Meta-analysis Of Proportions Research Articles

Prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) after acute myocardial infarction: a systematic review and meta-analysis

Abstract Background There is increasing recognition that patients experience a greater risk of mental illnesses after an acute myocardial infarction (AMI), with the former being linked to worse post-AMI outcomes. However, the prevalence of these conditions is largely unknown as most studies focus on depression and few on other illnesses such as anxiety and post-traumatic stress disorder (PTSD). Additionally, existing studies mostly involved diagnoses of mental illnesses through patient-reported questionnaires which may carry subjectivity (1). Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence and risk factors of developing depression, anxiety and PTSD after an AMI with the inclusion of only studies with official diagnoses of the mental illnesses. Methods Searches in MEDLINE, EMBASE, and PsycINFO up to January 23, 2023, identified 25 qualifying studies that examined the risk of depression, anxiety and PTSD after AMI, with case definitions based strictly on psychiatrist-administered structured interviews according to the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria. Meta-analyses of proportions using random-effects models estimated the pooled prevalence of each outcome at the <3-month and >3-month time-points. Heterogeneity was tested using I-squared statistics, if significant heterogeneity was found, subgroup analyses and meta-regression analyses were performed to identify the source of heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and Risk of Bias 2 (RoB2) Tool, and publication bias using the funnel plot and verified by the Egger’s and Begg’s tests. Results A total of 25 studies were included in the meta-analysis. The pooled prevalence of depression post-AMI (20 studies) was 16.70% (95% CI: 12.40%; 22.11%), with pooled prevalence <3-month and >3-month post-AMI at 19.46% (95% CI: 15.47%; 24.19%) and 14.87% (95% CI: 9.55%; 22.43%) respectively. Pooled prevalence of anxiety (7 studies) and PTSD (3 studies) were 11.96% (95% CI: 6.15; 21.96%) and 10.26% (95% CI:5.49;18.36%) respectively. Subgroup analysis showed that the pooled prevalence of both depression and anxiety are significantly higher in the female gender, in those with hypertension, diabetes or hyperlipidemia, and in smokers, while the pooled prevalence of depression is higher in unmarried than married individuals and in patients with a history of depression. Meta regression indicates that history of depression is a significant predictor of prevalence of depression (p= 0.0035, regression coefficient 1.54). Conclusion The prevalence of mental illnesses is high after AMI. Risk factors identified included female gender, hypertension, diabetes, hyperlipidemia, smoking, depression history, as well as one’s social set-up. These findings highlight the importance of screening at-risk patients and early intervention to improve long-term outcomes after AMI.Forest plot of depression prevalenceSubgroup analysis for depression

Assessment of the therapeutic efficacy of [177Lu]Lu-PSMA-X compared to taxane chemotherapy in taxane-chemo-naïve patients with metastatic castration-resistant prostate cancer: A systematic review and meta-analysis.

Radioligand therapy (RLT) with 177Lu-labelled prostate specific membrane antigen ([177Lu]Lu-PSMA-X, referring with "PSMA-X" to a generic PSMA chemical compound) inhibitors has emerged as a viable treatment option in metastatic castration resistant prostate cancer patients having previously progressed on taxane and androgen receptor inhibitors. The aim of this study was to perform a systematic review and meta-analysis to assess the therapeutic efficacy of [177Lu]Lu-PSMA-X compared to taxane chemotherapy in taxane-chemo-naïve patients with metastatic castration-resistant prostate cancer. Searches in several bibliographic databases were made using relevant key words, and articles published up to March 2024 were included. The endpoints included prostate specific antigen (PSA) response rate (RR), progression-free survival, and overall survival. Individual patient data were pooled when feasible. PSA50 was defined as the median proportion of patients achieving at least a 50% decline in serum PSA from baseline. A meta-analysis of the PSA50 response rate (proportion meta-analysis) was performed, generating pooled estimates and 95% confidence intervals (95% CI). From the initially selected 8,414 studies published between 2019 and 2023, 24 were included in the [177Lu]Lu-PSMA-X treated group and 17 in the taxane treated group. Our findings show that [177Lu]Lu-PSMA-X RLT yielded comparable PSA50 responses in taxane-naïve patients versus those receiving taxane chemotherapy, despite considerable study heterogeneity. Notably, the taxane-naïve group had more extensive pretreatment. This meta-analysis combines the largest cohorts of taxane-naïve mCRPC patients treated with [177Lu]Lu-PSMA-X RLT and taxane-treated mCRPC. It underscores similar PSA50 response rates in both groups, suggesting a potential role for [177Lu]Lu-PSMA-X RLT in taxane-naïve patients who cannot or choose not to undergo chemotherapy.

Examining the Prevalence and Effects of Gender-based Violence in Academic Settings: A Systematic Review and Meta-analyses.

Gender-based violence (GBV) in the academic job sector is a critical issue that intersects with broader systemic and structural inequities, but research is limited. To study the prevalence, effects, and prevention measures of interpersonal GBV within the academic job sector, a meta-analysis and systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Rigorous searches were conducted across the databases PubMed, OVID, Scopus, Web of Science, and CINAHL, using specific keywords related to GBV, workplace, and virtual work environments, identifying papers published between January 2013 and February 2023. Studies were evaluated based on the Population, Intervention, Comparison, Outcomes framework. Data from papers were extracted and grouped by reported instances, and prevalence data for interpersonal GBV were reported in university settings, including in-person, hybrid, and virtual environments, and among men, women, and those who identify as 2SLGBTQ+. A random effects meta-analysis of proportions was conducted to evaluate the reported point prevalence rates of interpersonal GBV in academia between 2012 and 2015. Subgroup analyses were performed for university staff only, females only, and males only. Out of the 1,290 records, 16 studies met the inclusion criteria. The types of violence identified include sexual harassment, workplace bullying and online harassment, which affects career advancement, and employee well-being. The meta-analyses, conducted with a 95% confidence interval [CI], identified that 51.4% (95% CI [39.9%, 63.0%]) of university staff members experience GBV, with females, 59.3% [38.1%, 80.5%], experiencing greater rates than males, 44% [28.1%, 44.1%]. The findings underscore the need for institutional interventions to address interpersonal GBV in academic workplaces.

Sociodemographic inequalities in the uptake of prenatal HIV testing in Ethiopia: Systematic review and meta-analysis.

In order to attain the ambitious 95-95-95 UNAIDS goals, HIV testing serves as the pivotal starting point and plays a crucial role in preventing, treating, and managing HIV. Equal access to HIV testing is crucial to stop the spread of the virus. Measuring healthcare disparities is vital for promoting fairness in health services and achieving global goals for HIV prevention and treatment. Ethiopia is actively engaged in efforts to achieve these goals and is dedicated to combating HIV/AIDS. To the best of our knowledge, no previous systematic review or meta-analysis has been conducted on sociodemographic inequalities in prenatal HIV testing in Ethiopia. Hence, this study aims to assess sociodemographic inequalities in prenatal HIV testing in Ethiopia. We conducted an extensive search across various databases, such as PubMed, Scopus, Google Scholar, and Embase, to collect articles and reports. The data we gathered was then exported to R software for further analysis. Our analysis involved performing a meta-analysis of proportions using a random effect model. To assess the variability among the included studies, we used statistical measures such as I2 statistics and the Cochran's Q test. The results of the pooled prenatal HIV testing, along with its corresponding 95% confidence interval, were presented using a forest plot. A comprehensive analysis of 20 research papers on prenatal HIV testing in Ethiopia revealed that the overall pooled prevalence of testing was 69% (95% CI [60.0-80.0]). Factors such as higher education, urban residence, income, a positive attitude towards testing, marriage, and discussions about testing during antenatal care (ANC) were found to positively influence testing rates. The prevalence of prenatal HIV testing among antenatal care attendees in Ethiopia falls short of the UNAIDS target. In order to enhance the testing rates, it is advised to implement targeted initiatives within Ethiopia's public health programs. To ensure effectiveness, these initiatives should adopt a sustainable and customized approach that takes into account the specific needs and circumstances of women, particularly those who are economically disadvantaged. Ethiopia can make significant strides in enhancing the prenatal HIV testing landscape by effectively implementing policies and programs that prioritize the welfare of the less privileged. As limitation this systematic review did not include longitudinal and qualitative studies that might have provided different results. Trial registration in PROSPERO with ID: CRD42024550564.

Detection of cardiac neuroendocrine tumour metastases by somatostatin receptor PET/CT: a systematic review and meta-analysis.

Cardiac neuroendocrine tumour metastases (CNTM) are rare, but advancements in molecular imaging including somatostatin receptor PET/CT (SSTR-PET/CT) could lead to a more frequent identification. The aim of this article is to perform a systematic review and meta-analysis on the detection of CNTM by SSTR-PET/CT. A comprehensive literature search of studies on CNTM detected by SSTR-PET/CT was carried out. Three different bibliographic databases were screened (Cochrane library, PubMed/MEDLINE, EMBASE) until 20 August 2024. Two review authors independently selected the eligible original articles and performed the quality assessment and the data extraction. Main findings of eligible studies were summarized and a proportion meta-analysis on the prevalence of patients with CNTM among those with neuroendocrine neoplasm (NEN) performing SSTR-PET/CT was carried out using a random-effects model. Ten articles reporting data on 163 patients with CNTM were included in the systematic review. SSTR was able to detect CNTM earlier compared to other radiological imaging techniques. Most patients with CNTM had other metastatic sites and CNTM were often asymptomatic. The meta-analysis of seven articles demonstrated a pooled prevalence of 1.5% (95% confidence interval: 1.0-1.9%) of patients with CNTM (n = 119) among those performing SSTR-PET/CT for NEN (n = 9,300). Moderate statistical heterogeneity was found (I 2 test: 62%). Evidence-based data demonstrate that SSTR-PET/CT enables early and better detection of CNTM compared to other radiological imaging methods. CNTM are encountered with a pooled prevalence of 1.5% of NEN patients performing SSTR-PET/CT. Prospective and multicentric studies are warranted to better clarify the impact of CNTM detection by SSTR-PET/CT on overall survival and clinical decision-making in NEN patients.

Audiovestibular symptoms in systemic sclerosis: a systematic review and meta-analysis.

Answer the following PICO question: Are patients diagnosed with systemic sclerosis (SSc) (Population) who are evaluated clinically and audiometrically (Intervention), have a higher prevalence of audiovestibular pathology when compared with non-SSc patients (Comparison), and how do they present symptomatically and on testing audiovestibular symptomatology and testing modalities (Outcome)? A systematic review and meta-analysis was performed. PubMed, Scopus, CINAHL, and Cochrane Library databases were searched from inception to November 27, 2023. Studies of patients diagnosed with SSc and audiologic and vestibular symptoms were selected for review. Studies of non-SSc pathologies, studies without audiovestibular outcomes, and case reports (fewer than four patients) were excluded. A meta-analysis of proportions and comparison of weighted proportions was performed in MedCalc 20.217. Thirteen studies with 414 SSc patients and 390 control patients were included. The mean ± SD symptom duration was 108.5 ± 71.8 (range: 6-600) months for SSc patients. Comparison of proportions showed patients with SSc were significantly more burdened with symptoms of tinnitus (Δ34.1% [95% CI, 27.6-40.5]; p < 0.0001), vertigo (Δ32.4% [95% CI, 24.8-40.3]; p < 0.0001), and subjective hearing loss (Δ26.0% [95% CI, 20.8-31.3]; p < 0.0001) compared to control patients. Findings regarding vestibular testing were not meta-analyzable because of incomplete data and lack of standard reporting. SSc patients showed statistically significant, yet not clinically significant, worse hearing than controls. These differences, along with increased reports of subjective audiological and vestibular symptoms in patients with SSc, emphasize interdisciplinary collaboration and assessment of SSc for audiovestibular pathologies in the appropriate clinical context.

Endoscopic and Open Treatment Techniques for Posterior Glottic Stenosis in Children: A Systematic Review and Meta-Analysis.

To evaluate the outcomes of open and endoscopic posterior cricoid split grafting and mucosal flaps for the treatment of pediatric posterior glottic stenosis (PGS). COCHRANE Library, CINAHL, PubMed, and Scopus databases. Studies were grouped by treatment method. Outcomes included decannulation rate, improvement in airway obstruction, remaining vocal symptoms, and subsequent airway procedures. A meta-analysis of continuous measures and proportions (%) with 95% confidence interval (CI) was conducted. Nineteen studies with 223 patients were included, with 72 patients having isolated PGS. Twelve studies (n = 23) reported endoscopic repair (group 1), while seven studies (n = 49) reported open techniques (group 2). Most patients in group 1 and group 2 had grade IV PGS (55.9% [26.1%-83.5%] and 56.9% [30.5%-80.8%], respectively). Post-operatively, 70.8% [43.5%-91.7%] of group 1 patients had tracheostomies with 83.4% [62.1%-95.5%] subsequently being decannulated, whereas 97.3% [89.1%-99.8%] of group 2 patients had tracheostomies post-operatively with 90.2% [79.2%-96.5%] subsequently being decannulated. Group 1 and group 2 had 87.1% [70.5%-96.3%] and 84.4% [64.9%-95.5%] improvement in airway obstruction, respectively. There are multiple open and endoscopic surgical options for pediatric PGS. Posterior cricoid split with cartilage graft and mucosal advancement flaps can be performed for high PGS grades. Endoscopic and open techniques are efficacious with high decannulation rates and improvement in airway obstruction, with endoscopic surgeries offering a less invasive approach. Laryngoscope, 2024.

Cardiovascular Events After Chimeric Antigen Receptor T-Cell Therapy for Advanced Hematologic Malignant Neoplasms

The frequency and clinical phenotypes of cardiotoxic events in chimeric antigen receptor (CAR) T-cell recipients remain poorly understood given that landmark approval trials typically exclude patients with high-risk cardiovascular profiles and data from nontrial settings are scarce. To summarize the prevalence of adverse cardiovascular events among adults receiving CAR T-cell therapies for advanced hematologic malignant neoplasms. MEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched from database inception until February 26, 2024. Observational studies were included if they comprised adult CAR T-cell recipients with advanced hematologic malignant neoplasms and if they systematically evaluated cardiovascular complications. Extraction of prespecified parameters related to the patient population, study design, and clinical events was performed at the study level by 2 independent reviewers in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. Meta-analysis of single proportions was conducted using random-effect models with Freeman-Tukey double arcsine transformations to calculate pooled prevalence estimates. Sensitivity analysis was performed using generalized linear mixed models with logit transformations. Ventricular and supraventricular arrhythmias, heart failure events, reduction in left ventricular ejection fraction, myocardial infarction, and cardiovascular and all-cause mortality. Thirteen studies comprising 1528 CAR T-cell recipients (median [IQR] age, 61 [58.7-63.0] years; 1016 males [66%]; 80% patients with lymphoma) were included. The median (IQR) duration of follow-up was 487 (294-530) days. On random-effects meta-analysis, we observed a pooled prevalence of 0.66% (95% CI, 0.00%-2.28%) for ventricular arrhythmia, 7.79% (95% CI, 4.87%-11.27%) for supraventricular arrhythmia, 8.68% (95% CI, 2.26%-17.97%) for left ventricular dysfunction, 3.87% (95% CI, 1.77%-6.62%) for heart failure events, 0.62% (95% CI, 0.02%-1.74%) for myocardial infarction, and 0.63% (95% CI, 0.13%-1.38%) for cardiovascular death. The pooled prevalence of all-cause mortality was 30.01% (95% CI, 19.49%-41.68%). Sensitivity analyses generated similar findings. This meta-analysis found a low prevalence of ventricular arrhythmia, myocardial infarction, and cardiovascular death among CAR T-cell recipients over a short-term to midterm follow-up. Left ventricular dysfunction and supraventricular arrhythmia were the most commonly reported cardiovascular complications, suggesting that cardiovascular surveillance strategies should focus on decreases in ejection fraction and supraventricular arrhythmia.

Attitudes of medical students towards abortion and their willingness to perform abortion: meta-analysis

Background and Objectives: This study evaluates the opinion of medical students about abortion and their willingness to perform the abortion. Methods: After a systematic review, meta-analyses of proportions were performed to achieve percent estimates of medical students’ opinions about abortion and willingness to perform the abortion. Results: 15 studies appraising 6341 medical students were included. Most medical students opined that abortion should be provided if the mother's life is threatened (89%), in case of rape (84%), if the mother's mental health is affected (79%), if the fetus is seriously defective (73%); and on mother’s request (37%). Medical students informed that they would perform abortion if the mother's life is threatened (87%); in case of rape (77%); if the fetus is seriously defective (78%); if the mother's mental health is threatened (65%); in case of teenage pregnancy (51%); on mother’s request (25%); and if court rules (19%). Religiosity was associated with significantly lower proabortion (favoring legalization of abortion) attitudes of medical students (OR: 0.10 [95% CI: 0.04, 0.24]; p&lt;0.00001) but longer duration of medical education was associated with higher proabortion attitudes (OR: 1.75 [95% CI: 1.42, 2.14]; p&lt;0.00001). Conclusion: Attitudes of medical students towards abortion are generally ambivalent where the majority opine that abortion should be performed under certain circumstances. Keywords: Abortion; medical students; attitudes; opinion.

7166 EFFECT OF ANTI-NEOPLASTIC THERAPIES ON CARCINOMA AND AGGRESSIVE PITUITARY TUMORS : A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Disclosure: V.D. Nunes-Nogueira: None. A.R. Cardoso: None. A.C. Zimmermann: None. Introduction: Approximately 10% of the pituitary adenomas can have an aggressive behavior and 0.2% can present metastasis, being classified as pituitary carcinomas. Objective: Evaluate the tumor control obtained by anti-neoplastic therapies that are still little explored in the context of carcinoma and aggressive pituitary tumors. Methods: A systematic review according to the Joanna Briggs Institute has been conducted. We have included studies that evaluated patients with carcinoma or aggressive pituitary tumors who underwent treatment with at least one of the following therapies: Temozolomide, VEGF Inhibitors, Peptide Receptor Radionuclide Therapy (PRRT), Everolimus, Immune Checkpoint Inhibitors, EGFR Inhibitors, Capecitabine and temozolomide (CAPTEM). The main outcome assessed by the study was the frequency of tumor response according to the RECIST protocol classification. Embase, Medline, LILACS, and CENTRAL were our source databases. Proportional meta-analyses were performed to calculate the overall frequencies of complete remission (CR), partial remission (PR; minimum shrinkage of 30%), stable disease (SD) and progression disease (PD). We used Stata Software 18, the updated command “metaprop_one” and fit the logistic normal random effect model. Results: None clinical trial was found, and sixty case report/case series were included. The most frequent therapy used was temozolomide (101 patients), followed by PRRT, pembrolizumab, lapatinib, CAPTEM, bevacizumab, ipilimumab/ nivolumab and everolimus, with respectively 9, 6 ,6, 6, 4, 3 and 1 individuals. The majority of patient in temozolomide studies had prolactinomas (40/101), followed by Cushing’s disease (25/101), the overall frequency of CR with this drug was 1% (ch^2=2.7; p=0.049, Predictive Interval (PI) 1% to 93%, 7 events), PR was 45% ( ch^2=1.8, p=0.091, PI= 8-89%, 46 events), SD 14% (CI 95%=5 a 33%, 20 events), and PD was 25% (95%CI: 14-40%, 28 events). Two patients receiving CAPTEM presented CR, no other studies presented this outcome. In the PRRT studies, the overall frequency of PR was 22% (95%CI 6 to 58%) and PD was 44% (95%CI 18 to 75).Conclusion: Temozolomide has been the therapy most frequent used in the management of carcinoma and aggressive pituitary tumor, being PR the most frequent outcome, followed by PD and SD, with low percentage of CR. The other drugs approached by this review showed similar poor response although they were less tested in the context of this neoplasms. Presentation: 6/2/2024

OTHR-17 MANAGEMENT AND OUTCOMES OF SELLAR, SUPRASELLAR, AND PARASELLAR MASSES IN LOW- AND MIDDLE-INCOME COUNTRIES: A SCOPING REVIEW AND PROPORTIONAL META-ANALYSIS OF 6584 MASSES

Abstract OBJECTIVE To aggregate data on treatment modalities, management approaches, and clinical outcomes of sellar, suprasellar, and parasellar masses in LMICs. METHODS We conducted a scoping review as per the Arksey and O’Malley framework. MEDLINE, Embase, Global Index Medicus, and African Journals Online were searched and included articles between 2000 and 2021 screened against predefined eligibility criteria. Pooled statistics were calculated using measures of central tendency and spread. A proportional meta-analysis was conducted to pool the mortality rates. RESULTS Of the 3526 articles generated by the search strategy, 173 articles were included. The mean age was 35.5 ± 15 years, and most were females (56.47%). Sellar masses predominated (85%; 95% CI = 93.16–118.58), and the most commonly used neuroimaging modality to diagnose these masses was an MRI (65.31%). Surgical resection was mostly utilised with endoscopic surgery (78%; 95% CI = 17.29–154.96) predominating over microsurgery (22%; 95% CI = 11.51–47.73). The transsphenoidal approach was mostly used for both endoscopic surgery and microsurgery (92.13% vs 93.21%), and the extent of resection was gross total resection in most cases (n = 3611). Non-surgical management included hormonal therapies (n = 2080), chemotherapy (n = 96 patients), and radiosurgery (n = 357). New onset diabetes insipidus (34.27%), followed by postoperative infection (27.95%), were the most commonly reported postoperative complications. The pooled overall mortality rate was 8.1% (95% CI: 0.031–0.146). CONCLUSION Although MRIs are considered to be the gold standard means of diagnosis for these masses, their use in LMICs is less reported. Despite new minimally invasive treatment options, endoscopic surgery is commonly used in LMICs. These translates to the fact that more effort is required in the effective care of patients with these masses in LMICs.

Indications, Postoperative Outcomes, and Complications of the Lateral Arm Free Flap: A Systematic Review and Meta-analysis

Background: The lateral arm free flap (LA-FF) has become an increasingly popular choice in the reconstruction of soft tissue defect in many anatomical regions. However, there is a paucity of literature regarding its safety and efficacy. The aim of this study is to analyze its different applications along with their surgical outcomes. Methods: A systematic review including all studies assessing the surgical outcomes of the LA-FF and proportional meta-analysis using a random-effect DerSimonian–Laird model was performed to assess the postsurgical complications and flap failures. Results: Twenty-five articles were included in the final analysis, representing a total of 1272 flaps in 1256 patients. Indications were mainly defects following tumoral resection and trauma. Across the different studies, the reported flap size range varied from 2 × 4 cm to 12 × 16 cm. The overall pooled flap failure rate across all indications was 3% [95% confidence interval (CI), 0.01–0.04], with a pooled failure rate of 2% (95% CI, 0.01–0.04) in the head and neck region, 3% (95% CI, 0.01–0.06) in the upper limb region, and 3% (95% CI, 0.01–0.06) in studies evaluating its use in different anatomical locations. The overall donor site complication rate was 11% (95% CI, 0.03–0.21), with no major complications described. Conclusions: This meta-analysis demonstrates safety and efficacy of the LA-FF in reconstructing moderate to large soft tissue defects. It is mainly used for head and neck posttumoral resection and upper and lower limb posttraumatic reconstruction.

Complications and failure after Kock continent ileostomy: A systematic review and meta-analysis

BackgroundA significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP.MethodsThis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review (CRD42023416961) searched PubMed, Scopus, and Web of Science for studies on adult patients with Kock continent ileostomy published after the year 2000. The main outcome measures were revision, complications, and failure of the KP. Risk factors for complications and failure were assessed using a meta-regression analysis. Risk of bias was assessed using the ROBINS-1 tool. A proportional meta-analysis of the main outcomes was performed.ResultsA total of 19 studies (2042 patients) were included. The weighted mean prevalence of complications was 60.4% [95% confidence interval (CI): 46.1–74.7%], of pouch revision was 46.6% (95% CI: 38.5–54.7%), and of pouch failure was 12.9% (95% CI: 9.3–16.4%). Studies conducted in the USA had a mean failure prevalence of 12.6% (95% CI: 6.2–18.9%) comparable to studies conducted in Europe (11.1%; 95% CI: 7.5–14.7%). Factors associated with higher complications were increased body mass index (BMI) and previous ileoanal pouch anastomosis (IPAA); however, these factors were not associated with increased pouch failure.ConclusionsThe KP is a highly complex operation as shown by a pooled complication prevalence of 60%, and thus, it should be only performed by experienced surgeons. Despite the high prevalence of complications and need for revisional surgery, patients are keen to preserve their KP. Increased BMI and a previous failed IPAA are risk factors for pouch complications, but not failure.

The Association of Circumcision and Genitourinary Cancer, Especially Penile Cancer and Prostate Cancer: A 30-Year Systematic Review and Meta-Analysis

Background: The relationship between genitourinary cancer and circumcision has been debated for a long time. Two types of genitourinary cancer that are often discussed in relation to circumcision are penile cancer and prostate cancer. Methods: A systematic review was conducted on the Science Direct database and Perish with the following databases: Pubmed, Google Scholar, and Crossref. Case-control studies were assessed with the Newcastle-Ottawa Scale. Meta-analysis was performed on penile cancer in situ, invasive penile cancer, and prostate cancer. Meta-analysis of proportions was carried out on penile cancer. Results: 10 studies were analyzed for penile cancer and prostate cancer, and 9 studies were analyzed for penile cancer proportion. Total OR in circumcision and penile cancer in situ (OR = 0.90; 95% CI 0.48–1.69; p = 0.74). Total OR in circumcision and invasive penile cancer (OR = 1.04; 95% CI 0.27–3.94; p = 0.95). Total OR in circumcision and prostate cancer (OR = 0.97; 95% CI 0.79–1.19; p = 0.78). The uncircumcised proportion among penile cancer cases (0.82; 95% CI 0.60–0.97). Conclusions: There was no significant relationship between circumcision and genitourinary cancer. Malignant cells in penile cancer and prostate cancer occur due to a chronic inflammatory process.

Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis.

To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility. MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value. Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001). OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.

Mountain sickness in altitude inhabitants of Latin America: A systematic review and meta-analysis.

Chronic and acute mountain sickness is known worldwide, but most of the available information comes from the eastern continent (Himalayas) without taking into account the west which has the most recent group located at altitude, the Andes. The aim of this study was to synthesize the evidence on the prevalence of acute and chronic mountain sickness in Latin American countries (LATAM). A systematic search of the variables of interest was performed until July 8, 2023 in the Web of Science, Scopus, PubMed and Embase databases. We included studies that assessed the prevalence of mountain sickness in high-altitude inhabitants (>1500 m.a.s.l) who lived in a place more than 12 months. These were analyzed by means of a meta-analysis of proportions. To assess sources of heterogeneity, subgroup analyses and sensitivity analyses were performed by including only studies with low risk of bias and excluding extreme values (0 or 10,000 ratio). PROSPERO (CRD42021286504). Thirty-nine cross-sectional studies (10,549 participants) met the inclusion criteria. We identified 5 334 and 2 945 events out of 10,000 with acute and chronic mountain sickness in LATAM countries. The most common physiological alteration was polycythemia (2,558 events), while cerebral edema was the less common (46 events). Clinical conditions were more prevalent at high altitudes for both types of MS. Acute mountain sickness (AMS) occurs approximately in 5 out of 10 people at high altitude, while chronic mountain sickness (CMS) occurs in 3 out of 10. The most frequent physiological alteration was polycythemia and the least frequent was cerebral edema.

Human Rights in Science: Observations From Ethics Committees on Medical Research Protocols

Objective: To determine the frequency with which Research Ethics Committees (RECs) identify breaches of ethical principles in research protocols. Theoretical Framework: Ethical principles in human research are established in the Nuremberg Code (informed consent and the common good), the Declaration of Helsinki (protection of vulnerable groups), and the Belmont Report (autonomy, beneficence, and justice). These principles are monitored by RECs to protect participants and ensure fairness in resource use. Informed consent ensures autonomy and the integrity of the research. Method: Searches were conducted in PubMed, Scopus, and Google Scholar up to November 30, 2023. A meta-analysis of single proportions was performed. PROSPERO Registration: CRD42021291893 Results and Discussion: Nine publications were reviewed, revealing violations of the principle of justice in up to 100% of protocols. In Latin America, violations were observed in 9% (95% CI: 7-12) of protocols, while in Europe, the rate was 15% (95% CI: 9-24). Autonomy was observed in 26% (95% CI: 20-33) of protocols, with 17% (95% CI: 13-22) in experimental studies. Observations on beneficence varied between 41.17% and 77.38%. Protocol-specific observations ranged between 5.26% and 27.11%, showing regional disparities among study types. RECs must ensure thorough evaluations to uphold autonomy and maximize benefits for participants. Research Implications: Provide a foundation for future investigations on the work of RECs, the implementation of ethical principles, and equity in research. Originality/Value: The publication of observations on ethical principles made by the Research Ethics Committees is essential for drafting new research protocols.

Reaction Risk to Direct Penicillin Challenges

While direct penicillin challenges might support the expansion of penicillin allergy delabeling efforts, the perceived risk of reactions remains a key barrier. To evaluate the frequency of reactions to direct penicillin challenges in individuals with penicillin allergy labels and to identify factors associated with such reactions. Three electronic databases were searched (MEDLINE, Web of Science, and Scopus) from inception to July 19, 2023, for primary studies assessing patients undergoing direct penicillin challenges. Articles were included regardless of publication year, language, status, or definition of allergy risk. Two reviewers independently selected original studies reporting the frequency of immunologically mediated reactions following a direct penicillin challenge in patients reporting a penicillin allergy. Two reviewers independently extracted data and independently assessed the quality of each primary study using a risk-of-bias tool for prevalence studies. The primary outcome was the frequency of reactions to direct penicillin challenges as calculated using random-effects bayesian meta-analysis of proportions. Secondary outcomes included risk factors for reactions and the frequency of severe reactions. A total of 56 primary studies involving 9225 participants were included. Among participants, 438 experienced reactions to direct penicillin challenges without prior testing, corresponding to an overall meta-analytic frequency of 3.5% (95% credible interval [CrI], 2.5%-4.6%). Meta-regression analyses revealed that studies performed in North America had lower rates of reaction to direct challenges (odds ratio [OR], 0.36; 95% CrI, 0.20-0.61), while studies performed in children (OR, 3.37; 95% CrI, 1.98-5.98), in outpatients (OR, 2.19; 95% CrI, 1.08-4.75), and with a graded (OR, 3.24; 95% CrI, 1.50-7.06) or prolonged (OR, 5.45; 95% CrI, 2.38-13.28) challenge had higher rates of reaction. Only 5 severe reactions (3 anaphylaxis, 1 fever with rash, and 1 acute kidney injury) were reported, none of which were fatal. This systematic review and meta-analysis found that reactions to direct penicillin challenges are infrequent, with rates comparable to indirect challenges after allergy testing. These findings suggest that direct challenges are safe for incorporation into penicillin allergy evaluation efforts across age groups and clinical settings.

The role of procedural factors on the outcomes of embolization followed by radiosurgery for the treatment of brain arteriovenous malformations: systematic review and proportional meta-analyses.

Multimodal therapy for brain arteriovenous malformations (bAVM) with embolization followed by stereotactic radiosurgery (E + SRS) has shown varying outcomes. Its benefits over other treatment modalities have been questioned. The goal of this systematic review was to determine the factors associated with cure and complication rates of this treatment strategy. A literature search in Medline and Global Index Medicus, from inception to October 2023, was performed. Studies reporting relevant outcome data from bAVM patients treated with E + SRS were included. Data on several patient, lesion and procedure-related factors were collected. Embolization intent was classified as Targeted (of high-risk features), Devascularizing (feeder embolization/flow reduction) and Occluding (intent-to-cure, nidus embolization). The primary outcome was obliteration rate. Secondary outcomes were post-SRS bleeding (PSB), post-embolization neurological complications (PENC) and post-SRS neurological complications (PSNC). Subgroup analyses included embolic agent, embolization intent and radiosurgery type. Proportional meta-analyses and meta-regressions were performed. Forty-one studies were included in the review. The pooled obliteration rate was 56.45% (95% CI 50.94 to 61.88). Meta-regression analyses showed higher obliteration rates with Copolymers and lower obliteration rates with Devascularizing embolization. The pooled PSB, PENC and PSNC rates were 5.50%, 13.75% and 5.02%, respectively. Meta-regression analyses showed higher rates of PSB, PENC and PSNC with Devascularizing embolization, Liquid & Solid embolic agents and Targeted & Devascularizing intent, respectively. Embolic agent and embolization intent were procedural factors associated with treatment outcomes of E + SRS in the management of bAVM patients. The efficacy and safety profiles favor copolymers as embolic agents and disfavor Devascularizing as embolization intent. The protocol of the systematic review was registered in PROSPERO as CRD42023474171.

Efficacy of Therapeutic Plasma Exchange (TPE) or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-induced Thrombocytopenia (HIT): a Systematic Review and Meta-analysis

ObjectiveConduct a systematic review and meta-analysis of the efficacy of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent thromboembolism in patients with heparin-induced thrombocytopenia (HIT) who undergo cardiopulmonary bypass (CPB) with heparin. DesignSystematic review and meta-analysis. SettingN/A. ParticipantsAdults having cardiac surgery with a history of HIT who received preoperative or intraoperative TPE or intravenous cangrelor as an adjunct to CPB with heparin. InterventionsNone Measurements and Main ResultsA systematic review was performed using Medline, PubMed, and Google Scholar. The primary outcome was avoidance of thromboembolism (venous or arterial) during or after CPB. Proportional meta-analysis with a random effects model was used to calculate a weighted-pooled proportion/efficacy for the study's primary outcome. Fifty-seven patients in 17 reports received TPE as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 3 (5.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 91.0% (95% CI=82.6% to 96.9%). Fifteen patients in 6 reports received intravenous cangrelor as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 2 (13.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 83.0% (95% CI=61.2% to 97.6%). ConclusionsTherapeutic plasma exchange (TPE) and cangrelor are feasible strategies to prevent thromboembolism in adults with HIT who require CPB with heparin. Given the relatively small number of cases in the published literature and a high likelihood for publication and detection biases, prudence remains warranted when using these strategies.