Pooled Effect Estimates Research Articles

Efficacy and Safety of Eldecalcitol for Osteoporosis: A Meta-Analysis of Randomized Controlled Trials.

ObjectEldecalcitol (ED-71) is a vitamin D analog for the treatment of osteoporosis. However, inconsistent results have been reported in this regard. Hence, this meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy and safety of ED-71 for osteoporosis.MethodsThe PubMed, Embase, and the Cochrane Library databases were systematically searched to identify potential trials from inception until April 2021. The investigated outcomes included bone mineral density and fractures at various sites, and potential adverse events. The pooled effect estimates were calculated using weighted mean difference (WMD) and relative risk (RR) with 95% confidence interval (CI) using the random-effects model.ResultsEight RCTs involving 2368 patients were selected for the final meta-analysis. The pooled results showed that ED-71 were associated with a higher level of femoral neck (FN) bone mineral density (BMD) (WMD: 0.92; 95% CI: 0.24–1.60; P = 0.008), while it had no significant effect on lumbar spine BMD (WMD: 1.09; 95% CI: –0.11 to 2.30; P = 0.076) and hip BMD (WMD: 1.12; 95% CI: –0.16 to 2.40; P = 0.088). Moreover, the use of ED-71 could protect against the risk of all osteoporotic fracture (RR: 0.70; 95% CI: 0.55–0.88; P = 0.003) and vertebral fracture (RR: 0.74; 95% CI: 0.55–0.98; P = 0.038), while it did not affect the risk of nonvertebral fracture (RR: 0.53; 95%CI: 0.23–1.23; P = 0.140). The subgroup analyses found that the effects of ED-71 were superior to those of alfacalcidol on both BMD and fracture results. Moreover, the use of ED-71 plus bisphosphonate was associated with a greater improvement in BMD at various sites compared with bisphosphonate alone. Finally, ED-71 was associated with an increased risk of increased urine calcium level (RR: 1.69; 95% CI: 1.33–2.15; P < 0.001).ConclusionThis study found that the use of ED-71 could improve BMD and fractures at various sites, especially compared with alfacalcidol or a combination with bisphosphonate for patients with osteoporosis.Systematic Review Registration[http://www.crd.york.ac.uk/prospero], identifier [CRD42021270536].

Prognostic Epstein-Barr Virus (EBV) miRNA biomarkers for survival outcome in EBV-associated epithelial malignancies: Systematic review and meta-analysis.

BackgroundThe EBV-associated epithelial tumours consist 80% of all EBV-associated cancer, where the nasopharyngeal cancer (NPC) and EBV-associated gastric carcinoma (EBVaGC) are considered as the most frequent EBV-associated epithelial tumours. It has been shown that the BART-encoded miRNAs are abundantly expressed in EBV-associated epithelial tumours, hence, these miRNAs may serve as diagnostic and prognostic biomarkers for EBV-associated epithelial tumours. Therefore, the purpose of this systematic review and meta-analysis is to assess these EBV miRNAs as prognostic biomarkers for NPC and GC.MethodThis systematic review was developed based on PRISMA guidelines and utilizing PubMed, Web of Science, Scopus, Cochrane, and Google scholar databases. The retrieved articles were thoroughly screened in accordance with the selection criteria. The hazard ratio (HR) and 95% confidence interval (CI) for patient survival outcomes were used to evaluate EBV miRNA expression levels. To assess the risk of bias, funnel plot symmetry and Egger’s bias test were employed.ResultEleven studies met the selection criteria for inclusion, and four were included in the meta-analysis. Most of the articles considered in this study were from China, with one study from South Korea. The overall pooled effect size estimation (HR) for upregulated EBV miRNAs was 3.168 (95% CI: 2.020–4.969), demonstrating that upregulated EBV miRNA expression enhanced the mortality risk in NPC and GC patients by three times.ConclusionTo the best of our knowledge, this is the first meta-analysis that investigates the significance of EBV miRNAs as prognostic biomarkers in NPC and GC patients. The pooled effect estimates of HR of the various studies revealed that higher EBV miRNA expression in NPC and GC may result in a worse survival outcome. To assess the clinical significance of EBV miRNAs as prognostic biomarkers, larger-scale prospective studies are needed.

Immunogenicity and Risk Factors Associated With Poor Humoral Immune Response of SARS-CoV-2 Vaccines in Recipients of Solid Organ Transplant

Recipients of solid organ transplant (SOT) experience decreased immunogenicity after COVID-19 vaccination. To summarize current evidence on vaccine responses and identify risk factors for diminished humoral immune response in recipients of SOT. A literature search was conducted from existence of database through December 15, 2021, using MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov. Studies reporting humoral immune response of the COVID-19 vaccines in recipients of SOT were reviewed. Two reviewers independently extracted data from each eligible study. Descriptive statistics and a random-effects model were used. This report was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were analyzed from December 2021 to February 2022. The total numbers of positive immune responses and percentage across each vaccine platform were recorded. Pooled odds ratios (pORs) with 95% CIs were used to calculate the pooled effect estimates of risk factors for poor antibody response. A total of 83 studies were included for the systematic review, and 29 studies were included in the meta-analysis, representing 11 713 recipients of SOT. The weighted mean (range) of total positive humoral response for antispike antibodies after receipt of mRNA COVID-19 vaccine was 10.4% (0%-37.9%) for 1 dose, 44.9% (0%-79.1%) for 2 doses, and 63.1% (49.1%-69.1%) for 3 doses. In 2 studies, 50% of recipients of SOT with no or minimal antibody response after 3 doses of mRNA COVID-19 vaccine mounted an antibody response after a fourth dose. Among the factors associated with poor antibody response were older age (mean [SE] age difference between responders and nonresponders, 3.94 [1.1] years), deceased donor status (pOR, 0.66 [95% CI, 0.53-0.83]; I2 = 0%), antimetabolite use (pOR, 0.21 [95% CI, 0.14-0.29]; I2 = 70%), recent rituximab exposure (pOR, 0.21 [95% CI, 0.07-0.61]; I2 = 0%), and recent antithymocyte globulin exposure (pOR, 0.32 [95% CI, 0.15-0.71]; I2 = 0%). In this systematic review and meta-analysis, the rates of positive antibody response in solid organ transplant recipients remained low despite multiple doses of mRNA vaccines. These findings suggest that more efforts are needed to modulate the risk factors associated with reduced humoral responses and to study monoclonal antibody prophylaxis among recipients of SOT who are at high risk of diminished humoral response.

Efficacy and safety of re-irradiation for locoregional esophageal squamous cell carcinoma recurrence after radiotherapy: a systematic review and meta-analysis

BackgroundThere is currently no standard treatment for locoregional recurrence of esophageal squamous cell carcinoma (ESCC) previously treated with radiotherapy. This study aimed to assess the efficacy and safety of re-irradiation for ESCC patients with locoregional recurrence.MethodsThe PubMed, EmBase, and Cochrane library databases were systematically searched for eligible studies published before January 2021. The pooled effect estimates were calculated using the random effects model. Subgroup analyses were conducted to assess the treatment effectiveness of re-irradiation based on specific characteristics.ResultsNine retrospective studies including 573 ESCC patients with locoregional recurrence were selected. The pooled incidences of the 1-year, 2-year, 3-year, and 5-year survival for patients after re-irradiation were 59% (95% confidence interval [CI]: 35–83; P < 0.001), 25% (95% CI: 16–33; P < 0.001), 25% (95% CI: 4–45; P = 0.017), and 15% (95% CI: 2–27; P = 0.024), respectively. The rates of complete response and local re-recurrence after re-irradiation were 54% (95% CI: 21–88; P = 0.001) and 62% (95% CI: 55–70; P < 0.001), respectively. The median overall survival and local failure-free survival for patients after re-irradiation were 13.94 months (95% CI: 4.18–46.51; P < 0.001) and 11.01 months (95% CI: 5.99–20.22; P < 0.001), respectively. Grade ≥ 3 adverse events of esophageal perforation, tracheoesophageal fistula, and radiation pneumonitis were significantly more common after re-irradiation.ConclusionsThis study found that re-irradiation for ESCC patients with locoregional recurrence after previous radiotherapy was feasible. However, patients should be carefully observed in order to treat associated adverse events, including esophageal perforation, tracheoesophageal fistula, and radiation pneumonitis.

Application of bivariate meta-analytic approach for pooling effect measures of correlated multiple outcomes in medical research

BackgroundMultivariate meta-analysis is used when multiple correlated outcomes are reported in a systematic review. This study explored the application of multivariate meta-analysis in such a context. The objectives of the present study were to compare the summary findings and decisions between univariate and bivariate meta-analyses, as well as to assess how much sensitive the results are towards the strength of the correlation between the outcome variables. MethodsA systematic review that reported two correlated outcomes, Intact parathyroid hormone levels and serum phosphate was chosen for demonstrating the applications of bivariate meta-analysis. Both univariate and bivariate meta-analyses with fixed effect and random effect models were carried out and the results were compared. A sensitivity analysis was performed for a wide spectrum of correlations from −1 to +1 to assess the impact of correlation on pooled effect estimates and its precision. ResultsPooled effect estimates generated through bivariate meta-analysis were found to be varying when compared to those obtained through univariate meta-analysis. The confidence interval of the pooled effect estimates obtained through bivariate meta-analysis was wider than in univariate meta-analysis. Further, the value of the pooled effect estimates along with its confidence intervals also differed for varied levels of correlations. ConclusionsThis study observed that when we have multiple correlated outcome variables to answer a single question bivariate meta-analysis could be a better approach. The magnitude of the correlation between the outcome variables also plays a vital role in meta-analysis.

Effects of lifestyle interventions on glucose regulation and diabetes risk in adults with impaired glucose tolerance or prediabetes: a meta-analysis.

The prevalence of diabetes mellitus is increasing and is related to sedentary lifestyles and obesity. Many studies were published on the effect of lifestyle interventions on glucose regulation and delay the onset of diabetes in adults with impaired glucose tolerance (IGT) or prediabetes. This study aimed to investigate the role of lifestyle interventions in individuals with IGT or prediabetes using a meta-analytic approach. PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from their inception up to January 2020 to select eligible randomized controlled trials (RCTs). The weighted mean difference (WMD; for fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPPG)) or relative risk (RR; for the risk of diabetes) with 95% confidence interval (CI) were calculated for pooled effect estimates using the random-effects model. Thirteen RCTs involving 3376 individuals with IGT or prediabetes were selected for this meta-analysis. The results showed that lifestyle interventions were associated with lower FPG (WMD: -0.14; 95% CI: -0.24 to -0.05 mmol/L; p=0.004) and 2hPPG (WMD: -0.66; 95% CI: -1.12 to -0.20 mmol/L; p=0.005) in adults with IGT or prediabetes. Moreover, the risk of diabetes was significantly reduced in individuals who received lifestyle interventions (RR: 0.75; 95% CI: 0.60-0.95; p=0.015). Lifestyle interventions could help improve glucose dysregulation and prevent the progression of diabetes in adults with IGT or prediabetes. Further large-scale RCTs should be conducted to assess the effects of long-term lifestyle interventions on diabetic complications in adults with IGT or prediabetes.

Clinical efficacy of melatonin as adjunctive therapy to non-surgical treatment of periodontitis: a systematic review and meta-analysis.

This study aimed to evaluate the effect of adjunctive melatonin supplementation on clinical outcomes after non-surgical periodontal treatment. PubMed, Embase, and Web of Science databases were systematically searched for randomised controlled trials (RCTs) of melatonin adjuvant therapy for periodontitis from inception until May 2021. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021250630). The risk of bias of included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. The pooled effect estimates were calculated by a random-effects model, and results were expressed as weighted mean differences (WMD). Seven RCTs comprising 412 participants were included in the meta-analysis. The pooled results showed that adjuvant use of melatonin for non-surgical periodontal treatment significantly improved the probing depth (PD) [WMD = -1.18, 95% CI (-1.75, -0.62) I2 = 85.7%], clinical attachment loss (CAL) [WMD = -1.16, 95% CI (-1.60, -0.72) I2 = 76.7%] and gingival index (WMD = -0.29, 95%CI [-0.48, -0.11], I2 = 63.6%) compared with non-surgical treatment alone. In addition, subgroup analysis showed that higher doses of melatonin (3-10mg) significantly improved PD [WMD = -1.32, 95%CI (-2.31, -0.15) I2 = 93%] and CAL [WMD = -1.30, 95%CI (-1.80, -0.81) I2 = 73.7%] compared with lower doses of melatonin (< 3mg). We found that adjunctive melatonin supplementation can significantly improve the periodontal status after non-surgical treatment, suggesting that melatonin may be a new adjuvant therapy for periodontitis when non-surgical periodontal treatment alone cannot achieve the desired improvement.

Meta-analysis of downregulated E-cadherin as a diagnostic biomarker for cervical cancer.

Downregulation of E-cadherin function or expression has been implicated in the progression of cervical cancer. This meta-analysis of updated publications was performed to assess the association of expression alteration of E-cadherin with disease severity and then to determine the diagnostic accuracy of E-cadherin in discriminating cervical lesions including cervical intraepithelial neoplasia (CIN) grade 1 (CIN1), CIN grade 2 (CIN2), CIN grade 3 (CIN3), and cervical cancer. The articles published from inception to January 2021 were searched in PubMed, EBSCO, CNKI, and WanFang Database and then evaluated according to the criteria of meta-analysis. The eligible studies were retrieved and further analyzed. A bivariate mixed effects binary regression model was applied to determine pooled effect estimates. 16 studies with 2436 subjects from 7 countries were eligible for this meta-analysis. When compared with CIN1 control, the pooled odds ratios (ORs) with 95% confidence interval (CI) for the association of E-cadherin positivity with CIN2, CIN3, and cervical cancer were 0.34 (95% CI 0.23-0.51), 0.23 (95% CI 0.10-0.54), and 0.10 (95% CI 0.07-0.14), respectively. The pooled sensitivity and specificity for CIN3 or worse were 0.60 (95% CI 0.48-0.70) and 0.82 (95% CI 0.73-0.88) respectively, with the AUC of 0.78 (95% CI 0.74-0.82). Similar performance was found in CIN2 or worse. These findings demonstrated that the loss of E-cadherin protein was associated with worsened cervical lesions. E-cadherin might serve as a promising diagnostic biomarker to facilitate the discrimination of precancerous and cancerous lesions.

Systematic review and meta-analysis of studies between short-term exposure to ambient carbon monoxide and non-accidental, cardiovascular, and respiratory mortality in China.

Although a growing number of original epidemiological studies imply a link between ambient pollution exposure and mortality risk, the findings associated with carbon monoxide (CO) exposure are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to evaluate the correlations between ambient CO and non-accidental, cardiovascular, and respiratory mortality in China. Eight databases were searched from inception to 15 May 2021. A random-effect model was used to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses as well as sensitivity analyses were performed. The I square value (I2) was used to assess heterogeneity among different studies. The assessment of publication bias on included studies was examined by funnel plot and Egger's test. The influence of a potential publication bias on findings was explored by using the trim-and-fill procedure. Ultimately, a total of 19 studies were included in our analysis. The pooled relative risk for each 1 mg/m3 increase of ambient carbon monoxide was 1.0220 (95%CI: 1.0102-1.0339) for non-accidental mortality, 1.0304 (95%CI:1.0154-1.0457) for cardiovascular mortality, and 1.0318 (95%CI:1.0132-1.0506) for respiratory mortality. None of subgroup analyses could explain the source of heterogeneity. Exclusion of any single study did not materially alter the pooled effect estimates. Although it was suggestive of publication bias, findings were generally similar with principal findings when we explored the influence of a potential publication bias using the trim-and-fill method. Our meta-analysis demonstrated that exposure to ambient CO was positive with risk of deaths from all non-accidental causes, total cardiovascular, and respiratory diseases. Based on these findings, tougher intervention policies and initiatives to reduce the health effects of CO exposure should be established.

Effectiveness of self-managed home and community exercise interventions in improving physical activity, body adiposity and related health indices in adults living with HIV: a protocol for a systematic review

Background and objectivesDisorders of adipose tissue distribution in people living with the human immunodeficiency virus (HIV) have been associated with significant metabolic derangements that increase their risk of cardiometabolic and other chronic diseases. Systematic reviews focusing on supervised laboratory-based exercise interventions demonstrate that these interventions improve adipose tissue distribution and related health outcomes in people living with HIV (PLWH). However, there is a need to examine the effectiveness of more pragmatic home or community exercise programmes. The aim of this review will be to synthesize existing evidence on the effectiveness of self-managed home or community exercise interventions to improve physical activity levels, adipose tissue distribution and associated health indices in PLWH.MethodsThis review will encompass interventional studies that evaluate the effect of prescribed exercise programmes performed in the home or community with minimal supervision, by adults living with HIV. The following will be searched from inception: PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.gov. Screening of studies and data extraction will be conducted by two independent reviewers. The risk of bias in included studies will be assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized concurrently controlled and single-arm interventional studies. A random effects meta-analysis will be used to pool effect estimates for outcomes of interest (measures of physical activity and body adiposity). However, if pooling is deemed inappropriate due to substantial differences between studies, a narrative synthesis will be performed. This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols 2015 statement (see Additional file 1).DiscussionThis review shall provide evidence to support or disapprove the prescription of self-managed exercise interventions in a particularly vulnerable population. We will equally explore the potential impact of technology in improving physical activity outcomes. Our findings could help guide clinicians involved in the care of PLWH in prescribing exercise and inform the design of future trials and research.Systematic review registrationPROSPERO CRD42021223357.

187 Ketamine and Spinal Fusion Surgery: Does It Increase or Reduce Postoperative Opioid Consumption? A Systematic Review and Meta-Analysis of Randomized Controlled Trial

INTRODUCTION: Ketamine is a commonly used anesthetic that can also be used for analgesia and sedation. However, none has examined its role in spinal fusion surgery. METHODS: Using the keywords ketamine, spinal fusion surgery, postoperative, and opioid, each reviewer individually carried out a literature search from PubMed, EuroPMC, and Cochrane CENTRAL until May 15, 2021. We only included studies with the adult population, a randomized controlled trial design, English language publications, and reported the key exposure. Additionally, only fully reviewed literature was included. We also excluded non-human literature. The primary endpoint was morphine consumption after 24 and 48 hours of undertaking surgery, whereas secondary endpoints were pain and complications. The pain was analyzed using the visual analogue scale (VAS). We performed a standardized mean difference meta-analysis for postoperative morphine consumption and pain. For complications, we reported the odds ratio as the pooled effect estimate. Each studies quality included was assessed using the Newcastle-Ottawa Scale. RESULTS: We included four notable studies in this study (n = 515). 34.5% male and 65.5% female with the mean age of 45.4 years old. We found that intraoperative ketamine administration were associated with lower postoperative opioid consumption -38.35 mg (95% CI -53.18, -23.52), decreased VAS score -0.83 (95% CI -1.26, -0.39), and lower postoperative complications (OR 0.80, 95% CI 0.60, 1.06). CONCLUSION: Ketamine administration intraoperatively resulted in a considerable reduction in morphine intake, decreased pain, and fewer adverse reactions in spinal fusion surgery patients.

Association between per- and polyfluoroalkyl substances and risk of gestational diabetes mellitus.

Existing evidence suggests that perfluoroalkyl and polyfluoroalkyl substances (PFASs) exposure might contribute to the incidence of gestational diabetes mellitus (GDM). This study aimed to perform a meta-analysis to identify the association between PFAS and the risk of GDM. We systematically searched PubMed, Ovid, Cochrane Library, and Web of Science databases for appropriate articles about the association between PFASs exposure and the risk of GDM before September 28, 2020. Odds ratios (OR) with 95% confidence intervals (CIs) were summarized by Stata 16.0 through fixed effect models according to heterogeneity. We also carried out subgroup analyses by geographic location, blood sampling time of subjects, method of chemical analysis, study design, sample size, and sampling year. In addition, a sensitivity analysis was conducted to explore the robustness of the results. A total of eight studies involving 5654 pregnant women were included in the meta-analysis. Perfluorooctanoic acid (PFOA) exposure was positively and significantly associated with the risk of GDM (OR=1.27, 95% CI: 1.02-1.59). Exposure to other types of PFASs such as perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), perfluorononanoic acid (PFNA) was not statistically significantly associated with the risk of GDM with the pooled effect estimates of 0.97 (95% CI: 0.86-1.09), 1.03 (95% CI: 0.86-1.24), and 0.80 (95% CI: 0.55-1.16) respectively. We conducted a meta-analysis to investigate the association between PFASs exposure and GDM and found that PFOA concentration was significantly associated with a higher risk of GDM, which is of great significance for the prevention and control of GDM in public health. Further studies are needed in order to establish causality and clarify the potential mechanism.

Protein intake in children and growth and risk of overweight or obesity: A systematic review and meta-analysis.

ObjectivesThe aim of this study was to examine the evidence for an association between the dietary protein intake in children and the growth and risk of overweight or obesity up to 18 years of age in settings relevant for the Nordic countries.MethodsWe searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to February 26, 2021 for randomized controlled trials (RCTs) or prospective cohort studies assessing for protein intake from foods (total and from different sources) in children. The outcomes include weight, height/length, adiposity indices, and/or risk of overweight and/or obesity. The risk of bias was evaluated with instruments for each respective design (Cochrane’s Risk of Bias 2.0 and RoB-NObS). A meta-analysis of five cohort studies was performed. The evidence was classified according to the criteria of the World Cancer Research Fund.ResultsThe literature search resulted in 9,132 abstracts, of which 55 papers were identified as potentially relevant. In total, 21 studies from 27 publications were included, of which five were RCTs and 16 were cohort studies. The RCTs found generally null effects of high-protein intake in infants on weight gain, nor that lower protein diets negatively affected growth. All included RCTs had some concern regarding the risk of bias and were limited by small sample sizes. Total protein intake and BMI were assessed in 12 cohorts, of which 11 found positive associations. The meta-analysis revealed a pooled effect estimate of 0.06 (95% CI 0.03, 0.1) kg/m2 BMI per one E% increment in total protein (I2 = 15.5). Therefore, the evidence for a positive relationship between total protein intake and BMI was considered probable. Furthermore, there was probable evidence for an association between higher intake of animal protein and increased BMI. There was limited, suggestive evidence for an effect of total protein intake and higher risk of overweight and/or obesity, while no conclusions could be made on the associations between animal vs. plant protein intake and risk of overweight and/or obesity.DiscussionIn healthy, well-nourished children of Western populations, there is probably a causal relationship between a high-protein intake in early childhood (≤ 18 months) – particularly protein of animal origin – and higher BMI later in childhood, with consistent findings across cohort studies. A lack of RCTs precluded a stronger grading of the evidence.

Sealants for preventing dental caries in primary teeth.

Sealants for preventing dental caries in primary teeth.

Effect of a vegetation fire event ban on hospital visits for respiratory diseases in Upper Northern Thailand.

Upper Northern Thailand (UNT) has been episodically affected by air pollution from vegetation burning, which causes adverse respiratory health effects. However, no study has evaluated the effect of regulatory actions to prohibit vegetation burning on respiratory morbidity. We examined the effect of a burning ban enforced in May 2016 on hospital visits for respiratory diseases in UNT. This study used data from eight provinces in UNT. Analyses were conducted for January to April of 2014-2016 (before ban enforcement) and January to April of 2017-2018 (after ban enforcement). Particulate matter of 10 microns in diameter or smaller (PM10) concentrations, numbers of satellite fire hotspots and age-standardized rates of hospital visits for respiratory diseases before and after ban enforcement were compared. The effect of the ban on hospital visits for respiratory diseases was evaluated using an interrupted time-series analysis controlled for season-specific temporal trends, day of week, public holiday, temperature, relative humidity, number of hospitals and offset population, with gastrointestinal diseases as a negative control. A meta-analysis was performed to pool province-specific effect estimates. The daily average PM10 concentration and the number of fire hotspots decreased after ban enforcement in all provinces in UNT, with percent changes ranging from 5.3 to 34.3% and 14.3 to 81.5%, respectively. The adjusted pooled effect estimates of hospital visits for respiratory diseases decreased by 9.1% (95% CI: 5.1, 12.9), whereas a null association was observed for gastrointestinal diseases. The burning ban had a positive impact on both air pollution levels and rates of hospital visits for respiratory diseases in UNT.

Assessing the causal relationship between income inequality and mortality and self-rated health: protocol for systematic review and meta-analysis

BackgroundIncome inequality has been linked to health and mortality. While there has been extensive research exploring the relationship, the evidence for whether the relationship is causal remains disputed. We describe the methods for a systematic review that will transparently assess whether a causal relationship exists between income inequality and mortality and self-rated health.MethodsWe will identify relevant studies using search terms relating to income inequality, mortality, and self-rated health (SRH). Four databases will be searched: MEDLINE, ISI Web of Science, EMBASE, and the National Bureau of Economic Research. The inclusion criteria have been developed to identify the study designs best suited to assess causality: multilevel studies that have conditioned upon individual income (or a comparable measure, such as socioeconomic position) and natural experiment studies. Risk of bias assessment of included studies will be conducted using ROBINS-I. Where possible, we will convert all measures of income inequality into Gini coefficients and standardize the effect estimate of income inequality on mortality/SRH. We will conduct random-effects meta-analysis to estimate pooled effect estimates when possible. We will assess causality using modified Bradford Hill viewpoints and assess certainty using GRADE.DiscussionThis systematic review protocol lays out the complexity of the relationship between income inequality and individual health, as well as our approach for assessing causality. Understanding whether income inequality impacts the health of individuals within a population has major policy implications. By setting out our methods and approach as transparently as we can, we hope this systematic review can provide clarity to an important topic for public policy and public health, as well as acting as an exemplar for other “causal reviews”.

Post-traumatic stress disorder psychological interventions in sub-Saharan Africa: protocol for a systematic review of the literature

IntroductionUntreated post-traumatic stress disorder (PTSD) results in considerable morbidity and higher risk of mortality. However, little is being done to treat PTSD in sub-Saharan Africa (SSA) settings where rates of...

Enteral Glutamine Supplementation is Associated with Lowering Wound Infection Morbidity and Length of Hospital Stay among Burn Patients: A Meta-analysis and Systematic Review

Background. Significant nutritional support to meet increased energy expenditure is vital for burn patient's survival. Burn injury may lead to a significant decrease in Glutamine levels, which inspired the hypothesis that glutamine supplementation following burn injury would improve outcomes. Hence, the purpose of this meta-analysis study was to provide the rationale for determining the efficacy and safety of enteral glutamine in burn patients.&#x0D; &#x0D; Methods. We conducted a meta-analysis based on PRISMA design to assess the potency of enteral glutamine supplementation as adjuvant treatment in patients with burn trauma. PubMed, Sciencedirect, and Google scholar were searched systematically using the following keywords: "enteral glutamine" and "burn patients" and "critical ill" and "infection" and "length of stay". Newcastle-Ottawa Scale (NOS) was used to assess the quality of papers included in our meta-analysis. A Z test was used to determine the significance of pooled effect estimates. Publication bias was assessed using Egger's. We used Comprehensive Meta-Analysis (CMA) version 2.1 to analyze the data.&#x0D; &#x0D; Results: A total of 12 studies recording 344 cases and 335 controls were enrolled for our analysis. Data on hospital Length of Stay (LOS) was found that enteral glutamine supplementation provided a significant result in reducing the LOS (Std mean diff: 0.70, 95%CI: 0.16 – 1.24; p=0.0100). We also found that a higher risk of positive wound culture was significantly observed in patients without the supplementation of enteral glutamine (OR 2.15, 95% CI: 1.41 – 3.27; p=0.0003) compared to patients receiving enteral glutamine supplementation among burn patients.&#x0D; &#x0D; Conclusion: In our meta-analysis study, enteral glutamine in burn patients confers significantly shorter LOS and lower risk of wound infection among burn patients. We suggest that enteral glutamine supplementation may be a beneficial intervention for the management of burn patients.

The Association of Frailty with Outcomes after Cancer Surgery: A Systematic Review and Metaanalysis

Cancer is common in older adults, who often have concurrent frailty. Frailty is a strong predictor of adverse outcomes in surgical patients. Our objective is to systematically review the association of frailty with postoperative mortality and other adverse outcomes in adult patients who have undergone nonemergency cancer surgery. After registration (CRD42020171163), we systematically reviewed PubMed, MEDLINE, EMBASE, and CINAHL databases to identify all studies reporting an association between a preoperative frailty measurement and a relevant outcome (primary: all-cause mortality in-hospital or within 30 days of surgery; secondary outcomes: postoperative complications, length of stay, discharge disposition, mortality between 30 days and 1 year, postoperative function, and delirium). All stages of the review were completed in duplicate. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Metaanalysis was used to pool effect estimates using random-effects models. A total of 2877 studies were identified, and 71 were included. Frailty was significantly associated with mortality within 30 days (adjusted odds ratio (OR) 3.02, 95% confidence interval (CI) 1.77-5.15), adverse discharge disposition (adjusted OR 2.14, 95% CI 1.52-3.02), postoperative complications (adjusted OR 2.39, 95% CI 1.64-3.49), longer-term mortality (unadjusted OR 4.32, 95% CI 2.15-8.67), and length of stay (mean difference 2.30, 95% CI 1.10-3.50). The number of studies presenting adequately adjusted estimates was small. Findings may be limited due to publication bias. In adults having elective cancer surgery, frailty is strongly associated with adverse health outcomes. Preoperative frailty assessment should be considered in prognostication.

The utilization of hyperbaric oxygenation therapy in hypospadias repair: a systematic review and meta-analysis

This study aimed to evaluate the efficacy and safety of Hyperbaric Oxygen Therapy (HBOT) use in hypospadias repair through systematic review and meta-analysis of comparative studies. A systematic literature search was performed in May 2021. Comparative studies assessing the surgical outcome of hypospadias repair between control versus HBOTutilization were identified andevaluated according to Cochrane collaboration recommendations. The assessed outcome includes hypospadias repair failures and graft failure for staged repair using a buccal graft. Relative risk with corresponding95% confidence intervals (CI) wereextrapolated. A random-effect model was used to generate pooled effect estimates. Heterogeneity and inter-study variability were assessed using Chi-square and I-square. Subgroup analysis was performed according to primary repair versus redo-hypospadias with buccal graft. PROSPERO registration (CRD42021251423). Five comparative studies with 576 cases (301 HBOT versus 275 controls) were included. Overall pooled effect estimates showed that the HBOT group has significantly lesser hypospadias repair failure (RR 0.52, 95%CI 0.37, 0.72). Subgroup analysis on the use of HBOT for graft take showed lesser graft failure compared to the control group(RR 0.20, 95%CI 0.05, 0.75), while the use of HBOT for primary and redo single staged hypospadias repair showed lesser complicationrate (RR 0.56, 95%CI 0.40, 0.78). Based on ROBINS-I assessment, all included comparative studies are determined to be of serious risk of bias mainly due to presence ofconfounding. The currently available low-quality of evidence suggests that compared to control groups, HBOT as an adjunctive intervention to complicated hypospadias repair was able to reduce surgical outcome failure and graft failure rates.