Pooled Rate Ratio Research Articles

The Uselessness of Anaerobic Antibiotic Coverage in Aspiration Pneumonia: A Systematic Review and Meta-Analysis

Introduction: Asthma is a prevalent respiratory condition, and biologic agents have proven effective in managing moderate to severe asthma. However, the role of biomarkers in guiding the use of biologic agents remains unclear. Method: On July 30, 2024, a systematic review and subsequent meta-analysis were conducted by searching three major online databases: PubMed, Web of Science, and Cochrane. Results: The final analysis included 10 studies with a total of 6,709 patients with moderate to severe asthma. The overall pooled effect across all ages demonstrated a rate ratio (RR) reduction of 0.61 (95% CI: 0.46 to 0.80; p < 0.01; I² = 71%). Subgroup analysis revealed an onset or treated age of less than 18 years with RRs of 0.79 (95% CI: 0.62 to 1.02; p = 0.07; I² = 0%) and 0.88 (95% CI: 0.42 to 1.84; p = 0.73; I² = 14%), respectively. Patients with varying blood eosinophil levels showed a pooled RR of 0.51 (95% CI: 0.38 to 0.69; p < 0.01; I² = 82.7%). However, blood eosinophil levels below 150/μL demonstrated a limited effect of biologic agents, with an RR of 0.77 (95% CI: 0.35 to 1.67; p = 0.50; I² = 87%). For patients with all levels of fraction of exhaled nitric oxide (FeNO), the RR was 0.43 (95% CI: 0.30 to 0.62; p < 0.01; I² = 84%). The test for subgroup differences yielded a p-value of < 0.001, indicating that patients with higher FeNO levels experienced a more significant reduction in RR. Conclusion: Patients with asthma onset or treatment before age 18 may benefit less from biologics. Blood eosinophil counts and FeNO levels aid in selecting these therapies.

Biomarkers Identifying the Effectiveness of Biologic Agents in Moderate to Severe Asthma: A Systematic Review and Meta-Analysis

Introduction: Asthma is a prevalent respiratory condition, and biologic agents have proven effective in managing moderate to severe asthma. However, the role of biomarkers in guiding the use of biologic agents remains unclear. Method: On July 30, 2024, a systematic review and subsequent meta-analysis were conducted by searching three major online databases: PubMed, Web of Science, and Cochrane. Results: The final analysis included 10 studies with a total of 6,709 patients with moderate to severe asthma. The overall pooled effect across all ages demonstrated a rate ratio (RR) reduction of 0.61 (95% CI: 0.46 to 0.80; p < 0.01; I² = 71%). Subgroup analysis revealed an onset or treated age of less than 18 years with RRs of 0.79 (95% CI: 0.62 to 1.02; p = 0.07; I² = 0%) and 0.88 (95% CI: 0.42 to 1.84; p = 0.73; I² = 14%), respectively. Patients with varying blood eosinophil levels showed a pooled RR of 0.51 (95% CI: 0.38 to 0.69; p < 0.01; I² = 82.7%). However, blood eosinophil levels below 150/μL demonstrated a limited effect of biologic agents, with an RR of 0.77 (95% CI: 0.35 to 1.67; p = 0.50; I² = 87%). For patients with all levels of fraction of exhaled nitric oxide (FeNO), the RR was 0.43 (95% CI: 0.30 to 0.62; p < 0.01; I² = 84%). The test for subgroup differences yielded a p-value of < 0.001, indicating that patients with higher FeNO levels experienced a more significant reduction in RR. Conclusion: Patients with asthma onset or treatment before age 18 may benefit less from biologics. Blood eosinophil counts and FeNO levels aid in selecting these therapies.

Sclerotherapy vs. surgical excision for lymphatic malformations of the head and neck: a systematic review and meta-analysis.

Lymphatic malformations (LMs) are abnormal lymphatic vessels with cystic characteristics, categorized as macrocystic, microcystic, or a combination of both. They represent the second most common vascular malformations, and their management involves multidisciplinary approaches based on clinical assessments and imaging studies. LMs manifest as a challenge to medical professionals in the head and neck, posing functional and aesthetic concerns. Our systematic review aims to compare the efficacy of sclerotherapy and surgery for LMs, identifying optimal treatment modalities for each scenario. We searched four electronic databases for related studies. Data were extracted from the included studies. We calculated the pooled rate ratios with 95% confidence intervals (CIs). The I2 test was used to detect heterogeneity. The inclusion of the studies required the following prerequisites: 1- Studies focusing on any lymphatic malformations in the head and neck, whether microcystic, macrocystic, or a mix of both; 2- Studies performed on more than ten patients; 3- All interventions used as surgery, sclerotherapy, or both. We included 58 studies in our systematic review, of which 45 were eligible for the meta-analysis. For macrocystic LMs, sodium tetradecyl sulfate (STS) mixed with ethanol and excision achieved the highest complete response rates at (92.9%) and (92.5%), respectively. Surgical excision showed the lowest poor response rate. Polidocanol microfoam had the highest poor response rate (11.1%). In microcystic LMs, combining sclerotherapy with excision showed the highest complete response rate (70.3%) and the lowest poor response rate (1.3%). Picibanil had the lowest complete response rate (9.1%) and the highest rate of poor response (61.4%). In mixed LMs, surgical excision had the highest complete response rate (70.3%). Both surgical excision and STS combined with ethanol are highly effective for treating macrocystic LMs, achieving similar complete response rates. The combination of sclerotherapy and surgical excision demonstrated the best outcomes in microcystic LMs. Surgical excision demonstrates superior efficacy over sclerotherapy for mixed LMs. These findings suggest that excision is generally more effective in achieving complete and excellent responses across all LM subtypes. Further high-quality studies are necessary to standardize and optimize treatment protocols.

Lower incidence of vaginal cancer after cervical human papillomavirus screening - long-term follow-up of Finnish randomized screening trial

ObjectiveAround 70% of vaginal cancers and 40–50% of vulvar cancers are attributable to human papillomavirus (HPV). Globally the burden of these diseases is estimated to grow due to the increasing HPV prevalence and rapidly aging global population. We aimed to examine if HPV screening for cervical cancer has an additional beneficial effect in preventing vaginal and vulvar cancers. To assess this, we used long-term follow-up data from the Finnish randomized HPV screening trial. MethodsBetween 2003 and 2008, over 236,000 women were individually randomized (1:1) to primary HPV or cytology screening in Southern Finland. We followed this cohort up to the year 2020. To compare the study arms, we calculated site-specific and pooled incidence rate ratios (IRRs) and mortality rate ratios (MRRs) for vaginal and vulvar cancers using Poisson regression. ResultsDuring 3,5 million person-years of follow-up, the IRR for vaginal cancer in the HPV arm compared to the cytology arm was 0.40 (95% CI 0.17–0.88) and the corresponding MRR was 0.74 (95% 0.21–2.24). The corresponding IRR for vulvar cancer was 0.73 (95% 0.50–1.08) and the MRR was 0.64 (95% 0.23–1.62). The pooled IRR was 0.67 (95% 0.47 ̶ 0.95) and MRR 0.67 (95% 0.31 ̶ 1.37). ConclusionWe found lower incidence of vaginal cancers with HPV screening compared to cytology screening. To validate our results, we recommend analyzing data on vaginal and vulvar cancers also from other HPV screening studies.

Examining potential Long COVID effects through utilization of healthcare resources: a retrospective, population-based, matched cohort study comparing individuals with and without prior SARS-CoV-2 infection.

A significant proportion of individuals reports persistent clinical manifestations following SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) acute infection. Nevertheless, knowledge of the burden of this condition-often referred to as 'Long COVID'-on the health care system remains limited. This study aimed to evaluate healthcare utilization potentially related to Long COVID. Population-based, retrospective, multi-center cohort study that analyzed hospital admissions and utilization of outpatient visits and diagnostic tests between adults aged 40 years and older recovered from SARS-CoV-2 infection occurred between February 2020 and December 2021 and matched unexposed individuals during a 6-month observation period. Healthcare utilization was analyzed by considering the setting of care for acute SARS-CoV-2 infection [non-hospitalized, hospitalized and intensive care unit (ICU)-admitted] as a proxy for the severity of acute infection and epidemic phases characterized by different SARS-CoV-2 variants. Data were retrieved from regional health administrative databases of three Italian Regions. The final cohort consisted of 307994 previously SARS-CoV-2 infected matched with 307994 uninfected individuals. Among exposed individuals, 92.2% were not hospitalized during the acute infection, 7.3% were hospitalized in a non-ICU ward and 0.5% were admitted to ICU. Individuals previously infected with SARS-CoV-2 (vs. unexposed), especially those hospitalized or admitted to ICU, reported higher utilization of outpatient visits (range of pooled Incidence Rate Ratios across phases; non-hospitalized: 1.11-1.33, hospitalized: 1.93-2.19, ICU-admitted: 3.01-3.40), diagnostic tests (non-hospitalized: 1.35-1.84, hospitalized: 2.86-3.43, ICU-admitted: 4.72-7.03) and hospitalizations (non-hospitalized: 1.00-1.52, hospitalized: 1.87-2.36, ICU-admitted: 4.69-5.38). This study found that SARS-CoV-2 infection was associated with increased use of health care in the 6 months following infection, and association was mainly driven by acute infection severity.

Abatacept and non-melanoma skin cancer in patients with rheumatoid arthritis: a comprehensive evaluation of randomised controlled trials and observational studies

ObjectivesThis study aims to evaluate non-melanoma skin cancer (NMSC) risk associated with abatacept treatment for rheumatoid arthritis (RA).MethodsThis evaluation included 16 abatacept RA clinical trials and 6 observational studies. NMSC...

A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget's Disease in Reducing Recurrence Following Surgical Excision.

To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget's disease (EMPD). Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32-0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03-1.84). Qualitative assessment of the remaining selected studies revealed equivocal results. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary.

Resuscitation of out-of-hospital cardiac arrest in China: A systematic review and Utstein-style data analysis based on the Chain of Survival

AimOut-of-hospital cardiac arrest (OHCA) contributes to substantial mortality, but its resuscitation status in China is unknown. We aimed to describe and analyze out-of-hospital cardiac arrest in terms of Chain of Survival. MethodsWe systematically collected Utstein-style publications. Scenarios were prespecified, including either emergency medical service (EMS) assessing and attending cardiac arrest, resuscitation attempted by a bystander, resuscitation attempted by EMS, or in-hospital treatment. Random-effect models were used in a meta-analysis to pool rate ratios (RRs) with 95% confidence intervals (CIs) from multiple cohorts. ResultsWe analyzed 59 Chains involving 233,376 Chinese patients. The median rate of survival to discharge (interquartile range) was 0.35 % (0.06 %–0.61 %), 3.66 % (3.06 %–3.85 %), 1.23 % (0.57%–1.36%), and 2.73% (2.04%–3.42%) for four scenarios. The rate was significantly higher for bystander resuscitation than for EMS (P = 0.025) or in-hospital treatment (P = 0.301). However, only 4.8 % (1.6 %–8.2 %) of patients received bystander resuscitation, with no bystander defibrillation and a median response time of 9–15 minutes for EMS. Compared with controls without witnesses, arrest being witnessed and with bystander resuscitation increased rates of survival to discharge by 1.97 (I2 = 0, P for I2 = 0.583; pooled RR 2.97; 95% CI 1.47–6.02) and 6.79 (I2 = 0, P for I2 = 0.593; pooled RR 7.79; 95 % CI 3.40–17.84) times, following a markedly increasing trend. ConclusionsA low probability of first aid at multiple points is linked to poor survival following OHCA. It is essential to strengthen front links in the Chain of Survival in China, including among witnesses, bystanders, and emergency response.

The Role of Cobalt Exposure in the Incidence of Cancer: A Systematic Review and Meta-Analysis Protocol

Background: Cobalt, a versatile transition metal, has widespread industrial applications, but its potential link to cancer has raised concerns. This systematic review and meta-analysis protocol aims to investigate the relationship between cobalt exposure and cancer incidence, addressing its implications for public health and occupational safety. Methods: A comprehensive literature search will be conducted in PubMed, Scopus, and Web of Science databases up to August 2023. Eligible studies will include human participants exposed to cobalt, with cancer incidence as an outcome. Both observational and analytical study designs will be considered. Results: Quantitative meta-analysis will be performed using random-effects models to calculate pooled Incidence Rate Ratios (IRRs). Subgroup and sensitivity analyses will explore heterogeneity and potential bias. Findings will be compared with prior research to assess consistency and support. Conclusion: This systematic review and meta-analysis protocol aims to provide a comprehensive assessment of the potential association between cobalt exposure and cancer incidence. The outcomes could have significant implications for occupational health, public safety, and policy decisions.

Interventions to increase cervical screening uptake among immigrant women: A systematic review and meta-analysis.

Numerous intervention studies have attempted to increase cervical screening uptake among immigrant women, nonetheless their screening participation remains low. This systematic review and meta-analysis aimed to summarise the evidence on interventions to improve cervical screening among immigrant women globally and identify their effectiveness. Databases PubMed, EMBASE, Scopus, PsycINFO, ERIC, CINAHL and CENTRAL were systematically searched from inception to October 12, 2021, for intervention studies, including randomised and clinical controlled trials (RCT, CCT) and one and two group pre-post studies. Peer-reviewed studies involving immigrant and refugee women, in community and clinical settings, were eligible. Comparator interventions were usual or minimal care or attention control. Data extraction, quality appraisal and risk of bias were assessed by two authors independently using COVIDENCE software. Narrative synthesis of findings was carried out, with the main outcome measure defined as the cervical screening uptake rate difference pre- and post-intervention followed by random effects meta-analysis of trials and two group pre-post studies, using Comprehensive Meta-Analysis software, to calculate pooled rate ratios and adjustment for publication bias, where found. The protocol followed PRISMA guidelines and was registered prospectively with PROSPERO (CRD42020192341). 1,900 studies were identified, of which 42 (21 RCTS, 4 CCTs, and 16 pre-post studies) with 44,224 participants, were included in the systematic review, and 28 with 35,495 participants in the meta-analysis. Overall, the uptake difference rate for interventions ranged from -6.7 to 96%. Meta-analysis demonstrated a pooled rate ratio of 1.15 (95% CI 1.03-1.29), with high heterogeneity. Culturally sensitive, multicomponent interventions, using different modes of information delivery and self-sampling modality were most promising. Interventions led to at least 15% increase in cervical screening participation among immigrant women. Interventions designed to overcome logistical barriers and use multiple channels to communicate culturally appropriate health promotion messages are most effective at achieving cervical screening uptake among immigrant women.

Influenza-associated hospitalisation and mortality rates among global Indigenous populations; a systematic review and meta-analysis.

More than 50 million influenza infections and over 100,000 deaths from influenza occur annually. While Indigenous populations experience an inequitable influenza burden, the magnitude of this inequity has not previously been estimated on a global scale. This study compared rates of influenza-associated hospitalisation and mortality between Indigenous and non-Indigenous populations globally. A systematic review and meta-analysis was conducted including literature published prior to 13 July 2021. Eligible articles either reported a rate ratio (RR) comparing laboratory-confirmed influenza-associated hospitalisation and/or mortality between an Indigenous population and a corresponding benchmark population, or reported sufficient information for this to be calculated using publicly available data. Findings were reported by country/region and pooled by country and period (pandemic/seasonal) when multiple studies were available using a random-effects model. The I2 statistic assessed variability between studies. Thirty-six studies (moderate/high quality) were included; all from high or high-middle income countries. The pooled influenza-associated hospitalisation RR (HRR) for indigenous compared to benchmark populations was 5·7 (95% CI: 2·7-12·0) for Canada, 5·2 (2.9-9.3) for New Zealand, and 5.2 (4.2-6.4) for Australia. Of the Australian studies, the pooled HRR for seasonal influenza was 3.1 (2·7-3·5) and for pandemic influenza was 6·2 (5·1-7·5). Heterogeneity was slightly higher among studies of pandemic influenza than seasonal influenza. The pooled mortality RR was 4.1 (3·0-5.7) in Australia and 3·3 (2.7-4.1) in the United States. Ethnic inequities in severe influenza persist and must be addressed by reducing disparities in the underlying determinants of health. Influenza surveillance systems worldwide should include Indigenous status to determine the extent of the disease burden among Indigenous populations. Ethnic inequities in pandemic influenza illustrate the need to prioritise Indigenous populations in pandemic response plans.

Abstract 13576: Stereotactic Cardiac Radiotherapy Reduces Structural Heart Disease Associated Refractory Ventricular Tachycardia - A Metaanalysis

Introduction: Cardiac stereotactic body radiotherapy (SBRT) is a paradigm changing treatment for refractory ventricular tachycardia (VT) in patients with structural heart disease. We sought to review the effectiveness of SBRT reported in published studies. Hypothesis: There is a reduction in VT events after cardiac SBRT. Methods: We performed a comprehensive literature search in PubMed, Embase and Google Scholar including all studies on cardiac SBRT for VT till May 2022. Efficacy was evaluated as random-effects pooled rate ratios (RR) of VT episodes, antitachycardia pacing (ATP) therapies and implantable cardioverter-defibrillator (ICD) shocks post-SBRT (after 6-week blanking) vs. during 3-12 months pre-SBRT, with patients serving as their own controls. Results: We included 12 single-arm studies on cardiac SBRT (90 patients) published 2017-2022 with median follow-up ranging 6-28 months. The pooled RR of VT episodes, ATP therapies and ICD shocks post- vs. pre-SBRT were 0.11 (95% CI 0.06-0.21, p<0.001), 0.09 (95% CI 0.04-0.20, p<0.001), and 0.10 (95% CI 0.05-0.19, p<0.001) as shown in Figure 1. There was significant heterogeneity in results (p<0.00001 for all 3 endpoints). The combined 1- and 2-year overall patient survival was 69% and 56% respectively (Figure 2). Conclusions: Cardiac SBRT reduces recurrent VT episodes and ICD shocks in patients with VT refractory to medical therapy and catheter ablation. There is heterogeneity in results from different studies, likely related to differences in patient selection and treatment techniques. The overall patient survival in this high-risk population compares favorably to data from catheter ablation trials.

Prevalence, risk factors, and clinical outcomes of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis.

Hemorrhagic transformation (HT) is a common complication of alteplase treatment. However, the prevalence rate, risk factors, and clinical outcomes of remote intracerebral hemorrhage (rICH) after intravenous thrombolysis in acute ischemic stroke are not well understood. Following a previously registered protocol, the PubMed, Web of Science, and Embase databases were systematically searched to identify relevant literature up to June 2022. Cohort studies reporting thrombolysis-related rICH in patients with acute ischemic stroke were included. Random effects models were used to calculate pooled prevalence rate, mean difference (MD) or odds ratio (OR) with corresponding 95% confidence interval (CI). Fourteen studies with 52,610 patients were included in this meta-analysis. The pooled rICH prevalence was 3.2% (95% CI 3.1-3.4%). Compared to patients without intracerebral hemorrhage (ICH), those with rICH were older, more likely to be female, and had a higher proportion of prior stroke, chronic heart failure and cardioembolism, and higher diastolic blood pressure. Small vessel disease markers (e.g., white matter hyperintensities and cerebral microbleeds) werestrongly associated with rICH. The presence of rICH decreased the likelihood of favorable outcomes (OR 0.36, 95% CI 0.31-0.41) and increased the risk of mortality (OR 4.37, 95% CI 2.86-6.67). Although rICH is uncommon after intravenous thrombolysis, its presence can lead to worse functional outcomes and higher mortality in acute ischemic stroke. Patients at high risk of rICH must be identified based on potential risk factors.

COVID-19 vaccination and carditis in children and adolescents: a systematic review and meta-analysis

BackgroundCoronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines.MethodsPubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included.ResultsA total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment.ConclusionsCarditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days.Graphical abstractCentral illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis.

Preventing suicidal and self-Injurious behavior in correctional facilities: A systematic literature review and meta-analysis.

SummaryBackgroundRates of suicide and self-harm are elevated in carceral institutions. Inmates are a vulnerable group since they are exposed to multiple risk factors. This paper critically reviews empirical research on programs to prevent suicidal and self-harmful behaviors in correctional facilities and summarizes effect sizes across studies.MethodsWe searched PsychINFO, PubMed, IEEEXPLORE and the CRISE Documentation Centre Database to identify relevant articles published before June 2022. Inclusion criteria were: peer-reviewed and with outcome data on effectiveness of prevention activities. Two reviewers independently assessed 905 articles to determine inclusion eligibility. Quality was assessed by two independent reviewers using the Quality Assessment Tool for Quantitative Studies. Meta-analyses using random-effect models were used to pool effect sizes for each outcome. This review was conducted in accordance with PRISMA guidelines.FindingsTwenty-four of the 905 articles, published between 1980 and 2022, were included. Studies were frequently conducted in the United States (n=13; 54%) and used varying study designs; most frequently pre-post with no control group (n=9; 38%). Sample sizes and interventions varied considerably. Most were of moderate quality (n=21; 88%). On average, prevention programs in correctional facilities were effective in decreasing suicide deaths (pooled rate ratio of 0·35 [95% CI 0·23 to 0·55; p<0·001]; I2=68·01%), incidents of self-harm (pooled Hedges'g of -0·54 (95% CI: -1·03 to -0·05; p=0·031]; I2=81·34%), and suicidal ideation (pooled Hedges'g of -0·39 [95% CI: -0·65 to -0·14; p=0·003]; I2=47·09%).InterpretationPrevention activities are effective in reducing suicide death, self-harm and suicidal ideation in correctional settings. Multicomponent programs, which include several preventive activities, seem to be most effective in reducing suicide deaths. Future evaluation studies should control for confounding variables by including control groups, having larger samples and limiting attrition. Standards for suicide prevention in jails and prisons should be included in National suicide prevention strategies.FundingNone.

Systematic review and meta-analysis of the association between bridging therapy and outcomes of chimeric antigen receptor T cell therapy in patients with large B cell lymphoma

BackgroundThe existing evidence about the impact of bridging therapy (BT) on chimeric antigen receptor (CAR)-T cell therapy in patients with large B cell lymphoma (LBCL) is conflicting. Therefore, we reviewed all available evidence to examine the association between BT and CAR-T therapy outcomes by systematic review and meta-analysis approach. MethodsTwo reviewers independently searched Embase, PubMed, Web of Science, and Cochrane library to identify all records that described BT for LBCL treated with CAR-T. We then applied a fixed- or random-effects meta-analysis to estimate the pooled hazard ratios (HRs) and rate ratio (RRs) for efficacy and safety endpoints and assessed differences across various BT modalities. The Newcastle-Ottawa Scale was used to evaluate study quality. ResultsTwenty-six reports from 24 studies involving 2014 patients were included in the analysis. Pooled results showed that patients requiring BT had significantly worse 1-year overall survival rate (RR = 0.76, 95% confidence interval [CI] 0.68–0.85, P < 0.001), 1-year progression-free survival rate (RR = 0.71, 95% CI 0.60–0.85, P < 0.001), progression-free survival (HR = 1.35, 95% CI 1.07–1.69, P = 0.01), overall response rate (RR = 0.88, 95% CI 0.81–0.95, P = 0.001), complete response rate (RR = 0.78, 95% CI 0.65–0.93, P = 0.005), and grade ≥3 immune effector cell-associated neurotoxicity syndrome (RR = 1.43, 95% CI 1.10–1.87, P = 0.007), and tended to have poorer overall survival (HR = 1.42, 95% CI 0.99–2.02, P = 0.056) and grade ≥3 cytokine release syndrome (RR = 1.59, 95% CI 0.92–2.75, P = 0.096). Prolonged cytopenias were the common toxicity event associated with BT. Radiotherapy may serve as a promising BT option that can provide safe and effective disease control for patients with LBCL before CAR-T infusion. The inconsistency of patient baselines in the current study hindered further comparisons between different BT modalities. Most of the available evidence was rated as low quality because of concerns over low comparability. ConclusionBT appears to be associated with comparatively poor efficacy and safety outcomes after CAR-T infusion. However, due to the considerable heterogeneity between the BT and non-BT cohorts at disease baseline, no definitive conclusions can be made for the true impact of BT on CAR-T until further randomized studies are conducted.

Temporal trends in associations between severe mental illness and risk of cardiovascular disease: A systematic review and meta-analysis.

BackgroundSevere mental illness (SMI; schizophrenia, bipolar disorders (BDs), and other nonorganic psychoses) is associated with increased risk of cardiovascular disease (CVD) and CVD-related mortality. To date, no systematic review has investigated changes in population level CVD-related mortality over calendar time. It is unclear if this relationship has changed over time in higher-income countries with changing treatments.Methods and findingsTo address this gap, a systematic review was conducted, to assess the association between SMI and CVD including temporal change. Seven databases were searched (last: November 30, 2021) for cohort or case–control studies lasting ≥1 year, comparing frequency of CVD mortality or incidence in high-income countries between people with versus without SMI. No language restrictions were applied. Random effects meta-analyses were conducted to compute pooled hazard ratios (HRs) and rate ratios, pooled standardised mortality ratios (SMRs), pooled odds ratios (ORs), and pooled risk ratios (RRs) of CVD in those with versus without SMI. Temporal trends were explored by decade. Subgroup analyses by age, sex, setting, world region, and study quality (Newcastle–Ottawa scale (NOS) score) were conducted. The narrative synthesis included 108 studies, and the quantitative synthesis 59 mortality studies (with (≥1,841,356 cases and 29,321,409 controls) and 28 incidence studies (≥401,909 cases and 14,372,146 controls). The risk of CVD-related mortality for people with SMI was higher than controls across most comparisons, except for total CVD-related mortality for BD and cerebrovascular accident (CVA) for mixed SMI. Estimated risks were larger for schizophrenia than BD. Pooled results ranged from SMR = 1.55 (95% confidence interval (CI): 1.33 to 1.81, p < 0.001), for CVA in people with BD to HR/rate ratio = 2.40 (95% CI: 2.25 to 2.55, p < 0.001) for CVA in schizophrenia. For schizophrenia and BD, SMRs and pooled HRs/rate ratios for CHD and CVD mortality were larger in studies with outcomes occurring during the 1990s and 2000s than earlier decades (1980s: SMR = 1.14, 95% CI: 0.57 to 2.30, p = 0.71; 2000s: SMR = 2.59, 95% CI: 1.93 to 3.47, p < 0.001 for schizophrenia and CHD) and in studies including people with younger age. The incidence of CVA, CVD events, and heart failure in SMI was higher than controls. Estimated risks for schizophrenia ranged from HR/rate ratio 1.25 (95% CI: 1.04 to 1.51, p = 0.016) for total CVD events to rate ratio 3.82 (95% CI: 3.1 to 4.71, p < 0.001) for heart failure. Incidence of CHD was higher in BD versus controls. However, for schizophrenia, CHD was elevated in higher-quality studies only. The HR/rate ratios for CVA and CHD were larger in studies with outcomes occurring after the 1990s. Study limitations include the high risk of bias of some studies as they drew a comparison cohort from general population rates and the fact that it was difficult to exclude studies that had overlapping populations, although attempts were made to minimise this.ConclusionsIn this study, we found that SMI was associated with an approximate doubling in the rate ratio of CVD-related mortality, particularly since the 1990s, and in younger groups. SMI was also associated with increased incidence of CVA and CHD relative to control participants since the 1990s. More research is needed to clarify the association between SMI and CHD and ways to mitigate this risk.

Efficacy and safety of racemic ketamine and esketamine for depression: a systematic review and meta-analysis

ABSTRACT Background Racemic ketamine and esketamine have demonstrated rapid antidepressant effects. We aimed to review the efficacy and safety of racemic and esketamine for depression. Research design and methods We conducted a PRISMA-guided review for relevant randomized controlled trials of racemic or esketamine for unipolar or bipolar major depression from database inception through 2021. We conducted random-effects meta-analyses using pooled rate ratios (RRs) and Cohen’s standardized mean differences (d) with their 95% confidence intervals (CI). Results We found 36 studies (2903 participants, 57% female, 45.1 +/- 7.0 years). Nine trials used esketamine, while the rest used racemic ketamine. The overall study quality was high. Treatment with any form of ketamine was associated with improved response (RR=2.14; 95% CI, 1.72-2.66; I2=65%), remission (RR=1.64; 95% CI, 1.33-2.02; I2=39%), and depression severity (d=-0.63; 95% CI, -0.80 to -0.45; I2=78%) against placebo. Overall, there was no association between treatment with any form of ketamine and retention in treatment (RR=1.00; 95% CI, 0.99-1.01; I2<1%), dropouts due to adverse events (RR=1.56; 95% CI, 1.00-2.45; I2<1%), or the overall number of adverse events reported per participant (OR=2.14; 95% CI, 0.82-5.60; I2=62%) against placebo. Conclusions Ketamine and esketamine are effective, safe, and acceptable treatments for individuals living with depression.

Determine the External or Intraluminal Antibiotics Prevent Catheter-Related Communicable Disease in Persons Receiving Hemodialysis when Comparing to No Antibiotic Treatment

Aim: Catheter-related diseases increase illness and mortality in dialysis patients. To determine if topical or intraluminal antibiotics prevent catheter-related bloodstream contagion in persons receiving hemodialysis when comparison to no antibiotic treatment. Methods: Inclusion and exclusion criteria chose controlled randomized studies utilizing topical or intraluminal antibiotics for contagion control measures in individuals receiving hemodialysis using catheters. Results: Pooled rate ratios for outcomes were estimated using fixed-effects modelling. Topical antibiotics decreased rate of bacteremia (ratio, 0.23 [96 percent confidence interval, 0.13 to 0.41]; 0.11 vs. 0.46 case of bacteremia per 120 catheter-days), exit-site contagion (ratio, 0.18 [CI, 0.09 to 0.39]; 0.07 vs. 0.42 case of infection per 120 catheter-days), catheter removal, in addition hospitalization for infectious disease. Intraluminal antibiotics decreased the risk of bacteremia and the necessity for catheter placement (Rate ratio, 0.33 [CI, 0.23 to 0.48]; 0.13 vs. 0.34 instance of bacteremia per 120 catheter-days). Intraluminal antibiotics did not lower rate of exit-site contagion appreciably, and no hospitalization statistics remained provided for some of those medicines. Conclusion: Antibiotics, including external and intraluminal, lowered the risk of bacteremia hence necessity for catheter elimination of problems. It is uncertain if all these tactics will result in antibiotic resistance and loss of potency over time. Keywords: Catheter-related diseases, dialysis patients, Topical or intraluminal antibiotics.

Third dose of SARS-CoV-2 vaccine: A systematic review of 30 published studies.

We analyzed published studies on the efficacy and safety of the third dose of the COVID‐19 vaccine in various general population settings. We conducted systematic searches of PubMed and EMBASE for series published in the English language through November 15, 2021, using the search terms “third” or “booster” or “three” and “dose” and “COVID‐19” or “SARS‐CoV‐2.” All articles were selected according to the MOOSE guidelines. The seroconversion risk after third doses was descriptively expressed as a pooled rate ratio ([seroconversion rate after the third dose]/[seroconversion rate after the second dose]). The search returned 30 studies that included a total of 2 734 437 vaccinated subjects. In more than 2 700 000 Israeli patients extracted from the general population, the reduction in the risk of infection ranged from 88% to 92%. Conversion rates for IgG anti‐spike ranged from 95% to 100%. In cancer or immunocompromised patients, mean IgG seroconversion was 39.4% before and 66.6% after third doses. A third dose seems necessary to protect against all COVID‐19 infection, severe disease, and death risk.