I2 Statistic Research Articles

Association between prediabetes and periodontitis: a meta-analysis of observational studies with multivariate analysis.

Growing evidence suggests that prediabetes may increase the risk of periodontitis, though the extent of this association remains unclear. To provide a clearer understanding, this meta-analysis focused on observational studies that utilized multivariate analyses to adjust for key confounding factors. A comprehensive search of PubMed, Embase, and Web of Science was conducted to identify observational studies assessing the relationship between prediabetes and periodontitis. Only studies that utilized multivariate analyses were included to minimize confounding bias. The quality of the studies was evaluated with the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model, with heterogeneity assessed by the I² statistic. Ten observational studies with 38,727 participants were included. Overall, individuals with prediabetes had a significantly higher risk of periodontitis compared to normoglycemic individuals (OR: 1.27, 95% CI: 1.09 to 1.48, p < 0.001) with moderate heterogeneity (I² = 53%). Subgroup analyses revealed a stronger association in studies where the proportion of men was < 45% compared to those ≥ 45% (OR: 1.75 vs. 1.15, p for subgroup difference = 0.01). Studies with lower quality (NOS score = 7) showed a stronger association compared to higher-quality studies (NOS score = 8 or 9, p for subgroup difference = 0.003). This meta-analysis found that prediabetes may be independently associated with an increased risk of periodontitis. Further research is needed to explore the mechanisms underlying this association and potential sex-specific effects.

Pooled prevalence and predictors of intraventricular hemorrhage (IVH) in preterm neonates (28–34 weeks) in Africa: a systematic review and meta-analysis

ObjectiveTo assess the pooled prevalence and predictors of intraventricular hemorrhage (IVH) among preterm neonates born between 28 and 34 weeks of gestational age in Africa.MethodA weighted inverse-variance random-effects model estimated the pooled prevalence and predictors of germinal matrix hemorrhage. Heterogeneity was assessed using forest plots and I² statistics, focusing on studies conducted in African settings. Cross-sectional studies published in English between 2004 and 2022 were identified through online and manual searches conducted from September 18 to October 27, 2024.Outcome measureIntraventricular hemorrhage/Germinal matrix hemorrhage (Grades I-IV), defined as bleeding in a developing brain region that typically resolves by term gestational age.ResultTen primary studies involving 2,622 preterm neonates born at 28–34 weeks of gestation were included. The pooled prevalence of IVH was nearly three in ten cases, with substantial heterogeneity across studies (I² = 99%, P < 0.001). Extremely premature neonates had almost twice the risk of IVH compared to those born after 28 weeks (AOR = 1.98; 95% CI: 1.31–3.64). Antenatal corticosteroid (ANC) administration reduced IVH risk by 35% (AOR = 0.65; 95% CI: 0.08–0.78), while intubation status showed no significant effect (AOR = 1.04; 95% CI: -0.19–2.28).ConclusionThe pooled prevalence of IVH in very preterm and very low birth weight (VLBW) neonates in Africa was considerable, affecting nearly three out of ten cases. Extremely premature neonates were almost twice as likely to develop IVH compared to those born after 28 weeks of gestation, while antenatal corticosteroid (ANC) administration significantly reduced the risk. Intubation status had no significant impact on IVH risk. These findings highlight the urgent need for healthcare professionals and policymakers to prioritize preterm care standards in Africa to improve neonatal outcomes.PROSPERO IDCRD42024499505.

Turnover intention among nurses in Iranian hospitals: a systematic review and meta-analysis

BackgroundThe turnover intention of nurses from their current positions have become a critical global public health challenge. In Iran, as a country facing with several of healthcare challenges, understanding the rate of nurses’ turnover intention is of paramount importance. This study aimed to determine the pooled proportion of turnover intention among Iranian hospital nurses through systematic review and meta-analysis.MethodsThis systematic review and meta-analysis adhered to PRISMA guidelines. Relevant studies were identified through a comprehensive search of English and Persian databases, including Web of Science, PubMed, Scopus, Science Information Database, IranMedex, and Magiran from January 2000 to November 2024. The Joanna Briggs Institute checklist was employed to assess the methodological quality of included studies. Pooled mean and standard error with 95% CI were calculated using a random effect model. Data analysis was performed using Comprehensive Meta-Analysis software, with the I² statistic used to evaluate heterogeneity among studies and Egger’s test and visual inspection of funnel plots used to investigate the publication bias.ResultsOverall, 42 studies were included in this systematic review and meta-analysis. In total, 12,898 nurses participated in the 42 included studies. The overall turnover intention was 2.96 ± 0.056 (95% CI: 2.85–3.07, P = 0.001). Based on subgroup analysis, the turnover intention was 2.95 ± 0.123 and 2.96 ± 0.064 before and after the implementing of health transformation plan (HTP). Also, subgroup analysis by COVID-19 pandemic showed that the turnover intention was 2.97 ± 0.072 and 2.94 ± 0.095 after and before COVID-19 pandemic, respectively. Based on visual inspection of the funnel plot, and egger’s test (2.04 ± 2.96, p = 0.45), no evidence of publication bias was observed.ConclusionNurses turnover intention in Iran are at a moderate level, in general and, before and after the implementation of the HTP and the COVID-19 pandemic. These results support the need to formulate evidence-based policies and plans to enhance nurse retention, contributing to the overall stability of the Iranian health system.

Time Allocation to Physical Activity and Sedentary Behaviour and Its Impact on Sarcopenia Risk: A Systematic Review and Meta-Analysis.

To evaluate the relationship between time spent in sedentary behaviour and physical activity and sarcopenia in older adults, and to analyse the effect of reallocating time between different intensities of activities on sarcopenia. Systematic review and meta-analysis. Following PRISMA guidelines, data were synthesised using a random-effects model, with heterogeneity assessed via Cochran's Q test and the I2 statistic. Study quality was evaluated using the Newcastle-Ottawa Scale by two independent reviewers. A comprehensive search was conducted in PubMed, Web of Science, Embase, CINAHL and Cochrane databases for studies published up to November 5, 2024, with no language or date restrictions. Relevant reference lists were also manually screened. The present review included six studies involving 9914 older adults. Three studies suggested that older adults without sarcopenia spent more time performing light physical activities (SMD: 0.35; 95% CI: 0.24-0.45) and moderate to vigorous physical activity (SMD: 0.61; 95% CI: 0.49-0.74) and had less sedentary behaviour (SMD: -0.34; 95% CI: -0.51 to -0.16) than did older adults with sarcopenia. Replacing sedentary behaviour with an equivalent amount of moderate to vigorous physical activity (10, 30, or 60 min) each day can reduce the risk of sarcopenia, with 30 min showing the best preventive effect. However, research findings on the relationship between substituting sedentary behaviour time with light physical activities and sarcopenia are inconsistent. Encouraging older adults to engage in moderate to vigorous physical activity, even in short bouts of 10 min, can significantly reduce the risk of sarcopenia. Healthcare professionals should tailor activity recommendations to individual preferences and physical conditions to promote overall health and reduce sedentary behaviour. No Patient or Public Contribution. CRD42023416166.

Lupus Flares: More Common in Dialysis Patients than in Post-Kidney Transplant Recipients - A Systematic Review and Meta-Analysis.

In this study, we performed a systematic literature review and meta-analysis to assess the frequency of Systemic Lupus Erythematosus (SLE) flares in patients with ESRD and patients undergoing renal replacement therapy (RRT) (hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant (KT). Literature from 1973 to 2023 was searched for studies on the frequency of lupus flares after RRT. Data were extracted for ESRD and each RRT modality. Forest plots and random effect models were used to evaluate the odds ratios (95% CI) of SLE flares after ESRD or RRT, and study heterogeneity was assessed using I2 statistics. 57 studies fulfilled the study entry criteria. 29 studies evaluated extra-renal SLE flares after HD/PD and 5 studies evaluated extra-renal SLE flares after KT. The frequency of extra-renal SLE flares was compared between HD and PD in 7 studies, and between HD/PD and KT in 4. The recurrence of lupus nephritis (LN) was analyzed in 29 studies. Overall, 35.9% of patients with ESRD had at least one extra-renal flare after RRT. The frequency of extra-renal SLE flare was similar in PD and HD (OR: 1.05, 95% CI: 0.57-1.94). Extra-renal flare risk was significantly higher in the PD/HD group compared to KT (OR: 4.36, 95%CI: 1.66-11.47, p=0.0028). The recurrence of LN after KT was 3.39%. Extra-renal lupus flares can still occur in more than one-third of patients with ESRD on RRT. Dialysis patients have a higher flare risk than those post-KT, with comparable flare risk among patients on HD and PD.

Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysis.

Depression is a common mental health problem among adult refugees in East Africa. Refugees in this region face numerous challenges, including mental health issues, with depression being one of the most common and debilitating conditions. However, there is a lack of systematic reviews and meta-analyses that have been conducted to determine the pooled prevalence and associated factors of depression among adult refugees in East Africa. This study aims to assess the prevalence of depression and its associated factors among adult refugees in East Africa through an analysis of pooled data. A comprehensive search of MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and African Journals Online (AJOL) will be conducted to identify studies that have reported the prevalence and associated factors of depression among adult refugees in East Africa. A checklist from the Joanna Briggs Institute (JBI) will be used to assess the methodological quality. The search will be limited to studies published in English. Data extraction, critical appraisal, and screening of all the retrieved articles will be conducted by two independent researchers. Statistical analysis will be performed using STATA-17 software packages. The meta-analysis will be conducted using a random-effects model. The heterogeneity of the studies will be assessed using the I2 statistic. The publication bias will be assessed using the funnel plot and Egger's test. For determinants of depression, an effect size with a 95% confidence interval will be reported. Ethical approval and informed consent are not required as this is a systematic review of existing publications. The final results will be published in a peer-reviewed journal and presented at national and international conferences. PROSPERO registration number: CRD42024496728.

Effectiveness of educational interventions to promote safe handling of pesticides: protocol for a systematic review and meta-analysis

IntroductionAppropriate use of pesticides minimises harm to human health and the environment. Despite regulations and restrictions on use, however, many farmers still use highly toxic pesticides in ways that endanger...

Kidney dysfunction and associated factors among adults living with human immuno-deficiency virus in Africa: a systematic review and meta-analysis

BackgroundKidney dysfunction among adults living with Human Immuno-Deficiency Virus (HIV) increases the risk of drug-related side effects, acute kidney injury, hospitalization, and progression to end-stage kidney disease. In developing regions like Africa, where access to kidney transplants and dialysis is limited, early detection of kidney disease among adults living with HIV has significant clinical and financial implications. Therefore, the objective of this review was to determine the pooled prevalence and identify associated factors of kidney dysfunction among adults living with HIV in Africa.MethodsThe report was presented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses checklists. The articles were searched using PubMed/MEDLINE, EMBASE, Scopus, Wiley Online Library, CINAHL/EBSCO, OVID/Wolters Kluwer, Cochrane Library, Google Scholar, Science Direct, and African Journal Online. Data were extracted using Microsoft Excel and exported to STATA MP Version 11 Software for analysis. Heterogeneity of studies was assessed by Cochran’s Q test and I2 statistics. Publication bias was detected by the visual inspection of the funnel plot and statistical Egger’s test.ResultsIn this study, the pooled prevalence of kidney dysfunction among adults living with HIV in Africa is estimated to be 16.85% (95% CI: 13.08 − 20.62, I²=96.2%, p-value = 0.000). Female sex (POR = 1.82; 95% CI; 1.31, 2.53), age ≥ 50 years (POR = 8.94; 95% CI: 1.82, 43.93), body mass index ≥ 30 kg/m² (POR = 4.70; 95% CI: 3.07, 7.22), diabetes mellitus (POR = 2.84; 95% CI: 1.59, 5.07), CD4 count < 200 cells/mm³ (POR = 3.64; 95% CI: 1.63, 8.13) and anemia (POR = 3.73, 95% CI = 2.00–6.94) were factors associated with kidney dysfunction among adults living with HIV.ConclusionsThis study revealed that the pooled prevalence of kidney dysfunction among adults living with HIV in Africa remains significant. Female sex, age ≥ 50 years, body mass index ≥ 30 kg/m², diabetes mellitus, CD4 count < 200 cells/mm³ and anemia were factors associated with kidney dysfunction. To reduce the morbidity and mortality associated with kidney dysfunction, it is advisable to create awareness and initiating early interventions through health education during their follow-up time, and initiating suitable medication at an early stage.

High-Frequency Chest Wall Oscillation versus Conventional Airway Clearance Techniques in Non-Cystic Fibrosis Bronchiectasis: A Meta-Analysis

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic lung disease characterized by irreversible airway dilation and impaired mucociliary clearance, leading to chronic cough, sputum production, and recurrent infections. This meta-analysis aims to compare the efficacy of high-frequency chest wall oscillation (HFCWO) with conventional airway clearance techniques (CACT) in adults with NCFB. Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted from January 2013 to March 2024. Randomized controlled trials (RCTs) comparing HFCWO with CACT (postural drainage, percussion, active cycle of breathing technique, positive expiratory pressure therapy) in adults with NCFB were included. The primary outcomes were a change in forced expiratory volume in one second (FEV1) and sputum weight. Secondary outcomes included quality of life, exacerbation frequency, and adverse events. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: Nine RCTs involving a total of 485 participants were included. The meta-analysis showed no statistically significant difference in FEV1 change between HFCWO and CACT (mean difference [MD] 0.05 L, 95% confidence interval [CI] -0.02 to 0.12; I² = 45%). HFCWO was associated with a statistically significant increase in sputum weight compared to CACT. SGRQ total score showed a statistically significant improvement in the HFCWO group compared to CACT (MD -4.21, 95% CI -7.88 to -0.54; I² = 58%). Conclusion: HFCWO may provide a modest benefit in terms of increased sputum clearance and improved quality of life compared to CACT in adults with NCFB. However, there was no significant difference in lung function (FEV1) or exacerbation frequency. The moderate to high heterogeneity in some outcomes suggests that further research is needed to confirm these findings and identify patient subgroups who may benefit most from HFCWO.

Prevalence of fatigue and perceived fatigability in older adults: a systematic review and meta-analysis

Fatigue is a common health complaint in older adults, but its prevalence varies widely among studies due to differences in populations and assessment tools. The objective of this review is to systematically evaluate the prevalence of fatigue and perceived fatigability in older adults with PRISMA 2020. Four databases—PubMed, Embase, Web of Science (WoS), and Cochrane Library—were systematically searched as of December 27, 2023. Cochrane Q tests and the I2 statistic were used using Stata16.0 to assess between-study heterogeneity. A total of 21 studies involving 17843 participants were included in this study. The prevalence of fatigue in older adults was 42.6%, and the prevalence of perceived physical fatigability and mental fatigability was 58.2% and 24.0%. Meta-analysis showed that the prevalence of perceived physical fatigability among older adults was very high. This prevalence varied with regional economic development level, age of the subjects, sample size, and representativeness of the subjects. Fatigue is a health dilemma faced by most older adults. To improve quality of life, early and regular fatigue assessment should be part of routine health screening for older adults.

S2AI and iliac screw prominence and removal for symptomatic prominence: a systematic review.

Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes. A systematic review following PRISMA guidelines was conducted using Medline, SPORTDiscus, Cochrane Library, and Scopus databases. Inclusion criteria encompassed studies evaluating screw prominence or removal rates for S2AI and iliac screws, individually or in comparison, involving adult patients with sacropelvic fixation. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted. Statistical analysis included relative risk difference (RR) calculations using a random effects model, with heterogeneity assessed via the I² statistic. Eighteen studies were included, comprising 1462 patients: 648 with S2AI screws and 814 with iliac screws. Symptomatic screw prominence was significantly lower for S2AI screws (1.9%, 12/648) compared to iliac screws (6.3%, 51/814), with a pooled RR difference of 0.08 (95% CI 0.04, p < 0.001). Screw removal rates due to prominence were 0% (0/12) for S2AI screws versus 27.5% (14/51) for iliac screws. Low heterogeneity was observed for both outcomes (I² = 3.32% for prominence, I² = 0.0% for removal). S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.

Unveiling neurogenic biomarkers for the differentiation between sepsis patients with or without encephalopathy: an updated meta-analysis

BackgroundSepsis-associated encephalopathy (SAE) is characterized by brain dysfunction in the context of sepsis and frequently leads to significant cognitive and neurological impairments, as well as an elevated risk of mortality. Accurate diagnosis of SAE is crucial for the timely initiation of optimal treatment and appropriate patient management. Neurogenic biomarkers hold promise as reliable serum diagnostic tools for the detection and longitudinal monitoring of SAE. This meta-analysis seeks to evaluate the diagnostic and prognostic utility of serum neurogenic biomarkers in patients with SAE.MethodsThe study protocol was registered in the PROSPERO database (CRD42023408312) and conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was conducted to comprehensively and critically evaluate the existing body of evidence regarding the use of serum neurogenic biomarkers: neuron-specific enolase (NSE), ubiquitin C-terminal hydrolase-L1 (UCH-L1), Tau, S100 calcium-binding protein β (S100β), and glial fibrillary acidic protein (GFAP) for the diagnosis and risk assessment of fatality in SAE. We conducted a systematic search of electronic bibliographic databases, including PubMed, Web of Science, Embase, Cochrane databases, CNKI, CQVIP, and WFSD. The quality and risk of bias of the selected studies were assessed using the QUADAS-2 tool. For biomarkers reported in two or more studies, pooled standardized mean differences and 95% confidence intervals were calculated. Heterogeneity among the included studies was examined using the I2 statistic and random-effects model was applied owing to large heterogeneity.ResultsForty-two studies were included in our meta-analysis. The levels of serum neurogenic biomarkers were significantly higher in patients with SAE as compared to septic patients with no-encephalopathy (NE): NSE (standardized mean difference (SMD) 1.98 (95% CI 1.55–2.42), P < 0.00001); UCH-L1 (SMD 1.75 (95% CI 0.90–2.59), P < 0.0001); Tau (SMD 1.14 (95% CI 1.01–1.28), P < 0.00001); S100β (SMD 1.82 (95% CI 1.45–2.19), P < 0.00001); and GFAP (SMD 3.63 (95% CI 1.85–5.41), P < 0.0001). In addition, significantly lower serum neurogenic biomarkers levels were noted in septic patients with survivors as compared to non-survivors: NSE (SMD − 1.87 (95% CI − 2.43 to − 1.32), P < 0.00001); UCH-L1 (SMD − 1. 71 (95% CI − 2.24 to − 1.19), P < 0.00001); Tau (SMD − 0.57 (95% CI − 0.79 to − 0.35), P < 0.00001); S100β (SMD − 1.34 (95% CI − 1.88 to − 0.80), P < 0.00001). However, no significant differences in serum GFAP levels [SMD -7.98 (95% CI − 22.23–6.27), P = 0.27) were found between the surviving and non-surviving groups.ConclusionThe increased serum neurogenic biomarkers may be predictive of SAE and mortality for septic patients, which are expected to be applied as a reliable blood-based diagnostic tool for detection and longitudinal monitoring in SAE patients. However, results should be interpreted with caution due to the high heterogeneity among studies.

Efficacy and Safety of DOACs versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Chronic Kidney Disease undergoing Hemodialysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis.

Atrial fibrillation (AF) is a relatively prevalent arrhythmia in patients with kidney failure requiring dialysis, who face a high risk of stroke and bleeding, and anticoagulation is a challenging decision. Although direct oral anticoagulants (DOACs) may offer advantages over warfarin K antagonists (VKAs), their use in this patient profile remains unclear. We conducted a systematic review and meta-analysis to compare DOACs and VKAs in patients with AF undergoing dialysis. PubMed, Embase, and Cochrane Central databases were analyzed. The outcomes analyzed were total stroke (a composite of ischemic and hemorrhagic stroke), ischemic stroke, all-cause death, cardiovascular death, myocardial infarction, major bleeding, clinically relevant non-major bleeding and gastrointestinal bleeding. Risk ratios (RRs) with 95% confidence intervals were calculated using a random effects model. R software (version 4.3.2) was used for statistical analyses. Heterogeneity was assessed with I2 statistics. The final analysis included 486 patients from 4 RCT studies. The median follow-up ranged from 5.8 to 18 months. Although a reduction in total stroke was observed in the group receiving DOACs (RR 0.40; 95% CI 0.17 - 0.92; p=0.031; I2 =0%), no significant difference was found between the groups for ischemic stroke (RR 0.42; 95% CI 0.17 - 1.04; p=0.062; I2 =0%). Additionally, a statistically significant reduction in major bleeding was noted in the DOAC group (RR 0.64; 95% CI 0.41 - 0.98; p=0.044; I2 = 0%). However, no significant differences were observed between the groups for all-cause death (RR 0.88; 95% CI 0.57 - 1.35; p=0.567; I2 =47%), cardiovascular death (RR 1.13; 95% CI 0.60 - 2.10; p=0.700; I2 =0%), or clinically relevant non-major bleeding (RR 1.11; 95% CI 0.67 - 1.84; p=0.669; I2 = 0%). In this meta-analysis, DOACs were associated with a lower risk of total stroke and major bleeding. However, DOACs and VKA groups exhibited similar rates of ischemic stroke, all-cause and cardiovascular death, clinically relevant non-major bleeding and gastrointestinal bleeding.

Safety and efficacy of purely endoscopic microvascular decompression for trigeminal neuralgia: systematic review and single arm meta-analysis.

Microscopic microvascular decompression(M-MVD) is considered the gold standard treatment for primary trigeminal neuralgia and presents excellent long-term pain control rates. Despite the effectiveness of M-MVD, the use of endoscopy in these procedures has proven to be a promising approach. To evaluate the safety and efficacy of purely endoscopic microvascular decompression (E-MVD). A systematic review of the literature was performed using the PubMed, Scopus, Embase, and Cochrane databases. The primary outcome was satisfactory pain relief in short-term (0-30 days), mid-term (mean follow-up >/= 12 months) and long-term (mean follow-up >/= 24 months). Secondary outcomes were CSF leak, facial weakness, hearing loss, facial numbness, the rate of intraoperative identification of the offending vessel(s), mortality, length of stay and operative time. Inclusion criteria were studies including only patient submitted to E-MVD. Exclusion were secondary trigeminal neuralgia and mean follow-up < 12 months. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with leave-one-out test. Thirteen articles met the inclusion criteria, comprising a total of 1336 patients. Patients submitted to E-MVD had mean satisfactory pain relief rates of 92.93% (95% CI: 89.52-96.34% I2 = 86%), 88.54% (95% CI: 83.73-93.54% I2 = 87%) and 83.38% (95% CI: 76.58-90.17% I2 = 83%) in the short-term, mid-term and long-term follow-ups, respectively. Furthermore, the incidence of postoperative complications was low, including CSF leak (1.29% (95% CI: 0.32-2.26% I2 = 20%)), facial weakness (0.50% (95% CI: 0.00-1.79% I2 = 60%)), hearing loss (0.81% (95% CI: 0.05-1.57% I2 = 7%)) and facial numbness (3.84% (95% CI: 1.95-6.20% I2 = 54%)). There was no mortality related to the procedure (0% (95% CI: 0-0%; I2 = 0%)). The offending vessel(s) were identified in 99.57% of the cases (95% CI: 98.17-100.00% I2 = 67%)). Our meta-analysis revealed that E-MVD is a safe and effective procedure for the treatment of primary trigeminal neuralgia. Further studies are necessary to compare its usefulness to the traditional M-MVD approach.

Effectiveness of flipped classrooms in Chinese students of clinical medicine major undergoing clinical practice: a meta-analysis

IntroductionClinical practice is a cornerstone of undergraduate training in Chinese medical education, ensuring the development of essential skills for future professionals. While flipped classrooms have gained popularity for their potential to enhance learning outcomes, the effectiveness of this approach in clinical settings remains underexplored. This study aims to address this research gap by consolidating evidence on the impact of flipped classrooms through a comprehensive meta-analysis.MethodsTwo researchers independently screened all the retrieved articles and did data extraction. The Cochrane Risk of Bias tool for randomized trials was used for methodological quality assessment. Weighted mean differences (WMD) and 95% confidence interval (CI) were used to compare the differences in theoretical and skill scores between the flipped classrooms and traditional lecture groups. The Cochran Q test and the I2 statistic were used for heterogeneity analysis. The funnel plots were used to assess the publication bias. All analyses will be performed via RevMan version 5.3.ResultsA total of 19 studies were included in the final analysis, 18 of which were eligible for quantitative analysis. As a high level of heterogeneity of included studies, random effect models were used. Both the theoretical and skill scores in flipped classroom students were higher than those in traditional lecture students (SMD = 8.33, 95% CI: 5.91–10.75, P < 0.001; SMD = 7.91, 95% CI: 5.86–9.91, P < 0.001, respectively). However, all included studies were of poor quality, and funnel plots indicated the presence of publication bias.ConclusionFlipped classrooms demonstrate potential in improving both theoretical knowledge and practical skills among medical students in clinical practice. Despite these promising results, the interpretation is limited by methodological shortcomings and potential publication bias in the included studies. Future research should focus on conducting high-quality, large-scale trials to validate these findings and explore their broader applicability.

Prevalence of prolonged transitional neonatal hypoglycemia and associated factors in Ethiopia: A systematic review and meta-analysis.

Most neonates experience transient hypoglycemia, which typically responds well to treatment and is associated with a favorable prognosis. However, hypoglycemia persisting beyond 48 hours, termed prolonged transitional Neonatal hypoglycemia (PTNHG), can result in abrupt neuronal injury and long-term neurodevelopmental impairments. Identifying its prevalence and associated risk factors is critical to inform clinical practices and improve neonatal outcomes. A weighted inverse-variance random-effects model was employed for the analysis. Heterogeneity among the studies was assessed using a forest plot, I2 statistics, and Egger's test. Data extraction was conducted from May 20 to May 27, 2023, for studies published since 2020. A random blood sugar (RBS) concentration of <47 mg/dL measured 48-72 hours after birth was used to define PTNHG. Eight studies comprising a total of 3686 neonates were included in the analysis. The pooled prevalence of PTNHG was 19.71% (95% CI: 16.85-22.56) with substantial heterogeneity (I2 = 79.20%, P < 0.001). Subgroup analysis revealed that PTNHG prevalence was similar for studies with sample sizes >400 and ≤400, at 18% (95% CI: 15-22) and 21% (95% CI: 17-26), respectively. Similarly, prevalence estimates were comparable when using RBS thresholds of <47 mg/dL (21%; 95% CI: 16-27) and <40 mg/dL (18%; 95% CI: 15-22). Significant factors associated with PTNHG included preterm birth (AOR = 3.31; 95% CI: 2.57-4.04), hypothermia (AOR = 3.41; 95% CI: 2.19-4.62), being an infant of a diabetic mother (IDM) (AOR = 4.71; 95% CI: 2.15-7.26), delayed breastfeeding initiation beyond one hour (AOR = 3.26; 95% CI: 2.03-4.49), and pathological jaundice (AOR = 2.37; 95% CI: 1.91-2.84). Nearly one-fifth of hospitalized neonates experienced PTNHG. Fortunately, most of the associated risk factors were modifiable. Prioritizing early breastfeeding initiation, particularly in cesarean section deliveries and IDM cases, and integrating PTNHG management into national NICU guidelines could significantly reduce the burden of neonatal hypoglycemia. Prospero ID: CRD42023424953. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023424953.

Ophthalmic Manifestations of the Mpox Virus: A Systematic Review and Meta-Analysis.

Recent outbreaks of monkeypox (Mpox) have raised concerns about its complications, including ophthalmic manifestations such as conjunctivitis, keratitis, and potential vision impairment. The lack of comprehensive data on these ocular complications hinders the development of effective clinical guidelines. This review aim to synthesize existing evidence on the prevalence and characteristics of Mpox-related ocular complications. A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus, covering studies up to September 8, 2024. Studies focusing on conjunctivitis, keratitis, eye lesions, visual impairment, and other ophthalmic outcomes in Mpox cases were included. Meta-analyses were performed using a random-effects model to estimate pooled prevalence rates, with heterogeneity assessed using the I² statistic. Sensitivity analyses and publication bias assessments were also conducted. A total of 25 studies were included, with 22 contributing to the meta-analysis. The pooled prevalence of conjunctivitis in Mpox cases was 8.9% (95% CI: 4.4%-17.1%), keratitis 3.4% (95% CI: 1.4%-7.7%), eye lesions 3.4% (95% CI: 1.4%-7.7%), and visual impairment 4.3% (95% CI: 0.8%-20.6%). Other ocular manifestations had a pooled prevalence of 12.4% (95% CI: 0.6%-76.9%). Significant heterogeneity was observed, particularly for conjunctivitis and other ocular manifestations, suggesting variability in presentation. Conjunctivitis is the most common ophthalmic complication of Mpox, followed by notable rates for keratitis, eye lesions, and visual impairment. These findings emphasize the need for early recognition, routine ocular exams, and effective management of Mpox-related eye complications. Further high-quality research is necessary to better understand and address these ocular complications.

Memory deficits in children and adolescents with a psychotic disorder: a systematic review and meta-analysis.

Early-onset psychosis (EOP) is a severe disorder which takes place before 18years. It entails diverse clinical and functional implications, and it may lead to critical impairments in neurocognitive functions. Although deficits in memory are well described in adult populations and they appear to be clinically related with psychosis, impairments in memory in EOP show inconsistencies between studies. This study aimed to gain insight into the relationship between EOP and memory impairments, studying the potential contribution of moderators (storage source and memory content) on the observed memory deficits. This systematic review and meta-analysis was conducted following the PRISMA-2020 guidelines. Search was conducted in English and Spanish in five databases. Case-control studies which met all requirements were selected. Overall effect size was calculated under the random-effects model and Z-based tests were used. Heterogeneity was analysed by the I2 statistic. Mixed-effects meta-regression analysis was used to study the influence of methodological quality of studies, mean age, proportion of female participants within sample, mean diagnosis, memory storage type, memory content as moderators on individual effect size variability. As a result, 32 articles were finally selected, pooling data from 2636 participants (49.29% EOP participants). Overall effect size was Hedges' g = - 1.01, CI95 = [ - 1.35, - 0.67], p < .01, indicating lower memory performance in the EOP group in comparison to healthy controls. Diagnosis and memory storage were found as significant moderators in the memory performance variance: larger deficits were found in children with psychosis and in working memory tasks.

The Association Between Sleep Duration and the Risk of Hypertension: A Systematic Review and Meta-analysis of Cohort Studies.

Hypertension onset is linked to sleep, but the precise sleep duration affecting it remains unclear. Our goal is to pinpoint the sleep duration impacting hypertension incidence, offering valuable insights for prevention and management. We conducted a systematic search in PubMed, Embase, Web of Science, CNKI, Cqvip, and Wanfang Database, up to May 30, 2023, focusing on cohort studies examining the association between nighttime sleep duration and hypertension risk in adults aged 18 and above. Two authors independently performed data extraction, quality assessment, and synthesis based on predefined criteria. A random-effects model was used to estimate pooled effect sizes with 95% confidence intervals (CIs). Heterogeneity was quantified using the I2 statistic, with potential sources explored through subgroup and sensitivity analyses to validate the robustness of the results. Out of the 173,734 participants included in the meta-analysis, 41,528 eventually developed hypertension. The analysis revealed a correlation between short sleep duration and increased risk of hypertension: 1.07 (95% CI 1.00-1.14) for those sleeping ≤ 7h, 1.04 (95% CI 1.02-1.07) for 6-7h, and 1.17 (95% CI 1.06-1.28) for < 6h. For women, with sleep duration 6-7 and < 6h, the pooled risk of hypertension incidence was 1.07 (1.02-1.12) and 1.12 (1.06-1.19). In individuals under 60years of age, an elevated risk of hypertension was observed with sleep durations of less than 6h and between 6 and 7h, with pooled risks of 1.24 (95% CI 1.10-1.39) and 1.05 (95% CI 1.00-1.11), respectively. Hypertension is significantly correlated with sleep duration under 7h, especially in women and those under 60, highlighting the importance of sleep management in hypertension prevention and treatment strategies. PROSPERO: CRD42022345513.

Evaluating the safety of robotic total gastrectomy with D2 lymphadenectomy for gastric cancer against the conventional laparoscopic approach: a systematic review and meta-analysis.

Gastric cancer poses a significant global health challenge, necessitating effective surgical interventions. A critical gap in the literature exists, as most studies do not differentiate between various surgical approaches, i.e., total, distal, and subtotal gastrectomy, and level of lymphadenectomy, when comparing robotic to conventional laparoscopic gastrectomy. This leads to a lack of clear evidence regarding the safety and efficacy of robotic total gastrectomy (RTG) specifically in the context of total gastrectomy with D2 lymphadenectomy.This systematic review and meta-analysis evaluates the safety of RTG with D2 lymphadenectomy compared to conventional laparoscopic total gastrectomy (LTG). A literature search was conducted up to November 1, 2024, following PRISMA guidelines. Eligible studies included studies comparing RTG and LTG, focusing on anastomotic leakage, Clavien-Dindo Grade ≥ III complications, conversion rates, mortality, overall complications, and reoperation rates. Data were synthesized using odds ratios (OR) and weighted mean differences (WMD), with statistical heterogeneity assessed using the I2 statistic. Five studies comprising 1131 patients (432 RTG, 700 LTG) were included. No significant differences were found in the following outcomes: anastomotic leakage (OR = 0.79 [95% CI: 0.35, 1.78], I2 = 0%, P = 0.57), Clavien-Dindo Grade ≥ III complications (OR = 0.86 [95% CI: 0.51, 1.45], I2 = 0%, P = 0.56), conversion to open surgery (OR = 0.34 [95% CI: 0.10, 1.18], I2 = 0%, P = 0.09), mortality (OR = 1.78 [95% CI: 0.23, 13.48], I2 = 0%, P = 0.58), overall complications (OR = 0.84 [95% CI: 0.62, 1.14], I2 = 0%, P = 0.26), and reoperation rates (OR = 0.88 [95% CI: 0.29, 2.67], I2 = 0%, P = 0.82). Sensitivity analysis proves the robustness of the findings. The analysis shows no significant differences in safety outcomes between RTG and LTG for gastric cancer, indicating both techniques are comparable. RTG may be a viable alternative to LTG, especially in centers with appropriate robotic capabilities. Further research is warranted to investigate long-term outcomes and the learning curve of robotic surgery.PROSPERO Registration: CRD42024606570.