Editorial: Review Articles, Systematic Reviews, Meta-Analysis, and the Updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines

The clinicopathologic and prognostic value of CD44 expression in patients with non-small cell lung cancer: A systematic review and meta-analysis

BACKGROUND

CD44 is a promising target in the prognosis and treatment of non-small cell lung cancer (NSCLC). The study deals with systematic review and meta-analysis to determine the association between CD44 overexpression and survival and clinicopathological characteristics in NSCLC patients.

METHODS

We used the databases Google Scholar, Web of Science, PubMed, Scopus, EMBASE, and Cochrane to conduct a systematic search of English-language literature published up to September 2023. The eligible studies were retrieved on CD44 expression, clinicopathological characteristics in NSCLC patients, and reported survival rates. The Cochran's and Higgins I2 tests were used to measure heterogeneity across the included studies. P < 0.05 was considered statistically significant in all cases. The sources of heterogeneity across the included studies were identified using subgroup analysis on histology (SCC, ADC, and LCC), tumor differentiation (well, moderate, and poor), TMN stage (I/II/III/IV), OS, and lymph node metastasis (negative and positive). All statistical analyses were carried out using meta-analysis (CMA) software.

RESULTS

The final analysis for prognostic significance and clinicopathological features on 3681 participants from 25 eligible studies. The pooled event rate of overexpression CD44 for overall survival in NSCLC was 38 % and was related to SCC with 76.6 %. Furthermore, subgroup analysis revealed a link between CD44 overexpression and moderate tumor differentiation (41.8 %). There was a substantial difference in CD44 overexpression in males, with 69.3 % (95 % CI: 64.3-73.9 %, I2 = 88.25 %) versus 31.5 % (95 % CI: 26.7-36.8 %, I2 = 92.15 %) in females. However, no significant relationship was observed between CD44 overexpression and TMN stages/lymph node metastasis.

CONCLUSION

The meta-analysis demonstrated that CD44 is an effective prognostic factor for NSCLC. Overexpression of CD44 has been linked to moderate tumor differentiation, SCC tumor histology, and a worse survival rate. However, no substantial relationship was found between CD44 and metastasis or TMN stages. Large-scale prospective research is required to validate CD44's clinical value as an unbiased prognostic indicator.

PTSD subtypes and their underlying neural biomarkers: a systematic review

Posttraumatic stress disorder (PTSD) is a heterogenous disorder with frequent diagnostic comorbidity. Research has deciphered this heterogeneity by identifying PTSD subtypes and their neural biomarkers. This review summarizes current approaches, symptom-based group-level and data-driven approaches, for generating PTSD subtypes, providing an overview of current PTSD subtypes and their neural correlates. Additionally, we systematically assessed studies to evaluate the influence of comorbidity on PTSD subtypes and the predictive utility of biotypes for treatment outcomes. Following the PRISMA guidelines, a systematic search was conducted to identify studies employing brain imaging techniques, including functional magnetic resonance imaging (fMRI), structural MRI, diffusion-weighted imaging (DWI), and electroencephalogram (EEG), to identify biomarkers of PTSD subtypes. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. We included 53 studies, with 44 studies using a symptom-based group-level approach, and nine studies using a data-driven approach. Findings suggest biomarkers across the default-mode network (DMN) and the salience network (SN) throughout multiple subtypes. However, only six studies considered comorbidity, and four studies tested the utility of biotypes in predicting treatment outcomes. These findings highlight the complexity of PTSD's heterogeneity. Although symptom-based and data-driven methods have advanced our understanding of PTSD subtypes, challenges remain in addressing the impact of comorbidities and the limited validation of biotypes. Future studies with larger sample sizes, brain-based data-driven approaches, careful account for comorbidity, and rigorous validation strategies are needed to advance biologically grounded biotypes across mental disorders.

Comparative analysis of dermal and inhalation exposures to antineoplastic drugs among workers in the workplaces: a systematic review

OBJECTIVE

Occupational exposure to antineoplastic drugs presents significant health risks to workers, necessitating a comprehensive understanding of both dermal and inhalation exposures. This systematic review examines the relative significance of cutaneous versus inhalation exposure among professionals handling these potent medications.

STUDY DESIGN

Systematic review.

METHODS

A systematic search using the PECO framework was conducted in PubMed, Scopus, and Web of Science, adhering to PRISMA guidelines. Data from surface and air sampling studies were collected and analyzed.

RESULTS

Ten studies met the inclusion criteria, assessing various antineoplastic drugs across different occupational settings. Surface contamination levels varied widely, with concentrations ranging from very low to high, whereas airborne monitoring consistently reported "Not Detectable" levels. Exposure levels were influenced by workplace practices, handling procedures, and the sensitivity of detection methods.

CONCLUSIONS

This systematic review of ten studies on dermal and inhalation exposure to antineoplastic drugs in various occupational settings reveals significant variability in contamination levels. Tailored safety measures, including stringent protocols, decontamination procedures, and respiratory protection, are essential for workplace safety. The review highlights the importance of standardized safety protocols, considering the impact of workplace practices and detection method sensitivity. Additionally, it underscores the health risks associated with even low-level exposure, emphasizing the need for biological monitoring. Despite some limitations, this study offers valuable insights for enhancing the safety of staffs handling these potent drugs, guiding future research and policy development.

Short versus long cephalomedullary nails for intertrochanteric femur fractures: A meta-analysis of randomized controlled trials

PURPOSE

We aim to evaluate the efficacy and safety of short cephalomedullary nails(CMN) versus long CMN in patients with intertrochanteric femur fractures(IFFs).

METHODS

The PubMed, Web of Science, and Embase databases were searched for relevant publications until July 2024. All randomized controlled studies evaluating the efficacy and safety of short CMN versus long CMN in patients with IFFs were included. We estimated the pooled risk ratio (RR) with 95% confidence intervals (CIs) for binary outcomes, and the mean difference (MD) for continuous outcomes.

RESULTS

A total of 7 studies with 658 patients were included in this analysis. There was no significant difference between the short CMN group and the long CMN group in Harris hip score, mortality within 1-year, overall complication rates, or reoperation rates. However, durations of surgery were significantly lower in the short CMN group compared to the long CMN group (MD: ‒21.83 minutes, 95% CI: ‒27.54 minutes, ‒16.13 minutes), along with significantly lower intraoperative blood loss (MD: ‒136.70 mL, 95% CI: ‒139.06 mL, ‒134.34 mL) and tip-apex distance (MD: ‒0.47 cm, 95% CI: ‒0.63 cm, ‒0.31 cm). There was also no significant difference in peri-implant fracture or lengths of hospital stays.

CONCLUSIONS

Short CMN are associated with shorter duration of surgery, reduced tip-apex distance, and lower intraoperative blood loss compared to long CMN for the fixation of IFFs. However, there were no significant differences in functional outcomes, overall complication rates, reoperation rates, mortality within one year, peri-implant fracture, or lengths of hospital stays.

Impacts of Communication Type and Quality on Patient Safety Incidents : A Systematic Review

BACKGROUND

Poor communication in health care increases the risk for patient safety incidents. However, there is no up-to-date synthesis of these data.

PURPOSE

To synthesize studies investigating how poor communication between health care practitioners and patients (and between different groups of practitioners) affects patient safety.

DATA SOURCES

Ovid MEDLINE, CINAHL, APA PsycInfo, CENTRAL, Scopus, and the ProQuest Dissertations & Theses Citation Index from 1 January 2013 to 7 February 2024.

STUDY SELECTION

Studies published in any language that quantified the effects of poor communication on patient safety.

DATA EXTRACTION

Two independent reviewers extracted data, assessed risk of bias, and appraised strength of evidence. Study heterogeneity precluded meta-analysis, so results were reported with narrative description, reporting medians and interquartile ranges (IQRs).

DATA SYNTHESIS

Forty-six eligible studies (67 826 patients) were included. Risk of bias was low for 20, moderate for 16, and high for 10 studies. Four studies investigated whether poor communication was the only identified cause of a patient safety incident; here, poor communication caused 13.2% (IQR, 6.1% to 24.4%) of safety incidents. Forty-two studies investigated whether poor communication contributed to patient safety incidents alongside other causes; here, poor communication contributed to 24.0% (IQR, 12.0% to 46.8%) of safety incidents. Study heterogeneity was high in terms of setting, continent, health care staff, and safety incident type. The strength of the evidence was low or very low.

LIMITATION

There was important study heterogeneity, generally low study quality, and poor reporting of essential data.

CONCLUSION

Poor communication is a major cause of patient safety incidents. Research is needed to develop effective interventions and to learn more about how poor communication leads to patient safety incidents.

PRIMARY FUNDING SOURCE

Stoneygate Trust. (PROSPERO: CRD42024507578).

Breast cancer and suicide: A comprehensive systematic review and meta-analysis of suicidal behaviours mortality and risk factors among women with breast cancer

BACKGROUND

Suicidal behaviours, including ideation, attempts, and mortality, are significant yet often overlooked concerns among women with breast cancer. While the psychological burden of breast cancer has been studied, comprehensive data on the prevalence and risk factors of suicidal behaviours in this population remain limited.

OBJECTIVE

This systematic review and meta-analysis aim to assess the prevalence, incidence, and risk factors associated with suicidal behaviours among women with breast cancer.

METHODS

A literature search was conducted using Embase, MEDLINE, CINAHL, Web of Science, and Academic Search Complete for studies published up to June 2024. Search terms included 'breast cancer,' 'suicidal behaviour,' 'suicide ideation,' 'suicide attempts,' 'self-harm,' and 'self-injury.' Eligible studies included primary data on suicidal ideation, attempts, or completed suicides among women with breast cancer. Meta-analyses were performed using random-effects models, and heterogeneity was assessed with the I2 statistic.

RESULTS

Twenty studies comprising 3450,022 participants were included. The pooled prevalence of suicidal ideation was 10 % (95 % CI 0.01-0.63, p < 0.001), while suicide attempts were reported at 2 % (95 % CI 0.01-0.03, p < 0.001). Suicide mortality was observed in 0.001 % (95 % CI 0.001-0.002, p < 0.001). Younger age (18-45 years), advanced cancer stages (stage IV), and unmarried status were significant risk factors.

CONCLUSION

Suicidal behaviours are prevalent among women with breast cancer, particularly in younger, unmarried patients with advanced cancer stages. Comprehensive mental health support is crucial in reducing suicide risk.

Exploring the Use of 5 Different Yo-Yo Tests in Evaluating V ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ and Fitness Profile in Team Sports: A Systematic Review and Meta-Analysis

This review aims to examine the relationship between five different Yo-Yo tests andV ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ as well as performance in various fitness tests, to provide practical guidance for fitness assessment. Thirty-three studies (n = 1362) were analyzed to qualitatively score correlation magnitude (r-values) between five different Yo-Yo tests withV ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ . The association between Yo-Yo tests and physical fitness tests were examined including 36 studies (n = 1262 participants). Large correlations were found betweenV ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ and Yo-Yo Intermittent Endurance level 1 (r = 0.67), and level 2 (r = 0.67), Yo-Yo Intermittent Recovery level 1 (r = 0.65), and level 2 (r = 0.55). Yo-Yo tests showed moderate correlations with the jump tests (r = 0.40). Large associations were reported between Yo-Yo tests performance and treadmill endurance test (r = 0.59) and the field-based endurance tests (r = 0.66), respectively. These findings confirm Yo-Yo tests as reliable and valid tests for estimatingV ̇ O 2 max $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ and endurance performance in team sports, supporting their integration in structured testing batteries. Coaches should supplement Yo-Yo tests with specific strength and sprint assessments for a comprehensive fitness evaluation of the team sport athletes.

Scoping Review on Mitigating the Silent Threat of Toxic Industrial Waste: Eco-Rituals Strategies for Remediation and Ecosystem Restoration

Background

The problem of toxic industrial waste impacting soil and water quality remains a significant environmental threat, yet comprehensive solutions are lacking. This review addresses this gap by exploring the effects of industrial waste on ecosystems and proposing strategies for remediation. Its aim is to provide a thorough understanding of the issue and suggest actionable solutions to minimize environmental damage.

Methods

A comprehensive scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were sourced from major academic databases, including Science Direct, Scopus, PubMed, Academic Search Premier, Springer Link, Google Scholar, and Web of Science. A total of 105 relevant articles were included based on strict eligibility criteria. The review process encompassed identification, screening, and eligibility checks, followed by data abstraction and analysis.

Results

The scoping review highlights the severe impact of toxic industrial waste on soil and water quality, emphasizing pollutants such as heavy metals (cadmium, lead, chromium), organic contaminants, and excess nutrients (nitrogen and phosphorus). These pollutants degrade aquatic ecosystems, causing acidification, eutrophication, and oxygen depletion, leading to biodiversity loss and the mobilization of toxic metals. Soil health is similarly compromised, with heavy metal contamination reducing fertility and disrupting microbial communities essential for nutrient cycling. Mitigation strategies, including cleaner production technologies, effluent treatment, bioremediation, and phytoremediation, offer promising solutions. These eco-friendly approaches effectively reduce pollutants, restore ecosystems, and enhance environmental sustainability, thus mitigating the long-term risks posed by industrial waste on soil and water quality.

Conclusions and recommendations

The findings confirm that toxic industrial waste is a critical environmental threat that impacts both aquatic ecosystems and terrestrial soils. Immediate action is necessary to address ecological degradation. Recommended strategies include banning harmful raw materials, pre-treatment of waste, riparian buffering, bioremediation, and stricter regulations to control pollution and safeguard ecosystems.

Impact of platform switching implants on crestal bone level: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Despite the widespread success of dental implants, crestal bone loss (CBL) remains a significant challenge, compromising long-term stability and esthetics.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of platform switching in reducing CBL compared with conventional implant designs.

MATERIAL AND METHODS

This systematic review and meta-analysis used primary and alternate search terms (identified through MeSH searching) to retrieve relevant studies published up to April 2024 from global databases, including PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov. The random-effects model was applied to calculate the weighted mean differences (WMD) and 95% confidence interval (95% CI) of the CBL for the meta-analysis. The quality of the included studies was assessed with the Cochrane Risk of Bias Tool (RoB 2).

RESULTS

The meta-analysis revealed that the platform-switching technique significantly reduced CBL compared with conventional implant designs. On average, implants with platform switching showed a 0.22-mm reduction in CBL (WMD=-0.22; 95% CI=-0.39, -0.05; I²=58.18%; Pheterogeneity=.069). Subgroup analyses indicated that this reduction was most pronounced for single implants (WMD=-0.42; 95% CI=-0.49, -0.35) and at the posterior mandible site (WMD=-0.48; 95% CI=-1.11, -0.15). Conventional loading restorations also showed a greater decrease in CBL compared with immediate and functional loading (WMD=-0.33 versus -0.06 and -0.08). Additionally, longer follow-up periods beyond 36 months resulted in a more substantial reduction in CBL (WMD=-0.50; 95% CI=-0.55, -0.45).

CONCLUSIONS

These findings support the use of platform switching as a strategy to enhance implant stability and long-term outcomes, highlighting its potential for improving clinical practices in implant dentistry. Further research is recommended to confirm these benefits and explore the underlying mechanisms.

Manual Therapy for Cervical Radiculopathy: Effects on Neck Disability and Pain - A Systematic Review and Network Meta-Analysis

Objective

To evaluate the application effects of different manual therapy approaches in the treatment of cervical radiculopathy using a network meta-analysis.

Methods

Prospective randomized controlled trials on manual therapy for cervical radiculopathy published in PubMed, the Cochrane Library, and Embase databases were retrieved. The neck disability index and visual analogue scale for neck pain were collected and subjected to network meta-analysis.

Results

A total of 8 eligible studies involving 632 participants with a mean age range of 40-47 years were included. The intervention duration ranged from 4 to 6 weeks. Three intervention groups were defined: Group C (exercise and other therapies without manual therapy), Group M (manual therapy without traction), and Group MT (manual therapy with traction). Larger circles indicate more patients, and thicker lines show more studies comparing interventions. Group M had the highest probability (68.1%) of improving the neck disability index, followed by Group MT (29.1%), with Group C the lowest (2.8%). Compared to Group C, neck disability index scores improved by 0.58 (95% CI: -0.17, 1.33) in Group M and by 0.36 (95% CI: -0.39, 1.11) in Group MT. The difference between Group M and Group MT was not significant (0.22, 95% CI: -0.59, 1.03). For neck pain (visual analogue scale score), Group M had the highest probability (59.5%) of improvement, followed by Group MT (39.6%), with Group C the lowest (0.9%). Compared to Group C, the visual analogue scale score improved by 0.74 (95% CI: -0.04, 1.52) in Group M and by 0.61 (95% CI: -0.18, 1.40) in Group MT. The difference between Group M and Group MT was not significant (0.13, 95% CI: -0.72, 0.98). Egger's regression test showed no apparent publication bias.

Conclusion

Manual therapy is an effective approach for improving neck pain and neck disability index in patients with cervical radiculopathy, but more evidence-based support is needed regarding the use of cervical traction.

Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis

This study aims to explore the link between exposure to tobacco smoke among nonsmokers and the risk of lung cancer in the United States. We searched six databases for studies on second-hand smoke (SHS) and lung cancer following PRISMA guidelines. Following the random effects model and specific statistical methods, our meta-analysis analyzed studies based on SHS exposure type. A total of 19 eligible studies were included in the review and 15 in the meta-analysis. We covered exposure from parents (childhood), spouses and partners (household), and work-related exposure (colleagues), with higher risk among non-smoking children and domestic partners. Findings reveal a consistent link between SHS exposure and increased lung cancer risk for this population (exposure effect sizes: 1.05-3.11). Analysis of childhood SHS exposure reveals a distinct increased risk associated with parental exposure. For nonsmokers living with smoking spouses, there is a marked 41% increase in risk. Higher risk was associated with more and more prolonged SHS exposure. Exposure to SHS in the workplace shows a correlation with lung cancer risk. Our findings highlight increased SHS-related lung cancer risk, particularly among non-smoking children and domestic partners, intensifying with the amount and duration of exposure, indicating the significant impact of SHS within domestic environments.

A systematic review and meta-analysis of urinary incontinence following successful obstetric fistula repair: findings from five countries in sub-Saharan Africa

BACKGROUND

Obstetric vesico-vaginal fistula is a known complication that can occur following damage to the bladder wall during prolonged obstructed labor and operative delivery. Urinary incontinence following the repair of obstetric fistula remains a significant health problem and can greatly damage a women's ability to function confidently. There are approximately two million women suffering from urinary incontinence following obstetric fistula repair, most of whom are primarily in Africa.

OBJECTIVE

We aimed to systematically review and conduct meta-analysis on the magnitude of urinary incontinence among women following successful obstetric fistula repair in sub-Saharan African countries.

METHODS

We thoroughly searched online database including Medline, Scopus, Science Direct, Excerpta Medica Database, African Journals Online and Google Scholar for eligible articles from their inception to November 10, 2024. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 checklist. To generate pooled prevalence of urinary incontinence, we used random-effects model. The presence of publication bias was determined using a funnel plot and Egger's regression test.

RESULTS

Out of 1044 articles found following our initial search and after titles and abstracts review, we considered 277 full text articles for inclusion. Lastly, a total of 12 articles from five sub-Saharan African countries comprising 6,104 participants met the inclusion criteria for quantitative meta-analysis. The pooled prevalence of urinary incontinence following obstetric fistula repair was 16.32% (95%CI: 11.80, 20.84; I2 = 96.5%, P < 0.001).

CONCLUSION AND IMPLICATIONS

Overall, our findings show post-fistula repair incontinence remains an important clinical problem. Therefore, we believe that policy planners and researchers of sub-Saharan African nations may use the findings of the current study for evidence based care planning and patient counseling strategy.

REGISTRATION

Registered in PROSPERO under protocol number CRD42023416541.

Exploring adolescent girls' involvement in decision-making processes regarding child marriage: A systematic review

Child marriage often involves adolescents aged 10-19 years and poses significant health risks and challenges to gender equality. The aim of this systematic review was to examine the involvement of adolescent girls in decision-making processes regarding child marriage and identify influencing factors. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review covered studies published between January 2014 and July 2024. The databases searched included ScienceDirect, Springer Link, PubMed, and Taylor & Francis, using terms related to adolescent girls, decision-making, and child marriage. Inclusion criteria targeted studies involving girls aged 10-19, with methods including qualitative, quantitative, longitudinal, and mixed- method, published in English. Data extraction and quality assessment followed the standards of the Joanna Briggs Institute. Of 6,967 articles, 29 met the inclusion criteria, spanning 26 countries across three continents, with 51.7% being qualitative studies. Economic pressure was identified as the primary driver of child marriage, with significant parental and community influences restricting the girls' decision-making autonomy. Parents, especially fathers, often force girls into marriage to reduce economic burdens and enhance family honor. Some adolescent girls initiate marriage to escape adverse home conditions or societal stigma. Education and strong family support emerged as protective factors, while entrenched social norms perpetuated early marriages. Comprehensive approaches including educational improvement, economic support, and social norm transformation are essential. Addressing child marriage requires multidimensional strategies, encompassing enhanced educational opportunities, economic support, and changing entrenched social norms. Future research should focus on interventions that boost adolescent girls' life skills and decision-making autonomy to delay marriage and enable informed choices.

Meta-Analysis of Exposure-Adverse Event Relationships for Antibody-Drug Conjugates

Antibody-drug conjugates (ADCs) have become a vital class of therapeutics in oncology because of their ability to selectively deliver potent drug molecules to tumor cells. However, ADC-associated toxicities cause high failure rates in the clinic and hinder their full potential. Due to the complex structure and pharmacokinetics of ADCs, it is challenging to identify the drivers of their toxicities. Here, quantitative analysis was performed to correlate the incidence of clinical adverse events (AEs) with nine different commonly measured exposure parameters collected from study-level summary data. We considered ADC analytes for different classes of ADCs, to identify ADC analytes that are strongly associated with the AEs for ADCs. Published clinical exposure and safety data for any grade and grade ≥3 AEs from 40 publications across six ADCs and three payloads were collected and analyzed. Exposure-AE relationships were quantified using logit models, and the strength of the correlations and rank order were determined. The analysis suggests that deruxtecan ADC-related toxicities correlated most strongly with the exposure of the free payload; monomethyl auristatin E (MMAE) ADC-related toxicities correlated with the free MMAE area under the curve; and pyrrolobenzodiazepine ADC-related toxicities correlated with no specific analyte but the dose. These findings agree with the published literature and support the notion that AE profiles are often shared by ADCs that deliver the same cytotoxic payload. The exposure-AE relationships presented here, together with identification of the most informative ADC analytes, may facilitate more focused mechanistic studies on the drivers of clinical AEs and could support dosing decisions during clinical development of ADCs.

Impact of Climate Change on Adolescents' Health Outcomes: An Evidence Gap Map Review

BACKGROUND

The evolving impact of climate change on adolescents' health is a pressing global concern. Climate change's effects on their physical, mental, and social well-being worsen unique developmental challenges for adolescents. This study aims to map existing evidence, identify gaps, and highlight research and intervention needs.

METHODS

Following Campbell standards, an evidence gap map (EGM) review was conducted. We searched for global studies on adverse climate events and adolescents aged 10-19 using five databases such as Medline, EMBASE, Global Health, CINAHL, and Scopus from September 1946 to June 01, 2023. Two independent reviewers completed the screening using Covidence software, and a critical appraisal of all included studies. EGM was developed using EPPI Mapper software, which presents a comprehensive overview of climate events and their impact on adolescents' health outcomes. This study protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis (INPLASY) (# INPLASY202410119).

FINDINGS

We included 44 studies that explored the impact of climate change on adolescents' health. Most included studies were from Asia (35), with limited evidence from Africa, Australia, and South America (one study each). Earthquakes, hurricanes, and tornadoes were the major climate events impacting adolescents' health and well-being globally (37 studies). However, wildfires, droughts, and extreme heat got less attention. Most studies reported climate change's impact on adolescents' mental health (44), with few studies reporting the effect on physiological and psychosocial aspects of adolescents' health and well-being (10).

CONCLUSION

The systematic examination reveals significant evidence gaps, particularly in Africa, Australia, and South America, and in climate events like wildfires, droughts, and extreme heat. Most studies focus on mental health, with limited research on physiological and psychosocial aspects. These gaps highlight key areas for future research and targeted interventions at the intersection of adolescent health and climate change.

The impact of prebiotics, probiotics and synbiotics on the prevention and treatment of atopic dermatitis in children: an umbrella meta-analysis

Background

Studies have suggested that the administration of prebiotics, probiotics and synbiotics (pre-, pro-, and synbiotics) may potentially decrease the incidence of atopic dermatitis (AD) and alleviate its severity in children; however, recent studies have yielded inconclusive findings.

Objective

This umbrella meta-analysis aimed to comprehensively assess the effect of pre-, pro-, and synbiotics on AD among children.

Methods

A systematic search was carried out in the PubMed and Scopus databases up to April 2024 to identify relevant meta-analyses. Relative risks (RR) and weighted mean differences (WMD) along with their 95% confidence intervals (CI) were pooled using a random effects model to evaluate the impacts on both the incidence of AD and its severity, as assessed by the Scoring Atopic Dermatitis (SCORAD) index.

Results

This umbrella meta-analysis included 38 meta-analyses, with 127,150 participants. The analysis suggested that intervention with pre-, pro-, and synbiotics significantly reduced the incidence of AD (RR = 0.74, 95% CI: 0.70-0.79), which was confirmed by subgroup analyses. The treatment significantly reduced SCORAD score (WMD = -3.75, 95% CI: -5.08 to -2.42). In subgroup analysis, multi-strain probiotics, Lactobacillus, synbiotics, and pre-, pro-, and synbiotics mixtures were found to significantly decrease the SCORAD score, while, Bifidobacterium and prebiotics alone did not show a significant effect on the SCORAD score. The treatment resulted in a significant decrease in SCORAD score among children with moderate to severe AD, but not in subjects with mild AD.

Conclusions

Probiotics and synbiotics could be promising interventions to reduce the risk of developing AD and alleviate its severity in children.

Incidence of Adverse Drug Reactions Among HIV Patients on Antiretroviral Drugs in Ethiopia: A Systematic Review and Meta-Analysis

Introduction: In recent decades, AIDS-related illnesses have declined due to the widespread use of highly active antiretroviral therapy (HAART). Despite the numerous benefits that HAART provides, it causes significant challenges for users in the form of adverse drug reactions (ADRs). Therefore, this systematic review and meta-analysis was conducted to explore the pooled incidence of antiretroviral therapy-related adverse drugs in Ethiopia. Methods: A systematic review and meta-analysis was conducted on cohort studies conducted among HIV patients living in Ethiopia. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A random-effects meta-analysis was used to determine the pooled incidence of ADR. Heterogeneity was assessed, and the source of variation was analyzed using subgroup and sensitivity analyses. Funnel plots and Egger's regression tests were used to investigate publication bias. Results: Based on the random effects model from 10 extracted studies, the pooled incidence rate of adverse effects of ART drugs was 5.09 (95% CI: 3.86-6.71) per 100 person-years, with significant heterogeneity (I 2 = 96.4%, p < 0.0001). It was also observed to be higher in subgroups from multicenter study areas, studies employing both prospective and retrospective designs, and among children. Discussion: The findings of this systematic review and meta-analysis revealed disparities in ADR incidence rates. In addition, the findings of this review showed that the occurrence of ART-related ADR in people living with HIV is common in the healthcare system. Conclusion: This systematic review and meta-analysis highlighted the significant incidence of adverse effects among individuals diagnosed with HIV in ART clinics in Ethiopia. A comprehensive strategy and coordinated collaboration among health planners, policymakers, and the community are essential to address this issue and integrate pharmacovigilance into service provision.

Sexual outcomes in men who have sex with men who underwent radical prostatectomy

BACKGROUND

Sexual difficulties are a recognized consequence of prostate cancer (PCa) treatments. An estimated one in three men who have sex with men (MSM) receive PCa a diagnosis during their lifetime. MSM may experience all types of sexual dysfunction as reported in men who have sex with women (MSW), along with a number of more specific bothersome problems. This systematic literature review aims to evaluate sexual outcomes in MSM who have undergone radical prostatectomy (RP).

METHODS

A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The searches were made using relevant keywords in the PubMed, Scopus, and Web of Science databases, thus including the whole literature from January 2000 to November 2023. Studies which did not allow to retrieve data on sexual outcomes on MSM treated with RP for PCa were excluded. Data on sexual outcomes and health-related quality of life (HRQoL) were retrieved, mostly including changes in libido, erectile function, ejaculatory disorders, orgasm, climacturia, changes in role-in-sex identity, changes in sexual partnerships, and the presence of painful receptive anal intercourses (AI).

PROSPERO ID

CRD42024502592.

RESULTS

Six articles met the inclusion criteria. In total, data of 260 patients were analyzed. Three main themes emerged: (a) MSM may experience specific sexual dysfunctions due to the different dynamics of their intimacy; (b) the lack of tool validated on gay and bisexual population to assess sexual outcomes (c) the need for a tailored approach that also takes into account sexual orientation throughout the oncological journey.

CONCLUSIONS

MSM undergoing RP may experience similar sexual problems as MSW. Painful AI should be considered a potential post-operative adverse outcome in MSM. Future studies should prioritize validating a questionnaire that explores AI. Healthcare providers should adopt a tailored approach that takes into account sexual orientation throughout the cancer journey.

Spatiotemporal and kinematic gait changes in flexible flatfoot: a systematic review and meta-analysis

OBJECTIVES

Foot postural alignment is linked to changes in gait patterns. This review aimed to compare spatiotemporal and kinematic parameters of the lower extremities in individuals with and without flexible flatfoot.

METHODS

Under PRISMA guidelines, a systematic review and meta-analysis were conducted by searching PubMed, Scopus, Web of Science, and Google Scholar databases for original and peer-reviewed articles with selected keywords from inception to November 2024. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger's test was used to assess publication bias.

RESULTS

After searching the mentioned databases, 5309 articles were found. Finally, sixteen articles were included in the current review. A significant difference was found between the two groups in ankle inversion (effect size; 0.291, 95% CI = 0.053_0.053, P = 0.017), eversion (effect size; -0.568, 95% CI= -0.784_-0.352, P = 0.001), and hip flexion (effect size; -0.348, 95% CI= -0.576_-0.120, P = 0.003). Also, stride length (effect size; 0.658, 95% CI = 0.184_1.133, P = 0.007) and gait speed (effect size; 0.447, 95% CI = 0.120_0.774, P = 0.007) significantly differed between the two groups.

CONCLUSION

This study indicated that subjects with flatfoot exhibited alterations in the inversion, eversion, hip flexion, stride length, and walking speed compared to neutral foot participants and demonstrated a distinct gait pattern throughout the entire gait cycle. Health specialists are advised to consider these findings when prescribing prevention and rehabilitation programs for musculoskeletal deformities in individuals with flexible flatfoot.

Applications for the management of Attention Deficit Hyperactivity Disorder: a systematic review

Background

Various interventions are available for managing Attention Deficit Hyperactivity Disorder (ADHD), including educational strategies and training programs. Recently, there has been a notable increase in the use of programs and apps as innovative tools to assist with ADHD management. This study aims to provide insights into the possibility of app-based therapies as a supplemental tool for ADHD care by analyzing the indicated advantages and supporting data.

Methods

This systematic review was conducted until May 4, 2024, in several electronic databases, PubMed, MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. In addition, we conducted a comprehensive search for relevant grey literature. The studies included trials, quasi-experimental studies, and observational studies on using apps to control ADHD. This includes studies that were published in English.

Results

A review of 14 studies investigated the effectiveness of ADHD applications. Several applications monitored symptoms and enhanced cognitive function. Healthcare providers enhanced communication using the AKL-X01 app to monitor and record symptoms. The FOCUS ADHD app was well accepted but did not improve treatment compliance. The Sensory Diet App, known for its user-friendly interface, effectively alleviated symptoms associated with ADHD. BRUSH DJ enhanced dental hygiene and concentration on toothbrushing.

Conclusion

Apps can potentially be adjunctive instruments for treating ADHD. Nevertheless, further study is required to validate their effectiveness over a long period and enhance their incorporation into complete treatment strategies for ADHD.

Systematic review registration

identifier CRD42024523528 (PROSPERO).

The association between maternal tobacco smoking during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring: A systematic review and meta-analysis

INTRODUCTION

Maternal tobacco smoking during pregnancy is a significant public health concern with potential long-lasting effects on child development. ADHD, a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, may be influenced by prenatal nicotine exposure. This systematic review and meta-analysis examine the association between maternal tobacco smoking during pregnancy and the risk of ADHD in offspring.

METHODS

Following PRISMA guidelines, we searched databases including PubMed, Web of Science, Cochrane Central, Embase, Scopus, CINAHL, LILACS, SciELO, Allied and Complementary Medicine Database (AMED), ERIC, CNKI, HTA Database, Dialnet, EBSCO, LENS, and Google Scholar for studies up to November 1, 2024. We included peer-reviewed studies reporting quantitative effect size estimates for the association between maternal tobacco smoking and ADHD. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

We identified 2,981 articles and included 55 studies (4,016,522 participants) in the analysis. The meta-analysis showed a significant association between maternal tobacco smoking during pregnancy and increased risk of ADHD in offspring (pooled Odds Ratio (OR) = 1.71, 95% CI: 1.55-1.88; P < 0.001). Egger's test indicated no publication bias (p = 0.204), but Begg's test did (p = 0.042). By employing the trim and fill method, the revised OR was estimated to be 1.54 (95% CI: 1.40-1.70; P < 0.001). The OR were 2.37 (95% CI: 1.72-3.28; P < 0.001) in cross-sectional studies, 1.72 (95% CI: 1.49-2.00; P < 0.001) in case-control studies, and 1.53 (95% CI: 1.34-1.74; P < 0.001) in cohort studies. Meta-regression showed study design and study region significantly influenced heterogeneity (P < 0.10). Sensitivity and subgroup analyses confirmed the robustness of these findings.

CONCLUSION

This systematic review and meta-analysis demonstrate a significant association between maternal tobacco smoking during pregnancy and increased odds of ADHD in offspring. These findings highlight the need for prenatal care guidelines and tobacco smoking cessation programs for pregnant women to reduce ADHD risk and promote optimal neurodevelopmental outcomes. Future research should explore underlying mechanisms and potential confounders further.

Viral load suppression rate of third-line antiretroviral therapy and its association with gender among HIV patients after second-line treatment failure in Africa: a systematic review and meta-analysis

INTRODUCTION

Previous works of literatures on the viral load suppression rate of third line antiretroviral therapy in Africa has produced inconsistent and inconclusive results, with rates varying between 62% and 95%. This variability poses challenges for policymakers and healthcare providers in making informed decisions. This systematic review and meta-analysis aimed to determine the overall viral load suppression rate of third line antiretroviral therapy in Africa and to clarify the contradictory relationship between gender and viral load suppression, based on existing primary studies.

METHODS

A systematic review and meta-analysis were conducted using PubMed, Medline, Cochrane Library, Henari, African Journals Online (AJOL), Web of science, and Google Scholar to access studies up to December 6, 2024. The PRISMA guideline, JBI, and Newcastle Ottawa quality assessment scale checklists were used. Heterogeneity was evaluated with Cochrane's Q and I2 statistics. Publication bias was checked using a funnel plot, Begg's and Egger's test, followed by the DerSimonian and Laird random effects model. Meta-regression, subgroup and sensitivity analyses were also performed. The odds ratio with a 95% confidence interval was used to assess the association of gender with the viral load suppression rate in patients on third-line antiretroviral therapy. All analyses were conducted using Stata 18.

RESULTS

A total of 14 primary studies with a total sample size of 1791 were included. The pooled magnitude of the viral load suppression rate was 79.82% (95%CI: 75.75%, 83.90%). Around 75% of the included studies' heterogeneity were explained by country, study year, study settings and quality level of the study level variables. There was not statistically significant association of gender with viral load suppression rate of third line antiretroviral therapy.

CONCLUSION AND RECOMMENDATION

The pooled magnitude of the viral load suppression rate was 79.82%. There was not statistically significant association of gender with viral load suppression rate of third line antiretroviral therapy. Therefore, to maintain and further improve the strong viral load suppression rates of TLARVT in Africa, it is essential to focus on appropriate regimen selection, patient counseling and switching, adherence support, and regular viral load testing. Future studies with larger sample sizes should explore the association between gender and viral load suppression to provide conclusive findings.

Food taboo practices and associated factors among pregnant women in Sub-Sahara Africa: a systematic review and meta-analysis

BACKGROUND

Even though maternal nutrition has improved, food taboos and poor dietary practices during pregnancy can still lead to nutrient deficiencies, increasing the risk of complications for both mothers and children. Therefore, this study aimed to generate pooled evidence from across different countries in Sub-Saharan Africa to inform effective prevention actions. This meta-analysis aims to determine the pooled prevalence of food taboo practices and identify associated factors among pregnant women in Sub-Saharan Africa.

METHODS

This study systematically reviewed relevant articles and reports from databases including Embase, MEDLINE, Science Direct, PubMed, Google, and Google Scholar. The Newcastle-Ottawa Scale assessed article quality. Data extraction and analysis were done using Excel and STATA 17, respectively. Heterogeneity was assessed using Cochran's Q test and the I2 statistic, with a random effects model employed for meta-analysis. Publication bias was evaluated and addressed using Duval and Tweedie's Trim and Fill analysis.

RESULTS

A total of fifty-eight studies with 20,262 pregnant women were included in this meta-analysis. The pooled proportion of food taboo practices reported by the 58 studies was 41% (95% CI: 34, 48%). In the subgroup analysis, the pooled proportion of food taboo practices for studies conducted in urban areas was 40% (95% CI: 32, 48%), while it was 43% (95% CI: 32, 56%) among rural residents. Factors associated with food taboo practices among pregnant women included being unable to read and write (AOR = 2.64%; 95% CI: 1.79-3.90; I2 = 56.9%), not receiving antenatal care follow-up (AOR = 3.73%; 95% CI: 2.83-3.90; I2 = 55.1%), and poor maternal nutrition knowledge (AOR = 3.33%; 95% CI: 1.56-7.09; I2 = 84.3%).

CONCLUSION

According to this review, over two out of every five pregnant mothers practiced food taboos in the region. The educational status of the mother, antenatal care follow-up, and maternal nutrition knowledge were factors affecting food taboo practices among pregnant women. Therefore, emphasis should be given to the uptake of antenatal care follow-up to improve maternal nutrition knowledge and nutritional status.

A systematic review on executive functions in female adolescents with eating disorders: Implications on daily life and relevance to rehabilitation

Background: Eating Disorders (ED) are prevalent in female adolescents and have far-reaching effects on daily participation and quality of life (QoL). Daily participation highly depends on Executive Functions (EF). Existing knowledge about EF in ED, as expressed in real life, is not fully documented or clear.Aim: We aimed to (i) characterise literature on EF deficits in ED among female adolescents; (ii) examine common methodologies of evaluating EED difficulties; (iii) identify literature gaps regarding EF implications on daily participation and QoL; and (iv) clarify concepts pertaining EF's role in ED to optimise rehabilitation.Methods: A systematic review was conducted using thematic synthesis to analyse relevant studies from four databases, covering the period between January 2000 and December 2023. The quality of the studies was assessed using the Critical Appraisal Skills Program Qualitative Research Checklist tool. We followed the guidelines of the PRISMA statement.Results: Forty-four articles met the inclusion criteria, 79.5% showed significant evidence of EF deficits in female adolescents with ED. Up to 19% of adolescents with ED showed EF deficits that explained ED symptomatology, reduced daily participation, and deteriorated QoL. Most studies used neuropsychological tools to measure EF. Ecological measurements that reflect EF implications on daily life were rarely used.Conclusion: ED rehabilitation should integrate ecological measures to evaluate EF implications on daily life. This approach is specifically relevant during adolescence to optimise development, daily participation, and QoL.

Electrical Hazards on Australian Farms: A Rapid Review of Electrical Perceptions in Agriculture

OBJECTIVE

Electrical hazards on farms are one of the occupational risks that contributes to farm injury and fatality. Whilst electricity accounts for a low number of farm injuries each year, it is disproportionately fatal. The aim of this study is to raise the awareness of electrical safety on farms by providing an overview of the literature that explores the evidence of farmers' perception of electrical risk. The review sought evidence of farmers' efforts to promote electrical safety awareness and uptake of electrocution prevention strategies.

METHOD

A rapid review was performed following the Cochrane Rapid Reviews Method Group and PRISMA guidelines, searching grey and peer-reviewed databases with criteria that included both farming and electrical risk. This resulted in 35 key articles of interest and five themes.

RESULTS

The prevalent causes and contributing factors of electrical incidents and near misses on farms is not easily explained. Farmers overlook its presence as one of the hazards on farm, but at the same time the element of danger or threat of electrocution deters farmers from taking unnecessary risks. The data to profile farmers at risk of electrical injury is inadequate however the scope of risk is described through five themes: epidemiology, risk perception, exposure, intervention and prevention.

CONCLUSION

Due to the seriousness of electrical injury, intervention and prevention strategies need to specifically address electrical hazards rather than incorporate electricity as a risk into all of the hazards found on farms. The review recommends future work that engages with Australian farmers and farm workers to better understand their experience of electricity exposures, the risks they are willing to take around overhead powerlines, and their insights into how to make working on farms safer.

Prevalence of metabolic syndrome in children and adolescents with obesity: a systematic review and meta-analysis

OBJECTIVE

This study investigated the prevalence trends of metabolic syndrome (MetS) in children and adolescents with obesity by systematically analyzing global data. Additionally, it aimed to compare regional disparities and criteria used to identify at-risk subpopulations among this demographic group.

METHODS

We searched three major databases, i.e., PubMed-Medline, Scopus, and Web of Science, from inception to August 31, 2023, yielding 2432 articles. We included original research papers reporting MetS prevalence among children and adolescents with obesity, irrespective of their regions and MetS diagnostic criteria used. We aggregated prevalence estimates using random-effects models to obtain the overall prevalence and conducted subgroup analyses for MetS criteria and study regions.

RESULTS

We included 57 studies, amounting to 27,923 participants. The overall prevalence of MetS in participants with obesity varied greatly across studies, ranging from 2.1% to 74.4%, with an average prevalence of 29.4%. This high prevalence of MetS was further supported by a meta-analysis comprising 57 studies that further strengthened the observation of a high prevalence of MetS, revealing an overall prevalence of 26% (95% CI: 0.22-0.30; I2 = 98%).

CONCLUSIONS

Children and adolescents with obesity face a heightened risk of developing MetS. There is a pressing need for heightened attention to this issue, particularly in low- and middle-income countries such as those in sub-Saharan Africa.

Systematic Review of Pain Assessment Measures Used in Pediatric Acute Lymphoblastic Leukemia

BACKGROUND

Pain is a prevalent, frequent, and often persistent symptom among children with acute lymphoblastic leukemia (ALL). Despite its high prevalence, pain has remained understudied, and no evidence-based recommendations exist for how best to assess and treat pain in this population. Without proper assessment, clinical efforts to improve pain management in pediatric ALL will be ineffective.

AIMS

Therefore, the purpose of this systematic review is to describe and identify gaps in measurement approaches that have been used to assess pain in pediatric ALL, evaluate the psychometric properties of available pediatric pain measures, and provide recommendations for clinical research and practice.

METHODS

Literature searches were performed following Cochrane and PRISMA guidelines for systematic reviews. Domains of pain assessed, measures used to assess pain, measure format, respondent, and timing of pain assessment were extracted from studies that met inclusion criteria. The psychometric properties of included measures were then evaluated. A total of 238 full-text articles were screened and 123 met inclusion criteria.

RESULTS

Most studies assessed pain using generic health-related quality of life instruments rather than pain-specific measures. A total of 39 measures were used across the 123 included studies, and the psychometric properties of the measures varied considerably.

CONCLUSIONS

Recommendations include a selection of well-validated pain assessment measures that are currently available and can be used to facilitate best practices in ALL pain assessment. Clinicians and investigators are encouraged to utilize a multidimensional pain assessment approach to inform and enhance pain care in pediatric ALL.

The Role of Machine Learning Approaches in Pediatric Oncology: A Systematic Review

To enhance patient outcomes in pediatric cancer, a better understanding of the medical and biological risk variables is required. With the growing amount of data accessible to research in pediatric cancer, machine learning (ML) is a form of algorithmic inference from sophisticated statistical techniques. In addition to highlighting developments and prospects in the field, the objective of this systematic study was to methodically describe the state of ML in pediatric oncology. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for relevant studies on four distinct databases (Scopus, Web of Science, PubMed, and Cochrane Library). A total of 1536 relevant studies were retrieved to the EndNote library (Clarivate, Philadelphia, USA) where duplicates were removed and the rest of the studies were assessed for eligibility based on titles, abstracts, and the availability of full-text articles. After assessing the studies for eligibility, we found 42 studies eligible for inclusion in this systematic review. We found nine studies on liquid tumors, 13 on solid tumors, and 20 on central nervous system (CNS) tumors. ML goals included classification, treatment response prediction, and dose optimization. Neural networks, k-nearest neighbors, random forests, support vector machines, and naive Bayes were among the techniques employed. The identified studies' strengths included treatment response prediction and automated analysis that matched or outperformed physician comparators. Significant variation in clinical applicability, criteria for reporting, limited sample numbers, and the absence of external validation cohorts were among the common issues. We found places where ML can improve clinical care in manners that would not be possible otherwise. Even though ML has great promise for enhancing pediatric cancer diagnosis, decision-making, and monitoring, the discipline is still in its infancy, and standards and recommendations will support future research to guarantee robust methodologic design and maximize therapeutic applicability.

COVID-19 vaccine acceptance and its association with knowledge and attitude among patients with chronic diseases in Ethiopia

COVID-19 vaccine acceptance is crucial for patients with chronic diseases, but previous studies in Ethiopia have yielded inconsistent and inconclusive findings. To fill this gap, we conducted a systematic review and meta-analysis following established guidelines. Our search included relevant articles published between 2019 and 2023 from various sources. We assessed study heterogeneity and publication bias, and performed subgroup and sensitivity analyses. Our findings indicate that the COVID-19 vaccine acceptance rate among patients with chronic diseases in Ethiopia was 55.4%. We also found that good knowledge and a favorable attitude toward the vaccine were positively associated with the acceptance rate. Based on these results, we recommend that healthcare professionals, policymakers, and healthcare guide developers should work more to address the relatively low acceptance rate. Improving the knowledge and attitude further about the COVID-19 vaccines is crucial. Future research should include community-based and qualitative studies to enhance our understanding of vaccines acceptance.

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis

BACKGROUND

Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients.

OBJECTIVE

Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension.

METHODS

PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R.

RESULTS

Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (-18.41, -7.68)] mmHg), olmesartan (11.67 [95% CI (-14.12, -9.21)] mmHg), telmisartan (11.11 [95% CI (-12.12, -10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4-6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern.

CONCLUSIONS

This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

Comparison of Efficacy and Safety Between Drug-Coated Balloons Versus Drug-Eluting Stents in the Treatment of De Novo Coronary Lesions in Large Vessels: A Study-Level Meta-Analysis of Randomized Control Trials

BACKGROUND

Drug-coated balloons (DCB) can be used as an alternative to drug-eluting stents (DES) in patients with de novo small vessel coronary artery disease. This study aims to assess the efficacy and safety of solely using DCB versus DES in percutaneous coronary intervention (PCI) for de novo coronary lesions in large vessels.

METHOD

A database search was conducted using PubMed, EMBASE, Cochrane Library, and http://Clinicaltrials.gov for trials comparing DCB only with DES in treating de novo coronary lesions in large vessels. Efficacy outcomes included coronary angiography (CAG), follow-up minimal lumen diameter (MLD), and late luminal loss (LLL). Safety outcomes included target lesion failure [TLF: cardiac death, myocardial infarction (MI), target lesion revascularization (TLR)] and their individual components.

RESULTS

We included seven randomized control trials (RCTs) with 816 patients, of which 422 and 394 patients were in the DCB and DES groups, respectively. MLD measured during the 6-12 months follow-up in the DCB group was statistically significantly smaller than in the DES group (MD -0.21, 95% CI -0.34 to -0.07, P = 0.003, I2 = 52%). LLL measured at 6-12 months follow-up was statistically significantly lower in the DCB group than in the DES group (MD -0.13, 95% CI -0.22 to -0.05, P = 0.003, I2 = 60%). TLF, cardiac death, MI, and TLR, were not statistically significantly different between the two groups.

CONCLUSION

Use of DCB was associated with less LLL at 6-12 months than DES and was not associated with any increase in adverse clinical events. This data suggests DCB are as effective in treating de novo coronary lesions in large vessels as DES.

Equine-assisted services for motor outcomes of autistic children: A systematic review

LAY ABSTRACT

Equine-assisted services use various aspects of horses, like their movement, warmth, and size, to enhance individuals' overall well-being. Many studies have underscored the positive impact of equine-assisted services on autistic children, affecting areas such as social interaction, communication, engagement, stereotypical behaviors, and motor functions. Given the growing recognition of motor functions as clinical specifiers in autism, it is imperative to specifically investigate how equine-assisted services influence these outcomes. To address this, we conducted a systematic review to synthesize existing literature on the effects of equine-assisted services on motor outcomes of autistic children. Our review encompassed study characteristics, features of equine-assisted service interventions, and major motor outcomes. We also evaluated the methodological quality of the equine-assisted service studies to offer insights for future research directions. Through thorough database searches and the use of the standardized procedure of conducting a systematic review (The Preferred Reporting Items for Systematic Reviews and Meta-analyses), 12 research studies were identified and included. These studies reported the effects of various equine-assisted service types (such as therapy, horsemanship, or learning) on motor outcomes of autistic children. Significant enhancements in coordination, strength, balance, posture, and overall motor skills indicate the effectiveness of equine-assisted services in improving motor outcomes of autistic children. Building on these findings, we provide recommendations for future research endeavors aimed at enhancing the reliability and validity of using equine-assisted services to improve motor outcomes of autistic children. This work contributes to a deeper understanding of how equine-assisted services can benefit this population and guides the development of more effective equine-assisted service interventions.

Healthcare providers' pain management practice and its associated factors in Ethiopia: A systematic review and meta- analysis

INTRODUCTION

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Under -treatment of pain continues to be a major health care problem in Ethiopia. Although it has this problem, it receives limited research attention. This systematic review and meta-analysis will provide valuable insights of prevalence and its factors of healthcare providers' pain management practice in Ethiopia.

METHODS

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Universal online databases such as PubMed, Cochrane, Google, Google Scholar, SCOPUS, Web of Science and Global Health were used to search for articles. Microsoft Excel for data extraction and STATA17 for data analysis were used. DerSimonian and Laird random-effects model was used to pool the odds ratios across studies and compute the overall pooled prevalence and its predictors. Egger's test with funnel plot symmetry and Cochrane's Q test was used to assess publication bias and heterogeneity respectively.

RESULTS

The overall pooled prevalence of health care providers' pain management practice was 39.6% (95% CI: 34.8, 44.5); I2 = 97.0%; P<0.001). Availability of pain management protocol (AOR = 5.1, 95%CI: 3.6, 6.7), Accessibility of analgesia (AOR = 4.5, 95%CI: 1.96, 7.0), higher educational level (AOR = 3.3, 95%CI: 2.5, 4.1), being female (AOR = 1.2, 95% CI: 1.6, 3.1), took training (AOR = 2.7, 95% CI: 1.8, 3.6), decreased work load (AOR = 4.9, 95% CI: -1.9, 11.7), increased work experience (AOR = 3.9, 95% CI: 2.9, 5.1), Being midwifery profession (AOR = 2.5,95% CI: 1.6, 3.4), having good attitude (AOR = 3.9,95%CI: 2.5, 5.4) and being knowledgeable (AOR = 4.2, 95%CI: 2.8, 5.6) of health care providers towards pain management practice were significantly associated in Ethiopia.

CONCLUSION

The overall prevalence of pain management practice among healthcare providers in Ethiopia is low compared with a national target of pain free hospital initiatives in Ethiopia. It needs a call to build health care providers' ongoing education, training, professional development and manageable workload.

Unveiling barriers to reproductive health awareness among rural adolescents: a systematic review

Introduction

Sexual and reproductive health (SRH) among adolescents is a critical aspect of global health. Rural adolescents often encounter significant barriers to reproductive health awareness, elevating their risks for unintended pregnancies, sexually transmitted infections (STIs), and other reproductive health issues. This systematic review seeks to identify and analyze the barriers hindering reproductive health awareness among rural adolescents.

Methods

This review followed PRISMA guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Taylor & Francis, focusing on studies published from 2019 to 2024. Keywords included "Adolescent," "Rural," "Reproductive Health," "Awareness," and "Barriers." Studies were screened based on eligibility criteria, and data were extracted and analyzed to identify key barriers at the individual, interpersonal, social/community, and health services levels.

Results

Out of 669 records, 20 studies met the inclusion criteria. Identified barriers at the individual level included lack of knowledge, myths, misconceptions, and feelings of shame and fear. Interpersonal barriers were related to poor communication between parents and adolescents and misinformation from peers. Social and community barriers encompassed rigid social norms, stigma, and discrimination. Health services barriers included limited access and negative experiences with reproductive health services.

Discussion

Rural adolescents face complex barriers to reproductive health awareness driven by factors at the individual, interpersonal, social, and health services levels. Comprehensive interventions, such as educational campaigns, training for healthcare providers, and improved access via mobile or online platforms, are essential to enhance reproductive health awareness and outcomes.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).

Effects of using wearable devices on reducing sedentary time and prolonged sitting in healthy adults: a network meta-analysis

OBJECTIVES

This study aimed to compare the effectiveness of different wearable intervention strategies in reducing sedentary time (ST) and prolonged sitting (PS) on healthy adults.

DESIGN

A network meta-analysis (NMA).

DATA SOURCES

PubMed, Web of Science, SPORTDiscus, ProQuest, Opengrey, Medline and Cochrane Central Register of Controlled Trials were searched up to 1 June 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCTs) that examined the effect of wearable device interventions on ST and PS among healthy adults were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used standardised methods to search, screen and code included studies. Bias risks were assessed using Cochrane tools (Risk of Bias 2.0). Data were analysed using a frequentist framework NMA to directly and indirectly compare the effects of the five different intervention strategies (comparators). The results were reported as standardised mean differences (SMDs) with 95% CI and surface under cumulative ranking curve (SUCRA) was used to rank the best interventions. The five comparators were as follows: (1) wearable-only intervention (only using wearable devices for self-monitoring); (2) wearable combined with online intervention (ie, online coaching and social media support); (3) wearable combined with offline intervention (ie, face-to-face seminars and courses); (4) comparison group (ie, traditional, non-wearable interventions); (5) control group (ie, maintaining daily routine, waitlist).

RESULTS

12 RCTs with a total of 2957 participants were included. Results of NMA showed that the 'wearable+online' has significantly better effects in reducing ST compared with control group, comparison group and 'wearable only', with moderate to large effect sizes (SMD=0.96, 95% CI 0.65 to 1.27; SMD=0.87, 95% CI 0.21 to 1.53; SMD=0.78, 95% CI 0.14 to 1.42, respectively). However, no significant differences were identified between the groups in reducing PS. The SUCRA values were ranked as wearable+online (98.1%), wearable+offline (64.4%,), 'wearable only' (40.5%), comparison group (25.9%) and control group (21.1%) for ST reduction. Similar rankings were observed for PS reduction, with probabilities of 69.9%, 61.1%, 59.7%, 37.1% and 22.1%, respectively.

CONCLUSIONS

Wearable+online is the best intervention strategy for reducing ST in healthy adults. Additionally, none of the wearable-based interventions effectively reduced PS in healthy adults, but as there is little research on PS, it should receive more attention in the future. PROSPERO registration number: CRD42021290017.

Barriers to accessing health care of older Chinese immigrants in Canada: a scoping review

Background

This scoping review aims to examine the extant literature and summarize findings related to barriers to accessing health care faced by older Chinese immigrants in Canada.

Methods

We conducted a search of electronic databases for peer-reviewed articles using a comprehensive set of keywords without limiting the search to a specific time period. To be included in our review, articles had to meet the following criteria: (a) published in a peer-reviewed journal, (b) written in English, (c) provide a clear description of the methods used, and (d) respond to our research question, which focuses on identifying barriers to accessing healthcare for older Chinese immigrants living in Canada.

Results

Fifteen papers were selected based on the criteria, and five main barriers were identified, which are ranked in descending order according to the number of times they were mentioned: culture and health beliefs (N = 13), language and communication (N = 7), structural and circumstances (N = 2), health literacy and information (N = 2), and demographic, social, and economic factors (N = 2).

Conclusions

The issue of accessing healthcare for older Chinese immigrants in Canada is complex, as it involves multiple aspects that are relevant to both patients and healthcare providers. Our research findings suggest that the culturally and linguistically sensitive education programs, inter-sectoral coordination, and social support should be improved for older Chinese immigrants and those of other ethnic backgrounds.

A meta-review of systematic reviews on the effectiveness of music therapy on depression, stress, anxiety and cognitive function in adult's with dementia or cognitive impairment

BACKGROUND

Subjective cognitive impairment has been reported to be associated with depressive symptoms, stress and anxiety in older people. This study examines the impact of music interventions on cognitive functioning, depression, anxiety, and stress for adults with dementia or cognitive impairment.

METHOD

We searched Academic Search Complete, CINAHL, Medline, and PsycINFO without restriction to date. Systematic reviews with or without meta-analysis of music interventions were included. Effect sizes were estimated using standardized mean difference (SMD), weighted mean difference (WMD), mean difference (MD), and Hedges g, as reported. Effect sizes were reported as 〈 0.1 = small effect to 〉 0.5 as large effect.

RESULTS

Twenty systematic reviews were included. There is evidence that music interventions can have effects on cognitive abilities compared to standard care, with a small to large decrease in anxiety.

CONCLUSION

Music interventions might have variable effects on improved cognitive functioning, depression, anxiety and stress.

The effect of psyllium consumption on blood pressure: Systematic review and dose-response meta-analysis of randomized controlled trials

Based on available evidence, psyllium has been found to play a role in preventing and improving hypertension. In light of this, the objective of this investigation is to perform a systematic review and meta-analysis to assess the effect of psyllium intake on blood pressure. In order to identify suitable publications, we conduct searches using Scopus, ISI Web of Science (WOS), and PubMed, and from 15 March 2022 to 15 July 2022. This study aims to evaluate the impact of psyllium consumption on blood pressure in adults through randomized controlled trials (RCTs). We used the fixed-effects model which are expressed as weighted mean differences (WMD) with 95% confidence intervals (CI). In this article, 14 RCT studies and 802 participants were included. Psyllium consumption significantly decreases systolic blood pressure (SBP): (weighted mean difference [WMD]: -2.24; 95% CI: -3.13, -1.35; p < .05), and non-significantly increases diastolic blood pressure (DBP): (WMD: 0.04; 95% CI: -0.52, 0.61; p > .05). Psyllium dosage and duration of consumption had a remarkable linear effect on SBP and DBP. Results showed a significant decrease in SBP and a non-significant increase in DBP following psyllium consumption.

The effect and optimal parameters of repetitive transcranial magnetic stimulation on lower extremity motor function in stroke patient: a systematic review and meta-analysis

PURPOSE

This study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating lower limb motor dysfunction after stroke and explore the optimal stimulation parameters.

METHODS

PubMed, Embase, Cochrane Library, and other relevant databases were systematically queried for randomised controlled trials (RCTs) investigating the efficacy of rTMS in addressing lower limb motor dysfunction post-stroke. The search encompassed records from inception to July 2022. The assessed outcomes encompassed parameters such as the Fugl-Meyer motor function score for lower limbs, balance function, and Barthel index (BI). Three independent researchers were responsible for research selection, data extraction, and quality assessment. Study screening, data extraction, and bias evaluation were performed independently by two reviewers. Data synthesis was undertaken using Review Manager 5.3, while Stata version 14.0 software was employed for generating the funnel plot.

RESULTS

A total of 13 studies and 428 patients were included. The meta-analysis indicated that rTMS had a positive effect on the BI (MD = 5.87, 95% CI [0.99, 10.76], p = 0.02, I2 = 86%, N of studies = 8, N of participants = 248). Subgroup analysis was performed on the stimulation frequency, treatment duration, and different stroke stages (stimulation frequency was low-frequency (LF)-rTMS (MD = 4.45, 95% CI [1.05, 7.85], p = 0.01, I2 = 0%, N of studies = 4, N of participants = 120); treatment time ≤ 15 d: (MD = 4.41, 95% CI [2.63, 6.18], p < 0.00001, I2 = 0%, N of studies = 4, N of participants = 124); post-stroke time ≤6 months: (MD = 4.37, 95% CI [2.42, 6.32], p < 0.0001, I2 = 0%, N of studies = 5, N of participants = 172).

CONCLUSION

LF-rTMS had a significant improvement effect on BI score, while high-frequency (HF)-rTMS and iTBS had no significant effect. And stroke time ≤6 months in patients with treatment duration ≤15 d had the best treatment effect.

Burden, consequences and associate factors of childhood maltreatment in Ethiopia: A systematic review and meta-analysis

Introduction

Child maltreatment is any type of abuse or child negligence which results the concrete or prospective hurt for those under age of eighteen. It is a global issue which severely endangered children's physical, emotional, behavioral, developmental and mental well-being for immediate and later in life. Although, its magnitude and devastating burden are difficult to comprehend, much remains to be done to know its prevalence and comprehensive impact. This meta-analysis and comprehensive review will provide important light on the burden, consequences, and contributing factors for child maltreatment.

Methods

This meta-analysis and comprehensive review was coded at Prospero number of CRD42024503799. Universal online databanks including PubMed, Cochrane, Google, Google Scholar, SCOPUS, and Web of Science and Global Health were used to search for articles. Microsoft Excel was used for data extraction, and STATA17 was used to analyze this systematic review and meta-analysis. A random effect model exploration was employed when heterogeneity among included studies were evidenced.

Results

The pooled prevalence of childhood maltreatment was 57.0 % (95 % CI = 32.00, 83.00). Included studies revealed that childhood maltreatment has multiple child health-related consequences. Being female (AOR = 2.94, 95 % CI: 1.48, 4.41), being young (AOR = 1.22, 95%CI: 1.09, 3.35), paternal illiteracy (AOR = 2.16, 95%CI: 1.012, 3.302) and have an open family discussion about sexual matters (AOR = 0.381 (95%CI: 0.121, 0.884) were considerably associated with child maltreatment.

Conclusion

This finding publicized that the burden and multiple consequences of childhood maltreatment need much attention. Childhood maltreatment has both immediate and life time consequences for children later in life. Being female, being young, having illiterate fathers, and open family discussion about sexual matters were associated factors of child maltreatment.

Comparative efficacy of intratympanic gentamicin and intratympanic corticosteroid in the treatment of Meniere's disease: a systematic review and meta-analysis

Purpose

We aimed to evaluate the efficacy of gentamicin compared to corticosteroids for the treatment of Meniere's disease.

Methods

An extensive search was conducted in PubMed, Embase, and Web of Science until May 2024. For continuous outcomes, pooled effect estimates were determined by calculating the weighted mean difference (WMD), while for binary outcomes, the risk ratio (RR) was used, each accompanied by their respective 95% confidence intervals (CIs). Heterogeneity among the studies was assessed using Cochran's I 2 and Q statistics.

Results

A total of 12 studies were selected, involving 694 patients. Our analysis found that the gentamicin group demonstrates superior vertigo control rates compared to the corticosteroid group (RR: 1.36, 95% CI: 1.13 to 1.65, p < 0.001). In subgroup analysis, the gentamicin group showed a higher vertigo control rates at 6 months compared to the corticosteroid group (RR: 1.69, 95% CI: 1.28 to 2.24, p < 0.001); however, there was no statistically significant difference between the two groups at 12 months (RR: 1.48, 95% CI: 0.88 to 2.49, p = 0.14). Regarding changes in pure tone average, the corticosteroid group was superior to the gentamicin group (WMD: 4.41, 95% CI: 3.31 to 5.52, p < 0.001).

Conclusion

Our study suggests that the intratympanic gentamicin group achieves higher vertigo control rates, whereas the corticosteroid group demonstrates better improvement in pure tone averages. However, the high heterogeneity in vertigo control rates warrants caution. Larger sample-sized randomized controlled trials are needed to further validate these findings.

Surveillance of antimicrobial utilization in Africa: a systematic review and meta-analysis of prescription rates, indications, and quality of use from point prevalence surveys

BACKGROUND

Antimicrobial resistance (AMR) is a global public health concern that is fueled by the overuse of antimicrobial agents. Low- and middle-income countries, including those in Africa,. Point prevalence surveys (PPS) have been recognized as valuable tools for assessing antimicrobial utilization and guiding quality improvement initiatives. This systematic review and meta-analysis aimed to evaluate the prescription rates, indications, and quality of antimicrobial use in African health facilities.

METHODS

A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Embase, Hinari (Research4Life) and Google Scholar. Studies reporting the point prevalence of antimicrobial prescription or use in healthcare settings using validated PPS tools were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis was conducted to combine the estimates. Heterogeneity was evaluated using Q statistics, I² statistics, meta-regression, and sensitivity analysis. Publication bias was assessed using a funnel plot and Egger's regression test, with a p-value of < 0.05 indicating the presence of bias.

RESULTS

Out of 1790 potential studies identified, 32 articles were included in the meta-analysis. The pooled prescription rate in acute care hospitals was 60%, with significant heterogeneity (I2 = 99%, p < 0.001). Therapeutic prescriptions constituted 62% of all the prescribed antimicrobials. Prescription quality varied: documentation of reasons in notes was 64%, targeted therapy was 10%, and parenteral prescriptions were 65%, with guideline compliance at 48%. Hospital-acquired infections comprised 20% of all prescriptions. Subgroup analyses revealed regional disparities in antimicrobial prescription prevalence, with Western Africa showing a prevalence of 65% and 44% in Southern Africa. Publication bias adjustment estimated the prescription rate at 54.8%, with sensitivity analysis confirming minor variances among studies.

CONCLUSION

This systematic review and meta-analysis provide valuable insights into antimicrobial utilization in African health facilities. The findings highlight the need for improved antimicrobial stewardship and infection control programs to address the high prevalence of irrational antimicrobial prescribing. The study emphasizes the importance of conducting regular surveillance through PPS to gather reliable data on antimicrobial usage, inform policy development, and monitor the effectiveness of interventions aimed at mitigating AMR.

A 25-Year Retrospective of the Use of AI for Diagnosing Acute Stroke: Systematic Review

BACKGROUND

Stroke is a leading cause of death and disability worldwide. Rapid and accurate diagnosis is crucial for minimizing brain damage and optimizing treatment plans.

OBJECTIVE

This review aims to summarize the methods of artificial intelligence (AI)-assisted stroke diagnosis over the past 25 years, providing an overview of performance metrics and algorithm development trends. It also delves into existing issues and future prospects, intending to offer a comprehensive reference for clinical practice.

METHODS

A total of 50 representative articles published between 1999 and 2024 on using AI technology for stroke prevention and diagnosis were systematically selected and analyzed in detail.

RESULTS

AI-assisted stroke diagnosis has made significant advances in stroke lesion segmentation and classification, stroke risk prediction, and stroke prognosis. Before 2012, research mainly focused on segmentation using traditional thresholding and heuristic techniques. From 2012 to 2016, the focus shifted to machine learning (ML)-based approaches. After 2016, the emphasis moved to deep learning (DL), which brought significant improvements in accuracy. In stroke lesion segmentation and classification as well as stroke risk prediction, DL has shown superiority over ML. In stroke prognosis, both DL and ML have shown good performance.

CONCLUSIONS

Over the past 25 years, AI technology has shown promising performance in stroke diagnosis.

The effect of repetitive transcranial magnetic stimulation on the Hamilton Depression Rating Scale-17 criterion in patients with major depressive disorder without psychotic features: a systematic review and meta-analysis of intervention studies

AIM

In line with the publication of clinical information related to the therapeutic process of repetitive transcranial magnetic stimulation (rTMS) and the updating of relevant treatment guidelines, the present meta-analysis study was designed and conducted to determine the effect of repetitive transcranial magnetic stimulation (rTMS) on the Hamilton Depression Rating Scale-17 (HDRS-17) criterion in patients with major depressive disorder (MDD) without psychotic features.

METHODS

In this study, a systematic search was conducted in electronic databases such as PubMed [Medline], Scopus, Web of Science, Embase, Ovid, Cochrane Library, and ClinicalTrials. gov using relevant keywords. The search period in this study was from January 2000 to January 2022, which was updated until May 2023. Randomized controlled trials (RCTs) that determined the effect of repetitive transcranial magnetic stimulation (rTMS) on the Hamilton Depression Rating Scale-17 (HDRS-17) criterion in patients with major depressive disorder (MDD) without psychotic features were included in the analysis. The quality of the included RCTs was assessed using the Cochrane Risk of Bias checklist. Statistical analyses were performed using STATA (Version 16) and RevMan (Version 5).

RESULTS

Following the combination of results from 16 clinical trial studies in the present meta-analysis, it was found that the mean Hamilton Depression Rating Scale-17 (HDRS-17) in patients with major depressive disorder (MDD) decreases by an average of 1.46 units (SMD: -1.46; % 95 CI: -1.65, -1.27, I square: 45.74%; P heterogeneity: 0.56). Subgroup analysis results indicated that the standardized mean difference of Hamilton Depression Rating Scale-17 (HDRS-17) varied based on the number of treatment sessions: patients receiving 10 or fewer repetitive transcranial magnetic stimulation (rTMS) sessions showed a mean Hamilton Depression Rating Scale-17 (HDRS-17) reduction of 2.60 units (SMD: -2.60; % 95 CI: -2.86, -2.33, I square: 55.12%; P heterogeneity: 0.55), while those receiving 11 to 20 sessions showed a mean Hamilton Depression Rating Scale-17 (HDRS-17) reduction of 0.28 units (SMD: -0.28; % 95 CI: -0.65, -0.09, I square: 39.91%; P heterogeneity: 0.89).

CONCLUSION

In conclusion, our meta-analysis demonstrates the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing depressive symptoms in major depressive disorder (MDD) patients. The complex results of subgroup analysis revealed insight on the possible benefits of a more focused strategy with fewer sessions, as well as the impact of treatment session frequency. These findings add to our understanding of repetitive transcranial magnetic stimulation (rTMS) as a therapeutic intervention for the treatment of major depressive illnesses.

The Effect of Vitamin D Supplementation on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis of Clinical Trials

Background and Aims: The purpose of this meta-analysis was to investigate the effect of vitamin D supplementation on hemoglobin A1C (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), and the total vitamin D level in patients with Type 2 diabetes (T2DM). Methods: A systematic search was conducted in databases such as PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov using relevant keywords from January 1990 to January 2024. After screening and extracting data, a qualitative evaluation of articles was performed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Results: The findings revealed that vitamin D supplementation significantly decreased the mean HbA1C (SMD: -0.15; 95% CI: -0.29, -0.20; I square: 79.76%; p value < 0.001) and mean FBS (SMD: -0.28; 95% CI: -0.40, -0.15; I square: 70.13%; p value < 0.001), lowered SBP (SMD: -0.06; 95% CI: -0.16, -0.05; I square: 39.63%; p value = 0.23), and reduced LDL (SMD: -0.11; 95% CI: -0.28, -0.05; I square: 73.66%; p value < 0.001). Furthermore, vitamin D supplementation increased the average HDL (SMD: 0.13; 95% CI: 0.04, 0.29; I square: 79.33%; p value < 0.001) and vitamin D levels (SMD: 1.78; 95% CI: 1.53, 2.04; I square: 91.92%; p value < 0.001) in patients with T2DM. Subgroup analyses showed that weight gain, BMI, and duration of the disease could reduce the effect of vitamin D supplementation on diabetes control in affected patients. Conclusion: The results also indicated that taking vitamin D supplements in the amount of 50,000 IU had a significant effect on reducing the indicators related to diabetes control. Based on the combined evidence, the findings of this meta-analysis suggest that vitamin D supplementation can significantly improve glycemic control and reduce the risk of complications associated with T2DM, especially cardiovascular diseases (CVDs).

Clinical and Morphological Aspects of Aggressive Salivary Gland Mixed Tumors: A Narrative Review

Salivary gland tumors are a rare and heterogeneous group of neoplasms of the head and neck region. The mixed category of these tumors include the following entities: pleomorphic adenoma (PA), carcinoma ex pleomorphic adenoma (CEPA), salivary carcinosarcoma (CS), and metastasizing PA (MPA). The most common benign tumor of the salivary glands is PA. Metastasis and malignant degeneration have been reported in cases of PA of a salivary gland origin. Judging by their behavior, MPA, CEPA, and CS can be considered aggressive tumors. Invasive CEPA has been identified in the parotid gland more frequently. MPA and CS cases reported in the current literature are rare. In this paper, we present, narratively, the clinico-morphological features of this group of mixed tumors.

Schistosomiasis endemicity and its role in sexually transmitted infections - a systematic review and meta-analysis

Introduction

Schistosomiasis, a tropical parasitic disease, affects 779 million people globally, with 85% of cases in Africa. The interplay between schistosomiasis and other sexually transmitted infections (STIs) can exacerbate health burdens, but most attention has focused on interactions with HIV, neglecting coinfections with other STIs. This systematic review and meta-analysis aims to understand the role Schistosoma infections play in STIs within schistosomiasis-endemic populations.

Methods

The study is a systematic review and meta-analysis investigating the link between Schistosoma infections and STIs in endemic regions. It uses PRISMA guidelines, electronic databases, and Google Scholar to assess prevalence, associations, and heterogeneity, reducing bias using a Meta-Mar statistical tool.

Results

A quantitative synthesis of 33 articles from 1975-2024 involved 22,587 participants from 13 countries, including regions in Africa, France, and China, examining coinfections of schistosomiasis and STIs, including HIV. The pooled estimates showed a significant risk association between schistosomiasis and STIs [RR (95% CI) = 1.18, (1.13-1.24); z/t = 7.55, p<0.0001] using a fixed effect model. Cochran's Q test (Tau2 = 0.5061, Chi2 = 476.65, df = 32, p<0.01) indicated significant heterogeneity. The Higgins I2 statistic of 93.0% (91.5%-94.7%), H = 3.86 (3.43-4.33), highlighted substantial variance between studies. Subgroup analysis showed West Africa [Weight IV = 1.7%, RR (95% CI) = 1.78 (1.28-2.47), I2 = 59%], East Africa [Weight IV = 10.5%, RR (95% CI) = 0.99 (0.86-1.13), I2 = 54%], and Southern Africa [Weight IV = 82.0%, RR (95% CI) = 1.16 (1.10-1.21), I2 = 97%] contributed significantly to the high heterogeneity in the pooled analysis. Females had a notably higher risk of STIs in the context of schistosomiasis (k = 17, RR: 1.30, 95% CI: 1.23-1.37, Q = 316.78, I2 = 94.9%), compared to males (k = 6, RR: 0.94, 95% CI: 0.77-1.15, Q = 53.44, I2 = 90.6%) and the combined group of females and males (k = 9, RR: 0.95, 95% CI: 0.88-1.02, Q = 16.38, I2 = 50.2%).

Conclusion

The study found a high risk of coinfections between schistosomiasis and STIs, particularly in West and Southern Africa, confirming female genital schistosomiasis as a major risk for STIs.

Efficacy of Mindfulness Exercises for Primary Osteoporosis Pain and Balance: A Systematic Review and Network Meta-Analysis

Mindfulness exercise has shown great benefits for patients with osteoporosis. However, there are various types of mindfulness exercises and no studies have compared their efficacy. The aim of this study was to compare the efficacy of mindfulness exercises on pain and balance in patients with primary osteoporosis. Articles published in 10 English and three Chinese language databases from January 1, 2003, to December 31, 2022, were systematically searched. Twenty-two studies (N = 1,603) of five types of mindfulness exercises (Pilates, Ba Duan Jin, Wu Qin Xi, Tai Chi, and Yi Jin Jing) were eligible for this meta-analysis. Evidence from this review indicated that all five of the mindfulness exercises included in this study effectively reduced pain and improved balance for patients with primary osteoporosis. Pilates had the highest value of surface under the cumulative ranking as the best intervention. Future studies could consider developing a standard guideline for mindfulness exercise to be incorporated into osteoporosis rehabilitation.

Prevalence of stress urinary incontinence and urge urinary incontinence in multiples sclerosis patients: a systematic review and meta-analysis

Urinary incontinence (UI), encompassing stress urinary incontinence (SUI) and urge urinary incontinence (UUI), is a prevalent and debilitating condition in patients with multiple sclerosis (MS), profoundly impacting their quality of life. This systematic review and meta-analysis aimed to elucidate the worldwide prevalence rates of SUI and UUI among MS patients. This study was conducted by examining observational studies published between 2000 and 2023. An exhaustive literature search was conducted across databases such as PubMed, MEDLINE, Web of Science, Scopus, ProQuest, and Google Scholar. The Meta-prop method facilitated pooled prevalence estimation of UUI and SUI, while Egger tests assessed publication bias. In total, 27 studies with 15,052 participants were included in the meta-analysis. The findings revealed a high random effect pooled prevalence of UUI at 41.02% (95% Confidence Interval [CI]: 30.57-51.89; I2 = 99%, p < 0.001) and SUI at 25.67% (95% CI: 19.30-32.58%; I2 = 94.9%, P < 0.001). Additionally, the pooled prevalence of mixed urinary incontinence (MUI) was reported at 18.81% (95% CI: 7.55-33.48; I2:95.44%, p < 0.001). The high heterogeneity observed suggests variable prevalence across populations and highlights the intricate nature of UI in MS. These findings underscore the critical need for dedicated supportive, therapeutic, and rehabilitative interventions to manage this common complaint in MS patients effectively.

The neurostructural consequences of glaucoma and their overlap with disorders exhibiting emotional dysregulations: A voxel-based meta-analysis and tripartite system model

BACKGROUND

Glaucoma, a progressive neurodegenerative disorder leading to irreversible blindness, is associated with heightened rates of generalized anxiety and depression. This study aims to comprehensively investigate brain morphological changes in glaucoma patients, extending beyond visual processing areas, and explores overlaps with morphological alterations observed in anxiety and depression.

METHODS

A comparative meta-analysis was conducted, using case-control studies of brain structural integrity in glaucoma patients. We aimed to identify regions with gray matter volume (GMV) changes, examine their role within distinct large-scale networks, and assess overlap with alterations in generalized anxiety disorder (GAD) and major depressive disorder (MDD).

RESULTS

Glaucoma patients exhibited significant GMV reductions in visual processing regions (lingual gyrus, thalamus). Notably, volumetric reductions extended beyond visual systems, encompassing the left putamen and insula. Behavioral and functional network decoding revealed distinct large-scale networks, implicating visual, motivational, and affective domains. The insular region, linked to pain and affective processes, displayed reductions overlapping with alterations observed in GAD.

LIMITATIONS

While the study identified significant morphological alterations, the number of studies from both the glaucoma and GAD cohorts remains limited due to the lack of independent studies meeting our inclusion criteria.

CONCLUSION

The study proposes a tripartite brain model for glaucoma, with visual processing changes related to the lingual gyrus and additional alterations in the putamen and insular regions tied to emotional or motivational functions. These neuroanatomical changes extend beyond the visual system, implying broader implications for brain structure and potential pathological developments, providing insights into the overall neurological consequences of glaucoma.