Comparison of ceftolozane-tazobactam and ceftazidime-avibactam for the treatment of infections caused by drug-resistant Pseudomonas aeruginosa: an updated systematic review and meta-analysis based on adjusted data from observational studies.

Ethambutol (EMB) serves as a critical first-line antimycobacterial agent pivotal in the management of Mycobacterium tuberculosis. The emergence of resistance to EMB, primarily driven by mutations in the embB gene, constitutes a formidable challenge to global tuberculosis (TB) eradication efforts. This meta-analysis followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and synthesized data from multiple databases, including PubMed, Embase, MEDLINE, Web of Science, and Elsevier Science, through August 2024. The selection criteria targeted studies reporting the prevalence and patterns of EMB resistance, utilizing both phenotypic and genotypic diagnostic methods. Data were extracted using Microsoft Excel, and statistical analyses were performed with Stata 17.0. Study heterogeneity was evaluated using the I2 statistic and Cochran's Q test. A random-effects model using the DerSimonian-Laird method estimated the pooled prevalence of EMB resistance, with subgroup analyses distinguishing new cases from those with a treatment history exceeding 1 month. Fifty-one studies (34,215 isolates; 2,776 EMB-resistant) were included. The pooled prevalence of EMB resistance was 10% (95% confidence interval [CI]: 8-12%; I2 = 92.99%), with substantial regional variation (Africa [15.56%] vs. Southeast Asia [6.60%]). Among multidrug-resistant TB patients, EMB resistance was 54% (95% CI: 45-63%) and reached 68% (95% CI: 65-72%) in the Eastern Mediterranean; previously treated patients had higher resistance than new cases (31% vs. 13%). Only 12 studies reported codon-specific embB data eligible for pooling, with embB306 most frequently reported and notable regional gaps for embB406/497 (e.g., Americas ND; Europe lacking 406/497). The study identifies substantial regional variations in EMB resistance and the prevalence of specific embB mutations. However, uneven regional representation (particularly limited data from Africa and the Americas) may affect the precision of global estimates. Enhancing diagnostic accuracy through molecular methods and developing regional surveillance systems are essential for effective management of EMB-resistant TB. Future research should prioritize comprehensive genomic analyses to identify novel resistance mutations and advance diagnostic methodologies. Future studies should adopt whole-genome sequencing and standardized codon-level reporting to enable comprehensive mutation profiling and improve comparability across surveillance systems.

Comparison of Complication Rates of Midline Catheter versus Peripherally Inserted Central Catheter: An Update Systematic Review and Meta-Analysis.

The effectiveness of housing-based interventions and harm reduction among adults experiencing homelessness: a systematic review of recent controlled evidence (2019-2025).

Percentage total weight loss (%TWL) is a robust and widely used outcome measure for assessing weight loss after metabolic and bariatric surgery (MBS). This study is an update of the 2021 systematic review on weight loss after MBS expressed in %TWL, now including results of one anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG). A total of 4,541 records were screened, and 49 studies were included, comprising both cohort and registry-based data. Descriptive pooled estimates suggested that OAGB was associated with the highest nadir %TWL within the first two years, whereas nadir %TWL appeared comparable between RYGB and SG. During longer-term follow-up, OAGB appeared to maintain a higher pooled mean %TWL than RYGB and SG. These findings should be interpreted cautiously given the heterogeneity of included studies and the limited availability of long-term data. They should be balanced against long-term complications and need for revisional surgery, which were beyond the scope of the present review. Standardized reporting and high-quality studies with extended follow-up using %TWL as the primary outcome are needed to improve comparability and interpretation of long-term weight loss after bariatric surgery.

Efficacy and safety of multiple treatments for small hepatocellular carcinoma: an updated systematic review and component network meta analysis.

Metformin has been shown to reduce hospitalisation and symptom duration among adults with COVID-19, but the effect has not been studied. We conducted this meta-analysis to assess the efficacy and safety of metformin in patients with COVID-19. Randomized controlled trials (RCTs) comparing metformin with placebo in COVID-19 were identified through major databases through November 2025. We performed statistical analyses using RevMan 5.4, employing the random-effects model, along with Risk Ratio (RR) and Mean Difference (MD) as the effect measures. Our meta-analysis of four RCTs showed that metformin did not significantly reduce the composite outcome of hospitalisation, emergency department (ED) visits, or death, compared with placebo (RR 0.60, 95% CI 0.40-0.90.21). The incidence of all-cause mortality (RR 1.00; 95% CI 0.06-15.91) and serious adverse events (RR 2.86; 95% CI 0.76-10.76) was also comparable between the two groups. Our meta-analysis, with low to moderate certainty, found that metformin may provide modest benefit in reducing hospitalisation, ED visits, or mortality in patients with COVID-19 without an association with increased serious adverse events. However, these findings should be interpreted cautiously, given the limited number of trials, low event rates, and clinical heterogeneity across studies. Further large RCTs are needed before metformin can be considered for use in COVID-19.

BackgroundUmbilical or paraumbilical hernia repair is relatively common in general surgical procedures, including laparoscopic and open repair. However, there is currently insufficient evidence to prove which surgical approach is related to better postoperative outcomes.MethodsThe meta-analysis was based on the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The related studies were searched and retrieved from major databases (PubMed, Cochrane, and Web of Science). Both random and fixed-effects models were used to calculate the pooled effect size.ResultsNine observation studies and four randomized controlled trials (RCTs) involving 5458 patients were finally analyzed. The open group shows a longer duration of hospital stays (MD = -71.01; 95% CI: -108.52, -33.51; P = 0.0002), a higher incidence rate early complications (OR = 0.46; 95% CI: 0.27, 0.77; P = 0.003), and recurrence (OR = 0.14; 95% CI: 0.08, 0.26; P < 0.00001) compared with the laparoscopic group. The subgroup analysis of open repair types showed a higher incidence of recurrence rate (P = 0.008) in the open suture group compared to the open mesh group. Notably, in comparison with the laparoscopic group, early complications (P = 0.01 and P = 0.0003) and recurrence (P = 0.04 and P < 0.00001) were more common in the open repair with and without mesh groups separately.ConclusionIn umbilical or paraumbilical hernia patients, compared to the laparoscopic repair, hospital stays, early complications, and recurrence were more common in the open repair. Moreover, a higher incidence rate of recurrence was observed in the open suture repair compared with the open mesh repair.

Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis.

Updated systematic literature review and network meta-analysis of cladribine tablets versus currently approved disease-modifying treatments for active relapsing-remitting multiple sclerosis.

Predictors of responsiveness to ketamine: An updated systematic review of neuroimaging findings.

Rapid weight loss following Metabolic bariatric surgery (MBS) is associated with an increased risk of developing de novo gallstone formation. We aimed to evaluate the efficacy of prophylactic ursodeoxycholic acid (UDCA) in preventing gallstone formation and reducing gallstone-related outcomes after MBS. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following the PRISMA guidelines through PubMed/MEDLINE, Cochrane, Embase, Scopus, Google Scholar, and clinicaltrials.gov. The primary outcome was gallstone formation at 12-24 months, while symptomatic gallstones and cholecystectomy incidence were secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analysis was conducted according to UDCA dose, duration of administration, and the type of operation. Meta-regression was performed to assess the effect of age and baseline BMI on gallstone formation. I2 and Cochrane Q p-value were used to assess the heterogeneity of the studies. Ten RCTs, including 3,575 participants, were included. Prophylactic UDCA reduced the incidence of gallstone formation by 67% at 12-24 months, and 73% at 6 months, while symptomatic gallstones were reduced by 70%. No statistically significant difference was found in the cholecystectomy rates. Subgroup analysis showed that UDCA doses of 500-600mg daily administered for 6-12 months were effective, with no significant differences in gallstone formation between surgical procedures. Meta-regression analysis showed a slight increase in gallstone risk with age and a slight decrease with higher BMI, although neither relationship reached statistical significance. Prophylactic UDCA may be an effective preventive measure for gallstone formation in MBS patients, however additional studies are needed to assess its effect on cholecystectomy. The systematic review was registered in PROSPERO under registration number CRD420251004594.

This research is an update of the systematic review conducted by Ni Chobhthaigh and Duffy in 2019, which included data up to 2017. The updated review covers a later period (2018-2023) and follows the updated PRISMA 2020 guidelines. The aim is to identify new evidence regarding the effectiveness of psychological interventions with adoptive parents on the well-being of their adopted children, and to provide an updated profile of the characteristics of effective interventions in this field.The literature review was conducted across two relevant databases and grey literature sources. Documents published in English between 2018 and 2023 that reported on the effectiveness of psychological interventions delivered to adoptive parents, measuring psychological outcomes in their adopted children, were included. The design of the interventions had to be evaluative, empirical, and quantitative. In total, eleven studies with 748 adoptive families or individuals describing seven different types of interventions were included, and the risk of bias in each was assessed in accordance with the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.Most interventions targeted adoptive families or adoptive parent couples. All interventions were based on attachment theory and measured the psychological well-being of adopted children (Cohen's d range: nonsignificant to 1.2), as well as the parent-child relationship (Cohen's d range: 0.21 - 0.97); in some cases, they also examined the behavioural functioning of the target population (Cohen's d range: 0,45 - 0.68).The findings from the two systematic reviews indicate promising results regarding the effectiveness of certain interventions based on the use of video feedback and the therapeutic effect of play. However, the high levels of risk of bias observed in some studies suggest caution when interpreting the findings.

Rheumatic and musculoskeletal diseases (RMDs) represent a significant public health challenge in Italy. RMDs are often chronic and lead to increased morbidity and mortality, partly due to an increased risk of infections. Patients with RMDs and those on immunosuppressive therapy show a higher susceptibility to vaccine-preventable diseases and to serious complications in case of infection. Therefore, vaccination is a crucial tool to reduce these risks. This guideline was developed by the Italian Society of Rheumatology and aimed to provide updated national recommendations for clinical practice on vaccinations in adult patients with RMDs. The GRADE ADOLOPMENT approach to combine adoption, adaptation, or de novo development of recommendations was used, and the 2022 American College of Rheumatology (ACR) guideline on vaccinations in RMDs was used as reference. The development process included an updated systematic review of the available evidence and an assessment of the ACR guidelines and their adaptability to the Italian context, followed by a discussion with experts in rheumatology and public health and representatives of healthcare professionals and patients. A set of recommendations was developed, and special attention was given to the current vaccination schedule and to the adjustment of anti-rheumatic drugs to optimize the response to vaccines. This guideline is a step forward in enhancing management and clinical practice for RMD patients in Italy and provides specific and evidence-based indications for infection prevention through vaccination. Their use is intended to promote health and alleviate the burden of morbidity and mortality in this vulnerable population.

To evaluate the efficacy and safety of oral proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in patients with hypercholesterolemia and assess their potential as a convenient alternative to injectable therapies. PubMed, Embase, Scopus, and CENTRAL were searched from inception to May 10th, 2026, using terms related to oral PCSK9 inhibitors and hypercholesterolemia. The study was registered with PROSPERO (CRD420261329028). Randomized controlled trials (RCTs) comparing oral PCSK9 inhibitors with placebo in adults receiving background lipid-lowering therapy were included. Two reviewers independently screened studies and extracted data on an Excel sheet. Five RCTs were analyzed. Oral PCSK9 inhibitors significantly reduced LDL cholesterol (mean difference [MD] -52.15 mg/dL; 95% CI -59.42 to -44.87), apolipoprotein B (MD -42.85 mg/dL; 95% CI -49.52 to -36.18), and lipoprotein(a) (MD -35.11 mg/dL; 95% CI -52.86 to -17.36) compared with placebo. Significant reductions were also observed in triglycerides and total cholesterol. Safety outcomes were comparable to placebo, with no increased risk of adverse events (risk ratio [RR] 1.04; 95% CI 0.98-1.09) or serious adverse events. Subgroup analyses indicated enhanced efficacy with enlicitide and specific dosing regimens. Oral PCSK9 inhibitors address major barriers inherent to injectable biologics. By eliminating needle-related anxiety, injection-site reactions, and the logistical burdens of cold-chain storage, these agents may significantly improve patient adherence and satisfaction. This transition to a convenient oral regimen facilitates integration into standard care, potentially expanding access for patients reluctant to maintain long-term injectable therapy. Oral PCSK9 inhibitors significantly improve atherogenic lipid profiles and are well tolerated. They represent a promising and convenient alternative to injectable PCSK9 inhibitors for managing hypercholesterolemia.

Sex differences in the use of spatial strategies in humans: An updated systematic review of the last decade.

Volume-outcome relationship proposed to exist for high-risk, low-volume procedures, such as the Norwood procedure. A systematic review published in 2014 examined impacts of hospital and surgeon volume, specialization, regionalization and teaching status on the patient-related outcomes of the Norwood procedure. The aim of this systematic review was to update the 2014 work by synthesizing current evidence alongside the original review. We searched PubMed, Embase (Elsevier), and the Cochrane Library for peer-reviewed comparative studies published from 1 March 2013 to 30 December 2024 (date of last search) to update the original review covering database inception to March 2013. Citation chasing of relevant reports was performed on 20 March 2025. Mortality-related outcomes were defined as primary and all others as secondary. In studies on the volume-outcome relationship with categorical volume definitions, effect estimates were compared between the highest and lowest categories, as defined in each study. Risk of bias and certainty of evidence were assessed using ROBINS-E and GRADE, respectively. Data were presented in tables and synthesized narratively. Eight additional studies reported in 13 publications were identified, resulting in a total of 18 studies (24 reports). Of these, 15 studies (20 reports), comprising 47 analyses, were included in the final synthesis. The reports were published between 2002 and 2025 and predominantly relied on routinely collected data from North America. Irrespective of statistical significance, 14 of 15 short-term and 4 of 5 long-term hospital-volume analyses, and 3 of 5 short-term and 3 of 3 long-term surgeon-volume analyses of mortality-related outcomes favored higher volume. Among 17 secondary outcome analyses, 14 favored higher hospital or surgeon volume. Evidence on hospital teaching status was limited to two older studies, which reported lower mortality in teaching hospitals. Overall, the certainty of evidence was rated as very low, reflecting heterogeneity in exposure definitions, reliance on routinely collected data, and limited use of analytical approaches that support causal interpretation. Although most analyses favored higher hospital or surgeon volume and teaching hospital status, the very low certainty of evidence limits its ability to inform clinical practice or policy, underscoring the need for stronger methodological approaches in future research. PROSPERO CRD42022385160.

We meta-analyzed randomized trials to assess efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) after bariatric surgery. We searched PubMed, Embase, and Cochrane Central for randomized trials comparing GLP-1 RAs with placebo after bariatric surgery. Primary outcomes were change in body weight (kg) and HbA1c (%) at 6 and 12 months. We also assessed percent total body weight loss (%TBWL), quality of life, and adverse events. We pooled mean differences (MDs) with 95% confidence intervals (CIs) using random effects and assessed heterogeneity with I² statistic. We also performed an exploratory subgroup analysis that compared very early (≤ 2 months) versus late (≥ 18 months) initiation after surgery. Seven RCTs (n = 460) met inclusion criteria; all evaluated liraglutide. GLP-1 RAs increased weight loss at 6 months (MD - 5.33kg; 95% CI - 9.42 to - 1.23; p = 0.02) but not at 12 months (MD - 5.05kg; 95% CI - 22.14 to 12.05; p = 0.33). GLP-1 RAs increased %TBWL at 6 months (MD 5.13%; 95% CI 2.14 to 8.11; p = 0.007) but not at 12 months (MD 3.96%; 95% CI - 3.33 to 11.26; p = 0.18). HbA1c did not differ at 6 or 12 months. Quality of life improved at 6 months in the trials reporting this outcome. Gastrointestinal adverse events were similar between groups. Subgroup analyses suggested differences by initiation timing. GLP-1 RA therapy improved short-term weight outcomes after bariatric surgery, with no statistically significant between-group differences at 12 months. Timing of initiation may influence response and should be explored in trials with longer follow up. PROSPERO ID CRD420251251321.

Characterizing updated and living meta-analyses Part 1: A methodological scoping review on methods for conducting meta-analyses in updated and living systematic reviews.

ObjectivesTo provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes.DesignSystematic review of randomised controlled trials.Data sourcesMEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted.Eligibility criteriaRandomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism).Data extraction and synthesisTwo reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted.Results23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies.ConclusionsWorkplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent.PROSPERO registration numberCRD420261289218.