Pooled Odds Ratio Research Articles

Association between earthquakes and perinatal outcomes: Asystematic review and meta-analysis.

Evidence for the association between earthquakes and adverse perinatal outcomes is limited. To evaluate the association between earthquakes and perinatal outcomes including preterm birth and low birth weight. We searched studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov on February 9, 2023. We included before-and-after studies that evaluated the associations between earthquakes and perinatal outcomes in women living in affected areas. Two independent reviewers extracted data. We calculated the pooled odds ratio (OR) with the random-effects model. We analyzed outcomes in subgroups of Asians and others. We evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation system. We included 2607405 women in 13 studies. Earthquakes may not increase preterm birth (nine studies, 1761760 participants: OR 1.10, 95% confidence interval [CI] 0.98-1.24, low certainty of evidence) or low birth weight (seven studies, 1753891 participants: OR 1.10, 95% CI 0.94-1.28, low certainty of evidence). Subgroup analyses showed that earthquakes may be associated with an increase of preterm birth among populations in Asia (OR 1.44, 95% CI 1.07-1.95), but this was not evident in others (OR 0.93, 95% CI 0.83-1.05). Perinatal outcomes might not change after earthquakes. Further research on the association between earthquakes and perinatal outcomes, combined with an assessment of the characteristics of the region, is needed.

Relationship between Parenting Styles and Tendency to Addiction in Iran: A Systematic Review and Meta-Analysis.

Various factors are involved in the initiation of drug abuse, such as genetic and social factors. Among the factors that can be mentioned in associated with the tendency to addiction in children is the role of family prediction. This study aimed to explore the relationship between parenting styles and addiction tendency in Iran. We searched Persian database included Magiran, SID, IranDoc and Noormagz for articles from 2007- 2022 in Iran. Seven articles with 1734 subjects were ultimately included in the qualitative and quantitative syntheses. Five subscales (parenting method) were brought up for investigation of the relationship between parenting styles and addiction tendency. The pooled odds ratio (OR) and its 95% confidence interval (CI) were calculated for each associated factors using random-effects/fixed-effects models. Publication bias was assessed using funnel plot and the Eggers test and each effect size was calculated manually. Based on Cohen's interpretation criterion are as follow: the mean effect size of the relationship with the permissive style is 0.33 (average), the mean effect size of the relationship with authoritative style is 0.31 (average), the mean effect size of the relationship with the dependent style is 0.28 (average), the mean effect size of the relationship with the freedom-control is - 0.02 (small), the mean effect size of the relationship with the method based on affection-rejection is 0.33 (moderate). Parenting styles have a significant relationship with addiction tendencies in Iran. Therefore, appropriate programs can be provided to strengthen and educate the correct and suitable parenting methods with their children as safe as possible in order to avoid risky behaviors and injuries such as addiction.

Effects of combination therapy of antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation: a systematic review and meta-analysis

BackgroundDisseminated intravascular coagulation (DIC) syndrome is a highly lethal condition characterized by the complication of multiple organ damage. Although the effects of combined antithrombin (AT) and recombinant thrombomodulin (rTM) on DIC syndrome have previously been examined, the results are inconsistent and inconclusive. Therefore, we conducted a systematic review on the combined administration of AT and rTM for the treatment of septic DIC to investigate the superiority of the combination therapy over either AT or rTM monotherapy using a random-effects analysis model.MethodWe searched electronic databases, including Medline, Cochrane Central Register of Controlled Trials, Scopus, and Igaku-Chuo Zasshi (ICHU-SHI) Japanese Central Review of Medicine Web from inception to January 2022. Studies assessing the efficacy of combined AT and rTM were included. The primary outcome was all-cause mortality, and the secondary outcome was occurrence of serious bleeding complications compared to monotherapy. We presented the pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CI) depending on reporting results in each primary study.ResultsWe analyzed seven enrolled clinical trials, all of which were observational studies. Combination therapy had a non-significant favorable association with lower 28-day mortality compared to monotherapy (HR 0.67 [0.43–1.05], OR 0.73 [0.45–1.18]). The I2 values were 60% and 72%, respectively, suggesting high heterogeneity.As a secondary outcome, bleeding complications were similar between the two groups (pooled OR 1.11 [0.55–2.23], I2 value 55%).ConclusionsAlthough the findings in this analysis could not confirm a statistically significant effect of AT and rTM combination therapy for septic DIC, it showed a promising effect in terms of improving mortality. The incidence of bleeding was low and clinically feasible. Further research is warranted to draw more conclusive results.Trial registrationThis study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN ID: 000049820).

A comprehensive meta-analysis of risk factors associated with osteosarcopenic obesity: a closer look at gender, lifestyle and comorbidities.

Osteosarcopenic obesity (OSO) represents a confluence of osteopenia/osteoporosis, sarcopenia, and obesity, contributing to increased morbidity and mortality risks. Despite escalating prevalence, its risk factors remain under-explored, necessitating this comprehensive systematic review and meta-analysis. A diligent search of PubMed, Scopus, and Cochrane databases was conducted for pertinent studies until June 2023. The random-effects model was employed to compute pooled odds ratios (ORs) and 95% confidence intervals (CIs), scrutinizing various risk factors like age, gender, lifestyle factors, and common comorbidities. Our meta-analysis incorporated 21 studies comprising 178,546 participants. We identified significant associations between OSO and factors such as female gender (OR 1.756, 95% CI 1.081 to 2.858), physical inactivity (OR 1.562, 95% CI 1.127-2.165), and hypertension (OR 1.482, 95% CI 1.207-1.821). Conversely, smoking (OR 0.854, 95% CI 0.672-1.084), alcohol consumption (OR 0.703, 95% CI 0.372-1.328), and dyslipidemia (OR 1.345, 95% CI 0.982-1.841) showed no significant associations. Remarkable heterogeneity was observed across studies, indicating considerable variation in effect sizes. Notably, OSO was strongly associated with frailty (OR 6.091; 95% CI 3.576-10.375). Our study underscored the substantial role of female gender, physical inactivity, and hypertension in the development of OSO, whilst suggesting a strong link between OSO and frailty. These findings emphasize the importance of early risk factor identification and targeted interventions in these groups. Further research is warranted to decode the complex pathophysiological interplay and devise effective prevention and management strategies.

Efficacy and safety of VEGF/VEGFR inhibitors for platinum-resistant ovarian cancer: a systematic review and meta-analysis of randomized controlled trials

BackgroundAlmost all patients with ovarian cancer will experience relapse and eventually develop platinum-resistant. The poor prognosis and limited treatment options have prompted the search for novel approaches in managing platinum-resistant ovarian cancer (PROC). Therefore, a meta-analysis was conducted to evaluate the efficacy and safety of combination therapy with vascular endothelial growth factor (VEGF) /VEGF receptor (VEGFR) inhibitors for PROC.MethodsA comprehensive search of online databases was conducted to identify randomized clinical trials published until December 31, 2022. Pooled hazard ratios (HR) was calculated for overall survival (OS) and progression-free survival (PFS), while pooled odds ratio (OR) was calculated for objective response rate (ORR) and treatment-related adverse events (TRAEs). Subgroup analysis was further performed to investigate the source of heterogeneity.ResultsIn total, 1097 patients from eight randomized clinical trials were included in this meta-analysis. The pooled HRs of OS (HR = 0.72; 95% CI: 0.62–0.84, p < 0.0001) and PFS (HR = 0.52; 95% CI: 0.45–0.59, p < 0.0001) demonstrated a significant prolongation in the combination group compared to chemotherapy alone for PROC. In addition, combination therapy demonstrated a superior ORR compared to monotherapy (OR = 2.34; 95%CI: 1.27–4.32, p < 0.0001). Subgroup analysis indicated that the combination treatment of VEGF/VEGFR inhibitors and chemotherapy was significantly more effective than monochemotherapy in terms of OS (HR = 0.71; 95% CI: 0.61–0.84, p < 0.0001), PFS (HR = 0.49; 95% CI: 0.42–0.57, p < 0.0001), and ORR (OR = 2.97; 95% CI: 1.89–4.67, p < 0.0001). Although the combination therapy was associated with higher incidences of hypertension, mucositis, proteinuria, diarrhea, and hand-foot syndrome compared to monochemotherapy, these toxicities were manageable and well-tolerated.ConclusionsThe meta-analysis demonstrated that combination therapy with VEGF/VEGFR inhibitors yielded better clinical outcomes for patients with PROC compared to monochemotherapy, especially when combined with chemotherapy. This analysis provides more treatment options for patients with PROC.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO], Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42023402050.

Healthcare setting staff satisfaction in Ethiopia: Systematic review and meta‐analysis

AbstractBackgroundJob satisfaction means how happy and content people are with their job. Workers who are satisfied with their jobs tend to get more work done and give better care. When workers are not happy at work, they are also not productive as well and many of them leave their jobs. This study aimed to address the level of job satisfaction and associated factors among healthcare setting staff in Ethiopia from 2012 to 2022.MethodsPubMed, Scopus, Cochrane, Google Scholar and African Index Medicus databases have been searched based on preferred reporting items for systematic review and meta‐analysis. Pooled estimate of job satisfaction level was done using the random effects model after significant heterogeneities have been checked by subgroup analysis. Publication bias was checked using funnel plot.ResultsPooled satisfaction level of healthcare workers in Ethiopia was 50.31%. Factors associated were autonomy (pooled odds ratio (POR) = 5.79, 95% CI: 1.99–16.90), training (POR = 3.09, 95% CI: 1.69–5.67), organizational policy (POR = 4.71, 95% CI: 2.09–10.61), reward (POR = 4.58,95% CI: 1.51–13.84), payment (POR = 3.89, 95% CI: 1.77–8.54), supervision (POR = 5.34, 95% CI: 3.72–7.67) and work environment (POR = 5.44, 95% CI: 2.80–10.58).ConclusionAbout half of healthcare staff in Ethiopia's healthcare settings were satisfied with their job. This result was lower than the job satisfaction level of other parts of the world, even in African countries. Healthcare settings should strive to provide a good working environment, with training opportunities, adequate payment, supportive supervision and conducive organizational policy.

Association of Low Birth Weight with the Risk of Childhood Stunting in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Background: Stunting is an important predictor of growth and development of children under 5 years of age, and it remains the significant problem in LMIC. However, LBW emerges as risk factor, but its association with LMIC needs attention. Objective: This systematic review and meta-analysis aimed to investigate the association of low birth weight with the risk of childhood stunting among the age group of 0–5 years in LMICs. Methods: PubMed, Google Scholar, MEDLINE, Embase, and Web of Science databases were searched from January 1, 2010 untill December 20, 2021. Cross-sectional, cohort, and case-control study designs were included in the meta-analyses. The pooled odds ratio with a 95% confidence interval was reported considering the random-effects and the quality-effects models. The subgroup analysis and meta-regression were conducted for study design, geographical location, and sample size. Results: Low birth weight was associated with >2-fold increased risk of childhood stunting (pooled OR: 2.32; 95% CI, 2.05–2.62). Asian studies have shown relatively higher risk than African studies in stratified analyses. The cohort studies predicted a higher risk of childhood stunting, followed by case-control and cross-sectional study designs, and the sample size stratification showed that studies with sample size <1,000 predicted much higher risk than relatively to the studies with sample size >1,000. The meta-regression was performed in all three subgroups, but none of the models appeared significant. Conclusion: This meta-analysis confirmed the association of low birth weight with the higher risk of childhood stunting among the 0–5 years’ age group and suggests a moderately higher risk in Asia as compared to Africa.

Regional anesthesia might reduce recurrence and metastasis rates in adult patients with cancers after surgery: a meta-analysis

BackgroundThe influence of anesthesia techniques on cancer recurrence and metastasis following oncological surgery is a topic of growing interest. This meta-analysis investigates the potential effects of regional anesthesia (RA), either independently or combined with general anesthesia (GA), on these outcomes.MethodsWe performed an extensive search across PubMed, Embase, and the Cochrane Library databases. The primary outcome was cancer recurrence, while the secondary outcomes were local recurrence and distant metastasis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by utilizing random-effects models. The Newcastle-Ottawa Scale (NOS) was used for quality assessment of observational studies, the Cochrane Risk of Bias Tool for Randomized Trials (Rob 2.0) was used for randomized controlled trials, and all the outcomes were assessed by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).ResultsThis study included 32 studies comprising 24,724 cancer patients. RA, either alone or in combination with GA, was significantly associated with reduced cancer recurrence compared to GA alone (OR = 0.82; 95% CI = 0.72 to 0.94; p < 0.01). This association remained significant for prostate cancer patients in subgroup analyses (OR = 0.71; 95% CI = 0.51 to 0.98; p = 0.04) and in the context of epidural anesthesia combined with GA. However, there were no significant associations noted for local recurrence or distant metastasis.ConclusionsThis meta-analysis provides evidence that RA, used alone or adjunctively with GA, is associated with a lower risk of cancer recurrence, particularly in patients with prostate cancer. However, no significant effects were observed on local recurrence or distant metastasis. Further prospective studies should be conducted to clarify this important issue.

Diagnostic Accuracy of Intraoperative Brain Smear: A Meta-Analysis of Studies from Resource-Limited Settings

BackgroundIntraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on a limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful is still undetermined. ObjectiveTo investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors. MethodsA systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMIC) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0. ResultsTwelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while four investigated adults and two included pediatric patients. The pooled diagnostic odds ratio was calculated to be 212.52 (CI: [104.27 - 433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively. ConclusionOur study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis.

Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies.

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.

Systematic review with meta-analysis: Steatosis severity and subclinical atherosclerosis in metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver condition recognised as an independent risk factor for cardiovascular disease (CVD). However, there is ongoing debate regarding the effective strategy for cardiovascular risk assessment in MASLD. To investigate the relationship between liver imaging, specifically focusing on the severity of steatosis and subclinical atherosclerosis. We conducted a thorough search across four databases, from 1950 to April 2023, to identify eligible studies employing imaging to explore the relationship between different degrees of steatosis and subclinical atherosclerosis among MASLD. Additionally, we conducted a quality assessment using the Newcastle Ottawa Scale, performed a meta-analysis employing the DerSimonian-Liard random-effects model, and conducted subgroup analyses for validation. In total, 19 studies, encompassing 147,411 middle-aged individuals without previous CVD (74.94% male; mean age 45.53 years [SD 10.69]; mean BMI 24.3 kg/m2 [SD 3.35]), were included. The pooled odds ratio for subclinical atherosclerosis was 1.27 (95% CI: 1.13-1.41, I2 = 76.68%) in mild steatosis and significantly increased to 1.68 (95% CI: 1.41-2.00, I2 = 89.02%) in moderate to severe steatosis. Sensitivity analysis, focusing on high-quality studies, consistently supported this finding and the results remained robust across subgroup analyses. Furthermore, meta-regression revealed that a higher mean AST and ALT, alongside a lower mean HDL, were significant moderators of this association. Even mild steatosis is associated with CVD risk, and steatosis severity further intensifies this association. These findings suggest that liver fat quantification enhances CVD risk stratification in patients with MASLD.

Endoscopic submucosal dissection vs transanal endoscopic surgery for rectal tumors: A systematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) and transanal endoscopic submucosal dissection (TES) are widely employed surgical techniques. However, the comparative efficacy and safety of both remain inconclusive. To comprehensively analyze and discern differences in surgical outcomes between ESD and TES. We conducted a systematic search of the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL from inception till August 2023. We analyzed outcomes including recurrence rate, en bloc resection, R0 resection rate, perforation rate, procedure length, and hospital stay length applying a random-effects inverse-variance model. We assessed publication bias by conducting an Egger's regression test and sensitivity analyses. We pooled data from 11 studies involving 1013 participants. We found similar recurrence rates, with a pooled odds ratio of 0.545 (95%CI: 0.176-1.687). En bloc resection, R0 resection, and perforation rate values were also similar for both ESD and TES. The pooled analysis for procedure length indicated a mean difference of -4.19 min (95%CI: -22.73 to 14.35), and the hospital stay was on average shorter for ESDs by about 0.789 days (95%CI: -1.671 to 0.093). Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes. Our findings show that individualized patient and surgeon preferences, alongside specific clinical contexts, can be considered when selecting between these two techniques.

A meta-analysis study on the association between smoking and male pattern hair loss.

Smoking-which often refers to recreational consumption of the nicotine-containing tobacco-is deemed a risk factor for both the development of and worsening of androgenetic alopecia (AGA). However, there is no published meta-analysis study on the effect of smoking on AGA; so, we quantitatively synthesized the evidence base pertaining to the recreational activity and this form of hair loss in men. We systematically searched PubMed and Scopus to identify published studies with suitable data, and pairwise meta-analyses were conducted. Our search identified eight studies-and the data thereof were used across four meta-analyses. We found that ever smokers are significantly (p < 0.05) more likely, than never smokers, to develop AGA (pooled odds ratio (OR) = 1.82, 95% confidence interval (CI): 1.55-2.14). Our results showed that the odds of developing AGA are significantly (p < 0.05) higher in men who smoke at least 10 cigarettes per day, than in their counterparts who smoke up to 10 cigarettes per day (pooled OR = 1.96, 95% CI: 1.17-3.29). For men with AGA, the odds of disease progression are significantly (p < 0.05) higher among ever smokers than in never smokers (pooled OR = 1.27, 95% CI: 1.01-1.60). We found no significant (p ≥ 0.05) association between smoking intensity and disease progression. Findings from the current study-which is the first meta-analysis to our knowledge reviewing the association between AGA and the extent of smoking, can guide further research and update clinical practice guidelines.

P31 Association of atopic dermatitis with thyroid diseases: a systematic review and meta-analysis

Abstract Background Atopic dermatitis (AD) and thyroid diseases have shared immune abnormalities, but their association was largely unclear. Objective To systematically examine the association of AD with thyroid diseases. Methods A systematic review was performed and the PubMed and Embase databases were searched on 26th August 2023. The risk of bias was assessed by using the Newcastle-Ottawa Scale. A random-effects model meta-analysis was performed and a subgroup analysis based on age groups was executed. Results The database searches yielded 205 records after removing duplicates. Nine case-controll studies with 5,367,891 subjects were included. The risk of bias of included was generally low to unclear. AD was significantly associated with thyroid diseases (pooled odds ratio (OR) 1.50, 95% confidence interval (CI) 1.23−1.85; studies = 6; I2 = 85%), which was present in both adults and children (pooled OR being 1.46 (95% CI 1.20−1.78; studies = 2; I2 = 63%) and 3.46 (95% CI 1.15−10.45; studies = 3; I2 = 63%). AD was also associated with Hashimoto disease (pooled OR 2.00, 95% CI 0.91−4.40, I2 = 95%; studies = 2) and Graves disease (pooled OR 2.21, 95% CI 0.59−8.31 I2 = 93%; studies = 2). Conclusions AD is associated with an increase of thyroid diseases. AD may be associated with Hashimoto and Graves diseases, but did not reach significance due to high statistical heterogeneity and paucity of evidence. Endocrinological consultation may be considered when AD patients present with thyroid symptoms.

The association between circulating 25-hydroxyvitamin D and pancreatic cancer: a systematic review and meta-analysis of observational studies.

The relationship between circulating 25-hydroxyvitamin D [25(OH)D] and pancreatic cancer has been well studied but remains unclear. The purpose of this study was to elucidate the association between circulating 25(OH)D and pancreatic cancer by using a meta-analytic approach. PubMed, Embase, and Wed of Science databases were searched through October 15, 2022. A random or fixed-effects model was used to estimate the pooled odds ratio (OR), risk ratio (RR), hazard ratio (HR) and their 95% confidence intervals (CIs). A total of 16 studies including 529,917 participants met the inclusion criteria, of which 10 reported incidence and 6 reported mortality. For the highest versus lowest categories of circulating 25(OH)D, the pooled OR of pancreatic cancer incidence in case-control studies was 0.98 (95% CI 0.69-1.27), and the pooled HRs of pancreatic cancer mortality in cohort and case-control studies were 0.64 (95% CI 0.45-0.82) and 0.78 (95% CI 0.62-0.95), respectively. The leave-one-out sensitivity analyses found no outliers and Galbraith plots indicated no substantial heterogeneity. Evidence from this meta-analysis suggested that high circulating 25(OH)D levels may be associated with decreased mortality but not incidence of pancreatic cancer. Our findings may provide some clues for the treatment of pancreatic cancer and remind us to be cautious about widespread vitamin D supplementation for the prevention of pancreatic cancer.

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

BackgroundFamily planning (FP) interventions have improved the use of modern contraceptives, yet a high unmet need for contraception still exists in South Asia. This systematic review of existing research was conducted to identify effective FP interventions that led to an increase in the uptake of modern methods of contraception in South Asia.MethodsFive electronic databases were searched for relevant studies published between January 1st, 2000 and May 4, 2023. Experimental studies that reported data on the impact of FP interventions on modern contraceptive use among women of reproductive age (15–49 years) in the South Asian region were included. A random-effects Inverse Variance weighted model was employed to pool the adjusted odds ratio (OR) on modern contraceptive use and unmet need for contraception. In addition, we computed subgroup meta-estimates based on intervention type and the urban-rural divide.ResultsAmong 643 studies identified, 21 met the inclusion criteria. The overall pooled odds ratio for modern contraceptive use was significantly higher (OR 1.51; 95% CI 1.35–1.70; heterogeneity; I2 = 81%) for FP interventions with a significant reduction in unmet need for contraception (OR 0.86; 95% CI 0.78–0.94, I2 = 50%). The subgroup analysis revealed demand-generation (OR 1.61; 95% CI 1.32–1.96), health system integrated (OR 1.53; 95% CI 1.07–2.20), and franchised FP clinic interventions (OR 1.32; 95% CI 1.21–1.44) had promoted the modern contraceptive uptake. Further, FP interventions implemented in urban settings showed a higher increase in modern contraceptive use (OR 1.73; 95% CI 1.44–2.07) compared to rural settings (OR 1.46; 95% CI 1.28–1.66). Given the considerable heterogeneity observed across studies and the low degree of certainty indicated by the GRADE summary for the primary outcome, caution is advised when interpreting the results.ConclusionThe review collated experimentally evaluated FP interventions that increased modern contraception use and reduced the unmet need in South Asia. The demand generation interventions were the most effective in increasing the uptake of modern contraceptive methods. Furthermore, the urban environment provides a conducive environment for interventions to improve contraceptive usage. However, further studies should assess which aspects were most effective on attitudes towards contraception, selection of more effective methods, and contraceptive behaviors.

Incidence and progression of atrial fibrillation in patients with and without heart failure using mineralocorticoid receptor antagonists: a meta-analysis.

Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF. We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure. Electronic databases were searched up to September, 2022 for randomized controlled trials (RCTs) that evaluated MRA use and reported AF outcomes. Primary outcome was a composite of new-onset or recurrent AF. Safety outcomes included hyperkalemia and gynecomastia risks. A random-effects meta-analysis estimated pooled odds ratios (OR) and 95% confidence intervals (CI). 12 RCTs, comprising 11,419 patients treated with various MRAs were included [5960 (52%) on MRA]. On follow-up (6-39months), 714 (5.5%) patients developed AF. MRA therapy was associated with a 32% reduction in the risk of new-onset or recurrent AF [OR 0.68 (95% CI 0.51-0.92), I2 = 40%]. On subgroup analysis, the greatest benefit magnitude was demonstrated in reducing AF recurrence [OR 0.50 (95% CI 0.30-0.83)] and among patients with left ventricular dysfunction [OR 0.59 (95% CI 0.40-0.85)]. Gynecomastia, but not hyperkalemia, was associated with MRA use. Meta-regression analysis demonstrated that therapy duration was a significant interaction factor driving the effect size (Pinteraction = 0.013). MRA use is associated with a reduction in AF risk, especially AF progression. A prominent effect is seen in patients with heart failure, further augmented by therapy duration. Prospective trials are warranted to evaluate MRA use as upstream therapy for preventing this common arrhythmia.

Balanced crystalloids versus isotonic saline in pediatric sepsis: a comprehensive systematic review and meta-analysis

Purpose We conducted a comprehensive meta-analysis to compare the effects of balanced crystalloids (BC) and isotonic saline (IS) in pediatric sepsis. Methods A systematic search was performed for studies comparing BC and IS in pediatric sepsis. Outcomes included mortality, acute kidney injury (AKI), need for renal replacement therapy (RRT), hospital length of stay (LOS), and pediatric intensive care unit (PICU) LOS. A random-effect models was used to calculated pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs). Results The analysis included six studies with 8753 children. BC demonstrated significant reductions in overall mortality (OR 0.84, 95% CI 0.71 to 0.98, P = 0.03, I2 = 0%) and AKI (OR 0.74, 95% CI 0.57 to 0.96, P = 0.03, I2 = 37%) compared to IS. RRT need was similar between the BC and IS groups (OR 0.79, 95% CI 0.60 to 1.02, P = 0.07, I2 = 0%). Hospital and PICU LOS did not differ significantly. However, subgroup analysis of randomized controlled trials revealed significantly shorter hospital LOS in the BC group (mean difference −0.66 days, 95% CI −1.10 to −0.23, P = 0.003, I2 = 0%). Conclusion Our meta-analysis demonstrates that using BC in pediatric sepsis is associated with reduced mortality, AKI, and hyperchloremia rates compared to IS, while maintaining similar hospital and PICU LOS. Large-scale randomized controlled trials are needed to validate these findings.

The secretor status of blood group antigens in the saliva in people with oral cancers: a systematic review

BackgroundHuman ABO blood group type and the antigenic secretor status are hypothesized to associate with oral diseases including oral cancer. Secretor status is the ability of individuals to secrete blood group antigens into body fluids. This study aimed to evaluate the secretor status of ABO antigens of saliva in patients with oral cancers or oral potentially malignant disorders (OPMDs) relative to healthy adults.MethodsA systematic and comprehensive online search from inception to April 28, 2022, was carried out in MEDLINE, Embase, PsycInfo, and Emcare. The language was limited to English. Yielded records were screened by two independent reviewers at the title and abstract phase and at full-text screening. Studies investigating adults (≥ 18 years) with oral cancers or oral potentially malignant disorders compared to adults free of oral cancer were included in this study. Data were extracted according to the planned objectives. Methodological quality was assessed, and the findings were analyzed narratively. Meta-analyses were conducted to pool the odds of the non-secretor status of oral cancers and OPMDs compared to healthy adults.ResultsThe search included a total of 34 studies from three databases. Nine duplicates were removed. During the title and abstract screening, 11 irrelevant studies were excluded. Twelve studies were screened during the full-text screening, and eight articles were eligible to be included in the final analysis. A pooled odds ratio (OR) of 3.80 (95%CI, 1.53–9.44) was estimated when pooled 1254 oral cancers and oral potentially malignant disorders patients compared to 666 healthy adults.Discussion and conclusionThe odds of being a non-secretor appear to be approximately 3.8 times higher in patients with oral cancers and oral potentially malignant disorders compared to healthy adults. The lack of ABO blood group antigens in body fluids of non-secretors is more exposed to exogenous antigens than secretors. The host-parasite interactions of secretors and non-secretors underlying oral cancer and other diseases may be evidence to support or refuse them. Clinicians may use the secretor status as a detection test during their regular oral check-ups for high-risk populations for oral cancers. Non-secretors can be given more attention considering them as high-risk groups, and in terms of prognosis, differences between these two groups may be expected.

Prognostic value and immunological role of PD-L1 gene in pan-cancer

ObjectivePD-L1, a target of immune checkpoint blockade, has been proven to take the role of an oncogene in most human tumors. However, the role of PD-L1 in human pan-cancers has not yet been fully investigated.Materials and methodsPan-cancer analysis was conducted to analyze expression, genetic alterations, prognosis analysis, and immunological characteristics of PD-L1. Estimating the correlation between PD-L1 expression and survival involved using pooled odds ratios and hazard ratios with 95% CI. The Kaplan–Meier (K-M) technique, COX analysis, and receiver operating characteristic (ROC) curves were applied to the survival analysis. Additionally, we investigated the relationships between PD-L1 and microsatellite instability (MSI), tumor mutational burden (TMB), DNA methyltransferases (DNMTs), the associated genes of mismatch repair (MMR), and immune checkpoint biomarkers using Spearman's correlation analysis. Also, immunohistochemical analysis and qRT-PCR were employed in evaluating PD-L1’s protein and mRNA expression in pan-caner.ResultsPD-L1 showed abnormal mRNA and protein expression in a variety of cancers and predicted prognosis in cancer patients. Furthermore, across a variety of cancer types, the aberrant PD-L1 expression was connected to the MSI, MMR, TMB, drug sensitivity, and tumor immune microenvironment (TIME). Moreover, PD-L1 was significantly correlated with infiltrating levels of immune cells (T cell CD8 + , neutrophil, and so on).ConclusionOur study provides a better theoretical basis and guidance for the clinical treatment of PD-L1.