Association Between Depression Before Hematopoietic Stem Cell Transplantation and Posttransplant Survival: A Systematic Review and Meta-analysis.

BACKGROUND: Depressive symptoms are often found in patients undergoing hematopoietic stem cell transplantation (HSCT). However, the impact of depression on overall survival and other outcomes after HSCT has not been systematically reviewed. OBJECTIVE: The objective of this review was to determine if depression before HSCT is associated with poor posttransplant outcomes. METHODS: We performed a systematic research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM) guidelines based on several databases (MEDLINE, EMBase, and PsycINFO) for cohort studies on adults undergoing HSCT, comparing overall survival or other outcomes (length of aplasia, infectious complications) between patients with depressive symptoms and controls. For studies reporting overall survival hazard ratios, we conducted a meta-analysis by calculating a 95% confidence interval hazard ratios, and we assessed heterogeneity with the I2 statistic. Study quality was assessed using the Newcastle-Ottawa Quality Assessment scale for cohort studies. RESULTS: A total of 18 studies were included in the systematic review (22,235 participants) and 8 in the meta-analysis. There were a variety of depression screening tools, the Hospital Anxiety and Depression Scale (HADS) being the most reported questionnaire. A significant association between depression and overall survival was found in 9 studies, whereas 8 studies shown no association. Depression tended to have an impact on length of aplasia and infectious complications. In the meta-analysis, depression was found to impact significantly overall survival after HSCT with a hazard ratio = 1.07 (95% confidence interval 1.03-1.11). A publication bias was found in the meta-analysis. CONCLUSION: Depression seems to have a significant impact on post-HSCT survival and on length of aplasia. A systematic screening of depression before HSCT should be considered, with validated tools such as HADS. Future research needs to be done to measure the impact of depression on HSCT response and understand its physiopathology.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis.

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6-15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6-16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

Giant congenital melanocytic nevus in a Cameroonian child: a case report.

BACKGROUND: Giant congenital melanocytic nevus is a very rare condition characterized by a large skin lesion and an increased risk of complications like neurocutaneous melanosis and malignant transformation. Reports of giant congenital melanocytic nevus are scarce in the sub-Saharan African literature and here we present a case of this disease in a Cameroonian adolescent. CASE PRESENTATION: A 12-year-old Cameroonian girl from the "Baka" ethnic group, with no relevant family and medical histories presented with a progressively extensive brownish-black nodular hypertrophic skin lesion of approximately 45 cm, which she had had since she was 2-days old. The lesion covered her entire back giving an appearance of "turtle child", which was highly suggestive of a giant congenital melanocytic nevus. She was booked in for a surgical intervention organized by a health campaign within her community. Meanwhile she was provided with psychological support and her family was counseled on warning signs of complications which would warrant an urgent consultation. CONCLUSIONS: Here we presented a case of giant congenital melanocytic nevus, apparently the first in the Cameroonian literature. In view of the potential severe complications as well as psychological trauma of this pathology, we draw clinicians' attention to this extremely rare but real pathology in our country, for a timely diagnosis and management.

Global incidence and case fatality rate of pulmonary embolism following major surgery: a protocol for a systematic review and meta-analysis of cohort studies.

BACKGROUND: Pulmonary embolism (PE) is a life-threatening condition common after major surgery. Although the high incidence (0.3-30%) and mortality rate (16.9-31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. Hence, we propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery. METHODS: Electronic databases including MEDLINE, EMBASE, SCOPUS, WHO global health library (including LILACS), Web of Science and Google scholar from inception to April 30, 2017, will be searched for cohort studies reporting on the incidence, determinants and case fatality rate of PE occurring after major surgery. Data from grey literature will also be assessed. Two investigators will independently perform study selection and data extraction. Included studies will be evaluated for risk of bias. Appropriate meta-analytic methods will be used to pool incidence and case fatality rate estimates from studies with identical features, globally and by subgroups of major surgical procedures. Random-effects and risk ratio with 95% confidence interval will be used to summarise determinants and predictors of mortality of PE in patients undergoing major surgery. DISCUSSION: This systematic review and meta-analysis will provide the most up-to-date epidemiology of PE in patients undergoing major surgery to inform health authorities and identify further research topics based on the remaining knowledge gaps. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017065126.

Prevalence and associated factors of active smoking among individuals living with hypertension and/or diabetes in Africa: a systematic review and meta-analysis protocol.

INTRODUCTION: Tobacco use significantly increases cardiovascular complications in people living with hypertension and/or diabetes. We aim to summarise data on the prevalence and factors associated with active smoking in these conditions in Africa. METHOD AND ANALYSIS: We will search PubMed, Embase, Google Scholar and African Journals Online for relevant abstracts of studies on active smoking in individuals living with diabetes and/or hypertension published from 1 January 2000 to 31 December 2016, with no language restriction. Additionally, relevant unpublished papers and conference proceedings will be checked, as well as references of included articles. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. Data will be analysed using Stata software (Stata V.14, Texas, USA). The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of smoking across studies. Also, we will assess factors associated to smoking. Heterogeneity of studies will be evaluated by the χ2 test on Cochrane's Q statistic. Funnel plots analysis and Egger's test will be done to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). A p value less than 0.05 will be considered significant for factors associated to smoking. ETHICS AND DISSEMINATION: This study is based on published data, and therefore ethical approval is not a requirement. This systematic review and meta-analysis is expected to serve as a basis for designing cost-effective interventions to reduce and prevent smoking in patients with diabetes and/or hypertension, and as a guide for future research based on the remaining gaps. The final report of this study in the form of a scientific paper will be published in peer-reviewed journals. Findings will further be presented at conferences and submitted to relevant health authorities.