,829,456 | 1 | The effect of statins on all-cause and cardiovascular mortality in patients with non-dialysis chronic kidney disease, patients on dialysis, and kidney transplanted recipients: an umbrella review of meta-analyses. Although some previous meta-analyses have demonstrated a relationship between statin therapy and all-cause mortality in patients with chronic kidney disease (CKD), conflicting results have been reported. Thus, we performed an umbrella review to understand the strength of evidence and validity of the claimed associations between statin use and all cause and cardiovascular mortality in CKD patients, including patients on dialysis (CKD stage 5D) and transplant recipients. We comprehensively re-analyzed the data of 14 meta-analyses of observational studies and randomized controlled trials on associations between statin use and different CKD groups - CKD, CKD stage 5D, and kidney transplant recipients. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria, including the statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval. For CKD patients, statin use showed suggestive evidence for an association with reduced all-cause mortality [relative risk (RR) 0.77, 95% confidence interval (0.69-0.87)]. For kidney transplant recipients, statin use showed suggestive evidence for an association with reduced cardiovascular mortality [RR 0.67, 95% CI (0.50-0.90)]. However, for patients on dialysis, statins showed neither cardiovascular [RR 0.93, 95% CI (0.86-1.01)] nor all-cause mortality [RR 0.98, 95% CI (0.89-1.08)] benefits. Our finding indicates that statin could improve all-cause and cardiovascular mortality in patients with non-dialysis CKD. |
02/08/2022 | Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis. | Acute kidney injury (AKI) that develops during pregnancy results from pregnancy-induced hypertension, hemorrhage, and sepsis, associated with morbidity and mortality in the fetus and mother. This meta-analysis was conducted to evaluate the incidence of pregnancy-related AKI (PR-AKI) and adverse clinical outcomes. PubMed and Scopus were systematically searched for studies published between 1980 and 2021. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI as well as adverse fetal and maternal clinical outcomes. A random-effects model meta-analysis was performed to generate summary estimates. The meta-analysis included 31 studies (57,529,841 participants). The pooled incidence of PR-AKI was 2.0% (95% confidence interval [CI] 1.0-3.7). Only 49.3% of patients received antenatal care. The most common cause of PR-AKI was preeclampsia (36.6%, 95% CI 29.1-44.7). The proportion of patients requiring hemodialysis was 37.2% (95% CI 26.0-49.9). More than 70% of patients had complete recovery of renal function, while 8.5% (95% CI 4.7-14.8) remained dependent on dialysis. The pooled mortality rate of PR-AKI was 12.7% (95% CI 9.0-17.7). In addition, fetal outcomes were favorable, with an alive birth rate of 70.0% (95% CI 61.2-77.4). However, the rate of abortion and/or stillbirth was approximately 25.4% (95% CI 18.1-34.4), and the rate of intrauterine death was 18.6% (95% CI 12.8-26.2). Although the incidence of PR-AKI is not high, this condition has a high impact on morbidity and mortality in both fetal and maternal outcomes. Early prevention and treatment from health care professionals are needed in PR-AKI, especially in the form of antenatal care and preeclampsia medication. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Acute Kidney Injury', 'Cross-Sectional Studies', 'Female', 'Humans', 'Incidence', 'Pre-Eclampsia', 'Pregnancy', 'Prognosis', 'Prospective Studies', 'Renal Dialysis', 'Retrospective Studies', 'Stillbirth'] | 35,905,231 | 1 | Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis. Acute kidney injury (AKI) that develops during pregnancy results from pregnancy-induced hypertension, hemorrhage, and sepsis, associated with morbidity and mortality in the fetus and mother. This meta-analysis was conducted to evaluate the incidence of pregnancy-related AKI (PR-AKI) and adverse clinical outcomes. PubMed and Scopus were systematically searched for studies published between 1980 and 2021. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI as well as adverse fetal and maternal clinical outcomes. A random-effects model meta-analysis was performed to generate summary estimates. The meta-analysis included 31 studies (57,529,841 participants). The pooled incidence of PR-AKI was 2.0% (95% confidence interval [CI] 1.0-3.7). Only 49.3% of patients received antenatal care. The most common cause of PR-AKI was preeclampsia (36.6%, 95% CI 29.1-44.7). The proportion of patients requiring hemodialysis was 37.2% (95% CI 26.0-49.9). More than 70% of patients had complete recovery of renal function, while 8.5% (95% CI 4.7-14.8) remained dependent on dialysis. The pooled mortality rate of PR-AKI was 12.7% (95% CI 9.0-17.7). In addition, fetal outcomes were favorable, with an alive birth rate of 70.0% (95% CI 61.2-77.4). However, the rate of abortion and/or stillbirth was approximately 25.4% (95% CI 18.1-34.4), and the rate of intrauterine death was 18.6% (95% CI 12.8-26.2). Although the incidence of PR-AKI is not high, this condition has a high impact on morbidity and mortality in both fetal and maternal outcomes. Early prevention and treatment from health care professionals are needed in PR-AKI, especially in the form of antenatal care and preeclampsia medication. |
14/02/2024 | How does alcohol use impact morbidity and mortality of liver cirrhosis? A systematic review and dose-response meta-analysis. | Alcohol consumption is the most important risk factor responsible for the disease burden of liver cirrhosis (LC). Estimates of risk relationships available usually neither distinguish between different causes such as alcohol-related LC or hepatitis-related LC, nor differentiate between morbidity and mortality as outcome. We aimed to address this research gap and identify dose-response relationships between alcohol consumption and LC, by cause and outcome. A systematic review using PubMed/Medline and Embase was conducted, identifying studies that reported an association between level of alcohol use and LC. Meta-regression models were used to estimate the dose-response relationships and control for heterogeneity. Totally, 44 studies, and 1 secondary data source, with a total of 5,122,534 participants and 15,150 cases were included. Non-linear dose-response relationships were identified, attenuated for higher levels of consumption. For morbidity, drinking 25 g/day was associated with a RR of 1.81 (95% CI 1.68-1.94) compared to lifetime abstention; 50 g/day and 100 g/day corresponded to 3.54 (95% CI 3.29-3.81) and 8.15 (95% CI 7.46-8.91), respectively. For mortality, for 25 g/day, a RR of 2.65 (95% CI 2.22-3.16); for 50 g/day, a RR of 6.83 (95% CI 5.84-7.97); for 100 g/day, a RR of 16.38 (95% CI 13.81-19.42) were identified. A higher risk for alcohol-related and all-cause LC as compared to hepatitis C-related LC was found. Our results demonstrated higher acceleration for mortality compared to morbidity. The current findings will inform the way we quantify the burden due to LC attributable to alcohol use. | ['Systematic Review', 'Meta-Analysis', 'Journal Article'] | ['Humans', 'Alcohol Drinking', 'Risk Factors', 'Liver Cirrhosis', 'Morbidity', 'Liver Cirrhosis, Alcoholic'] | 37,684,424 | 0 | How does alcohol use impact morbidity and mortality of liver cirrhosis? A systematic review and dose-response meta-analysis. Alcohol consumption is the most important risk factor responsible for the disease burden of liver cirrhosis (LC). Estimates of risk relationships available usually neither distinguish between different causes such as alcohol-related LC or hepatitis-related LC, nor differentiate between morbidity and mortality as outcome. We aimed to address this research gap and identify dose-response relationships between alcohol consumption and LC, by cause and outcome. A systematic review using PubMed/Medline and Embase was conducted, identifying studies that reported an association between level of alcohol use and LC. Meta-regression models were used to estimate the dose-response relationships and control for heterogeneity. Totally, 44 studies, and 1 secondary data source, with a total of 5,122,534 participants and 15,150 cases were included. Non-linear dose-response relationships were identified, attenuated for higher levels of consumption. For morbidity, drinking 25 g/day was associated with a RR of 1.81 (95% CI 1.68-1.94) compared to lifetime abstention; 50 g/day and 100 g/day corresponded to 3.54 (95% CI 3.29-3.81) and 8.15 (95% CI 7.46-8.91), respectively. For mortality, for 25 g/day, a RR of 2.65 (95% CI 2.22-3.16); for 50 g/day, a RR of 6.83 (95% CI 5.84-7.97); for 100 g/day, a RR of 16.38 (95% CI 13.81-19.42) were identified. A higher risk for alcohol-related and all-cause LC as compared to hepatitis C-related LC was found. Our results demonstrated higher acceleration for mortality compared to morbidity. The current findings will inform the way we quantify the burden due to LC attributable to alcohol use. |
02/05/2023 | Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study. | Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs. | ['Systematic Review', 'Journal Article', 'Review', "Research Support, Non-U.S. Gov't"] | ['Pregnancy', 'Female', 'Humans', 'Hypertension, Pregnancy-Induced', 'Delphi Technique', 'Risk Factors', 'Health Education', 'Biomarkers'] | 37,125,389 | 1 | Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study. Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs. |
15/01/2024 | Evaluating the Psychometric Properties of Patient-Reported Outcome Measures for Assessing Symptoms in Hemodialysis: A Systematic Review Using COSMIN Guidelines. | Patient-reported outcome measures (PROMs) may have an important role in screening and monitoring for unpleasant symptoms in kidney failure. However, there is still little evidence on the psychometric properties of the measures available to assess physical and psychological symptoms in people on hemodialysis. This gap makes it difficult to decide which measure is the most appropriate for use in clinical practice and research with this population. This systematic review aimed to critically appraise, compare, and summarize the quality of the measurement properties of PROMs used to assess symptoms in adults on hemodialysis. The protocol for this review was registered in PROSPERO (CRD42023393441). The last database search update was performed on November 25, 2022. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines informed methodological quality assessment, data extraction, analysis, and synthesis. Twenty-seven primary studies reported the measurement properties of 16 PROMs used to assess physical and psychological symptoms in adults on hemodialysis. Results showed that most measures lacked the necessary psychometric evidence to attest their suitability for this study population, and few underwent rigorous validation procedures. Overall, caveats were found on methodological quality and evidence of content validity and structural validity, and little data was available on responsiveness, measurement error, and cross-cultural validity. The current systematic review provides the basis for identifying PROMs with potential utility for assessing symptoms in hemodialysis care. Several recommendations are presented to help guide future research aimed at improving the rigor of validation and/or translation procedures of existing (and future) measures using COSMIN guidelines. | ['Systematic Review', 'Journal Article', 'Review'] | ['Adult', 'Humans', 'Patient Reported Outcome Measures', 'Physical Examination', 'Psychometrics', 'Quality of Life', 'Renal Dialysis', 'Reproducibility of Results'] | 37,734,480 | 1 | Evaluating the Psychometric Properties of Patient-Reported Outcome Measures for Assessing Symptoms in Hemodialysis: A Systematic Review Using COSMIN Guidelines. Patient-reported outcome measures (PROMs) may have an important role in screening and monitoring for unpleasant symptoms in kidney failure. However, there is still little evidence on the psychometric properties of the measures available to assess physical and psychological symptoms in people on hemodialysis. This gap makes it difficult to decide which measure is the most appropriate for use in clinical practice and research with this population. This systematic review aimed to critically appraise, compare, and summarize the quality of the measurement properties of PROMs used to assess symptoms in adults on hemodialysis. The protocol for this review was registered in PROSPERO (CRD42023393441). The last database search update was performed on November 25, 2022. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines informed methodological quality assessment, data extraction, analysis, and synthesis. Twenty-seven primary studies reported the measurement properties of 16 PROMs used to assess physical and psychological symptoms in adults on hemodialysis. Results showed that most measures lacked the necessary psychometric evidence to attest their suitability for this study population, and few underwent rigorous validation procedures. Overall, caveats were found on methodological quality and evidence of content validity and structural validity, and little data was available on responsiveness, measurement error, and cross-cultural validity. The current systematic review provides the basis for identifying PROMs with potential utility for assessing symptoms in hemodialysis care. Several recommendations are presented to help guide future research aimed at improving the rigor of validation and/or translation procedures of existing (and future) measures using COSMIN guidelines. |
04/12/2023 | Epley manoeuvre's efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis. | Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings. Systematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix-Hallpike test), and all adverse events. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Twenty-seven randomised controlled trials were identified. In primary-care settings, EM reduced the subjective symptoms [risk ratio (RR), 3.14; 95% confidence interval (CI), 1.96-5.02]; however, there was no applicable article for all adverse events. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42; 95% CI, 1.64-3.56), resulting in an increase in negative findings (RR, 1.81; 95% CI, 1.40-2.34). The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings. Regardless of primary-care and subspecialty settings, EM for BPPV was effective. This study has shown the significance of performing EM for BPPV in primary-care settings. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up. The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Benign Paroxysmal Positional Vertigo', 'General Practitioners', 'Hospitalization', 'Language', 'MEDLINE'] | 38,042,776 | 0 | Epley manoeuvre's efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis. Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings. Systematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix-Hallpike test), and all adverse events. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Twenty-seven randomised controlled trials were identified. In primary-care settings, EM reduced the subjective symptoms [risk ratio (RR), 3.14; 95% confidence interval (CI), 1.96-5.02]; however, there was no applicable article for all adverse events. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42; 95% CI, 1.64-3.56), resulting in an increase in negative findings (RR, 1.81; 95% CI, 1.40-2.34). The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings. Regardless of primary-care and subspecialty settings, EM for BPPV was effective. This study has shown the significance of performing EM for BPPV in primary-care settings. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up. The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021. |
08/08/2023 | Efficacy and safety of moxibustion on cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials. | The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I<sup>2</sup> = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'China', 'Fatigue', 'Moxibustion', 'Multicenter Studies as Topic', 'Neoplasms', 'Randomized Controlled Trials as Topic'] | 37,548,752 | 0 | Efficacy and safety of moxibustion on cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials. The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I<sup>2</sup> = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality. |
06/03/2024 | Effectiveness of tranexamic acid in burn patients undergoing surgery - a systematic review and meta-analysis. | Reducing blood loss during excisional surgery in burn patients remains a challenge. Tranexamic acid during surgery can potentially reduce blood loss. The use of tranexamic acid during excisional surgery in burn patients has recently been described in a review and meta-analysis. However, quality assessment on studies included was not performed and this review did not apply independent reviewers. Quality assessment of studies investigating the effectiveness of tranexamic acid in burn patients is crucial before concusions can be drawn. Therefore, we conducted a systematic review and meta-analysis of the literature investigating the effectiveness of tranexamic acid in burn patients undergoing surgery. A systematic review and meta-analysis of the literature was conducted. The study was pre-registered in PROSPERO database (CRD42023396183). Five studies including two randomised controlled trials (RCTs) with a total of 303 patients were included. Risk of bias of the included studies was moderate to high. Individual results of the studies were heterogeneous. In three studies of moderate quality the administration of tranexamic acid resulted in a reduction of blood loss per unit excised area, accounting as moderate level of evidence. In two low-quality studies and one moderate quality study the administration of tranexamic acid resulted in a reduction of transfused packed Red Blood Cells (pRBC's), accounting for moderate level of evidence. Postoperative haemoglobin levels were higher after tranexamic acid administration in one study, accounting for insufficient evidence. Meta-analysis pooling overall blood loss from two separate RCTs failed to detect a statistically significant reduction. Substantial heterogeneity was observed. Moderate level of evidence indicates that tranexamic acid reduces blood loss per unit of excised area and transfusion of packed Red Blood Cells. Results indicate that tranexamic acid can be beneficial in burn patients undergoing surgery. More high-quality research is needed to confirm these results. Future studies should focus on the dosing of tranexamic acid, the administration approaches, and even consider combining these approaches. PROSPERO: CRD42023396183. | ['Meta-Analysis', 'Systematic Review'] | ['Humans', 'Tranexamic Acid', 'Burns', 'Databases, Factual', 'Postoperative Period', 'Qualitative Research', 'Randomized Controlled Trials as Topic'] | 38,438,978 | 0 | Effectiveness of tranexamic acid in burn patients undergoing surgery - a systematic review and meta-analysis. Reducing blood loss during excisional surgery in burn patients remains a challenge. Tranexamic acid during surgery can potentially reduce blood loss. The use of tranexamic acid during excisional surgery in burn patients has recently been described in a review and meta-analysis. However, quality assessment on studies included was not performed and this review did not apply independent reviewers. Quality assessment of studies investigating the effectiveness of tranexamic acid in burn patients is crucial before concusions can be drawn. Therefore, we conducted a systematic review and meta-analysis of the literature investigating the effectiveness of tranexamic acid in burn patients undergoing surgery. A systematic review and meta-analysis of the literature was conducted. The study was pre-registered in PROSPERO database (CRD42023396183). Five studies including two randomised controlled trials (RCTs) with a total of 303 patients were included. Risk of bias of the included studies was moderate to high. Individual results of the studies were heterogeneous. In three studies of moderate quality the administration of tranexamic acid resulted in a reduction of blood loss per unit excised area, accounting as moderate level of evidence. In two low-quality studies and one moderate quality study the administration of tranexamic acid resulted in a reduction of transfused packed Red Blood Cells (pRBC's), accounting for moderate level of evidence. Postoperative haemoglobin levels were higher after tranexamic acid administration in one study, accounting for insufficient evidence. Meta-analysis pooling overall blood loss from two separate RCTs failed to detect a statistically significant reduction. Substantial heterogeneity was observed. Moderate level of evidence indicates that tranexamic acid reduces blood loss per unit of excised area and transfusion of packed Red Blood Cells. Results indicate that tranexamic acid can be beneficial in burn patients undergoing surgery. More high-quality research is needed to confirm these results. Future studies should focus on the dosing of tranexamic acid, the administration approaches, and even consider combining these approaches. PROSPERO: CRD42023396183. |
06/05/2020 | Renal Injury in All-Comers After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. | Background Acute kidney injury (AKI) following aortic valve replacement is associated with poor prognosis. Transcatheter aortic valve replacement (TAVR) is a novel strategy with a percutaneous approach and early recovery time. We conducted this meta-analysis to compare TAVR to surgical aortic valve replacement (SAVR) and their respective renal outcomes. Methods We searched for randomized controlled trials (RCTs) using MEDLINE, PUBMED, and Google Scholar databases from their inception till April 6, 2019, and included eight trials comparing TAVR to SAVR in cases that reported AKIs. Results We found a significant reduction in AKI after TAVR compared to SAVR at 30 days [n = 66 vs. n = 160, respectively; odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.28-0.51; p: <0.00001, I<sup>2</sup> = 0%]. At one year, a trend towards reduced renal failure was noted in the TAVR arm compared to the SAVR arm (n = 74 vs. n = 129, respectively; OR = 0.57, 95% CI = 0.32-1.01; p = 0.05, I<sup>2</sup> = 69%). Conclusion Based on our findings and analysis, we have concluded that TAVR is associated with significantly reduced renal injury at 30 days when compared to SAVR. | ['Journal Article'] | [] | 32,523,841 | 1 | Renal Injury in All-Comers After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Background Acute kidney injury (AKI) following aortic valve replacement is associated with poor prognosis. Transcatheter aortic valve replacement (TAVR) is a novel strategy with a percutaneous approach and early recovery time. We conducted this meta-analysis to compare TAVR to surgical aortic valve replacement (SAVR) and their respective renal outcomes. Methods We searched for randomized controlled trials (RCTs) using MEDLINE, PUBMED, and Google Scholar databases from their inception till April 6, 2019, and included eight trials comparing TAVR to SAVR in cases that reported AKIs. Results We found a significant reduction in AKI after TAVR compared to SAVR at 30 days [n = 66 vs. n = 160, respectively; odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.28-0.51; p: <0.00001, I<sup>2</sup> = 0%]. At one year, a trend towards reduced renal failure was noted in the TAVR arm compared to the SAVR arm (n = 74 vs. n = 129, respectively; OR = 0.57, 95% CI = 0.32-1.01; p = 0.05, I<sup>2</sup> = 69%). Conclusion Based on our findings and analysis, we have concluded that TAVR is associated with significantly reduced renal injury at 30 days when compared to SAVR. |
08/11/2022 | Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis. | Clinical practice guidelines emphasize the importance of the prevention and treatment of non-specific back pain through exercise therapy and health education. However, it has not yet been confirmed that the combination of exercise plus education is more effective than usual medical care. The aim of this study was to determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than usual medical care. A systematic search in PubMed, Scopus, Web of Science and Medline was conducted with the terms Back Pain, Neck Pain, Musculoskeletal Pain, Exercise, Exercise Therapy, Health Education, Cognitive Behavioral Therapy, Primary Prevention, Secondary Prevention and Clinical Trial. The inclusion criteria were: articles published from 2016 to 2021, the intervention included exercise and education, and the sample consisted of non-specific back pain patients. A total of 4 randomized controlled trials were selected (average PEDro score 6.5 points). The meta-analysis showed statistically significant differences in the pain intensity, standardized mean differences was found to be -0.75 (95% CI = -1.41 to -0.08; <i>p</i> = 0.03); and in disability, standardized mean differences was found to be -0.24 (95% CI = -0.38 to -0.1; <i>p</i> = 0.001). Interventions combining exercise and education seem to have a greater preventive effect on non-specific back pain than usual medical care.Key messagesExercise therapy and health education combination prevent better non-specific back pain than usual care.Combining exercise with educational interventions has a higher improvement on disability and kinesophobia than usual care. | ['Meta-Analysis', 'Systematic Review'] | ['Humans', 'Low Back Pain', 'Exercise Therapy', 'Back Pain', 'Pain Measurement', 'Health Education'] | 36,331,870 | 0 | Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis. Clinical practice guidelines emphasize the importance of the prevention and treatment of non-specific back pain through exercise therapy and health education. However, it has not yet been confirmed that the combination of exercise plus education is more effective than usual medical care. The aim of this study was to determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than usual medical care. A systematic search in PubMed, Scopus, Web of Science and Medline was conducted with the terms Back Pain, Neck Pain, Musculoskeletal Pain, Exercise, Exercise Therapy, Health Education, Cognitive Behavioral Therapy, Primary Prevention, Secondary Prevention and Clinical Trial. The inclusion criteria were: articles published from 2016 to 2021, the intervention included exercise and education, and the sample consisted of non-specific back pain patients. A total of 4 randomized controlled trials were selected (average PEDro score 6.5 points). The meta-analysis showed statistically significant differences in the pain intensity, standardized mean differences was found to be -0.75 (95% CI = -1.41 to -0.08; <i>p</i> = 0.03); and in disability, standardized mean differences was found to be -0.24 (95% CI = -0.38 to -0.1; <i>p</i> = 0.001). Interventions combining exercise and education seem to have a greater preventive effect on non-specific back pain than usual medical care.Key messagesExercise therapy and health education combination prevent better non-specific back pain than usual care.Combining exercise with educational interventions has a higher improvement on disability and kinesophobia than usual care. |
10/08/2021 | Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies. | Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Animals', 'Databases, Factual', 'Enteral Nutrition', 'Enterocolitis, Necrotizing', 'Female', 'Gastrointestinal Microbiome', 'Gastrointestinal Tract', 'Humans', 'Infant, Newborn', 'Infant, Newborn, Diseases', 'Inflammation', 'Intestinal Mucosa', 'Milk, Human'] | 34,069,699 | 0 | Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies. Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions. |
05/01/2024 | Prevalence of intentions to receive monkeypox vaccine. A systematic review and meta-analysis. | Immunization, as a preventive strategy against infectious diseases, has consolidated its position as a fundamental pillar in the field of public health. Therefore, the present study aimed to determine the prevalence of the intention to receive the monkeypox (Mpox) vaccine. A systematic review and meta-analysis of the available evidence was performed using five databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) with a search strategy until July 24, 2023. Data analysis was performed in R software version 4.2.3. The quality of the included cross-sectional studies was assessed using the "JBI-MAStARI". In addition, a subgroup analysis by population and continent was developed. Twenty-nine cross-sectional articles with a total sample of 52 658 participants were included. The pooled prevalence of intention to vaccinate against Mpox was 61% (95% CI: 53-69%; 52,658 participants; 29 studies; I<sup>2</sup> = 100%). In the subgroup analysis, the intention to be vaccinated against Mpox according to continents was 64% (95% CI: 53-74%; 13,883 participants; 17 studies; I<sup>2</sup> = 99%) in Asian countries, 43% (95% CI: 39-47%; 1538 participants; 3 studies; I<sup>2</sup> = 53%) in African countries, 62% (95% CI: 45-78%; 35,811 participants; 6 studies; I<sup>2</sup> = 99%) in European countries, and 63% (95% CI: 32-89%; 1426 participants; 3 studies; I<sup>2</sup> = 99%) in American countries. In the subgroup analysis on the intention to be vaccinated against Mpox, according to study subjects, it was 54% (95% CI: 45-62%; 10,296 participants; 11 studies; I<sup>2</sup> = 99%) in the general population, 57% (95% CI: 33-79%; 3333 participants; 10 studies; I<sup>2</sup> = 99%) in health care workers, and 76% (95% CI: 70-82%; 39,029 participants; 8 studies; I<sup>2</sup> = 98%) in the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community. In addition, as a secondary outcome, a prevalence of refusal of Mpox vaccination was found to be 22% (95% CI: 16-30%; 45,577 participants; 21 studies; I<sup>2</sup> = 99%). The study highlights the importance of recognizing regional and subgroup disparities in Mpox vaccine willingness and refusal. It emphasizes the importance of employing strategies to achieve widespread vaccination coverage and safeguard public health worldwide. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Female', 'Humans', 'Cross-Sectional Studies', 'Intention', 'Mpox (monkeypox)', 'Prevalence', 'Prospective Studies', 'Smallpox Vaccine', 'Male'] | 38,166,776 | 0 | Prevalence of intentions to receive monkeypox vaccine. A systematic review and meta-analysis. Immunization, as a preventive strategy against infectious diseases, has consolidated its position as a fundamental pillar in the field of public health. Therefore, the present study aimed to determine the prevalence of the intention to receive the monkeypox (Mpox) vaccine. A systematic review and meta-analysis of the available evidence was performed using five databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) with a search strategy until July 24, 2023. Data analysis was performed in R software version 4.2.3. The quality of the included cross-sectional studies was assessed using the "JBI-MAStARI". In addition, a subgroup analysis by population and continent was developed. Twenty-nine cross-sectional articles with a total sample of 52 658 participants were included. The pooled prevalence of intention to vaccinate against Mpox was 61% (95% CI: 53-69%; 52,658 participants; 29 studies; I<sup>2</sup> = 100%). In the subgroup analysis, the intention to be vaccinated against Mpox according to continents was 64% (95% CI: 53-74%; 13,883 participants; 17 studies; I<sup>2</sup> = 99%) in Asian countries, 43% (95% CI: 39-47%; 1538 participants; 3 studies; I<sup>2</sup> = 53%) in African countries, 62% (95% CI: 45-78%; 35,811 participants; 6 studies; I<sup>2</sup> = 99%) in European countries, and 63% (95% CI: 32-89%; 1426 participants; 3 studies; I<sup>2</sup> = 99%) in American countries. In the subgroup analysis on the intention to be vaccinated against Mpox, according to study subjects, it was 54% (95% CI: 45-62%; 10,296 participants; 11 studies; I<sup>2</sup> = 99%) in the general population, 57% (95% CI: 33-79%; 3333 participants; 10 studies; I<sup>2</sup> = 99%) in health care workers, and 76% (95% CI: 70-82%; 39,029 participants; 8 studies; I<sup>2</sup> = 98%) in the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community. In addition, as a secondary outcome, a prevalence of refusal of Mpox vaccination was found to be 22% (95% CI: 16-30%; 45,577 participants; 21 studies; I<sup>2</sup> = 99%). The study highlights the importance of recognizing regional and subgroup disparities in Mpox vaccine willingness and refusal. It emphasizes the importance of employing strategies to achieve widespread vaccination coverage and safeguard public health worldwide. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). |
09/08/2022 | Systematic Review and Meta-Analysis Program Based on Effectiveness of a Multidisciplinary Model of Care for Patients with Chronic Kidney Disease. | The effectiveness of the multidisciplinary nursing model in the nursing of chronic kidney disease (CKD) by using meta-analysis is explored. Relevant literatures that are in line with the multidisciplinary nursing model for CKD intervention are searched and screened from domestic and foreign literature databases such as Wanfang Medical Center, CNKNET, VIP, and PubMed, and Meta-analysis is conducted with RevMan 5.2 software. A total of 6 literatures are included, and the publication bias of the included literatures is low. Meta-analysis shows that the multidisciplinary group had a better Hb compliance rate, Hb level, Scr, eGFR, SBP, and DBP than the traditional group. The experimental results show that multidisciplinary nursing intervention can improve the nursing effect of patients with CKD and help to improve Hb, Scr, blood pressure, and glomerular filtration function of patients. | ['Journal Article', 'Meta-Analysis', 'Systematic Review', 'Retracted Publication'] | ['Blood Pressure', 'Humans', 'Renal Insufficiency, Chronic'] | 35,935,312 | 1 | Systematic Review and Meta-Analysis Program Based on Effectiveness of a Multidisciplinary Model of Care for Patients with Chronic Kidney Disease. The effectiveness of the multidisciplinary nursing model in the nursing of chronic kidney disease (CKD) by using meta-analysis is explored. Relevant literatures that are in line with the multidisciplinary nursing model for CKD intervention are searched and screened from domestic and foreign literature databases such as Wanfang Medical Center, CNKNET, VIP, and PubMed, and Meta-analysis is conducted with RevMan 5.2 software. A total of 6 literatures are included, and the publication bias of the included literatures is low. Meta-analysis shows that the multidisciplinary group had a better Hb compliance rate, Hb level, Scr, eGFR, SBP, and DBP than the traditional group. The experimental results show that multidisciplinary nursing intervention can improve the nursing effect of patients with CKD and help to improve Hb, Scr, blood pressure, and glomerular filtration function of patients. |
16/04/2020 | State-of-the-Art Renal Imaging in Children. | Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders. | ['Journal Article', 'Research Support, N.I.H., Extramural', 'Systematic Review'] | ['Child', 'Contrast Media', 'Cystography', 'Diffusion Magnetic Resonance Imaging', 'Echocardiography, Three-Dimensional', 'Elasticity Imaging Techniques', 'Humans', 'Kidney', 'Kidney Diseases', 'Printing, Three-Dimensional', 'Tomography, X-Ray Computed', 'Ultrasonography', 'Urethra', 'Urinary Bladder', 'Urinary Tract'] | 31,915,193 | 1 | State-of-the-Art Renal Imaging in Children. Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders. |
14/09/2021 | A systematic review of the effective laser wavelength range in delivering photobiomodulation for pain relief in active orthodontic treatment. | This systematic review aimed to establish an effective wavelength range for PhotoBioModulation (PBM) to relieve pain in orthodontic treatments. The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane. In the initial search, 255 papers were obtained. Deleting duplicates in the search left 180 items. One manually searched study was included for a total of 181 studies. According to PRISMA guidelines and a thorough analysis of their methodology, the final sample was composed of 13 RCTs. The final statistical analysis was performed in 11 studies. The statistical analysis sought to strengthen the collected data, determining the correlation coefficient (r) for the same time interval (24h) using a scale equivalent to the standard value (0-10cm). Aiming to reduce the effect of heterogeneity, the difference in cm between control group (GC) and experimental group (EG) averages was considered the outcome. This difference was correlated with the wavelength in nm, calculating the Pearson linear correlation coefficient, and calculating a logarithmic correlation. The dispersion of the data obtained in the experimental groups at each given wavelength showed that the most significant number of studies were in the ranges of 780-830nm. The correlation between the wavelength and the difference between the control and experimental group averages, either linear (R2=0.0564, r=0.237) or logarithmic (R2=0.0688, r=0.262) was not significant (P>0.90). Therefore, pain reduction after 24h is not significantly dependent of wavelength. The majority of RCTs related to pain relief in orthodontic treatment showed 780-830nm as the most effective photobiomodulation wavelength range for orthodontic pain relief. However, pain reduction after 24h is not significantly dependent of wavelength. The protocol was registered in PROSPERO (CRD42019119799). | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Databases, Factual', 'Humans', 'Laser Therapy', 'Lasers', 'Orthodontics', 'Pain', 'Pain Measurement', 'Tooth Movement Techniques'] | 33,060,065 | 0 | A systematic review of the effective laser wavelength range in delivering photobiomodulation for pain relief in active orthodontic treatment. This systematic review aimed to establish an effective wavelength range for PhotoBioModulation (PBM) to relieve pain in orthodontic treatments. The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane. In the initial search, 255 papers were obtained. Deleting duplicates in the search left 180 items. One manually searched study was included for a total of 181 studies. According to PRISMA guidelines and a thorough analysis of their methodology, the final sample was composed of 13 RCTs. The final statistical analysis was performed in 11 studies. The statistical analysis sought to strengthen the collected data, determining the correlation coefficient (r) for the same time interval (24h) using a scale equivalent to the standard value (0-10cm). Aiming to reduce the effect of heterogeneity, the difference in cm between control group (GC) and experimental group (EG) averages was considered the outcome. This difference was correlated with the wavelength in nm, calculating the Pearson linear correlation coefficient, and calculating a logarithmic correlation. The dispersion of the data obtained in the experimental groups at each given wavelength showed that the most significant number of studies were in the ranges of 780-830nm. The correlation between the wavelength and the difference between the control and experimental group averages, either linear (R2=0.0564, r=0.237) or logarithmic (R2=0.0688, r=0.262) was not significant (P>0.90). Therefore, pain reduction after 24h is not significantly dependent of wavelength. The majority of RCTs related to pain relief in orthodontic treatment showed 780-830nm as the most effective photobiomodulation wavelength range for orthodontic pain relief. However, pain reduction after 24h is not significantly dependent of wavelength. The protocol was registered in PROSPERO (CRD42019119799). |
22/09/2021 | Circulating IL-17 Level Is Positively Associated with Disease Activity in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. | Previous studies on the relationship between the circulating level of interleukin-17 (IL-17) and disease activity in systemic lupus erythematosus (SLE) were contradictory. This study is aimed at quantitatively assessing the correlation between the circulating IL-17 level and disease activity in SLE patients. A systematic search for related literature was conducted via PubMed, Web of Science, EMBASE, and Cochrane Library (up to January 26, 2021). The relationship between circulating IL-17 levels and SLE activity was evaluated using Fisher's <i>z</i> value, which was then converted to <i>r</i>. The standardized mean difference (SMD) and its 95% confidence interval (CI) were used to describe the difference between the circulating IL-17 level in patients with active and inactive SLE. STATA 16.0 was used to perform statistical analysis. Random-effects model was performed to synthesize data. Twenty-six studies involving 1,560 SLE patients were included in this review. The pooled <i>r</i> value was 0.38 (95% CI: 0.25-0.50; <i>I</i> <sup>2</sup> = 83.8%, <i>P</i> < 0.001) between the SLE activity and circulating level of IL-17. Patients with active SLE had higher level of circulating IL-17 than that of inactive (pooled SMD = 0.95, 95% CI: 0.38-1.53; <i>I</i> <sup>2</sup> = 90.5%, <i>P</i> < 0.001). The subgroup analysis suggested that the region and detection method of circulating IL-17 might not be a source of heterogeneity. No significant publication bias was found. In summary, circulating IL-17 level has a low positive relationship with SLE activity. It is necessary to carefully consider the use of circulating IL-17 as a biomarker of the disease activity in SLE patients. The relationship between the circulating level of IL-17 and SLE activity should be further confirmed in randomized controlled studies. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Adolescent', 'Adult', 'Female', 'Humans', 'Interleukin-17', 'Lupus Erythematosus, Systemic', 'Male', 'Middle Aged', 'Publication Bias', 'Young Adult'] | 34,337,065 | 0 | Circulating IL-17 Level Is Positively Associated with Disease Activity in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Previous studies on the relationship between the circulating level of interleukin-17 (IL-17) and disease activity in systemic lupus erythematosus (SLE) were contradictory. This study is aimed at quantitatively assessing the correlation between the circulating IL-17 level and disease activity in SLE patients. A systematic search for related literature was conducted via PubMed, Web of Science, EMBASE, and Cochrane Library (up to January 26, 2021). The relationship between circulating IL-17 levels and SLE activity was evaluated using Fisher's <i>z</i> value, which was then converted to <i>r</i>. The standardized mean difference (SMD) and its 95% confidence interval (CI) were used to describe the difference between the circulating IL-17 level in patients with active and inactive SLE. STATA 16.0 was used to perform statistical analysis. Random-effects model was performed to synthesize data. Twenty-six studies involving 1,560 SLE patients were included in this review. The pooled <i>r</i> value was 0.38 (95% CI: 0.25-0.50; <i>I</i> <sup>2</sup> = 83.8%, <i>P</i> < 0.001) between the SLE activity and circulating level of IL-17. Patients with active SLE had higher level of circulating IL-17 than that of inactive (pooled SMD = 0.95, 95% CI: 0.38-1.53; <i>I</i> <sup>2</sup> = 90.5%, <i>P</i> < 0.001). The subgroup analysis suggested that the region and detection method of circulating IL-17 might not be a source of heterogeneity. No significant publication bias was found. In summary, circulating IL-17 level has a low positive relationship with SLE activity. It is necessary to carefully consider the use of circulating IL-17 as a biomarker of the disease activity in SLE patients. The relationship between the circulating level of IL-17 and SLE activity should be further confirmed in randomized controlled studies. |
19/06/2020 | Nodal CTV selection according to primary tumour location and pT stage for biliary tract cancer. | To assist radiation oncologists in determining the elective nodal CTV for biliary tract cancer, we aimed to provide the rules for selection of the CTV for each subsite of biliary tract with respect to the pT stage, based on the analysis of the incidence and location of metastatic lymph nodes. Systematic review and meta-analysis was performed to determine the rate of pathological nodal involvement of each individual lymph node station (LNS) as a function of the primary tumour pT stage (pT1-2 vs. pT3-4) separately for right intrahepatic cholangiocarcinoma (rIHC), left/hilar intrahepatic cholangiocarcinoma l/hIHC), proximal extrahepatic cholangiocarcinoma (pEHC), middle extrahepatic cholangiocarcinoma (mEHC), distal extrahepatic cholangiocarcinoma (dEHC) and gall bladder cancer (GBC). A 5% or higher risk of involvement was assumed to justify inclusion of the LNS in the CTV. Coeliac LNS, which is usually included in the CTV in clinical practice, has a low risk of involvement and can presumably be omitted for pT1-2 GBC, for dEHC irrespective of pT stage and for mEHC. Para-aortic and superior mesenteric artery (SMA) LNS that are usually omitted have a high risk of involvement. Para-aortic LNS should be considered for inclusion for all the subsites except for pT1-2 dEHC, and SMA LNS for all the subsites except for pT1-2 dEHC, pT1-2 GBC and pEHC. Left gastric artery, lesser curvature and paracardial LNS should be considered for inclusion for l/hIHC. This systematic review provides an evidence-based strategy for nodal CTV selection in biliary tract cancer according to primary tumour location and pT stage. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Bile Duct Neoplasms', 'Bile Ducts, Intrahepatic', 'Biliary Tract Neoplasms', 'Cholangiocarcinoma', 'Humans', 'Lymphatic Metastasis', 'Neoplasm Staging', 'Radiotherapy, Adjuvant'] | 31,402,569 | 0 | Nodal CTV selection according to primary tumour location and pT stage for biliary tract cancer. To assist radiation oncologists in determining the elective nodal CTV for biliary tract cancer, we aimed to provide the rules for selection of the CTV for each subsite of biliary tract with respect to the pT stage, based on the analysis of the incidence and location of metastatic lymph nodes. Systematic review and meta-analysis was performed to determine the rate of pathological nodal involvement of each individual lymph node station (LNS) as a function of the primary tumour pT stage (pT1-2 vs. pT3-4) separately for right intrahepatic cholangiocarcinoma (rIHC), left/hilar intrahepatic cholangiocarcinoma l/hIHC), proximal extrahepatic cholangiocarcinoma (pEHC), middle extrahepatic cholangiocarcinoma (mEHC), distal extrahepatic cholangiocarcinoma (dEHC) and gall bladder cancer (GBC). A 5% or higher risk of involvement was assumed to justify inclusion of the LNS in the CTV. Coeliac LNS, which is usually included in the CTV in clinical practice, has a low risk of involvement and can presumably be omitted for pT1-2 GBC, for dEHC irrespective of pT stage and for mEHC. Para-aortic and superior mesenteric artery (SMA) LNS that are usually omitted have a high risk of involvement. Para-aortic LNS should be considered for inclusion for all the subsites except for pT1-2 dEHC, and SMA LNS for all the subsites except for pT1-2 dEHC, pT1-2 GBC and pEHC. Left gastric artery, lesser curvature and paracardial LNS should be considered for inclusion for l/hIHC. This systematic review provides an evidence-based strategy for nodal CTV selection in biliary tract cancer according to primary tumour location and pT stage. |
20/03/2024 | Estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa: a systematic review with meta-analysis. | Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Child', 'Humans', 'Cerebral Palsy', 'Africa South of the Sahara', 'Comorbidity', 'Malnutrition', 'Prevalence'] | 38,499,717 | 0 | Estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa: a systematic review with meta-analysis. Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent. |
22/02/2023 | N-/T-Type vs. L-Type Calcium Channel Blocker in Treating Chronic Kidney Disease: A Systematic Review and Meta-Analysis. | Renin-angiotensin system (RAS) inhibitors and calcium channel blockers (CCB) are often used together in chronic kidney disease (CKD). The PubMed, EMBASE, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) in order to explore better subtypes of CCB for the treatment of CKD. This meta-analysis of 12 RCTs with 967 CKD patients who were treated with RAS inhibitors demonstrated that, when compared with L-type CCB, N-/T-type CCB was superior in reducing urine albumin/protein excretion (SMD, -0.41; 95% CI, -0.64 to -0.18; <i>p</i> < 0.001) and aldosterone, without influencing serum creatinine (WMD, -3.64; 95% CI, -11.63 to 4.35; <i>p</i> = 0.37), glomerular filtration rate (SMD, 0.06; 95% CI, -0.13 to 0.25; <i>p</i> = 0.53), and adverse effects (RR, 0.95; 95% CI, 0.35 to 2.58; <i>p</i> = 0.93). In addition, N-/T-type CCB did not decrease the systolic blood pressure (BP) (WMD, 0.17; 95% CI, -1.05 to 1.39; <i>p</i> = 0.79) or diastolic BP (WMD, 0.64; 95% CI, -0.55 to 1.83; <i>p</i> = 0.29) when compared with L-type CCB. In CKD patients treated with RAS inhibitors, N-/T-type CCB is more effective than L-type CCB in reducing urine albumin/protein excretion without increased serum creatinine, decreased glomerular filtration rate, and increased adverse effects. The additional benefit is independent of BP and may be associated with decreased aldosterone (PROSPERO, CRD42020197560). | ['Journal Article', 'Review'] | [] | 36,986,438 | 1 | N-/T-Type vs. L-Type Calcium Channel Blocker in Treating Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Renin-angiotensin system (RAS) inhibitors and calcium channel blockers (CCB) are often used together in chronic kidney disease (CKD). The PubMed, EMBASE, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) in order to explore better subtypes of CCB for the treatment of CKD. This meta-analysis of 12 RCTs with 967 CKD patients who were treated with RAS inhibitors demonstrated that, when compared with L-type CCB, N-/T-type CCB was superior in reducing urine albumin/protein excretion (SMD, -0.41; 95% CI, -0.64 to -0.18; <i>p</i> < 0.001) and aldosterone, without influencing serum creatinine (WMD, -3.64; 95% CI, -11.63 to 4.35; <i>p</i> = 0.37), glomerular filtration rate (SMD, 0.06; 95% CI, -0.13 to 0.25; <i>p</i> = 0.53), and adverse effects (RR, 0.95; 95% CI, 0.35 to 2.58; <i>p</i> = 0.93). In addition, N-/T-type CCB did not decrease the systolic blood pressure (BP) (WMD, 0.17; 95% CI, -1.05 to 1.39; <i>p</i> = 0.79) or diastolic BP (WMD, 0.64; 95% CI, -0.55 to 1.83; <i>p</i> = 0.29) when compared with L-type CCB. In CKD patients treated with RAS inhibitors, N-/T-type CCB is more effective than L-type CCB in reducing urine albumin/protein excretion without increased serum creatinine, decreased glomerular filtration rate, and increased adverse effects. The additional benefit is independent of BP and may be associated with decreased aldosterone (PROSPERO, CRD42020197560). |
05/09/2023 | Interventions for fatigue in people with kidney failure requiring dialysis. | Fatigue is a common and debilitating symptom in people receiving dialysis that is associated with an increased risk of death, cardiovascular disease and depression. Fatigue can also impair quality of life (QoL) and the ability to participate in daily activities. Fatigue has been established by patients, caregivers and health professionals as a core outcome for haemodialysis (HD). We aimed to evaluate the effects of pharmacological and non-pharmacological interventions on fatigue in people with kidney failure receiving dialysis, including HD and peritoneal dialysis (PD), including any setting and frequency of the dialysis treatment. We searched the Cochrane Kidney and Transplant Register of Studies up to 18 October 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. Studies evaluating pharmacological and non-pharmacological interventions affecting levels of fatigue or fatigue-related outcomes in people receiving dialysis were included. Studies were eligible if fatigue or fatigue-related outcomes were reported as a primary or secondary outcome. Any mode, frequency, prescription, and duration of therapy were considered. Three authors independently extracted data and assessed the risk of bias. Treatment estimates were summarised using random effects meta-analysis and expressed as a risk ratio (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI) or standardised MD (SMD) if different scales were used. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ninety-four studies involving 8191 randomised participants were eligible. Pharmacological and non-pharmacological interventions were compared either to placebo or control, or to another pharmacological or non-pharmacological intervention. In the majority of domains, risks of bias in the included studies were unclear or high. In low certainty evidence, when compared to control, exercise may improve fatigue (4 studies, 217 participants (Iowa Fatigue Scale, Modified Fatigue Impact Scale, Piper Fatigue Scale (PFS), or Haemodialysis-Related Fatigue scale score): SMD -1.18, 95% CI -2.04 to -0.31; I<sup>2</sup> = 87%) in HD. In low certainty evidence, when compared to placebo or standard care, aromatherapy may improve fatigue (7 studies, 542 participants (Fatigue Severity Scale (FSS), Rhoten Fatigue Scale (RFS), PFS or Brief Fatigue Inventory score): SMD -1.23, 95% CI -1.96 to -0.50; I<sup>2</sup> = 93%) in HD. In low certainty evidence, when compared to no intervention, massage may improve fatigue (7 studies, 657 participants (FSS, RFS, PFS or Visual Analogue Scale (VAS) score): SMD -1.06, 95% CI -1.47, -0.65; I<sup>2</sup> = 81%) and increase energy (2 studies, 152 participants (VAS score): MD 4.87, 95% CI 1.69 to 8.06, I<sup>2</sup> = 59%) in HD. In low certainty evidence, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD -0.64, 95% CI -1.03 to -0.25; I<sup>2</sup> = 75%) in HD. A wide range of heterogenous interventions and fatigue-related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our capability to pool and analyse the data. Due to the paucity of studies, the effects of pharmacological and other non-pharmacological interventions on fatigue or fatigue-related outcomes, including non-physiological neutral amino acid, relaxation with or without music therapy, meditation, exercise with nandrolone, nutritional supplementation, cognitive-behavioural therapy, ESAs, frequent HD sections, home blood pressure monitoring, blood flow rate reduction, serotonin reuptake inhibitor, beta-blockers, anabolic steroids, glucose-enriched dialysate, or light therapy, were very uncertain. The effects of pharmacological and non-pharmacological treatments on death, cardiovascular diseases, vascular access, QoL, depression, anxiety, hypertension or diabetes were sparse. No studies assessed tiredness, exhaustion or asthenia. Adverse events were rarely and inconsistently reported. Exercise, aromatherapy, massage and acupressure may improve fatigue compared to placebo, standard care or no intervention. Pharmacological and other non-pharmacological interventions had uncertain effects on fatigue or fatigue-related outcomes in people receiving dialysis. Future adequately powered, high-quality studies are likely to change the estimated effects of interventions for fatigue and fatigue-related outcomes in people receiving dialysis. | ['Journal Article', 'Meta-Analysis', 'Review'] | ['Humans', 'Cardiovascular Diseases', 'Fatigue', 'Kidney', 'Quality of Life', 'Randomized Controlled Trials as Topic', 'Renal Dialysis', 'Renal Insufficiency'] | 37,651,553 | 1 | Interventions for fatigue in people with kidney failure requiring dialysis. Fatigue is a common and debilitating symptom in people receiving dialysis that is associated with an increased risk of death, cardiovascular disease and depression. Fatigue can also impair quality of life (QoL) and the ability to participate in daily activities. Fatigue has been established by patients, caregivers and health professionals as a core outcome for haemodialysis (HD). We aimed to evaluate the effects of pharmacological and non-pharmacological interventions on fatigue in people with kidney failure receiving dialysis, including HD and peritoneal dialysis (PD), including any setting and frequency of the dialysis treatment. We searched the Cochrane Kidney and Transplant Register of Studies up to 18 October 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. Studies evaluating pharmacological and non-pharmacological interventions affecting levels of fatigue or fatigue-related outcomes in people receiving dialysis were included. Studies were eligible if fatigue or fatigue-related outcomes were reported as a primary or secondary outcome. Any mode, frequency, prescription, and duration of therapy were considered. Three authors independently extracted data and assessed the risk of bias. Treatment estimates were summarised using random effects meta-analysis and expressed as a risk ratio (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI) or standardised MD (SMD) if different scales were used. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ninety-four studies involving 8191 randomised participants were eligible. Pharmacological and non-pharmacological interventions were compared either to placebo or control, or to another pharmacological or non-pharmacological intervention. In the majority of domains, risks of bias in the included studies were unclear or high. In low certainty evidence, when compared to control, exercise may improve fatigue (4 studies, 217 participants (Iowa Fatigue Scale, Modified Fatigue Impact Scale, Piper Fatigue Scale (PFS), or Haemodialysis-Related Fatigue scale score): SMD -1.18, 95% CI -2.04 to -0.31; I<sup>2</sup> = 87%) in HD. In low certainty evidence, when compared to placebo or standard care, aromatherapy may improve fatigue (7 studies, 542 participants (Fatigue Severity Scale (FSS), Rhoten Fatigue Scale (RFS), PFS or Brief Fatigue Inventory score): SMD -1.23, 95% CI -1.96 to -0.50; I<sup>2</sup> = 93%) in HD. In low certainty evidence, when compared to no intervention, massage may improve fatigue (7 studies, 657 participants (FSS, RFS, PFS or Visual Analogue Scale (VAS) score): SMD -1.06, 95% CI -1.47, -0.65; I<sup>2</sup> = 81%) and increase energy (2 studies, 152 participants (VAS score): MD 4.87, 95% CI 1.69 to 8.06, I<sup>2</sup> = 59%) in HD. In low certainty evidence, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD -0.64, 95% CI -1.03 to -0.25; I<sup>2</sup> = 75%) in HD. A wide range of heterogenous interventions and fatigue-related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our capability to pool and analyse the data. Due to the paucity of studies, the effects of pharmacological and other non-pharmacological interventions on fatigue or fatigue-related outcomes, including non-physiological neutral amino acid, relaxation with or without music therapy, meditation, exercise with nandrolone, nutritional supplementation, cognitive-behavioural therapy, ESAs, frequent HD sections, home blood pressure monitoring, blood flow rate reduction, serotonin reuptake inhibitor, beta-blockers, anabolic steroids, glucose-enriched dialysate, or light therapy, were very uncertain. The effects of pharmacological and non-pharmacological treatments on death, cardiovascular diseases, vascular access, QoL, depression, anxiety, hypertension or diabetes were sparse. No studies assessed tiredness, exhaustion or asthenia. Adverse events were rarely and inconsistently reported. Exercise, aromatherapy, massage and acupressure may improve fatigue compared to placebo, standard care or no intervention. Pharmacological and other non-pharmacological interventions had uncertain effects on fatigue or fatigue-related outcomes in people receiving dialysis. Future adequately powered, high-quality studies are likely to change the estimated effects of interventions for fatigue and fatigue-related outcomes in people receiving dialysis. |
07/12/2021 | A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section. | The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference = - 1.19, 95% confidence interval [CI]: - 1.76 to - 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16-3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Adolescent', 'Adult', 'Anesthesia', 'Arterial Pressure', 'Cesarean Section', 'Clinical Trials as Topic', 'Female', 'Humans', 'Infant, Newborn', 'Pre-Eclampsia', 'Pregnancy', 'Pregnancy Outcome', 'Vasoconstrictor Agents', 'Young Adult'] | 33,707,559 | 0 | A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section. The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference = - 1.19, 95% confidence interval [CI]: - 1.76 to - 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16-3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS. |
02/11/2023 | A meta-analysis and systematic review of single vs. multimodal neuroimaging techniques in the classification of psychosis. | Psychotic disorders are characterized by structural and functional abnormalities in brain networks. Neuroimaging techniques map and characterize such abnormalities using unique features (e.g., structural integrity, coactivation). However, it is unclear if a specific method, or a combination of modalities, is particularly effective in identifying differences in brain networks of someone with a psychotic disorder. A systematic meta-analysis evaluated machine learning classification of schizophrenia spectrum disorders in comparison to healthy control participants using various neuroimaging modalities (i.e., T1-weighted imaging (T1), diffusion tensor imaging (DTI), resting state functional connectivity (rs-FC), or some combination (multimodal)). Criteria for manuscript inclusion included whole-brain analyses and cross-validation to provide a complete picture regarding the predictive ability of large-scale brain systems in psychosis. For this meta-analysis, we searched Ovid MEDLINE, PubMed, PsychInfo, Google Scholar, and Web of Science published between inception and March 13th 2023. Prediction results were averaged for studies using the same dataset, but parallel analyses were run that included studies with pooled sample across many datasets. We assessed bias through funnel plot asymmetry. A bivariate regression model determined whether differences in imaging modality, demographics, and preprocessing methods moderated classification. Separate models were run for studies with internal prediction (via cross-validation) and external prediction. 93 studies were identified for quantitative review (30 T1, 9 DTI, 40 rs-FC, and 14 multimodal). As a whole, all modalities reliably differentiated those with schizophrenia spectrum disorders from controls (OR = 2.64 (95%CI = 2.33 to 2.95)). However, classification was relatively similar across modalities: no differences were seen across modalities in the classification of independent internal data, and a small advantage was seen for rs-FC studies relative to T1 studies in classification in external datasets. We found large amounts of heterogeneity across results resulting in significant signs of bias in funnel plots and Egger's tests. Results remained similar, however, when studies were restricted to those with less heterogeneity, with continued small advantages for rs-FC relative to structural measures. Notably, in all cases, no significant differences were seen between multimodal and unimodal approaches, with rs-FC and unimodal studies reporting largely overlapping classification performance. Differences in demographics and analysis or denoising were not associated with changes in classification scores. The results of this study suggest that neuroimaging approaches have promise in the classification of psychosis. Interestingly, at present most modalities perform similarly in the classification of psychosis, with slight advantages for rs-FC relative to structural modalities in some specific cases. Notably, results differed substantially across studies, with suggestions of biased effect sizes, particularly highlighting the need for more studies using external prediction and large sample sizes. Adopting more rigorous and systematized standards will add significant value toward understanding and treating this critical population. | ['Meta-Analysis', 'Systematic Review'] | ['Humans', 'Diffusion Tensor Imaging', 'Neuroimaging', 'Psychotic Disorders', 'Brain', 'Schizophrenia', 'Magnetic Resonance Imaging'] | 37,563,277 | 0 | A meta-analysis and systematic review of single vs. multimodal neuroimaging techniques in the classification of psychosis. Psychotic disorders are characterized by structural and functional abnormalities in brain networks. Neuroimaging techniques map and characterize such abnormalities using unique features (e.g., structural integrity, coactivation). However, it is unclear if a specific method, or a combination of modalities, is particularly effective in identifying differences in brain networks of someone with a psychotic disorder. A systematic meta-analysis evaluated machine learning classification of schizophrenia spectrum disorders in comparison to healthy control participants using various neuroimaging modalities (i.e., T1-weighted imaging (T1), diffusion tensor imaging (DTI), resting state functional connectivity (rs-FC), or some combination (multimodal)). Criteria for manuscript inclusion included whole-brain analyses and cross-validation to provide a complete picture regarding the predictive ability of large-scale brain systems in psychosis. For this meta-analysis, we searched Ovid MEDLINE, PubMed, PsychInfo, Google Scholar, and Web of Science published between inception and March 13th 2023. Prediction results were averaged for studies using the same dataset, but parallel analyses were run that included studies with pooled sample across many datasets. We assessed bias through funnel plot asymmetry. A bivariate regression model determined whether differences in imaging modality, demographics, and preprocessing methods moderated classification. Separate models were run for studies with internal prediction (via cross-validation) and external prediction. 93 studies were identified for quantitative review (30 T1, 9 DTI, 40 rs-FC, and 14 multimodal). As a whole, all modalities reliably differentiated those with schizophrenia spectrum disorders from controls (OR = 2.64 (95%CI = 2.33 to 2.95)). However, classification was relatively similar across modalities: no differences were seen across modalities in the classification of independent internal data, and a small advantage was seen for rs-FC studies relative to T1 studies in classification in external datasets. We found large amounts of heterogeneity across results resulting in significant signs of bias in funnel plots and Egger's tests. Results remained similar, however, when studies were restricted to those with less heterogeneity, with continued small advantages for rs-FC relative to structural measures. Notably, in all cases, no significant differences were seen between multimodal and unimodal approaches, with rs-FC and unimodal studies reporting largely overlapping classification performance. Differences in demographics and analysis or denoising were not associated with changes in classification scores. The results of this study suggest that neuroimaging approaches have promise in the classification of psychosis. Interestingly, at present most modalities perform similarly in the classification of psychosis, with slight advantages for rs-FC relative to structural modalities in some specific cases. Notably, results differed substantially across studies, with suggestions of biased effect sizes, particularly highlighting the need for more studies using external prediction and large sample sizes. Adopting more rigorous and systematized standards will add significant value toward understanding and treating this critical population. |
04/10/2022 | Gastrointestinal adverse events of metformin treatment in patients with type 2 diabetes mellitus: A systematic review, meta-analysis and meta-regression of randomized controlled trials. | Metformin is the first choice drug in the treatment of type 2 diabetes mellitus but its administration may be linked to gastrointestinal adverse events limiting its use. The objective of this systematic review and meta-analysis was to assess the risk of gastrointestinal adverse events related to metformin use in patients with type 2 diabetes treated with metformin. PUB MED/CINAHL/Web of Science/Scopus were searched from database inception until 08.11.2020 for articles in English and randomized controlled trials related to patients with type 2 diabetes treated with metformin were included. From 5315 publications, we identified 199 potentially eligible full-text articles. Finally, 71 randomized controlled trials were included in the meta-analysis. In these studies, metformin use was associated with higher risk of abdominal pain, diarrhea and nausea comparing to control. The risks of abdominal pain and nausea were highest comparing to placebo. Bloating risk was only elevated when metformin treatment was compared to DPP4i. The risk of gastrointestinal adverse events such as abdominal pain, nausea and diarrhea is higher in type 2 diabetes patients treated with metformin compared to other antidiabetic drugs. There is a higher risk of bloating and diarrhea with metformin immediate-release than with metformin extended release formulation. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289975, identifier CRD42021289975. | ['Meta-Analysis', 'Systematic Review'] | ['Abdominal Pain', 'Delayed-Action Preparations', 'Diabetes Mellitus, Type 2', 'Diarrhea', 'Humans', 'Hypoglycemic Agents', 'Metformin', 'Nausea', 'Randomized Controlled Trials as Topic'] | 36,187,122 | 0 | Gastrointestinal adverse events of metformin treatment in patients with type 2 diabetes mellitus: A systematic review, meta-analysis and meta-regression of randomized controlled trials. Metformin is the first choice drug in the treatment of type 2 diabetes mellitus but its administration may be linked to gastrointestinal adverse events limiting its use. The objective of this systematic review and meta-analysis was to assess the risk of gastrointestinal adverse events related to metformin use in patients with type 2 diabetes treated with metformin. PUB MED/CINAHL/Web of Science/Scopus were searched from database inception until 08.11.2020 for articles in English and randomized controlled trials related to patients with type 2 diabetes treated with metformin were included. From 5315 publications, we identified 199 potentially eligible full-text articles. Finally, 71 randomized controlled trials were included in the meta-analysis. In these studies, metformin use was associated with higher risk of abdominal pain, diarrhea and nausea comparing to control. The risks of abdominal pain and nausea were highest comparing to placebo. Bloating risk was only elevated when metformin treatment was compared to DPP4i. The risk of gastrointestinal adverse events such as abdominal pain, nausea and diarrhea is higher in type 2 diabetes patients treated with metformin compared to other antidiabetic drugs. There is a higher risk of bloating and diarrhea with metformin immediate-release than with metformin extended release formulation. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289975, identifier CRD42021289975. |
30/09/2022 | COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. | Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included, selected from scientific articles available in three scientific databases between 1 January 2020 and 6 February 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI=43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Breast Feeding', 'COVID-19', 'COVID-19 Vaccines', 'Female', 'Humans', 'Pregnancy', 'Vaccination', 'Vaccination Hesitancy', 'Vaccines'] | 35,818,804 | 0 | COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group. The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included, selected from scientific articles available in three scientific databases between 1 January 2020 and 6 February 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI=43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education. |
15/01/2024 | Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis. | Continuous passive motion (CPM) is commonly used as a postoperative rehabilitation treatment, along with physical therapy, for postoperative knee rehabilitation. However, the comparison between the two in terms of efficacy in postoperative knee replacement recovery is unclear. To compare efficacy and safety of combined CPM versus physical therapy alone in postoperative rehabilitation after knee arthroplasty. PubMed, Embase, and Web of Science databases were used to retrieve and access clinical studies on the efficacy of CPM compared with physical therapy. Review Manager software was used for study publication bias assessment and data analysis based on inclusion criteria. A total of 6 articles covering 557 patients were included in the study. In terms of range of motion (ROM), passive knee flexion was similar between CPM and physical therapy (PT) (WMD, - 0.17; 95% CI, - 0.98-0.64; p = 0.68). At long-term follow-up, passive knee extension was similar between CPM and physical therapy (PT) (WMD, - 0.28; 95% CI, - 1.47 to - 0.92; I<sup>2</sup> = 65%, p =0.65). In addition, CPM generates significantly higher in length of stay (WMD, 0.50; 95% CI, - 0.31 to 0.69; I<sup>2</sup> = 3%, p < 0.001). CPM generates significantly higher treatment costs and incurs more care costs relative to physical therapy. Compared to PT, combined with CPM failed to significantly improve ROM of the knees and patient's satisfaction. In addition, CPM treatment significantly increased the cost of hospitalization. | ['Meta-Analysis', 'Systematic Review'] | ['Humans', 'Arthroplasty, Replacement, Knee', 'Knee Joint', 'Motion Therapy, Continuous Passive', 'Physical Therapy Modalities', 'Range of Motion, Articular'] | 38,218,933 | 0 | Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis. Continuous passive motion (CPM) is commonly used as a postoperative rehabilitation treatment, along with physical therapy, for postoperative knee rehabilitation. However, the comparison between the two in terms of efficacy in postoperative knee replacement recovery is unclear. To compare efficacy and safety of combined CPM versus physical therapy alone in postoperative rehabilitation after knee arthroplasty. PubMed, Embase, and Web of Science databases were used to retrieve and access clinical studies on the efficacy of CPM compared with physical therapy. Review Manager software was used for study publication bias assessment and data analysis based on inclusion criteria. A total of 6 articles covering 557 patients were included in the study. In terms of range of motion (ROM), passive knee flexion was similar between CPM and physical therapy (PT) (WMD, - 0.17; 95% CI, - 0.98-0.64; p = 0.68). At long-term follow-up, passive knee extension was similar between CPM and physical therapy (PT) (WMD, - 0.28; 95% CI, - 1.47 to - 0.92; I<sup>2</sup> = 65%, p =0.65). In addition, CPM generates significantly higher in length of stay (WMD, 0.50; 95% CI, - 0.31 to 0.69; I<sup>2</sup> = 3%, p < 0.001). CPM generates significantly higher treatment costs and incurs more care costs relative to physical therapy. Compared to PT, combined with CPM failed to significantly improve ROM of the knees and patient's satisfaction. In addition, CPM treatment significantly increased the cost of hospitalization. |
02/10/2023 | L. barbarum (Lycium barbarum L.) supplementation for lipid profiles in adults: A systematic review and meta-analysis of RCTs. | Dyslipidemia is a global health concern with an increasing prevalence worldwide. Lycium barbarum (L. barbarum) is widely used as a medicinal and functional food, and evidence suggests that it may be beneficial for lipid management. In this study, we performed a systematic review and meta-analysis of randomized controlled trials investigating the effects of L. barbarum supplementation on lipid profiles in adults. PubMed, China National Knowledge Infrastructure, The Cochrane Library, Web of Science, and Wanfang Database were searched from inception until October 2022. The random-effect model was applied, and the pooled effect sizes were expressed as mean differences (MDs) and 95% confidence intervals (CIs). The meta-analysis of 5 randomized controlled trials involving 259 subjects indicated that L. barbarum supplementation significantly decreased the triglyceride (TG) concentration (MD: 0.14 mmol/L, 95% CI: 0.08-0.20) and increased the high-density lipoprotein cholesterol concentration (HDL-C) (MD: -0.07 mmol/L, 95% CI: -0.13 to -0.01). However, the reductions in total cholesterol (TC) concentration (MD: 0.11 mmol/L, 95% CI: -0.37 to 0.59) and low-density lipoprotein cholesterol (LDL-C) concentration (MD: 0.21 mmol/L, 95% CI: -0.46 to 0.89) were not statistically significant. The present study showed that L. barbarum supplementation might have some beneficial effects on TG and HDL-C concentrations in adults, and L. barbarum fruit has an even greater effect on TG and HDL-C concentrations. Considering the sensitivity analyses and limitations of the study included, further large-scale studies are needed to confirm these findings. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Adult', 'Lycium', 'Triglycerides', 'Cholesterol, HDL', 'Cholesterol, LDL', 'Dietary Supplements'] | 37,773,857 | 0 | L. barbarum (Lycium barbarum L.) supplementation for lipid profiles in adults: A systematic review and meta-analysis of RCTs. Dyslipidemia is a global health concern with an increasing prevalence worldwide. Lycium barbarum (L. barbarum) is widely used as a medicinal and functional food, and evidence suggests that it may be beneficial for lipid management. In this study, we performed a systematic review and meta-analysis of randomized controlled trials investigating the effects of L. barbarum supplementation on lipid profiles in adults. PubMed, China National Knowledge Infrastructure, The Cochrane Library, Web of Science, and Wanfang Database were searched from inception until October 2022. The random-effect model was applied, and the pooled effect sizes were expressed as mean differences (MDs) and 95% confidence intervals (CIs). The meta-analysis of 5 randomized controlled trials involving 259 subjects indicated that L. barbarum supplementation significantly decreased the triglyceride (TG) concentration (MD: 0.14 mmol/L, 95% CI: 0.08-0.20) and increased the high-density lipoprotein cholesterol concentration (HDL-C) (MD: -0.07 mmol/L, 95% CI: -0.13 to -0.01). However, the reductions in total cholesterol (TC) concentration (MD: 0.11 mmol/L, 95% CI: -0.37 to 0.59) and low-density lipoprotein cholesterol (LDL-C) concentration (MD: 0.21 mmol/L, 95% CI: -0.46 to 0.89) were not statistically significant. The present study showed that L. barbarum supplementation might have some beneficial effects on TG and HDL-C concentrations in adults, and L. barbarum fruit has an even greater effect on TG and HDL-C concentrations. Considering the sensitivity analyses and limitations of the study included, further large-scale studies are needed to confirm these findings. |
16/11/2021 | Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies. | Antipsychotic agents are the basis for the pharmacological management of acute and chronic schizophrenia, bipolar disorders, mood disorders with psychotic feature, and other psychotic disorders. Antipsychotic medication use is frequently associated with unfavorable adverse effects such as extrapyramidal side effects (EPSEs). Hence, this systematic review and meta-analysis was aimed to determine the magnitude of antipsychotic-induced EPSEs. A literature search was conducted using legitimate databases, indexing services, and directories including PubMed/MEDLINE (Ovid®), EMBASE (Ovid®), google scholar and WorldCat to retrieve studies. Following screening and eligibility, the relevant data were extracted from the included studies using an Excel sheet and exported to STATA 15.0 software for analyses. The Random effects pooling model was used to analyze outcome measures at a 95% confidence interval. Besides, publication bias analysis was conducted. The protocol has been registered on PROSPERO with ID: CRD42020175168. In total, 15 original articles were included for the systematic review and meta-analysis. The pooled prevalence of antipsychotic-induced EPSEs among patient taking antipsychotic medications was 37% (95% CI: 18-55%, before sensitivity) and 31% (95% CI: 19-44%, after sensitivity). The prevalence of antipsychotic-induced parkinsonism, akathisia, and tardive dyskinesia was 20% (95% CI: 11-28%), 11% (95% CI: 6-17%), and 7% (95% CI: 4-9%), respectively. To confirm a small-study effect, Egger's regression test accompanied by funnel plot asymmetry demonstrated that there was a sort of publication bias in studies reporting akathisia and tardive dyskinesia. The prevalence of antipsychotic-induced EPSEs was considerably high. One in five and more than one in ten patients experienced parkinsonism and akathisia, respectively. Appropriate prevention and early management of these effects can enhance the net benefits of antipsychotics. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Antipsychotic Agents', 'Geography', 'Humans', 'Movement Disorders', 'Observational Studies as Topic', 'Outcome Assessment, Health Care', 'Publication Bias', 'Tardive Dyskinesia'] | 34,506,552 | 0 | Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies. Antipsychotic agents are the basis for the pharmacological management of acute and chronic schizophrenia, bipolar disorders, mood disorders with psychotic feature, and other psychotic disorders. Antipsychotic medication use is frequently associated with unfavorable adverse effects such as extrapyramidal side effects (EPSEs). Hence, this systematic review and meta-analysis was aimed to determine the magnitude of antipsychotic-induced EPSEs. A literature search was conducted using legitimate databases, indexing services, and directories including PubMed/MEDLINE (Ovid®), EMBASE (Ovid®), google scholar and WorldCat to retrieve studies. Following screening and eligibility, the relevant data were extracted from the included studies using an Excel sheet and exported to STATA 15.0 software for analyses. The Random effects pooling model was used to analyze outcome measures at a 95% confidence interval. Besides, publication bias analysis was conducted. The protocol has been registered on PROSPERO with ID: CRD42020175168. In total, 15 original articles were included for the systematic review and meta-analysis. The pooled prevalence of antipsychotic-induced EPSEs among patient taking antipsychotic medications was 37% (95% CI: 18-55%, before sensitivity) and 31% (95% CI: 19-44%, after sensitivity). The prevalence of antipsychotic-induced parkinsonism, akathisia, and tardive dyskinesia was 20% (95% CI: 11-28%), 11% (95% CI: 6-17%), and 7% (95% CI: 4-9%), respectively. To confirm a small-study effect, Egger's regression test accompanied by funnel plot asymmetry demonstrated that there was a sort of publication bias in studies reporting akathisia and tardive dyskinesia. The prevalence of antipsychotic-induced EPSEs was considerably high. One in five and more than one in ten patients experienced parkinsonism and akathisia, respectively. Appropriate prevention and early management of these effects can enhance the net benefits of antipsychotics. |
23/08/2023 | Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis. | Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. The total population in our 41 pooled studies comprised 1 112 136 patients - average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized-controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48-1.06, P -value = 0.013, I2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86-1.34, P -value = 0.921, I2 = 0.0%). There was no significant difference in stroke outcomes between the TR approach and the TF approach. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Female', 'Humans', 'Aged', 'Risk Factors', 'Radial Artery', 'Femoral Artery', 'Heart', 'Stroke', 'Percutaneous Coronary Intervention', 'Treatment Outcome'] | 37,409,665 | 0 | Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis. Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. The total population in our 41 pooled studies comprised 1 112 136 patients - average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized-controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48-1.06, P -value = 0.013, I2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86-1.34, P -value = 0.921, I2 = 0.0%). There was no significant difference in stroke outcomes between the TR approach and the TF approach. |
26/02/2024 | Impact of Canagliflozin on Kidney and Cardiovascular Outcomes by Type 2 Diabetes Duration: A Pooled Analysis of the CANVAS Program and CREDENCE Trials. | The study was undertaken because it was unknown whether the duration of type 2 diabetes modifies the effects of sodium-glucose cotransporter 2 inhibitor canagliflozin on cardiovascular (CV) and kidney outcomes. This post hoc analysis of the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program (N = 10,142) and Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE) trial (N = 4,401) evaluated hazard ratios and 95% CIs using Cox proportional hazards for the effects of canagliflozin on CV and kidney outcomes, including progression and regression of albuminuria over 5-year intervals of disease duration. Canagliflozin had ranges of benefit across intervals of diabetes duration, with no heterogeneity for major adverse CV events, CV death or heart failure hospitalization, and kidney failure requiring therapy or doubling serum creatinine. Furthermore, canagliflozin reduced albuminuria progression and increased albuminuria regression with no interaction across all diabetes duration subgroups. Our findings suggest that earlier treatment with canagliflozin confers consistent cardiorenal benefits to individuals with type 2 diabetes. | ['Meta-Analysis', 'Journal Article'] | ['Humans', 'Canagliflozin', 'Diabetes Mellitus, Type 2', 'Sodium-Glucose Transporter 2 Inhibitors', 'Albuminuria', 'Cardiovascular Diseases', 'Kidney'] | 38,252,809 | 1 | Impact of Canagliflozin on Kidney and Cardiovascular Outcomes by Type 2 Diabetes Duration: A Pooled Analysis of the CANVAS Program and CREDENCE Trials. The study was undertaken because it was unknown whether the duration of type 2 diabetes modifies the effects of sodium-glucose cotransporter 2 inhibitor canagliflozin on cardiovascular (CV) and kidney outcomes. This post hoc analysis of the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program (N = 10,142) and Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE) trial (N = 4,401) evaluated hazard ratios and 95% CIs using Cox proportional hazards for the effects of canagliflozin on CV and kidney outcomes, including progression and regression of albuminuria over 5-year intervals of disease duration. Canagliflozin had ranges of benefit across intervals of diabetes duration, with no heterogeneity for major adverse CV events, CV death or heart failure hospitalization, and kidney failure requiring therapy or doubling serum creatinine. Furthermore, canagliflozin reduced albuminuria progression and increased albuminuria regression with no interaction across all diabetes duration subgroups. Our findings suggest that earlier treatment with canagliflozin confers consistent cardiorenal benefits to individuals with type 2 diabetes. |
11/04/2023 | Autoantibodies against type I interferons in COVID-19 infection: A systematic review and meta-analysis. | In this study, we aimed to study the rate of autoantibodies against type I interferons (IFNs) in patients with COVID-19 and analyze its dependence on severity of infection and some other variables. A systemic review with the search terms: "COVID-19" or "SARS-CoV-2" and "autoantibodies" or "autoantibody" and "IFN" or "interferon" for the period 20 December 2019 to 15 August 2022 was carried out using PubMed, Embase, Cochrane, and Web of Science. R 4.2.1 software was used for meta-analysis of the published results. Pooled risk ratios and 95% confidence intervals (CIs) were calculated. We identified eight studies involving 7729 patients, of whom 5097 (66%) had severe COVID-19 and 2632 (34%) had mild or moderate symptoms. The positive rate of anti-type-I-IFN-autoantibodies in the total dataset was 5% (95% CI, 3-8%), but reached 10% (95% CI, 7-14%) in those with severe infection. The most common subtypes were anti-IFN-α (89%) and anti-IFN-ω (77%). The overall prevalence in male patients was 5% (95% CI, 4-6%), and in female patients 2% (95% CI, 1-3%). Severe COVID-19 is associated with high rates of autoantibodies against type-I-IFN and more so in male than female patients. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Male', 'Female', 'COVID-19', 'Interferon Type I', 'Autoantibodies', 'Interferons', 'Interferon-alpha', 'SARS-CoV-2'] | 36,907,547 | 0 | Autoantibodies against type I interferons in COVID-19 infection: A systematic review and meta-analysis. In this study, we aimed to study the rate of autoantibodies against type I interferons (IFNs) in patients with COVID-19 and analyze its dependence on severity of infection and some other variables. A systemic review with the search terms: "COVID-19" or "SARS-CoV-2" and "autoantibodies" or "autoantibody" and "IFN" or "interferon" for the period 20 December 2019 to 15 August 2022 was carried out using PubMed, Embase, Cochrane, and Web of Science. R 4.2.1 software was used for meta-analysis of the published results. Pooled risk ratios and 95% confidence intervals (CIs) were calculated. We identified eight studies involving 7729 patients, of whom 5097 (66%) had severe COVID-19 and 2632 (34%) had mild or moderate symptoms. The positive rate of anti-type-I-IFN-autoantibodies in the total dataset was 5% (95% CI, 3-8%), but reached 10% (95% CI, 7-14%) in those with severe infection. The most common subtypes were anti-IFN-α (89%) and anti-IFN-ω (77%). The overall prevalence in male patients was 5% (95% CI, 4-6%), and in female patients 2% (95% CI, 1-3%). Severe COVID-19 is associated with high rates of autoantibodies against type-I-IFN and more so in male than female patients. |
08/05/2023 | Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. | No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. CRD42022301005. | ['Meta-Analysis', 'Systematic Review'] | ['Humans', 'Middle Aged', 'Adrenal Gland Neoplasms', 'Adrenalectomy', 'Laparoscopy', 'Length of Stay', 'Network Meta-Analysis', 'Retroperitoneal Space', 'Treatment Outcome', 'Randomized Controlled Trials as Topic'] | 37,145,303 | 0 | Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. CRD42022301005. |
12/04/2023 | Global ambient particulate matter pollution and neurodegenerative disorders: a systematic review of literature and meta-analysis. | Previous studies on particulate matter (PM) exposure and neurodegenerative disorders showed inconsistent results, and few studies systematically examined the long-term effect of PM on neurodegenerative diseases, including all-cause dementia, Alzheimer's disease, Parkinson's disease, vascular dementia, amyotrophic lateral sclerosis, and cognitive function decline. We systematically searched for published studies in PubMed, Embase, Cochrane Library, and Web of Science up to October 31, 2022. To facilitate a comparison of effect sizes from different studies, we standardized units across studies to a 10 μg/m<sup>3</sup> increase for PM. Heterogeneity was assessed by Cochran's Q test and I<sup>2</sup> statistic. Publication bias was evaluated using funnel plots and Egger's tests. Subgroup analysis, meta-regression, and sensitivity analysis were performed. The protocol for this review was registered with PROSPERO (CRD42021277112). Of the 3403 originally identified studies, a meta-analysis was finally performed in 49 studies. The results showed that there was a significant positive association between long-term PM<sub>2.5</sub> exposure and all-cause dementia, Alzheimer's disease as well as Parkinson's disease, with pooled OR of 1.30 (95%CI: 1.14, 1.47, I<sup>2</sup> = 99.3%), 1.65 (95%CI: 1.37, 1.94, I<sup>2</sup> = 98.2%), and 1.17 (95%CI: 1.00, 1.33, I<sup>2</sup> = 91.8%). A positive association between PM<sub>10</sub> and vascular dementia was observed (OR = 1.12, 95%CI: 1.04, 1.21, I<sup>2</sup> = 0.0%). Association between PM exposure and decreased cognitive function score was found. Our results highlight the important role of PM pollution, particularly PM<sub>2.5</sub>, in the risk of age-related neurodegenerative diseases and cognitive function decline. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Air Pollutants', 'Air Pollution', 'Alzheimer Disease', 'Dementia, Vascular', 'Environmental Exposure', 'Parkinson Disease', 'Particulate Matter'] | 36,763,275 | 0 | Global ambient particulate matter pollution and neurodegenerative disorders: a systematic review of literature and meta-analysis. Previous studies on particulate matter (PM) exposure and neurodegenerative disorders showed inconsistent results, and few studies systematically examined the long-term effect of PM on neurodegenerative diseases, including all-cause dementia, Alzheimer's disease, Parkinson's disease, vascular dementia, amyotrophic lateral sclerosis, and cognitive function decline. We systematically searched for published studies in PubMed, Embase, Cochrane Library, and Web of Science up to October 31, 2022. To facilitate a comparison of effect sizes from different studies, we standardized units across studies to a 10 μg/m<sup>3</sup> increase for PM. Heterogeneity was assessed by Cochran's Q test and I<sup>2</sup> statistic. Publication bias was evaluated using funnel plots and Egger's tests. Subgroup analysis, meta-regression, and sensitivity analysis were performed. The protocol for this review was registered with PROSPERO (CRD42021277112). Of the 3403 originally identified studies, a meta-analysis was finally performed in 49 studies. The results showed that there was a significant positive association between long-term PM<sub>2.5</sub> exposure and all-cause dementia, Alzheimer's disease as well as Parkinson's disease, with pooled OR of 1.30 (95%CI: 1.14, 1.47, I<sup>2</sup> = 99.3%), 1.65 (95%CI: 1.37, 1.94, I<sup>2</sup> = 98.2%), and 1.17 (95%CI: 1.00, 1.33, I<sup>2</sup> = 91.8%). A positive association between PM<sub>10</sub> and vascular dementia was observed (OR = 1.12, 95%CI: 1.04, 1.21, I<sup>2</sup> = 0.0%). Association between PM exposure and decreased cognitive function score was found. Our results highlight the important role of PM pollution, particularly PM<sub>2.5</sub>, in the risk of age-related neurodegenerative diseases and cognitive function decline. |
22/03/2021 | Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis. | There is considerable public and scientific debate as to whether screen use helps or hinders early child development, particularly the development of language skills. To examine via meta-analyses the associations between quantity (duration of screen time and background television), quality (educational programming and co-viewing), and onset of screen use and children's language skills. Searches were conducted in MEDLINE, Embase, and PsycINFO in March 2019. The search strategy included a publication date limit from 1960 through March 2019. Inclusion criteria were a measure of screen use; a measure of language skills; and statistical data that could be transformed into an effect size. Exclusion criteria were qualitative studies; child age older than 12 years; and language assessment preverbal. The following variables were extracted: effect size, child age and sex, screen measure type, study publication year, and study design. All studies were independently coded by 2 coders and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Based on a priori study criteria, quantity of screen use included duration of screen time and background television, quality of screen use included co-viewing and exposure to educational programs, and onset of screen use was defined as the age children first began viewing screens. The child language outcome included assessments of receptive and/or expressive language. Participants totaled 18 905 from 42 studies included. Effect sizes were measured as correlations (r). Greater quantity of screen use (hours per use) was associated with lower language skills (screen time [n = 38; r = -0.14; 95% CI, -0.18 to -0.10]; background television [n = 5; r = -0.19; 95% CI, -0.33 to -0.05]), while better-quality screen use (educational programs [n = 13; r = 0.13; 95% CI, 0.02-0.24]; co-viewing [n = 12; r = 0.16; 95% CI, 0.07-.24]) were associated with stronger child language skills. Later age at screen use onset was also associated with stronger child language skills [n = 4; r = 0.17; 95% CI, 0.07-0.27]. The findings of this meta-analysis support pediatric recommendations to limit children's duration of screen exposure, to select high-quality programming, and to co-view when possible. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Child', 'Child Language', 'Humans', 'Parents', 'Television'] | 32,202,633 | 0 | Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis. There is considerable public and scientific debate as to whether screen use helps or hinders early child development, particularly the development of language skills. To examine via meta-analyses the associations between quantity (duration of screen time and background television), quality (educational programming and co-viewing), and onset of screen use and children's language skills. Searches were conducted in MEDLINE, Embase, and PsycINFO in March 2019. The search strategy included a publication date limit from 1960 through March 2019. Inclusion criteria were a measure of screen use; a measure of language skills; and statistical data that could be transformed into an effect size. Exclusion criteria were qualitative studies; child age older than 12 years; and language assessment preverbal. The following variables were extracted: effect size, child age and sex, screen measure type, study publication year, and study design. All studies were independently coded by 2 coders and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Based on a priori study criteria, quantity of screen use included duration of screen time and background television, quality of screen use included co-viewing and exposure to educational programs, and onset of screen use was defined as the age children first began viewing screens. The child language outcome included assessments of receptive and/or expressive language. Participants totaled 18 905 from 42 studies included. Effect sizes were measured as correlations (r). Greater quantity of screen use (hours per use) was associated with lower language skills (screen time [n = 38; r = -0.14; 95% CI, -0.18 to -0.10]; background television [n = 5; r = -0.19; 95% CI, -0.33 to -0.05]), while better-quality screen use (educational programs [n = 13; r = 0.13; 95% CI, 0.02-0.24]; co-viewing [n = 12; r = 0.16; 95% CI, 0.07-.24]) were associated with stronger child language skills. Later age at screen use onset was also associated with stronger child language skills [n = 4; r = 0.17; 95% CI, 0.07-0.27]. The findings of this meta-analysis support pediatric recommendations to limit children's duration of screen exposure, to select high-quality programming, and to co-view when possible. |
21/06/2023 | Impact of surgical resection on the survival in Mexican patients with gastric cancer: A meta-analysis and systematic review. | Gastric cancer (GC) is one of the most frequent cancer types in Mexico. The primary method used as a treatment is surgical resection. The role of surgery in increasing survival is controversial. This study aimed to determine whether surgical resection increases the survival of patients with GC in a Mexican population. A systematic review of literature searches (Evidence-based MEDLINE/PubMed, Web of Science, Cochrane Library, and SciELO) and meta-analysis were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. The published articles from 2000 to the current time were divided into cross-sectional and randomized studies. The inclusion criteria were survival, surgical resections, patients treated in Mexico, and primary GC. The effect estimation was calculated using the risk ratio (RR). The random-effects model and a confidence interval (CI) of 95% were used. The RR of the pooled studies was 1.09 (95% CI, 0.71-1.67). RR of 0.82 (95% CI, 0.63-1.07) was obtained in cross-sectional studies, and randomized studies showed a RR of 2.08 (95% CI, 0.25-17.07). This work is the first systematic study that assesses the role of surgery on the survival of patients with GC in the Mexican population, the results showed that surgical resection did not improve survival in patients with GC. | ['Systematic Review', 'Meta-Analysis', 'Journal Article'] | ['Humans', 'Stomach Neoplasms', 'Mexico', 'Cross-Sectional Studies'] | 37,335,646 | 0 | Impact of surgical resection on the survival in Mexican patients with gastric cancer: A meta-analysis and systematic review. Gastric cancer (GC) is one of the most frequent cancer types in Mexico. The primary method used as a treatment is surgical resection. The role of surgery in increasing survival is controversial. This study aimed to determine whether surgical resection increases the survival of patients with GC in a Mexican population. A systematic review of literature searches (Evidence-based MEDLINE/PubMed, Web of Science, Cochrane Library, and SciELO) and meta-analysis were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria. The published articles from 2000 to the current time were divided into cross-sectional and randomized studies. The inclusion criteria were survival, surgical resections, patients treated in Mexico, and primary GC. The effect estimation was calculated using the risk ratio (RR). The random-effects model and a confidence interval (CI) of 95% were used. The RR of the pooled studies was 1.09 (95% CI, 0.71-1.67). RR of 0.82 (95% CI, 0.63-1.07) was obtained in cross-sectional studies, and randomized studies showed a RR of 2.08 (95% CI, 0.25-17.07). This work is the first systematic study that assesses the role of surgery on the survival of patients with GC in the Mexican population, the results showed that surgical resection did not improve survival in patients with GC. |
10/12/2021 | Efficacy and safety of Huaiqihuang granule as adjuvant treatment for primary nephrotic syndrome in children: a meta-analysis and systematic review. | Huaiqihuang (HQH) granule is a traditional Chinese herbal complex that has been used as an adjuvant treatment in clinics for the primary nephrotic syndrome (PNS) for many years. However, the effectiveness and safety of HQH have not been systematically discussed. This review aimed to evaluate the effectiveness and safety of HQH in paediatric patients with PNS. The following databases were searched from inception to Mar 2019: MEDLINE, Cochrane Library, EMBASE, CNKI, Wanfang Database, the Chinese Scientific Journal Database and the Chinese biomedical literature service system. All the randomized controlled trials (RCTs) eligible for inclusion were included. The primary outcomes were relapse, infection, remission and adverse events. The secondary outcomes included serum immunoglobulin levels (IgA, IgG or IgM), T-lymphocyte subtype (CD3+ , CD4+ , CD8+ , CD4+ /CD8+), IL-10, TNF-α, TNF-γ, total cholesterol and time of proteinuria turning negative. Fourteen RCTs (885 patients) were identified. Treatment with HQH reduced the chance of relapse [relative risk (RR): 0.47; 95% CI: 0.34, 0.66; P < 0.001] and infections (RR: 0.47; 95% CI: 0.35, 0.62; P < 0.001). No significant difference was found in adverse events. HQH also increased the serum levels of IgA [weighted mean difference (WMD): 0.40; 95% CI: 0.20, 0.60; P < 0.001] and IgG (WMD: 1.58; 95% CI: 1.38-1.78; P < 0.001), as well as CD4<sup>+</sup> [standard mean difference (SMD): 0.90; 95% CI: 0.12-1.68; P = 0.02], CD3<sup>+</sup> (WMD: 4.04; 95% CI: 3.27-4.82; P < 0.001), and the CD4<sup>+</sup>/CD8<sup>+</sup>ratio (WMD: 0.31; 95% CI: 0.21-0.41; P < 0.001), but decreased the level of CD8<sup>+</sup> cells (WMD: -3.39; 95% CI: -5.73-1.05; P = 0.004). No statistically significant difference was found in IgM (WMD: 0.05; 95% CI: -0.13, 0.24; P = 0.57). HQH could reduce the rate of relapse and the frequency of infection in children with PNS. No apparent adverse effects were found. Moreover, the beneficial influence of HQH may act through immunomodulation. Additional multi-center, large-sample, high-quality studies are needed to confirm the effectiveness and safety of HQH. | ['Journal Article', 'Meta-Analysis', 'Review', 'Systematic Review'] | ['Child', 'Drugs, Chinese Herbal', 'Humans', 'Nephrotic Syndrome', 'Recurrence', 'Tumor Necrosis Factor-alpha'] | 34,075,551 | 1 | Efficacy and safety of Huaiqihuang granule as adjuvant treatment for primary nephrotic syndrome in children: a meta-analysis and systematic review. Huaiqihuang (HQH) granule is a traditional Chinese herbal complex that has been used as an adjuvant treatment in clinics for the primary nephrotic syndrome (PNS) for many years. However, the effectiveness and safety of HQH have not been systematically discussed. This review aimed to evaluate the effectiveness and safety of HQH in paediatric patients with PNS. The following databases were searched from inception to Mar 2019: MEDLINE, Cochrane Library, EMBASE, CNKI, Wanfang Database, the Chinese Scientific Journal Database and the Chinese biomedical literature service system. All the randomized controlled trials (RCTs) eligible for inclusion were included. The primary outcomes were relapse, infection, remission and adverse events. The secondary outcomes included serum immunoglobulin levels (IgA, IgG or IgM), T-lymphocyte subtype (CD3+ , CD4+ , CD8+ , CD4+ /CD8+), IL-10, TNF-α, TNF-γ, total cholesterol and time of proteinuria turning negative. Fourteen RCTs (885 patients) were identified. Treatment with HQH reduced the chance of relapse [relative risk (RR): 0.47; 95% CI: 0.34, 0.66; P < 0.001] and infections (RR: 0.47; 95% CI: 0.35, 0.62; P < 0.001). No significant difference was found in adverse events. HQH also increased the serum levels of IgA [weighted mean difference (WMD): 0.40; 95% CI: 0.20, 0.60; P < 0.001] and IgG (WMD: 1.58; 95% CI: 1.38-1.78; P < 0.001), as well as CD4<sup>+</sup> [standard mean difference (SMD): 0.90; 95% CI: 0.12-1.68; P = 0.02], CD3<sup>+</sup> (WMD: 4.04; 95% CI: 3.27-4.82; P < 0.001), and the CD4<sup>+</sup>/CD8<sup>+</sup>ratio (WMD: 0.31; 95% CI: 0.21-0.41; P < 0.001), but decreased the level of CD8<sup>+</sup> cells (WMD: -3.39; 95% CI: -5.73-1.05; P = 0.004). No statistically significant difference was found in IgM (WMD: 0.05; 95% CI: -0.13, 0.24; P = 0.57). HQH could reduce the rate of relapse and the frequency of infection in children with PNS. No apparent adverse effects were found. Moreover, the beneficial influence of HQH may act through immunomodulation. Additional multi-center, large-sample, high-quality studies are needed to confirm the effectiveness and safety of HQH. |
26/06/2023 | Cognitive protection of incretin-based therapies in patients with type 2 diabetes mellitus: A systematic review and meta-analysis based on clinical studies. | Cognitive dysfunction, including mild cognitive impairment and dementia, is increasingly recognized as an important complication of type 2 diabetes mellitus. The aims of the preset study was to investigate the cognitive protection of incretin-based therapies, including glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, in patients with type 2 diabetes mellitus. PubMed, EMBASE, Cochrane library, Web of Science and PsycINFO were searched from the inception through 17 January 2023 for randomized controlled trials and cohort studies on the association between incretin-based therapies and cognitive function. A total of 15 studies were finally included in our systematic review, and eight of which were incorporated into our meta-analysis. Pooled results showed that the Mini-Mental State Examination score in incretin-based therapy groups was increased by 1.20 compared with the control group (weighted mean difference 1.20, 95% confidence interval 0.39-2.01). The results of eight studies assessed by the Newcastle Ottawa Quality Assessment Scale and the Cochrane Collaboration's tool, and the quality of the eight studies were at a relatively high level. Egger's regression did not show significant publication bias. Current evidence shows that incretin-based therapies might be more effective, when compared with the other hypoglycemic drugs, for cognitive improvement in patients with type 2 diabetes mellitus. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Incretins', 'Diabetes Mellitus, Type 2', 'Hypoglycemic Agents', 'Dipeptidyl-Peptidase IV Inhibitors', 'Cognition', 'Glucagon-Like Peptide-1 Receptor'] | 37,147,888 | 0 | Cognitive protection of incretin-based therapies in patients with type 2 diabetes mellitus: A systematic review and meta-analysis based on clinical studies. Cognitive dysfunction, including mild cognitive impairment and dementia, is increasingly recognized as an important complication of type 2 diabetes mellitus. The aims of the preset study was to investigate the cognitive protection of incretin-based therapies, including glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, in patients with type 2 diabetes mellitus. PubMed, EMBASE, Cochrane library, Web of Science and PsycINFO were searched from the inception through 17 January 2023 for randomized controlled trials and cohort studies on the association between incretin-based therapies and cognitive function. A total of 15 studies were finally included in our systematic review, and eight of which were incorporated into our meta-analysis. Pooled results showed that the Mini-Mental State Examination score in incretin-based therapy groups was increased by 1.20 compared with the control group (weighted mean difference 1.20, 95% confidence interval 0.39-2.01). The results of eight studies assessed by the Newcastle Ottawa Quality Assessment Scale and the Cochrane Collaboration's tool, and the quality of the eight studies were at a relatively high level. Egger's regression did not show significant publication bias. Current evidence shows that incretin-based therapies might be more effective, when compared with the other hypoglycemic drugs, for cognitive improvement in patients with type 2 diabetes mellitus. |
26/01/2022 | Validation of the academic research consortium high bleeding risk criteria in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis of 10 studies and 67,862 patients. | To assess the performance of the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in stratifying the risk of bleeding and ischaemic events after percutaneous coronary intervention (PCI). MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC-HBR criteria in patients treated with PCI. The primary outcome measure of this meta-analysis was major bleeding. The analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non-HBR group (RR, 2.56, 95% CI 2.28-2.89). The average C-statistic was 0.64 (95% CI 0.60-0.68), indicating modest discrimination. The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all-cause death was higher in HBR vs. Non-HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88-1.16). The mean effect size for the cumulative incidence of major bleeding exceeded the HBR cut-off value of 4% for all major criteria except one, and for two out of six minor criteria, namely age ≥ 75 years and moderate CKD. The ARC-HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Aged', 'Brain Ischemia', 'Gastrointestinal Hemorrhage', 'Humans', 'Percutaneous Coronary Intervention', 'Platelet Aggregation Inhibitors', 'Risk Assessment', 'Risk Factors', 'Stroke', 'Treatment Outcome'] | 34,774,882 | 0 | Validation of the academic research consortium high bleeding risk criteria in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis of 10 studies and 67,862 patients. To assess the performance of the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in stratifying the risk of bleeding and ischaemic events after percutaneous coronary intervention (PCI). MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC-HBR criteria in patients treated with PCI. The primary outcome measure of this meta-analysis was major bleeding. The analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non-HBR group (RR, 2.56, 95% CI 2.28-2.89). The average C-statistic was 0.64 (95% CI 0.60-0.68), indicating modest discrimination. The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all-cause death was higher in HBR vs. Non-HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88-1.16). The mean effect size for the cumulative incidence of major bleeding exceeded the HBR cut-off value of 4% for all major criteria except one, and for two out of six minor criteria, namely age ≥ 75 years and moderate CKD. The ARC-HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. |
28/02/2022 | Late Kidney Effects of Nephron-Sparing vs Radical Nephrectomy for Wilms Tumor: A Systematic Review and Meta-Analysis. | We compare differences in long-term kidney function between patients undergoing either radical nephrectomy (RN) or nephron-sparing surgery (NSS) in unilateral and bilateral Wilms tumor (WT), respectively. A systematic search was performed in September 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed long-term (>1-year postoperative) outcomes included chronic kidney disease, hypertension and glomerular filtration rate, among others. Odds ratio and mean difference with 95% confidence interval were extrapolated from available data for quantitative synthesis. Random-effects meta-analysis and meta-regression were performed according to study design and techniques. The systematic review was prospectively registered on PROSPERO (CRD42020205378). A total of 23 studies describing 293 cases of unilateral WT and 386 cases of bilateral WT were included in the qualitative synthesis. Overall effect estimates demonstrate that patients undergoing RN have significantly increased odds of developing abnormal kidney function (OR 4.29, 95% CI 1.02, 18.00) and lower estimated glomerular filtration rate at long-term followup (mean difference -8.99, 95% CI -16.40, -1.58) compared to those undergoing NSS. In bilateral WT, patients undergoing RN with contralateral NSS have higher odds of developing abnormal kidney function (OR 3.82, 95% CI 1.76, 8.33) and hypertension (OR 5.81, 95% CI 1.31, 25.68) compared to bilateral NSS. Current evidence is low quality but suggests that NSS for unilateral and bilateral WT may be associated with better kidney function or blood pressure at late followup. Further research to investigate sources of heterogeneity is recommended. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Kidney Function Tests', 'Kidney Neoplasms', 'Nephrectomy', 'Nephrons', 'Wilms Tumor'] | 34,963,311 | 1 | Late Kidney Effects of Nephron-Sparing vs Radical Nephrectomy for Wilms Tumor: A Systematic Review and Meta-Analysis. We compare differences in long-term kidney function between patients undergoing either radical nephrectomy (RN) or nephron-sparing surgery (NSS) in unilateral and bilateral Wilms tumor (WT), respectively. A systematic search was performed in September 2020. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed long-term (>1-year postoperative) outcomes included chronic kidney disease, hypertension and glomerular filtration rate, among others. Odds ratio and mean difference with 95% confidence interval were extrapolated from available data for quantitative synthesis. Random-effects meta-analysis and meta-regression were performed according to study design and techniques. The systematic review was prospectively registered on PROSPERO (CRD42020205378). A total of 23 studies describing 293 cases of unilateral WT and 386 cases of bilateral WT were included in the qualitative synthesis. Overall effect estimates demonstrate that patients undergoing RN have significantly increased odds of developing abnormal kidney function (OR 4.29, 95% CI 1.02, 18.00) and lower estimated glomerular filtration rate at long-term followup (mean difference -8.99, 95% CI -16.40, -1.58) compared to those undergoing NSS. In bilateral WT, patients undergoing RN with contralateral NSS have higher odds of developing abnormal kidney function (OR 3.82, 95% CI 1.76, 8.33) and hypertension (OR 5.81, 95% CI 1.31, 25.68) compared to bilateral NSS. Current evidence is low quality but suggests that NSS for unilateral and bilateral WT may be associated with better kidney function or blood pressure at late followup. Further research to investigate sources of heterogeneity is recommended. |
23/10/2020 | Serum soluble urokinase type plasminogen activated receptor and focal segmental glomerulosclerosis: a systematic review and meta-analysis. | Soluble urokinase plasminogen activated receptor (suPAR) is a biomarker that may predict the occurrence of focal segmental glomerulosclerosis (FSGS); however, there is still controversy about whether suPAR can predict FSGS. In this study, we performed a systematic evaluation and meta-analysis to prove whether suPAR can predict FSGS, and to detect a threshold concentration of suPAR that can be used to diagnose FSGS. In addition, a threshold concentration of suPAR for the diagnosis of FSGS was proposed. Systematic review and meta-analysis. We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China Biology Medicine databases for studies published from the inception dates to 1 December 2018. ELIGIBILITY CRITERIA: (1) Data involving the suPAR level were from blood samples; (2) FSGS was diagnosed by biopsy; and (3) randomised controlled trials, cohort studies, case-control studies and cross-sectional studies. Initially, a total of 364 studies were searched, among which 29 studies were finally included. In addition, seven studies described the cut-off value of suPAR, which ranged from 2992.6 to 5500 pg/mL. The results showed that the suPAR levels in the primary FSGS group were significantly higher when compared with that in the normal control group (p<i><</i>0.001; standard mean difference (SMD): 2.56; 95% CI 1.85 to 3.28), and significant differences were observed in the secondary FSGS and in the normal control group (p<i><</i>0.001; SMD: 1.68; 95% CI 1.37 to 1.98). A suPAR concentration of 3000 pg/mL may be the best threshold for the diagnosis of primary FSGS (sensitivity=0.72; specificity=0.88; area under the curve=0.85). Our results suggested that suPAR might be a potential biomarker for predicting primary and secondary FSGS. In addition, our data showed that a suPAR concentration of 3000 pg/mL might be used as a threshold for the diagnosis of FSGS. CRD42019120948. | ['Journal Article', 'Meta-Analysis', "Research Support, Non-U.S. Gov't", 'Systematic Review'] | ['Biomarkers', 'Glomerulosclerosis, Focal Segmental', 'Humans', 'Predictive Value of Tests', 'Prognosis', 'Receptors, Urokinase Plasminogen Activator'] | 31,594,897 | 1 | Serum soluble urokinase type plasminogen activated receptor and focal segmental glomerulosclerosis: a systematic review and meta-analysis. Soluble urokinase plasminogen activated receptor (suPAR) is a biomarker that may predict the occurrence of focal segmental glomerulosclerosis (FSGS); however, there is still controversy about whether suPAR can predict FSGS. In this study, we performed a systematic evaluation and meta-analysis to prove whether suPAR can predict FSGS, and to detect a threshold concentration of suPAR that can be used to diagnose FSGS. In addition, a threshold concentration of suPAR for the diagnosis of FSGS was proposed. Systematic review and meta-analysis. We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China Biology Medicine databases for studies published from the inception dates to 1 December 2018. ELIGIBILITY CRITERIA: (1) Data involving the suPAR level were from blood samples; (2) FSGS was diagnosed by biopsy; and (3) randomised controlled trials, cohort studies, case-control studies and cross-sectional studies. Initially, a total of 364 studies were searched, among which 29 studies were finally included. In addition, seven studies described the cut-off value of suPAR, which ranged from 2992.6 to 5500 pg/mL. The results showed that the suPAR levels in the primary FSGS group were significantly higher when compared with that in the normal control group (p<i><</i>0.001; standard mean difference (SMD): 2.56; 95% CI 1.85 to 3.28), and significant differences were observed in the secondary FSGS and in the normal control group (p<i><</i>0.001; SMD: 1.68; 95% CI 1.37 to 1.98). A suPAR concentration of 3000 pg/mL may be the best threshold for the diagnosis of primary FSGS (sensitivity=0.72; specificity=0.88; area under the curve=0.85). Our results suggested that suPAR might be a potential biomarker for predicting primary and secondary FSGS. In addition, our data showed that a suPAR concentration of 3000 pg/mL might be used as a threshold for the diagnosis of FSGS. CRD42019120948. |
23/05/2021 | Clinical frailty scale as a point of care prognostic indicator of mortality in COVID-19: a systematic review and meta-analysis. | COVID-19 has resulted in the largest pandemic experienced since 1918, accounting for over 2 million deaths globally. Frail and older people are at the highest risk of mortality. The main objective of the present research was to quantify the impact of clinical frailty scale (CFS) by increasing severity of frailty and to identify other personal prognostic factors associated with increased mortality from COVID-19. This study offers a contemporary systematic review and meta-analysis to analyse the stratified mortality risk by increasing CFS sub-categories (1-3, 4-5 and 6-9). Databases searched included EMBASE, MEDLINE, CAB Abstracts, PsychInfo, and Web of Science with end-search restriction the 18th December 2020. Publications identified via MedRevix were followed up on the 23rd March 2021 in peer-reviewed database search, and citations were updated as published. Prospective and retrospective cohort studies which reported the association between CFS and COVID-19 mortality were included. Thirty-four studies were eligible for systematic review and seventeen for meta-analysis, with 81-87% (I<sup>2</sup>) heterogeneity. All studies [N: 34] included patients from a hospital setting, comprising a total of 18,042 patients with mean age 72.8 (Min: 56; Max: 86). The CFS 4-5 patient group had significantly increased mortality when compared to patients with CFS 1-3 [(RE) OR 1.95 (1.32 (95% CI), 2.87 (95% CI)); I<sup>2</sup> 81%; <i>p</i> = 0.0008]. Furthermore, CFS 6-9 patient group displayed an even more noticeable mortality increase when compared to patients with CFS 1-3 [(RE) OR 3.09 (2.03, 4.71); I<sup>2</sup> 87%; <i>p</i><0.0001]. Generic inverse variance analysis of adjusted hazard ratio among included studies highlighted that CFS (<i>p</i> = 0.0001), male gender (<i>p</i> = 0.0009), National Early Warning Score (<i>p</i> = 0.0001), Ischaemic Heart Disease (IHD) (<i>p</i> = 0.07), Hypertension (HT) (<i>p</i><0.0001), and Chronic Kidney Disease (CKD) (<i>p</i> = 0.0009) were associated with increased COVID-19 mortality. Our findings suggest a differential stratification of CFS scores in the context of COVID-19 infection, in which CFS 1-3 patients may be considered at lower risk, CFS 4-5 at moderate risk, and CFS 6-9 at high risk of mortality regardless of age. Overall, our study not only aims to alert clinicians of the value of CFS scores, but also highlight the multiple dimensions to consider such as age, gender and co-morbidities, even among moderately frail patients in relation to COVID-19 mortality. None. | ['Journal Article'] | [] | 34,036,252 | 1 | Clinical frailty scale as a point of care prognostic indicator of mortality in COVID-19: a systematic review and meta-analysis. COVID-19 has resulted in the largest pandemic experienced since 1918, accounting for over 2 million deaths globally. Frail and older people are at the highest risk of mortality. The main objective of the present research was to quantify the impact of clinical frailty scale (CFS) by increasing severity of frailty and to identify other personal prognostic factors associated with increased mortality from COVID-19. This study offers a contemporary systematic review and meta-analysis to analyse the stratified mortality risk by increasing CFS sub-categories (1-3, 4-5 and 6-9). Databases searched included EMBASE, MEDLINE, CAB Abstracts, PsychInfo, and Web of Science with end-search restriction the 18th December 2020. Publications identified via MedRevix were followed up on the 23rd March 2021 in peer-reviewed database search, and citations were updated as published. Prospective and retrospective cohort studies which reported the association between CFS and COVID-19 mortality were included. Thirty-four studies were eligible for systematic review and seventeen for meta-analysis, with 81-87% (I<sup>2</sup>) heterogeneity. All studies [N: 34] included patients from a hospital setting, comprising a total of 18,042 patients with mean age 72.8 (Min: 56; Max: 86). The CFS 4-5 patient group had significantly increased mortality when compared to patients with CFS 1-3 [(RE) OR 1.95 (1.32 (95% CI), 2.87 (95% CI)); I<sup>2</sup> 81%; <i>p</i> = 0.0008]. Furthermore, CFS 6-9 patient group displayed an even more noticeable mortality increase when compared to patients with CFS 1-3 [(RE) OR 3.09 (2.03, 4.71); I<sup>2</sup> 87%; <i>p</i><0.0001]. Generic inverse variance analysis of adjusted hazard ratio among included studies highlighted that CFS (<i>p</i> = 0.0001), male gender (<i>p</i> = 0.0009), National Early Warning Score (<i>p</i> = 0.0001), Ischaemic Heart Disease (IHD) (<i>p</i> = 0.07), Hypertension (HT) (<i>p</i><0.0001), and Chronic Kidney Disease (CKD) (<i>p</i> = 0.0009) were associated with increased COVID-19 mortality. Our findings suggest a differential stratification of CFS scores in the context of COVID-19 infection, in which CFS 1-3 patients may be considered at lower risk, CFS 4-5 at moderate risk, and CFS 6-9 at high risk of mortality regardless of age. Overall, our study not only aims to alert clinicians of the value of CFS scores, but also highlight the multiple dimensions to consider such as age, gender and co-morbidities, even among moderately frail patients in relation to COVID-19 mortality. None. |
14/02/2024 | Efficacy and safety of Gegen Qinlian decoction in the treatment of type II diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. | The study aims to systematically assess the efficacy and safety of Gegen Qinlian decoction in the treatment of type 2 diabetes mellitus. We systematically searched a total of nine databases from the time of creation to 20 March 2023. The quality of the literature was assessed using the risk of bias assessment tool in the Cochrane Handbook. RevMan 5. 3 and Stata 14.0 were applied to conduct meta-analysis. A total of 17 studies, encompassing 1,476 patients, were included in the study. Gegen Qinlian decoction combined with conventional treatment was found to significantly reduce FBG (MD = -0.69 mmol/L, 95% CI -0.84 to -0.55, p < 0.01; I<sup>2</sup> = 67%, p<0.01), 2hPG (MD = -0.97 mmol/L, 95% CI -1.13 to -0.81, p < 0.01; I<sup>2</sup> = 37%, p=0.09), HbA1c (MD = -0.65%, 95% CI -0.78 to -0.53, p < 0.01; I<sup>2</sup> = 71%, p<0.01), TC (MD = -0.51 mmol/L, 95% CI -0.62 to -0.41, p < 0.01; I<sup>2</sup> = 45%, p=0.09), TG (MD = -0.17mmol/L, 95% CI -0.29 to -0.05, p < 0.01; I<sup>2</sup> = 78%, p<0.01), LDL-C (MD = -0.38mmol/L, 95% CI -0.53 to -0.23, p < 0.01; I<sup>2</sup> = 87%, p<0.01), HOMA-IR (SMD = -1.43, 95% CI -2.32 to -0.54, p < 0.01; I<sup>2</sup> = 94%, p<0.01), and improved HDL-C (MD = 0.13 mmol/L, 95% CI 0.09-0.17, p < 0.01; I<sup>2</sup> = 30%, p=0.24). Only three studies explored the differences in efficacy between GQD alone and conventional treatment in improving glucose-lipid metabolism and insulin resistance, and some of the outcome indicators, such as 2hPG and HDL-C, were examined in only one study. Therefore, the effect of GQD alone on glucose-lipid metabolism and insulin resistance cannot be fully determined, and more high-quality studies are needed to verify it. Publication bias analysis revealed no bias in the included studies. Gegen Qinlian Decoction has certain efficacy and safety in enhancing glycolipid metabolism and alleviating insulin resistance, potentially serving as a complementary therapy for type 2 diabetes mellitus. Rigorous, large-sample, multicenter RCTs are needed to verify this. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023413758, PROSPERO CRD42023413758. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Diabetes Mellitus, Type 2', 'Drugs, Chinese Herbal', 'Glucose', 'Insulin Resistance', 'Randomized Controlled Trials as Topic'] | 38,344,688 | 0 | Efficacy and safety of Gegen Qinlian decoction in the treatment of type II diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. The study aims to systematically assess the efficacy and safety of Gegen Qinlian decoction in the treatment of type 2 diabetes mellitus. We systematically searched a total of nine databases from the time of creation to 20 March 2023. The quality of the literature was assessed using the risk of bias assessment tool in the Cochrane Handbook. RevMan 5. 3 and Stata 14.0 were applied to conduct meta-analysis. A total of 17 studies, encompassing 1,476 patients, were included in the study. Gegen Qinlian decoction combined with conventional treatment was found to significantly reduce FBG (MD = -0.69 mmol/L, 95% CI -0.84 to -0.55, p < 0.01; I<sup>2</sup> = 67%, p<0.01), 2hPG (MD = -0.97 mmol/L, 95% CI -1.13 to -0.81, p < 0.01; I<sup>2</sup> = 37%, p=0.09), HbA1c (MD = -0.65%, 95% CI -0.78 to -0.53, p < 0.01; I<sup>2</sup> = 71%, p<0.01), TC (MD = -0.51 mmol/L, 95% CI -0.62 to -0.41, p < 0.01; I<sup>2</sup> = 45%, p=0.09), TG (MD = -0.17mmol/L, 95% CI -0.29 to -0.05, p < 0.01; I<sup>2</sup> = 78%, p<0.01), LDL-C (MD = -0.38mmol/L, 95% CI -0.53 to -0.23, p < 0.01; I<sup>2</sup> = 87%, p<0.01), HOMA-IR (SMD = -1.43, 95% CI -2.32 to -0.54, p < 0.01; I<sup>2</sup> = 94%, p<0.01), and improved HDL-C (MD = 0.13 mmol/L, 95% CI 0.09-0.17, p < 0.01; I<sup>2</sup> = 30%, p=0.24). Only three studies explored the differences in efficacy between GQD alone and conventional treatment in improving glucose-lipid metabolism and insulin resistance, and some of the outcome indicators, such as 2hPG and HDL-C, were examined in only one study. Therefore, the effect of GQD alone on glucose-lipid metabolism and insulin resistance cannot be fully determined, and more high-quality studies are needed to verify it. Publication bias analysis revealed no bias in the included studies. Gegen Qinlian Decoction has certain efficacy and safety in enhancing glycolipid metabolism and alleviating insulin resistance, potentially serving as a complementary therapy for type 2 diabetes mellitus. Rigorous, large-sample, multicenter RCTs are needed to verify this. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023413758, PROSPERO CRD42023413758. |
28/07/2021 | Gastric ischemic preconditioning may reduce the incidence and severity of anastomotic leakage after οesophagectomy: a systematic review and meta-analysis. | Anastomotic leakage after esophagectomy is a severe and life-threatening complication. Gastric ischemic preconditioning is a strategy for the improvement of anastomotic healing. Aim of this systematic review and meta-analysis is to investigate the impact of gastric ischemic preconditioning on postoperative morbidity. A systematic literature search was performed to identify studies comparing patients undergoing gastric ischemic preconditioning before esophagectomy with nonpreconditioned patients. Meta-analysis was conducted for the overall incidence of anastomotic leakage, severe anastomotic leakage, anastomotic stricture, postoperative morbidity, and mortality. Mantel-Haenszel odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed concerning preconditioning technique, the interval between preconditioning and surgery and the extent of preconditioning. Fifteen cohort studies were identified. Gastric preconditioning was associated with reduced overall incidence of anastomotic leakage (OR 0.73; 95% CI, 0.53-1.0; P = 0.050) and severe anastomotic leakage (OR 0.27; 95% CI, 0.14-0.50; P < 0.010), but not with anastomotic stricture (OR 1.18; 95% CI 0.38 to 3.66; P = 0.780), major postoperative morbidity (OR 1.03; 95% CI 0.45 to 2.36; P = 0.940) or mortality (OR 0.69; 95% CI 0.39 to 1,23; P = 0.210). Subgroup analyses did not identify any differences between embolization and ligation while increasing the interval between preconditioning and esophagectomy as well as the extent of preconditioning might be beneficial. Gastric ischemic preconditioning may be associated with a reduced incidence of overall and severe anastomotic leakage. Randomized studies are necessary to further evaluate its impact on leakage, refine the technique and define patient populations that will benefit the most. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Anastomosis, Surgical', 'Anastomotic Leak', 'Esophageal Neoplasms', 'Esophagectomy', 'Humans', 'Incidence', 'Ischemic Preconditioning', 'Stomach'] | 32,372,088 | 0 | Gastric ischemic preconditioning may reduce the incidence and severity of anastomotic leakage after οesophagectomy: a systematic review and meta-analysis. Anastomotic leakage after esophagectomy is a severe and life-threatening complication. Gastric ischemic preconditioning is a strategy for the improvement of anastomotic healing. Aim of this systematic review and meta-analysis is to investigate the impact of gastric ischemic preconditioning on postoperative morbidity. A systematic literature search was performed to identify studies comparing patients undergoing gastric ischemic preconditioning before esophagectomy with nonpreconditioned patients. Meta-analysis was conducted for the overall incidence of anastomotic leakage, severe anastomotic leakage, anastomotic stricture, postoperative morbidity, and mortality. Mantel-Haenszel odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed concerning preconditioning technique, the interval between preconditioning and surgery and the extent of preconditioning. Fifteen cohort studies were identified. Gastric preconditioning was associated with reduced overall incidence of anastomotic leakage (OR 0.73; 95% CI, 0.53-1.0; P = 0.050) and severe anastomotic leakage (OR 0.27; 95% CI, 0.14-0.50; P < 0.010), but not with anastomotic stricture (OR 1.18; 95% CI 0.38 to 3.66; P = 0.780), major postoperative morbidity (OR 1.03; 95% CI 0.45 to 2.36; P = 0.940) or mortality (OR 0.69; 95% CI 0.39 to 1,23; P = 0.210). Subgroup analyses did not identify any differences between embolization and ligation while increasing the interval between preconditioning and esophagectomy as well as the extent of preconditioning might be beneficial. Gastric ischemic preconditioning may be associated with a reduced incidence of overall and severe anastomotic leakage. Randomized studies are necessary to further evaluate its impact on leakage, refine the technique and define patient populations that will benefit the most. |
04/05/2020 | Traditional Chinese medicine combined with western medicine for the treatment of secondary pulmonary tuberculosis: A PRISMA-compliant meta-analysis. | To evaluate the differences between traditional Chinese medicine combined with western medicine and western medicine alone for the treatment of secondary tuberculosis and its impact on the evaluation of clinical efficacy and safety of patients in randomized controlled trials. A literature search of all major academic databases was conducted (PubMed, CNKI, Wanfang, VIP). Meta-analysis was conducted using RevMan 5.3 and Stata 12.0 software for those studies that satisfied the inclusion criteria. Ethical approval was not necessary because no people or animals were selected as subjects in this meta-analysis. Twenty-three randomized controlled trials were included in this meta-analysis. The following indicators in the treatment group (traditional Chinese medicine decoction combined with western medicine chemotherapy) improved in comparison with those in the control group:focus absorption rate (RR:1.18; 95% CI: 1.15-1.22);sputum smear negative rate (RR: 1.17; 95% CI: 1.09-1.27);comprehensive clinical effective rate (RR: 1.18; 95% CI: 1.14-1.22);cavity closure rate (RR: 1.37; 95% CI: 1.12-1.67).The difference of Immune function indicator likes CD4+ level (SMD: 0.76; 95% CI: -0.25 to 1.76) between the treatment group and the control group was not significant. In addition, safety evaluation indicators like the decrease rate of white blood cell (WBC) and platelets (PLT) and the elevation rate of alanine aminotransferase (ALT) and uric acid (UA) in the treatment group were reduced compared with those in the control group (P < .05). The curative effect of combining traditional Chinese and western medicine for the treatment of secondary tuberculosis is better than that of western medicine alone and is conducive to reducing the incidence of adverse reactions. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Alanine Transaminase', 'Antitubercular Agents', 'CD4 Lymphocyte Count', 'Drug Therapy, Combination', 'Drugs, Chinese Herbal', 'Humans', 'Phytotherapy', 'Platelet Count', 'Randomized Controlled Trials as Topic', 'Sputum', 'Treatment Outcome', 'Tuberculosis, Pulmonary', 'Uric Acid'] | 32,311,924 | 0 | Traditional Chinese medicine combined with western medicine for the treatment of secondary pulmonary tuberculosis: A PRISMA-compliant meta-analysis. To evaluate the differences between traditional Chinese medicine combined with western medicine and western medicine alone for the treatment of secondary tuberculosis and its impact on the evaluation of clinical efficacy and safety of patients in randomized controlled trials. A literature search of all major academic databases was conducted (PubMed, CNKI, Wanfang, VIP). Meta-analysis was conducted using RevMan 5.3 and Stata 12.0 software for those studies that satisfied the inclusion criteria. Ethical approval was not necessary because no people or animals were selected as subjects in this meta-analysis. Twenty-three randomized controlled trials were included in this meta-analysis. The following indicators in the treatment group (traditional Chinese medicine decoction combined with western medicine chemotherapy) improved in comparison with those in the control group:focus absorption rate (RR:1.18; 95% CI: 1.15-1.22);sputum smear negative rate (RR: 1.17; 95% CI: 1.09-1.27);comprehensive clinical effective rate (RR: 1.18; 95% CI: 1.14-1.22);cavity closure rate (RR: 1.37; 95% CI: 1.12-1.67).The difference of Immune function indicator likes CD4+ level (SMD: 0.76; 95% CI: -0.25 to 1.76) between the treatment group and the control group was not significant. In addition, safety evaluation indicators like the decrease rate of white blood cell (WBC) and platelets (PLT) and the elevation rate of alanine aminotransferase (ALT) and uric acid (UA) in the treatment group were reduced compared with those in the control group (P < .05). The curative effect of combining traditional Chinese and western medicine for the treatment of secondary tuberculosis is better than that of western medicine alone and is conducive to reducing the incidence of adverse reactions. |
13/06/2024 | A systematic review and meta-analysis of the effect of clozapine on cognitive functions in patients with treatment-resistant schizophrenia. | This study aimed to conduct a systematic review and meta-analysis on cognitive performances of patients with treatment-resistant schizophrenia (TRS) after clozapine treatment and to examine the potential effect of follow-up duration and clozapine dosage. Five electronic databases were searched and studies were included if treatment-resistant schizophrenia patients were treated with clozapine and with baseline and follow-up cognitive functions assessments. Cognitive measures were categorised into six domains based on DSM-5-TR. Random-effect model analysis was used to pool the effect estimates. Moderator effects of clozapine dosage, follow up duration, duration of illness, age, years of education and change in positive symptoms severity were examined with meta-regression. Nineteen articles were included with 50 cognitive measures reported. Systematic review found inconsistent results. Twelve cognitive measures were included for meta-analysis and found overall improvement of cognitive performances after clozapine treatment SMD = 0.11 [95 % CI 0.02, 0.20] (p = 0.021). Patients with younger age, more years of education and improvements in positive symptoms are more likely to improve in cognitive performances. Subgroup analysis found significant improvement in studies with follow-up periods of 6-months or longer but not for studies with shorter follow-up periods. Clozapine may improve some domains of cognitive function, particularly over a longer period. However, the overall inconsistent results suggest that more studies with larger sample size and standard cognitive function assessments would be needed to enhance our understanding of the impact of clozapine on the cognitive functions in the TRS patients. | ['Systematic Review', 'Journal Article', 'Meta-Analysis'] | ['Clozapine', 'Humans', 'Antipsychotic Agents', 'Schizophrenia, Treatment-Resistant', 'Cognitive Dysfunction', 'Schizophrenia', 'Cognition'] | 37,788,946 | 0 | A systematic review and meta-analysis of the effect of clozapine on cognitive functions in patients with treatment-resistant schizophrenia. This study aimed to conduct a systematic review and meta-analysis on cognitive performances of patients with treatment-resistant schizophrenia (TRS) after clozapine treatment and to examine the potential effect of follow-up duration and clozapine dosage. Five electronic databases were searched and studies were included if treatment-resistant schizophrenia patients were treated with clozapine and with baseline and follow-up cognitive functions assessments. Cognitive measures were categorised into six domains based on DSM-5-TR. Random-effect model analysis was used to pool the effect estimates. Moderator effects of clozapine dosage, follow up duration, duration of illness, age, years of education and change in positive symptoms severity were examined with meta-regression. Nineteen articles were included with 50 cognitive measures reported. Systematic review found inconsistent results. Twelve cognitive measures were included for meta-analysis and found overall improvement of cognitive performances after clozapine treatment SMD = 0.11 [95 % CI 0.02, 0.20] (p = 0.021). Patients with younger age, more years of education and improvements in positive symptoms are more likely to improve in cognitive performances. Subgroup analysis found significant improvement in studies with follow-up periods of 6-months or longer but not for studies with shorter follow-up periods. Clozapine may improve some domains of cognitive function, particularly over a longer period. However, the overall inconsistent results suggest that more studies with larger sample size and standard cognitive function assessments would be needed to enhance our understanding of the impact of clozapine on the cognitive functions in the TRS patients. |
13/07/2021 | The effects of palm oil on serum lipid profiles: A systematic review and meta-analysis. | Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of saturated fatty acids, but its effect on serum lipid levels is unclear. The study aimed to compare the effects of palm oil consumption with other edible oils rich in monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on serum lipid profiles. We searched Medline, Embase, Cochrane Central Registry of Controlled Trials and CINAHL. Clinical trials were eligible if they compared palm oil-rich diets with diets rich in MUFAs or PUFAs. We pooled results of included studies using a random effects model and assessed the quality of the evidence and certainty of conclusions using the GRADE approach. Intake of palm oil intake compared to oils rich in MUFA was associated with increased levels of total cholesterol (TC) [mean difference (MD)=0.27 mmol/L; 95% CI 0.08 to 0.45], LDL-C (MD=0.20 mmol/L; 95% CI 0.02 to 0.37) and HDL-C (MD=0.06 mmol/L; 95% CI 0.02 to 0.10). Similarly, for comparison with oils rich in PUFAs, palm oil showed increased in TC (MD=0.38 mmol/L; 95% CI 0.14 to 0.62), LDL-C (MD= 0.44 mmol/L; 95% CI 0.01 to 0.88) and HDL-C (MD=0.08 mmol/L; 95% CI 0.03 to 0.13). For both comparisons, there were no significant effects on triglycerides. Even though palm oil increases marginally the level of serum lipids, the evidence is mostly of low to moderate quality. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Diet', 'Dietary Fats', 'Humans', 'Lipids', 'Palm Oil'] | 32,990,612 | 0 | The effects of palm oil on serum lipid profiles: A systematic review and meta-analysis. Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of saturated fatty acids, but its effect on serum lipid levels is unclear. The study aimed to compare the effects of palm oil consumption with other edible oils rich in monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on serum lipid profiles. We searched Medline, Embase, Cochrane Central Registry of Controlled Trials and CINAHL. Clinical trials were eligible if they compared palm oil-rich diets with diets rich in MUFAs or PUFAs. We pooled results of included studies using a random effects model and assessed the quality of the evidence and certainty of conclusions using the GRADE approach. Intake of palm oil intake compared to oils rich in MUFA was associated with increased levels of total cholesterol (TC) [mean difference (MD)=0.27 mmol/L; 95% CI 0.08 to 0.45], LDL-C (MD=0.20 mmol/L; 95% CI 0.02 to 0.37) and HDL-C (MD=0.06 mmol/L; 95% CI 0.02 to 0.10). Similarly, for comparison with oils rich in PUFAs, palm oil showed increased in TC (MD=0.38 mmol/L; 95% CI 0.14 to 0.62), LDL-C (MD= 0.44 mmol/L; 95% CI 0.01 to 0.88) and HDL-C (MD=0.08 mmol/L; 95% CI 0.03 to 0.13). For both comparisons, there were no significant effects on triglycerides. Even though palm oil increases marginally the level of serum lipids, the evidence is mostly of low to moderate quality. |
12/06/2023 | The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis. | Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles. The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Pregnancy', 'Humans', 'Female', 'Postnatal Care', 'Developing Countries', 'Parturition', 'Postpartum Period', 'Telemedicine'] | 37,296,420 | 0 | The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis. Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles. The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes. |
29/11/2021 | Effects of Acute Heat and Cold Exposures at Rest or during Exercise on Subsequent Energy Intake: A Systematic Review and Meta-Analysis. | The objective of this meta-analysis was to assess the effect of acute heat/cold exposure on subsequent energy intake (EI) in adults. We searched the following sources for publications on this topic: PubMed, Ovid Medline, Science Direct and SPORTDiscus. The eligibility criteria for study selection were: randomized controlled trials performed in adults (169 men and 30 women; 20-52 years old) comparing EI at one or more meals taken <i>ad libitum</i>, during and/or after exposure to heat/cold and thermoneutral conditions. One of several exercise sessions could be realized before or during thermal exposures. Two of the thirteen studies included examined the effect of heat (one during exercise and one during exercise and at rest), eight investigated the effect of cold (six during exercise and two at rest), and three the effect of both heat and cold (two during exercise and one at rest). The meta-analysis revealed a small increase in EI in cold conditions (g = 0.44; <i>p</i> = 0.019) and a small decrease in hot conditions (g = -0.39, <i>p</i> = 0.022) for exposure during both rest and exercise. Exposures to heat and cold altered EI in opposite ways, with heat decreasing EI and cold increasing it. The effect of exercise remains unclear. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Cold Temperature', 'Energy Intake', 'Energy Metabolism', 'Environmental Exposure', 'Exercise', 'Female', 'Health Impact Assessment', 'Hot Temperature', 'Humans', 'Male', 'Meals', 'Rest'] | 34,684,424 | 0 | Effects of Acute Heat and Cold Exposures at Rest or during Exercise on Subsequent Energy Intake: A Systematic Review and Meta-Analysis. The objective of this meta-analysis was to assess the effect of acute heat/cold exposure on subsequent energy intake (EI) in adults. We searched the following sources for publications on this topic: PubMed, Ovid Medline, Science Direct and SPORTDiscus. The eligibility criteria for study selection were: randomized controlled trials performed in adults (169 men and 30 women; 20-52 years old) comparing EI at one or more meals taken <i>ad libitum</i>, during and/or after exposure to heat/cold and thermoneutral conditions. One of several exercise sessions could be realized before or during thermal exposures. Two of the thirteen studies included examined the effect of heat (one during exercise and one during exercise and at rest), eight investigated the effect of cold (six during exercise and two at rest), and three the effect of both heat and cold (two during exercise and one at rest). The meta-analysis revealed a small increase in EI in cold conditions (g = 0.44; <i>p</i> = 0.019) and a small decrease in hot conditions (g = -0.39, <i>p</i> = 0.022) for exposure during both rest and exercise. Exposures to heat and cold altered EI in opposite ways, with heat decreasing EI and cold increasing it. The effect of exercise remains unclear. |
18/04/2024 | Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach. | In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject. This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001). The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Carpal Tunnel Syndrome', 'Diabetes Mellitus'] | 38,626,071 | 0 | Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach. In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject. This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001). The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant. |
04/06/2021 | Metastases to meningioma-review and meta-analysis. | Meningiomas are a common tumor within the cranial cavity. They may be a target for metastatic spread of cancer elsewhere in the body. We analyzed all the data in the literature about tumor-to-meningioma metastasis (TTMM). We performed a meta-analysis using the PRISMA checklist to locate all cases of TTMM in the PubMed and Medline databases. We collected patient and cancer parameters, meningioma parameters, and clinical factors. We located 124 articles, describing 152 cases of patients with TTMM. The mean (± SD) age of all patients was 62.21 ± 10.8 years, with even distribution above and below the mean. Of the cases, 65.9% were reported in women. The most common cancer origins of TTMM were breast and lung carcinoma, followed by kidney, prostate, and GI tract carcinoma. Cancer status is not a good marker of TTMM when managing a meningioma. In 36.69% of cases, TTMM was the presentation of an unknown cancer. In nearly 60% of the known cases, cancer was considered in remission for at least 1 year. Meningioma parameters are unhelpful when considering a TTMM. The distribution of meningioma location is similar to other series of meningioma reported in the literature. Meningioma grade is similar to meningiomas without TTMM. In 57.89%, the patient presented with a focal deficit. Presenting factors were seizures, elevated ICP, and others. Over 95% of cases were symptomatic at presentation. TTMM should be suspected in cases of meningioma in a patient with background cancer, regardless of meningioma parameters or cancer status. | ['Journal Article', 'Meta-Analysis', 'Review'] | ['Aged', 'Breast Neoplasms', 'Carcinoma', 'Female', 'Humans', 'Kidney Neoplasms', 'Lung Neoplasms', 'Male', 'Meningeal Neoplasms', 'Meningioma', 'Middle Aged', 'Prostatic Neoplasms'] | 33,389,125 | 1 | Metastases to meningioma-review and meta-analysis. Meningiomas are a common tumor within the cranial cavity. They may be a target for metastatic spread of cancer elsewhere in the body. We analyzed all the data in the literature about tumor-to-meningioma metastasis (TTMM). We performed a meta-analysis using the PRISMA checklist to locate all cases of TTMM in the PubMed and Medline databases. We collected patient and cancer parameters, meningioma parameters, and clinical factors. We located 124 articles, describing 152 cases of patients with TTMM. The mean (± SD) age of all patients was 62.21 ± 10.8 years, with even distribution above and below the mean. Of the cases, 65.9% were reported in women. The most common cancer origins of TTMM were breast and lung carcinoma, followed by kidney, prostate, and GI tract carcinoma. Cancer status is not a good marker of TTMM when managing a meningioma. In 36.69% of cases, TTMM was the presentation of an unknown cancer. In nearly 60% of the known cases, cancer was considered in remission for at least 1 year. Meningioma parameters are unhelpful when considering a TTMM. The distribution of meningioma location is similar to other series of meningioma reported in the literature. Meningioma grade is similar to meningiomas without TTMM. In 57.89%, the patient presented with a focal deficit. Presenting factors were seizures, elevated ICP, and others. Over 95% of cases were symptomatic at presentation. TTMM should be suspected in cases of meningioma in a patient with background cancer, regardless of meningioma parameters or cancer status. |
18/08/2021 | The Effect of β-Blockers for Burn Patients on Clinical Outcomes: Systematic Review and Meta-Analysis. | To assess the effects and safety of β-blockers in hospitalized patients with burns. A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity. Risk of bias was assessed using the individual domain approach. Four RCTs reported in 11 publications were included. Primary outcome of mortality was assessed in children (2 trials, n = 424) and adults (2 trials, n = 148) with severe burns. No significant difference was found between propranolol and control for mortality (risk ratio [RR] = 0.82, 95% CI = 0.48-1.39, 4 trials with broad confidence intervals in adults and children), sepsis (RR = 0.81, 95% CI = 0.46-1.43, 2 trials), and survivors' length of stay (absolute mean difference = 2.53, 95% CI = -2.58-7.63, 3 trials). There was no significant difference in bradycardia (RR = 1.33, 95% CI = 0.77-2.3, 2 trials), hypotension (RR = 1.26, 95% CI = 0.73-2.17, 3 trials), or cardiac arrhythmia (RR: 2.97, 95% CI: 0.12-71.87, 1 trial). The evidence was graded as very low certainty, due to trial's internal risk of bias, imprecision, and possible selective reporting. No sufficient evidence was found to support or refute an advantage for β-blocker use in children or adults after burns. Additional studies are needed to create a consensus and formulate practice guidelines on the optimal β-blocker to use, indications for initiation, and duration of treatment. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Adrenergic beta-Antagonists', 'Adult', 'Arrhythmias, Cardiac', 'Burns', 'Child', 'Humans', 'Hypotension', 'Propranolol'] | 32,686,565 | 0 | The Effect of β-Blockers for Burn Patients on Clinical Outcomes: Systematic Review and Meta-Analysis. To assess the effects and safety of β-blockers in hospitalized patients with burns. A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity. Risk of bias was assessed using the individual domain approach. Four RCTs reported in 11 publications were included. Primary outcome of mortality was assessed in children (2 trials, n = 424) and adults (2 trials, n = 148) with severe burns. No significant difference was found between propranolol and control for mortality (risk ratio [RR] = 0.82, 95% CI = 0.48-1.39, 4 trials with broad confidence intervals in adults and children), sepsis (RR = 0.81, 95% CI = 0.46-1.43, 2 trials), and survivors' length of stay (absolute mean difference = 2.53, 95% CI = -2.58-7.63, 3 trials). There was no significant difference in bradycardia (RR = 1.33, 95% CI = 0.77-2.3, 2 trials), hypotension (RR = 1.26, 95% CI = 0.73-2.17, 3 trials), or cardiac arrhythmia (RR: 2.97, 95% CI: 0.12-71.87, 1 trial). The evidence was graded as very low certainty, due to trial's internal risk of bias, imprecision, and possible selective reporting. No sufficient evidence was found to support or refute an advantage for β-blocker use in children or adults after burns. Additional studies are needed to create a consensus and formulate practice guidelines on the optimal β-blocker to use, indications for initiation, and duration of treatment. |
02/11/2023 | Global status of <i>Anaplasma phagocytophilum</i> infections in human population: A 50-year (1970-2020) meta-analysis. | Anaplasma phagocytophilum causes human granulocytic anaplasmosis; a febrile tick-borne bacterial zoonosis of increasing public health importance in many parts of the world which is life threatening in undiagnosed, misdiagnosed and untreated cases. In this study we determined and reported the global status of the pathogen in man. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used to perform a systematic review and meta-analysis of data published in six electronic databases between 1970 and 2020. We pooled data using the random-effects model, performed sensitivity analysis by the single study deletion method and assess across study bias by the funnel plot and its statistical significance by the Egger's regression test. A total of 7018 cases of A. phagocytophilum were reported from 48,619 individuals examined across 22 countries in three continents. Overall pooled estimate was 8.13% (95% CI: 5.70 - 11.47) with a range of 4.64 (95% CI: 1.78 - 11.54) to 12.18% (95% CI: 7.66 - 18.83) across sub-groups. Regional prevalence was highest in North America 11.07% (95% CI: 3.13 - 32.38), while that in relation to study population was highest among occupationally exposed population 11.41% (95% CI: 5.69 - 21.56). The study revealed a significant variation in the prevalence of A. phagocytophilum across Asia, Europe and North America, with the highest prevalence in North America and among occupationally exposed population. To curtail the menace of this growing public health crisis, we recommend integrated control programmes involving tick control, the use of appropriate clothing by occupationally exposed population and health education. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Animals', 'Humans', 'Anaplasmosis', 'Ticks'] | 37,843,237 | 0 | Global status of <i>Anaplasma phagocytophilum</i> infections in human population: A 50-year (1970-2020) meta-analysis. Anaplasma phagocytophilum causes human granulocytic anaplasmosis; a febrile tick-borne bacterial zoonosis of increasing public health importance in many parts of the world which is life threatening in undiagnosed, misdiagnosed and untreated cases. In this study we determined and reported the global status of the pathogen in man. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used to perform a systematic review and meta-analysis of data published in six electronic databases between 1970 and 2020. We pooled data using the random-effects model, performed sensitivity analysis by the single study deletion method and assess across study bias by the funnel plot and its statistical significance by the Egger's regression test. A total of 7018 cases of A. phagocytophilum were reported from 48,619 individuals examined across 22 countries in three continents. Overall pooled estimate was 8.13% (95% CI: 5.70 - 11.47) with a range of 4.64 (95% CI: 1.78 - 11.54) to 12.18% (95% CI: 7.66 - 18.83) across sub-groups. Regional prevalence was highest in North America 11.07% (95% CI: 3.13 - 32.38), while that in relation to study population was highest among occupationally exposed population 11.41% (95% CI: 5.69 - 21.56). The study revealed a significant variation in the prevalence of A. phagocytophilum across Asia, Europe and North America, with the highest prevalence in North America and among occupationally exposed population. To curtail the menace of this growing public health crisis, we recommend integrated control programmes involving tick control, the use of appropriate clothing by occupationally exposed population and health education. |
17/02/2021 | Association between antihypertensive treatment and adverse events: systematic review and meta-analysis. | To examine the association between antihypertensive treatment and specific adverse events. Systematic review and meta-analysis. Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. To avoid small early phase trials, studies were required to have at least 650 patient years of follow-up. Searches were conducted in Embase, Medline, CENTRAL, and the Science Citation Index databases from inception until 14 April 2020. The primary outcome was falls during trial follow-up. Secondary outcomes were acute kidney injury, fractures, gout, hyperkalaemia, hypokalaemia, hypotension, and syncope. Additional outcomes related to death and major cardiovascular events were extracted. Risk of bias was assessed using the Cochrane risk of bias tool, and random effects meta-analysis was used to pool rate ratios, odds ratios, and hazard ratios across studies, allowing for between study heterogeneity (τ<sup>2</sup>). Of 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years. Most of the trials (n=40, 69%) had a low risk of bias. Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05, 95% confidence interval 0.89 to 1.24, τ<sup>2</sup>=0.009). Antihypertensives were associated with an increased risk of acute kidney injury (1.18, 95% confidence interval 1.01 to 1.39, τ<sup>2</sup>=0.037, n=15), hyperkalaemia (1.89, 1.56 to 2.30, τ<sup>2</sup>=0.122, n=26), hypotension (1.97, 1.67 to 2.32, τ<sup>2</sup>=0.132, n=35), and syncope (1.28, 1.03 to 1.59, τ<sup>2</sup>=0.050, n=16). The heterogeneity between studies assessing acute kidney injury and hyperkalaemia events was reduced when focusing on drugs that affect the renin angiotensin-aldosterone system. Results were robust to sensitivity analyses focusing on adverse events leading to withdrawal from each trial. Antihypertensive treatment was associated with a reduced risk of all cause mortality, cardiovascular death, and stroke, but not of myocardial infarction. This meta-analysis found no evidence to suggest that antihypertensive treatment is associated with falls but found evidence of an association with mild (hyperkalaemia, hypotension) and severe adverse events (acute kidney injury, syncope). These data could be used to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, especially in patients at high risk of harm because of previous adverse events or poor renal function. PROSPERO CRD42018116860. | ['Journal Article', 'Meta-Analysis', "Research Support, Non-U.S. Gov't", 'Systematic Review'] | ['Acute Kidney Injury', 'Aged', 'Antihypertensive Agents', 'Blood Pressure', 'Causality', 'Gout', 'Humans', 'Hyperkalemia', 'Hypokalemia', 'Middle Aged', 'Randomized Controlled Trials as Topic'] | 33,568,342 | 1 | Association between antihypertensive treatment and adverse events: systematic review and meta-analysis. To examine the association between antihypertensive treatment and specific adverse events. Systematic review and meta-analysis. Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. To avoid small early phase trials, studies were required to have at least 650 patient years of follow-up. Searches were conducted in Embase, Medline, CENTRAL, and the Science Citation Index databases from inception until 14 April 2020. The primary outcome was falls during trial follow-up. Secondary outcomes were acute kidney injury, fractures, gout, hyperkalaemia, hypokalaemia, hypotension, and syncope. Additional outcomes related to death and major cardiovascular events were extracted. Risk of bias was assessed using the Cochrane risk of bias tool, and random effects meta-analysis was used to pool rate ratios, odds ratios, and hazard ratios across studies, allowing for between study heterogeneity (τ<sup>2</sup>). Of 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years. Most of the trials (n=40, 69%) had a low risk of bias. Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05, 95% confidence interval 0.89 to 1.24, τ<sup>2</sup>=0.009). Antihypertensives were associated with an increased risk of acute kidney injury (1.18, 95% confidence interval 1.01 to 1.39, τ<sup>2</sup>=0.037, n=15), hyperkalaemia (1.89, 1.56 to 2.30, τ<sup>2</sup>=0.122, n=26), hypotension (1.97, 1.67 to 2.32, τ<sup>2</sup>=0.132, n=35), and syncope (1.28, 1.03 to 1.59, τ<sup>2</sup>=0.050, n=16). The heterogeneity between studies assessing acute kidney injury and hyperkalaemia events was reduced when focusing on drugs that affect the renin angiotensin-aldosterone system. Results were robust to sensitivity analyses focusing on adverse events leading to withdrawal from each trial. Antihypertensive treatment was associated with a reduced risk of all cause mortality, cardiovascular death, and stroke, but not of myocardial infarction. This meta-analysis found no evidence to suggest that antihypertensive treatment is associated with falls but found evidence of an association with mild (hyperkalaemia, hypotension) and severe adverse events (acute kidney injury, syncope). These data could be used to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, especially in patients at high risk of harm because of previous adverse events or poor renal function. PROSPERO CRD42018116860. |
29/03/2023 | Systematic Review of Signs and Symptoms Associated with Hematopoietic Stem Cell Transplantation-Associated Thrombotic Microangiopathy. | Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) is a serious complication of the transplantation process that has been consistently associated with substantially greater morbidity and mortality compared with HSCT recipients who do not develop TMA. This study aimed to systematically review published signs and symptoms of HSCT-TMA and compare patients with HSCT-TMA and HSCT recipients who do not develop TMA. Publications were identified using multiple search term variations for stem cell transplantation that were entered into the PubMed, Embase, and CINAHL databases. Two reviewers screened references at the abstract level before reviewing full texts against inclusion and exclusion criteria using a PICOS-T framework. Complication proportions were grouped by organ class and then by complication type. Meta-analyses were conducted using a random-effects model in RevMan 5.4. After 2338 references were screened, a total of 30 studies were included in our analyses. The majority of studies (n = 23; 14 adult, 5 pediatric, 4 both) examined allogeneic transplantations only. Four studies examined autologous transplantation only (all pediatric), and 3 studies included both transplantation types (all pediatric). HSCT-TMA was associated with renal dysfunction (odds ratio [OR], 11.04 for adult, allogeneic and 7.35 for pediatric, all transplantations), renal failure (OR, 2.41 for adult and pediatric, allogeneic), renal replacement therapy (OR, 6.99 for pediatric, all transplantations and 60.85 for adult, allogeneic), and hypertension (OR, 5.44 for adult, allogeneic). HSCT-TMA was associated with respiratory failure (OR, 8.00 for adult and pediatric, allogeneic), pulmonary hypertension (OR, 9.86 for adult and pediatric, allogeneic), need for pleurocentesis (OR, 5.45 for pediatric, all transplantations), noninvasive ventilation (OR, 6.15 for pediatric, all transplantations), and invasive mechanical ventilation (OR, 5.18 for pediatric, all transplantations). Additionally, HSCT-TMA was associated with neurologic symptoms (OR, 2.28 for adult and pediatric, allogeneic), pericardial effusion (OR, 2.56 for adult and pediatric, allogeneic and 8.76 for pediatric, all transplantations), liver injury (OR, 3.87 for adult, allogeneic), infection (OR, 9.25 for adult, allogeneic; 2.06 for pediatric, all transplantations), gastrointestinal (GI) bleeding (OR, 7.78 for adult and pediatric, allogeneic), and acute graft-versus-host disease grade III-IV (OR, 3.29 for adult and pediatric, allogeneic). This study represents the first systematic review of HSCT-TMA signs and symptoms. Current diagnostic criteria systems involve laboratory markers for multiorgan dysfunction, including renal dysfunction, liver injury, and general tissue damage. Diagnostic criteria include neurologic symptoms, increased need for transfusions, and hypertension. This study identified additional associations with HSCT-TMA, including increased pulmonary hypertension, respiratory failure, fever, GI bleeding, and pericardial effusion. These symptoms might be included for evaluation in future diagnostic criteria and current practice. | ['Journal Article', 'Systematic Review', 'Research Support, N.I.H., Extramural'] | ['Adult', 'Child', 'Humans', 'Hematopoietic Stem Cell Transplantation', 'Hypertension', 'Hypertension, Pulmonary', 'Pericardial Effusion', 'Thrombotic Microangiopathies'] | 36,592,719 | 1 | Systematic Review of Signs and Symptoms Associated with Hematopoietic Stem Cell Transplantation-Associated Thrombotic Microangiopathy. Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) is a serious complication of the transplantation process that has been consistently associated with substantially greater morbidity and mortality compared with HSCT recipients who do not develop TMA. This study aimed to systematically review published signs and symptoms of HSCT-TMA and compare patients with HSCT-TMA and HSCT recipients who do not develop TMA. Publications were identified using multiple search term variations for stem cell transplantation that were entered into the PubMed, Embase, and CINAHL databases. Two reviewers screened references at the abstract level before reviewing full texts against inclusion and exclusion criteria using a PICOS-T framework. Complication proportions were grouped by organ class and then by complication type. Meta-analyses were conducted using a random-effects model in RevMan 5.4. After 2338 references were screened, a total of 30 studies were included in our analyses. The majority of studies (n = 23; 14 adult, 5 pediatric, 4 both) examined allogeneic transplantations only. Four studies examined autologous transplantation only (all pediatric), and 3 studies included both transplantation types (all pediatric). HSCT-TMA was associated with renal dysfunction (odds ratio [OR], 11.04 for adult, allogeneic and 7.35 for pediatric, all transplantations), renal failure (OR, 2.41 for adult and pediatric, allogeneic), renal replacement therapy (OR, 6.99 for pediatric, all transplantations and 60.85 for adult, allogeneic), and hypertension (OR, 5.44 for adult, allogeneic). HSCT-TMA was associated with respiratory failure (OR, 8.00 for adult and pediatric, allogeneic), pulmonary hypertension (OR, 9.86 for adult and pediatric, allogeneic), need for pleurocentesis (OR, 5.45 for pediatric, all transplantations), noninvasive ventilation (OR, 6.15 for pediatric, all transplantations), and invasive mechanical ventilation (OR, 5.18 for pediatric, all transplantations). Additionally, HSCT-TMA was associated with neurologic symptoms (OR, 2.28 for adult and pediatric, allogeneic), pericardial effusion (OR, 2.56 for adult and pediatric, allogeneic and 8.76 for pediatric, all transplantations), liver injury (OR, 3.87 for adult, allogeneic), infection (OR, 9.25 for adult, allogeneic; 2.06 for pediatric, all transplantations), gastrointestinal (GI) bleeding (OR, 7.78 for adult and pediatric, allogeneic), and acute graft-versus-host disease grade III-IV (OR, 3.29 for adult and pediatric, allogeneic). This study represents the first systematic review of HSCT-TMA signs and symptoms. Current diagnostic criteria systems involve laboratory markers for multiorgan dysfunction, including renal dysfunction, liver injury, and general tissue damage. Diagnostic criteria include neurologic symptoms, increased need for transfusions, and hypertension. This study identified additional associations with HSCT-TMA, including increased pulmonary hypertension, respiratory failure, fever, GI bleeding, and pericardial effusion. These symptoms might be included for evaluation in future diagnostic criteria and current practice. |
21/09/2020 | Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis. | This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of -343.56 mL (95% confidence interval: -316.41, -370.72) significantly differed from zero (<i>p</i> = 0.005) with a heterogeneity of <i>I</i> <sup>2</sup> = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Administration, Topical', 'Adult', 'Aged', 'Antifibrinolytic Agents', 'Cardiac Surgical Procedures', 'Female', 'Humans', 'Male', 'Middle Aged', 'Postoperative Hemorrhage', 'Randomized Controlled Trials as Topic', 'Risk Factors', 'Time Factors', 'Tranexamic Acid', 'Treatment Outcome'] | 31,170,736 | 0 | Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis. This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of -343.56 mL (95% confidence interval: -316.41, -370.72) significantly differed from zero (<i>p</i> = 0.005) with a heterogeneity of <i>I</i> <sup>2</sup> = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings. |
28/03/2022 | Efficacy and Safety of Intravascular Lithotripsy in Calcified Coronary Lesions: A Systematic Review and Meta-Analysis. | Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment. We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included. A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness. IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Calcium', 'Humans', 'Lithotripsy', 'Stents', 'Treatment Outcome', 'Vascular Calcification'] | 34,024,748 | 0 | Efficacy and Safety of Intravascular Lithotripsy in Calcified Coronary Lesions: A Systematic Review and Meta-Analysis. Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment. We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included. A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness. IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques. |
09/07/2021 | Impact of preservation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF): a systematic review and meta-analysis. | Esophageal atresia-tracheoesophageal fistula (EA-TEF) is one of the common congenital anomalies occurring in newborns. Over the last eight decades, various technical modifications have been proposed in the surgical repair of EA-TEF. Preservation of azygos vein is one such modification that has gained considerable attention. However, a consensus statement regarding the superiority of its preservation over its division is lacking. We aim to compare the outcomes of surgery between the two groups of newborns, i.e., those undergoing repair with and without azygos vein preservation, in terms of its complications. The authors systematically searched the databases PubMed, EMBASE, Web of Science, and Scopus through December 2020. The incidence of anastomotic complications and chest infection was compared among the two groups of newborns, i.e., those undergoing surgical repair with (group A) and without azygos vein preservation (group B). Statistical analysis was performed using a fixed-effects model, and pooled risk ratio (RR) and heterogeneity (I<sup>2</sup>) were calculated. The methodological quality of the studies was assessed using the Downs and Black scale. Six comparative studies, consisting of a total of 671 newborns, were included in the meta-analysis. As compared to group B, newborns belonging to group A showed a significantly lower incidence of pneumonitis in the postoperative period (RR 0.31; 95% CI 0.17-0.57, p = 0.0001). However, no significant difference in the incidence of anastomotic complications including anastomotic leak (RR 0.73; 95% CI 0.48-1.12, p = 0.15) and stricture (RR 0.63; 95% CI 0.36-1.09, p = 0.10) was observed between the two groups. The average Downs and Black scale scores ranged from 20 to 24. The risk of bias was low (n = 1) and moderate (n = 5) in the included studies. Kappa statistics showed a value of 0.902 (p < 0.001), highlighting an almost perfect agreement among the two observers. The present meta-analysis revealed the superiority of surgical repair of EA-TEF performed with preservation of azygos vein in terms of the incidence of postoperative chest infection. However, no significant difference in the occurrence of anastomotic leak and stricture was observed between the two groups. The level of evidence of the published comparative studies is limited. Therefore, well designed, randomized controlled trial utilizing a standardized operative approach on a larger sample-size needs to be conducted for optimal comparison between the two approaches. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Anastomosis, Surgical', 'Anastomotic Leak', 'Azygos Vein', 'Constriction, Pathologic', 'Digestive System Surgical Procedures', 'Esophageal Atresia', 'Female', 'Humans', 'Infant, Newborn', 'Male', 'Pneumonia', 'Retrospective Studies', 'Tracheoesophageal Fistula', 'Treatment Outcome', 'Vascular Surgical Procedures'] | 33,907,863 | 0 | Impact of preservation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF): a systematic review and meta-analysis. Esophageal atresia-tracheoesophageal fistula (EA-TEF) is one of the common congenital anomalies occurring in newborns. Over the last eight decades, various technical modifications have been proposed in the surgical repair of EA-TEF. Preservation of azygos vein is one such modification that has gained considerable attention. However, a consensus statement regarding the superiority of its preservation over its division is lacking. We aim to compare the outcomes of surgery between the two groups of newborns, i.e., those undergoing repair with and without azygos vein preservation, in terms of its complications. The authors systematically searched the databases PubMed, EMBASE, Web of Science, and Scopus through December 2020. The incidence of anastomotic complications and chest infection was compared among the two groups of newborns, i.e., those undergoing surgical repair with (group A) and without azygos vein preservation (group B). Statistical analysis was performed using a fixed-effects model, and pooled risk ratio (RR) and heterogeneity (I<sup>2</sup>) were calculated. The methodological quality of the studies was assessed using the Downs and Black scale. Six comparative studies, consisting of a total of 671 newborns, were included in the meta-analysis. As compared to group B, newborns belonging to group A showed a significantly lower incidence of pneumonitis in the postoperative period (RR 0.31; 95% CI 0.17-0.57, p = 0.0001). However, no significant difference in the incidence of anastomotic complications including anastomotic leak (RR 0.73; 95% CI 0.48-1.12, p = 0.15) and stricture (RR 0.63; 95% CI 0.36-1.09, p = 0.10) was observed between the two groups. The average Downs and Black scale scores ranged from 20 to 24. The risk of bias was low (n = 1) and moderate (n = 5) in the included studies. Kappa statistics showed a value of 0.902 (p < 0.001), highlighting an almost perfect agreement among the two observers. The present meta-analysis revealed the superiority of surgical repair of EA-TEF performed with preservation of azygos vein in terms of the incidence of postoperative chest infection. However, no significant difference in the occurrence of anastomotic leak and stricture was observed between the two groups. The level of evidence of the published comparative studies is limited. Therefore, well designed, randomized controlled trial utilizing a standardized operative approach on a larger sample-size needs to be conducted for optimal comparison between the two approaches. |
19/06/2020 | Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies. | The use of stereotactic ablative radiotherapy for recurrent and metastatic renal cell carcinoma (RCC) is not yet standard treatment due to uncertainties regarding its efficacy and safety. The objective of the systematic review and meta-analysis was to assess the efficacy and safety of stereotactic radiotherapy for metastatic RCC. A Population, Intervention, Control, Outcome, Study Design (PICOS)/Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol was utilized to select studies published during 1998-2019. The primary outcome was 1 year local control and 1 year overall survival; the secondary outcome was Common Terminology Criteria for Adverse Events grade 3-4 toxicity. Weighted random-effect meta-analyses were conducted using the DerSimonian and Laird method, heterogeneity was evaluated using the I<sup>2</sup> statistic and Cochran Q test, and the Egger test assessed publication bias. A total of 265 studies were screened and 28 studies were included. There were 1602 mutually exclusive patients (679 extracranial/923 intracranial) and 3892 lesions (1159 extracranial/2733 intracranial). The median age was 62yr. The median treatment volume was 59.7cc for extracranial (interquartile range: 31.1-71.4) and 2.3cc for intracranial (interquartile range: 1.3-4.3) lesions. Under the random-effect model, the summary effect size for 1-yr local control was 89.1% (95% confidence interval [CI]: 83.6-93.7%, I<sup>2</sup>=71%) and 90.1% (95% CI: 83.5-95.3%, I<sup>2</sup>=74%) for extracranial and intracranial disease, respectively. The 1-yr survival rates were 86.8% (95% CI: 62-99.8%, I<sup>2</sup>=95%) and 49.7% (95% CI: 41.1-58.3%, I<sup>2</sup>=74%) for extracranial and intracranial disease, respectively. The incidence of any grade 3-4 toxicity was 0.7% (95% CI: 0-2.1%, I<sup>2</sup>=0%) for extracranial disease and 1.1% (95% CI: 0-7.4%, I<sup>2</sup>=53%) for intracranial disease. Stereotactic radiotherapy is safe and efficacious for RCC oligometastases, with local control at 90% and any significant toxicity at 1%, reported at 1yr. Further prospective studies are needed. Stereotactic radiotherapy is safe and effective in treating kidney cancer that has spread to other parts of the body: 90% of cancers do not progress in the treated region and <1% of patients have side effects at 1yr. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Brain Neoplasms', 'Carcinoma, Renal Cell', 'Dose-Response Relationship, Radiation', 'Humans', 'Kidney Neoplasms', 'Neoplasm Recurrence, Local', 'Progression-Free Survival', 'Prospective Studies', 'Radiation Tolerance', 'Radiosurgery', 'Radiotherapy Dosage'] | 31,302,061 | 1 | Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies. The use of stereotactic ablative radiotherapy for recurrent and metastatic renal cell carcinoma (RCC) is not yet standard treatment due to uncertainties regarding its efficacy and safety. The objective of the systematic review and meta-analysis was to assess the efficacy and safety of stereotactic radiotherapy for metastatic RCC. A Population, Intervention, Control, Outcome, Study Design (PICOS)/Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol was utilized to select studies published during 1998-2019. The primary outcome was 1 year local control and 1 year overall survival; the secondary outcome was Common Terminology Criteria for Adverse Events grade 3-4 toxicity. Weighted random-effect meta-analyses were conducted using the DerSimonian and Laird method, heterogeneity was evaluated using the I<sup>2</sup> statistic and Cochran Q test, and the Egger test assessed publication bias. A total of 265 studies were screened and 28 studies were included. There were 1602 mutually exclusive patients (679 extracranial/923 intracranial) and 3892 lesions (1159 extracranial/2733 intracranial). The median age was 62yr. The median treatment volume was 59.7cc for extracranial (interquartile range: 31.1-71.4) and 2.3cc for intracranial (interquartile range: 1.3-4.3) lesions. Under the random-effect model, the summary effect size for 1-yr local control was 89.1% (95% confidence interval [CI]: 83.6-93.7%, I<sup>2</sup>=71%) and 90.1% (95% CI: 83.5-95.3%, I<sup>2</sup>=74%) for extracranial and intracranial disease, respectively. The 1-yr survival rates were 86.8% (95% CI: 62-99.8%, I<sup>2</sup>=95%) and 49.7% (95% CI: 41.1-58.3%, I<sup>2</sup>=74%) for extracranial and intracranial disease, respectively. The incidence of any grade 3-4 toxicity was 0.7% (95% CI: 0-2.1%, I<sup>2</sup>=0%) for extracranial disease and 1.1% (95% CI: 0-7.4%, I<sup>2</sup>=53%) for intracranial disease. Stereotactic radiotherapy is safe and efficacious for RCC oligometastases, with local control at 90% and any significant toxicity at 1%, reported at 1yr. Further prospective studies are needed. Stereotactic radiotherapy is safe and effective in treating kidney cancer that has spread to other parts of the body: 90% of cancers do not progress in the treated region and <1% of patients have side effects at 1yr. |
23/09/2022 | Association of Kidney Stones and Recurrent UTIs: the Chicken and Egg Situation. A Systematic Review of Literature. | Kidney stone disease (KSD) and recurrent urinary tract infections (rUTI) are frequently concomitant conditions. We conducted a systematic review to determine the association of UTI in patients with KSD and to assess the outcomes of kidney stone treatment in the resolution of rUTI. Our systematic review included 17 papers and a strong association between KSD and rUTI was demonstrated by numerous studies. Surgical clearance of kidney stones usually resulted in the resolution of UTI, but discordant data persist regarding recurrence rates after surgery. In vitro studies might unveil the causative role of bacteria in the formation of "metabolic" stones. Our SR clearly shows that UTI and KSD are mutually coexisting, and reciprocally causal and such patients should be counselled for proactive intervention by stone removal especially when UTIs are recurrent or additional risk factors are present irrespective of stone composition. To prevent further UTI episodes, if possible, a stone culture must be obtained for an effectively targeted antibiotic treatment regime tailored to bacterial prevalence. | ['Journal Article', 'Review', 'Systematic Review'] | ['Anti-Bacterial Agents', 'Humans', 'Kidney Calculi', 'Lithotripsy', 'Ureteroscopy', 'Urinary Tract Infections'] | 35,877,059 | 1 | Association of Kidney Stones and Recurrent UTIs: the Chicken and Egg Situation. A Systematic Review of Literature. Kidney stone disease (KSD) and recurrent urinary tract infections (rUTI) are frequently concomitant conditions. We conducted a systematic review to determine the association of UTI in patients with KSD and to assess the outcomes of kidney stone treatment in the resolution of rUTI. Our systematic review included 17 papers and a strong association between KSD and rUTI was demonstrated by numerous studies. Surgical clearance of kidney stones usually resulted in the resolution of UTI, but discordant data persist regarding recurrence rates after surgery. In vitro studies might unveil the causative role of bacteria in the formation of "metabolic" stones. Our SR clearly shows that UTI and KSD are mutually coexisting, and reciprocally causal and such patients should be counselled for proactive intervention by stone removal especially when UTIs are recurrent or additional risk factors are present irrespective of stone composition. To prevent further UTI episodes, if possible, a stone culture must be obtained for an effectively targeted antibiotic treatment regime tailored to bacterial prevalence. |
30/07/2020 | Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. | A systematic review and meta-analysis was conducted in an attempt to systematically collect and evaluate the associations of epidemiological, comorbidity factors with the severity and prognosis of coronavirus disease 2019 (COVID-19). The systematic review and meta-analysis was conducted according to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Sixty nine publications met our study criteria, and 61 studies with more than 10,000 COVID-19 cases were eligible for the quantitative synthesis. We found that the males had significantly higher disease severity (RR: 1.20, 95% CI: 1.13-1.27, P <0.001) and more prognostic endpoints. Older age was found to be significantly associated with the disease severity and six prognostic endpoints. Chronic kidney disease contributed mostly for death (RR: 7.10, 95% CI: 3.14-16.02), chronic obstructive pulmonary disease (COPD) for disease severity (RR: 4.20, 95% CI: 2.82-6.25), admission to intensive care unit (ICU) (RR: 5.61, 95% CI: 2.68-11.76), the composite endpoint (RR: 8.52, 95% CI: 4.36-16.65,), invasive ventilation (RR: 6.53, 95% CI: 2.70-15.84), and disease progression (RR: 7.48, 95% CI: 1.60-35.05), cerebrovascular disease for acute respiratory distress syndrome (ARDS) (RR: 3.15, 95% CI: 1.23-8.04), coronary heart disease for cardiac abnormality (RR: 5.37, 95% CI: 1.74-16.54). Our study highlighted that the male gender, older age and comorbidities owned strong epidemiological evidence of associations with the severity and prognosis of COVID-19. | ['Journal Article', 'Meta-Analysis', "Research Support, Non-U.S. Gov't", 'Systematic Review'] | ['Adult', 'Age Factors', 'Aged', 'Aged, 80 and over', 'Betacoronavirus', 'COVID-19', 'Comorbidity', 'Coronavirus Infections', 'Female', 'Humans', 'Male', 'Middle Aged', 'Pandemics', 'Pneumonia, Viral', 'Prognosis', 'Risk Factors', 'SARS-CoV-2', 'Sex Factors'] | 32,658,868 | 1 | Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. A systematic review and meta-analysis was conducted in an attempt to systematically collect and evaluate the associations of epidemiological, comorbidity factors with the severity and prognosis of coronavirus disease 2019 (COVID-19). The systematic review and meta-analysis was conducted according to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Sixty nine publications met our study criteria, and 61 studies with more than 10,000 COVID-19 cases were eligible for the quantitative synthesis. We found that the males had significantly higher disease severity (RR: 1.20, 95% CI: 1.13-1.27, P <0.001) and more prognostic endpoints. Older age was found to be significantly associated with the disease severity and six prognostic endpoints. Chronic kidney disease contributed mostly for death (RR: 7.10, 95% CI: 3.14-16.02), chronic obstructive pulmonary disease (COPD) for disease severity (RR: 4.20, 95% CI: 2.82-6.25), admission to intensive care unit (ICU) (RR: 5.61, 95% CI: 2.68-11.76), the composite endpoint (RR: 8.52, 95% CI: 4.36-16.65,), invasive ventilation (RR: 6.53, 95% CI: 2.70-15.84), and disease progression (RR: 7.48, 95% CI: 1.60-35.05), cerebrovascular disease for acute respiratory distress syndrome (ARDS) (RR: 3.15, 95% CI: 1.23-8.04), coronary heart disease for cardiac abnormality (RR: 5.37, 95% CI: 1.74-16.54). Our study highlighted that the male gender, older age and comorbidities owned strong epidemiological evidence of associations with the severity and prognosis of COVID-19. |
13/04/2022 | Risk Prediction Models for Kidney Cancer: A Systematic Review. | Early detection of kidney cancer improves survival; however, low prevalence means that population-wide screening may be inefficient. Stratification of the population into risk categories could allow for the introduction of a screening programme tailored to individuals. This review will identify and compare published models that predict the risk of developing kidney cancer in the general population. A search identified primary research reporting or validating models predicting the risk of kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines and evaluated using the PROBAST assessment tool. The search identified 15 281 articles. Sixty-two satisfied the inclusion criteria; performance measures were provided for 11 models. Some models predicted the risk of prevalent undiagnosed disease and others future incident disease. Six of the models had been validated, two using external populations. The most commonly included risk factors were age, smoking status, and body mass index. Most of the models had acceptable-to-good discrimination (area under the receiver-operating curve >0.7) in development and validation. Many models also had high specificity; however, several had low sensitivity. The highest performance was seen for the models using only biomarkers to detect kidney cancer; however, these were developed and validated in small case-control studies. We identified a small number of risk models that could be used to stratify the population according to the risk of kidney cancer. Most exhibit reasonable discrimination, but a few have been validated externally in population-based studies. In this review, we looked at mathematical models predicting the likelihood of an individual developing kidney cancer. We found several suitable models, using a range of risk factors (such as age and smoking) to predict the risk for individuals. Most of the models identified require further testing in the general population to confirm their usefulness. | ['Journal Article', "Research Support, Non-U.S. Gov't", 'Review', 'Systematic Review'] | ['Biomarkers', 'Humans', 'Kidney Neoplasms', 'Mass Screening', 'Prognosis', 'Risk Factors'] | 32,680,829 | 1 | Risk Prediction Models for Kidney Cancer: A Systematic Review. Early detection of kidney cancer improves survival; however, low prevalence means that population-wide screening may be inefficient. Stratification of the population into risk categories could allow for the introduction of a screening programme tailored to individuals. This review will identify and compare published models that predict the risk of developing kidney cancer in the general population. A search identified primary research reporting or validating models predicting the risk of kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines and evaluated using the PROBAST assessment tool. The search identified 15 281 articles. Sixty-two satisfied the inclusion criteria; performance measures were provided for 11 models. Some models predicted the risk of prevalent undiagnosed disease and others future incident disease. Six of the models had been validated, two using external populations. The most commonly included risk factors were age, smoking status, and body mass index. Most of the models had acceptable-to-good discrimination (area under the receiver-operating curve >0.7) in development and validation. Many models also had high specificity; however, several had low sensitivity. The highest performance was seen for the models using only biomarkers to detect kidney cancer; however, these were developed and validated in small case-control studies. We identified a small number of risk models that could be used to stratify the population according to the risk of kidney cancer. Most exhibit reasonable discrimination, but a few have been validated externally in population-based studies. In this review, we looked at mathematical models predicting the likelihood of an individual developing kidney cancer. We found several suitable models, using a range of risk factors (such as age and smoking) to predict the risk for individuals. Most of the models identified require further testing in the general population to confirm their usefulness. |
29/03/2022 | The clinical and radiological cerebrovascular abnormalities associated with renovascular hypertension in children: a systematic review. | Renovascular disease is an important secondary cause of hypertension in childhood. In this cohort, many may have undiagnosed cerebrovascular disease, and some children present acutely with cerebrovascular complications. However, these associations are yet to be defined in the literature.A systematic review of clinical and radiological abnormalities associated with renovascular hypertension in the global pediatric (< 18 years) population. The MEDLINE, Embase, and Google Scholar databases were searched, from database inception to 26 January 2021. Primary articles were unrestricted by study design and geographical location but were limited to those published in English.A total of 303 individuals (median age: 7.6 years [range 10 days-17.9 years]; M:F, 174:129) from 34 studies were included, across 13 countries. Twenty-seven individual cases were published for children with coexisting renovascular hypertension and cerebrovascular disease. Most children had bilateral renal artery stenosis, secondary to fibromuscular dysplasia and had coexisting occlusive cerebrovascular disease. The majority presented with neurological symptoms, and cerebral complication ranged from asymptomatic cerebrovascular stenosis to acute stroke and posterior reversible encephalopathy syndrome. The location or underlying etiology of the renovascular disease did not predict the location or extent of the cerebrovascular disease. The evidence from the cohort studies was limited, as none specifically established a cohort of children with coexisting disease. Furthermore, the conclusions drawn were subjected to considerable bias from the treating clinicians.A prospective cohort of children with renovascular hypertension and cerebrovascular complications should be established so the long-term prognosis and impact of treatment may be better understood. | ['Journal Article', 'Review', 'Systematic Review'] | ['Cerebrovascular Disorders', 'Child', 'Humans', 'Hypertension, Renovascular', 'Radiology'] | 34,240,276 | 1 | The clinical and radiological cerebrovascular abnormalities associated with renovascular hypertension in children: a systematic review. Renovascular disease is an important secondary cause of hypertension in childhood. In this cohort, many may have undiagnosed cerebrovascular disease, and some children present acutely with cerebrovascular complications. However, these associations are yet to be defined in the literature.A systematic review of clinical and radiological abnormalities associated with renovascular hypertension in the global pediatric (< 18 years) population. The MEDLINE, Embase, and Google Scholar databases were searched, from database inception to 26 January 2021. Primary articles were unrestricted by study design and geographical location but were limited to those published in English.A total of 303 individuals (median age: 7.6 years [range 10 days-17.9 years]; M:F, 174:129) from 34 studies were included, across 13 countries. Twenty-seven individual cases were published for children with coexisting renovascular hypertension and cerebrovascular disease. Most children had bilateral renal artery stenosis, secondary to fibromuscular dysplasia and had coexisting occlusive cerebrovascular disease. The majority presented with neurological symptoms, and cerebral complication ranged from asymptomatic cerebrovascular stenosis to acute stroke and posterior reversible encephalopathy syndrome. The location or underlying etiology of the renovascular disease did not predict the location or extent of the cerebrovascular disease. The evidence from the cohort studies was limited, as none specifically established a cohort of children with coexisting disease. Furthermore, the conclusions drawn were subjected to considerable bias from the treating clinicians.A prospective cohort of children with renovascular hypertension and cerebrovascular complications should be established so the long-term prognosis and impact of treatment may be better understood. |
28/12/2022 | Effectiveness of psychosocial interventions on the burden and quality of life of informal caregivers of hemodialysis patients: a systematic review. | To systematically review the effectiveness of psychosocial interventions developed for informal caregivers of hemodialysis patients. Relevant studies were identified through five electronic databases: PubMed, Scopus, Web of Science, ProQuest, and the CENTRAL. Randomized controlled trials (RCTs) and quasi-experimental studies describing interventions for informal caregivers of adult in-center hemodialysis patients (≥18 years old) were included and independently appraised by two reviewers using the Joanna Briggs Institute Statistics Assessment and Review Instruments critical appraisal checklists. Eleven articles evaluating eight intervention programs were included in this review, covering a total of 729 informal caregivers. Most studies implemented educational or psycho-educational interventions (<i>n</i> = 6). Psycho-educational interventions designed to promote caregivers' ability to care and to cope with the caregiving role had positive effects on burden and/or quality of life. Psychological interventions also had large effects on reducing the burden over time. There are still few interventions available to caregivers of hemodialysis patients. Psychosocial interventions showed great potential in improving the caregiver burden and quality of life. Further research with rigorous designs is needed to achieve stronger evidence on the extent of the current findings. CRD42021247916.Implications for rehabilitationPatients with end-stage renal disease (ESRD) undergoing in-center hemodialysis often require emotional and/or practical support from family members or friends.Research has consistently shown that informal caregivers of hemodialysis patients may experience significant burden and a negative impact on their quality of life as a result of their caregiving role during the disease trajectory.This review evidenced that intervention programs involving education and psychological strategies had large positive effects on reducing caregiver burden and improving quality of life.The findings provide valuable evidence to recommend the inclusion of psychosocial programs to family caregivers as part of comprehensive renal care. | ['Systematic Review', 'Journal Article', "Research Support, Non-U.S. Gov't"] | ['Adult', 'Humans', 'Adolescent', 'Caregivers', 'Psychosocial Intervention', 'Quality of Life', 'Family', 'Renal Dialysis'] | 34,913,777 | 1 | Effectiveness of psychosocial interventions on the burden and quality of life of informal caregivers of hemodialysis patients: a systematic review. To systematically review the effectiveness of psychosocial interventions developed for informal caregivers of hemodialysis patients. Relevant studies were identified through five electronic databases: PubMed, Scopus, Web of Science, ProQuest, and the CENTRAL. Randomized controlled trials (RCTs) and quasi-experimental studies describing interventions for informal caregivers of adult in-center hemodialysis patients (≥18 years old) were included and independently appraised by two reviewers using the Joanna Briggs Institute Statistics Assessment and Review Instruments critical appraisal checklists. Eleven articles evaluating eight intervention programs were included in this review, covering a total of 729 informal caregivers. Most studies implemented educational or psycho-educational interventions (<i>n</i> = 6). Psycho-educational interventions designed to promote caregivers' ability to care and to cope with the caregiving role had positive effects on burden and/or quality of life. Psychological interventions also had large effects on reducing the burden over time. There are still few interventions available to caregivers of hemodialysis patients. Psychosocial interventions showed great potential in improving the caregiver burden and quality of life. Further research with rigorous designs is needed to achieve stronger evidence on the extent of the current findings. CRD42021247916.Implications for rehabilitationPatients with end-stage renal disease (ESRD) undergoing in-center hemodialysis often require emotional and/or practical support from family members or friends.Research has consistently shown that informal caregivers of hemodialysis patients may experience significant burden and a negative impact on their quality of life as a result of their caregiving role during the disease trajectory.This review evidenced that intervention programs involving education and psychological strategies had large positive effects on reducing caregiver burden and improving quality of life.The findings provide valuable evidence to recommend the inclusion of psychosocial programs to family caregivers as part of comprehensive renal care. |
05/02/2020 | Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as therapeutic options in the treatment of renal cancer: A meta-analysis. | Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) which have been used in the treatment of cardiovascular diseases, have also been shown to have anti-tumor effects against various cancers that include renal cancer. The aim of current paper was to explore the potential clinical impact of ACEI/ARB inhibitors in renal cancer. We used several databases: EMBASE, PubMed and the Cochrane library, to identify clinical studies that assessed the relationship between ACEIs/ARBs treatment and risk of renal cancer incidence or survival of renal cancer patients. The hazard ratio (HR) with 95% confidence intervals were obtained for assessing the relationship between ACEIs/ARBs and renal cancer mortality. The HR for the relationship between ASIs use and survival of renal cancer indicated that patients with renal cancer being treated with ACEIs/ARBs had a significantly lower mortality than non-user (HR 0.723, 95% CI 0.568-0.921, p = 0.009). The HR for the relationship between ACEIs use and survival of renal cancer indicated that patients with renal cancer that used ACEIs had a higher mortality than non-users (HR 1.352, 95% CI 0.917-1.991, p = 0.128). The HR for the relationship between ARBs use and survival of renal cancer indicated that patients with renal cancer that used ARBs had a decreased of mortality than non-users (HR 0.818, 95% CI 0.691-0.969, p = 0.02). This meta-analysis demonstrated that treatment with ACEIs/ARBs may improve renal cancer survival and reduce the mortality of patients with renal cancer. | ['Journal Article', 'Meta-Analysis'] | ['Angiotensin Receptor Antagonists', 'Angiotensin-Converting Enzyme Inhibitors', 'Humans', 'Kidney Neoplasms', 'Survival Analysis'] | 31,863,771 | 1 | Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as therapeutic options in the treatment of renal cancer: A meta-analysis. Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) which have been used in the treatment of cardiovascular diseases, have also been shown to have anti-tumor effects against various cancers that include renal cancer. The aim of current paper was to explore the potential clinical impact of ACEI/ARB inhibitors in renal cancer. We used several databases: EMBASE, PubMed and the Cochrane library, to identify clinical studies that assessed the relationship between ACEIs/ARBs treatment and risk of renal cancer incidence or survival of renal cancer patients. The hazard ratio (HR) with 95% confidence intervals were obtained for assessing the relationship between ACEIs/ARBs and renal cancer mortality. The HR for the relationship between ASIs use and survival of renal cancer indicated that patients with renal cancer being treated with ACEIs/ARBs had a significantly lower mortality than non-user (HR 0.723, 95% CI 0.568-0.921, p = 0.009). The HR for the relationship between ACEIs use and survival of renal cancer indicated that patients with renal cancer that used ACEIs had a higher mortality than non-users (HR 1.352, 95% CI 0.917-1.991, p = 0.128). The HR for the relationship between ARBs use and survival of renal cancer indicated that patients with renal cancer that used ARBs had a decreased of mortality than non-users (HR 0.818, 95% CI 0.691-0.969, p = 0.02). This meta-analysis demonstrated that treatment with ACEIs/ARBs may improve renal cancer survival and reduce the mortality of patients with renal cancer. |
30/12/2021 | Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs. | Analgesics that contain codeine are commonly prescribed for postoperative pain, but it is unclear how they compare with nonopioid alternatives. We sought to compare the effectiveness of codeine and nonsteroidal anti-inflammatory drugs (NSAIDs) for adults who underwent outpatient surgery. We conducted a systematic review and meta-analysis of randomized controlled trials comparing codeine and NSAIDs for postoperative pain in outpatient surgery. We searched MEDLINE and Embase from inception to October 2019 for eligible studies. Our primary outcome was the patient pain score, converted to a standard 10-point intensity scale. Our secondary outcomes were patient-reported global assessments and adverse effects. We used random-effects models and grading of recommendations assessment, development and evaluation (GRADE) to assess the quality of evidence. Forty studies, including 102 trial arms and 5116 patients, met inclusion criteria. The studies had low risk of bias and low-to-moderate heterogeneity. Compared with codeine, NSAIDs were associated with better pain scores at 6 hours (weighted mean difference [WMD] 0.93 points, 95% confidence interval [CI] 0.71 to 1.15) and at 12 hours (WMD 0.79, 95% CI 0.38 to 1.19). Stronger NSAID superiority at 6 hours was observed among trials where acetaminophen was coadministered at equivalent doses between groups (WMD 1.18, 95% CI 0.87 to 1.48). NSAIDs were associated with better global assessments at 6 hours (WMD -0.88, 95% CI -1.04 to -0.72) and at 24 hours (WMD -0.67, 95% CI -0.95 to -0.40), and were associated with fewer adverse effects, including bleeding events. We found that adult outpatients report better pain scores, better global assessments and fewer adverse effects when their postoperative pain is treated with NSAIDs than with codeine. Clinicians across all specialties can use this information to improve both pain management and opioid stewardship. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Ambulatory Surgical Procedures', 'Analgesics, Opioid', 'Anti-Inflammatory Agents, Non-Steroidal', 'Codeine', 'Humans', 'Pain, Postoperative', 'Randomized Controlled Trials as Topic'] | 34,860,688 | 0 | Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs. Analgesics that contain codeine are commonly prescribed for postoperative pain, but it is unclear how they compare with nonopioid alternatives. We sought to compare the effectiveness of codeine and nonsteroidal anti-inflammatory drugs (NSAIDs) for adults who underwent outpatient surgery. We conducted a systematic review and meta-analysis of randomized controlled trials comparing codeine and NSAIDs for postoperative pain in outpatient surgery. We searched MEDLINE and Embase from inception to October 2019 for eligible studies. Our primary outcome was the patient pain score, converted to a standard 10-point intensity scale. Our secondary outcomes were patient-reported global assessments and adverse effects. We used random-effects models and grading of recommendations assessment, development and evaluation (GRADE) to assess the quality of evidence. Forty studies, including 102 trial arms and 5116 patients, met inclusion criteria. The studies had low risk of bias and low-to-moderate heterogeneity. Compared with codeine, NSAIDs were associated with better pain scores at 6 hours (weighted mean difference [WMD] 0.93 points, 95% confidence interval [CI] 0.71 to 1.15) and at 12 hours (WMD 0.79, 95% CI 0.38 to 1.19). Stronger NSAID superiority at 6 hours was observed among trials where acetaminophen was coadministered at equivalent doses between groups (WMD 1.18, 95% CI 0.87 to 1.48). NSAIDs were associated with better global assessments at 6 hours (WMD -0.88, 95% CI -1.04 to -0.72) and at 24 hours (WMD -0.67, 95% CI -0.95 to -0.40), and were associated with fewer adverse effects, including bleeding events. We found that adult outpatients report better pain scores, better global assessments and fewer adverse effects when their postoperative pain is treated with NSAIDs than with codeine. Clinicians across all specialties can use this information to improve both pain management and opioid stewardship. |
18/11/2022 | Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis. | Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = -21.83, 95% CI [-34.76, -8.90]; MD = -23.8, 95% CI [-32.55, -15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = -18.74, 95% CI [-31.93, -5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time. | ['Systematic Review', 'Meta-Analysis'] | ['Humans', 'Endoscopic Mucosal Resection', 'Network Meta-Analysis', 'Treatment Outcome', 'Dissection', 'Colorectal Neoplasms', 'Retrospective Studies'] | 34,937,035 | 0 | Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis. Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = -21.83, 95% CI [-34.76, -8.90]; MD = -23.8, 95% CI [-32.55, -15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = -18.74, 95% CI [-31.93, -5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time. |
01/04/2021 | Prevalence of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID-19): A Meta-analysis of 27,492 Patients. | Olfactory dysfunction has been observed as one of the clinical manifestations in COVID-19 patients. We aimed to conduct a systematic review and meta-analysis to estimate the overall pooled prevalence of olfactory dysfunction in COVID-19 patients. Systematic review and meta-analyses. PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between 1 December 2019 and 23 July 2020. We used random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I<sup>2</sup> statistic and Cochran's Q test. Robustness of the pooled estimates was checked by different subgroup and sensitivity analyses This study is registered with PROSPERO (CRD42020183768). We identified 1162 studies, of which 83 studies (n = 27492, 61.4% female) were included in the meta-analysis. Overall, the pooled prevalence of olfactory dysfunction in COVID-19 patients was 47.85% [95% CI: 41.20-54.50]. We observed olfactory dysfunction in 54.40% European, 51.11% North American, 31.39% Asian, and 10.71% Australian COVID-19 patients. Anosmia, hyposmia, and dysosmia were observed in 35.39%, 36.15%, and 2.53% of the patients, respectively. There were discrepancies in the results of studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations. The discrepancy might be due to false-negative reporting observed in self-reported health measures. The prevalence of olfactory dysfunction in COVID-19 patients was found to be 47.85% based on high-quality evidence. Due to the subjective measures of most studies pooled in the analysis, further studies with objective measures are advocated to confirm the finding. 2 Laryngoscope, 131:865-878, 2021. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['COVID-19', 'Humans', 'Olfaction Disorders', 'Prevalence'] | 33,219,539 | 0 | Prevalence of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID-19): A Meta-analysis of 27,492 Patients. Olfactory dysfunction has been observed as one of the clinical manifestations in COVID-19 patients. We aimed to conduct a systematic review and meta-analysis to estimate the overall pooled prevalence of olfactory dysfunction in COVID-19 patients. Systematic review and meta-analyses. PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between 1 December 2019 and 23 July 2020. We used random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I<sup>2</sup> statistic and Cochran's Q test. Robustness of the pooled estimates was checked by different subgroup and sensitivity analyses This study is registered with PROSPERO (CRD42020183768). We identified 1162 studies, of which 83 studies (n = 27492, 61.4% female) were included in the meta-analysis. Overall, the pooled prevalence of olfactory dysfunction in COVID-19 patients was 47.85% [95% CI: 41.20-54.50]. We observed olfactory dysfunction in 54.40% European, 51.11% North American, 31.39% Asian, and 10.71% Australian COVID-19 patients. Anosmia, hyposmia, and dysosmia were observed in 35.39%, 36.15%, and 2.53% of the patients, respectively. There were discrepancies in the results of studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations. The discrepancy might be due to false-negative reporting observed in self-reported health measures. The prevalence of olfactory dysfunction in COVID-19 patients was found to be 47.85% based on high-quality evidence. Due to the subjective measures of most studies pooled in the analysis, further studies with objective measures are advocated to confirm the finding. 2 Laryngoscope, 131:865-878, 2021. |
11/01/2023 | The incidence and risk factors for femoral head necrosis after femoral neck fracture in pediatric patients: a systematic review and meta-analysis. | The incidence of avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) in the literature varies widely, and the risk factors associated with AVN after PFNF are controversial. Therefore, this study aimed to accurately investigate the incidence of AVN after PFNF and systematically evaluate and meta-classify their risk factors. A comprehensive search was performed of PubMed, Web of Science, and Embase. The pooled rate and 95% confidence interval (CI) were used to assess the incidence of AVN after PFNF, and pooled odds ratio (OR) were calculated to measure the effect sizes. In addition, we performed subgroup, stratified, and publication bias analyses. A total of 30 articles were included in our meta-analysis, with 303 AVN cases among 1185 patients. The pooled incidence of AVN after PFNF was 22% (95% CI 18%, 27%). Subgroup analyses indicated Delbet type I-IV fracture incidences with AVN of 45%, 32%, 17%, and 12%, respectively. The incidence of AVN after PFNF in Asia was 19%, lower than in Africa at 36%, Europe at 26%, and North America at 23%. In addition, the larger sample size group and the earlier published literature group showed a higher incidence of necrosis. Stratified analyses showed that patient age and Delbet fracture classification were both important factors affecting AVN after PFNF (OR = 1.61, p = 0.02 and OR = 3.02, p < 0.001, respectively), while the time to treatment was not (OR = 0.9, p = 0.71). The pooled incidence of AVN after PFNF was ~ 22%; furthermore, the available evidence demonstrates that patient age and Delbet type of fracture were important influencing factors of AVN after PFNF. | ['Meta-Analysis', 'Systematic Review', 'Journal Article'] | ['Humans', 'Child', 'Incidence', 'Femur Head Necrosis', 'Femoral Neck Fractures', 'Risk Factors', 'Europe'] | 36,624,532 | 0 | The incidence and risk factors for femoral head necrosis after femoral neck fracture in pediatric patients: a systematic review and meta-analysis. The incidence of avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) in the literature varies widely, and the risk factors associated with AVN after PFNF are controversial. Therefore, this study aimed to accurately investigate the incidence of AVN after PFNF and systematically evaluate and meta-classify their risk factors. A comprehensive search was performed of PubMed, Web of Science, and Embase. The pooled rate and 95% confidence interval (CI) were used to assess the incidence of AVN after PFNF, and pooled odds ratio (OR) were calculated to measure the effect sizes. In addition, we performed subgroup, stratified, and publication bias analyses. A total of 30 articles were included in our meta-analysis, with 303 AVN cases among 1185 patients. The pooled incidence of AVN after PFNF was 22% (95% CI 18%, 27%). Subgroup analyses indicated Delbet type I-IV fracture incidences with AVN of 45%, 32%, 17%, and 12%, respectively. The incidence of AVN after PFNF in Asia was 19%, lower than in Africa at 36%, Europe at 26%, and North America at 23%. In addition, the larger sample size group and the earlier published literature group showed a higher incidence of necrosis. Stratified analyses showed that patient age and Delbet fracture classification were both important factors affecting AVN after PFNF (OR = 1.61, p = 0.02 and OR = 3.02, p < 0.001, respectively), while the time to treatment was not (OR = 0.9, p = 0.71). The pooled incidence of AVN after PFNF was ~ 22%; furthermore, the available evidence demonstrates that patient age and Delbet type of fracture were important influencing factors of AVN after PFNF. |
11/07/2023 | Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis. | This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE). A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies. The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE. Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins. The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Humans', 'Acid Etching, Dental', 'Composite Resins', 'Dental Bonding', 'Dental Cements', 'Dentin-Bonding Agents', 'Materials Testing', 'Reproducibility of Results', 'Resin Cements', 'Randomized Controlled Trials as Topic'] | 36,566,829 | 0 | Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis. This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE). A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies. The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE. Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins. The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence. |
28/07/2021 | Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis. | Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries. The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model. The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0-5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7-19.7) and 0.5% (95% CI: 0.2-0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5-4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4-5.1). Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries. | ['Journal Article', 'Meta-Analysis', 'Systematic Review'] | ['Bolivia', 'Central America', 'Chagas Disease', 'Female', 'Humans', 'Latin America', 'Pregnancy', 'Pregnant Women', 'Prevalence', 'Trypanosoma cruzi'] | 32,946,555 | 0 | Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis. Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries. The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model. The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0-5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7-19.7) and 0.5% (95% CI: 0.2-0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5-4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4-5.1). Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries. |
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