The Democratic Republic of Congo (DRC) is recognized as the global epicenter of human Mpox. While vaccination is crucial for outbreak prevention, especially as the disease transitions from zoonotic spillover to sustained human-to-human transmission, comprehensive assessments of vaccination coverage trends across the country are notably absent from the literature. This systematic review and meta-analysis address this gap by providing the first pooled estimate of Mpox vaccine uptake and acceptance in the DRC over a 54-year period (1970-2024). Our study captures critical transitions, including the post-smallpox eradication era and recent global outbreaks, to identify temporal trends, geographic disparities in this high-risk setting. We conducted this review following PRISMA guidelines, systematically searching PubMed, Scopus, ScienceDirect, Web of Sciences, CINAHL, and Embase. Grey literature was also searched to ensure comprehensiveness. Using random-effects models, we calculated pooled estimates for vaccine uptake and acceptance rates, with prespecified subgroup analyses examining variations by: (1) period, (2) geographic region, and (3) type of participants. We quantified heterogeneity using I² statistics and conducted meta-regression to identify predictors of vaccination coverage heterogeneity. A p-value ˂ 0.05 was considered statistically significant. Our analysis revealed a pooled Mpox vaccine uptake of 20.01% (95% CI: 7.45-43.75) with high heterogeneity (I² = 99.4%, p < 0.001), indicating substantial variability across studies. Vaccine acceptance was higher at 54.17% (95% CI: 20.82-84.16) with high heterogeneity (I² = 97.6%, p < 0.001). Temporal analysis showed a significant decline from 32.30% (95% CI: 14.62-57.75) coverage during 1970-2000 to 1.36% (95% CI: 0.29-6.11) in 2020-2024. Geographic disparities existed, with the Northwest regions achieving 47.11% (95% CI: 13.46-83.61) coverage compared to 5.47% (95% CI: 0.56-37.32) in Eastern conflict-affected zones. Meta-regression identified no significant predictors of coverage heterogeneity. Despite moderate acceptance rates, actual Mpox vaccination uptake in the DRC remains low, with worsening coverage in recent years and substantial regional inequities. These findings underscore the urgent need for context-specific interventions to bridge the intention-action gap in this high-risk setting.

The aim of this study was to assess the impact of organized screening programs on incidence and mortality rates of cervical cancer in women. A systematic review of the relevant literature was performed in accordance with the PRISMA 2020 protocol by searching PubMed, Scopus and Web of Science. Endnote20 and Rayyan Systematic Review Screening Software were used for duplicate removal and then, independent evaluation was done by two reviewers. The quality of studies was assessed using the Newcastle Ottawa scale. A random-effects meta-analysis was performed in order to compute the pooled effect size, with Hartung-Knapp adjustment for random effects model. DerSimonian-Laird estimator for Tau2, Mantel-Haenszel estimator used in calculation of Q and Tau2, and calculation of I2 based on Q were used to assess and quantify heterogeneity between studies. Inverse variance method was also used. The results of the meta-analysis show that women who were regularly screened in an organized cervical cancer screening program were statistically significantly less likely to develop (OR = 0.40, 95% CI 0.29-0.55) or die (OR = 0.31, 95% CI 0.16 to 0.58) from cervical cancer. Significant heterogeneity among the case-control studies evaluating the incidence of cervical cancer has been detected (Tau2 = 0.1034; χ2 = 245.42; df = 12, p < 0.0001; I2 = 95.1%). Moderate to high heterogeneity among the case-control studies evaluating the mortality has been detected (Tau2 = 0.1161; χ2 = 20.12; df = 3, p < 0.0002; I2 = 85.1%). The results of tests for assessing asymmetry (Egger's and Begg's test, p < 0.05), indicates the absence of publication biases. The results of our meta-analysis show that women who participate in organized screening programs are significantly less likely to develop and die from cervical cancer, especially if they are screened regularly. Women who irregularly participated in an organized cervical cancer screening program have almost equal risk for cervical cancer compared to women who did not participate in an organized cervical cancer screening program. Women with irregular participation in an organized cervical cancer screening program have a cervical cancer risk that is nearly comparable to the risk among non-participants.

Abstract Objectives This study aims to systematically analyze the effects of acupuncture as an adjunctive therapy for minimizing side effects following miscarriage, particularly focusing on pain relief and physical and emotional stability. By reviewing randomized controlled trials, the study seeks to identify effective acupuncture points and standardize their use in post-abortion care. Methods This study systematically reviewed and analyzed randomized controlled trials on the effectiveness of electroacupuncture in managing pain after miscarriage. The review followed PRISMA guidelines, included eight databases, and focused on comparing electroacupuncture to no intervention, analgesics, or combined treatments, with outcomes centered on pain and uterine bleeding. Results This study reviewed 260 articles on electroacupuncture for post-abortion pain, ultimately including six studies in the qualitative analysis and three in the meta-analysis. The results suggest that electroacupuncture significantly reduces pain compared to no intervention and may be more effective than analgesics, though high heterogeneity in the data requires cautious interpretation. Conclusion This study demonstrates the effectiveness and safety of electroacupuncture for managing miscarriage side effects, with a need for more diverse and standardized research. Graphical Abstract

Background: The relationship between maternal thyroid function and psychiatric morbidity remains inconclusive, particularly regarding the association with antepartum depression (APD). This meta-analysis aimed to precisely quantify the association between the three primary maternal thyroid hormone concentrations—thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3)—measured in late pregnancy and in the presence of APD. Methods: We conducted a systematic review and meta-analysis of observational studies identified through comprehensive database searches (PubMed, Web of Science, Scopus). Four exploratory studies were ultimately included, enrolling a total of 689 participants. We used random-effects models to pool the mean difference (MD) in hormone concentrations between depressed and non-depressed cohorts. Subgroup analyses were performed based on the study population (general versus hypothyroid), and publication bias was assessed using Begg’s and Egger’s tests. Results: None of the pooled hormone concentrations demonstrated a statistically significant association with APD. The overall MDs were non-significant for TSH (MD = −0.07, 95% CI: [−0.32, 0.18], p = 0.59), FT4 (MD = −0.11, 95% CI: [−1.14, 0.92], p = 0.83), and FT3 (MD = 0.53, 95% CI: [−0.20, 1.25], p = 0.15). Substantial and significant heterogeneity was detected across all models (I2 ranging from 70% to 94%). This heterogeneity was largely driven by conflicting directional findings (some studies linking APD to hypothyroid trends, others to hyperthyroid trends), masking a potential non-linear or categorical effect. Statistical tests found no significant evidence of publication bias for TSH (p = 0.33), FT4 (p = 0.12), or FT3 (p = 0.33). Conclusions: The absolute mean concentrations of TSH, FT4, and FT3 in late pregnancy are not robust concurrent biomarkers for antepartum depressive symptoms. The high heterogeneity suggests that APD may be associated with categorical dysfunction (i.e., TSH levels at the extreme high or low ends of the reference range) rather than linear changes in hormone concentration. Future research should prioritize investigating categorical risks, the influence of thyroid autoimmunity, and employing gold-standard diagnostic interviews to better delineate the complex endocrinological risk factors for APD. Due to the limited number of studies, these results should be considered hypothesis-generating rather than confirmatory. PROSPERO registration: CRD420251233154.

Transient ischaemic attack (TIA) is a strong predictor of stroke, has a high risk of recurrence, and may lead to a variety of sequelae. The purpose of this study was to understand the epidemiological characteristics and trends of TIA through a systematic review and meta-analysis, to identify high-risk populations, and to provide a basis for prevention and intervention measures. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched Chinese-language (CNKI, Wanfang, VIP, and CBM) and English-language databases (PubMed, Cochrane, Embase, and Web of Science) from inception to October 25, 2024. Cross-sectional or cohort studies reporting the prevalence or incidence of TIA were included. Quality assessment was performed using the AHRQ and NOS scales. Data synthesis was performed with Stata 17.0, employing a random-effects model for high heterogeneity (I² > 50%). Subgroup analyses were conducted on the basis of region, publication year, gender, age and diagnostic criteria. From 20,114 screened records, 47 studies were included, contributing a total of 50 datasets for analysis (23 for prevalence and 27 for incidence). The global pooled prevalence of TIA was 1.95% (95% CI: 1.27-2.77%), and the prevalence was elevated in Asia (2.19%) and among older adults (> 65 years, 5.13%). The annual incidence was 54 per 100,000 person-years, with the highest incidence occurring in the Americas (81 per 100,000). No significant gender differences were found in terms of prevalence or incidence. The incidence decreased over time but increased with age. The use of imaging-based criteria is associated with a lower and likely more accurate estimation of TIA prevalence. This study provides updated global estimates of TIA epidemiology, revealing significant variations influenced by diagnostic criteria, age, and region. The substantial heterogeneity and potential underreporting highlight the need for standardized, imaging-based diagnostic protocols in future research. The development of precise risk stratification tools and region-specific prevention strategies is imperative for mitigating the global burden of TIA.

Cervical cancer is largely preventable, yet causes around 300,000 deaths annually, disproportionately affecting vulnerable women. In here, we aim to estimate the risk of high-grade cervical lesions and cervical cancer among vulnerable populations in high- and upper-middle-income countries. We conduct a systematic review and meta-analysis of studies published up to February 2024 (from 2004 for HIV) across four databases. Risk of bias is assessed using the Newcastle-Ottawa Scale. We include women with low socioeconomic status, migrants, prisoners, sex workers, women with substance use disorders, mental illness, and living with HIV. The primary outcome is the pooled risk of cervical cancer and high-grade lesions; the secondary outcome is subgroup-specific risk. The analysis focuses on biologically defined females, with sex determined by author reporting. In this work, based on 127 studies, we show that vulnerable women face higher risks of cervical cancer (RR2.78; 95%CI 2.32-3.32) and high-grade lesions (RR 2.5; 95%CI 2.05-3.04), with high heterogeneity supporting equity-focused prevention strategies.

Khat chewing and its association with oral/esophageal squamous cell carcinoma and oral white lesions: A systematic review and meta-analysis.

The Eeffectiveness of distraction cards in reducing pain in children: A meta-analysis of randomized controlled trials.

Effectiveness of pulpotomy compared with pulpectomy for irreversible pulpitis in primary teeth: A systematic review and meta-analysis.

Influence of different cell passage numbers on bovine cloned embryo: A systematic review and meta-analysis.

Vascular Surgeon Presence and Protocolized Approach for Better Outcomes in Lower Extremity Vascular Trauma.

Transcatheter closure versus antithrombotic therapy for cryptogenic stroke in elderly patients with patent foramen ovale: a systematic review and meta-analysis of non-randomized studies.

Next-generation sequencing for diagnosing primary osteoarticular infections compared to conventional culture: A systematic review and meta-analysis.

Tenofovir disoproxil fumarate (TDF) is effective in treating hepatitis B virus, (HBV) but has been associated with nephrotoxicity. In contrast, tenofovir alafenamide fumarate (TAF) has emerged as a safer alternative, reducing kidney exposure while maintaining antiviral efficacy. This meta-analysis evaluates improvements in kidney function following the switch from TDF to TAF. Our study was registered in PROSPERO (CRD42024565358) and included 10 randomized controlled trials (RCTs) involving 1,179 patients with chronic kidney disease (CKD). We compared renal function before and after switching to TAF. Significant improvements in glomerular filtration rate (GFR) were observed, indicating enhanced kidney function post-switch. The findings confirm that TAF has a superior renal safety profile compared to TDF, particularly in long-term treatments. The clinical relevance of TAF for HBV patients with CKD aligns with current guideline shifts favoring TAF. Despite limitations such as high heterogeneity, this study supports TAF as a safer management strategy for HBV patients with CKD, demonstrating improved kidney outcomes and reduced nephrotoxicity risks. These findings support its broader use in clinical practice and highlight the need for further research on long-term renal outcomes.

Vulvovaginal candidiasis: A global perspective through systematic review and meta-analysis.

A0146 Randomized Controlled Trials (RCTs) on complicated Urinary Tract Infection (cUTI) show low adherence to the FDA research guidance, high heterogeneity and poor comparability

A systematic review and meta-analysis on partial foot amputation in diabetic foot ulcers.

A systematic review, meta-analysis, and trial sequential analysis on association of circulating vascular cell adhesion molecule-1 (VCAM-1) levels in obstructive sleep apnea adults: A possible link between cardiovascular disease and obstructive sleep apnea.

Effects of environmental air pollution on anxiety and depression in adults: an updated systematic review and meta-analysis.

To determine the prevalence of potentially inappropriate prescribing (PIP), potentially inappropriate medication (PIM), potential prescription omission (PPO), potentially harmful drug-drug interactions (PDDI) and identify associated factors among older Ethiopians. Systematic review and meta-analysis DATA SOURCE: We searched PubMed, HINARI, Scopus and Web of Science databases to identify eligible studies published up to 31 October 2025. Observational studies reported the prevalence of PIP, PIM, PPO and PDDI among older adults from any healthcare settings were screened. Two independent reviewers selected studies, extracted data and assessed the risk of bias. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale and Hoy risk of bias tool, respectively, while the certainty of evidence of outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation based on Cochrane recommendations. We used a random-effects model for analyses to estimate the pooled prevalence and associated factors. All data analyses were done using Stata V.17 software. The national prevalence of PIP, PIM, PPO and PDDI was estimated as main outcomes. Variations were estimated based on regions, age groups, outcome evaluation tool, disease type and healthcare setting. The review included 25 studies (n=5662 participants) for PIP or PIM, 14 studies (n=2706 participants) for PDDI and 6 studies (n=1342 participants) for PPO. The pooled prevalence estimate was 41% (95% CI 33% to 48%), I2=96.87% for PIP, 37% (95% CI 31% to 44%), I2=96.33% for PIM, 55% (95% CI 36% to 73%), I2=99.00% for PDDI and 14% (95% CI 6% to 24%), I2=95.07% for PPO. The majority of the studies have very good quality (very good=13, good=1, satisfactory=11 for PIP and PIM; very good=11, satisfactory=3 for PDDI; very good=6 for PPO) and low risk of bias (low risk=18, moderate risk=7 for PIP and PIM; low risk=12, moderate risk=2 for PDDI and low risk=6 for PPO), while all studies for each outcome have low certainty of evidence. Subgroup analyses revealed significant regional and contextual variations. Polypharmacy was significantly associated with PIP (OR=3.72, 95% CI 2.53 to 5.46, p<0.01, I2=69.56%), PIM (OR=4.20, 95% CI 2.91 to 6.06, p<0.01, I2=57.83%) and PDDI (OR=4.51, 95% CI 3.05 to 6.69, p<0.01, I2=0.00%), while hypertension (OR=2.46, 95% CI 1.38 to 4.36, p<0.01 I2=0.00%) was associated with PIP. This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study indicates a high burden of inappropriate medication prescribing and its associated factors, underscoring the importance of further robust studies to clarify prescribing practices and associated factors. CRD42024556744.