Measuring inconsistency in meta-analyses

Association between hedonic hunger and food addiction: A systematic review and meta-analysis

AIMS

In recent years, food addiction has gained significant interest from the scientific community. Hedonic hunger has been identified as a crucial risk factor contributing to food addiction. Therefore, this systematic review and meta-analysis aim to consolidate the current evidence regarding the relationship between hedonic hunger and food addiction among healthy individuals.

DATA SYNTHESIS

A comprehensive search was conducted across three databases - PubMed, Web of Science, and Scopus - up to October 2024. The review included all original observational studies published in English that utilized the Power of Food Scale (PFS) to measure hedonic hunger and the Yale Food Addiction Scale (YFAS) along with its derivatives to evaluate food addiction in healthy participants. The quality of the studies was assessed using the Joanna Briggs Institute checklist. The meta-analysis was performed using StataMP-17 software. Following the screening process, seven cross-sectional studies comprising a total of 2518 participants were included. The findings from the meta-analysis revealed a positive and statistically significant correlation between the score of PFS and the score of YFAS (r = 0.53, 95 % CI: 0.35, 0.71). Furthermore, the meta-regression analysis indicated that the percentage of female participants and sample size did not significantly affect the relationship between hedonic hunger and food addiction.

CONCLUSIONS

Given the established positive association, it may be advantageous to consider the impact of hedonic hunger in strategies aimed at managing food addiction.

Occurrence rate and risk factors for rest and procedural pain in critically ill patients: A systematic review and meta-analysis

OBJECTIVES

To summarize the occurrence rates and identified the risk factors for pain at rest and during procedures in critically ill patients.

METHODS

This study conducted a systematic review and meta-analysis. The Embase, PubMed, CINAHL Plus, Web of Science Core Collection and ProQuest Dissertations & Theses A&I databases were searched from inception to January 10, 2025, for relevant studies. Two independent researchers screened the articles, reviewed them, and extracted data. The data were analyzed using a random-effects model.

RESULTS

This meta-analysis included 23 observational studies with prospective, retrospective, and cross-sectional study designs encompassing 8,073 adult participants. The pooled occurrence rate of pain at rest among critically ill patients was 41 % (95 % confidence interval [CI] = 0.27 to 0.57), whereas that of pain during procedures was 68.4 % (95 % CI = 0.58 to 0.77). Most studies on intensive care unit (ICU)-related pain were conducted in the Asia Pacific region, the Americas, and Western Europe. Age was determined to be negatively associated with pain at rest, whereas opioid use percentage and percentage of male were positively associated with the occurrence of pain during procedures.

CONCLUSIONS

Pain at rest and during procedures is highly prevalent and often undertreated in ICU patients. Health-care providers should develop and implement effective pain management strategies to mitigate both pain at rest and procedural pain in critically ill patients.

IMPLICATIONS FOR CLINICAL PRACTICE

Pain is a frequent and troubling experience for patients in the ICU, so healthcare providers need to assess and address it regularly. This study also pinpointed specific factors linked to pain at rest and during procedures, some of which can be changed or managed. These results offer ICU medical team valuable insights for identifying high-risk patients and delivering personalized interventions to minimize pain.

Azelnidipine and its role in decreasing urinary albumin creatinine ratio in people with type 2 diabetes and hypertension: a systematic review and meta-analysis

Purpose

Type 2 diabetes mellitus and hypertension frequently coexist, increasing the risk of cardiovascular and renal complications. Urinary Albumin Creatinine Ratio (UACR) serves as a crucial predictor of these outcomes. While renin-angiotensin system inhibitors are often initial therapy, evidence suggests a potential role for Azelnidipine, a non-dihydropyridine calcium channel blocker, in reducing UACR, especially in cases of persistent proteinuria despite optimal therapy. However, conflicting results from existing studies necessitate a comprehensive systematic review and meta-analysis to clarify Azelnidipine's (AZL) efficacy in reducing UACR in people with type 2 diabetes mellitus and hypertension.

Methods

This meta-analysis, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included randomized controlled trials (RCTs) published until January 15, 2024. Studies involving individuals with type 2 diabetes mellitus and hypertension were included, comparing AZL or AZL-containing regimens with other antihypertensive agents. The primary outcome was changes in UACR, with secondary outcomes including alterations in Glycated Hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and estimated glomerular filtration rate (eGFR).

Results

Six RCTs involving 731 participants were included. Meta-analysis revealed a significant reduction in UACR in the AZL group compared to controls (Mean Difference (MD) = -47.96; 95% Confidence Interval (CI): -79.56, -16.37; p = 0.003). AZL also significantly decreased HR (MD = -3.70; 95% CI: -6.66, -0.74; p = 0.01), while no significant changes were observed in HbA1c, SBP, DBP, or eGFR. Sensitivity analyses demonstrated the nuanced impacts of individual studies on results, highlighting the importance of careful interpretation.

Conclusion

This meta-analysis confirms AZL's efficacy in reducing UACR and HR in people with type 2 diabetes mellitus and hypertension.

Acute Effects of Dynamic and Ballistic Stretching on Flexibility: A Systematic Review and Meta-analysis

Dynamic stretching (DS) uses a controlled movement through the range of motion (ROM) of the active joint(s) by contracting the agonist muscles without being held in an end position. In contrast, ballistic stretching (BS) typically uses uncontrolled movements of a higher velocity with bouncing actions. However, BS is often considered to be a form of DS. When considered together, DS and BS reportedly increase flexibility, evidenced by single- and multiple-joint ROM improvements and other measurements. However, a meta-analysis with subgroup analyses revealing the acute effects of DS and BS on flexibility in detail, independently of other stretching methods, has yet to be conducted. The purpose of this meta-analysis was to investigate the acute effects of DS and BS on flexibility in healthy participants. The PubMed, Web of Science, and Scopus databases were searched for eligible papers published before September 9, 2024; 17 papers were included in the meta-analysis. The main meta-analysis was performed with a random-effect model, and subgroup analyses were performed to examine the effects of age (young vs. middle-aged and older), sex (male vs. mixed sex), stretching methods (DS vs. BS), stretched muscles (hamstrings vs. plantar flexors vs. multiple muscles), and flexibility outcomes (single-joint ROM vs. straight-leg raise test vs. sit-and-reach test). A small increase in flexibility was found following DS and BS (considered together) (effect size = 0.372, Z = 3.936, 95% confidence interval = 0.187-0.557, p < 0.001, I2 = 27%). Subgroup analyses revealed no significant differences between age (p = 0.24), sex (p = 0.76), stretching method (p = 0.83), stretched muscle (p = 0.20), or flexibility outcome (p = 0.34) groups. Our results suggest that DS and BS effectively provide acute, small-magnitude improvements in flexibility that are not significantly affected by individual characteristics, stretching methods, stretched muscles, or flexibility outcomes.

Intrapleural Fibrinolytics Versus Thoracic Surgery for Complicated Pleural Infections: A Systematic Review and Meta-Analysis

BACKGROUND

Intrapleural fibrinolytic therapy (IPFT) is an option for complicated pleural effusion (CPE). However, concerns remain about its use compared with thoracic surgery (TS). Therefore, we conducted a systematic review and meta-analysis to assess the length of stay associated with IPFT compared to TS in treating CPE.

METHOD

We searched PubMed, Embase, and Cochrane Library databases for studies that compared TS with IPFT in patients with complicated pleural infections. We used a random-effects model with a 95% confidence interval (CI) to pool the data. R version 4.4.1 was used for statistical analysis and heterogeneity was examined using I2 statistics.

RESULTS

A total of 16 studies, including 13 randomised controlled trials, involving a total of 764 were analysed. Of whom, 40% underwent IPFT. The success rate was higher in the TS group (odds ratio 0.3; 95% CI 0.11-0.78; p=0.014; I2=47%), and had a significantly shorter length of stay (mean difference 2.76; 95% CI 1.40-4.13; p<0.001; I2=92%) compared with the IPFT group. There were no statistical differences between groups in the mortality endpoint. Considering only the paediatric population, there were also no statistically significant differences for length of stay (mean difference 1.32; 95% CI -2.37 to 5.01; p=0.08; I2=91%) or success rates (odds ratio 0.86; 95% CI 0.27-2.74; p=0.74; I2=0%).

CONCLUSIONS

Our findings suggest that TS is an effective treatment for pleural infections. There is no significant increase in adverse events, and both treatments are equally effective and safe.

Value of Abbreviated Magnetic Resonance Sequence in Hepatocellular Carcinoma Screening: A Systematic Review and Meta-analysis

RATIONALE AND OBJECTIVES

To systematically review the diagnostic efficacy of abbreviated magnetic resonance imaging sequence (AMRI) screening for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Medline (via PubMed), EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the diagnostic efficacy of AMRI screening for HCC from inception to August 10th, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2), then, the meta-analysis with a bivariate mixed-effects regression model was performed by using Stata 14.0 software.

RESULTS

A total of 19 studies involving 3914 participants were included which published from 2013 to 2024. The results of meta-analysis showed that pooled sensitivity and specificity of AMRI for HCC were 0.85 (95% confidence interval (CI) 0.83 to 0.87) and 0.93 (95%CI 0.91 to 0.94). Subgroup analysis showed that the pooled sensitivity and specificity of NC (Non-Contrast) AMRI and HBP (Hepatobiliary Phase Images) AMRI were 0.84 (95%CI 0.80 to 0.87), 0.92 (95%CI 0.89 to 0.94) and 0.88 (95%CI 0.84 to 0.91), 0.93 (95%CI 0.91 to 0.95), respectively. And the T2 (T2 Weighted Imaging)+DWI (Diffusion Weighted Imaging)+HBP protocol in HBP AMRI had the highest diagnostic efficacy, its pooled sensitivity, specificity and the area under the summary receiver operating characteristic (SROC) curve (AUC) were 0.88 (95%CI 0.83 to 0.92), 0.93 (95%CI 0.91 to 0.95), and 0.96 (95%CI 0.94 to 0.98), respectively.

CONCLUSION

Current evidence suggests that the AMRI protocols demonstrated potential for HCC detection, which employing a limited number of sequences with the aim of achieving a diagnostic performance comparable to conventional complete contrast-enhanced MRI (CE-MRI). Among them, T2+DWI+HBP protocol shows the relatively highest diagnostic efficiency, which is perhaps the most promising application in clinical practice. Nevertheless, the results still should be carefully interpreted in the relevant context of medical history, physical examination, and biochemical indicators.

Urinary pentosidine as a potential biomarker of impaired bone health: a systematic review and meta-analysis

Background

Urinary pentosidine, an advanced glycation end product (AGE), has been proposed as a potential biomarker for impaired bone health, especially in older adults and those with diabetes. This study aimed to systematically review and meta-analyze the association of urinary pentosidine with bone mineral density (BMD) and fracture risk.

Methods

A comprehensive search of Embase, PubMed, Scopus, and Web of Science databases was conducted and records were gathered from 1960 to February 2024. Relevant papers were screened and data were extracted by two independent reviewers. Hedges' g standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated to compare urinary pentosidine levels between patients with and without fractures.

Results

A total of 12 studies comprising 5,878 participants were included in the systematic review. The meta-analysis revealed that patients with fractures had significantly higher urinary pentosidine levels compared to those without fractures (SMD [95% CI] = 0.53 [0.39-0.68]; I² = 54%; P < 0.01). In patients with vertebral fractures, pentosidine levels were also elevated (SMD [95% CI] = 0.51 [0.32-0.70]; I² = 64%; P < 0.01). Additionally, some studies demonstrated that an increase in urinary pentosidine was significantly associated with fracture risk (aHR = 1.20 [95% CI = 1.07-1.33]; P = 0.001) and BMD reduction (β = -0.125 [95% CI = -0.248, -0.002]; P = 0.047). However, other studies showed inconsistent results, particularly regarding the association between pentosidine and BMD or fracture risk in non-diabetic populations (aRR [95%CI] = 1.08 [0.79-1.49]; P = 0.6). Diagnostic accuracy analyses revealed a sensitivity of 71.9% and specificity of 61.2% for urinary pentosidine in predicting vertebral fracture in patients with type 2 diabetes mellitus.

Conclusion

This systematic review and meta-analysis demonstrate that elevated urinary pentosidine levels are associated with an increased risk of fractures and, to a lesser extent, reduced bone mineral density. Its diagnostic accuracy improves when integrated with other clinical markers, such as BMD and bone turnover indices. However, due to the variability in results, further research is needed to standardize pentosidine's use as a reliable biomarker for impaired bone health in clinical practice.

The Efficacy of Dual-layer Stent Compared to Single-layer Stent in Carotid Revascularization: A Systematic Review and Meta-analysis

BACKGROUND

Prior studies have demonstrated the dual-layer stent (DLS) was associated with encouraging results in carotid revascularization. This meta-analysis aimed to study the comparative efficacy between DLS and single-layer stent (SLS).

METHODS

The studies were retrieved from PubMed, Embase, and Scopus up to June 2023. The methodological evaluation was performed using the corresponding scale. Pooled analysis was conducted using R Studio to calculate the effects, including odds ratio (OR) and mean difference (MD). Heterogeneity among results was assessed using the I2 statistic. Sensitivity analysis and subanalysis were also performed.

RESULTS

In this meta-analysis, nine articles comprising 1,127 patients who underwent carotid stenting (606 with DLS) were studied. No significant difference between DLS and SLS was found in stroke (at 30 days DLS: 4/555 vs. SLS: 11/496; OR 0.38, 95% confidence interval [CI] 0.14-1.03; at 12 months DLS: 1/249 vs. SLS: 4/152; OR 0.21, 95% CI 0.03-1.36), death (at 30 days DLS: 3/526 vs. SLS: 0/467; OR 0.80, 95% CI 0.20-3.11; at 12 months DLS: 5/249 vs. SLS: 3/152; OR 1.12, 95% CI 0.25-5.03), stroke/death (at 30 days DLS: 6/526 vs. SLS: 11/467; OR 0.43, 95% CI 0.16-1.17; at 12 months DLS: 6/249 vs. SLS: 7/152; OR 0.52, 95% CI 0.17-1.61), new lesions (DLS: 56/202 vs. SLS: 96/254; OR 0.62, 95% CI 0.28-1.40), lesion count (MD = -0.24, 95% CI -0.82-0.34), lesion diameter (MD = -0.03, 95% CI -1.21-1.15), in-stent restenosis (ISR; DLS: 5/204 vs. SLS: 8/190; OR 0.61, 95% CI 0.21-0.74) and acute thrombosis (DLS: 4/146 vs. SLS: 1/122; OR 2.03, 95% CI 0.31-13.26). Subgroup analysis indicated that CGuard and Casper had shown similar efficacy in preventing stroke, death, and new brain lesions.

CONCLUSION

DLS has shown comparable prognoses to the first-generation stent concerning stroke, stroke/death, new magnetic resonance imaging lesion incidence, lesion count, lesion diameter, ISR and acute thrombosis. Further randomized trials are warranted to demonstrate whether patients with high-risk carotid plaques can benefit significantly from DLS.

Validity of non-traditional measures of obesity compared to total body fat across the life course: A systematic review and meta-analysis

IntroductionTraditional obesity measures including body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio have limitations. The primary objective of this study was to identify and review the validity of non-traditional obesity measures, using measures of total body fat as the reference standard, that have been used across multiple life stages. MethodsWe conducted a systematic review and searched MEDLINE, Embase, and PsycINFO. We included observational studies published from 2013 to October 2023 among "the general population" for any life stage that reported the validity of non-traditional obesity measures compared to total body fat reference standards. Separate meta-analyses were performed to pool correlation coefficients and mean differences for non-traditional obesity measures that were evaluated at multiple life stages. ResultsA total of 123 studies were included, and 55 validated non-traditional obesity measures were identified. Of these, 13 were evaluated at multiple life stages. Two-dimensional (2D) digital imaging technologies, three-dimensional (3D) body scanners, relative fat mass (RFM), and mid-upper arm circumference had high or moderate validity (pooled correlation coefficient >0.70). Pooled mean differences were small (<6%) between total body fat percentage from reference standards and from RFM, 2D digital imaging technologies, 3D body scanners, and the body adiposity index. Heterogeneity (I2) was >75% in most meta-analyses. ConclusionNumerous validated non-traditional obesity measures were identified; relatively few were evaluated at multiple life stages and did not consider health risks associated with adiposity. More research is needed to define valid obesity measures across all life stages that assess health and adiposity.

The efficacy of virtual-reality teaching and learning method in enhancing interprofessional knowledge, clinical skill performance, and self-confidence in nursing education: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the efficacy of virtual reality in enhancing nursing students' knowledge, clinical skill performance, and self-confidence.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

Six databases-CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, and Web of Science-were comprehensively searched for randomized controlled trials, published from database inception to May 3, 2024, which investigated virtual reality in nursing education.

REVIEW METHODS

Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to examine five domains of potential bias in the trials. Random effects models were applied in the meta-analysis and assessment of heterogeneity.

RESULTS

Nine studies with a total of 660 nursing students were included in the final analysis. Virtual-reality teaching and learning appeared to improve students' knowledge (pooled standardized mean difference [SMD] = 0.24; 95 % confidence interval [CI] = 0.01-0.46; p = 0.04) and self-confidence (pooled SMD = 0.40; 95 % CI = 0.16-0.64; p < 0.001). Egger's regression test of each pooled result indicated that publication bias had only a minor influence on the pooled analysis.

CONCLUSION

Virtual-reality learning was effective in increasing nursing students' knowledge and self-confidence in nursing learning. The incorporation of virtual reality into the teaching and learning process in nursing education is a promising strategy to enhance nursing students' competencies. Future research is necessary to improve virtual reality-based learning methods, as well as to determine their long-term implications for nursing education.

Prevalence and risk factors for lymph node metastasis in duodenal neuroendocrine tumors: a systematic review and meta-analysis

BACKGROUND

Although the status of lymph node metastasis (LNM) is crucial in determining treatment strategy for duodenal neuroendocrine tumors (D-NETs), robust evidence for their potential LNM risk remains lacking. This systematic review aimed to summarize the prevalence and risk factors of LNM in D-NETs.

METHODS

This systematic review of electronic databases identified eligible case-control and cohort studies for D-NET resected either endoscopically or surgically, published from 1990 to 2023. The primary outcome was the pooled prevalence of LNM in D-NETs. Secondary outcomes included the pooled prevalence of LNM according to tumor location and functionality, as well as identifying pathological risk factors for LNM. Meta-analysis was performed.

RESULTS

We identified 36 studies that involved 1,396 patients with D-NETs, including 326 with LNM. The pooled prevalence of LNM in D-NETs was 22.7% (95% confidence interval [CI] 17.3-29.2%). The prevalence was high in ampullary/peri-ampullary D-NETs and functional D-NETs (46.8 and 53.3%, respectively), whereas it was low in non-functional, non-ampullary D-NETs (NAD-NETs) (9.5%). Pathological risk factors for LNM in NAD-NETs included tumor size > 10 mm (odds ratio [OR] 7.31 [95% CI 3.28-16.31]), tumor invasion into the muscularis propria or deeper (OR 7.79 [3.65-16.61]), lymphovascular invasion (OR 5.67 [2.29-14.06]), and World Health Organization grading of G2 (OR 2.47 [1.03-5.92]).

CONCLUSION

Approximately one-fourth of the patients with D-NETs had LNM. Endoscopic resection might be acceptable for non-functional NAD-NETs with diameters of 10 mm or less, but additional surgical resection with lymphadenectomy may be recommended for cases exhibiting pathological risk factors.

Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies

BACKGROUND

Three primary strategies for MRI-targeted biopsies (TB) are available: Cognitive TB (COG-TB), MRI-US Fusion TB (FUS-TB), and In Bore TB (IB-TB). Despite nearly a decade of practice, a consensus on the preferred approach is lacking, with previous studies showing comparable PCa detection rates among the three methods.

METHODS

We conducted a search of PubMed, EMBASE, PubMed, Web of Science, and Scopus databases from 2014 to 2023, to identify studies comparing at least two of the three methods and reporting clinically significant PCa (csPCa) detection rates. The primary and secondary outcomes were to compare the csPCa and insignificant prostate cancer (iPCa, ISUP GG 1) detection rates between TB techniques. The tertiary outcome was to compare the complication rate between TB techniques. Detection rates were pooled using random-effect models. Planned sensitivity analyses included subgroup analysis according to the definition of csPCa and positive MRI, previous biopsy status, biopsy route, prostate volume, and lesion characteristics.

RESULTS

A total of twenty studies, involving 4928 patients, were included in the quantitative synthesis. The meta-analysis unveiled comparable csPCa detection rates among COG-TB (0.37), FUS-TB (0.39), and IB-TB (0.47). iPCa detection rate was also similar between TB techniques (COG-TB: 0.12, FUS-TB: 0.17, IB-TB: 0.18). All preplanned sensitivity analyses were conducted and did not show any statistically significant difference in the detection of csPCa between TB methods. Complication rates, however, were infrequently reported, and when available, no statistically significant differences were observed among the techniques.

CONCLUSIONS

This unique study, exclusively focusing on comparative research, indicates no significant differences in csPCa and iPCa detection rates between COG-TB, FUS-TB, and IB-TB. Decisions between these techniques may extend beyond diagnostic accuracy, considering factors such as resource availability and operator preferences. Well-designed prospective studies are warranted to refine our understanding of the optimal approach for TB in diverse clinical scenarios.

Timing is everything: the age-related impact of plyometric training on lower limb explosive strength in male adolescents and its general effectiveness in female adolescents

OBJECTIVE

This study investigates the impact of plyometric training on age-related lower limb explosive strength in male adolescents and its effectiveness in female adolescents.

METHODS

A thorough search was conducted across five databases from their inception until September 20, 2024. Study quality was assessed using the Cochrane Risk Assessment Tool, and data analysis was performed with Stata 15 software.

RESULTS

Plyometric training positively affected countermovement jump (CMJ) (MD = 2.90 cm, 95% CI (2.35, 3.45)), squat jump (SJ) (MD = 2.57 cm, 95% CI (1.69, 3.44)), and 20-m sprint performance (MD = - 0.09 s, 95% CI (- 0.14, - 0.05)). Subgroup analysis revealed varying improvements across age stages. In CMJ, the early adolescence (EA) group (MD = 2.57 cm, 95% CI (1.74, 3.40)), mid-adolescence (MA) group (MD = 3.04 cm, 95% CI (2.30, 3.79)), and post-adolescence (PA) group (MD = 3.89 cm, 95% CI (1.96, 5.81)) showed progressive enhancement. The MA group exhibited superior improvements in SJ (MD = 3.78 cm, 95% CI (2.19, 5.36)) and 20-m sprint (MD = - 0.11 s, 95% CI (- 0.18, - 0.05)) compared to the EA group (SJ: MD = 2.10 cm, 95% CI (1.43, 2.77); sprint: MD = - 0.06 s, 95% CI (- 0.11, - 0.01)). The PA group showed no significant improvements (SJ: MD = 1.31 cm, 95% CI (- 1.05, 3.67); sprint: MD = - 0.27 s, 95% CI (- 0.61, 0.07)). For female adolescents, plyometric training effectively improved CMJ (MD = 2.55 cm, 95% CI (1.43, 3.66)), SJ (MD = 2.33 cm, 95% CI (1.36, 3.31)), and 20-m sprint performance (MD = - 0.22 s, 95% CI (- 0.33, - 0.12)).

CONCLUSION

Plyometric training significantly enhances lower limb explosive strength in both male and female adolescents, with age-dependent effects for male adolescents. The greatest improvement in CMJ was observed in the PA stage, followed by the MA stage, while the EA stage showed the least. The MA stage exhibited the best improvements in SJ and sprint performance.

TRAIL REGISTRY

The study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023406914).

Estimating the incidence of transfusion-associated circulatory overload using active surveillance: A systematic review and meta-analysis

BACKGROUND

Transfusion-associated circulatory overload (TACO) is an adverse event that is the leading cause of transfusion-related death. It is underrecognized, and the aim of this study was to synthesize the available evidence from active surveillance studies to estimate its incidence.

STUDY DESIGN AND METHODS

This study is a systematic review and meta-analysis of publications reporting TACO incidence using active surveillance. A research librarian searched Medline and Embase, identifying publications between January 1991 and June 2024. Studies reporting TACO either by patient, blood component (red blood cells [RBCs], platelets, or plasma) or transfusion episode were identified, and all patient settings were eligible. A random effects model estimated TACO incidence, and potential sources of heterogeneity were evaluated using meta-regression.

RESULTS

Twenty-two studies met eligibility criteria and were included for analysis. The rate per patient was 22.2/1000 (95% CI: 16.2-29.2) based on 21 studies. The rate estimate of TACO among total blood components (RBCs, plasma, and platelets combined) reported in 10 studies was 2.2/1000 units transfused (95% CI: 1.2-3.5/1000). There was substantial between-study variation in rates and more recent studies tended to report higher rates. Although the platelet point estimate was higher than the point estimates for RBCs and plasma, the confidence intervals overlapped. Only two studies reported TACO rates per transfusion episode and the pooled estimate was 6.3/1000 (95% CI: 1-16.3/1000), about three times greater than the overall per unit estimate.

DISCUSSION

Clinicians should consider quantitative risks of important transfusion-related harms, such as TACO, when making the decision to transfuse.

Effects of black seed (Nigella sativa L.) on cardiometabolic indices in type 2 diabetic patients: A systematic review and meta-analysis of RCTs

BACKGROUND

Black seed is known for its health benefits in traditional medicine. While recent studies suggest it may improve cardiometabolic health, its impact on type 2 diabetes mellitus (T2DM) remains unclear. This study aims to meta-analysis randomized controlled trials (RCTs) to assess the effects of black seed supplementation on cardiometabolic indices in T2DM patients.

METHODS

Following PRISMA guidelines, a comprehensive database search was conducted up to January 2025, and data were extracted from relevant RCTs. Mean differences (MD) and standard deviations (SD) were analyzed using a random-effects model, heterogeneity was assessed, and publication bias was evaluated.

RESULTS

The pooled meta-analysis of 16 RCTs showed that black seed supplementation significantly reduced fasting blood glucose (FBG) (MD: -21.43 mg/dL; p = 0.005), hemoglobin A1c (HbA1c) (MD: -0.44; p = 0.01), total cholesterol (TC) (MD: -18.80 mg/dL; p = 0.04) and low-density lipoprotein (LDL) (MD: -19.53 mg/dL; p = 0.003). No significant effects were observed for 2-hour postprandial glucose (2-hpp), fasting insulin, homeostatic model assessment (HOMA), triglycerides (TG), high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and body weight, or body mass index (BMI). Subgroup analyses revealed that black seed supplementation effectively reduced FBG for longer than 8 weeks; additionally, HbA1c, HOMA, and LDL in higher doses (>1 g/day), shorter durations (≤8 weeks), and use of the oil form.

CONCLUSION

Black seed supplementation appears to significantly improve FBG, HbA1c, TC, and LDL levels in patients with T2DM. However, no significant effects were observed on other metabolic parameters, including insulin, TG, liver enzymes, kidney function, or body weight. These findings suggest that black seed may be a beneficial adjunct therapy for glycemic and lipid control in T2DM patients but require further research to confirm its broader metabolic effects.

Risk of cardiovascular disease following degarelix versus gonadotropin-releasing hormone agonists in patients with prostate cancer: a systematic review and meta-analysis

BACKGROUND

Prostate cancer treatment involves hormonal therapies that may carry cardiovascular risks, particularly for long-term use. Gonadotropin-releasing hormone (GnRH) antagonists, such as degarelix, may offer advantages over agonists, but comprehensive comparative cardiovascular outcomes are not well established. This study aimed to systematically review and analyze the cardiovascular safety profiles of degarelix compared to those of traditional GnRH agonists, providing critical insights for optimizing treatment strategies.

METHODS

We used Medline (PubMed), Scopus, Embase, Cochrane, and Web of Science databases to identify included studies using a preferred search strategy. All studies assessed the cardiovascular events profile between degarelix versus GnRH agonists were included in our study. We used the review manager version 5.4 to perform the analysis.

RESULTS

13 studies (160,214 participants) were included in this meta-analysis. Degarelix was associated with a significantly lower incidence of major adverse cardiovascular events [RR: 0.60, 95%CI (0.41, 0.88), P value = .008]. Incidence of stroke [RR: 0.92, 95%CI (0.56, 1.50), P value= .74], hypertension [RR: 0.85, 95%CI (0.37, 1.93), P value= .69], myocardial infarction [RR: 0.82, 95%CI (0.55, 1.21), P value= .31], heart failure [RR: 0.88, 95%CI (0.63, 1.23), P value= .46] and arrhythmia [RR: 0.61, 95%CI (0.24, 1.54), P value= .30] did not reach a statistically significant difference between groups.

CONCLUSION

Degarelix demonstrates a lower incidence of major adverse cardiovascular events compared to GnRH agonists, suggesting a potential cardiovascular safety advantage in prostate cancer treatment. Further studies are required to prove the results of our systematic review and meta-analysis.

Gender differences in the associations of adverse childhood experiences with depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Gender differences in the associations of adverse childhood experiences (ACEs) with depression and anxiety, remain underexplored. We aimed to quantify and directly compare gender-specific associations between ACEs and depression and anxiety.

METHODS

We systematically searched PubMed, Medline, and Embase for observational studies. Eligible articles should have reported effect sizes for depression or anxiety associated with varying number or specific types of ACEs. Using a random-effects model, we calculated the gender-specific pooled odds ratios (ORs) and derived the pooled women-to-men ratio of ORs (RORs) for the associations of ACEs with depression or anxiety, with corresponding 95 % confidence intervals (CIs).

RESULTS

In total, 42 articles met inclusion criteria. Regarding anxiety, gender differences were most pronounced for individuals exposed to 2 ACEs (compared to none), with women showing significantly higher odds of anxiety than men (ROR = 2.04, 95 % CI = 1.15-3.62), In addition, women exposed to emotional abuse (ROR = 0.66, 95 % CI = 0.52-0.83), sexual abuse (ROR = 0.58, 95 % CI = 0.37-0.91), and having a family member incarcerated (ROR = 0.83, 95 % CI = 0.71-0.98) showed lower odds of anxiety than men. For depression, women exposed to bullying showed lower odds of depression compared to men (ROR = 0.86, 95 % CI = 0.83-0.88).

CONCLUSIONS

Gender differences in the associations between ACEs and mental health outcomes vary by type and cumulative exposure to ACEs. This finding highlights the importance of incorporating gender-specific perspectives in research and interventions addressing the long-term mental health effects of ACEs.

Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies

Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE. PROTOCOL REGISTRATION: PROSPERO CRD42024602342.

Risk factors for infection in patients undergoing hip replacement: a systematic review and meta-analysis

A meta-analysis was conducted to determine the risk of infection following hip replacement and risk factors were identified for surgical site infection. PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as well as the reference lists of previous systematic reviews and meta-analyses. The pooled odds ratio (OR) was estimated using a random effects model for each investigated factor. The evidence of observational studies was classified as high quality (class I), moderate quality (class II or III) or low quality (class IV) based on the GRADE system. A total of 25,383 potential articles met the inclusion criteria in the database search. After reviewing the titles, abstracts, and full texts, 27 articles were included in the final analysis, encompassing 699,473 patients who underwent hip arthroplasty. High-quality evidence shows that BMI (≥30 kg/m2) (OR 2.16; 95% CI 1.72-2.70), male sex (OR 1.39; 95% CI 1.26-1.53), operation time (≥120 min) (OR 1.72; 95% CI 1.39-2.14), American Society of Anesthesiologists (ASA) class ≥3 (OR 2.05; 95% CI 1.49-2.83), diabetes (OR 1.33; 95% CI 1.23-1.43), and heart disease (OR 1.99; 95% CI 1.48-2.68) are associated with a greater risk of infection. The meta-analysis revealed that age and renal disease were not associated with infection. In conclusion, this meta-analysis identified significant risk factors for infection after hip-replacement surgery, including BMI, male sex, operation time, heart disease, diabetes, and ASA class.

Terlipressin for the treatment of hepatorenal syndrome: a meta-analysis of randomized controlled trials

OBJECTIVE

This study aimed to evaluate the efficacy and safety of terlipressin and albumin in patients with hepatorenal syndrome.

METHODS

A systematic review with meta-analysis of randomized controlled trials comparing terlipressin and albumin versus albumin with or without placebo in patients with cirrhosis and hepatorenal syndrome was performed. The study protocol was registered at the PROSPERO platform (CRD42021246684).

RESULTS

Nine randomized controlled trials fulfilled the selection criteria and were included in this meta-analysis. There was no evidence of a significant difference between the groups regarding mortality in 15 days [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.47-1.13, P  = 0.16, I2  = 52%] or in 90 days (RR = 0.94, 95% CI = 0.80-1.09, P  = 0.84, I2  = 29%). Regarding hepatorenal syndrome reversal failure, a significant benefit was demonstrated in the terlipressin and albumin group (RR = 0.64, 95% CI = 0.53-0.78, P  < 0.00001, I2  = 72%). There was no evidence of a significant difference between the groups regarding adverse events (RR = 3.5, 95% CI = 0.94-13.09, P  = 0.06, I2  = 89%).

CONCLUSION

Terlipressin associated with albumin led to a significantly lower rate of hepatorenal syndrome reversal failure, but there was no evidence of a significant effect of this treatment regarding mortality or adverse events.

Clinical outcomes of roux-en-Y gastric bypass versus medical therapy in type 2 diabetes mellitus: a systematic review and meta-analysis

Background

The growing incidence of obesity has led to a proportionate rise in type 2 diabetes mellitus (T2DM) and its associated complications. We aimed to compare the long-term outcomes of Roux-en-y Gastric Bypass surgery (RYGB) and conventional medical management in T2DM obese patients.

Methods

PubMed, Google Scholar, and Clinicaltrial.gov were searched from inception to September 2023. Randomized Controlled Trials (RCTs) and cohort studies were included in this meta-analysis. The primary outcomes were the T2DM remission at 1, 2, 3, and 5 years and the accomplishment of the ADA composite triple treatment goal. The revised Cochrane risk of bias tool 2.0 and New-Castle Ottawa scale were used to assess the quality of the studies. This meta-analysis was registered prospectively on PROSPERO CRD42023466324.

Results

Of the 3,323 studies yielded from our initial search, 22 were included in this evidence analysis, with 5,176 total patients (1,984 and 3,192 patients in RYGB and conventional medical management groups). A significant increase in the accomplishment in the ADA's composite triple treatment goal was observed in RYGB group as compared to the conventional medical management group (RR 2.41, 95% CI 1.39-4.15, p-value 0.002, I2 35%). Diabetes remission was a clinically successful outcome after 1, 2, 3, and 5 years of the RYGB surgery in the patients (1 year; RR 4.74, 95%CI 2.46-9.12, p-value < 0.00001, I2 0%, 2 years; RR 8.95, 95% CI 1.71-46.71, p-value 0.009, I2 92%3 years; RR 18.18 95%CI 7.57-43.62, p-value < 0.00001, I2 0%, 5 years; RR 0.22, 95% CI 2.31-16.75, p-value 0.0003, I2 = 71%).

Conclusion

The pooled analysis of the given data concluded that the RYGB surgery was more effective in treating T2DM in patients than conventional medical management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01526-z.

Effect of laxative use and laxative type on colorectal cancer risk: A pooling up analysis and evidence synthesis

Colorectal cancer (CRC) is the third most common cancer worldwide and there is a controversy regarding the influence of laxative use on the incidence of CRC. Therefore, the present study aimed to investigate the effects of laxative use and different subtypes of laxatives on the incidence of CRC. To this aim, a comprehensive search of three databases (PubMed, Embase and the Cochrane Library) was conducted on April 12, 2022, using key words that included 'laxative' and 'CRC', which initially retrieved 305 records. Ultimately, 12 studies involving 415,313 patients met all eligibility criteria and were included in a meta-analysis. Subsequently, patients were categorized into the laxative use and non-laxative use groups. Stata 16.0 software was used for all data analyses. The results indicated that laxative use was not significantly associated with CRC risk [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.75-1.20; P=0.65; I2=94.63%]. In the subgroup analyses, the effects of different laxative types were further examined. Notably, all types of laxatives except for fiber laxatives showed no significant influence on CRC risk (P>0.1). By contrast, fiber laxatives were associated with a reduced risk of CRC (OR, 0.74; 95% CI, 0.59-0.93; P=0.01; I2=32.15%), suggesting a potential protective effect of this medication. In conclusion, the findings of the present study suggest that the use of laxatives does not increase the risk of CRC. Moreover, the use of fiber laxatives may have a protective effect by reducing CRC incidence.

A meta-analysis to study the effects and relationships of various selenium sources and forms on production performance, antioxidant status and egg quality of laying hens

BACKGROUND

Nowadays, there is increasing interest in optimizing the beneficial effects on egg quality and production by investigating various levels and sources of Se.

METHODS

Data of various forms, sources and levels of Se were analyzed using a meta-analysis approach in terms of their effects on production, antioxidant activity and egg Se deposition of laying hens by using 81 peer-reviewed publications.

RESULTS

Overall, laying hens' performance and egg quality attributes were not affected by Se supplementation, except for minor changes in egg weight and eggshell thickness in response to higher Se levels in diets. Noticeable effects were found on antioxidant activities where organic Se outperformed the inorganic form. Strong linear relationships between Se levels in the diet and Se content of whole egg, egg yolk and egg albumen were found where Se in the form of selenomethionine (SM) exhibited a stronger relationship with Se content in whole egg (R2 = 0.954), egg yolk (R2 = 0.972) and egg albumen (R2 = 0.926) than other forms of organic Se and inorganic Se (sodium selenite). Also observed was a Se preferential deposition in egg yolk compared with egg albumen especially for SM, indicating a higher bioavailability and deposition rate of SM than other Se sources.

CONCLUSION

Various forms of Se could be safely supplemented to diets at high doses of up to 5 mg kg-1 without adversely affecting hens' performance while enhancing antioxidant status. Supplementation with SM could be the most effective strategy to improve egg Se status among other forms of Se which may be beneficial for consumers. © 2025 Society of Chemical Industry.

Association of iron deficiency and anemia with obesity among children: A systematic review and meta-analysis

INTRODUCTION

Obesity is a potential risk factor for anemia in children. This systematic review (SR) was undertaken to estimate the association of obesity with iron deficiency (ID) and ID anemia (IDA), in children.

METHODS

A systematic literature search for observational studies was done in PubMed, EMBASE, Scopus, and the Cochrane library, with additional hand-searching. Two reviewers independently screened the search output, included eligible studies, extracted data, and assessed study quality using the National Institutes of Health tool. The main outcomes were association of obesity with anemia (IDA), and ID. Secondary outcomes were hemoglobin level, serum iron, ferritin, transferrin receptor saturation, and hepcidin. Meta-analysis was done using a random-effects model. Comparisons were expressed through pooled OR with 95% CI.

RESULTS

Forty-two studies comprising one cohort, 29 cross-sectional, and 12 case-control studies comparing 16,633 children living with obesity and 32,573 children without obesity were included. The pooled OR (95% CI) for ID was 1.64 (1.22, 2.21), 16 studies, 20,949 children; and 0.78 (0.43, 1.43), 17 studies, 40,022 children, for IDA. The pooled prevalence of ID was 20.07% (14.98, 25.16) among children living with obesity (16 studies, 3147 children), compared to 16.1% (11.82, 20.38) in children without obesity. Children living with obesity had significantly lower levels of hemoglobin, iron, % transferrin saturation, and higher levels of ferritin and hepcidin than children without obesity.

CONCLUSION

There is a significant association between iron deficiency and obesity in children.

The Association Between Parent-to-Child Fear Learning Pathways and Anxiety Sensitivity: A Systematic Review and Meta-analysis

Although anxiety sensitivity (AS), or the fear of anxiety-related symptoms, has been identified as a risk factor for the development of anxiety psychopathology, the pathways through which this fear is learned have not been fully elucidated. In the current review and meta-analysis, we aimed to systematically examine the association between parent-to-child fear learning pathways (vicarious learning, negative information, reinforcement, and punishment) and AS. A comprehensive search of literature was conducted in PsychINFO, PubMed, Embase, and Web of Science databases, using search terms combining categories related to fear learning pathways, anxiety-related symptoms, parents, children, and adolescents. Based on this search strategy, 28 studies were identified as relevant, of which 11 were included in the systematic review and 10 in the meta-analysis. The overall findings indicated that parent-to-child fear learning pathways are significantly associated with AS. The meta-analysis demonstrated a small but significant association between fear learning pathways and AS, although the type of fear learning pathway did not significantly moderate this relationship. However, age emerged as a significant moderator, suggesting a stronger association in children and adolescents compared to adults. Given that these findings are primarily based on cross-sectional studies, this review underscores the need for longitudinal and experimental research to further clarify the role of parent-to-child fear learning pathways in anxiety sensitivity. Additionally, a better understanding of these pathways may help inform existing interventions and fear prevention strategies, such as those aimed at reducing parental modeling of fearful behaviors or promoting positive verbal messages about anxiety symptoms.

Deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma: A systematic review and patient-level meta-analysis

There has been much controversy regarding the order in which cytoreductive nephrectomy (CN) and systemic therapy (ST) are applied for patients with metastatic renal cell carcinoma (mRCC). We aimed to investigate the role of deferred CN (dCN) in mRCC, particularly in the current era of immunotherapy. A systematic literature search was conducted on PubMed, Embase, and Scopus for studies comparing dCN versus any non-dCN strategy, in any temporal sequence, with the provision of Kaplan-Meier curves for overall survival (OS). A graphical reconstructive algorithm was used to obtain OS of individual patients, which was then pooled under random-effects individual patient data (IPD) meta-analysis using Cox-models to determine hazard ratios (HRs) and 95% CI. Altogether, 12 studies (5,350 patients) were analyzed. dCN (ST followed by CN) was associated with significantly improved OS over nondeferred CN (CN followed by ST, ST alone, or CN alone) (HR = 0.60, 95% CI, 0.53-0.67, P < 0.001). Subgroup comparisons restricted to studies comparing dCN versus upfront CN (uCN, CN then ST) were also in favor of dCN (HR = 0.69, 95% CI, 0.61-0.78, P < 0.001), even among those in which immunotherapy as ST was used in all patients (HR = 0.57, 95% CI, 0.39-0.84, P = 0.005). In mRCC patients suitable for CN, dCN is associated with significantly improved OS over nondeferred CN strategies, including uCN. Although limited by inclusion of nonrandomized studies and immortal time bias, this meta-analysis strengthens existing guidelines to offer dCN to surgically fit patients who do not progress on ST in the current age of immunotherapy.

Endoscopic band ligation versus argon plasma coagulation in the treatment of gastric antral vascular ectasia: systematic review and meta-analysis

BACKGROUND AND AIMS

Argon plasma coagulation (APC) is the established endoscopic treatment for gastric antral vascular ectasia (GAVE). Recently, the use of endoscopic band ligation (EBL) has gained recognition as an alternate approach. The objective of our study was to compare the efficacy and safety of APC versus EBL in the treatment of GAVE.

METHODS

Multiple databases were searched for articles on APC versus EBL for GAVE treatment. Preferred outcomes were subjected to systematic review and meta-analysis.

RESULTS

We analyzed 10 studies involving 476 subjects (47.47% men and mean age of 56.25 years). The number of sessions required for the obliteration of lesions was higher with APC. The pooled eradication rate of GAVE with EBL was 88.6% (95% CI, 79.9-81.5; I2 = 13.5%) and with APC was 57.9% (95% CI, 43.7-71; I2 = 59%; relative risk [RR], 1.52; 95% CI, 1.16-2.02; I2 = 72%; P < .001). EBL had a lower bleeding recurrence (6.6%; 95% CI, 3.4-12.5; I2 = 0%) compared with APC (39.7%, 95% CI, 26.9-54.15; I2 = 55%; RR, 0.21; 95% CI, 0.09-0.44; I2 = 0%; P < .001). GAVE recurrence with EBL was 7.3% (95% CI, 3.8-13.6; I2 = 0%) and with APC was 38.5% (95% CI, 24.4-54.9; I2 = 64%; RR, 0.22; 95% CI, 0.109-0.446; I2 = 0%; P < .01). Transfusion requirements and hospitalizations were lower with EBL compared with APC. Adverse events associated with EBL were 16.8% (95% CI, 6.6-36.7; I2 = 83%) compared with APC at 9.3% (95% CI, 5.6-15.1; I2 = 19%; RR, 2.11; 95% CI, 0.8-5.46; I2 = 58%; P = .1).

CONCLUSIONS

EBL demonstrated better eradication with fewer treatment sessions, recurrent bleeding, hospitalizations, and transfusion requirements as compared with APC. It is time that EBL be used as the first-line endoscopic treatment for GAVE.

Outcomes of transcatheter vs surgical aortic valve replacement in pre-existing chronic liver disease patients: A meta-analysis of observational studies

Aortic valve stenosis in patients with chronic liver diseases, particularly liver cirrhosis and End-Stage Liver Disease, poses significant management challenges due to the interplay between cardiovascular and hepatic dysfunction. This systematic review and meta-analysis compared the safety and efficacy of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this high-risk population. An extensive search of PubMed, Embase, and Web of Science (inception to January 5, 2025) identified 11 retrospective studies comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals, were calculated using random-effects models. The analysis revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 % CI: 0.30-0.42; I2 = 7.6 %), acute kidney injury (RR 0.51, 95 % CI: 0.33-0.78; I2 = 57.2 %), bleeding (RR 0.33, 95 % CI: 0.28-0.39; I2 = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23-0.51; I2 = 6.1 %), and blood transfusion (RR 0.48, 95 % CI: 0.40-0.57; I2 = 7.6 %). TAVR was also associated with shorter hospital stays (MD -6.77 days, 95 % CI: -9.17 to -4.38; I2 = 97.5 %). No significant differences were observed in vascular complications requiring surgery or hospital charges and post-operative infections. These findings suggest TAVR offers significant advantages over SAVR in reducing complications such as mortality, acute kidney injury, and bleeding in patients with liver disease. However, further randomized trials are necessary to confirm long-term outcomes and establish optimal treatment strategies for this high-risk population.

Chronic musculoskeletal pain and its relationship with cognitive function in older adults: A systematic review and meta-analysis

BACKGROUND

The relationship between chronic musculoskeletal pain and cognitive function in older adults remains unclear. This study aimed to investigate whether the cognitive function of older adults with chronic musculoskeletal pain differs from asymptomatic older adults.

METHODS

Four databases (PubMed, Science Direct, Web of Science, and Scopus) were searched. Two researchers independently reviewed the references against the eligibility criteria and performed the quality assessment of included studies using The National Institutes of Health (NIH) - Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

A total of 8484 references were found and ten articles, published between 2006 and 2021, were included. Only one study was classified as being of good quality, the remaining were of fair quality. Independent meta-analysis were performed for global cognition and specific cognitive domains (language, attention/orientation, executive function, memory, processing speed, and visuospatial skills). Differences between older adults with and without chronic musculoskeletal pain were found for the domains of general cognition (k = 10; d = -0.20; 95% CI = -0.38, -0.03; z = -2.25, p = 0.03) and language (k = 8; d =  -0.16; 95% CI = -0.28, -0.05; z = -2.72, p = 0.006), with very low certainty of evidence.

CONCLUSION

Overall, and considering the very low certainty of evidence for both global cognition and specific cognitive domains, we are uncertain about whether cognitive function differs between older adults with and without chronic musculoskeletal pain. Further research is needed comparing cognitive performance between older adults with and without chronic musculoskeletal pain, on the long-term impact of pain on cognitive functioning, and on the mechanisms underlying this potential relationship.

Lower limb lymphoedema-related mental depression: A systematic review and meta-analysis of non-cancer-related studies

Background

Lower limb lymphoedema, characterized by persistent swelling in the legs due to lymphatic dysfunction, not only imposes a physical burden but is also associated with significant mental depression. While emerging research suggests a strong link between lower limb lymphoedema and depression, the extent of the problem remains underexplored. This study aims to investigate the relationship between lower limb lymphoedema and mental depression through a meta-analysis of existing studies.

Methods

A comprehensive search was conducted across databases including PubMed, MEDLINE, EMBASE, International Scientific Indexing, Web of Science, and Google Scholar. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A weighted inverse variance random-effects model was used for pooled estimates, along with subgroup analysis, heterogeneity assessment, publication bias testing, and sensitivity analysis. The prediction interval was computed to estimate where future observations may fall. The review protocol was registered in PROSPERO (CRD42024541596).

Results

Thirteen studies involving 3503 patients with lower limb lymphoedema due to lymphatic filariasis, podoconiosis, or leprosy were included. The pooled estimate of depression related to lower limb lymphoedema was 38.4 % (95 % CI: 26.3 %, 50.5 %). High heterogeneity (I2 = 81.48 %) highlighted significant variability among the studies. Depression was more prevalent among leprosy patients (38.1 %) and podoconiosis patients (36.4 %), showing little difference between the two. However, the prevalence was notably lower among those with lymphatic filariasis (22.4 %). A higher prevalence of depression was found in Africa (39.4 %) compared to other regions (36.1 %).

Conclusion

Patients with lower limb lymphoedema experience disproportionately high rates of mental depression compared to the general population. Integrating mental health assessment and treatment into care packages for lymphoedema management is essential, with special attention needed for leprosy patients.

Limited Evidence to Fully Determine the Implementation of Evidence-Based Practice by Healthcare Providers in Africa: A Systematic Review and Meta-Analysis

AIM

Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.

METHODS

We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.

RESULTS

Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83-2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76-2.15), and having EBM training (OR = 3.08, 95% CI: 2.08-4.57), and a managerial role (OR = 2.16, 95% CI: 1.37-3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5-2.37) and internet access (OR = 1.90, 95% CI: 1.54-2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.

CONCLUSION

This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers' scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.

Arthroscopic Procedure for Femoroacetabular Impingement Syndrome in Adolescents: A Systematic Review and Meta-analysis

Femoroacetabular impingement (FAI) is caused by aberrant anatomy involving the proximal femur with or without the acetabulum resulting in mechanical impingement. FAI's effects can be devastating in the young. In recent studies, significant associations have been found between skeletal immaturity, FAI, and sports involvement. Hip arthroscopy for FAI has been demonstrated to produce good results. We opted to update the review and meta-analysis to further narrow the research gap in the literature by including recently published studies and a comprehensive review of the arthroscopic approach for FAI. Prior to January 1, 2024, PubMed, Embase, and Google Scholar databases were searched for the studies with data on surgical procedures and patient-related outcomes for arthroscopic FAI. RevMan 5.2 was utilized to calculate the pooled mean differences with a 95% confidence interval to compare reported postoperative and preoperative patients' outcomes. In total, 24 studies of adolescent subjects with a mean age of less than 20 years, including 1,619 patients and 1,767 hips, were included. Eleven studies included acetabuloplasty and femoroplasty as major treatments. When preoperative and postoperative outcomes were compared, statistically significant changes were seen in the mHHS (modified Harris hip score), HOS-ADL (Hip Outcome Score-Activities of Daily Living), HOS-SSS (Hip Outcome Score-Sports-Specific Subscale), i-HOT (International Hip Outcome Tool 12 questions), NAHS (Nonarthritic Hip Score), and the visual analog scale. Numbness, neuropraxia and infections were seen in only 12 patients. This meta-analysis demonstrated overall improvements in hip pain, quality of life, and hip function along with few complications.

The metabolic effects of intermittent fasting in patients with type 2 diabetes exist in the short term but disappear after its discontinuation: A systematic review and meta-analysis of randomized controlled trials

This meta-analysis aimed to determine the short- (< 3 months) and long-term (≥ 3 months) metabolic effects of IF in patients with type 2 diabetes. We hypothesized that IF is non-inferior to other dietary control methods (including continuous energy restriction, standard diet, Mediterranean diet and ad libitum diet) in terms of both short-term and long-term metabolic impacts in patients with type 2 diabetes. We searched for studies in the MEDLINE, EMBASE, and Cochrane Library until August 20, 2023. Studies with non-type 2 diabetes patients, interventions other than IF, no control group, or non-randomized clinical trial designs were excluded. A meta-analysis was then conducted with a random effects model. The Risk of Bias was assessed using the Cochrane risk-of-bias tool (ROB 2). 12 articles with a total of 966 participants were included. IF significantly decreased glycated hemoglobin A1c (HbA1c) (standardized mean difference [SMD]: -0.93; 95% confidence interval [CI]: -1.64, -0.22; P = 0.01), fasting plasma glucose (FPG) (SMD: -0.73; 95% CI: -0.92, -0.54; P < 0.00001) and body weight (SMD: -1.11; 95% CI: -1.92, -0.31; P = 0.007) in the short term compared to control interventions, but showed a similar effect to control interventions in the long term. Substantial heterogeneity existed among our studies. Over the intervention period, long-term IF may safely and feasibly help patients with type 2 diabetes effectively manage blood sugar and reduce body weight, but the metabolic benefits of IF don't endure after its discontinuation. Therefore, continual long-term IF may provide more lasting metabolic benefits.

Outcomes of Endoscopic versus Microscopic Ossicular Chain Reconstruction-A Systematic Review and Meta-analysis

OBJECTIVE

The efficacy of the transcanal endoscopic approach in tympanoplasty, cholesteatoma removal, and stapedotomy is detailed. This study reviews evidence on the feasibility of endoscopic ossiculoplasty as a suitable alternative to traditional microscopic ossiculoplasty.

DATA SOURCES

PubMed, Embase, and Cochrane Library were searched from inception to 19 June 2024 for articles comparing endoscopic and microscopic ossicular chain reconstruction.

REVIEW METHODS

This systematic review was conducted in accordance with PRISMA guidelines. The primary outcomes assessed include air bone gap closure, pre-operative and post-operative air bone gap, pure tone audiometry, and word recognition scores. The secondary outcomes include operation time, surgical success, and surgical complications. These outcomes between microscopic and endoscopic techniques were pooled and compared as mean differences using a random-effects model. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) scale were adopted to assess for study bias in observational studies and randomized controlled trials, respectively.

RESULTS

This study included five studies comprising 504 patients. While endoscopic ossiculoplasty had shorter operating durations (95% CI -42.97 to -1.57), it conferred comparable air bone gap closure (95% CI -0.34 to 3.76), post-operative pure tone audiogram (95% CI 10.97-18.77), and surgical success. Additional qualitative strengths identified in endoscopic ear surgery include improvements in visualization, decreased need for supplemental incisions, excellent ergonomics, and reduced post-operative pain.

CONCLUSION

Overall, endoscopic ossiculoplasty may confer comparable audiological outcomes to microscopic ossiculoplasty and may serve as a reasonable alternative surgical approach. Laryngoscope, 135:1899-1907, 2025.

Post-pulmonary tuberculosis lung function: a systematic review and meta-analysis

BACKGROUND

Although post-tuberculosis lung disease poses a substantial threat to individuals who have recovered from pulmonary tuberculosis, data showing objective functional impairment in such people are scarce. We did a systematic review and meta-analysis to estimate respiratory impairment after pulmonary tuberculosis disease and examine differences in ventilatory defects.

METHODS

We systematically searched Embase, MEDLINE, and CINAHL from Jan 1, 2000, to Dec 13, 2024. We included any study design with data on lung function tests in individuals with a previous diagnosis of pulmonary tuberculosis versus healthy controls. Outcomes extracted from eligible studies included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1 as a percentage of the predicted value (FEV1%), FVC as a percentage of the predicted value (FVC%), and FEV1/FVC ratio. Pre-bronchodilator values were preferentially selected. Random effects mean difference models were used when possible and standardised mean difference where it was necessary to standardise to a single scale (ie, FEV1%, FVC%, and FEV1/FVC ratio). Between-study heterogeneity was estimated with I2. This study was prospectively registered with PROSPERO (CRD42021248838).

FINDINGS

Of the 5594 publications found, data from 19 studies were included for meta-analyses, reporting on 75 960 individuals of whom 7447 had past pulmonary tuberculosis. All studies reporting absolute values, using various levels of adjustment or standardisation, showed that previous pulmonary tuberculosis had a negative effect across all spirometric values: FEV1 -0·41 L (95% CI -0·51 to -0·32, I2=90·4%), FVC -0·25 L (-0·33 to -0·17, I2=80·6%), and FEV1/FVC ratio -0·37 (-0·54 to -0·19, I2=92·0%). In those studies, using reference values to derive FEV1% and FVC %, prior pulmonary tuberculosis had a pooled standardised mean difference of -0·44 (-0·60 to -0·28, I2=95·6%) and -0·33 (-0·54 to -0·13, I2=91·3%), respectively, compared with controls.

INTERPRETATION

People who recover from pulmonary tuberculosis have significantly decreased lung function compared with controls, with FEV1 more affected than FVC, giving a mixed obstructive and restrictive picture with predominantly airflow obstruction.

FUNDING

Breathing Matters.

Once-weekly Basal Insulin Fc versus daily insulin degludec for glycemic control in diabetes: a systematic review, meta-analysis, and meta-regression

Introduction

Diabetes management often requires insulin therapy, yet adherence to daily injections can be challenging due to complexity, injection pain, and fear of hypoglycemia. Basal Insulin Fc (BIF) is a novel once-weekly insulin analog designed to simplify regimens, improve adherence, and enhance glycemic control. This meta-analysis evaluates the efficacy and safety of BIF compared to once-daily insulin degludec.

Methods

A systematic search of PubMed, Google Scholar, EBSCO, ScienceDirect, and the Cochrane Library, along with ClinicalTrials.gov, was conducted up to November 2024 to identify RCTs comparing BIF with insulin degludec. The search employed MeSH terms like "type 1 diabetes mellitus," "type 2 diabetes mellitus," "once weekly basal insulin Fc," and "insulin degludec." Studies were screened in accordance with PRISMA guidelines, and data on glycemic outcomes, safety, and patient demographics were extracted. Statistical analysis included pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs) using random-effects models. Heterogeneity was assessed using the I2 statistic, and sensitivity analyses were conducted for cases of high heterogeneity. Subgroup and meta-regression analyses assessed moderators such as diabetes type, insulin status, follow-up duration, and heterogeneity.

Results

Five RCTs with 2,562 participants (Type 1 and Type 2 diabetes) were included. BIF showed non-inferiority to degludec in HbA1c reduction (MD 0.03, p = 0.37) and percentage time in range (MD 0.56, p = 0.27). No significant differences were observed in self-monitored fasting blood glucose (MD 2.73, p = 0.40) or clinically significant hypoglycemia (RR 1.00, p = 0.95). However, BIF increased time spent below range (MD 0.30, p = 0.0004) and was associated with higher treatment-emergent adverse events (RR 1.12, p = 0.006). The subgroup analysis highlighted differences in hypoglycemia risks between Type 1 and Type 2 diabetes.

Conclusion

BIF offers comparable glycemic control to insulin degludec while reducing injection frequency, potentially enhancing adherence. However, increased hypoglycemia risks in certain subgroups and higher adverse event rates warrant further evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01602-y.

ACEi and ARBs as Primary Prevention of Cancer Therapy-Related Cardiomyopathy in Patients Undergoing Chemotherapy with Anthracyclines: A Systematic Review and Meta-Analysis

INTRODUCTION

Anthracyclines treat a myriad of malignancies; however, they are known to lead to cancer therapy-related cardiomyopathy (CTRC). Randomized controlled trials (RCTs) evaluating the role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in primary prevention of CTRC have yielded mixed results.

METHODS

A systematic search of MEDLINE, Cochrane, and Scopus databases was performed to identify RCTs that evaluated outcomes in patients receiving anthracyclines and ACEi or ARBs versus control. The primary outcome was occurrence of CTRC. All data were pooled using a random-effects model.

RESULTS

The final analysis included 10 RCTs, with 1049 patients assessed. The weighted follow-up period was 16.8 months. The average age was 43.2 years and 90% were female. Breast cancer (80%) and lymphomas (13%) were the most common malignancies. There was no statistically significant difference between the groups with regards to occurrence of CTRC (16% vs 24%; risk ratio (RR) 0.67, 95% confidence interval (CI) [0.31, 1.45]). Compared with control, ACEi/ARBs were associated with favorable absolute changes in left ventricular ejection fraction (LVEF) (standardized mean difference (SMD) + 1.20%, 95% CI [0.40, 2.00]), left ventricular end-diastolic volume (SMD - 0.36 mL, 95% CI [- 0.66, - 0.06]), and left ventricular end-systolic volume (SMD - 1.04 mL, 95% CI [- 1.79, - 0.29]). There was also a lower risk of arrhythmias in the ACEi/ARBs group compared to control (1.6% vs 8.0%; RR 0.30, 95% CI [0.10, 0.94]), but no difference in all-cause mortality (2.8% vs 3.2%; RR 0.82, 95% CI [0.26, 2.61]), or heart failure (1.2% vs 7.1%; RR 0.40, 95% CI [0.03, 4.54]).

CONCLUSIONS

ACEi/ARBs therapy was not associated with a reduction in CTRC among patients with cancer receiving anthracyclines. However, there were favorable changes in LVEF and left ventricular remodeling with ACEi/ARBs therapy. Further large-scale studies are needed to better understand the potential role of ACEi/ARBs in preventing long-term cardiotoxicity.

Efficacy and safety of tenapanor vs placebo in treating CKD patients on dialysis and with hyperphosphatemia: a systematic review and meta-analysis of 2251 patients

BACKGROUND

Hyperphosphatemia is common in chronic kidney disease (CKD) patients, especially patients on hemodialysis. Tenapanor is a novel drug with fewer side effects and high compliance compared to traditional phosphate binders. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of tenapanor.

METHODS

A comprehensive search was conducted on PubMed, Scopus, Web of Science, and Cochrane Library, from inception to June 25, 2024. Nine randomized controlled trials (RCTs) and three single-arm studies comparing tenapanor to placebo were included. By adopting a random-effect empirical Bayes model, STATA and RevMan were used to pool dichotomous and continuous data. The primary outcome assessed was serum phosphate. Secondary outcomes included intact parathyroid hormone (iPTH), serum calcium, potassium, and sodium, bowel movement frequency, stool consistency using BSFS score and safety outcomes.

RESULTS

Twelve studies with a total of 2,251 patients were included. Tenapanor was superior to placebo in reducing phosphate at all assessed end points, week 1 (MD = -1.28 mg/dL, P < 0.001), week 2 (MD = -1.07 mg/dL, P < 0.001), week 3 (MD = -1.22 mg/dL, P < 0.001), and week 4 (MD = -0.91 mg/dL, P < 0.001). In addition, iPTH was almost statistically significantly lower in the tenapanor group (MD = -36.53 ng/L, P = 0.07). Moreover, it led to a statistically significant reduction in sodium level (MD = -0.7 mmol/L, P = 0.0003). On the contrary, tenapanor had no statistically significant effect on calcium or potassium levels. Bowel movement frequency and stool consistency were significantly higher in the tenapanor group at all assessed end points. Regarding safety analysis, diarrhea and nausea were statistically significantly higher in the tenapanor group, (RR = 3.71, P < 0.001) and (RR = 1.97, P < 0.001), respectively. There were no significant differences in other adverse events.

CONCLUSION

Based on our meta-analysis, tenapanor can effectively reduce serum phosphate, iPTH, and sodium. Additionally, it improves bowel movement frequency and stool consistency. However, it is associated with a higher risk of GIT symptoms that should be considered and managed during treatment. We recommend conducting further RCTs to perform head-to-head comparisons against other active comparators such as phosphate binders.

Efficacy of gut-brain neuromodulators in irritable bowel syndrome: an updated systematic review and meta-analysis

BACKGROUND

Gut-brain neuromodulators might be efficacious for irritable bowel syndrome (IBS), but there has been no synthesis of evidence from randomised controlled trials (RCTs) of some drug classes, and whether they have pain-modifying properties in IBS is unclear. We updated a previous systematic review and meta-analysis of RCTs examining these questions.

METHODS

We searched MEDLINE (from Jan 1, 1946, to Jan 1, 2025), Embase and Embase Classic (from Jan 1, 1947, to Jan 1, 2025), and the Cochrane Central Register of Controlled Trials (from database inception to Jan 1, 2025). Trials recruiting adults with IBS and that compared gut-brain neuromodulators versus placebo over at least 4 weeks of treatment were eligible. Dichotomous symptom data were pooled using a random effects model to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI.

FINDINGS

The search strategy identified 3625 citations. 28 RCTs were eligible containing 2475 patients. Ten RCTs were identified since our previous meta-analysis, containing 1348 patients. The RR of global IBS symptoms not improving with gut-brain neuromodulators versus placebo in 22 RCTs (2222 patients) was 0·77 (95% CI 0·69-0·87). The best evidence in terms of persistence of global IBS symptoms was for tricyclic antidepressants (TCAs) in 11 trials (1144 patients; RR 0·70, 0·62-0·80). The RR of abdominal pain not improving with gut-brain neuromodulators versus placebo in 19 RCTs (1792 patients) was 0·72 (95% CI 0·62-0·83). The best evidence was for TCAs in seven trials (708 patients; RR 0·69, 0·54-0·87), but there was also a benefit of selective serotonin reuptake inhibitors in seven RCTs (324 patients; RR 0·74, 0·56-0·99), and serotonin and norepinephrine reuptake inhibitors in two trials (94 patients; RR 0·22, 0·08-0·59). Adverse events were not significantly more common with gut-brain neuromodulators, although rates of withdrawal due to adverse events were significantly higher. The certainty in the evidence for tricyclic antidepressants for global IBS symptoms was moderate, but it was low to very low for all other endpoints and drug classes studied.

INTERPRETATION

Some gut-brain neuromodulators are efficacious in reducing global symptoms and abdominal pain in IBS. The findings support guidelines that recommend use of tricyclic antidepressants for ongoing global symptoms or abdominal pain but also highlight a potential for SSRIs to be modestly effective for abdominal pain. More data for SNRIs, azapirones, and tetracyclic antidepressants in IBS are required.

FUNDING

None.

Global occurrence rates of sleep disturbances among institutionalized older adults: A systematic review and meta-analysis

Sleep disturbances are a common issue among institutionalized older adults, yet their exact occurrence rates have not been comprehensively investigated. This meta-analysis aimed to determine the occurrence rates of sleep disturbances in this population. We systematically searched the PubMed, EMBASE, and CINAHL from their inception until 30 June 2024. A total of 9308 institutionalized older adults from 52 observational studies were included, each reporting the occurrence rates of sleep disturbances. The pooled occurrence rates of obstructive sleep apnea, poor sleep quality, insomnia, excessive daytime sleepiness, and circadian rhythm disruption among institutionalized older adults were 67 %, 65 %, 43 %, 30 %, and 30 %, respectively. Age, duration of institutional stay, dependence in activities of daily living, and physical and psychological comorbidities had significant moderating effects on the occurrence rates of sleep disturbances. Sleep disturbances, particularly obstructive sleep apnea, poor sleep quality, and insomnia, are alarmingly prevalent among institutionalized older adults. Our findings underscore the critical need for early detection and intervention to address these disturbances, which could significantly improve the overall well-being and quality of life in this vulnerable population.

Parental Stress and Well-Being: A Meta-analysis

The current meta-analysis aims to investigate the relationship between parental stress and well-being, by focusing on the positive dimensions of parental well-being, such as happiness and life satisfaction, which are often overlooked in favor of negative outcomes like depression. It also extends the scope beyond specific populations, such as parents of children with special needs, to include parents of typically developing children. This meta-analysis included evidence from cross-sectional, longitudinal, daily diary, and intervention studies. By examining various moderators related to parent and child variables (such as gender, age, job status) and study characteristics, this analysis aims to inform more effective, targeted interventions to enhance parental well-being. Systematic searches of the Web of Science, PubMed, APA PsychNet, Scopus, ProQuest, and Google Scholar databases yielded 86 studies, involving 22,108 parents of children aged 0 to 18 years. The PROSPERO registration number for this study is CRD42023428750. Elected outcomes were continuous self-report measures to assess stress and well-being of parents. Our findings indicated a significant negative medium-sized association between parental stress and well-being (r = - .40), i.e., greater parental stress was robustly linked to reduced well-being. Higher-quality studies reported stronger stress-well-being associations, underscoring the role of methodological rigor in producing reliable estimates. Additionally, studies utilizing the Parental Stress Index (PSI) demonstrated stronger associations, highlighting its utility as a validated measure for capturing parental stress. Overall, these findings emphasize the need for evidence-based prevention and intervention programs to address parental stress and improve well-being.

Combination of medical therapy and percutaneous transluminal renal angioplasty versus medical therapy alone for patients with atherosclerotic renal artery stenosis: systematic review and meta-analysis

We investigated whether the combination of medical therapy plus percutaneous transluminal renal angioplasty (PTRA) provides superior clinical outcomes compared to those afforded by medical therapy alone in patients with hypertension due to atherosclerotic renal artery stenosis (ARAS) by conducting a systematic review and meta-analysis of the relevant randomized controlled trials (RCTs). The evaluated outcomes included: (1) cardiovascular disease (CVD)-related mortality, (2) the incidence of CVD events, (3) changes in blood pressure (BP), (4) suppression of renal function decline, (5) changes in the number of antihypertensive drugs used, and (6) serious adverse events. Nine RCTs involving 2275 patients were analyzed, revealing that the combination therapy significantly reduced the number of antihypertensive drugs compared to medical therapy alone (mean difference: -0.42, 95% confidence interval: -0.71 to -0.12). However, there were no significant differences between the combination therapy and medical therapy alone in CVD mortality, the incidence of CVD events, BP changes, suppression of renal function decline, or serious adverse events. The included studies demonstrated a low-to-moderate risk of bias, with performance and detection bias being the most prominent concerns. Together our findings demonstrate that compared to medical therapy alone, the combination of medical therapy + PTRA reduced the number of antihypertensive drugs used but did not improve adverse CVD or renal outcomes. The quality of the included RCTs represents a potential limitation of this analysis.

Effectiveness of self-monitoring devices measuring the urinary sodium-to-potassium ratio, urinary salt (sodium) excretion, or salt concentration in foods for blood pressure management: a systematic review and meta-analysis

Self-monitoring devices that measure the urinary sodium-to-potassium (Na/K) ratio, urinary salt or sodium excretion, or salt concentration in foods have emerged as tools that can guide dietary adjustments for blood pressure (BP) control. This systematic review and meta-analysis investigated whether these self-monitoring devices can help to control BP in adults. The PubMed, Cochrane Library, and Ichushi-Web databases were searched to identify randomized controlled trials that compared the effect of these devices (with or without additional dietary education) plus usual care on BP with that of usual care alone. The pooled effect of weighted mean difference between the intervention and control groups at the end of follow-up was estimated by random-effects meta-analysis. The primary outcome was the change in BP. Secondary outcomes included changes in the urinary Na/K ratio, and sodium and potassium excretions. Of 1525 studies screened, eight (with 1442 participants) were eligible for inclusion. Meta-analysis showed greater reductions in systolic BP by 2.45 (95% confidence interval, 0.04, 4.86) mmHg and diastolic BP by 1.38 (-0.15, 2.90) mmHg in the intervention vs. control groups. However, heterogeneity was high (I² = 69.4% for systolic BP and 65.1% for diastolic BP). The BP-lowering effect was not statistically different across different follow-up durations (4 weeks or 2-6 months) and intervention approaches (self-monitoring alone or combined with dietary education) (all p values for heterogeneity >0.1). Reductions in the urinary Na/K ratio and sodium excretion were greater in the intervention group. Self-monitoring devices may assist with BP reduction by promoting decreased sodium intake and increased potassium intake.

Unlocking knowledge: a meta-analysis assessing the efficacy of educational escape rooms in health sciences education

Educational escape rooms within health sciences education are gaining traction as a unique and engaging game-based strategy for reviewing instructional content. Educational escape rooms cultivate valuable skills such as teamwork, communication, creativity, attention to detail, and the ability to apply knowledge under time pressures. While several studies have independently assessed learners' knowledge gains after educational escape room interventions, the present work meta-analyzes the efficacy of educational escape rooms across studies and student learners within health sciences education. A systematic search across seven databases was performed by a health sciences librarian from inception to March 24, 2023. Record screenings, full-text reviews, and data extractions were managed within Covidence. MERSQI criteria were used to assess study quality. Pooled effect sizes (Standardized Mean Differences = SMD) were estimated through meta-analysis to summarize learner performance outcomes after educational escape room interventions. Eleven studies followed a longitudinal pretest-posttest design, and five studies followed a control-treatment group design. Learners' posttest scores after participating in an educational escape room were statistically higher than their pretest scores as indicated by a large positive summary effect size (SMD ≥ 0.893; p <0.001). Educational escape rooms were also effective for treatment group participants (n = 508), who significantly outperformed (SMD = 0.616; p <0.001) control group participants (n = 555). Most escape rooms were employed as a mechanism for reviewing educational content. This meta-analytic review suggests escape rooms are effective educational interventions for increasing knowledge gains among health sciences learners and highlights common implementation practices to help guide educators interested in this game-based learning approach.

Telomere length and telomerase activity in men and non-pregnant women with and without metabolic syndrome: a systematic review and bootstrapped meta-analysis

Purpose

We performed a systematic review and meta-analysis to examine the associations between telomere length and telomerase activity in subjects with and without metabolic syndrome (MetS).

Methods

The meta-analysis protocol was registered in the PROSPERO database. The PubMed, Embase, Cochrane Library, and LILACS databases were searched for studies reporting telomere length or telomerase activity in adult men and non-pregnant women with and without MetS. The risk of bias was assessed with the Newcastle-Ottawa Scale. Random effects and inverse variance methods were used to meta-analyze associations. We conducted a bootstrapped analysis to test the accuracy of clinical results.

Results

Five studies reported telomere length and two studies telomerase activity. There was no significant difference in telomere length (standardized mean difference [SMD]: 0.10, 95% confidence interval [CI]: -0.07, 0.28, I 2: 54%), between subjects of similar age (mean difference: 2.68, 95%CI: -0.04, 5.40 years) with and without the MetS. Subjects with MetS displayed significantly higher body mass index, triglycerides, and blood pressure, and lower HDL-cholesterol values than subjects without the syndrome. A bootstrapping mediation analysis of telomere length confirmed the clinical results. There was no significant difference in telomerase activity (SMD: 1.19, 95% CI -0.17, 2.55, I 2: 93%) between subjects with and without the MetS.

Conclusion

There were no significant differences of telomere length and telomerase activity in patients with MetS and subjects of similar age without the syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01513-4.

Buprenorphine-naloxone versus buprenorphine for opioid use disorder during pregnancy: A systematic review and meta-analysis

BACKGROUND

The standard of care for treating opioid use disorder (OUD) during pregnancy includes either buprenorphine or methadone. Although buprenorphine-naloxone presents an alternative due to the reduced risk of misuse , evidence regarding its impact on pregnancy and infant health remains limited. This systematic review and meta-analysis aims to compare buprenorphine-naloxone vs buprenorphine alone for OUD during pregnancy, assessing gestational and neonatal outcomes.

METHODS

We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify studies comparing buprenorphine-naloxone versus buprenorphine for OUD during pregnancy. The primary outcome assessed was neonatal abstinence syndrome (NAS). Pooled risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (CI) were calculated using R statistical software and quality assessment was performed following Cochrane recommendations.

RESULTS

Six retrospective cohorts were included, encompassing 9348 mother-infant dyads, of whom 38.3 % received buprenorphine-naloxone. NAS requiring treatment (RR 0.77; 95 % CI 0.71-0.84; p < 0.01) and small for gestational age infants (RR 0.86; 95 % CI 0.76-0.98; p = 0.03) were significantly less frequent in the buprenorphine-naloxone group. No significant differences were found between the groups for cesarean delivery (RR 1.04; 95 % CI 0.98-1.11; p = 0.20), low birth weight (RR 1.07; 95 % CI 0.91-1.24; p = 0.41), and preterm delivery (RR 1.07; 95 % CI 0.96-1.21; p = 0.22).

CONCLUSION

Pregnant people treated with buprenorphine-naloxone had neonates with a lower risk of small for gestational age and NAS. Further research is needed to confirm these findings and explore other pregnancy-related and neonatal outcomes.

Effect of physical activity interventions on executive functions in school-age children with ADHD: A meta-analysis of randomized controlled trials

BACKGROUND

Physical activity interventions positively influence executive functions in both the general population and individuals with ADHD. However, there is limited research focusing on school-aged children, who have the highest ADHD diagnosis rates. This study aims to provide targeted intervention strategies for improving executive function in this population, offering a practical reference for selecting specific exercise types when designing interventions for children with ADHD.

METHODS

A systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant RCTs up to September 2023. Two independent reviewers handled literature screening, data extraction, and quality assessment. Stata 15.1 software was used for the meta-analysis.

RESULTS

The meta-analysis included 19 studies, revealing that physical activity interventions significantly improved executive functions in school-aged children with ADHD. Cognitive flexibility (SMD = 0.70, 95 % CI: 0.09, 1.31) and working memory (SMD = 0.74, 95 % CI: 0.20, 1.28) showed moderate to large effects, while inhibition switching had a small to medium effect (SMD = -0.35, 95 % CI: -0.74, 0.03). Subgroup analysis indicated that cognitively engaging exercises were more effective, with intervention outcomes moderated by duration, frequency, and length.

LIMITATIONS

Inconsistent measurement tools among the included studies may introduce biases.

CONCLUSIONS

Physical activity interventions are effective in enhancing executive functions in school-aged children with ADHD. Cognitively engaging exercises show the most promise, especially when tailored by intervention duration, frequency, and length.

Relationship between patients with atopic dermatitis and the incidence of stroke: A systematic review with meta-analysis

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a variety of comorbidities, including cardiovascular and mental health issues. Recent studies have suggested a potential link between AD and an increased risk of stroke, particularly ischemic stroke. However, the association remains unclear, warranting further investigation.

METHODS

This study conducted a systematic review and meta-analysis to explore the relationship between AD and stroke risk. PRISMA guidelines were followed, and a comprehensive search was carried out in multiple databases, including PubMed/MEDLINE, Biblioteca Virtual em Saúde (BVS), Embase, Cochrane, Web of Science, and Scopus. Observational studies reporting on the incidence of stroke in patients with AD were included. A meta-analysis was performed to assess the odds ratio (OR), hazard ratio (HR), and relative risk (RR) for stroke incidence. Heterogeneity and publication bias were evaluated using Cochran's Q test, I² statistic, and funnel plots.

RESULTS

A total of 11 studies were included, with the majority being cohort studies. The meta-analysis revealed a significant association between AD and an increased risk of ischemic stroke, with an HR of 1.19 (95 % CI 1.13-1.26, p < 0.00001) and moderate heterogeneity (I² = 57 %). However, no statistically significant increase in hemorrhagic stroke risk was observed (HR = 1.13, 95 % CI 1-1.29, p = 0.06). Patients with severe AD exhibited a higher stroke risk compared to those with mild AD, with ORs of 1.29 (95 % CI 1.07-1.56) and 1.06 (95 % CI 0.88-1.27), respectively.

CONCLUSIONS

This meta-analysis confirms a significant association between AD and ischemic stroke, particularly in patients with severe AD. Further research is needed to understand this relationship better and explore potential preventative strategies, including the role of AD treatment in reducing stroke risk.

Sociodemographic barriers in epilepsy surgery in the United States: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to perform a systematic review and meta-analysis to identify sociodemographic barriers that could contribute to the underutilization of epilepsy surgery.

METHODS

PubMed, EMBASE, and Web of Science databases were systematically reviewed from January 2002 until August 2024. The studies examining the impact of sociodemographic barriers on epilepsy surgery were included. The primary outcomes were the odds ratio (OR) and 95 % confidence intervals (CI) for receiving surgery compared to not-receiving surgery in persons with epilepsy. Race/ethnicity, sex, and insurance had sufficient data to perform a meta-analysis of OR and 95 % CI.

RESULTS

Overall, 1,520,813 patients from 12 studies were evaluated, among which relevant studies were selected for comparing sex (338,170 males and 341,821 females), race (1,056,571 White, 224,693 Hispanic, and 239,549 Black/African-American [Black/AA]), and insurance (232,908 private, 190,849 Medicaid, and 204,478 Medicare). Black/AA patients were significantly less likely to have surgery compared to Whites (OR 0.46, CI 0.35-0.61) or Hispanics (OR: 0.54, CI 0.43-0.67). White patients were more likely to have surgery than other groups examined (OR 1.61, CI 1.28-2.02). There were no significant differences in surgical odds when comparing males to females (OR 1.00, CI 0.97-1.03). Compared to the private insurance, patients with Medicaid (OR 0.61, CI 0.49-0.75) or Medicare (OR: 0.49, CI 0.32-0.77) were less likely to obtain surgery.

CONCLUSION

This meta-analysis highlights the impact of race/ethnicity, sex, and insurance status in the likelihood of receiving epilepsy surgery and can inform targeted interventions and policies aimed at ensuring equity for disadvantaged groups.