Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.

This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I2 statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.

The I2 statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.

By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.

Internet-based interventions (IBI) increase access to evidence-based treatments for mental disorders, but knowledge of their mechanisms of change is limited. Self-efficacy, a key factor in psychotherapy, is especially relevant in IBI due to its self-help focus. We investigated self-efficacy and related constructs as outcomes, predictors/moderators, and mediators in randomized controlled trials.

A systematic search was conducted across PsycINFO, PubMed, CINAHL, and Web of Science. Two reviewers selected studies, extracted data, and assessed bias. Effects were quantified using random effect models and supplemented by narrative syntheses and box score visualizations.

70 studies (N = 17,407 participants) were included. IBI showed moderate effects on self-efficacy in within (d = 0.47) and between (d = 0.46) comparisons, with guided interventions having the largest effect (d = 0.66). Findings on self-efficacy as a predictor/moderator were mixed, though some studies suggested individuals with lower self-efficacy benefit more. Self-efficacy emerged as a mediator through which IBI affected treatment outcomes.

Self-efficacy appears influential in IBI efficacy and may itself be a valuable treatment target. However, mixed results and methodological limitations in mediator studies highlight the need for further research, particularly on long-term effects.

Laboratory-based stress inductions are commonly used to elicit acute stress but vary widely in their procedures and effectiveness. We compared the effects of stress induction techniques on measures of two major biological stress systems: the early sympathetic-adrenal-medullary (SAM) and the delayed hypothalamic-pituitary-adrenal (HPA) axis response.

A review and meta-analysis to examine the relationship between stress induction techniques on cardiorespiratory and salivary measures of SAM and HPA system activity.

A systematic literature search identified 245 reports and 700 effects.

The overall effect of stress induction techniques on the stress response was moderate (Fisher's zr = 0.44), inducing stronger SAM-related (zr = 0.48) versus HPA-related (zr = 0.37) responses. Three factors moderated these associations: the stress system examined (SAM vs HPA), the specific stress induction technique employed (e.g., Cold Pressor), the physiological sampling time relative to the stress induction, and participant sex. Loud music elicited the most robust SAM-related effects, whereas combined stress inductions elicited the most robust HPA-related effects. Men showed stronger stress responses than women.

Stress induction techniques variably elicit SAM - and HPA-related responses. Results recommend specific induction techniques for targeting stress systems, highlighting the importance of carefully selecting methodologies in laboratory contexts.

Methylphenidate (MPH) is a stimulant medicine often used to treat attention deficit hyperactivity disorder (ADHD), as it may positively affect behaviour and brain activity. This work aims to systematise the current literature about the effects of MPH on the amplitude of P300 in individuals with ADHD.

A systematic review and meta-analysis of empirical studies measuring P300 amplitude and comparing MPH administration to either a pre-MPH condition or healthy controls was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Our results revealed no overall (n = 13) significant differences between individuals diagnosed with ADHD and medicated with MPH and controls. Although, a moderation analysis by region found differences between both groups on frontal sites. When comparing the pre- and post-effects of MPH on the same individuals (n = 17), it appears that P300 amplitude tends to increase post-administration in central and posterior regions. In this second meta-analysis, a moderation by task revealed a larger effect size for go/no-go.

In general, MPH was found to increase P300 amplitude in ADHD, somewhat normalising this aspect of their brain activity. The main limitations of the included studies are the insufficiently explained dosages and the skewness for male participants. Future research directions are discussed.

Multi-regional clinical trial (MRCT) has become an increasing trend for its supporting simultaneous global drug development. After MRCT, consistency assessment needs to be conducted to evaluate regional efficacy. The weighted Z-test approach is a common consistency assessment approach in which the weighting parameter W does not have a good practical significance; the discounting factor approach improved from the weighted Z-test approach by converting the estimation of W in original weighted Z-test approach to the estimation of discounting factor D. However, the discounting factor approach is an approach of frequency statistics, in which D was fixed as a certain value; the variation of D was not considered, which may lead to un-reasonable results. In this paper, we proposed a Bayesian approach based on D to evaluate the treatment effect for the target region in MRCT, in which the variation of D was considered. Specifically, we first took D random instead of fixed as a certain value and specified a beta distribution for it. According to the results of simulation, we further adjusted the Bayesian approach. The application of the proposed approach was illustrated by Markov Chain Monte Carlo simulation.

Vaccine hesitancy remains a significant public health challenge globally, requiring innovative, evidence-based approaches to improve uptake. This systematic review and meta-analysis evaluated the effectiveness of stage-of-change (SOC)-tailored interventions, the customized strategies based on an individual's readiness for behavioral changes, in promoting vaccination uptake. Data were synthesized from randomized controlled trials (RCTs), quasi-experimental, and non-experimental studies identified through MEDLINE, PubMed, Web of Science, Embase, Global Health, and APA PsycInfo databases. Five eligible studies published between 2004 and 2023 were included, with three RCTs and one quasi-experimental study contributing to the meta-analysis. The pooled standard mean difference (SMD) for vaccination uptake was 0.54 (95% confidence interval [CI]: 0.49, 0.59, p < .001), indicating a significant medium effect size with no heterogeneity (I2 = 0%, p = .88). Subgroup analyses showed SOC-tailored interventions were particularly effective for older adults (SMD = 0.57, 95% CI: 0.22 to 0.92, p = .03) and for parents or caregivers to increase children's vaccination uptake (SMD = 0.53, 95% CI: 0.32 to 0.74, p = .02). These findings provided preliminary evidence on the effectiveness of SOC-tailored interventions in addressing vaccine hesitancy. Future research should explore geographically diverse settings and cost-effective delivery methods to maximize the impact.

This study aims to determine whether preoperative supplementation of vitamin D reduces the incidence of hypocalcemia following total thyroidectomy.

Conducted in conformity with the PRISMA statement, a systematic review and meta-analysis of randomized clinical trials (RCT) was performed assessing postoperative hypocalcemia and postoperative symptomatic hypocalcemia.

The search strategy yielded 3808 potentially relevant publications, with eight RCTs ultimately included. These eight trials included a total of 902 patients (22.73% male, n = 205/902), with a median age of 48.9 years (95% CI, 43.5-53.5). Four trials administered only vitamin D in the interventional arm, three trials administered both calcium and vitamin D in the interventional arm, and one trial administered vitamin D in the interventional arm and calcium in both arms. Pooled results from the eight included trials showed a reduced risk of postoperative hypocalcemia in the intervention arm (RR, 0.77; 95% CI, 0.62-0.96; p = 0.02). When excluding the studies that administered calcium supplements in addition to vitamin D, the pooled results showed a similar reduced risk of postoperative hypocalcemia (RR, 0.74; 95% CI, 0.57-0.96; p = 0.03). Analysis of six trials reporting the incidence of postoperative symptomatic hypocalcemia (n = 564) showed a reduced risk in the vitamin D arm, with or without calcium, compared to the control arm (RR, 0.56; 95% CI, 0.34-0.93; p = 0.023).

Our findings suggest that preoperative vitamin D administration, with or without calcium carbonate, significantly reduces the risk of postoperative hypocalcemia and symptomatic hypocalcemia in patients undergoing total thyroidectomy.

Chemical sanitizers are applied to food processing surfaces to inactivate bacterial pathogens. Pathogen type, surface type along with sanitizer type, concentration, and contact time are important factors potentially impacting sanitation efficacy. Numerous studies on chemical agents and lab-generated biofilms have been published; however, cross-study comparisons can be difficult. A systematic literature review (SLR) and meta-analysis were conducted to evaluate chemical sanitizer efficacy against Listeria monocytogenes, Salmonella spp., and Shiga toxin-producing Escherichia coli (STEC) within lab-generated biofilms on food contact surfaces (FCSs). The SLR included 13 peer-reviewed articles published between 2000 and 2020. Sanitizer concentration, type, contact time, surface type, and bacteria type were explored using multilevel mixed effects models to determine their impact on bacterial log reduction on FCS. The overall estimated log reduction was 2.90 (effect size [ES]) with a 95% CI = 2.40, 3.39 (p < 0.0001). The multilevel mixed effects model estimated log reductions of 2.67-3.82 for peracetic acid (PAA), quaternary ammonium compounds, sodium hypochlorite, hydrogen peroxide + PAA, and calcium hypochlorite, with significant differences across sanitizers. No significant differences were found between L. monocytogenes and STEC; however, both pathogens were significantly different from Salmonella spp. All pathogens were significant predictors of mean log reduction (p < 0.0001). No significant differences were found between surface types, while all were significant predictors of mean log reduction (p < 0.0001). Neither sanitizer concentration (p = 0.5554) nor sanitizer contact time (p = 0.1800) were found to be significant predictors of estimated mean log reduction. These findings highlight the importance of specific sanitizers and tailored approaches based on surface types and pathogen considerations.

Although anxiety sensitivity (AS), or the fear of anxiety-related symptoms, has been identified as a risk factor for the development of anxiety psychopathology, the pathways through which this fear is learned have not been fully elucidated. In the current review and meta-analysis, we aimed to systematically examine the association between parent-to-child fear learning pathways (vicarious learning, negative information, reinforcement, and punishment) and AS. A comprehensive search of literature was conducted in PsychINFO, PubMed, Embase, and Web of Science databases, using search terms combining categories related to fear learning pathways, anxiety-related symptoms, parents, children, and adolescents. Based on this search strategy, 28 studies were identified as relevant, of which 11 were included in the systematic review and 10 in the meta-analysis. The overall findings indicated that parent-to-child fear learning pathways are significantly associated with AS. The meta-analysis demonstrated a small but significant association between fear learning pathways and AS, although the type of fear learning pathway did not significantly moderate this relationship. However, age emerged as a significant moderator, suggesting a stronger association in children and adolescents compared to adults. Given that these findings are primarily based on cross-sectional studies, this review underscores the need for longitudinal and experimental research to further clarify the role of parent-to-child fear learning pathways in anxiety sensitivity. Additionally, a better understanding of these pathways may help inform existing interventions and fear prevention strategies, such as those aimed at reducing parental modeling of fearful behaviors or promoting positive verbal messages about anxiety symptoms.

Obesity is a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP1-RA) and bariatric surgery (BS) are effective weight loss interventions; however, the genetic factors influencing treatment response remain largely unexplored. Moreover, most previous studies have focused on race and ethnicity rather than genetic ancestry. Here we analyzed 10,960 individuals from 9 multiancestry biobank studies across 6 countries to assess the impact of known genetic factors on weight loss. Between 6 and 12 months, GLP1-RA users had an average weight change of -3.93% or -6.00%, depending on the outcome definition, with modest ancestry-based differences. BS patients experienced -21.17% weight change between 6 and 48 months. We found no significant associations between GLP1-RA-induced weight loss and polygenic scores for body mass index or type 2 diabetes, nor with missense variants in GLP1R. A higher body mass index polygenic score was modestly linked to lower weight loss after BS (+0.7% per s.d., P = 1.24 × 10-4), but the effect attenuated in sensitivity analyses. Our findings suggest known genetic factors have limited impact on GLP1-RA effectiveness with respect to weight change and confirm treatment efficacy across ancestry groups.

Radiofrequency ablation (RFA) is increasingly being investigated as a treatment for parathyroid lesions, with favorable outcomes, especially in patients who are ineligible for surgery or decline surgery. We aimed to assess the efficacy and safety of RFA in treating hyperparathyroidism.

PubMed and Embase were searched for original literature published on or before July 18, 2024. We included 14 eligible studies with 593 patients (241 with primary hyperparathyroidism [PHPT], 310 with secondary hyperparathyroidism [SHPT], and 42 with tertiary hyperparathyroidism [THPT]). Serial pooled means of biochemical indexes (parathyroid hormone [PTH], calcium, phosphorus), volume reduction ratio (VRR) after RFA, and complication rate were calculated.

In PHPT, the pooled mean baseline PTH value of 158.7 pg/mL and serum calcium value of 10.96 mg/dL significantly decreased to 57.3 pg/mL and 9.55 mg/dL, respectively, at 12 months (both p < 0.001), with both being within normal ranges. The pooled mean VRR gradually increased, reaching 95.6% at 12 months. In SHPT, the pooled mean baseline PTH value of 1683.7 pg/mL significantly decreased to 267.2 pg/mL at 12 months (p < 0.001), which was within the target reference level (PTH ≤ 585 pg/mL). In THPT, the mean baseline PTH value of 1284.9 pg/mL decreased to 161.6 pg/mL at 1 year (p < 0.001). The pooled incidence rates of total, major, and minor complications were 27.9%, 7.5%, and 20.0%, respectively.

RFA showed promising effectiveness and safety profiles, particularly for patients who are ineligible for surgery or decline surgical intervention.

Question What is the efficacy and safety of RFA in treating hyperparathyroidism? Findings In PHPT, pooled mean values of biochemical indexes (serum PTH, calcium) were normal throughout 12-month follow-up. In SHPT and THPT, pooled mean PTH stayed within target ranges throughout 12-month follow-up. Clinical relevance RFA showed efficacy and safety in treating hyperparathyroidism, maintaining biochemical indexes within normal or target ranges throughout 12-month follow-ups. RFA would be a valuable treatment option for patients who are ineligible for surgery or who decline surgical intervention.

Antimicrobial drugs are used to treat bacterial pathogens that cause infections in humans and animals. Despite their importance, antimicrobial drugs exhibit inefficiency in treating infections if used irrationally without adherence to standard guidelines. Currently there is a lack of review literatures concerning antimicrobial resistance status in the southern sub Saharan African countries, hence the study is designed for and provides valuable insights into the status and comparison of antimicrobial resistance among foodborne bacteria in Zambia relative to other regions of the world, using systematic literature review and meta-analysis. For meta-analysis of bacterial and AMR prevalence and, generation of forest plots, functions from R packages were used and meta-regression analysis using the random effect model with the R functions "escalc" and "rma" from R "metafor" package was used to determine sample size on bacterial prevalence. A total of 434 articles were identified and downloaded after a systematic research. The study has implicated that the most common foodborne bacteria in the last five years in Zambia are salmonella spp., E. coli., and L. monocytogens. Based on the random effect model, the prevalence of bacterial pathogens across all studies in food samples was observed to be 11% and in human samples was 14%. The study found a significant increase in antimicrobial resistance (AMR) burden among foodborne pathogens in Zambia compared to other regions of the world over the past five years. This rise is attributed to the bacteria's ability to develop resistance mechanisms and easily spread between humans, animals, and the environment. Ineffective surveillance, inadequate management by stakeholders, and public unawareness have further exacerbated the problem, requiring effective policy implementations in the health sector.

Anxiety during pregnancy can be harmful to both mother and baby, with anxiety rates remaining high despite psychological intervention efforts. This study aimed to evaluate the effectiveness of collaborative and single psychological interventions in reducing anxiety compared with standard antenatal care.

A literature search was conducted in four databases (Scopus, Cochrane Library, PubMed, and ScienceDirect) for relevant studies published from 2016 to January 2024. The population in this review is pregnant women with anxiety who received psychological interventions either from a single health worker or involving collaboration. Psychological interventions were compared with standard antenatal care with maternal anxiety outcome scores to measure the efficacy of pre-post psychological intervention methods, with measurements taken only during pregnancy. The study designs included the use of the Randomized Controlled Trials method. This study restricted articles to languages ​​other than English and used a review design and pharmacological interventions. Two independent reviewers performed data extraction and quality assessment using RoB 2. Statistical analysis was conducted using R-Studio. Data analysis was performed using meta-count packages with a random effect model.

There were 14 eligible articles identified from the initial 3,346 records, with 1 article excluded from the meta-analysis. Psychological interventions were effective in reducing anxiety compared with standard care (Standardised Mean Difference (SMD) - 0.64, 95% CI - 0.98--0.31). Analysis by type of intervention group showed differences between the two groups in mindfulness interventions (SMD - 0.55, 95% CI - 0.8--0.31), motivational interviewing (SMD - 0.70, 95% CI - 1.08--0.33), and supportive counseling (SMD - 0.73, 95% CI - 1.19-0.28). There were no differences between the Cognitive Behavioral Therapy (SMD - 0.80, 95% CI (- 1.80-0.19)) and Thinking Healthy Program intervention groups (SMD - 0.35, 95% CI - 0.81-0.11). Analysis of interventions conducted by a multidisciplinary team (collaborative) showed higher efficacy (SMD - 0.88, 95% CI - 1.60--0.15) compared with a single professional (noncollaborative) (SMD - 0.47, 95% CI - 0.72--0.22).

Collaborative interventions show better efficacy than a single intervention, with psychological therapy being more effective in reducing anxiety rather than standard antenatal care. Future research should improve the cooperative approach and examine its long-term effects on maternal and newborn outcomes.

This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration code CRD42024497417.

Gambling disorder (GD) is associated with deficits in various cognitive functions. Specifically for executive function (EF), previous findings are inconsistent, despite deficits being reported for shifting, inhibition, planning, and working memory domains. Although a worse performance in EF measures related to GD severity is often reported, there is a need to clarify current evidence. This study aims to systematically review and perform a meta-analysis to clarify the association between EF deficits and GD. The current study followed the preferred reporting items for systematic reviews and meta-analyses protocols. The meta-analysis used a random effects model and robust variance estimation to analyze the data, using Hedge's g to report effect sizes. A total of 21 studies were systematically reviewed, of which 17 were included for meta-analysis. Meta-analysis was performed for shifting, inhibition, planning, and verbal fluency. Due to a lower number of studies, working memory data was systematically reviewed, but no meta-analysis was performed. Significant effect sizes were found for shifting and inhibition, indicative of deficits in participants with GD. No significant deficits were found for the other EF domains. Working memory results revealed inconsistent evidence, even when divided into verbal and visuospatial modalities. There is enough evidence of deficits in shifting and inhibition in participants with GD. However, better sample characterization should be considered in future studies to better understand the sources of potential heterogeneity. Consideration of gambling severity as a continuous variable could allow for a more detailed analysis of EF alterations across the various degrees of GD.

Adenotonsillar hypertrophy is the leading cause of obstructive sleep apnea (OSA) in children, with adenotonsillectomy (AT) being the most common surgical treatment. Although AT is widely performed, its efficacy in treating mild OSA remains uncertain. Current literature suggests that children with mild OSA might benefit from non-surgical management, but there is a lack of evidence ND studies evaluating the outcomes of AT specifically for mild OSA. The aim of this systematic review and meta-analysis is to provide conclusive insights into the effectiveness of adenotonsillectomy in improving health outcomes and quality of life for children with mild obstructive sleep apnea.

PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. We included original studies that evaluated the safety or effectiveness of AT in the management of mild OSA among pediatric patients. For quantitative analysis, data were synthesized using a random-effects model in R (version 4.3.3), and heterogeneity was assessed using statistical methods including the restricted maximum-likelihood estimator and the I2 statistic. We also conducted analyses of change scores and covariance to estimate the effect of AT on the severity of mild OSAS.

Our review included 27 studies after screening 1851 citations. The meta-analysis demonstrated significant improvements with AT for mild OSA. The Pediatric Sleep Questionnaire scores improved with a mean difference (MD) of -0.32 (95% CI [-0.39; -0.25], p < 0.001). AHI decreased significantly with an MD of -1.45 (95% CI [-2.11; -0.80], p < 0.001). Comparison with watchful waiting revealed AT to be more effective: AHI showed an MD of -1.22 (95% CI [-1.92; -0.53], p < 0.001), and the arousal index had an MD of -1.73 (95% CI [-2.95; -0.51], p = 0.005). Safety data indicated that while AT is generally safe, it is associated with minor complications such as postoperative desaturation and occasional bleeding. Long-term serious adverse events were rare.

AT effectively improves symptoms in children with mild OSA, outperforming watchful waiting in several key metrics. This review supports AT as a viable option but underscores the importance of considering individual patient factors in treatment decisions.

Intestinal protozoal infections caused by Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum are prevalent in Malaysia. They cause severe diarrheal diseases with symptoms such as bloody stools, abdominal pain, stomach discomfort, and bloating. These infection outbreaks have been reported in diverse socioeconomic backgrounds and geographical regions usually during the rainy season or in areas with poor sanitation. Despite the importance of these infections, data on its overall prevalence, risk factors, and diagnostic methods remain limited.

The aim of this study is to systematically review and synthesize evidence on the risk factors, prevalence, and detection methods for intestinal protozoal infections in Malaysia, offering insights that are applicable to other tropical and low-income regions.

Studies on intestinal protozoal infections among Malaysian patients published after January 2010 up to November 2024 will be eligible for inclusion. The eligibility criteria include studies investigating infections caused by E. histolytica, G. lamblia, and C. parvum using validated diagnostic methods such as microscopy, molecular techniques, or immunoassays. Case reports, reviews, and studies without original data will be excluded. Comprehensive database searches will be conducted in PubMed/MEDLINE, Scopus, ProQuest, Web of Science, Google Scholar, and the Cochrane Library. The reference lists of selected papers are also checked. A standardized data extraction form will be used to record study characteristics, outcomes, and associated variables. Risk of bias will be assessed using the Joanna Briggs Institute tools and Newcastle-Ottawa Scale approach. Data synthesis will utilize a random effects model to estimate pooled prevalence and identify risk factors associated with these infections. Subgroup analyses will examine variations by geographic region and diagnostic method. Statistical heterogeneity will be assessed using I2 statistic and meta-regression. Publication bias will be assessed using Egger and Begg funnel plot test. The results are reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

This systematic review was funded in June 2024. Database searches were started in July 2024, and we identified 1652 papers as of December 2024 for screening. Completion of study screening is anticipated by May 2025, with data extraction and analysis expected to conclude by December 2025.

Our study will address critical knowledge gaps in the epidemiology and risk factors of intestinal protozoal infections in Malaysia. Study limitations include potential bias in study selection, heterogeneity in diagnostic methods, and differences in the reporting quality of the included studies. Our findings will provide valuable insights into the prevalence of these infections, the associated risk factors, and the diagnostic techniques employed, which should strengthen public health measures, improve diagnostic procedures, and guide future research to reduce the prevalence of intestinal protozoal infections in Malaysia.

PROSPERO (International Prospective Registry of Systematic Reviews) registration CRD42023456199; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023456199.

DERR1-10.2196/66350.

Tuberculosis (TB) in cattle negatively affects the cattle economy in Africa, with zoonotic TB posing drug-resistance issues in humans. The burden of TB in cattle and zoonotic TB in humans in sub-Saharan Africa (SSA) is not well understood. This study aimed to determine the prevalence of both TB in cattle and zoonotic TB in humans in SSA through meta-analysis.

Research on TB prevalence was sourced from multiple databases. A random effects meta-analysis model estimated TB prevalence in SSA and its regions, while meta-regression identified risk factors. The analysis included 114 studies for cattle and 59 for humans.

The estimated TB prevalence in cattle was 5.06% (95% CI: 3.76-6.78), with a higher burden in West Africa. The prevalence was greater on farms than at abattoirs. Among humans, M. bovis prevalence was 0.73% (95% CI: 0.53-1.01), increasing to 1.56% (95% CI: 1.04-2.33) in TB incident cases, especially in the West and East Africa. Higher prevalence was noted among livestock workers, and in drug-resistant cases. Significant factors influencing TB prevalence varied for cattle and humans, including country, diagnostic methods, and study populations.

Focusing interventions on farms and livestock workers could help reduce the disease burden.

Estimating the current association between childhood adversity and the risk of psychosis is crucial for prevention and intervention. We provided an updated synthesis of evidence from the past four decades, expanded the available data by investigating a broad array of adversity subtypes, and explored sex differences and the age of psychosis onset as relevant factors.

We searched PubMed, EMBASE, PsycINFO, Web of Science, WANFANG, and CNKI, for case-control, cross-sectional and cohort studies on the association between adversity and psychotic symptoms/illness. Multi-level meta-analysis, prediction intervals calculation, and sensitivity analyses were conducted.

The main analysis included 183 study samples (N=349,265), with 119 case-control studies (15,186 cases; 14,879 controls), 51 cross-sectional studies (N=299,659), and 13 cohort studies (N=19,541). Significant associations between adversity and psychosis were observed across all study designs, yielding an overall odds ratio of 2.80 (95% CI=2.18, 3.60). Secondary analyses revealed that exposure to each adversity subtype increased the odds of psychosis, with the highest odds ratio (3.54 [95% CI=3.04, 4.13]) for emotional abuse, and the lowest odds ratio of (1.58 [95% CI=1.48, 1.68]) for parental antipathy. No statistically significant sex differences were observed, although the odds ratio for sexual abuse was higher for women. Onset of psychosis was earlier in adversity-exposed individuals (mean difference=-0.79 years, 95% CI=-1.47 to -0.12).

This is the largest meta-analysis to date on the association between childhood adversity and psychosis. The results have broad clinical implications, as they highlight the need for selective prevention of exposure to early adversities and the implementation of trauma-informed therapies in the treatment of psychosis.

Bovine adenoviruses (BAdVs) are major contributors to the bovine respiratory disease complex (BRDC). A systematic review and meta-analysis were carried out to explore the epidemiology of BAdV across diverse cattle populations using different detection methods. The study showed a higher BAdV prevalence of 0.66 in general cattle populations using antibody detection, compared with 0.28 in cattle showing clinical signs. The study identified significant prevalence differences between BAdV-3 (0.87) and BAdV-7 (0.21) in general cattle populations. However, in clinical cattle, BAdV-3 and BAdV-7 showed similar prevalence at 0.27 and 0.32, respectively. Moreover, a high herd-based BAdV seroprevalence of 0.82 was observed. When nucleic acid detection methods were used in general cattle populations, a lower BAdV (0.05) prevalence was observed, in contrast to the higher prevalence (0.32) in cattle exhibiting clinical signs. In contrast, using antigen detection in cattle with clinical signs of disease showed a prevalence of 0.06, compared to 0.32 with nucleic acid methods, indicating detection method-specific sensitivity and specificity. The study also highlighted the role of BAdV in BRDC, particularly BAdV-3 and BAdV-7. Existing empirical evidence on BAdV epidemiology and pathobiology is scarce and requires further investigation; however, the current findings offer insights into the epidemiology of BAdV and its role in the BRDC, which could potentially inform and enhance disease control strategies.

Exercise-induced fatigue is a common consequence of physical activities. Particularly in older adults, it can affect gait performance. Due to a wide variety in fatiguing protocols and gait parameters used in experimental settings, pooled effects are not yet clear. Furthermore, specific elements of fatiguing protocols (i.e., intensity, duration, and type of activity) might lead to different changes in gait parameters. We aimed to systematically quantify to what extent exercise-induced fatigue alters gait in community-dwelling older adults, and whether specific elements of fatiguing protocols could be identified.

This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. In April 2023, PubMed, Web of Science, Scopus, Cochrane and CINAHL databases were searched. Two independent researchers screened and assessed articles using ASReview, Rayyan, and ROBINS-I. The extracted data related to spatio-temporal, stability, and variability gait parameters of healthy older adults (55 +) before and after a fatiguing protocol or prolonged physical exercise. Random-effects meta-analyses were performed on both absolute and non-absolute effect sizes in RStudio. Moderator analyses were performed on six clusters of gait parameters (Dynamic Balance, Lower Limb Kinematics, Regularity, Spatio-temporal Parameters, Symmetry, Velocity).

We included 573 effect sizes on gait parameters from 31 studies. The included studies reflected a total population of 761 older adults (57% female), with a mean age of 71 (SD 3) years. Meta-analysis indicated that exercise-induced fatigue affected gait with a standardized mean change of 0.31 (p < .001). Further analyses showed no statistical differences between the different clusters, and within clusters, the effects were non-uniform, resulting in an (indistinguishable from) zero overall effect within all clusters. Elements of fatiguing protocols like duration, (perceived) intensity, or type of activity did not moderate effects.

Due to the (mainly) low GRADE certainty ratings as a result of the heterogeneity between studies, and possible different strategies to cope with fatigue between participants, the only conclusion that can be drawn is that older adults, therapist, and researchers should be aware of the small to moderate changes in gait parameters as a result of exercise-induced fatigue.

Relying on published data alone might be insufficient for meta-analyses to be reliable and trustworthy since selective outcome reporting is common, especially for adverse events (AEs). We investigated the existence of selective reporting and its potential for bias in a case study exploring AEs of duloxetine in adults.

We systematically searched all previous meta-analyses/pooled analyses on duloxetine published on PubMed for seven indications approved by the American and European health authorities. We included all randomized controlled trials (RCTs) vs placebo. For each RCT, we extracted the number of serious adverse events (SAEs), AEs, drop-outs (DOs) and drop-outs for safety reasons (DOSRs) using four information sources: published articles, clinical study registries, clinical study reports and data available in meta-analyses/pooled analyses. To assess the range of differences resulting from these four extraction strategies, we performed 4 meta-analyses using random effect models as well as a complete meta-analysis combining all sources.

A total of 70 RCTs (including 24,330 patients) were included. Of those, SAEs were identified for 42 studies (61%) in published articles, 58 (84%) in study reports (8 study reports were not retrieved), 24 (34.7%) in registries, and 21 (30.4%) in meta-analyses/pooled analyses. For 2 (2.9%), 2 (2.9%), 2 (2.9%) and 1 (1.4%) studies, we found respectively no data on SAEs, AEs, DOs, and DOSRs in any sources. Discrepant results across sources were found in 24 (34.5%), 20 (28.5%), 13 (18.6%), and 9 (12.8%) studies, respectively for SAEs, AEs, DOs, and DOSRs. Despite variations in point estimates and their 95% confidence intervals, we did not find different results in the conclusions of meta-analyses depending on the different information sources used, except for DOs, for which no effect was found using results published in registries, in contrast to other information sources.

None of the four information sources provided complete retrieval of safety results for duloxetine in adults across various indications. However, we did not find strong evidence that this underreporting leads to different conclusions in meta-analyses. Nonetheless, this finding remains uncertain, as we were unable to obtain complete information for all studies despite extensive searches.

Individuals' math value beliefs are theorized to influence who persists in STEM. However, the existing findings on gender differences in adolescents' math value beliefs are inconsistent. The goal of this study was to use three existing datasets to help clarify when gender differences emerge for high school adolescents and for whom (i.e., adolescents across historical time, grade level, and race/ethnicity). Specifically, we examined the extent to which gender differences in adolescents' math value beliefs (i.e., interest, utility, and attainment) replicated (1) across three datasets spanning the 1990s to 2010s, (2) from 9th-12th grade, and (3) within each of the four largest U.S. racial/ethnic groups (i.e., Asian, Black, Latine, and White adolescents).

We tested these aims with three existing longitudinal U.S. datasets: the California Achievement Motivation Project (CAMP) (n = 8855), the Childhood and Beyond Study (CAB) (n = 582), and the High School Longitudinal Study (HSLS) (n = 21,000). Students were in high school (9th-12th grade) and half were girls (49%-53%). All three datasets included measures with the same or similar math value belief items, making conceptual replication possible.

Overall, we did not find strong evidence for meaningful gender differences in adolescents' math value beliefs overall. We did find meaningful gender differences in the oldest data set (CAB). When examined within each racial/ethnic group, we found no evidence of gender differences in math value beliefs among Black or Latine adolescents, but some differences among Asian and White adolescents. The findings align with the gender similarities hypothesis, suggesting adolescent girls and boys had similar math value beliefs.

This meta-analysis aimed to explore penile cancer survival based on p53 and Ki-67 status. A systematic literature search identified studies assessing overall and cancer-specific survival after penile cancer with p53 or Ki-67 expression. Pooled hazard ratios (HRs) and restricted mean survival time (RMST) differences were calculated using a random-effects model. The analysis included 930 and 391 men for p53 expression in overall survival (OS) and cancer-specific survival (CSS), respectively. Those with the p53 mutant pattern exhibited significantly worse OS and CSS compared to the p53 wild-type pattern (HROS=2.42, 95% CI 1.75-3.34; HRCSS=4.18, 95% CI 1.87-9.35). The 5-year RMST difference for OS, according to p53 status, was -10.62 months (95% CI -16.20 to -5.03). We included 202 men with penile cancer tested for Ki-67 expression and found an HR of CSS of 1.96 (95% CI 1.15-3.32). In conclusion, men with the p53 mutant pattern penile cancer have worse OS and CSS than men with p53 wild-type pattern penile cancer. Evidence regarding Ki-67 status was sparse, but the pooled estimate indicated that penile cancers with high Ki-67 expression may have a slightly worse CSS than those with low Ki-67 expression. These findings may inform clinicians when planning the best management and follow-up strategy for penile cancer patients.

The triglyceride glucose (TyG) index is used to assess insulin resistance, which is associated with the occurrence and development of cardiovascular diseases, but the risk of carotid plaques is controversial in Asia. We searched PubMed, Embase, Scopus, and Cochrane Library for articles published up to October 15, 2023, to assess the association and dose-response association of the TyG index with the risk of carotid plaques in Asia. The random effects model was used to calculate the effect estimates and 95% confidence intervals (CIs). A total of 534 articles were retrieved, and eleven studies were selected, involving 145 218 Asian participants. When the TyG index was analyzed as a categorical variable, compared with the low TyG index, the high TyG index increased the risk of carotid plaques (OR=1.38, 95% CI: 1.20, 1.60, p<0.001). As continuous variables were analyzed, similar results were observed (OR=1.33, 95% CI: 1.22, 1.45, p<0.001). Meanwhile, dose-response analysis showed that the risk of carotid plaque increased by 1.03 times for every unit increase in the TyG index (RR=1.03, 95% CI: 1.02, 1.03, p<0.001). Our meta-analysis indicates an association between the TyG index and the risk of carotid plaques in Asia. Further studies are required to substantiate these findings.

The depth of the facial artery (FA) probably is the most crucial factor while performing aesthetic procedures. The course of FA varies on different levels. The knowledge of exact depth can help physicians to locate the FA more accurately, thereby enhancing the safety of filler injections. This research is the first meta-analysis focused on the quantitative comparison of depth on five different levels of facial artery including angular artery.

Twelve research papers were included in the meta-analysis. The analyses were performed in five distinctive places: (1) on the horizontal level of cheilion, (2) between oral commissure and nasal alae, (3) on the horizontal level of nasal alae, (4) between nasal alae and medial eye canthus and (5) on the horizontal level of medial eye canthus.

A total of 794, 514, 1095, 414 and 450 arteries were analyzed at the following horizontal levels, respectively: at the level of cheilion, between the nasal alae and oral commissure, at the level of nasal alae, between the nasal alae and medial eye canthus and at the level of medial eye canthus. The final results were as follows: 9.72, 95% CI (6.50-12.94) [mm], 10.34, 95% CI (5.24-15.44) [mm], 9.21, 95% CI (7.05-11.38) [mm], 4.68, 95% CI (4.04-5.31) [mm] and 2.38, 95% CI (1.38-3.38) [mm], respectively.

It appears that performing filler injections up to a depth of 4.5 mm, superficially to the facial artery, is considered safe at the level of the oral commissure. The depth between nasal alae and oral commissure varies significantly. A USG exam during the initial consultation prior to any aesthetic procedure might be a reasonable solution in the upper parts of the nasolabial fold.

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To systematically analyze the regional disease control of nasal vestibule squamous cell carcinoma (NVSCC) after primary treatment.

The study was performed according to the PRISMA guidelines, searching on Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases.

A total of 37 studies with 1861 patients (70.5 % males; median age of 58.2 years) were included. Overall, the cumulative regional recurrence (RR) rate was 10.7 % (95 %CI: 8.4 %-13.5 %) with a median follow-up of 51.7 months. The RR rate in clinical node negative patients who didn't undergo any elective neck treatment was 13.7 % (n = 548, 95 %CI: 9.7 %-19.0 %). When stratified by T stage, regardless of the classification used, RR rate was 10.4 % (n = 750, 95 % CI: 7.9 %-13.5 %) for T1-T2 tumors and 25.5 % (n = 102, 95 % CI: 16.4 %-37.4 %) for T3-T4 tumors.

Elective neck treatment does not seem justified in patients with early-stage primary NVSCC. However, for locally advanced tumors, elective neck treatment should be strongly considered.

Women experiencing reduced fetal movements (RFM) have an increased risk of adverse pregnancy outcomes (APO). This study aimed to identify factors most associated with APO in RFM pregnancies.

Individual participant data meta-analysis (IPD-MA).

Multiple maternity units across the UK.

1175 singleton pregnancies with RFM between 28+0 and 41+0 weeks' gestation from four prospective cohorts and two randomised controlled trials (RCTs).

Factors associated with APO were assessed using two-stage IPD-MA.

A composite adverse pregnancy outcome, including: adjusted Odds Ratio, stillbirth, fetal growth restriction (FGR, birthweight ≤ 3rd centile) and neonatal intensive care unit (NICU) admission.

APO occurred in 7.7% of RFM pregnancies, with FGR being the most common complication (4.6%). The strongest associations with APO were observed for abnormal fetal heart rate (adjusted Odds Ratio (aOR) = 3.65, 95% CI: 1.84-7.23), cigarette smoking (aOR = 2.96, 95% CI: 1.36-6.44) and maternal past medical history (aOR = 2.35, 95% CI: 1.14-4.82). Lower estimated fetal weight (EFW) centile was also significantly associated with APO (aOR = 0.97, 95% CI: 0.95-0.99), though substantial heterogeneity was present between studies (I2 = 80.74%, Q-statistic: p < 0.001).

IPD-MA enabled the synthesis of individual-level data across studies, allowing for more accurate and reliable associations by accounting for heterogeneity. Further work is required to investigate the model's generalisability across diverse populations.

Staphylococcus is a genus of bacteria responsible for various infections ranging from mild skin to severe systemic diseases. Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS) are significant challenges owing to their resistance to multiple antibiotics, including macrolides, such as erythromycin, clarithromycin, and azithromycin.

This study aimed to systematically review and synthesize data on the prevalence of macrolide resistance in Staphylococcus spp., identify trends and changes in resistance patterns over time, and assess how testing methods and guidelines affect reported resistance rates.

The study conducted a systematic search of the Scopus, PubMed, Web of Science, and EMBASE databases. Studies have reported the proportion of macrolide-resistant Staphylococcus spp. Two authors independently extracted and analyzed the data using a random-effects model. Heterogeneity was assessed, and subgroup analyses were performed based on country, continent, species, AST guidelines, methods, and period.

In total, 223 studies from 76 countries were included. The pooled prevalence of resistance to erythromycin, clarithromycin, and azithromycin were 57.3, 52.6, and 57.9%, respectively. Significant heterogeneity was observed across studies (I2 > 95%, p < 0.001). Oceania (72%) had the highest erythromycin resistance, whereas Europe had the lowest (40.7%). Subgroup analyses revealed variations in resistance based on the species, with higher resistance in MRSA than in MSSA and CoNS than in other species. Over time, a slight decrease in erythromycin resistance has been observed (59.6% from 2015-2019 to 55% from 2020-2023).

This study emphasizes the high prevalence of macrolide resistance in Staphylococcus spp. and its notable regional variation. These findings highlight the necessity for standardized methodologies and global surveillance to manage macrolide resistance effectively. Controlling antibiotic resistance should prioritize enhancing public health measures and updating treatment guidelines.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=557756, CRD42024557756.

Heat waves are associated with increased fatalities from adverse cardiovascular events attributed to the negative effects of heat on cardiac function. However, scientific understanding of acute cardiac adjustments to heat has come primarily from laboratory experiments employing insulated and encapsulated heating modalities, most commonly water-perfused suits. We evaluated whether findings from those studies reflect cardiac responses during more natural exposures to hot ambient conditions simulated in climate-controlled chambers by synthesizing the findings from over 400 laboratory-based heat exposure studies (6858 participant-exposures) published between 1961-2024. Among all included studies, median (interquartile range) elevations in core temperature and heart rate from baseline to end-exposure were 0.9 (0.5-1.3)°C and 27 (15-40) beats/min. Multilevel mixed-effects meta-analyses revealed exacerbated elevations in heart rate, cardiac output, and rate pressure product (estimate of cardiac workload) and blunted falls in systolic pressure in participants heated via encapsulated modalities. Leveraging the large dataset, we also provide empirical estimates of body temperature and cardiovascular responses to a wide range of conditions experienced during heat waves. With rising global temperatures, ecologically-minded physiological research is needed to improve understanding of the effects of heat stress on cardiac responses and further the development of robust climate health models and evidence-based heat-health guidance.

Background/Objectives: Compliance with healthcare standards is an absolute must for every healthcare organization seeking accreditation. Several factors were found to affect compliance, and in Saudi Arabia, certain standards were observed for non-compliance. Therefore, this systematic review and meta-analysis seeks to identify the factors associated with non-compliance with healthcare accreditation in Saudi Arabia. Methods: This study adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The population, intervention, comparison, and outcome (PICO) model was used to refine the research question. The Peer Review of Electronic Search Strategies (Press) guidelines were used to improve the search strategy. The databases used for the search were PubMed, Web of Science, Scopus, and Google Scholar. The dates searched were from 1 January 2000 to 1 November 2024. We used a data extraction form for study characteristics and outcome data, which was piloted on five studies in this review. The risk of bias was assessed by using the Joanna Briggs Institute (JBI) tool and the Mixed Methods Appraisal Tool (MMAT). The analysis was carried out using the Fisher r-to-z transformed correlation coefficient as the outcome measure. A random-effects model was fitted to the data. Results: A total of ten studies were included for qualitative synthesis and five for quantitative synthesis. Several factors were observed for non-compliance, including insufficient training organization hurdles, a lack of implementation strategies, and the attitudes of healthcare providers. The estimated average correlation coefficient based on the random-effects model was 0.2568 (95% CI: -0.1190 to 0.6326). Conclusions: The dimension of quality in healthcare through pooled correlations from various studies highlighted a weak association among these dimensions.

We hypothesised that the association between quality of leadership and mental distress would be stronger in Germany than in Denmark. The two countries differ in terms of working life cultures and labour markets, factors possibly mitigating the association of quality of leadership with mental distress. Data were based on the German Study on Mental Health at Work (2012-2017) and the Danish Work Environment Cohort Study (2000-2005 and 2005-2010), comprising 9,613 observations. A two-part model approach was employed, combining logistic and generalized linear regression models, with mental distress at follow-up as outcome variable. Heterogeneity of the country-specific estimates was assessed using a Cochran Q test. Among all participating employees, the logistic regression showed that higher quality of leadership was associated with lower mental distress (> 0) in both Germany and Denmark. This association was stronger in Germany, with the country difference being statistically significant (p = 0.036). Among employees with mental distress at follow-up, the generalized linear models revealed that quality of leadership was associated with decreased mental distress in Denmark, but not in Germany, with the country difference also being significant (p = 0.014). The inconsistent results did not support our hypothesis of a stronger association between quality of leadership and mental health in Germany. All results taken into consideration, the findings suggest that poor quality of leadership is associated with the development of mental distress in both countries. Further research is needed to examine the association between quality of leadership and mental health in other countries.

Previous meta-analyses suggest that fluoride exposure is adversely associated with children's IQ scores. An individual's total fluoride exposure comes primarily from fluoride in drinking water, food, and beverages.

To perform a systematic review and meta-analysis of epidemiological studies investigating children's IQ scores and prenatal or postnatal fluoride exposure.

BIOSIS, Embase, PsycInfo, PubMed, Scopus, Web of Science, CNKI, and Wanfang, searched through October 2023.

Studies reporting children's IQ scores, fluoride exposure, and effect sizes.

Data were extracted into the Health Assessment Workplace Collaborative system. Study quality was evaluated using the OHAT risk-of-bias tool. Pooled standardized mean differences (SMDs) and regression coefficients were estimated with random-effects models.

Children's IQ scores.

Of 74 studies included (64 cross-sectional and 10 cohort studies), most were conducted in China (n = 45); other locations included Canada (n = 3), Denmark (n = 1), India (n = 12), Iran (n = 4), Mexico (n = 4), New Zealand (n = 1), Pakistan (n = 2), Spain (n = 1), and Taiwan (n = 1). Fifty-two studies were rated high risk of bias and 22 were rated low risk of bias. Sixty-four studies reported inverse associations between fluoride exposure measures and children's IQ. Analysis of 59 studies with group-level measures of fluoride in drinking water, dental fluorosis, or other measures of fluoride exposure (47 high risk of bias, 12 low risk of bias; n = 20 932 children) showed an inverse association between fluoride exposure and IQ (pooled SMD, -0.45; 95% CI, -0.57 to -0.33; P < .001). In 31 studies reporting fluoride measured in drinking water, a dose-response association was found between exposed and reference groups (SMD, -0.15; 95% CI, -0.20 to -0.11; P < .001), and associations remained inverse when exposed groups were restricted to less than 4 mg/L and less than 2 mg/L; however, the association was null at less than 1.5 mg/L. In analyses restricted to low risk-of-bias studies, the association remained inverse when exposure was restricted to less than 4 mg/L, less than 2 mg/L, and less than 1.5 mg/L fluoride in drinking water. In 20 studies reporting fluoride measured in urine, there was an inverse dose-response association (SMD, -0.15; 95% CI, -0.23 to -0.07; P < .001). Associations remained inverse when exposed groups were restricted to less than 4 mg/L, less than 2 mg/L, and less than 1.5 mg/L fluoride in urine; the associations held in analyses restricted to the low risk-of-bias studies. Analysis of 13 studies with individual-level measures found an IQ score decrease of 1.63 points (95% CI, -2.33 to -0.93; P < .001) per 1-mg/L increase in urinary fluoride. Among low risk-of-bias studies, there was an IQ score decrease of 1.14 points (95% CI, -1.68 to -0.61; P < .001). Associations remained inverse when stratified by risk of bias, sex, age, outcome assessment type, country, exposure timing, and exposure matrix.

This systematic review and meta-analysis found inverse associations and a dose-response association between fluoride measurements in urine and drinking water and children's IQ across the large multicountry epidemiological literature. There were limited data and uncertainty in the dose-response association between fluoride exposure and children's IQ when fluoride exposure was estimated by drinking water alone at concentrations less than 1.5 mg/L. These findings may inform future comprehensive public health risk-benefit assessments of fluoride exposures.

Haemophilus spp., particularly Haemophilus influenzae, are major global pathogens causing various infections. Macrolides are crucial in treating these infections, but rising resistance to macrolides in Haemophilus spp. highlights the growing threat of antimicrobial resistance (AMR).

This study aims to assess the prevalence of macrolide resistance in Haemophilus spp, across different global regions.

A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus databases from May 2015 to December 2023 to identify studies on macrolide resistance in Haemophilus spp. The review included English-language full-text articles that reported resistance proportions and sample sizes. Study quality was assessed using the JBI Critical Appraisal Tool. Statistical analysis was performed using a random-effects model using the metafor package in R.

A total of 10,114 articles were retrieved, and after a comprehensive evaluation, 15 studies (from 19 reports) met the eligibility criteria for inclusion in this systematic review and meta-analysis. Most studies (eight reports from three countries) focused on clarithromycin susceptibility, revealing a pooled prevalence of 7.2%. High heterogeneity was observed for azithromycin (I² = 96.31%, p < 0.001). Azithromycin resistance was higher than clarithromycin, with a resistance rate of 9.3% (nine reports), while erythromycin resistance was significantly higher at 79% (four reports). Subgroup analysis revealed significant variations in resistance prevalence based on geographic location and continent for azithromycin, erythromycin, and clarithromycin. Additionally, notable differences were observed in resistance rates depending on antimicrobial susceptibility testing (AST) methods and AST guidelines for both azithromycin and erythromycin. Clarithromycin resistance increased from 0.7% (2015-2019) to 12.6% (2020-2023).

The study underscores the significant challenges of macrolide resistance in treating Haemophilus spp. infections. Additionally, ongoing surveillance of resistance patterns and exploring contributing factors are crucial to enhancing treatment effectiveness.

Naldemedine is a peripheral acting µ-opioid receptor antagonist approved by the Food and Drug Administration to treat opioid-induced constipation. Concerns about side effects like opioid withdrawal prevent its widespread use, especially for cancer patients. We performed this systematic review and meta-analysis to evaluate existing safety data of naldemedine treating opioid-induced constipation following the PRISMA guidelines. We searched PubMed and the Cochrane Library on April 16th 2024 to identify studies evaluating naldemedine treatment among patients with opioid-induced constipation. Our analysis found no differences between groups comparing naldemedine therapy with placebo-control for treatment-emergent adverse events (OR = 1.06; 95%-CI: 0.91-1.24), serious adverse events (OR = 1.02; 95%-CI: 0.76-1.38). We found no increased risk for opioid withdrawal, while an increased risk for gastrointestinal disorders (OR = 2.08; 95%-CI: 1.72-2.51), particularly higher incidences of diarrhea (OR = 2.44; 95%-CI: 1.81-3.29) and abdominal pain (OR = 3.31; 95%-CI: 2.16-5.06) were found. In the cancer subgroup, treatment-emergent and serious adverse events were more frequent. However, no increased risk for opioid withdrawal was observed. This analysis confirms naldemedine's overall safety in treating opioid-induced constipation, with manageable gastrointestinal side effects. However, the higher adverse events in cancer patients require further investigation to ensure safe use in this population.

The biology underlying the connection between social relationships and health is largely unknown. Here, leveraging data from 42,062 participants across 2,920 plasma proteins in the UK Biobank, we characterized the proteomic signatures of social isolation and loneliness through proteome-wide association study and protein co-expression network analysis. Proteins linked to these constructs were implicated in inflammation, antiviral responses and complement systems. More than half of these proteins were prospectively linked to cardiovascular disease, type 2 diabetes, stroke and mortality during a 14 year follow-up. Moreover, Mendelian randomization (MR) analysis suggested causal relationships from loneliness to five proteins, with two proteins (ADM and ASGR1) further supported by colocalization. These MR-identified proteins (GFRA1, ADM, FABP4, TNFRSF10A and ASGR1) exhibited broad associations with other blood biomarkers, as well as volumes in brain regions involved in interoception and emotional and social processes. Finally, the MR-identified proteins partly mediated the relationship between loneliness and cardiovascular diseases, stroke and mortality. The exploration of the peripheral physiology through which social relationships influence morbidity and mortality is timely and has potential implications for public health.

The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.

This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.

Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), BRCA mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, -0.15; 95% CI, -0.26 to -0.03).

To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.

Cryptosporidium infection is a significant parasitic disease affecting both humans and animals worldwide. However, there is limited data on its prevalence in canine populations across Africa. This study was carried out between December 2021 and August 2022 to assess the burden of Cryptosporidium infection in dogs on the continent through a meta-analysis and a targeted survey of dogs presented at veterinary clinics in Nigeria. A systematic review and meta-analysis were conducted using available studies on Cryptosporidium prevalence in dogs from African countries to determine the pooled prevalence. Additionally, a survey was carried out to determine the prevalence of Cryptosporidium oocysts in 309 dogs presented at veterinary clinics across several Nigerian states using microscopy and the presence of Cryptosporidium DNA was confirmed using the nested PCR methods. Data suitable for meta-analysis were found from only three African countries - Nigeria, Zambia, and Mozambique - highlighting a significant research gap across the continent. The pooled estimates of Cryptosporidium infection in Africa was 13.7% (95% CI: 7.7, 22.9), with country-specific rates of 22% in Nigeria, 5.9% in Zambia, and 6.4% in Mozambique. The survey conducted in Nigeria revealed a low prevalence of Cryptosporidium oocysts (6.7%) in dogs presented at clinics, while PCR confirmed the presence of Cryptosporidium DNA in positive samples. The findings highlight the significance of Cryptosporidium as a health concern in African canine populations, with prevalence rates comparable to global figures. The low prevalence observed in clinical settings indicates that routine screening should still be prioritized to ensure early detection and treatment, given the potential zoonotic risk posed by C. canis (the dominant species in dogs). Further research is needed to address the geographic and diagnostic gaps identified and to explore the clinical and public health implications of Cryptosporidium infection in dogs across Africa.

It is known that the serotonin and norepinephrine systems change with age. Consequently, response to antidepressants having different effects on these two systems may vary between patients of different ages. We systematically searched Embase/Medline/PsychINFO until December 2024 for randomised controlled trials (RCT) in patients with unipolar major depressive disorder comparing response rates to serotonergic versus noradrenergic antidepressants (PROSPERO pre-registration #CRD42020145386). Our primary outcome was to assess the effect of age on response rates to serotonergic versus noradrenergic antidepressants in unipolar depression. We then performed a pooled analysis of individual participant data (IPD). Seventy-four RCTs with a total of 8981 participants (4488 with serotonergic and 4493 with noradrenergic antidepressants) were included in the meta-analysis. We found no differences in the response rates to the two antidepressants, although the improvement in depressive symptoms was greater in the noradrenergic arm (subset of n = 31 studies, z = -2.61; p = 0.009); younger age was associated with a greater response to serotonergic than noradrenergic agents both in terms of response rates (estimate = -0.011; p-value = 0.041) and symptom improvement (estimate = -0.016; p-value<0.0001), even after controlling for year of publication, study design, baseline severity, type of noradrenergic medication, inpatients, and dropout rates. The effect of age on antidepressant response was also confirmed in the IPD pooled analysis (n = 339), in which responders to serotonergic antidepressants were significantly younger than non-responders (p-value = 0.028) and than responders to noradrenergic antidepressants (p-value = 0.034). Our study highlights the importance of age when considering the efficacy of serotonergic versus noradrenergic antidepressants as part of a precision psychiatry-oriented approach.

The impact of genetic ancestry on the development of clonal hematopoiesis (CH) remains largely unexplored. Here, we compared CH in 136,401 participants from the Mexico City Prospective Study (MCPS) to 416,118 individuals from the UK Biobank (UKB) and observed CH to be significantly less common in MCPS compared to UKB (adjusted odds ratio = 0.59, 95% confidence interval (CI) = [0.57, 0.61], P = 7.31 × 10-185). Among MCPS participants, CH frequency was positively correlated with the percentage of European ancestry (adjusted beta = 0.84, 95% CI = [0.66, 1.03], P = 7.35 × 10-19). Genome-wide and exome-wide association analyses in MCPS identified ancestry-specific variants in the TCL1B locus with opposing effects on DNMT3A-CH versus non-DNMT3A-CH. Meta-analysis of MCPS and UKB identified five novel loci associated with CH, including polymorphisms at PARP11/CCND2, MEIS1 and MYCN. Our CH study, the largest in a non-European population to date, demonstrates the power of cross-ancestry comparisons to derive novel insights into CH pathogenesis.

Host plant use in Lepidoptera has been a primary focus in studies of ecological specialization, and multiple factors are likely to be involved in shaping the evolution of diet breadth. Here, we first describe the Salient Aroma Hypothesis, suggesting that the availability of chemical information, particularly host-associated aromas, plays a critical role in shaping dietary specialization. According to the Salient Aroma Hypothesis, herbivores active during periods when chemical information is abundant, particularly during the daytime hours when plant aromas are hypothesized to be more prevalent, are more likely to evolve specialized diets. First, with meta-analysis, we show that plants release more diverse and abundant volatile compounds during daylight hours, increasing the availability of chemical information. We found that diurnal Lepidoptera tend to have specialized diets, while nocturnal species are more generalized, consistent with the prediction of the Salient Aroma Hypothesis. We further observed that morphological differences in the antennae of female Lepidoptera are correlated with variation in diet breadth and diel activity patterns, indirectly supporting the Salient Aroma Hypothesis. While multiple factors influence host plant specialization, the Salient Aroma Hypothesis offers a useful framework linking chemical information availability (e.g. plant volatiles) and ecological specialization.