Meta-analysis Of Observational Studies In Epidemiology Research Articles

Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.

The use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented. We performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955). Twelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively. ECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case.

Pharmacological Thromboprophylaxis for VTE Post-Endovenous Ablation of Varicose Veins: Network Meta-Analysis.

Endovenous ablation has revolutionized treatment of varicose vein surgery but is associated with a risk of venous thromboembolism. There is no consensus regarding anticoagulation protocols for these patients. This network meta-analysis (NMA) aims to identify which anticoagulant is optimal in this cohort for clot prevention with minimal risk of adverse bleeding events. Library databases were searched for studies where patients were treated with one or more anticoagulants following endovenous ablation for varicose veins. The methodological quality of included studies was quantified using the Risk of Bias (ROB) assessment tools. Findings were reported using the meta-analysis of observational studies in epidemiology (MOOSE) checklist. Statistical analysis was carried out using metainsight (rpackage). Observational data on just under 1500 patients prescribed post ablation anticoagulation (Rivaroxaban, Enoxaparin, Fondaparinux) were analyzed. Patient characteristics were comparable across the cohorts. 81 thrombotic and 40 minor bleeding events occurred in total. Overall rivaroxaban is found to be superior to the other agents. This NMA indicates that prophylactic rivaroxaban is the highest ranked anticoagulant for thromboprophylaxis in patients post endovenous ablation for varicose veins, with a low risk of adverse bleeding. The choice whether to anticoagulate these patients is likely to remain at the discretion of the treating clinician.

Human Leukocyte Antigens and Sulfamethoxazole/Cotrimoxazole–Induced Severe Cutaneous Adverse Reactions

Sulfamethoxazole (SMX) and cotrimoxazole (CTX), a fixed-dose combination of SMX and trimethoprim in a 5:1 ratio, are antibacterial sulfonamides commonly used for treating various diseases. A substantial prevalence of severe cutaneous adverse reactions (SCARs) following the administration of these drugs has been reported. However, the association between human leukocyte antigen (HLA) genotypes and SMX/CTX-induced SCARs has remained unclear. To investigate the association between HLA genotypes and SMX/CTX-induced SCARs. A comprehensive search was conducted in CENTRAL (Cochrane Library), MEDLINE, and Embase from inception to January 17, 2023. Case-control studies that recruited patients who had experienced SCARs following SMX or CTX were included, and HLA alleles were analyzed. Two independent authors extracted data on study characteristics and outcome data. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. The Newcastle-Ottawa Scale for case-control studies was used to assess study quality. Odds ratios (ORs) were calculated using a random-effects model for meta-analysis. The prespecified outcome was the OR comparing SMX/CTX-induced SCARs with healthy or SMX/CTX-tolerant controls based on different HLA alleles. Six studies involving 322 patients with SCAR were included, including 236 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis, 86 with drug reaction with eosinophilia and systemic symptoms, 8448 healthy controls, and 229 tolerant controls. Significant associations were found in HLA-A*11:01 (OR, 2.10; 95% CI, 1.11-4.00), HLA-B*13:01 (OR, 5.96; 95% CI, 1.58-22.56), HLA-B*15:02 (OR, 2.23; 95% CI, 1.20-4.14), HLA-B*38:02 (OR, 3.47; 95% CI, 1.42-8.48), and HLA-C*08:01 (OR, 2.63; 95% CI, 1.07-6.44) compared with tolerant controls. In the Stevens-Johnson syndrome/toxic epidermal necrolysis subgroup, significant associations were found in HLA-B*15:02 (OR, 3.01; 95% CI, 1.56-5.80) and HLA-B*38:02 (OR, 5.13; 95% CI, 1.96-13.47). In the drug reaction with eosinophilia and systemic symptoms subgroup, significant associations were found in HLA-A*68:01 (OR, 12.86; 95% CI, 1.09-151.34), HLA-B*13:01 (OR, 23.09; 95% CI, 3.31-161.00), HLA-B*39:01 (OR, 4.56; 95% CI, 1.31-15.82). The results of this systematic review and meta-analysis suggest that multiple HLA alleles (HLA-A*11:01, HLA-B*13:01, HLA-B*15:02, HLA-B*38:02, and HLA-C*0801) are associated with SMX/CTX-induced SCARs.

Visual Impairment and Suicide Risk

Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. All published studies were considered without restrictions on study design, publication date, or language. Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

Mucosa-Associated Lymphoid Tissue Surgeries as a Possible Risk for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal disorders that are caused by genetic susceptibility and environmental factors and affects a significant portion of the global population. The gut-associated lymphoid tissue (GALT) is known to play a crucial role in immune modulation and maintaining gut microbiota balance. Dysbiosis in the latter has a known link to IBD. Therefore, the increasing prevalence of adenoidectomy in children should be explored for its potential association with IBD. The objective of this paper was to assess the association between adenoid tissue removal and the risk of developing Crohn's disease (CD) and ulcerative colitis (UC). We conducted a pooled meta-analysis to evaluate the extended clinical outcomes in patients who underwent appendicectomy and tonsillectomy compared to those who did not. Our approach involved systematically searching the PubMed database for relevant observational studies written in English. We followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines to collect data from various time periods, and to address the diversity in study results; we employed a random-effects analysis that considered heterogeneity. For outcomes, odds ratios (ORs) were pooled using a random-effects model. Seven studies, out of a total of 114,537, met our inclusion criteria. Our meta-analysis revealed a significant association between appendicectomy and CD (OR: 1.57; 95% confidence interval (CI): 1.01 - 2.43; heterogeneity I2 = 93%). Similarly, we found a significant association between tonsillectomy and CD (OR: 1.93; 95% CI: 0.96 - 3.89; I2 = 62%). However, no significant association was observed between appendicectomy and UC (OR: 0.60; 95% CI: 0.24 - 1.47; I2 = 96%), while a modest association was found between tonsillectomy and UC (OR: 1.24; 95% CI: 1.18 - 1.30; I2 = 0%). In summary, we found that the trend of appendicectomy is linked to higher odds of CD, and tonsillectomy is more likely associated with increased odds for both CD and UC, with a risk of bias present.

Impact of Frailty and Sarcopenia on Thirty-Day and Long-Term Mortality in Patients Undergoing Elective Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.

Background: The aim of this study was to assess the prognostic role of frailty and sarcopenia on the survival of patients with AAA undergoing elective endovascular repair (EVAR). Methods: A systematic review of the literature was conducted in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE). The association of frailty or sarcopenia with 30-day mortality and late survival was expressed as odds ratios (ORs) or hazard ratios (HRs) with a 95% confidence interval (CI). Meta-analysis random effects models were applied. The five-factor modified frailty index (mFI-5) was used as a frailty metric and sarcopenia was determined using computed tomography angiography (CTA) with measurements of the total psoas muscle area. Frailty was defined as patients with mFI-5 ≥ 0.6 and sarcopenia was defined as the total psoas muscle area (TPA) within the lowest tertile. Results: Thirteen observational cohorts reporting a total of 56,756 patient records were eligible for analysis. Patients with frailty (mFI-5 ≥ 0.6) had significantly increased 30-day mortality than those without frailty (random effects method: OR, 4.84, 95% CI 3.34-7.00, p < 0.001). Patients with sarcopenia (lowest TPA tertile) had significantly increased 30-day mortality according to the fixed effects method (OR, 3.30, 95% CI 2.17-5.02, p < 0.001), but not the random effects method (OR, 2.64, 95% CI 0.83-8.39, p = 0.098). Patients with sarcopenia or frailty had a significantly increased hazard ratio (HR) for late mortality than those without frailty or sarcopenia according to the random effects method (HR, 2.39, 95% CI 1.66-3.43, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.86). The relation of frailty to age extracted from four studies demonstrates that the risk of frailty increases with age according to the random effects method (standard mean differences, SMD, 0.52, 95% CI 0.44-0.61, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.64). Conclusions: Patients with sarcopenia or frailty have a significantly increased risk of mortality following elective EVAR. Prospective studies validating the use of frailty and sarcopenia for risk prediction after EVAR are needed before these tools can be used to support decision making.

Relation between dietary inflammatory potential and sleep features: Systematic review of observational studies

BACKGROUND: Diet and sleep represent key behavioral risk factors for major non-communicable diseases. Dietary factors may modulate systemic inflammation and potentially affect the human brain functionality, finally affecting the sleep-wake cycle. In this context, the Dietary Inflammatory Index (DII) has been studied as a tool to investigate the dietary inflammatory potential and its relationship with a variety of health conditions. OBJECTIVE: The aim of this study was to perform a systematic revision of observational studies on the inflammatory potential of the diet assessed through the DII and sleep features. METHODS: A systematic search of observational studies on DII and sleep features was conducted on Pubmed and EMBASE electronic databases. The Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines were used to plan the methodology. Studies identified through the search were selected according to inclusion/exclusion criteria. RESULTS: The systematic search and review led to the selection of 13 studies. Most studies including the general population reported an association between higher inflammatory potential of the diet and worse sleep quality and suboptimal sleep duration. Some studies also reported an association with daytime sleepiness and sleep apnea. However, some studies including younger individuals (i.e., college students or young employees) reported null findings. Four studies conducted in individuals with a variety of health conditions also showed some relation between DII and sleep features, although results were not fully consistent. CONCLUSIONS: Data published so far suggests an association between DII and sleep features. However, lack of randomized clinical trials and better designed observational studies, imply that further research on this matter is warranted to understand whether a causal relation could explain current findings.

Adverse neonatal outcomes in pregnant women with asthma: An updated systematic review and meta-analysis.

A systematic review and meta-analysis from 2013 reported increased risks of congenital malformations, neonatal death and neonatal hospitalization amongst infants born to women with asthma compared to infants born to mothers without asthma. Our objective was to update the evidence on the associations between maternal asthma and adverse neonatal outcomes. We performed an English-language MEDLINE, Embase, CINAHL, and COCHRANE search with the terms (asthma or wheeze) and (pregnan* or perinat* or obstet*). Studies published from March 2012 until September 2023 reporting at least one outcome of interest (congenital malformations, stillbirth, neonatal death, perinatal mortality, neonatal hospitalization, transient tachypnea of the newborn, respiratory distress syndrome and neonatal sepsis) in a population of women with and without asthma. The study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality of individual studies was assessed by two reviewers independently using the Newcastle-Ottawa Scale. Random effects models (≥3 studies) or fixed effect models (≤2 studies) were used with restricted maximum likelihood to calculate relative risk (RR) from prevalence data and the inverse generic variance method where adjusted odds ratios (aORs) from individual studies were combined. A total of 18 new studies were included, along with the 22 studies from the 2013 review. Previously observed increased risks remained for perinatal mortality (relative risk [RR] 1.14, 95% confidence interval [CI]: 1.05, 1.23 n = 16 studies; aOR 1.07, 95% CI: 0.98-1.17 n = 6), congenital malformations (RR 1.36, 95% CI: 1.32-1.40 n = 17; aOR 1.42, 95% CI: 1.38-1.47 n = 6), and neonatal hospitalization (RR 1.27, 95% CI: 1.25-1.30 n = 12; aOR 1.1, 95% CI: 1.07-1.16 n = 3) amongst infants born to mothers with asthma, while the risk for neonatal death was no longer significant (RR 1.33, 95% CI: 0.95-1.84 n = 8). Previously reported non-significant risks for major congenital malformations (RR1.18, 95% CI: 1.15-1.21; aOR 1.20, 95% CI: 1.15-1.26 n = 3) and respiratory distress syndrome (RR 1.25, 95% CI: 1.17-1.34 n = 4; aOR 1.09, 95% CI: 1.01-1.18 n = 2) reached statistical significance. Healthcare professionals should remain aware of the increased risks to neonates being born to mothers with asthma.

Abstract TMP92: Dementia and Cognitive Impairment in Stroke: A Systematic Review and Meta-Analysis of Reperfusion Treatment Outcomes

Background: Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) outcomes are unclear in patients with pre-stroke dementia or cognitive impairment. Although these individuals make up ~12% of acute stroke patients, they are often excluded from both stroke trials and routine care. This systematic review and meta-analysis explored reperfusion therapy outcomes in this population. Methods: Using the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, this systematic review investigated studies on acute ischemic stroke patients with dementia or cognitive impairment treated with either IVT or EVT. Primary outcome was defined as favorable 90-day outcome (modified Rankin Scale (mRS) score 0-2). Secondary outcomes included 90-day mortality, radiographic intracranial hemorrhage (ICH) and symptomatic ICH (SICH). Results: 9 articles were included from 825 screened. 5 observational studies of IVT use in patients with (n=1078) and without dementia (n=2805) were selected for a meta-analysis. There were no significant differences in favourable 90-day mRS (adjusted OR 0.61, 95% CI 0.24 to 1.59), 90-day mortality (unadjusted OR of 1.19, 95% CI 0.86 to 1.64), ICH (unadjusted OR 1.32, 95% CI 0.79 to 2.19) and SICH (unadjusted OR of 0.94, 95% CI 0.70 to 1.25). EVT in dementia patients in one study found only increased odds of ICH (adjusted OR 1.57 95%CI 1.03 to 2.40). For patients with cognitive impairment, no significant association was found with assessed outcomes in a pooled analysis of 3 IVT studies and one EVT study found poorer 90-day mRS outcomes. Conclusions: This systematic review and meta-analysis suggests no considerable safety concerns for IVT or EVT use in patients with pre-existing dementia or cognitive impairment, compared to those without. Uncertainty remains in the efficacy of these therapies for these individuals. Rigorous, patient-caregiver informed design, and a more nuanced outcome approach are warranted for future studies. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021240499.

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants

ObjectivesPostoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. MethodsWe systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. ResultsOf 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. ConclusionsConspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.

Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis.

This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. No Patient or Public Contribution.

Exposure to heavy metals and neurocognitive function in adults: a systematic review

AbstractExposure of individuals to heavy metals (HMs) is a growing concern with far-reaching implications for human health. HMs encompass a diverse range of elements that, when present in excess or in particular chemical forms, have the potential to elicit adverse effects on the central nervous system and cognitive function. This systematic review aims to comprehensively investigate the relationship between exposure to HMs and neurocognitive function in adults. The methodological framework for this review adheres rigorously to the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines. A meticulous and extensive search strategy was executed within PubMed and Web of Science, specifically targeting articles published in the English language until the cutoff date of December 5, 2023. The evaluation of the retrieved studies was systematically conducted by employing the assessment approach outlined by (Gascon et al. in Environ Int 86 60 67, 2016). The initial search yielded a substantial pool of 1573 articles, culminating in a refined selection comprising eight pertinent studies, collectively enrolling a participant cohort totalling n = 1,828,126. Notably, the studies under review predominantly manifested a cross-sectional or cohort design and were geographically situated within the continents of North America and Asia. Furthermore, it is imperative to underscore that a predominant and recurring observation emanating from the majority of the scrutinized investigations underscores a significant correlation between exposure to cadmium (Cd) and mercury (Hg) and deleterious neurocognitive outcomes in the adult population. In summary, our systematic review postulates that exposure to HMs through various routes of exposure harbors the potential for adverse effects on adult neurocognitive function; however, it is incumbent upon future research endeavors to validate and corroborate these findings through further empirical exploration.

Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies

BackgroundAccess to fertility treatments is considered a reproductive right, but because of the quarantine due to the coronavirus pandemic most infertility treatments were suspended, which might affect the psychological and emotional health of infertile patients. Therefore, this study was conducted to review the mental health of infertile patients facing treatment suspension due to the coronavirus pandemic.MethodsThis study was conducted based on the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. The Web of Science, PubMed, Embase, Scopus, and Cochrane library databases were searched by two independent researchers, without time limitation until 31 December 2022. All observational studies regarding the mental health of infertile patients facing treatment suspension including anxiety, depression, and stress were included in the study. Qualitative studies, editorials, brief communications, commentaries, conference papers, guidelines, and studies with no full text were excluded. Quality assessment was carried out using Newcastle–Ottawa Scale by two researchers, independently. The random effects model was used to estimate the pooled prevalence of mental health problems. Meta-regression and subgroup analysis were used to confirm the sources of heterogeneity.ResultsOut of 681 studies, 21 studies with 5901 infertile patients were systematically reviewed, from which 16 studies were included in the meta-analysis. The results of all pooled studies showed that the prevalence of anxiety, depression, and stress in female patients was 48.4% (95% CI 34.8–62.3), 42% (95% CI 26.7–59.4), and 55% (95% CI 45.4–65), respectively. Additionally, 64.4% (95% CI 50.7–76.1) of patients wished to resume their treatments despite the coronavirus pandemic.ConclusionTreatment suspension due to the coronavirus pandemic negatively affected the mental health of infertile patients. It is important to maintain the continuity of fertility care, with special attention paid to mental health of infertile patients, through all the possible measures even during a public health crisis.

Knowledge, attitudes and prevention practices related to dog-mediated rabies in Ethiopia: a systematic review and meta-analysis of observational epidemiological studies from inception to 2023.

Rabies is a horrific and neglected zoonotic disease that kills thousands of people worldwide each year and continues to pose threats to public health. Prevention and control of dog-transmitted rabies require mapping the level of understanding, perception, and existing practices to minimize its impacts on health. Therefore, we undertook this systematic review and meta-analysis to pool evidence from available data on knowledge, attitudes, and prevention practices regarding the disease from studies conducted in various areas of Ethiopia. Articles were searched in electronic bibliographic medical databases such as the Excerpta Medica database, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We used Microsoft Excel spreadsheets and STATA software version 16 for the data excerption and analysis, respectively. The variability among studies was evaluated via Higgins and Thompson's I2 statistics and the x2 test (significant at p ≤ 0.1). The Dersimonian and Laird random-effect meta-analysis model was used to estimate the pooled effect at a 95% uncertainty interval (UI). Visual inspection and Egger's test (significant at p ≤ 0.05) were used to identify the presence of small-study effects. The search identified 1,249 electronic records. Of them, 27 studies involving 11,150 participants met the inclusion criteria. The pooled prevalence of a good level of knowledge was 62.24% (95% UI: 48.56, 75.92). Furthermore, the pooled prevalence of a favorable level of attitudes towards rabies and a good level of rabies prevention practices was only 56.73% (95% UI: 47.16, 66.29) and 52.73% (95% UI: 43.32, 62.15), respectively. The study revealed credible gaps in attitudes and prevention practices, though some level of knowledge about dog-mediated rabies was demonstrated. Therefore, we call for country-wide cross-sectoral collaboration to allow for the realization of a global elimination strategy for dog-mediated human rabies.

NIMG-88. THALLIUM 201 SINGLE PHOTON EMISSION CT (TI-SPECT) FOR DIFFERENTIATION OF MALIGNANT VERSUS BENIGN NERVOUS SYSTEM SPACE OCCUPYING LESIONS: A RETROSPECTIVE STUDY, SYSTEMATIC REVIEW, AND META-ANALYSIS

Abstract Importance Thallium-201 single-photon emission computed tomography (TI-SPECT) imaging has been used historically to distinguish malignant cerebral neoplasms from infectious etiologies. Objectives Our study aims to review existing literature and conduct a retrospective study and meta-analysis on the use of TI-SPECT to differentiate malignant from non-malignant nervous system lesions. Data Sources A retrospective study on use of TI-SPECT in differentiating malignant versus benign nervous system masses was conducted in two tertiary hospitals in the Philippines. Systematic review of relevant studies regarding TI-SPECT for brain and spinal cord lesions was also done. Meta-analysis was performed to generate pooled sensitivity and specificity. Study Selection All study types published in the English language were included – randomized controlled trials (RCTs), prospective/retrospective cohort studies, and case series and reports; abstract only studies were excluded. Studies that involved either pediatric and adult cases were considered. Data Extraction and Synthesis The study complied with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) Guidelines. Main Outcome and Measure The primary outcome was sensitivity and specificity of TI-SPECT. This involved getting correlation of positive and negative thallium scan uptake with either biopsy results (if available) or diagnosis via clinical response to treatment (i.e. whether cases that were managed as infection or demyelination showed improvement on follow-up). RESULTS: Thirty-two (32) articles were qualitatively described and 25 datasets were subjected to meta-analysis. Pooled sensitivity and specificity were 0.89 (95% CI: 0.82-0.94) and 0.82 (95% CI: 0.74-0.88), respectively with an area under the curve (AUC) for diagnostic accuracy of 0.92. CONCLUSION: and Relevance Thallium scans may be utilized to discriminate malignant from benign nervous system lesions, especially, in cases with a &amp;gt;80% pre-test probability. Further studies are needed to validate this findings.

Systematic Review and Meta-analysis of Clinical Outcomes After Endovascular Treatment in Patients With Femoropopliteal Lesions Greater Than 150 mm.

Indications for endovascular treatment of femoropopliteal (FP) lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased but the choice of the best endovascular treatment remains to be defined. The aim of this meta-analysis was to summarize all studies investigating endovascular treatment of FP lesions greater than 150 mm from 2010 to 2021. Articles were searched using PubMed, Scopus, and Cochrane. Included studies were randomized controlled trials (RCTs), cohort studies, and case series (prospective and retrospective) that evaluated any endovascular procedure in patients with long FP lesions classified TASC (Trans-Atlantic Inter-Society Consensus document II on management of peripheral arterial disease) C and/or D, and a mean length >150 mm, primary outcome had to be the 1-year primary patency. Overall estimate of primary patency, secondary patency, and freedom from target lesion revascularization (TLR) at 1 year depending on the different devices were investigated. The meta-analysis was conducted following the requirements of the MOOSE (Meta-analysis of Observational Studies in Epidemiology) checklist. Forty-four papers comprising 4847 patients and 5282 treated limbs were included. Mean lesions length ranged from 150.5 to 330 mm. The pooled 1-year primary and secondary patencies, and freedom from TLR rates were 0.71 (95% CI: 0.67-0.74), 0.87 (95% CI: 0.83-0.91), and 0.79 (95% CI: 0.74-0.84), respectively. Primary permeability at 1 year were 0.68 (95% CI: 0.62-0.73), 0.67 (95% CI: 0.60-0.74), 0.74 (95% CI: 0.64-0.84), and 0.83 (95% CI: 0.78-0.88) for bare metal stents, covered stents (CSs), drug-eluting stents, and drug-coated balloons (DCBs), respectively. Lesions treated with DCB had the highest 1-year primary patency rate. At 1-year, endovascular procedures for FP lesions greater than 150 mm obtain satisfactory results. High primary patency rates were obtained with drug-coated devices, while CSs obtained less favorable results. Randomized studies comparing different devices in the treatment of long FP lesions remain necessary to determine the most optimal approach for the management of these patients. This paper highlights on the one hand the satisfactory results of endovascular treatment on complex femoropopliteal lesions formerly reserved for conventional surgery. On the other hand, among the available devices, paclitaxel-eluting devices seem to show superior results which should make them recommended as first-line treatment.

Exploring Heterogeneity in perinatal depression: a comprehensive review

Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.

Assessment of Post-Operative Outcomes of Surgical Excision of Gliomas of the Eloquent Areas of the Brain under Awake versus General Anaesthesia

Background Surgical excision of eloquent gliomas can be done under general anaesthesia or awake anaesthesia. Surgical excision of eloquent gliomas using awake anaesthesia helps to avoid intra-operative manipulation of the eloquent areas of the brain and thus avoid post-operative neurological deficits. Aim to compare the operative outcomes of eloquent glioma resection performed under general anaesthesia compared to awake anaesthesia to assess the safety and effectiveness of each intervention. Materials and Methods This systematic review and meta-analysis were conducted in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Metaanalysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers reported their findings according to each of the items listed in those checklists (1). Results Seven studies reported the early motor deficit, while the rest of the studies have no data concerning early motor deficit. The overall effect estimates did not favor awake craniotomy over general anesthesia in terms of motor deficit (RR 0.92, 95% CI 0.48– 1.4). The pooled studies showed significant heterogeneity (p = 0.001; I2 =85%. Conclusion The use of awake craniotomy for surgical resection of gliomas of the eloquent areas is largely limited to small retrospective studies. Within these studies, awake craniotomy achieves both an acceptable rate of GTR and a low rate of persistent neurological deficits. The results of this study illustrate the potential feasibility of awake craniotomy for surgical resection of gliomas of the eloquent areas and emphasize the need for future prospective studies to better determine its efficacy and outcome.

Parameters of Conversion from Temporary External Fixation to Internal Fixation in Open Fractures in Adults

Background Open fractures often have extensive soft-tissue damage requiring multiple procedures such as debridement, soft-tissue coverage, and definitive fixation through the cooperative work of orthopedic and plastic surgeons. Combined treatment for both the fracture and soft-tissue. Patients obtain many benefits from early fixation. Early stabilization facilitates patient mobility and alleviates pain and discomfort. Aim of the Work Systematically reviewing available evidence from published articles to assess points of conversion from this temporary external fixation to internal fixation in open fractures. Patients and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of the interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The moderate negative correlation between CRP and duration of conversion from EF to IF is probably because the downward trend of CRP from the peak value was considered one factor in the timing of conversion to IF, Strategy to perform definitive IF as early as possible resulted in 91% of patients undergoing definitive IF within 3 weeks after injury. In addition, this strategy is described to be beneficial for early soft-tissue repair with low infection rate. Subsequent conversion to ORIF can safely be performed once the patient is hemodynamically and systemically stable and any local soft-tissue injury has resolved, union rate of 91%, an infection rate of 16% and one fixation failure. All the infections occurred in open fractures, of which 75% were Gustilo grade III. Conclusion In conclusion, temporary external fixation for open fracture of the lower limb followed by conversion to internal fixation, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with open fracture. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection.

Comparison between Tonsillectomy by Coblation, Bipolar and Surgical Dissection

Abstract Background Tonsillectomy is one of the most common paediatric surgical procedures performed worldwide. Although it is one of the most widely performed procedures in otorhinolaryngology, none of the commonly used techniques for tonsillectomy is considered optimal till now. Objective To compare coblation, bipolar diathermy, and surgical dissection approaches for tonsillectomy in terms of operative time, surgical blood loss, postoperative pain and the incidence of postoperative complications. Methods A systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. Guidelines and an electronic search of information was conducted to identify studies that compare between coblation, cold dissection and bipolar diathermy techniques. Results This study showed that bipolar diathermy tonsillectomy was the lowest risk of primary bleeding followed by coblation then cold dissection tonsillectomy but with insignificant difference. Coblation technique was the highest secondary bleeding risk followed by cold dissection and the lowest risk was figured in bipolar diathermy procedure also the difference did not reach statistical significance. Coblation tonsillectomy was the best technique regarding blood loss and operative time with significant difference in the comparison with cold dissection and insignificant in the comparison with bipolar diathermy. Because of using a different postoperative pain measures in the studies we could not pool its data, but the majority of studies showed that coblation technique was better as regard postoperative pain than cold dissection and bipolar diathermy. While there was no significant difference between cold dissection and bipolar diathermy in the most studies Conclusion Overall, bipolar diathermy procedure for tonsillectomy was considered the best technique regarding primary and secondary bleeding outcomes, but the difference did not reach statistical significance. Coblation procedure for tonsillectomy was considered the best technique regarding intraoperative blood loss with significant difference except in comparison between bipolar diathermy and coblation the difference was not significant. Coblation technique also considered the best one regarding operative time with significant difference in direct comparison between coblation and cold, and insignificant in other comparisons. By systematic review on 21 studies coblation technique shows less postoperative pain than cold dissection and bipolar diathermy in the majority of studies comparing coblation with every technique. And there was no significant difference between studies compared cold dissection with bipolar diathermy regarding postoperative pain.