The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Introduction to network meta-analysis: understanding what it is, how it is done, and how it can be used for decision-making

Network meta-analysis (NMA), a statistical technique that allows systematic reviewers to simultaneously compare more than 2 alternatives, makes use of indirect evidence from studies comparing interventions of interest to a common comparator. The capacity for multiple simultaneous comparisons makes NMA appealing for evidence-based decision-makers. This article, aimed at users of systematic reviews (SRs) with NMAs and at those who are considering conducting SRs with NMAs, provides an introductory level overview of this topic. We describe the main considerations that those conducting systematic reviews with NMA should bear in mind, including decisions regarding grouping interventions into analysis nodes, and testing the assumptions that assure the validity of NMA. We explain and illustrate how both systematic reviewers and users should draw conclusions from NMA that are appropriate and useful for decision-making. Finally, we provide a list of tools that facilitate the conduct and interpretation of NMAs.

Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-Analysis

OBJECTIVES

To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.

METHODS

We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).

RESULTS

We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.

CONCLUSIONS

The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.

Metabolomics as a Tool for Unraveling the Impact of Enantioselectivity in Cellular Metabolism

Metabolomics is an emerging interdisciplinary field focused on the comprehensive analysis of all metabolites within biological samples, making it valuable for areas such as drug development, and environmental analysis. Many compounds, including pharmaceuticals and agrochemicals that have been extensively studied by metabolomics are chiral. The intrinsic chirality of biological targets can lead to a selective recognition of enantiomers resulting in distinct pharmacokinetic, pharmacodynamic and/or toxicological profiles (enantioselectivity). Given that metabolomics captures an instant snapshot of an organism's metabolic state, it serves as a powerful tool to investigate chiral compounds and understand enantioselective effects. Herein, a systematic compilation of scientific literature was performed and 48 enantioselectivity studies using metabolomics were selected. These studies revealed an increasing focus on chiral pesticides (77%), the use of animal models (59%), reliance on LC-MS techniques (52%), and predominantly untargeted approaches (83%). Enantioselective effects were described in most studies. This review describes significant advances in this emerging field and highlights the use of metabolomics to unravel the role of stereochemistry in cellular metabolism by the examination of enantiomer-specific metabolic effects. Furthermore, it elucidates enantioselectivity mechanism that can be further applied to other groups of chiral compounds.

Staff-reported barriers and facilitators to the implementation of healthcare interventions within regional and rural areas: a rapid review

BACKGROUND

Individuals in rural areas consistently demonstrate higher mortality and morbidity rates, and poorer access to healthcare, compared to their metropolitan counterparts. Optimizing the implementation of evidence-based interventions can reduce these inequities. Existing literature outlines numerous barriers and facilitators to the implementation of healthcare interventions, but these are generally not specific to rural areas. This rapid review aims to synthesize barriers and facilitators to the implementation of healthcare interventions in regional and rural healthcare services as reported by healthcare staff, including clinicians, managers, and administrators.

METHODS

A systematic search for peer-reviewed publications was conducted using CINAHL, PsycINFO, Medline, and Embase databases (1/1/2000-29/08/2023). Eligible publications were primary research articles published in English, assessing staff-reported barriers and facilitators to implementing healthcare interventions within regional and rural areas of high-income countries. Qualitative, quantitative, and mixed-methods designs were included. Eligible healthcare settings encompassed acute, sub-acute, primary care, community health, and aged care. Barrier and facilitator data were coded and grouped into sub-themes and broader themes, with results presented narratively.

RESULTS

Thirty-nine publications met the inclusion criteria. Most studies were conducted in Australia or the USA (both n = 18, 46%), within primary care (n = 13, 33%) or hospital settings (n = 12, 31%) in rural (n = 22, 56%) or regional (n = 9, 23%) locations. Implementation barriers and facilitators were grouped into four overarching themes: intervention-level (intervention feasibility and fit; complexity; privacy and confidentiality); staff-level (staff attitudes and beliefs; knowledge, skills, and confidence; staff roles and professional identity), patient-level (patient characteristics; attitudes), and system-level (leadership support; environmental resources and context; geographic vastness; networks and communication).

CONCLUSIONS

These findings provide essential guidance for policymakers, healthcare leaders, and researchers in planning and designing future implementation efforts in regional and rural healthcare settings. By considering factors across intervention, staff, patient, and system levels, stakeholders can address challenges and leverage local strengths to enhance implementation success and reduce health disparities.

TRIAL REGISTRATION

PROSPERO registration number: CRD42023470736. Registered 19/10/2023.

Addressing Health Disparities in Hematologic Malignancies: from Genes to Outreach

SIGNIFICANCE

This review underscores our shared responsibility to champion multidimensional strategies rooted in basic and translational science, community involvement, and societal responsiveness for a meaningful impact. Unifying themes include the need to enhance collaborative infrastructure to engage laboratory researchers, epidemiologists, data scientists, clinicians, patients, community leaders, and policymakers; patient-level support services; outreach, education, and navigation for patients at the community level; recruitment and retention of underrepresented groups in the healthcare and research workforce; and funding for these efforts.

Epley maneuver, performed by family doctors or emergency physicians, for benign paroxysmal positional vertigo in adults

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of the Epley maneuver, performed by family doctors or emergency physicians, for adults with benign paroxysmal positional vertigo.

Fetal outcomes and associated factors of antepartum hemorrhage in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Antepartum hemorrhage (APH) is a significant obstetric complication characterized by bleeding from the genital tract before the onset of labor. It poses serious risks to both maternal and fetal health, with potential outcomes including preterm birth, low birth weight, and increased perinatal mortality. In Ethiopia, where access to comprehensive prenatal care and emergency obstetric services may be limited, the impact of APH on fetal outcomes is a pressing concern. Despite the gravity of this condition, there is a lack of synthesized evidence on its prevalence and the associated risk factors specific to the Ethiopian context. This systematic review and meta-analysis aim to consolidate existing research on the fetal outcomes of APH and identify the key factors contributing to its incidence and severity in Ethiopia.

METHODS

Following the PRISMA checklist guidelines, this study concentrated on research undertaken in Ethiopia. Comprehensive searches across multiple databases Google Scholar, Google, Web of Science, and PubMed yielded six pertinent studies. Data were systematically gathered using a structured checklist and analyzed with STATA version 14. The Cochrane Q test and the I² statistic were utilized to assess heterogeneity. Additionally, publication bias was examined using Egger's weighted regression, a funnel plot, and Begg's test.

RESULTS

This study reviewed 525 research articles that included a total of 22,914 participants. Our meta-analysis revealed that the pooled prevalence of perinatal mortality due to antepartum hemorrhage in Ethiopia is 21.79% (95% CI: 12.32-31.25). Key factors influencing perinatal mortality associated with antepartum hemorrhage included living in rural areas (OR =  1.62, 95% CI: 1.33-1.98), delays in seeking medical care for over 12 hours (OR =  5.43, 95% CI: 1.01-29.14), prematurity (OR =  9.00, 95% CI: 5.39-15.03), and experiencing severe vaginal bleeding prior to arrival at a medical facility (OR =  7.04, 95% CI: 2.14-23.13).

CONCLUSION

The study reveals a high perinatal mortality rate of 21.79% associated with antepartum hemorrhage in Ethiopia. Contributing factors include rural residence, delays in seeking care, prematurity, and severe vaginal bleeding. To reduce mortality, improve rural healthcare, strengthen emergency systems, and enhance prenatal care. Public education on early intervention and specialized care for premature infants are also essential. Collaboration among healthcare providers, government, and NGOs is crucial for effective, sustainable solutions.

Care for Atrial Fibrillation and Outcomes in Rural Versus Urban Communities in the United States: A Systematic and Narrative Review

Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with increased morbidity and mortality. Differences have been identified between medical care delivered in urban and rural settings, and rurality-based disparities may exist in AF care. We performed a systematic review investigating the effect of rurality on AF care and outcomes in the United States. PubMed was queried for entries on AF and rurality: ("atrial fibrillation" OR "atrial flutter") AND ("rural" OR "urban" OR "rurality" OR "metro" OR "metropolitan") AND ("united states" OR "US" OR "U.S.") published up to September 24, 2023. Anticoagulation, rhythm control, settings of care, outcomes, and all-cause mortality were reviewed in relevant studies. The search identified 395 total articles. After screening, 14 relevant articles were included in the review. These studies ranged from 1993 to 2020 and analyzed approximately 41.7 million AF patient encounters. The use of catheter ablation for AF per electrophysiologist was similar across the rural-urban spectrum. Patients with AF and rural residence were less likely to receive a direct oral anticoagulant and more likely to remain on warfarin (relative risk, 0.90 [95% CI, 0.88-0.92]). Patients in rural communities were less likely to receive non-emergent AF care (odds ratio [OR], 0.96 [95% CI, 0.93-0.98]). In-hospital mortality for patients with AF admitted to rural hospitals was higher than urban hospitals (OR, 1.19 [95% CI, 1.01-1.39)]. Measurable differences exist in both treatments and outcomes of patients with AF between rural and urban settings in the United States. These differences should inform future investigations and strategies to improve health in people with AF.

Efficacy and safety of PD-1/PD-L1 inhibitors for natural killer/T-cell lymphoma: a single-arm meta-analysis

BACKGROUND

With the advent of asparaginase-based drugs, patients with natural killer/T-cell lymphoma (NKTCL) have achieved excellent efficacy. However, the prognosis is poor in patients with advanced disease, and even worse in relapse/refractory patients. This meta-analysis aimed to evaluate the efficacy and safety of PD-1/PD-L1 inhibitor monotherapy or combination treatment strategies in patients with NKTCL.

METHOD

Seven databases were extensively searched from inception to November 2023 and updated in April 2024, with no language restrictions. The pooled overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (AEs) were calculated via a random effects model. Heterogeneity was tested utilizing the I-square (I2) test and Cochrane's Q test. Subgroup analysis was used to compare the effects of single PD-1/PD-L1 inhibitors or combination treatment in NKTCL patients.

RESULTS

A total of thirteen single-arm studies involving 460 patients were enrolled. The results revealed that the pooled ORR was 62% (95% CI: 48-76%). In terms of survival outcomes, the pooled 1-year OS was 67% (95% CI: 47-87%) and the 2-year OS was 47% (95% CI: 24-69%). Moreover, the 1-year and 2-year PFS rates were 66% (95% CI: 48-84%) and 59% (95% CI: 34-84%), respectively. With regard to treatment toxicity, the pooled incidence of all-grade AEs was 86% (95% CI: 79-93%), and the pooled incidence of grade 3 or higher AEs was 29% (95% CI: 22-36%). Leukopenia and hypoalbuminemia were identified as the most common hematologic and non-hematologic adverse events, respectively.

CONCLUSION

Evidence suggests that PD-1/PD-L1 inhibitors are promising treatment options for newly diagnosed NKTCL patients. PD-1/PD-L1 inhibitors combined with chemotherapy or chidamide has demonstrated superior clinical efficacy in patients with relapsed/refractory NKTCL.

TRIAL REGISTERATION

Open Science Framwork: osf.io/2bwh3.

Health literacy of primary caregivers of children with cerebral palsy in low- and middle-income countries: a systematic review

OBJECTIVE

We aimed to synthesise existing literature on the health literacy of primary caregivers (PCGs) of children with cerebral palsy (CP) in low- and middle-income countries (LMICs).

DESIGN

Systematic review informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Ovid MEDLINE, Ovid EMBASE, CINAHL via EBSCO, Scopus and Web of Science were searched from inception to January 2024.

ELIGIBILITY CRITERIA

Original studies including observational or experimental data, examining health literacy and/or health literacy proxies using Optimising Health Literacy and Access domains as indicators (eg, education, social support, self-efficacy, health attitudes, reading and writing skills) in primary caregivers of children with CP in LMICs.

DATA EXTRACTION AND SYNTHESIS

Data from included studies were systematically recorded using an Excel template, with information extracted independently by two reviewers. We used the Study Quality Assessment Tool developed by the National Health, Lung, and Blood Institute.

RESULTS

The systematic review yielded 2734 articles, with 15 eligible for inclusion. None used health literacy (HL) measurement tools, and there was limited reporting on specific HL domains. Studies spanned 11 LMICs across 5 major regions. PCGs, predominantly mothers, exhibited varying levels of service awareness, service utilisation and social support. Literacy levels significantly impacted HL proficiency, exposing a notable research gap in LMICs.

CONCLUSIONS

This study presents the first comprehensive analysis of health literacy among PCGs of children with CP in LMICs. Findings reveal a striking absence of tailored health literacy literature, impacting current considerations of PCGs' understanding and management of their child's condition. Additionally, challenges in social support, healthcare navigation and low literacy levels further hinder effective caregiving in LMICs.

Efficacy and safety of antiviral therapies for the treatment of persistent COVID-19 in immunocompromised patients since the Omicron surge: a systematic review

BACKGROUND

Persistent COVID-19 (pCOVID-19) in immunocompromised patients is characterized by unspecific symptoms and pulmonary infiltrates due to ongoing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) replication. Treatment options remain unclear, leading to different approaches, including combination therapy and extended durations. The purpose of this study was to assess the efficacy and safety of antiviral therapies for pCOVID-19 in immunocompromised patients since the Omicron surge.

METHODS

We searched MEDLINE and Scopus from 1 January 2022 to 6 August 2024 for cohort studies and case series on nirmatrelvir/ritonavir, remdesivir, ensitrelvir and molnupiravir. Evidence certainty was rated using Grading of Recommendations Assessment, Development, and Evaluation for outcomes including viral clearance, recurrence/relapse, mortality, adverse events (AEs) and symptom resolution.

RESULTS

Thirteen studies involving 127 cases were included. Evidence certainty was very low. In combination therapy with at least two direct antiviral agents, viral clearance was 79%, with a 16% recurrence rate. All-cause mortality was 9%, and mortality was 6% while SARS-CoV-2 positive. In 47 cases, AEs were reported in 11%. Symptom resolution ranged from 3 to 6 days in two studies. In combination therapy with one direct antiviral agent and passive immunization, viral clearance was 89%, with an 11% recurrence rate and no deaths. In four documented cases, no AEs were observed. In monotherapy, viral clearance was 100%, with a 15% recurrence rate. One death, unrelated to SARS-CoV-2, occurred. In 12 documented cases, no AEs were observed.

CONCLUSIONS

Based on very low certainty evidence, combining one direct antiviral with passive immunization resulted in high rates of viral clearance and few recurrences. AEs occurred in cases treated with at least two direct antivirals. Controlled studies are needed.

The link between adherence to antihypertensive medications and mortality rates in patients with hypertension: a systematic review and meta-analysis of cohort studies

BACKGROUND

Hypertension (HTN) significantly contributes to cardiovascular disease (CVD) and mortality. This systematic review and meta-analysis specifically investigates how different levels of adherence to antihypertensive therapy (AHT) affect mortality rates in HTN patients. By synthesizing cohort studies, it aims to enhance understanding and inform clinical practices to improve outcomes in hypertensive populations.

METHODS

Our meta-analysis employed a comprehensive search strategy using keywords related to hypertension, medical adherence, and mortality across PubMed, Scopus, and Web of Science, up to July 2024. The eligibility criteria focused on cohort studies linking AHT adherence to mortality. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias (ROB). Quantitative analyses involved hazard ratios (HR) and confidence intervals (CI), with an 80% adherence threshold. Subgroup and meta-regression analyses were also conducted using STATA-17 to explore various outcome factors.

RESULTS

From initial 1,999 studies 12 cohort studies included in our analysis. All included studies had low ROB score. A meta-analysis of 12 studies involving 2,198,311 patient with HTN revealed that poor adherence to treatment significantly increased all-cause mortality (HR: 1.32 [1.14, 1.51], p < 0.001) with high heterogeneity (I²: 98.73%). Additionally, an analysis of four studies with 1,695,872 patients indicated that low adherence was linked to elevated cardiovascular mortality (HR: 1.61 [1.43, 1.78], p < 0.001), showing moderate heterogeneity (I²: 49.51%).

CONCLUSIONS

The study found that poor adherence to AHT significantly increases overall and cardiovascular mortality risk, underscoring the need for improved compliance strategies. Limitations like inconsistent definitions, observational biases, and varying follow-up durations necessitate further research to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Prevalence of hepatitis E virus in domestic animals in the Chinese mainland: a systematic review and meta-analysis

BACKGROUND

China, especially the Chinese mainland, is a highly endemic area of hepatitis E, and its incidence rate has been increasing in recent years. Hepatitis E virus (HEV) is the causative agent of hepatitis E, with a variety of domestic animals as potential hosts. The shift in the main epidemic strain and the increasing trend of zoonotic HEV infection in the Chinese mainland need urgent attention. This systematic review aimed to provide a summary of HEV detection and its characteristics in domestic animals in the Chinese mainland.

METHODS

A total of 1,019 literatures published in Chinese and English before 2024.1.15 were retrieved from four databases including Pubmed, ScienceDirect, Wan Fang and CNKI. Eventually, 73 eligible studies were included in this review, involving HEV detection data of 64,813 samples collecting from 13 kinds of common domestic animals, locating in 28 provinces and municipalities.

RESULTS

HEV antibodies and RNA were detected among 12 and 7 kinds of domestic animals respectively, with the pooled prevalence of 37.94% (95% CI:32.28-43.77) and 7.62% (95% CI: 5.56-9.96) respectively. The prevelance of HEV for swine samples was higher than other species. In addition, the prevalence of HEV among Tibetan swine, cattle and goats were also at a relatively high level. Further subgroup analysis focusing on comprehensive data from swine was conducted. The results showed, the seroprevalence of HEV antibodies gradually decreased over the time of sampling. HEV RNA was detected in various samples, including bile, feces, liver, and serum. The detection rate for fecal samples was the highest, which was 16.60% (95% CI: 12.17-21.55). Further genotyping of HEV RNA was classified. The results warn us about the circulation of genotype 3 HEV in the eastern region of the Chinese mainland.

CONCLUSION

The results collected from the included studies provided valuable data on HEV prevalence across various species, and the characteristics, trends, and potential influencing factors were fully discussed. This review provides public health professionals, policymakers, and researchers with comprehensive and up-to-date research data on zoonotic HEV.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation: Cochrane systematic review and meta-analysis

AIMS

Depression and anxiety occur frequently in individuals with cardiovascular disease and are associated with poor prognosis. This Cochrane systematic review and meta-analysis assessed the effectiveness of psychological interventions on psychological and clinical outcomes in adults with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF).

METHODS AND RESULTS

CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases were searched from January 2009 to July 2022 for randomized controlled trials of psychological interventions vs. controls in adults with CHD, HF, or AF. Twenty-one studies (n = 2591) were assessed using random-effects models. We found psychological interventions reduced depression [standardized mean difference (SMD) -0.36; 95% confidence interval (CI) -0.65 to -0.06; P = 0.02], anxiety (SMD -0.57; 95% CI -0.96 to -0.18; P = 0.004), and improved mental health-related quality of life (HRQoL) (SMD 0.63, 95% CI 0.01 to 1.26; P = 0.05) (follow-up 6-12 months), but not physical health-related quality of life, all-cause mortality or major adverse cardiovascular events compared with controls. High heterogeneity was present across meta-analyses. Meta-regression analysis showed that psychological interventions designed to target anxiety, were more effective than non-targeted interventions.

CONCLUSION

This review found that psychological interventions improved depression, anxiety and mental HRQoL, with those targeting anxiety to show most benefit. Given the statistical heterogeneity, the precise magnitude of effects remains uncertain. Increasing use of multifactorial psychological interventions shows promise for incorporating patient needs and preferences. Investigation of those at high risk of poor outcomes, comparison of intervention components and those with AF is warranted.

Prevalence and main characteristics of primary aldosteronism in bilateral macronodular adrenal disease: a systematic review of the literature

CONTEXT

Bilateral macronodular adrenal disease (BMAD) typically presents with bilateral benign adrenocortical macronodules and variable cortisol excess. Anecdotal evidence suggests oversecretion of other adrenal steroids, including mineralocorticoids.

HYPOTHESIS

We hypothesized that primary aldosteronism (PA) can occur in BMAD, resulting in a distinct, more severe phenotype compared to BMAD with isolated cortisol hypersecretion or unilateral PA (uPA).

OBJECTIVE

To assess the prevalence and characteristics of PA in BMAD.

METHODS

We systematically reviewed case reports and series of BMAD patients with PA, following PRISMA guidelines. BMAD was defined by bilateral adrenal nodules ≥10 mm. PA diagnosis followed US or Japanese Endocrine Society guidelines. We compared these findings with 2 cohorts from LMU Hospital Munich: BMAD with isolated cortisol hypersecretion and uPA.

RESULTS

From 1018 articles, 18 representing 68 cases were included. Of these, 66 had BMAD with PA and 2 had BMAD with aldosterone precursor excess. The PA proportion in published BMAD series ranged from 2% to 43%. BMAD patients with PA were predominantly male (75%) and younger (median 51.5 years) than those with isolated cortisol hypersecretion (median 60.5 years, P < .01). Their median blood pressure was higher (170/100 mm Hg) compared to those with isolated cortisol hypersecretion (138/80 mm Hg) or uPA (153/94 mm Hg, P < .01). Treatment was only described in 28 cases, with 93% undergoing adrenalectomy. Clinical outcome was similar across groups post-treatment.

CONCLUSION

This review highlights the need for increased screening for PA in younger, hypertensive BMAD patients. Larger multicenter studies are needed to determine the association between these conditions, cardiovascular risk, and optimal treatment.

The burden of neonatal sepsis and its risk factors in Africa. a systematic review and meta-analysis

BACKGROUND

Neonatal sepsis is a significant cause of newborn mortality in low- and middle-income countries (LMICs). Together, infections, complications of preterm birth, and intrapartum-related conditions contribute to nearly 90% of all neonatal deaths. Africa experiences high rates of neonatal deaths due to sepsis, with insufficient prevention efforts. Understanding the burden of neonatal sepsis is essential to reducing these deaths in the region. This study aims to estimate the pooled magnitude of neonatal sepsis and identify its associated risk factors in Africa.

METHOD

For this study, we gathered data by searching various databases until August 20, 2024, including PubMed/MEDLINE, PubMed Central, Hinari, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. Full-text articles in English, both published and unpublished, from 2000 to 2024 were included. However, sources like citations without abstracts or full texts, unidentified reports, editorials, summaries of research, meta-analyses, and qualitative studies were not included in the study. We evaluated the quality of the selected papers using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. Data extraction was completed in Microsoft Excel, and analysis was conducted using STATA V.17 Statistical Software. We assessed study heterogeneity with the I2 statistic and the Cochrane Q test. Publication bias was evaluated both visually through a funnel plot and statistically through Egger's regression and Begg's tests. Subgroup analyses were performed to identify sources of heterogeneity, and a sensitivity analysis was conducted to find any outlier studies.

RESULT

This review includes 49 studies with 87,548 neonates. The overall magnitude of neonatal sepsis in Africa was found to be 40.98% (95% confidence interval (CI): 30.50% to 51.46%) P: 0.00. The study found that factors such as prolonged rupture of membranes (Odds ratio (OR) 4.11, 95% CI: 2.81-5.41) P: 0.00, a history of the urinary tract or sexually transmitted infections (OR 3.28, 95% CI: 1.97-4.58) P: 0.00, low birth weight (< 2500 g) (OR 6.95, 95% CI: 3-10.89) P: 0.00, an Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score below 7 at the first minute (OR 7.56, 95% CI: 3.39-11.73) P: 0.00, preterm birth (OR 5.38, 95% CI: 3.23-7.5) P: 0.00, and neonates who were resuscitated at birth (OR 3.26, 95% CI: 1.96-4.56) P: 0.00.

CONCLUSION

The magnitude of neonatal sepsis in Africa remains high. This study identified several contributing factors, including prolonged rupture of membranes, a history of urinary tract or sexually transmitted infections, low birth weight (< 2500 g), an APGAR score below 7 at one minute, preterm birth, and resuscitation at birth. These findings underscore the importance of routinely screening for risk factors such as prolonged membrane rupture and maternal infections. Enhancing antenatal care, training providers in early neonatal sepsis management, and enforcing infection control measures.

Assessing Adherence to the PRISMA-DTA Guideline in Diagnostic Test Accuracy Systematic Reviews: A Five-Year Follow-up Analysis

BACKGROUND

We evaluated reporting of diagnostic test accuracy (DTA) systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-DTA and PRISMA-DTA for abstracts.

METHODS

We searched MEDLINE for recent DTA systematic reviews (September 2023-Mar 2024) to achieve a sample size of 100. Analyses evaluated adherence to PRISMA-DTA (and abstracts), on a per-item basis. Association of reporting with journal, country, impact factor (IF), index-test type, subspecialty area, use of supplemental material, PRISMA citation, word count, and PRISMA adoption was evaluated. Comparison to the baseline evaluation from 2019 was done. Protocol: https://doi.org/10.17605/OSF.IO/P25TE.

RESULTS

Overall adherence (n = 100) was 78% (20.3/26.0 items, SD = 2.0) for PRISMA-DTA and 52% (5.7/11.0 items, SD = 1.6) for abstracts. Infrequently reported items (<33% of studies): eligibility criteria, definitions for data extraction, synthesis of results, and characteristics of the included studies. Infrequently reported items in abstracts were characteristics of the included studies, strengths and limitations, and funding. Reporting completeness for full text was minimally higher in studies in higher IF journals [20.7 vs 19.8 items; 95% confidence interval (95%CI) (0.09; 1.77)], as well as studies that cited PRISMA [21.1 vs 20.1 items; 95%CI (0.04; 1.95)], or used supplemental material (20.7 vs 19.2 items; 95%CI (0.63; 2.35)]. Variability in reporting was not associated with author country, journal, abstract word count limitations, PRISMA adoption, structured abstracts, study design, subspecialty, open-access status, or index test. No association with word counts was observed among full text or abstracts. Compared to the baseline evaluation, reporting was improved for full texts [71% to 78%; 95%CI (1.18; 2.26)] but not for abstracts [50% to 52%; 95%CI (-0.20; 0.60)].

CONCLUSIONS

Compared to the baseline evaluation published in 2019, we observed modest improved adherence to PRISMA-DTA and no improvement in PRISMA-DTA for abstracts reporting.

Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Lumbar facet cysts (LFCs) are considered the result of facet degeneration and segmental instability. Their surgical management has been controversial. Decompression only (DO) is less invasive, but it does not address the underlying degeneration/spondylolisthesis. Decompression and fusion (DF) is more invasive with higher perioperative morbidity. Comparative studies are scant in current literature. The objective of this study was to identify all such studies and synthesize outcomes including recurrence and reoperation rates. Secondary outcomes included back pain resolution, radiculopathy resolution, and length of stay.

METHODS

In this PROSPERO-registered Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review, the MEDLINE, Embase, and Cochrane databases were searched to identify comparative studies of DO vs DF patients with LFCs. A meta-analysis with random effects model was performed, and heterogeneity was assessed with the I2 statistic. Visual representation of results was performed with forest plots.

RESULTS

Nine comparative studies encompassing 3393 patients (DO: 1940, DF: 1453) were included. Spondylolisthesis rates were statistically significantly lower in the DO group (DO 24.3%; DF 65.8%; OR 0.04; CI 0.01-0.31; P < .01). The DO group had statistically significantly higher odds of cyst recurrence (DO 6.3%; DF 0%; OR 5.74; CI 1.51-21.72; P = .01) and lower odds of back pain resolution at follow-up (DO 56.6%; DF 74.5%; OR 0.43; CI 0.2-0.91; P = .03) compared with the DF group. Reoperation rates (DO 7.2%; DF 5.9%; OR 1.37; CI 0.72-2.6; P = .3) and odds for resolution of radiculopathy (DO 77.3%; DF 87.2%; OR 0.6; CI 0.3-1.21; P = .2) were comparable between the 2 groups. Length of stay was statistically significantly shorter in the DO group (mean difference -1.5; CI -2.38 to -0.63; P < .001).

CONCLUSION

Decompression with concomitant fusion was associated with lower odds of cyst recurrence and higher odds of back pain resolution but slightly longer hospital stay. Reoperation rates and radiculopathy resolution were comparable between the two groups.

Exploring the Human-Animal Interaction (HAI) for Children with ASD Across Countries: A Systematic Review

Human-Animal Interaction (HAI) has been widely adopted as an approach to enhance the well-being of children with ASD, who often experience significant social impairments, emotional dysregulation, and other daily challenges. Given the potential variation of HAI across countries, there is a particular need to explore this phenomenon within different cultural contexts and to illuminate directions for facilitating positive HAI among children with ASD. The purpose of this review is to systematically synthesize the current knowledge of HAI as applied to children with ASD and to discuss possible variations across different cultural contexts. A systematic database search was conducted to synthesize HAI characteristics from existing studies that met the selection criteria. The results highlighted that most of the selected studies (N = 97) were conducted in Europe or the United States. The most common format of HAI identified was animal-assisted intervention, followed by pet ownership. Dogs and horses were the primary animals involved in HAI for children with ASD, while the majority of HAI occurred in home settings and at horse riding or training centres. To conclude, this review provides a more comprehensive lens for understanding the phenomenon of HAI for children with ASD across different countries and discusses cultural variations in terms of the companion animals involved, the formats, and the settings of HAI. It also offers therapeutic insights into the multicultural aspects of HAI, which may shed light on future interventions for children with ASD through HAI in more diverse settings.

Mental health first aid training and assessment for healthcare professionals and medical nursing students: a systematic review

PURPOSE

To summarize the effect of mental health first aid (MHFA) on paramedics and medical nursing students and provide direction to future training and research.

METHODS

Seven databases, including Web of Science, PubMed, Embase, Cochrane, China Knowledge, Wanfang, and China Biomedical Literature Database, were searched for relevant studies from database establishment up to January 31, 2023. The Cochrane risk of bias tool was used to assess the quality of randomized controlled trials, qualitative studies, and single-armed trials on the basis of the literature evaluation criteria developed by the JBI Center for Evidence-Based Healthcare in Australia. Mixed-sex studies were assessed by using the mixed-methods assessment tool (MMAT 2018).

RESULTS

The review identified 11 studies that met the criteria, most of which reported on the effects of MHFA training in terms of mental health literacy (referred to as MHL), MHFA intentions and confidence, stigma, and changes in social distance. A few studies analyzed the strengths and weaknesses of MHFA training courses, motivation to complete MHFA, barriers and facilitators to MHFA training, and participants' perceptions of implementing MHFA training.

CONCLUSIONS

The MHFA curriculum is practical for healthcare workers and medical nursing students. In the future, a standardized training program based on the population characteristics of healthcare workers and medical nursing students must be developed to standardize the measurement of outcome indicators to reflect the effectiveness of implementing the MHFA training curriculum. Our study has been registered to PROSPERO under registration number CRD42024519793.

Telemedicine in Tanzania: a systematic literature review

PURPOSE

This review explores the challenges and opportunities of implementing telemedicine in rural Tanzania. The study examines how telemedicine can address healthcare gaps in underserved areas and identifies key barriers that hinder its full adoption. It also provides insights into strategies for improving healthcare delivery through telemedicine in rural settings.

DESIGN/METHODOLOGY/APPROACH

A systematic literature review methodology was employed following the PRISMA guidelines. The study collected and analysed relevant academic and grey literature from PubMed, Google Scholar and Scopus databases. The search focused on telemedicine in rural Tanzania, with a thematic analysis used to categorise the challenges and opportunities identified in the literature.

FINDINGS

The review found that the major challenges to telemedicine implementation in rural Tanzania include inadequate telecommunications infrastructure, limited digital literacy among healthcare providers, insufficient financial investment and weak regulatory frameworks. Despite these barriers, telemedicine presents significant opportunities to improve healthcare access, particularly by connecting rural patients with specialists, reducing travel times and integrating telemedicine with national health insurance systems. Innovations such as drone-based medical deliveries and SMS-based health interventions also show promise.

ORIGINALITY/VALUE

This paper comprehensively overviews telemedicine's potential to transform healthcare delivery in rural Tanzania. It synthesises existing literature, highlights critical gaps in telemedicine adoption and proposes actionable strategies for overcoming these barriers. The study contributes valuable insights for policymakers, healthcare providers and stakeholders interested in leveraging telemedicine to enhance healthcare outcomes in underserved regions.

The impact of exercise interventions on postural control in individuals with Down syndrome: a systematic review and meta-analysis

BACKGROUND

Individuals with Down syndrome have severe difficulties maintaining proper postural control when standing upright. Therefore, the goal of the present review and meta-analysis was to examine the effects of exercise interventions on improving postural control in individuals with Down syndrome.

METHODS

This systematic review was reported following the PRISMA guidelines; while Cochrane guidelines were adopted for methodological guidance. Reports were searched in PubMed, Science Direct, Physiotherapy Evidence Database scale (PEDro), EMBASE, Web of Science (WOS), Scopus and Google Scholar from 2000 to January 2025. Randomized clinical trials and quasi-experimental studies were assessed in English. Review, meta-analysis, and descriptive studies were excluded from the study. Two researchers screened and evaluated data based on PEO criteria and the quality of studies was assessed using the PEDro scale.

RESULTS

Among between 374 studies, Six articles were included in the present review and meta-analysis. Four studies showed that exercise interventions improve postural control in individuals with Down syndrome. However, the results of 2 studies indicated that exercise interventions do not improve postural control in these individuals. Ultimately, after analyzing the studies, the statistical results showed a significant difference between the intervention group and the control group (p = 0.001), indicating the effectiveness of exercise interventions and subsequent improvement in postural control in individuals with Down syndrome. According to PEDro scale, four studies were low quality, and two were high quality. Also, applying GRADE criteria, there is a "Low" certainty of evidence observed. The mean effect size of the exercises in the 6 included studies in the present review was 0.67, indicating a small effect size.

CONCLUSIONS

The exercise interventions improve postural control in individuals with Down syndrome. In addition, Due to the small sample size and the small number of studies included, to deal with the risk of bias in the studies, a new randomized controlled trial with a stronger methodology and large sample size comparing exercises and other strategies or different types of exercises is recommended.

Effectiveness of virtual reality technology in rehabilitation after anterior cruciate ligament reconstruction: A systematic review and meta-analysis

BACKGROUND

Anterior cruciate ligament reconstruction (ACLR) can be fully recovered with effective rehabilitation, which also lowers the risk of developing osteoarthritis in the knee. Virtual reality technology (VRT) has been used for rehabilitation after ACLR. However, it is unclear how VRT compares to traditional therapy in terms of effectiveness.

DESIGN

A systematic review and a meta-analysis.

OBJECTIVES

We hypothesised that VRT would be a more effective treatment than traditional therapy in post-ACLR rehabilitation. This study aimed to evaluate the effects of VRT on rehabilitation following ACLR, providing insights for its application in clinical settings.

MATERIALS AND METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed using RevMan and Stata software according to PRISMA guidelines. We conducted a systematic search of the PubMed, Web of Science, Embase, The Cochrane Library, EBSCO, CNKI, CBM, VIP, and Wanfang databases for RCTs examining the effects of VRT in patients following ACLR. The literature search was conducted from the inception of the database to March 2024, utilizing keywords such as "anterior cruciate ligament," "anterior cruciate ligament reconstruction," "anterior cruciate ligament injury," and "virtual reality." The outcome indicators comprised knee function, walking function, gait function, and knee muscle strength. We assessed the quality of RCTs using the Cochrane Risk of Bias tool and the Jadad scale.

RESULTS

There were a total of 6 RCTs included in this study, involving 387 patients who had undergone ACLR. The experimental group comprised 194 patients, while the control group comprised 193 patients. The findings demonstrated that VRT significantly enhanced knee function, walking ability, gait function, and knee muscle strength post-ACLR. Specifically, it led to improvements in the IKDC score (MD: 4.23; 95% CI 1.76-6.71), FAC score (0.40; 0.32-0.48), Lysholm score (6.36; 3.05-9.67), step length (3.99; 2.72-5.27), step speed (0.13; 0.10-0.16), step frequency (4.85; 0.22-9.47), extensor peak torque (12.03; 3.28-20.78), and flexor peak torque (14.57; 9.52-19.63). Subgroup analysis revealed that fully immersive VR did not significantly improve knee function as compared to non-immersive VR.

CONCLUSION

This study is the first to systematically compare VRT with traditional therapy, and we found that VRT is a more effective treatment than traditional therapy in post-ACLR rehabilitation. This provides evidence for integrating VRT into post-ACLR rehabilitation protocols. However, more high-quality studies with large samples are needed to verify the findings.

PROTOCOL REGISTRATION

This study has been registered in PROSPERO (No. CRD42024534918).

Somatosensory training: a systematic review and meta-analysis with methodological considerations and clinical insights

Somatosensory training, which involves repetitive somatosensory stimulation, has been employed to enhance somatosensory performance by modulating excitability in the primary somatosensory cortex. This process, known as perceptual learning, can benefit stroke patients with somatosensory deficits. However, its effectiveness in both healthy individuals and stroke patients has not been thoroughly investigated. This systematic review and meta-analysis aimed to evaluate the effectiveness of somatosensory training in these groups. However, no eligible data on stroke patients were identified, excluding them from the analysis. In healthy participants, somatosensory training improved performance in 61.2% datasets, but this effect was observed only at the stimulated site. Additionally, it increased early somatosensory-evoked potential amplitudes in 76.9% of datasets at the stimulated site, with no effect on the non-stimulated site. Despite these moderate improvements, the risk of bias assessment revealed methodological concerns including randomization process, proper control conditions, blinding information, and missing data. The meta-analysis focused on the impact of somatosensory training on tactile two-point discrimination (TPD) in various factors, including different age groups, stimulus durations, stimulus frequencies, and stimulus types. A marked reduction in TPD threshold was observed at the stimulated finger post-training compared to pre-training, though there was a noticeable heterogeneity across studies. In contrast, no significant changes occurred at the non-stimulated fingers, and the subgroup analysis found no specific factors influencing TPD improvements. Although somatosensory training benefits healthy individuals, the variability and methodological concerns highlight the need for further high-quality research to optimize its use in treating somatosensory deficits in stroke patients.

The Landscape of Obesity Education Worldwide - Are We Doing Enough? Scoping Review of Content of Obesity Educational Interventions in Medical Schools and Residency Programs

No study appraised the curricular content of published obesity education interventions (OEI) delivered to medical students, residents, or fellows. This scoping review identified and described the curricular content of published OEI, examined the specific obesity-related domains addressed, and proposed potential directions for future intervention development. We searched PubMed and Web of Science databases. Original articles on OEI delivered to medical students, residents, or fellows were included. Data extraction was guided by the Obesity Medicine Education Collaborative's framework and the Accreditation Council for Graduate Medical Education-International (ACGME-I) competencies framework. The curricular content of OEI was categorized and visually mapped to identify trends and gaps. A total of 490 studies were identified, and 60 were included. Conceptually, twelve obesity domains emerged: epidemiology, health policy, prevention; basic sciences; nutrition; physical activity; behavioral aspects; counseling; pharmacotherapy; metabolic/bariatric surgery (MBS); weight stigma; ethics/professionalism; health literacy; and practice guidelines. Geographically, most OEI (88.3%) were implemented in North America. Three-quarters of OEI were for medical students, less OEI were for residents, and none for fellows. Content-wise, the OEI for medical students and for residents exhibited strikingly limited coverage of all obesity domains, although those for residency programs had more limited coverage than those for medical schools. Across medical schools, the most common domains addressed were basic sciences (48.3%), counseling, and nutrition (45% each); the least included were pharmacotherapy (13.3%), ethics/professionalism (3.3%), and health literacy (1.6%). For residency programs, the most common domains addressed were basic sciences and counseling (21.6% for each); the least were pharmacotherapy and MBS (6.6% each), weight stigma (5%), ethics/professionalism (3.3%) and health literacy (1.6%). Many critical domains of obesity remain inadequately addressed in the education provided in medical schools and residency programs. Future OEI should incorporate these to equip future physicians with knowledge, skills, and attitudes to care for patients with obesity.

Personalized nursing as the missing link of providing care: A systematic review

This study aimed to evaluate the efficacy of personalized nursing care. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched multiple databases and search engines, including PubMed, Scopus, ProQuest, CINAHL, and Google Scholar, for articles published between 2011 and September 31, 2022. To evaluate the quality of the incorporated studies, we utilized established assessment tools, including the CONSORT checklist, STROBE statement, and Kmet standard criteria. A qualitative narrative synthesis approach was employed for data synthesis. The systematic review included 24 studies involving 5428 participants. Across these studies, a consistent positive correlation was found between personalized care administered by nurses and participant satisfaction. Patients receiving personalized care experienced reduced negative emotional symptoms, suggesting potential therapeutic benefits extending beyond physical health outcomes. Health guidance education, individualized healthcare plan and dedicated nursing team were the examples of personalized nursing interventions. The results underlined the importance of personalized nursing in delivering essential services. Personalized nursing aims to improve the quality of care by adapting it to each individual's unique needs and characteristics. Patient or public contribution: This study did not include contributions from patients or the public. Systematic Review Registration: CRD42022367814.

Virtual simulation for flow-diverter selection and sizing in the endovascular treatment of intracranial aneurysms: A systematic review and meta-analysis

BACKGROUND

Endovascular treatment (EVT) of intracranial aneurysms (IAs) has improved significantly with the integration of virtual simulation software (VSS) in surgical planning and device selection. Despite promising outcomes, discrepancies remain between physician and VSS recommendations. This review synthesizes evidence on (1) comparisons between VSS-chosen and physician-chosen dimensions; (2) VSS-chosen and postoperative measured dimensions; and (3) the success rate of VSS-guided device deployment.

METHODS

A systematic search adhering to PRISMA guidelines was conducted in Medline, Embase, Web of Science, and Cochrane databases up to January 2024. Eligible studies included case series, cohort studies, and randomized trials assessing VSS for stent selection in IAs treatment. Mean difference (MD) and single-arm meta-analysis with 95% confidence intervals (CIs) under a random-effects model were performed for continuous and binary outcomes. Subanalyses were conducted for Sim&Size and PreSize software.

RESULTS

Ten studies comprising 658 IAs were included. Pipeline Embolization Device was most commonly used. Findings demonstrated (1) high accuracy of VSS when comparing simulated and postoperative lengths (MD -1.7 mm; 95% CI -4.37 to 0.98 mm); (2) physician-chosen lengths overestimated compared to VSS (MD -2.11 mm; -3.43 to -0.79 mm); (3) no significant difference in physician- versus VSS-chosen diameters (MD -0.04 mm; -0.13 to 0.06 mm); and (4) high VSS-guided deployment success (96%; 93-99%) with low complications (4%). Subanalyses showed 95% and 92% deployment success rates for Sim&Size and PreSize, respectively.

CONCLUSION

VSS effectively estimates device length and achieves high deployment success, with low complication rates, supporting its utility in EVT planning.

Prevalence of tobacco use among healthcare workers in Italy: A systematic review and meta-analysis

OBJECTIVE

The objective of this work is to be able to assess the prevalence of tobacco use among health care workers, particularly among physicians and nurses, and whether there has been a decrease over time in the scope of work.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Observational studies and systematic reviews that examined smoking prevalence in healthcare workers were included and classified. Data extraction and analysis was performed on all included studies that consider only hospital and healthcare services workers. The search strategy included three electronic databases (PubMed, Scopus and Web of Science) between March 01, 2023, and April 30, 2024.

RESULTS

700 articles were found and once duplicates and studies not fulfilling the inclusion criteria were removed, 23 articles were examined. The average pooled prevalence calculated on the basis of tobacco use among physicians was 21.4 % in the period 1998-2021; if we break down the population by gender, the prevalence is 17.4 % for females and 21.8 % for males. If we consider high quality studies (NOS >7) the prevalence among physicians rises to 22.9 %, an increase from 2010 where the prevalence was 19.1 %. About nurses, we have an overall prevalence of 37.6 %, while considering only high-quality articles the prevalence was 37.2 %; the time frame (before and after 2010) did not impact smoking prevalence.

CONCLUSION

Smoking prevalence in healthcare workers is high, particularly among nurses. Companies should raise awareness and strengthen strategies to reduce the prevalence of this phenomenon among employees; moreover, workers should not only be aware of the risks, but also promote prevention in the population in order to prevent major tobacco-related diseases.

Age-specific DRLs for pediatric brain CT: A review for exploring the practices in Saudi Arabia

This review explores the establishment of diagnostic reference levels (DRLs) for pediatric brain computed tomography (CT) examinations in Saudi Arabia and compares them with nine other countries. An extensive search strategy was employed across various databases, resulting in the inclusion of 9 studies. The studies included patient-based and phantom-based investigations into DRLs, highlighting variations across age groups and countries. Findings suggest notable differences in CT dose index (CTDI mGy) and dose length product (DLP mGy.cm) values. There was a difference in the classification of age group between Saudi food and drug administration (SFDA) and literature. For the age groups 0-5 years and 6-15 years, the DRLs for the SFDA were as follows: CTDI (28 and 42 mGy) and DLP (482 and 697 mGy cm). The discussion emphasizes the importance of age-specific DRLs to optimize radiation doses while ensuring patient safety and diagnostic efficacy. Recommendations include adopting globally accepted standards for dose optimization and continued research into factors influencing DRL variations. Limitations include varying age groupings among studies and limited access to some relevant literature. Overall, this study underscores the importance of standardizing DRLs for pediatric CT to improve patient care and safety.

Treatment-induced ripple effect: a systematic review exploring the abscopal phenomenon in Glioblastoma multiforme

PURPOSE

This systematic review aimed to collate and synthesize the available literature on the abscopal effect in Glioblastoma multiforme (GBM) neoplasms, focusing on the reported biochemical mechanisms driving the abscopal effect.

METHODS

A systematic search was conducted in PubMed, Cochrane Database of Systematic Reviews, and Epistemonikos from inception to May 1, 2023. Studies exploring the abscopal effect in GBM were included. The Clinical Relevance Assessment of Animal Preclinical research (RAA) tool was used to assess methodological quality of preclinical studies. Data on preclinical models, biochemical mechanisms, and outcomes were extracted and synthesized systrmatically.

RESULTS

Out of a total of 7 studies, five preclinical studies met the inclusion criteria. The studies utilized various in vivo mouse models, including bilateral tumor models and immunohumanized mice. Key biochemical mechanisms identified included immunogenic cell death, danger-associated molecular pattern release, macrophage activation, and enhanced T cell responses. Combinatorial approaches involving oncolytic virotherapy, nanoparticle-based treatments, radiation therapy, and immune checkpoint inhibitors showed promise in inducing abscopal effects. Significant tumor growth inhibition and improved survival were reported in treated animals. However, the RAA analysis highlighted concerns regarding research transparency and internal validity across studies.

CONCLUSIONS

This systematic review highlighted the potential of the abscopal effect in GBM, demonstrating its ability to enhance anti-tumor immune responses both locally and systemically. The synergistic effects of combinatorial approaches showed promise for improving outcomes. However, the low methodological quality of existing studies underscored the need for more rigorous preclinical research. Future studies should focus on improving research transparency, exploring the abscopal effect in other primary CNS neoplasms, and translating these findings into clinical trials to assess safety and efficacy in humans.

Methods of Assessment of Zinc Status in Humans: An Updated Review and Meta-analysis

CONTEXT

The assessment of zinc status is difficult but essential for the identification of zinc deficiency and evaluation of interventions to improve zinc status.

OBJECTIVE

The purpose of this systematic review (SR) and meta-analysis was to update the previously published SR of biomarkers of zinc status, conducted by the European Micronutrient Recommendations Aligned (EURRECA) network in 2009, to answer the question: Which putative measures (biomarkers) of zinc status appropriately reflect a change in zinc intake of at least 2 weeks?

DATA SOURCES

A structured search strategy was used to identify articles published between January 2007 and September 2022 from MEDLINE (Ovid), Embase (Ovid), Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL). Relevant articles were identified using previously defined eligibility criteria.

DATA EXTRACTION

Data were extracted and combined with data from the previous SR.

DATA ANALYSIS

A random-effects model was used to calculate pooled mean differences using STATA (StataCorp). The risk of bias and the certainty of evidence for all outcomes were assessed. Additional data on 7 of the 32 previously reported biomarkers were identified, along with data on an additional 40 putative biomarkers from studies published since 2007. Pooled data analysis confirmed that, in healthy participants, both plasma/serum zinc concentration and urinary zinc excretion responded to changes in zinc intake (plasma/serum: mean effect [95% CI], controlled studies: 2.17 µmol/L [1.73, 2.61]; P < .005, I2 = 97.8; before-and-after studies: 2.87 µmol/L [2.45, 3.30]; P < .005, I2 = 98.1%; urine zinc: 0.39 mmol/mol creatinine [0.17, 0.62]; P < .005, I2 = 81.2; 3.09 µmol/day [0.16, 6.02]; P = .039, I2 = 94.3).

CONCLUSION

The updated analyses support the conclusion that plasma/serum and urinary zinc respond to changes in zinc intake in studies of healthy participants. Several additional putative biomarkers were identified, but more studies are needed to assess the sensitivity and reliability.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO no. CRD42020219843.

Impact of Diet Modifications on Body Weight, Body Composition, Treatment Outcomes, and Quality of Life During Primary Treatment for Breast Cancer: A Systematic Review

CONTEXT

Breast cancer is a significant public health challenge, with 290 000 new cases annually and significant healthcare costs. Treatment advancements have led to improvements in survival, but common adverse effects include weight gain, fatigue, nausea, and taste changes, decreasing quality of life.

OBJECTIVE

This review aims to assess the impact of diet and lifestyle interventions during primary treatment for breast cancer and their effects on body weight, body composition, treatment-related adverse outcomes, and patient-reported quality of life.

DATA SOURCES AND DATA EXTRACTION

A search of PubMed, CINAHL, and EMBASE conducted through May 10, 2023, identified 31 publications describing 27 interventions including diet or diet plus exercise. The Cochrane Risk of Bias tool assessed the quality of publications.

DATA ANALYSIS

The findings suggest that whole foods, aerobic and strength-training exercises, and intermittent fasting during treatment may improve body weight and composition, treatment-related outcomes, and quality of life. Limitations include variation in study duration, small sample sizes, and limited sociodemographic data.

CONCLUSION

Improvements seen with increased diet quality and reduced caloric intake, with or without exercise, challenge current standard-of-care recommendations during treatment for breast cancer. While there is a need for additional research, healthcare teams can confidently promote healthy diets and exercise during primary treatment for breast cancer to manage weight and improve treatment-related side effects and quality of life.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. 42023425613.

Efficacy and Safety of Janus Kinase Inhibitors in Patients with Vitiligo: A Systematic Review and Meta-Analysis

Although several case reports and small clinical trials have reported promising outcomes with Janus kinase (JAK) inhibitors for vitiligo, high-quality evidence and guidelines are lacking. We evaluated the efficacy and safety of JAK inhibitors for the treatment of vitiligo using a meta-analysis of randomized controlled trials (RCTs). We searched the PubMed, Embase, and Cochrane Library databases up to August 2023, with additional studies from ClinicalTrials.gov and company websites. We assessed outcomes, including percentage improvement in total vitiligo area score index (TVASI) and facial vitiligo area score index (FVASI); the proportion of patients achieving 50% improvement in TVASI (TVASI50) and 50% and 75% improvement in FVASI (FVASI50 and FVASI75); the risk of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), infections, and skin-related adverse events (AEs). Five studies with 1,550 participants were included. JAK inhibitors were associated with a higher proportion of TVASI50 (relative risk [RR] 2.67, 95% confidence interval [CI] 1.24-5.78) and FVASI75 (RR 3.97, 95%CI 2.62-6.02) responders than placebo. JAK inhibitors significantly increased the risk of skin-related AEs (RR 1.96, 95% CI 1.29-2.98) compared with placebo. However, the risk of TEAEs, SAEs, and infections was not significantly different between the JAK inhibitor and placebo groups. Subgroup analysis showed that JAK1 and JAK1/2 inhibitors were more effective than JAK3 inhibitors. However, there was insufficient evidence to suggest that the route of administration affects the efficacy and safety of JAK inhibitors in vitiligo. These findings indicate that JAK inhibitors are effective in repigmentation and well tolerated in patients with vitiligo.

A systematic review of stereotactic radiosurgery for metastatic spinal sarcomas

PURPOSE

Sarcomas metastasizing to the spine are a rare entity. Ideally an En-bloc resection is necessary to achieve durable local control (LC) rates. However, anatomical constraints often limit the degree of tumor resection. Because of this, other therapeutic modalities either replacing or as an adjuvant to resection are necessary. Stereotactic radiosurgery (SRS) is a reasonable candidate therapy.

METHODS

We conducted a systematic review of the literature using the following databases: PubMed, Science Direct, and Cochrane library. We used a combination of the following terms connected by boolean operators: "Metastatic Sarcoma, Sarcoma of the Spine, Spine Sarcoma, Metastasis, stereotactic radiosurgery, SRS." All retrospective and prospective cohorts, as well as randomized control trials reporting on patients with histopathologically confirmed metastatic sarcomas of the bony elements of the vertebrae, thecal sac, cord, or associated soft tissues of the spine were included. We excluded animal studies, case reports, case series, patients < 18 (pediatric cohorts), review articles and meta-analyses. No date filters were applied to our search.

RESULTS

Our final analysis included 5 studies ranging from 2009 to 2024 reporting on 260 patients and 371 associated lesions. Leiomyosarcoma was the most frequently reported histologic subtype (60%). Most lesions were localized to the thoracic spine (48.6%). 75% of studies reported a median dose < 30 Gy, and achieved biologically equivalent doses (BEDs) ranging from < 50-100. Pooled 1-year median survival was 64.5% (IQR: 61.8-75.10). Pooled 1-year median LC was 86% (IQR: 79.4-88.5). Three of five studies (60%) for OS and 4/5 (80%) for LC had data availability suitable for meta-analysis. The 1-year OS and LC rates proportions across these studies were 67% (proportion = 0.67, 95% CI: 0.57-0.75, p = 0.07, I2 = 63%), and 84% (proportion = 0.84, 95% CI: 0.78-0.89, p = 0.10, I2 = 52%) respectively. Median follow up across all studies was 18 months (IQR:12.7-31.3).

CONCLUSIONS

SRS is a reasonable alternative therapy in either the up front, salvage or adjuvant setting which can facilitate durable LC.

The bioinductive collagen implant yields positive histological, clinical and MRI outcomes in the management of rotator cuff tears: A systematic review

PURPOSE

The aim of this study is to report and discuss the outcomes of clinical, histological and animal studies exploring the application of bio-inductive collagen implants (BCIs) to partial and full-thickness rotator cuff tears (PT- and FT-RCTs) in addition to reporting on cost-related factors.

METHODS

Review of literature was performed using the PRISMA guidelines. A systematic electronic literature search was conducted using the CENTRAL, CINAHL, Cochrane Library, EBSCOhost, EMBASE and Google Scholar bibliographic databases. Microsoft Excel was used to create tables onto which extracted data were recorded. Tables were organized based on the research statement formulated using the PICO approach. No statistical analysis was performed.

RESULTS

Nine studies evaluated clinical and MRI outcomes of BCI augmentation for FT-RCTs, seven evaluated similar outcomes when applied to PT-RCTs, two additional studies were case reports and three studies assessed application to FT- and PT-RCTs without stratification of results, one of which also reported on histological data. Two studies reported on histological data alone, and finally, two reported on healthcare costs. BCI augmentation, alone and combined with rotator cuff repair (RCR), displays generally good histological, postoperative clinical and MRI outcomes for PT- and FT-RCT treatment. Recent economic analyses seem to be in favour of the use of this procedure, when selected and applied for appropriate patient populations.

CONCLUSION

Several studies have shown promising results of BCI application to PT- and FT-RCTs, both concomitantly and independently from RCR. Investigations report promising histological characteristics, improved clinical outcomes, increased tendon thickness, reduced defect size and lower re-tear rates.

LEVEL OF EVIDENCE

Level IV.

The Association of Preoperative Bone Mineral Density and Outcomes After Anterior Cervical Discectomy and Fusion: A Systematic Review

STUDY DESIGN

This is a systematic review.

OBJECTIVE

To evaluate anterior cervical discectomy and fusion (ACDF) outcomes and complications as a function of preoperative bone mineral density (BMD).

SUMMARY OF BACKGROUND DATA

Preoperative BMD optimization is commonly initiated before lumbar spinal fusion, but the effects of BMD on ACDF are less known. Consequently, it remains unclear whether preoperative BMD optimization is recommended before ACDF.

METHODS

This systematic review included relevant clinical articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Web of Science, SCOPUS, and MEDLINE from database inception until October 1, 2023. Eligible studies included those evaluating low BMD and outcomes after ACDF. All articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale and Critical Appraisal Skills Programme (CASP) assessment tools.

RESULTS

The initial retrieval yielded 4271 articles for which 4 articles with 671 patients were included in the final analysis. The mean patient age was 56.4 ± 3.9 years, and 331 patients (49.3%) were female. A total of 265 (39.5%) patients had low BMD (T score<-1.0) before ACDF. Preoperative low BMD was associated with cage subsidence in single-level ACDF (odds ratio (OR) 2.57; P =0.063; 95% Confidence Interval (CI): 0.95-6.95), but this result did not reach statistical significance. Osteoporosis (T score<-2.5) was associated with the development of adjacent segment disease following ACDF (OR 4.41; P <0.01; 95% CI: 1.98-9.83). Low pre-operative BMD was associated with reoperation within 2 years ( P <.05) and strongly associated with pseudarthrosis (OR: 11.01; P =0.002; 95% CI 2.4-49.9).

CONCLUSIONS

Patients with low BMD who undergo ACDF have higher rates of subsidence, adjacent segment disease, and pseudarthrosis than those with normal BMD. Given the individual and system-wide burdens associated with these complications, some patients may benefit from preoperative BMD screening and optimization before undergoing ACDF.

Response of VO2max to dark chocolate consumption in healthy subjects: A systematic review and meta-analysis of randomized controlled trials

The potential role of dark chocolate (DC) in enhancing exercise performance remains underexplored. While DC has been associated with various health benefits, its specific impact on endurance performance, particularly VO2max, has not been conclusively established. This meta-analysis examined the effect of DC on VO2max in healthy individuals using PRISMA guidelines. Following the application of inclusion and exclusion criteria, five randomized controlled trials (RCTs) involving 144 participants were included, with VO2max as the primary outcome. The meta-analysis revealed no significant effect of DC on VO2max (SMD = 0.14, 95% CI: -0.16 to 0.44, p = 0.36). Heterogeneity among the studies was low (Q-value = 3.34, I2 = 0.00, p = 0.50), and sensitivity analysis confirmed the robustness of the findings, as excluding individual studies did not alter the results (SMD = 0.14, 95% CI: -0.16 to 0.44, p = 0.36). In conclusion, this meta-analysis suggests that DC consumption does not significantly improve VO2max in healthy individuals. Future research should explore the effects of DC on other aspects of exercise performance, as well as its long-term impact, to better understand its potential role in athletic and health-related outcomes.

Detection of Enterococcus faecalis and the red complex bacteria analyzed by the Checkerboard technique for DNA-DNA hybridization in endodontic infections: A systematic review and meta-analysis

Endodontic infections include conditions such as pulp necrosis, apical periodontitis, abscesses, granulomas, and periapical cysts. Detection of pathogenic microorganisms responsible for these diseases is essential for accurate diagnosis and future therapy. Enterococcus faecalis, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were analyzed qualitatively and quantitatively using the Checkerboard methodology for DNA-DNA hybridizations as a bacterial identification tool. Clinical investigations have shown a significant frequency of these microorganisms. The present systematic review and meta-analysis aimed to determine the prevalence of E. faecalis and red complex bacteria (RCB) (P. gingivalis, T. forsythia, and T. denticola) analyzed by the Checkerboard DNA-DNA hybridization technique in endodontic infections. This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines-electronic databases: PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar. Statistical analysis was performed using STATA V.15 software. Seventeen articles were included, of which a total of 620 samples were evaluated. Five hundred sixty-seven samples were taken from infected root canals, 34 samples from periradicular tissues, and 27 samples from periapical abscesses of infected teeth. The prevalence of E. faecalis in endodontic infections in all studies was 74 %, of P. gingivalis was 63 %, of T. forsythia 46 %, and of T. denticola 58 %. The presence of bacteria such as E. faecalis reduces the efficiency of endodontic therapy and leads to recurring infections. It is recognized that "RCB" can be identified in endodontic lesions; however, they are not usually prominent. The DNA-DNA hybridization approach is critical for identifying bacteria and detecting difficult-to-culture microorganisms, making it a helpful and cost-effective tool for directing personalized endodontic treatments.

Identifying the panorama of potential pandemic pathogens and their key characteristics: a systematic scoping review

The globe has recently seen several terrifying pandemics and outbreaks, underlining the ongoing danger presented by infectious microorganisms. This literature review aims to explore the wide range of infections that have the potential to lead to pandemics in the present and the future and pave the way to the conception of epidemic early warning systems. A systematic review was carried out to identify and compile data on infectious agents known to cause pandemics and those that pose future concerns. One hundred and fifteen articles were included in the review. They provided insights on 25 pathogens that could start or contribute to creating pandemic situations. Diagnostic procedures, clinical symptoms, and infection transmission routes were analyzed for each of these pathogens. Each infectious agent's potential is discussed, shedding light on the crucial aspects that render them potential threats to the future. This literature review provides insights for policymakers, healthcare professionals, and researchers in their quest to identify potential pandemic pathogens, and in their efforts to enhance pandemic preparedness through building early warning systems for continuous epidemiological monitoring.

ESTRO guidelines for developing questionnaires in survey-based radiation oncology research

Survey-based research is increasingly used in radiation oncology, yet survey-based research methodology is often unfamiliar in the field. This guideline offers comprehensive instructions for conducting survey-based research in radiation oncology, covering critical aspects such as survey design, validation, dissemination, analysis, and reporting. Tailored to professionals, it emphasizes the importance of methodological rigour to ensure reliable and actionable data collection. Dissemination strategies are highlighted to maximize response rates and enhance data completeness across diverse clinical, research and industrial settings. Rigorous analysis techniques are discussed to uncover insights that optimize operational efficiencies and inform evidence-based practices. Transparent reporting is underscored as crucial for enhancing the credibility and applicability of findings. This guideline aims to be a practical resource for enhancing research standards in survey-based research for researchers and practitioners in radiation oncology.

The impact of intermittent fasting on fertility: A focus on polycystic ovary syndrome and reproductive outcomes in Women-A systematic review

Introduction

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder characterized by hyperandrogenism, insulin resistance, and menstrual irregularities, leading to infertility in many women. Emerging evidence suggests intermittent fasting (IF), particularly time-restricted feeding (TRF), may improve reproductive and metabolic outcomes in women with PCOS by addressing core pathophysiological mechanisms. This systematic review examines the impact of IF on fertility and reproductive hormones in women with PCOS.

Methods

A systematic search was conducted in PubMed, Scopus, and Cochrane Library using predefined search terms related to intermittent fasting, fertility, and PCOS. Eligible studies published between 2014 and 2024 were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria targeted primary research evaluating the effects of IF on reproductive outcomes, menstrual irregularities, and metabolic parameters in women with PCOS. Data extraction and quality assessment were performed using the Caldwell framework.

Results

Three studies were included in the review. TRF interventions led to significant improvements in menstrual regularity, with 33-40 % of participants reporting normalized cycles. Reductions in total testosterone, free androgen index, anti-Müllerian hormone (AMH), and luteinizing hormone (LH) levels were observed, alongside increased sex hormone-binding globulin (SHBG). TRF also improved insulin sensitivity, reduced body weight, and decreased inflammatory markers, all of which contribute to enhanced reproductive outcomes. Key outcomes included a 9 % reduction in testosterone levels, 26 % reduction in the free androgen index (FAI), and significant improvements in menstrual regularity (33-40 %).

Conclusions

Intermittent fasting, particularly TRF, shows potential as a non-pharmacological intervention to improve reproductive health and fertility in women with PCOS. By targeting hyperandrogenism, insulin resistance, and menstrual irregularities, TRF offers a promising lifestyle approach. However, larger randomized controlled trials with long-term follow-up are needed to confirm these findings and establish IF as a standard therapeutic option for PCOS management.

Efficacy and safety of laparoscopic bariatric surgery in patients of 70 years and older: A systematic review and meta-analysis

INTRODUCTION

Aging population and growing obesity prevalence are two major public health issues. Bariatric surgery has been shown to be both safe and effective, but its role in the treatment of the elderly remains controversial.

OBJECTIVES

To evaluate the efficacy and safety of laparoscopic bariatric surgery in patients over 70 years of age.

METHODS

A systematic review and assessment of the literature was performed in November-December 2023. Inclusion criteria gathered studies of elderly (age ≥70 years old) who underwent laparoscopic bariatric surgery. The data extraction focused on weight loss, obesity-related diseases, and complications.

RESULTS

Fourteen retrospective studies were included, involving 3923 septuagenarians (female, 69.70%). One year after the surgery, the mean excess weight loss was 54.66%. At last follow-up, the improvement in obesity-related diseases was regarded as 50% diagnosed with diabetes, 36% with hypertension, 50% with reflux, 36% with sleep apnea, and 25% with hyperlipidemia. The overall postoperative major morbidity and mortality were about 2% and 1%, respectively.

CONCLUSIONS

This systematic review suggests that laparoscopic bariatric surgery is an effective and safe treatment for patients over 70 years of age.

Validated Tools Used to Assess Musculoskeletal Injuries in Dancers: A Systematic Review

Introduction: Dance is a physically demanding art form that often results in musculoskeletal injuries. To effectively treat these injuries, standardized and reliable assessment tools designed to the dancer's needs are required. Thus, the aim of this review is to identify studies that have employed validated tools to assess musculoskeletal injuries in ballet, modern, and contemporary dancers, focusing on describing the content and psychometric quality of the tools used. Methods: This systematic review is registered at PROSPERO (CRD42022306755). PubMed, Cochrane, LILACS, Web of Science and SPORTDiscus databases were searched by two independent reviewers. Articles assessing musculoskeletal injuries with validated tools in ballet, modern and/or contemporary dancers and written in English, Portuguese, or Spanish were included. Non-peer reviewed articles, books, conference abstracts, thesis/review articles, or case design studies were excluded. The original validation studies were compiled when necessary. Two independent reviewers conducted a standardized data extraction and evaluated the methodological quality using an adapted Downs and Black checklist. Results: From the 3933 studies screened, 172 were read to verify if they met the inclusion criteria, resulting in 37 studies included accounting for 16 unique validated tools. Two were imaging exams, one was an injury classification system, and 13 were self-reported injury questionnaires. Only four injury assessment tools were validated for dancers, emphasizing the need for further validation studies for the dance population. Most of the articles (57%) achieved high-quality methodological scores and the remaining (43%) reported medium-quality scores. Conclusions: Valid, reliable, and specific tools to assess dance injuries are lacking in general. For enhanced methodological rigor in future studies, the incorporation of validated tools is recommended to improve methodological quality and facilitate cross-study comparisons. Researchers may consider conducting validation studies, involving processes such as translation into another language, validation of modifications to the original tool, or reporting reliability within the article itself.

Role of Incretin Mimetics in Cardiovascular Outcomes and Other Classical Cardiovascular Risk Factors beyond Obesity and Diabetes Mellitus in Nondiabetic Adults with Obesity: a Meta-analysis of Randomized Controlled Trials

BACKGROUND

Emerging data on cardiovascular outcomes, specifically major adverse cardiovascular events (MACE), are being reported from various trials involving incretin mimetics, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and glucose-dependent insulinotropic polypeptide (GIP), especially among patients with obesity and diabetes. Our aim was to evaluate this matter, while also involving various traditional cardiovascular risk factors [e.g., several body weight (BW) parameters, blood pressure (BP), lipid profile].

METHODS

A search of PubMed, Europe PMC, ScienceDirect, Cochrane, and ClinicalTrials.gov up to September 2024 was performed to identify GLP-1 RA and GIP trials in MACE risk reduction as a primary endpoint. Our secondary endpoints included a reduction in BW, waist circumference (WC), body mass index (BMI), BP changes, and lipid modifying effects, while also yielding safety concerns surrounding the use of these pharmaceutical agents. Mean differences (MD) and risk ratios (RR) were summarized using random-effects model.

RESULTS

A total of 11 eligible randomized controlled trials (RCTs) comprising 8 GLP-1 RA trials and 3 dual GLP-1 RA/GIP (tirzepatide) trials were included. Compared with control groups, GLP-1 RA significantly reduced the MACE risk by 32% [RR 0.68 (95% CI 0.53-0.87); P = 0.002; I2 = 73%, P-heterogeneity < 0.001] and 59% for tirzepatide [RR 0.41 (95% CI 0.18-0.92); P = 0.03; I2 = 0%, P-heterogeneity = 0.96]. Incretin mimetics also substantially reduced BW, BP, and improved lipid panel measures. However, there was an increased risk of adverse events, specifically gastrointestinal disorders within the incretin mimetics subset.

CONCLUSIONS

Incretin mimetics have shown promise in reducing MACE risk while also enhancing cardiovascular risk factors, including blood pressure and lipid profile, in adults with obesity without diabetes.

Andean medicinal plants and their secondary metabolites: Connections between Aymara traditional medicine and modern pharmacology

This review examines Aymara traditional medicine, which is deeply rooted in cultural perceptions of health and disease, and its utilization of medicinal plants rich in secondary metabolites-such as flavonoids, alkaloids, and saponins-to support immune function, emphasizing the synergy between ancestral knowledge and modern scientific research. Adhering to PRISMA 2020 guidelines, this review incorporates empirical studies from 2013 to 2024 on secondary metabolites and Aymara medicine, with a focus on the immunomodulatory effects of plants, while excluding non-indexed or irrelevant studies. Potential limitations include publication bias and reliance on secondary data. Three key plant genera-Azorella, Centaurium, and Amaranthus-were identified for their traditional medicinal uses, highlighting their pharmacological benefits, such as anti-inflammatory, antioxidant, and hepatoprotective effects. Specifically, xanthones, a class of secondary metabolites found in Centaurium, exhibit notable antioxidant, anti-inflammatory, antitumoral, and cardioprotective properties, which support their traditional use in treating hypertension and related ailments. Centaurium spp. is characterized by its bioactive compounds (secoiridoids, flavonoids, phenolic acids, and xanthones), offering valuable immunomodulatory, anti-inflammatory, digestive, and antimicrobial properties recognized in both scientific and traditional Aymara medicine for treating diseases and maintaining physical and spiritual balance. Overall, the study of secondary metabolites in Andean medicinal plants like Azorella, Centaurium, and Amaranthus underscores their diverse bioactive compounds with pharmacological properties, highlighting the Aymara community's integration of traditional and modern medicine through holistic practices that promote health, balance, and resilience against disease, while emphasizing the potential of these practices to enhance contemporary healthcare.

Medical device-related pressure injuries in the operating room: A scoping review

AIMS

To map the existing literature describing medical device-related pressure injuries in patients during surgery, including investigation of the incidence, types of medical devices, risk factors and strategies for preventing medical device-related pressure injuries.

DESIGN

A scoping review.

DATA SOURCES

In April 2023, three databases were searched. Studies about adult patients undergoing surgery, from 2014 onwards, in English and Chinese were included. Data were extracted about study characteristics and data related to research questions. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework were used to synthesize findings.

RESULTS

Two different types of evidence were included in this review; 14 research studies and two quality improvement studies. The incidence of medical device-related pressure injuries in the operating room was 0.56%-24.5% and respiratory devices were the most common medical devices investigated. Length of surgery, age and BMI were risk factors for medical device-related pressure injuries in a few studies. The application of a prophylactic dressing and dressing maintenance was the most common prevention strategy.

CONCLUSION

Ongoing research is needed to confirm the incidence of, and risk factors for, medical device-related pressure injuries in the operating room. Additionally, more high-quality evidence is needed to underpin current prevention strategies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Operating room nurses need to be aware of the risks of medical device-related pressure injuries and assess and plan prevention strategies accordingly. Once more high-quality evidence is available, operating room nurses could implement prevention strategies like prophylactic dressings.

REPORTING METHOD

Scoping Reviews (PRISMA-ScR) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Efficacy of chimeric antigen receptor engineered natural killer cells in the treatment of hematologic malignancies: a systematic review and meta-analysis of preclinical studies

BACKGROUND

Chimeric antigen receptor (CAR) engineered NK cells (CAR-NK) are a novel approach to the immunotherapy of hematologic malignancies which seeks to overcome some of the challenges faced by CAR-T cells (CAR-T). With few published clinical studies, preclinical studies can identify strategies to accelerate clinical translation. We conducted a systematic review on the preclinical in vivo use of CAR-NK for the treatment of hematologic malignancies to assess these therapies in a holistic and unbiased manner.

METHODS

Our protocol was registered with PROSPERO (ID: CRD42023438375). We performed a search of OVID MEDLINE, OVID Embase, and Embase for animal studies employing human CAR-NK cells in the treatment of hematologic malignancies. Screening of studies for eligibility criteria was performed in duplicate. Our primary outcomes were survival and reduction in tumor volume. Data extraction from individual experiments was performed by one reviewer using DigitizeitTM software and verified by a second reviewer. Meta-analysis and subgroup analyses were performed using Comprehensive Meta-AnalysisTM software. Information for descriptive outcomes was extracted in duplicate by two independent reviewers. Risk of bias was assessed using the SYRCLE Risk of Bias Tool for Animal Studies.

RESULTS

A total of 34 papers met eligibility criteria. Overall, CD19 was the most common antigen targeted however there was substantial diversity in antigenic targets, source material for generating CAR-NK cells, and NK cell modifications. Mice treated with CAR-NK therapy survived significantly longer than untreated mice (median survival ratio of 1.18, 95% CI: 1.10-1.27, P < 0.001), and mice treated with nonengineered NK cells (median survival ratio 1.13, 95% CI: 1.03-1.23, P < 0.001). Similarly, treatment with CAR-NK significantly reduced the tumor burden when compared to untreated mice (ratio of mean tumor volume 0.23, 95% CI: 0.17-0.32, P < 0.001) or mice treated with nonengineered NK cells (ratio of mean tumor volume 0.37, 95% CI: 0.28-0.51, P < 0.001). Subgroup analysis showed that cotreatment with IL-15 reduced tumor volume but did not increase survival. In general, CAR-NK cell persistence was short but was increased by IL-15.

CONCLUSIONS

CAR-NK shows promise for the treatment of hematologic malignancies in preclinical models.

Paclitaxel-Coated Balloon for the Management of In-Stent Coronary Restenosis: An Updated Meta-Analysis and Trial Sequential Analysis

BACKGROUND

Drug-coated balloons present a potentially advantageous therapeutic approach for managing coronary in-stent restenosis (ISR). However, the comparative benefits of paclitaxel-coated balloons (PCBs) over uncoated balloons (UCBs) remain unclear.

AIMS

We conducted a systematic review and meta-analysis to evaluate and compare the clinical outcomes of patients treated with PCBs and UCBs.

METHODS

We systematically searched PubMed, Embase, and Cochrane for studies comparing PCBs and UCBs in managing coronary ISR. We used a random-effects model to pool risk ratios (RRs) and their 95% confidence intervals (CIs). Statistical analyses were conducted using Review Manager 5.4.1. Heterogeneity was assessed using I2 statistics. Quality and risk of bias were evaluated using the Cochrane Collaboration's tool.

RESULTS

We included seven randomized controlled trials with 1349 patients, of whom 840 underwent percutaneous coronary intervention with PCB. In our pooled analysis, patients treated with PCB had lower risks of target lesion revascularization (RR 0.31, 95% CI 0.18-0.52; p < 0.01), target vessel revascularization (0.53, 0.42-0.67; p < 0.01), major adverse cardiac events (MACEs) (0.25, 0.16-0.38; p < 0.01), and myocardial infarction (MI) (0.59, 0.37-0.95; p = 0.03). However, there were no significant differences in all-cause mortality (0.79, 0.37-1.70; p = 0.54), cardiac death (0.46, 0.03-8.12; p = 0.60), while tendencies for a significant difference were found for target lesion failure (0.39, 0.13-1.11; p = 0.08), or stent thrombosis (0.21, 0.03-1.35 p = 0.10).

CONCLUSION

These findings suggest that PCBs are superior to UCBs regarding the occurrence of target lesion revascularization, target vessel revascularization, MACEs, and MI, but they do not differ in all-cause mortality, and cardiac death, while trends to significant differences favoring PCB were found to stent thrombosis and target lesion failure.

Rifampicin and its neuroprotective properties in humans - A systematic review

BACKGROUND

Rifampicin is an antimicrobial drug used in the treatment of mycobacterial and gram-positive bacterial infections. In vitro studies suggest additional rifampicin-associated reduction of neurotoxicity. The aim of this study was to review the evidence for neuroprotective effects of rifampicin in infectious and non-infectious diseases in human studies.

METHODS

A systematic literature search was done in MEDLINE and Embase including studies from 1 Jan 1946/47-20 Jan 2024, in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) (PROSPERO ID: CRD42022349852). Original articles investigating the effect of rifampicin on infections of the central nervous system (CNS) or on neurodegenerating diseases, were included. Screening, data extraction and risk of bias assessment were done using the Covidence software. Two authors assessed and extracted articles independently and blinded to each other.

RESULTS

1438 articles were identified of which eight were included in the final analysis: Four studies included patients with infectious diseases and four studies with neurodegenerative diseases. A neuroprotective effect of rifampicin was shown in five studies. The studies found reduced inflammatory parameters in the cerebrospinal fluid, improved neurological outcome, less cognitive decline, less brain atrophy or less metabolic decline on imaging as an effect of rifampicin. One RCT showed worsening of cognitive assessment scales in neurodegenerative patients.

CONCLUSION

Current evidence suggests a neuroprotective effect of rifampicin in humans. As evaluation of neuroprotection is not standardized, a consensus definition for evaluation of clinical, radiological, and neuropsychological follow-up after pharmacological intervention would be helpful for future studies assessing neuroprotection.