Random-effects Model Analysis Research Articles

Medicinal plants with anti-SARS-CoV activity repurposing for treatment of COVID-19 infection: A systematic review and meta-analysis.

The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus) has emerged as a significant threat to public health with startling drawbacks in all sectors globally. This study investigates the practicality of some medicinal plants for SARS-CoV-2 therapy using a systematic review and meta-analysis of their reported SARS-CoV-1 inhibitory potencies. Relevant data were systematically gathered from three databases, viz., Web of Science, PubMed and Scopus. The information obtained included botanical information, extraction method and extracts concentrations, as well as the proposed mechanisms. Fourteen articles describing 30 different plants met our eligibility criteria. Random effects model and subgroup analysis were applied to investigate heterogeneity. According to subgroup analysis, the substantial heterogeneity of the estimated mean based on the IC 50 values reporting the most potent anti-SARS-CoV 3C--like protease (3CLpro) inhibitors (10.07 %, p < 0.0001), was significantly higher compared to the most active anti-SARS-CoV papain-like protease (PLpro) inhibitors (6.12 %, p < 0.0001). More importantly, the literature analysis revealed that fruit extracts of Rheum palmatum L. and the compound cryptotanshinone isolated from the root of Salvia miltiorrhiza (IC 50 = 0.8 ± 0.2 μmol L-1) were excellent candidates for anti--SARS-CoV targeting PLpro. Meanwhile, iguesterin (IC 50 = 2.6 ± 0.6 μmol L-1) isolated from the bark of Tripterygium regelii emerged as the most excellent candidate for anti-SARS--CoV targeting 3CLpro. The present systematic review and meta-analysis provide valuable and comprehensive information about potential medicinal plants for SARS-CoV-2 inhibition. The chemotypes identified herein can be adopted as a starting point for developing new drugs to contain the novel virus.

Prevalence and factors for food allergy in different populations from different regions: A protocol for a systematic review and meta-analysis.

BackgroundTo determine the prevalence of food allergy (FA) and factors associated with these occurrences in different populations from different regions.Materials and methodsThe literature search will be conducted via Pubmed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Vip and Wanfang databases. Ratio rate (RR), odds ratio (OR) and 95% confidence intervals (CIs) will be adopted to evaluate prevalence and factors for FA in different populations from different regions. When the heterogeneity is small (I2<50%), the fixed effect model will be analyzed, otherwise, random effects model analysis will be performed. When the heterogeneity is large (I2≥50%), Meta regression will be used to explore the sources of inter-study heterogeneity. When the heterogeneity is large (I2≥50%) and the results are statistically significant (P<0.05), subgroup analysis will be analyzed based on age, gender, race/region, literature quality and other factors. Funnel plots will be used to reflect reporting bias and the Begg’s test will be used to test the symmetry of the funnel plots. When publication bias occurs, “cut-and-fill” method will be adopted to adjust publication bias. And sensitivity analysis will be performed for all outcome indicators.DiscussionThis meta-analysis will evaluate the prevalence of FA and factors associated with these occurrences in different populations from different regions on the basis of existing evidences. Our study may be crucial to analyze similarities and differences regarding FA between different individuals from diverse regions and eventually define preventive or diagnostic approaches specifically tailored to certain populations and regions.Systematic review registrationOSF registration number: 10.17605/OSF.IO/VQXU9

Secondary colon cancer in patients with ulcerative colitis: a systematic review and meta-analysis.

A meta-analysis was conducted on the incidence of colon cancer in patients with ulcerative colitis (UC). This study aimed to evaluate the correlation between UC and colon cancer, and provide a theoretical guidance for clinical diagnoses and treatments of UC. Articles were searched in Chinese database with "ulcerative colitis", "UC", "colon cancer", "colorectal cancer", "incidence", and "meta-analysis" as the search terms. Articles were searched in English database with "ulcerative colitis", "UC", "colon cancer", "incidence rate", and "meta-analysis" as the search terms. Moreover, articles with the topic of "correlation between UC and colon cancer" were screened. The quality of articles was assessed using Rev Man 5.3 software provided by Cochrane system. Eleven articles were included, most of which were of medium and high quality. Results of meta-analysis showed that 12,216 patients with UC were included in this study, and 110 patients developed colon cancer. There was statistical heterogeneity (Chi2=103.10, I2=90%, P<0.00001). Random-effect model analyses showed that there were no significant differences between colon cancer in patients with UC and those without colon cancer (Z=12.44, P<0.00001). A systematic review of articles found that the course and development of colon cancer in patients with UC might affect the occurrence of colon cancer. UC was a risk factor for colorectal cancer. It was found that the course of disease and the occurrence and development of UC might affect the occurrence of colon cancer through a systematic review of articles. UC was one of the risk factors of colorectal cancer.

Risks of overweight in the offspring of women with gestational diabetes at different developmental stages: A meta-analysis with more than half a million offspring.

We conducted a meta-analysis to evaluate the association of maternal gestational diabetes mellitus (GDM) and offspring overweight from birth to adulthood, and to assess the effects of lifestyle interventions in women with GDM on this risk of offspring overweight. We identified literature from PubMed and 12 other electronic databases and retrieved relevant literature published before October 20, 2020. Random-effects model analysis was used to calculate relative risks (RRs) of overweight and weighted mean differences of body mass index among children stratified into different developmental stages. Forty-nine cohort studies (n = 559,377) and four randomized controlled trials (n = 1277) were included. We found that offspring of women with GDM were at an increased risk for overweight with age, from 1.14 (95% confidence interval [CI]: 1.06-1.22) under 5 years, 1.37 (95% CI: 1.31-1.44) at 5 to <10 years, 2.00 (95% CI: 1.79-2.23) at 10 to <18 years, to 2.05 (95% CI: 1.65-2.55) over 18 years of age (p < 0.05 for differences among groups). However, it was not observed that lifestyle interventions for GDM decreased the elevated overweight risk (RR: 0.94, 95% CI: 0.80-1.11, I2 = 0.0%). These findings highlight the need for adopting an active and healthy lifestyle in this high-risk group.

School reopening and risks accelerating the COVID-19 pandemic: A systematic review and meta-analysis protocol.

One of the most recent concerns of this pandemic regards the role of schools reopening in disease transmission, as well as the impact of keeping schools closed. While school reopening seems critical for the education and mental health of children, adolescents, and adults, so far the literature has not systematically reached a consensus whether to recommend the return to schools in a way that would be safe for students and staff. To synthesize and critically evaluate the scientific evidence on the potential risk of accelerating the Coronavirus Disease 2019 (COVID-19) pandemic among children, adolescents, young adults, and adults with school reopening. This systematic review and meta-analysis protocol was elaborated following the PRISMA-P. We will include all observational study designs, which report on the potential risk of accelerating the COVID-2019 pandemic with school reopening. Electronic databases included were MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, SCOPUS and CNKI. Additional sources will be also retrieved, including Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Public Health Gray Literature Sources and Health Evidence, Google Scholar, and pre-prints [medRXiv]. No restriction to language or date will be used as search strategy. In an independently manner, two investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected observational studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Cochrane methods and in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). This systematic review and meta-analysis will provide better insights into safety in the return to school in the context of the COVID-2019 pandemic, at a time when vaccination advances unevenly in several countries around the world. Hence, consistent data and robust evidence will be provided to help decision-makers and stakeholders in the current pandemic scenario. CRD42021265283; https://clinicaltrials.gov.

Sarcopenia's Prognostic Impact on Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.

Background: Although sarcopenia has been reported to predict survival in cancer patients, its impact on patients who received immune checkpoint inhibitors (ICIs) has not been thoroughly investigated. This systematic review aimed to assess the long-term oncologic impact of sarcopenia on patients who received ICIs. Methods: A systematic review of studies indexed in the PubMed, Embase, and Cochrane databases, up to April 1, 2021, was conducted. Studies that reported hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on sarcopenia in patients treated with ICIs were included. The inverse variance method was used with a random-effects model for data analysis. Results: A total of 1284 patients from 14 studies were included. Among the patients who received ICIs, patients with sarcopenia had a significant increase in overall mortality compared to patients without sarcopenia in univariate analyses (HR = 1.66, 95% CI = 1.20–2.29, p = 0.002) and in adjusted HRs (HR = 1.55, 95% CI = 1.15–2.10, p = 0.004). The same results were obtained for PFS by both univariate analysis (HR = 1.75, 95% CI = 1.37–2.23, p < 0.001) and adjusted HRs (HR = 1.63, 95% CI 1.28–2.09, p < 0.001). Conclusions: Sarcopenia appears to be an effective biomarker for predicting long-term oncologic outcomes in patients receiving ICI therapy and hence plays an important role when making treatment decisions. However, the fundamental role of this association with survival should be further investigated in large cohorts and clinical trials.

Effect of Hydroxychloroquine on Lipid Levels: A Systematic Review and Metaanalysis.

It has been suggested that hydroxychloroquine may have positive effects on LDL-C, HDL-C, and triglyceride levels; however, the hypolipidemic activities of this drug are still uncertain. The aim of this meta-analysis of randomized controlled trials was to explore the effect of hydroxychloroquine on circulating lipid concentrations. Randomized controlled trials examining the impact of hydroxychloroquine on lipid parameters were searched in PubMed, Web of Science, Scopus, and Google Scholar databases. Meta-analysis was performed using a random-effects model and sensitivity analysis through the leave one-out method. Meta-analysis showed that patients receiving hydroxychloroquine therapy significantly decreased total cholesterol (WMD: 0.18 mmol/L, 95% CI: -0.28, -0.08, I2 = 6%, p = 0.0004), LDL-C (WMD: -0.21 mmol/L, 95% CI: -0.36, -0.06, I2 = 75%, p = 0.006), triglycerides (WMD: -0.09 mmol/L, 95% CI: -0.15, -0.04, I2 = 22%, p = 0.001), and non-HDL-C (WMD: -0.28 mmol/L, 95% CI: -0.45, -0.12, I2 = 0%, p = 0.0009), and increased HDL-C concentrations (WMD: 0.03 mmol/L, 95% CI: 0.00, 0.06, I2 = 0%, p = 0.03). Our results suggest that hydroxychloroquine improves lipid parameters by reducing total cholesterol, LDL-C, triglycerides, non-HDL-C, and increasing HDL-C levels.

Cervical cancer screening utilization and predictors among eligible women in Ethiopia: A systematic review and meta-analysis.

Despite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia. Databases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples' region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women's formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%). This meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.

Ganglioside-monosialic acid (GM1) for prevention of chemotherapy-induced peripheral neuropathy: a meta-analysis with trial sequential analysis

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side effect that largely remains an unresolved clinical issue, leading to long-term morbidity. This meta-analysis aimed to evaluate the efficacy and safety of Ganglioside-monosialic acid (GM1) in preventing CIPN.MethodsSystematic literature searches of PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were performed to identify randomized controlled trials and cohort studies that evaluated the efficacy of GM1 for preventing CIPN. Conventional meta-analysis with a random-effects model and trial sequential analysis (TSA) were performed.ResultsA total of five studies involving 868 participants were included. The results showed that GM1 did not reduce the overall incidence of grade ≥ 2 CIPN when the common terminology criteria for adverse events (CTCAE) was used (OR 0.34, 95% CI 0.34–1.11). Subgroup analyses showed that GM1 could not reduce the risk of CTCAE grade ≥ 2 CIPN (OR 0.63, 95% CI 0.35–1.13) and neurotoxicity criteria of Debiopharm (DEB-NTC) grade ≥ 2 CIPN (OR 0.25, 95% CI 0.01–7.10) in oxaliplatin-treated patients, despite that GM1 was associated with a reduced risk of CTCAE grade ≥ 2 CIPN in the taxane subgroup of one study (OR 0.003, 95% CI 0.00–0.05). These results were confirmed by the sub-analysis of randomized controlled trials (RCTs). In TSA, the z-curve for the taxane subgroup crossed the upper trial sequential monitoring boundary (TSMB) but do not reach the required information size (RIS). The z-curves for the oxaliplatin subgroup remained in the nonsignificant area and did not reach the RIS. Further, GM1 did not influence the rate of response to chemotherapy and CTCAE grade ≥ 2 adverse events such as fatigue, nausea, diarrhea, and rash.ConclusionsGM1 seemed to be well-tolerated and did not influence the anti-cancer effects of chemotherapeutic agents. Although the data did not confirm the effectiveness of GM1 in preventing oxaliplatin-induced peripheral neuropathy, GM1 might be able to prevent taxane-induced peripheral neuropathy. More studies are required in different ethnic populations receiving taxane-based chemotherapy to confirm these findings.

Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis

BackgroundTranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients.MethodsFor this systematic review and meta-analysis, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials from inception until June 1, 2020. We included randomized trials comparing intravenous tranexamic acid and placebo or no intervention in bleeding patients. The primary outcomes were thrombotic events, venous thromboembolism, acute coronary syndrome, stroke and seizures. A meta-analysis was performed using a random effects model and meta-regression analysis was performed to evaluate how effects vary by dose. We assessed the certainty of evidence using the grading of recommendations, assessment, development and evaluations (GRADE) approach.ResultsA total of 234 studies with 102,681 patients were included in the meta-analysis. In bleeding patients, there was no evidence that TXA increased the risk of thrombotic events (RR = 1.00 [95% CI 0.93–1.08]), seizures (1.18 [0.91–1.53]), venous thromboembolism (1.04 [0.92–1.17]), acute coronary syndrome (0.88 [0.78–1.00]) or stroke (1.12 [0.98–1.27]). In a dose-by-dose sensitivity analysis, seizures were increased in patients receiving more than 2 g/day of TXA (3.05 [1.01–9.20]). Meta-regression showed an increased risk of seizures with increased dose of TXA (p = 0.011).ConclusionTranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients. However, because there may be dose-dependent increase in the risk of seizures, very high doses should be avoided.

Effect of intra-partum Oxytocin on neonatal encephalopathy: a systematic review and meta-analysis

BackgroundOxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy.MethodsThe protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals.ResultsWe included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001).ConclusionsIntra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

SP7.2.2 Fascial defect closure in laparoscopic incisional/ventral hernia: a systematic review and meta-analysis of published randomized, controlled trials

Abstract Aims Closure of fascial defect (CFD) during laparoscopic incisional/ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR. Methods A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z = 0.21; P = 0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z = 1.41; P = 0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z = 0.18; P = 0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z = 1.80; P = 0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z = 2.95; P = 0.003). Conclusion Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.

SP3.1.15 Prophylactic negative pressure closed wound therapy in patients undergoing laparotomy for any indication is effective in reducing surgical site infection rate: An upgraded meta-analysis of published randomized, controlled trials

Abstract Aims Surgical site infections (SSIs) are a significant clinical and economic burden on health-care providers. The patients suffering from SSIs have been reporting poor health-related quality of life leading to psychological implications. The objective of this study to explore the role of negative pressure wound therapy (NPWT) in general surgical patients undergoing laparotomy and with closed wounds. Methods A systematic review of the randomized, controlled trials reporting the use of NPWT in general surgical patients undergoing laparotomy for any reason published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of nine randomized, controlled trials on 1238 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of NPWT in patients with closed laparotomy wound was associated with significantly reduced risk of SSIs (odds ratio, 0.60; 95% CI, 0.45, 0.81; z = 3.39; P = 0.0007). However, there was significant heterogeneity (Chi2 = 17.06, df = 8, [p = 0.03]; I2 = 82 %) among included studies. Conclusion The use of NPWT in general surgical patients undergoing laparotomy seems to have proven clinical advantages of reducing SSIs and may routinely be used as a prophylactic tool.

SP7.2.5 Robotic incisional/ventral hernia repair is feasible approach compared to laparoscopic repair: a systematic review

Abstract Aims Robotic incisional/ventral hernia repair (R-IVHR) is gaining popularity due to higher safety as well as feasibility profile. The objective of this study is to present a systematic review exploring the role of robotics compared to laparoscopic approach in the management of incisional/ventral hernia. Methods A systematic review of all types of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the clinical outcomes in patients undergoing either R-IVHR versus Laparoscopic (L-IVHR) was performed. Results A total of 8289 patients in 7 studies were included. There was minimal heterogeneity (Tau2 = 0.29, chi2 = 9.10, df, I2 = 45 %) among included studies for the variables of recurrence rate and post-operative complications, but statistically significant heterogeneity (Tau2 = 1.05, chi2 = 132.81, I2 = 96 %) was observed for the duration of operation. In the random effects model analysis using the statistical software Review Manager, statistically the R-IVHR prolonged the duration of operation (Standardized mean difference, 2.24; 95% CI, 1.37, 3.11; z = 5.06; P = 0.00001) but the post-operative complication rate (OR 0.63; 95% CI, 0.30, 1.34; z = 1.20; P = 0.23) as well as the recurrence rate (OR 0.63; 95% CI, 0.14, 2.74; z = 0.62; P = 0.53) were similar. Conclusion R-IVH repair is feasible and safe, but the duration of operation is significantly longer. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of R-IVHR.

SP7.1.3 An integrated and upgraded meta-analysis of published randomized, controlled trials exploring the role of oral metronidazole as post-operative proctological analgesic agent

Abstract Aims Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic. Methods A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies. Conclusion The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.

TP7.2.12 Robotic versus laparoscopic inguinal hernia repair: a systematic review

Abstract Aims Robotic inguinal hernia repair (RIHR) is considered to improve surgical outcomes in patients undergoing inguinal hernia surgery. The objective is to present a systematic review of RIHR compared to laparoscopic repair (LIHR). Methods A systematic review of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the surgical outcomes in patients undergoing RIHR versus LIHR was performed. Results A total of 12565 patients in 10 comparative studies were included. In the random effects model analysis using the statistical software Review Manager, statistically the RIHR prolonged the duration of operation (Standardized mean difference (SMD), 3.33; z = 5.84; P = 0.00001) but the length of stay (SMD, -0.8; z = 0.66; P = 0.51) and post-operative pain score (SMD, -0.47; z = 1.19; P = 0.24) were similar in both groups. In addition, the recurrence rate was similar in both groups (p = 0.92). The incidence of post-operative complications (OR 1.67; 95% CI, 1.14, 2.45; z = 2.64; P = 0.008) and chronic groin pain (OR 2.14; 95% CI, 0.97, 4.72; z = 1.88; P = 0.06) was higher in RIHR group. Conclusion RIHR is feasible and safe, but the duration of operation is significantly longer with equivocal other variables such as stay and pain score. There was higher incidence of post-operative morbidity and chronic groin pain as well. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of RIHR.

Association between Serum Prolactin Levels and Neurodegenerative Diseases: Systematic Review and Meta-Analysis

Introduction: Prolactin (PRL) exerts inflammatory and anti-inflammatory properties and is also thought to play an important role in the pathogenesis of neurodegenerative diseases (NDs). However, serum PRL levels in patients with NDs were inconsistent in the research literature. Objective: We aimed to assess the serum PRL levels in patients with NDs. Methods: Electronic databases, including MEDLINE, Embase, Cochrane Library database, clinicaltrials.gov, Web of Science, and Google Scholar, and reference lists of articles were searched up to December 31, 2020. Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by fixed-effect or random-effect model analysis. Results: A total of 36 comparisons out of 29 studies (3 RCTs and 26 case controls) focusing on NDs (including Parkinson’s disease, Alzheimer’s disease, Huntington’s disease [HD], multiple sclerosis [MS], and epilepsy) were reported. The meta-analysis showed that there was no statistically significant difference in serum PRL levels between patients with NDs and healthy controls (SMD = 0.40, 95% CI: −0.16 to 0.96, p = 0.16). Subgroup analysis showed that serum PRL levels in patients with HD and MS were higher than those of healthy controls. Furthermore, patients with NDs aged <45 years had higher serum PRL levels (SMD = 0.97, 95% CI: 0.16–1.78, p = 0.018) than healthy controls. High serum PRL levels were found in subgroups such as the microenzymatic method, Asia, and the Americas. Conclusions: Our meta-analysis showed serum PRL levels in patients with HD and MS were significantly higher than those in healthy controls. Serum PRL levels were associated with age, region, and detection method. Other larger sample studies using more uniform detection methods are necessary to confirm our results.

Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis.

Several studies have previously shown the benefit of thiamine supplementation in critically ill patients. In order to fully appraise the available data, we performed a meta-analysis of 18 published studies. A thorough systematic search was conducted. The studies enrolling critically ill patients receiving thiamine supplementation was compared with the standard of care (SOC) group. Data was analyzed using RevMan 5.4. Clinical outcomes were pooled using Odds Ratio (OR) and mean differences. Eighteen studies (8 RCTs and 10 cohort studies) met the criteria for quantitative synthesis. In the analysis of RCTs, thiamine supplementation showed 42% lower odds of developing ICU delirium (OR 0.58, 95% CI, 0.34-0.98). A reduction in mortaliy was observed on performing fixed effect model analysis however, a level of statistical significance could not be reached on performing random effect model analysis (OR, 0.78; 95% CI, 0.59 to 1.04). Further sub-group analysis of 13 studies in patients with sepsis, there was no difference in mortality between the two groups (OR, 0.83; 95% CI, 0.63 to 1.09). Thiamine supplementation in critically ill patients showed a reduction in the incidence of ICU delirium among RCTs. However, there was no significant benefit in terms of overall mortality, and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.

Surgical Management of Focal Chondral Defects of the Talus: A Bayesian Network Meta-analysis

Background: No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus. Purpose: A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up. Study Design: Bayesian network meta-analysis; Level of evidence, 4. Methods: This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables. Results: Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, –2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant. Conclusion: At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome.

A meta-analytic review of comprehension deficits in students with dyslexia.

Beyond the established difficulties of individuals with dyslexia in word recognition and spelling, it remains unclear how severe their difficulties in comprehension are. To examine this, we performed a meta-analytic review. A random-effects model analysis of data from 76 studies revealed a large deficit in reading comprehension in individuals with dyslexia compared to their chronological-age (CA) controls (g = 1.43) and a smaller one compared to their reading-level (RL) matched controls (g = 0.64). Individuals with dyslexia also differed significantly from their CA controls in listening comprehension (g = 0.43). Results further showed significant heterogeneity in the effect sizes that was partly explained by orthographic consistency (the deficits were larger in languages with low orthographic consistency) and vocabulary matching (the deficits were larger in studies in which the groups were not matched on vocabulary). These findings suggest, first, that individuals with dyslexia experience significant difficulties in both reading and listening comprehension, but the effect sizes are smaller than those reported in the literature for word reading and spelling. Second, our findings suggest that the deficits in reading comprehension are likely a combination of deficits in both decoding and oral language skills.