Neurosurgical research in Southeast Asia: A bibliometric analysis.

OBJECTIVES: Bibliometric analysis can provide insight into the growth, development and dissemination of research in neurosurgery. Little work has been done to examine the role of country-specific characteristics affecting research productivity. We aimed to characterize andcompare the research productivity among SEA countries in terms of bibliometric indicesand determine associations with country-specific factors. METHODS: We performed a systematic search of all articles by authors affiliated with a neurosurgical department in any of the Southeast Asian countries, indexed in 3 databases from inception to June 10, 2020. Bibliometric indices - number of publications, number of citations, average citations per publication, h-index, and the i-10-index - were computed for each country. Correlations between the indices and country-specific characteristics (population size, GDP per capita, percentage of GDP allocation to research and development (R&D), number of neurosurgeons, number of neurosurgeons per capita, and number of collaborations with non-SEA authors) were determined. RESULTS: The number of publications showed an increasing trend up to 2019. Most studies were cohort studies (37%) or case reports or series (37%). Of the country-specific factors analyzed, only percentage of the GDP allocated to R&D was positively correlated with number of publications (p = 0.0004), total citations (p < 0.0001), H-index (p < 0.0001), and i(10)-index (p < 0.0001). Number of collaborations also positively correlated with the same indices. CONCLUSION: Our bibliometric analysis showed increasing contribution by neurosurgeons in the SEA region. Correlational analysis support the view that increased R&D budget allocation and international collaboration can improve neurosurgical research capacity and productivity.

Survival times of patients with glioblastoma in low- and middle-income countries: a systematic review and meta-analysis.

Little is known about the survivorship of glioblastoma (GBM) patients in low- and middle-income countries (LMICs). We hypothesize that this would be lower than published figures for high-income countries due to cancer health disparities. We performed a systematic review and meta-analysis to estimate the median overall survival (OS) of GBM in LMICs and determine factors affecting OS. A systematic review of 12 electronic databases was conducted according to PRISMA guidelines to identify studies of newly diagnosed adult GBM patients done in countries classified as LMIC by the World Bank (WB) from inception to December 2020. Random effects meta-analysis of collected median overall survival data was done. Subgroup analysis and meta-regression were done to determine if WB income classification (WBIC), start year of recruitment (pre- or post-popularization of the standard Stupp protocol), and treatment modality affected OS. The 24 articles (n = 2,552) that met the inclusion criteria were from 8 low-middle income and upper-middle income countries, with 0 articles from low-income countries. Random effects analysis of 24 studies showed a pooled median OS of 14.17 months (95% CI 12.90-15.43, I2 = 79). Subgroup analysis showed a significant difference (p < 0.05) in the pooled median OS of studies predating Stupp protocol (12.54 mo, 95% CI 11.13-13.96, I2 = 80%; n = 1027) and studies postdating Stupp protocol (15.64 mo, 95% CI 13.58-17.69, I2 = 77; n = 1412). Subgroup analysis of WBIC and treatment modalities did not show significant differences. Published data on the survivorship of GBM patients in LMICs is sparse, highlighting the need for good quality pragmatic studies from LMICs. The limited evidence suggests improving survivorship after introduction of the Stupp protocol.

Prevalence and prognostic associations of cardiac abnormalities among hospitalized patients with COVID-19: a systematic review and meta-analysis.

Although most patients recover from COVID-19, it has been linked to cardiac, pulmonary, and neurologic complications. Despite not having formal criteria for its diagnosis, COVID-19 associated cardiomyopathy has been observed in several studies through biomarkers and imaging. This study aims to estimate the proportion of COVID-19 patients with cardiac abnormalities and to determine the association between the cardiac abnormalities in COVID-19 patients and disease severity and mortality. Observational studies published from December 1, 2019 to September 30, 2020 were obtained from electronic databases (PubMed, Embase, Cochrane Library, CNKI) and preprint servers (medRxiv, bioRxiv, ChinaXiv). Studies that have data on prevalence were included in the calculation of the pooled prevalence, while studies with comparison group were included in the calculation of the odds ratio. If multiple tests were done in the same study yielding different prevalence values, the largest one was used as the measure of prevalence of that particular study. Metafor using R software package version 4.0.2 was used for the meta-analysis. A total of 400 records were retrieved from database search, with 24 articles included in the final analysis. Pooled prevalence of cardiac abnormalities in 20 studies was calculated to be 0.31 [95% Confidence Intervals (CI) of (0.23; 0.41)], with statistically significant heterogeneity (percentage of variation or I-squared statistic I2 = 97%, p < 0.01). Pooled analysis of 19 studies showed an overall odds ratio (OR) of 6.87 [95%-CI (3.92; 12.05)] for cardiac abnormalities associated with disease severity and mortality, with statistically significant heterogeneity (I2 = 85%, between-study variance or tau-squared statistic τ2 = 1.1485, p < 0.01). Due to the high uncertainty in the pooled prevalence of cardiac abnormalities and the unquantifiable magnitude of risk (although an increased risk is certain) for severity or mortality among COVID-19 patients, much more long-term prognostic studies are needed to check for the long-term complications of COVID-19 and formalize definitive criteria of "COVID-19 associated cardiomyopathy".