Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis / Asociación entre el gen BDNF (rs6265) y predisposición a la esquizofrenia: estudio prospectivo y metaanálisis actualizado

Introduction: Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case–control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia. Method: This meta-analysis gathered data from 25 case–control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the “Leave one out” method, and we used the Egger test and Begg's funnel plot to identify publication bias. Results: Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value > .05. Conclusions: Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case–control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.(AU)

Introducción: Se sabe que los polimorfismos del gen BDNF provocan alteraciones neuronales y parecen ser un factor causal en muchos trastornos neuropsiquiátricos. Es por ello que se han llevado a cabo varios metaanálisis y estudios de casos y controles con el objetivo de evaluar la posible relación entre BDNF y la esquizofrenia. Método: Realizamos un metaanálisis de 25 estudios de casos y controles, que incluyó un total de 8.384 pacientes con esquizofrenia y 8.821 controles. Se analizó la relación entre el polimorfismo de nucleótido simple rs6265 y la esquizofrenia mediante odds ratios combinados y sus intervalos de confianza del 95% con 5 modelos genéticos diferentes. Utilizamos el método de validación cruzada dejando uno fuera («leave one out»), la prueba de Egger y el gráfico en embudo de Begg para identificar posibles sesgos de publicación. Resultados: Los estudios sobre el polimorfismo rs6265 (G/A) muestran una asociación no significativa con la esquizofrenia en los 5 modelos genéticos. En el análisis por subgrupos, no se encontró relación con las poblaciones caucásica y asiática (p > 0,05). Conclusiones: La presencia de polimorfismos rs6265 no aumenta la predisposición a desarrollar esquizofrenia. Sin embargo, se deben realizar más estudios de casos y controles sobre polimorfismos de BDNF, con muestras más numerosas y con individuos de diferentes grupos étnicos, para comprender mejor los mecanismos patogénicos de la enfermedad.(AU)

Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis.

INTRODUCTION: Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case-control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia. METHOD: This meta-analysis gathered data from 25 case-control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the "Leave one out" method, and we used the Egger test and Begg's funnel plot to identify publication bias. RESULTS: Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value>.05. CONCLUSIONS: Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case-control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.

[Prevalence of burnout syndrome in physicians working in Spain: systematic review and meta-analysis]. / Prevalencia del síndrome de burnout en médicos que trabajan en España: revisión sistemática y metaanálisis.

OBJECTIVE: To analyze the prevalence of burnout syndrome in physicians working in Spain through a systematic review with meta-analysis METHOD: We searched PubMed/MEDLINE, Embase, and PsycINFO (up to June 2023). Observational studies conducted in Spain reporting the prevalence of burnout in physicians were included. From each study, methodological characteristics and results were extracted, and their quality was evaluated. We performed a narrative synthesis with random effects meta-analysis to calculate proportions. RESULTS: Sixty-seven studies with 16,076 participants were included. For the primary outcome, the meta-analysis revealed a global prevalence of burnout in physicians of 24% (95%CI: 19%-29%; 46 studies; 8821 participants; I2=97%). From subgroup analysis, differences were observed depending on the diagnostic criteria used: 18% (95%CI: 13%-23%) for three dimensions of burnout, 29% (95%CI: 24%-34%) for two dimensions and 51% (95%CI: 42%-60%) for one dimension. The heterogeneity between studies could not be fully explained through additional analyses where non-statistically significant differences were found with other variables (e.g., study quality, setting, professional category or medical specialty). CONCLUSIONS: A high prevalence of burnout syndrome was found in physicians working in Spain. These results can contribute to estimating the burden associated with burnout in physicians at a national level and to the design of future studies. Strategies appear to be necessary to prevent and mitigate this situation. PROTOCOL REGISTRATION: Open Science Framework: https://osf.io/b2h4m/.

Effect of probiotics on cognitive function in adults with mild cognitive impairment or Alzheimer's disease: A meta-analysis of randomized controlled trials.

BACKGROUND: Recent clinical studies have yielded controversial results regarding the effect of probiotics on cognitive function in Alzheimer's disease (AD) or mild cognitive impairment (MCI) subjects. To clarify the efficacy of probiotics on cognition, we conducted a meta-analysis of randomized controlled trials (RCTs). METHODS: Instructions of the PRISMA 2020 statement were followed. Literature from the PubMed, Embase and Cochrane databases were systematically searched and manually screened for relevant published RCTs. We performed statistical analysis using RevMan, and assessed the risk of bias using the R software. RESULTS: A total of 12 studies comprising 852 patients with MCI or AD were identified. The results of meta-analysis showed that probiotics improved global cognitive function (SMD=0.67; 95% CI, 0.32, 1.02), recall/delayed memory (SMD=0.67; 95% CI: 0.32, 1.02), attention (SMD=0.31; 95% CI: 0.04, 0.58) and visuospatial/constructional (SMD=0.24; 95% CI: 0.06, 0.42) cognitive domain. CONCLUSION: This meta-analysis found that probiotic supplementation is associated with an improvement in cognitive performance among patients with AD and MCI. However, current evidence is limited, and more reliable large-scale RCTs with higher methodological quality are needed.

Efficacy and acceptability of music therapy for post-traumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials.

Background: Music therapy is increasingly examined in randomized controlled trials (RCTs) and shows potential in treating post-traumatic stress disorder (PTSD).Objective: This systematic review and meta-analysis critically evaluates the current clinical evidence supporting the efficacy and acceptability of music therapy for PTSD.Method: RCTs comparing music therapy in addition to care as usual (CAU) versus either CAU alone or CAU combined with standard psychotherapy/pharmacotherapy for PTSD were retrieved from major English - and Chinese-language databases. Standardized mean differences (SMDs) for post-treatment PTSD symptom scores and risk differences (RDs) for retention rates upon treatment completion were calculated to assess the efficacy and acceptability of music therapy, respectively. The Cochrane risk of bias (RoB) tool 2.0 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were used to assess the RoB of included studies and certainty of the evidence, respectively.Results: Nine studies, incorporating 527 PTSD patients, were included, all with high RoB. The post-treatment PTSD symptom scores were significantly lower in the music therapy group than the inactive control group (SMD = -1.64, P < .001), but comparable between the music therapy group and the active control group (SMD = -0.28, P = .330). The retention rates did not differ significantly between the music therapy group and both control groups (RD = 0.03, P = .769; RD = 0.16, P = .829). The GRADE rated certainty level of evidence as low.Conclusions: Although meta-analytic findings suggest that music therapy is effective in reducing post-traumatic symptoms in individuals with PTSD, with its therapeutic effect comparable to that of standard psychotherapy, the low level of certainty limits its generalizability. More methodologically stringent studies are warranted to strengthen the clinical evidence for the efficacy and acceptability of music therapy for PTSD.

This systematic review critically appraised the existing methodologically rigorous evidence for the efficacy and acceptability of music therapy for post-traumatic stress disorder (PTSD).The post-treatment PTSD symptom scores were significantly lower in the music therapy group than the inactive control group and comparable between the music therapy group and the active control group.The post-treatment retention rates did not differ significantly between the music therapy group and both the inactive and active control groups.

Menor síndrome adyacente superior y menor tasa de reoperación. Resultados a mediano y largo plazo de la artroplastia cervical frente a la artrodesis cervical anterior: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados / Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials

Objetivo: Comparar a mediano y largo plazo los resultados quirúrgicos postoperatorios, sobre todo la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación, de los pacientes operados con artroplastia cervical o artrodesis cervical anterior en los ensayos clínicos aleatorizados (ECA) publicados de un nivel cervical. Métodos: Revisión sistemática y metaanálisis. Se seleccionaron 13 ECA. Se analizaron los resultados clínicos, radiológicos y quirúrgicos, tomando como variables primarias la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación. Resultados: Fueron 2.963 los pacientes analizados. El grupo de artroplastia cervical mostró una menor tasa de síndrome adyacente superior (p<0,001), menor tasa de reoperación (p<0,001), menor dolor radicular (p=0,002) y una mejor puntuación en el índice de discapacidad cervical (p=0,02) y en el componente físico SF-36 (p=0,01). No se encontraron diferencias significativas en la tasa del síndrome adyacente inferior, tasa de eventos adversos, dolor cervical ni componente mental SF-36. Se halló en la artroplastia cervical un rango de movilidad medio de 7,91 grados en el seguimiento final y una tasa de osificación heterotópica de 9,67%. Conclusión: En el seguimiento a mediano y largo plazo, la artroplastia cervical mostró menor tasa de síndrome adyacente superior y menor tasa de reintervención. No se hallaron diferencias estadísticamente significativas en la tasa del síndrome adyacente inferior ni en la tasa de eventos adversos.(AU)

Objective: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. Methods: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. Results: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. Conclusion: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.(AU)

[Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials / Menor síndrome adyacente superior y menor tasa de reoperación. Resultados a mediano y a largo plazo de la artroplastia cervical frente a la artrodesis cervical anterior: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados

Objetivo: Comparar a mediano y largo plazo los resultados quirúrgicos postoperatorios, sobre todo la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación, de los pacientes operados con artroplastia cervical o artrodesis cervical anterior en los ensayos clínicos aleatorizados (ECA) publicados de un nivel cervical. Métodos: Revisión sistemática y metaanálisis. Se seleccionaron 13 ECA. Se analizaron los resultados clínicos, radiológicos y quirúrgicos, tomando como variables primarias la tasa del síndrome adyacente, tasa de eventos adversos y tasa de reoperación. Resultados: Fueron 2.963 los pacientes analizados. El grupo de artroplastia cervical mostró una menor tasa de síndrome adyacente superior (p<0,001), menor tasa de reoperación (p<0,001), menor dolor radicular (p=0,002) y una mejor puntuación en el índice de discapacidad cervical (p=0,02) y en el componente físico SF-36 (p=0,01). No se encontraron diferencias significativas en la tasa del síndrome adyacente inferior, tasa de eventos adversos, dolor cervical ni componente mental SF-36. Se halló en la artroplastia cervical un rango de movilidad medio de 7,91 grados en el seguimiento final y una tasa de osificación heterotópica de 9,67%. Conclusión: En el seguimiento a mediano y largo plazo, la artroplastia cervical mostró menor tasa de síndrome adyacente superior y menor tasa de reintervención. No se hallaron diferencias estadísticamente significativas en la tasa del síndrome adyacente inferior ni en la tasa de eventos adversos.(AU)

Objective: To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. Methods: Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. Results: Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. Conclusion: In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.(AU)

Tratamiento de la depresión comórbida después de un síndrome coronario agudo: metaanálisis de ensayos controlados aleatorizados / Treatment of comorbid depression after acute coronary syndrome: meta-analysis of randomized controlled trials

La depresión postsíndrome coronario agudo (post-SCA) aumenta el riesgo cardíaco; sin embargo, la eficacia de las terapias antidepresivas para su tratamiento no está suficientemente demostrada. Nuestro objetivo es metaanalizar ensayos controlados con muestras homogéneas que permitan explicar la inconsistencia de los resultados obtenidos hasta el momento. Tras revisar 1525 artículos, dos revisores independientes identificaron 7 estudios que cumplían criterios muy restrictivos para asegurar la homogeneidad de las muestras. Los resultados indicaron que los pacientes tratados con intervenciones de eficacia demostrada para la depresión reducen sus niveles de trastorno depresivo significativamente más que los sujetos sin este tratamiento, y que existen diferencias significativas en el número de pacientes que reducen los síntomas depresivos de forma clínicamente relevante. Además, se observaron menos eventos cardiovasculares adversos durante el tratamiento, aunque esta diferencia fue mínimamente significativa y no se mantuvo tras el seguimiento. Estos resultados sugieren que la inconsistencia de los datos actualmente disponibles podría deberse a dificultades metodológicas que evidencian la necesidad de nuevas investigaciones que aclaren el efecto del tratamiento de la depresión sobre el pronóstico post-SCA.(AU)

Depression post-acute coronary syndrome (ACS) increases the cardiac risk;however, the efficacy of antidepressant therapies for its treatment has not beensufficiently demonstrated. Our aim is to meta-analyze controlled trials withhomogeneous samples that allow us to explain the inconsistency of the resultsobtained so far. After reviewing 1525 articles, two independent reviewersidentified 7 studies that met very restrictive criteria to ensure homogeneity of thesamples. The results indicated that patients treated with interventions of provenefficacy for the depression, reduce their levels of depressive disorder significantlymore than subjects without this treatment and that there are significantdifferences in the number of patients who reduce depressive symptoms in clinically relevant way. In addition, fewer adverse cardiovascular events wereobserved during treatment, although this difference was minimally significant andwas not maintained after the follow-up. These results suggest that theinconsistency of the currently available data could be due to methodologicaldifficulties evidencing the need for further research to clarify the effect ofdepression treatment on post-ACS prognosis.K EY WORDS : coronary heart disease, acute coronary syndrome, depressiontreatment, meta-analysis.(AU)

Prevalencia de la enfermedad pulmonar esclerodermia-intersticial limitada frente a la extensa en el momento del diagnóstico de SSc-EPID según los criterios de Goh et al. Revisión sistemática y metaanálisis / Prevalence of the limited vs. extensive scleroderma-related interstitial lung disease at the time of diagnosis of SSc-ILD based on Goh et al. criteria. Systematic review and meta-analysis

Introducción: Goh et al. propusieron en 2008 un algoritmo clasificatorio de SSc-EPID limitada o extensa. La prevalencia de ambos en el momento del diagnóstico de SSc-EPID no se conoce con exactitud. Métodos: La revisión se realizó mediante MEDLINE y SCOPUS desde 2008 hasta 2023 y utilizando los términos: «sistémica», «esclerodermia» o «enfermedad pulmonar intersticial» [MesH]. Se utilizó la escala de Newcastle-Ottawa para la evaluación de la calificación de los estudios observacionales y la escala de Jadad para los ensayos clínicos. Se realizó el método inverso ponderado por la varianza. Resultados: Se incluyeron inicialmente 27 estudios en la revisión sistemática y metaanálisis (SRMA). De ellos, 17 estudios no tenían datos coincidentes. Comunicaron datos de 2.149 pacientes, 1.369 (81,2%) eran mujeres. La edad media era de 52,4 (DE 6,6) años. El 45,2% de los pacientes presentaban el subtipo difuso y el 54,8% el subtipo limitado o esclerodermia sinusal. El 38,7% de los pacientes presentaban anticuerpos antitopoisomerasa positivos y el 14,2% anticuerpos anticentrómero positivos. El porcentaje medio de capacidad vital forzada al inicio del estudio fue del 80,5% (DE 6,9) y de capacidad de difusión pulmonar para el monóxido de carbono fue del 59,1% (DE 9,6). Doce estudios presentaron datos de extensión de SSc-EPID ajustados por PFR y se incluyeron en el metaanálisis. Los 10 estudios observacionales de cohortes se analizaron por separado. El porcentaje global de afectación limitada se estimó en un 63,5% (IC del 95%: 55,3-73; p<0,001) utilizando el modelo de efectos aleatorios. La heterogeneidad entre estudios (I2) fue del 9,8% (IC del 95%: 0-68,2%). La afectación pulmonar extensa se estimó en 34,3% (IC del 95%: 26-45,4; p<0,001). La heterogeneidad entre estudios (I2) fue del 0% (IC del 95%: 0-61,6%) con el modelo de efectos aleatorios.(AU)

Introduction: Goh et al. proposed in 2008 a classificatory algorithm of limited or extensive SSc-ILD. The prevalence of both at the time of diagnosis of SSc-ILD is not known with exactitude. Methods: The review was undertaken by means of MEDLINE and SCOPUS from 2008 to 2023 and using the terms: “systemic”, “scleroderma” or “interstitial lung disease” [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment for observational studies and the Jadad scale for clinical trials. The inverse variance-weighted method was performed. Results: Twenty-seven studies were initially included in the systematic review and meta-analysis (SRMA). Of these, 17 studies had no overlapping data. They reported data from 2,149 patients, 1,369 (81.2%) were female. The mean age was 52.4 (SD 6.6) years. 45.2% of the patients had the diffuse subtype and 54.8% had the limited or sine scleroderma subtype. A total of 38.7% of the patients showed positive antitopoisomerase antibodies and 14.2% positive anticentromere antibodies. The mean percentage of forced vital capacity at baseline was 80.5% (SD 6.9) and of diffusing capacity of the lungs for carbon monoxide was 59.1% (SD 9.6). Twelve studies presented SSc-ILD extension data adjusted for PFTs and were included in the meta-analysis. The 10 observational cohort studies were analyzed separately. The overall percentage of limited extension was estimated at 63.5% (95%CI 55.3–73; p<0.001) using the random-effects model. Heterogeneity between studies (I2) was 9.8% (95%CI 0–68.2%) with the random-effects model. Extensive pulmonary involvement was estimated at 34.3% (95%CI 26–45.4; p<0.001). Heterogeneity between studies (I2) was 0% (95%CI 0–61.6%) with the random-effects model. Conclusion: The overall percentage of limited SSc-ILD at the time of diagnosis of SSc-ILD was estimated at 63.5% and extensive at 34.3%.(AU)

Effectiveness and safety of injectable PCSK9 inhibitors in dyslipidaemias’ treatment and cardiovascular disease prevention: An overview of 86 systematic reviews and a network metaanalysis / Eficacia y seguridad de los inyectables inhibidores de la PCSK9 en el tratamiento de dislipidemias y la prevención de enfermedades cardiovasculares: una visión general de 86 revisiones sistemáticas y un metaanálisis en red

Objective Multiple systematic reviews (SR) have been performed on the effects of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), often providing conflicting findings. This overview and network meta-analysis (NMA) aimed to summarize SR findings on the efficacy and safety of PCSK9i and provide an updated NMA. Materials and methods MEDLINE (Pubmed), Scopus, Cochrane, Epistemonikos and Google Scholar were searched from inception to September 21, 2023 for SRs of randomized controlled trials (RCTs) and from January 1, 2020 to September 21, 2023 for additional RCTs. Double-independent study selection, data extraction and quality assessment were performed. Qualitative analysis was performed for SRs and a frequentist random-effects model NMA was performed for RCTs. Results Totally, 86 SRs and 76 RCTs were included. Alirocumab (77/86 [90%]) and evolocumab (73/86 [85%]) were mostly analyzed. Associations from SRs (35/42 [83%]) and the updated NMA indicated PCSK9i benefit on major adverse cardiovascular events (MACEs). Reductions were also noted for cerebrovascular events (47/66 [71%]), coronary revascularization (29/33 [88%]) and myocardial infarction (41/63 [65%]). Alirocumab was associated with reductions on all-cause mortality (RR=0.82, 95%CI [0.72,0.94]). Data on any CV event reduction were conflicting (7/16 [44%]). Inclisiran appeared effective only on MACEs (RR=0.76, 95%CI [0.61,0.94]). No reductions in heart failure were observed (0/16). No increases were identified between PCSK9i and any (0/35) or serious adverse events (0/52). However, PCSK9i were associated with injection-site reactions (20/28 [71%]). Conclusion PCSK9i appeared to be effective in CV outcomes and their clinical application was generally safe. (AU)

Objetivo Las revisiones sistemáticas (RS) sobre los efectos de los inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (PCSK9i), presentan resultados contradictorios. Esta revisión general y metaanálisis en red (MER) tiene como objetivo resumir los hallazgos sobre la eficacia y seguridad de los PCSK9i. Materiales y métodos Se realizaron búsquedas en MEDLINE (PubMed), Scopus, Cochrane, Epistemonikos y Google Scholar desde sus inicios hasta el 21 de septiembre de 2023 para las RS de ensayos controlados aleatorios (ECA) y desde el 1 de enero de 2020 hasta 21 de septiembre de 2023 para los ECA adicionales. La selección de estudios, extracción de datos y evaluación de calidad se llevaron a cabo de manera doble e independiente. Se realizó un análisis cualitativo de las SR y un modelo de efectos aleatorios frecuentistas MER para los ECA. Resultados En total, se incluyeron 86 SR y 76 RCT. Alirocumab (77/86 [90%]) y evolocumab (73/86 [85%]) fueron los más analizados. Se reconocieron beneficios de los PCSK9i en eventos cardiovasculares adversos mayores (ECVAM), reducción de eventos cerebrovasculares (47/66 [71%]), revascularización coronaria (29/33 [88%]) e infartos de miocardio (41/63 [65%]). Alirocumab redujo la mortalidad por todas las causas (RR: 0,82; IC del 95%: 0,72-0,94). Los resultados sobre la reducción de cualquier evento cardiovascular (CV) fueron contradictorios (7/16 [44%]). Inclisiran pareció ser efectivo solo en la reducción de ECVAM (RR: 0,76; IC del 95%: 0,61-0,94). No se observaron reducciones en insuficiencia cardíaca (0/16) o relación con eventos adversos serios (0/52). Sin embargo, se asociaron con reacciones en el lugar de la inyección (20/28 [71%]). (AU)

The effect of erythropoiesis-stimulating agents on systolic and diastolic blood pressure in hemodialysis patients: A systematic review and meta-analysis of clinical trials.

OBJECTIVE: Anemia is a common condition in end-stage renal disease (ESRD) patients. Erythropoiesis-stimulating agents (ESAs) are commonly used to treat anemia in these patients. However, concerns have been raised regarding their potential effects on blood pressure. This systematic review and meta-analysis aim to investigate the relationship between ESAs and changes in systolic and diastolic blood pressure in hemodialysis patients. METHOD: This study is a systematic review and meta-analysis based on clinical trial studies published in various databases, including Web of Science, Cochrane Library, Science Direct, PubMed, Embase, Scopus, and Google Scholar, between 1980 and the end of 2022. We evaluated the quality of articles using the Jadad scale checklist and analyzed the data using Stata 15 software. RESULTS: Our meta-analysis included 34 clinical trial studies. The results showed a significant increase in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the consumption of ESAs compared to before consumption. The mean difference in SBP was 4.84mmHg (95% CI: 2.74-6.94; p-value<0.001) and in DBP was 4.69mmHg (95% CI: 2.67-6.71; p-value<0.001). No publication bias was observed. Our meta-regression analysis showed that sample size, quality assessment score, and geographical location of the study were significant factors related to observed heterogenicity in to mean difference of SBP (p-value≤0.20). For DBP, the sample size, quality assessment score and follow-up duration were significant variables (p-value≤0.20). CONCLUSION: Based on the findings of our study, it appears that receiving ESAs is associated with a significant increase in both SBP and DBP in hemodialysis patients, with an increase of about 5mmHg.

The potential diagnostic accuracy of circulating microRNAs for Alzheimer's disease: A meta-analysis.

BACKGROUND & OBJECTIVE: Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease that seriously affects cognitive ability and has become a key public health problem. Many studies have identified the possibility of peripheral blood microRNA as effective non-invasive biomarkers for AD diagnosis, but the results are inconsistent. Therefore, we carried out this meta-analysis to evaluate the diagnostic accuracy of circulating microRNAs in the diagnosis of AD patients. METHODS: We performed a systematic literature search of the following databases: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure, updated to March 15, 2021. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity, and Deeks' funnel plot was used to assess whether there was publication bias. RESULTS: 62 studies from 18 articles were included in this meta-analysis. The pooled sensitivity was 0.82 (95% CI: 0.78-0.85), specificity was 0.80 (95% CI: 0.76-0.83), PLR was 4. 1 (95% CI: 3.4-4.9), NLR was 0.23 (95% CI: 0.19-0.28), DOR was 18 (95% CI: 13-25) and AUC was 0.88 (95% CI: 0.84-0.90). Subgroup analysis shows that the microRNA clusters of plasma type performed a better diagnostic accuracy of AD patients. In addition, publication bias was not found. CONCLUSIONS: Circulating microRNAs can be used as a promising non-invasive biomarker in AD diagnosis.

The potential diagnostic accuracy of circulating microRNAs for Alzheimer's disease: A meta-analysis / La precisión diagnóstica de los microARN circulantes para la enfermedad de Alzheimer: un metaanálisis

Background & objective Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease that seriously affects cognitive ability and has become a key public health problem. Many studies have identified the possibility of peripheral blood microRNA as effective non-invasive biomarkers for AD diagnosis, but the results are inconsistent. Therefore, we carried out this meta-analysis to evaluate the diagnostic accuracy of circulating microRNAs in the diagnosis of AD patients. Methods We performed a systematic literature search of the following databases: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure, updated to March 15, 2021. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity, and Deeks’ funnel plot was used to assess whether there was publication bias. Results 62 studies from 18 articles were included in this meta-analysis. The pooled sensitivity was 0.82 (95% CI: 0.78–0.85), specificity was 0.80 (95% CI: 0.76–0.83), PLR was 4. 1 (95% CI: 3.4–4.9), NLR was 0.23 (95% CI: 0.19–0.28), DOR was 18 (95% CI: 13–25) and AUC was 0.88 (95% CI: 0.84–0.90). Subgroup analysis shows that the microRNA clusters of plasma type performed a better diagnostic accuracy of AD patients. In addition, publication bias was not found. Conclusions Circulating microRNAs can be used as a promising non-invasive biomarker in AD diagnosis. (AU)

Antecedentes y objetivo La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa progresiva e irreversible que afecta gravemente la capacidad cognitiva y se ha convertido en un problema clave de salud pública. Muchos estudios han identificado la posibilidad de que los microARN de sangre periférica sean biomarcadores no invasivos para el diagnóstico de la EA, pero los resultados son inconsistentes. Por lo tanto, llevamos a cabo este metaanálisis para evaluar la precisión diagnóstica de los microARN circulantes en el diagnóstico de pacientes con EA. Métodos Realizamos una búsqueda bibliográfica sistemática de las siguientes bases de datos: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database y China National Knowledge Infrastructure, actualizado a 15 de marzo de 2021. Se utilizó un modelo de efectos aleatorios para agrupar la sensibilidad, especificidad, razón de probabilidad positiva, razón de probabilidad negativa, razón de probabilidades de diagnóstico y área bajo la curva. Se realizó una metarregresión y un análisis de subgrupos para explorar las fuentes de heterogeneidad, y se utilizó el gráfico en embudo de Deek's para evaluar si había sesgo de publicación. Resultados En este metaanálisis se incluyeron 62 estudios de 18 artículos. La sensibilidad combinada fue de 0,82 (IC 95%: 0,78-0,85), la especificidad fue de 0,80 (IC 95%: 0,76-0,83), la PLR fue de 4,1 (IC 95%: 3,4-4,9), la NLR fue de 0,23 (IC 95%: 0,19-0,28), la DOR fue de 18 (IC 95%: 13-25) y el AUC fue de 0,88 (IC 95%: 0,84-0,90). El análisis de subgrupos muestra que los microARN clústeres de tipo plasmático tuvieron una mejor precisión diagnóstica de pacientes con EA. Además, no se encontró sesgo de publicación. Conclusión Los microARN circulantes pueden utilizarse como un biomarcador no invasivo prometedor para el diagnóstico de la EA. (AU)

Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis.

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167.

Secondary traumatic stress is considered an occupational hazard for nurses. Emergency department nurses, in particular, face a greater risk of secondary traumatic stress compared to other professions.While various studies have investigated the prevalence of secondary traumatic stress among these nurses, findings have been inconsistent.The pooled prevalence of secondary traumatic stress among emergency nurses is 65%. Subgroup analysis by region shows that Asia experiences the highest combined prevalence at 74%, with North America at 59% and Europe at 53%. Emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%­78%).

The effect of telehealth on incontinence severity given to women with urinary incontinence: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Although urinary incontinence does not cause mortality, it is a global health problem that adversely affects the quality of life and health of women. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of the studies investigating the effect of telehealth given to women with urinary incontinence (UI) on the severity of incontinence. METHODS: The literature review for this systematic review was conducted between August-Semptember 2023 using four electronic databases. Y-based articles were scanned using MeSH-based keywords. Randomized Controlled Trials conducted over the last decade were included in the screening. RESULTS: The analysis included six studies involving 826 women with UI. After telehealth intervention, there was a significant difference in UI symptom severity (MD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) and quality of life (SMD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) compared to the control groups. It had no effect on sexuality (MD: -4.65 95% CI: -9.60 to 0.30, Z=1.84, p=0.07), and anxiety (SMD: -0.15, 95% CI: -0.38 to 0.08, Z=1.27, p=0.21). CONCLUSION: In this analysis, it was found that telehealth interventions performed on women with UI increased the quality of life while reducing the severity of incontinence in women, but had no effect on sexuality, and anxiety.

Short versus long intramedullary nails for intertrochanteric hip fracture: Meta-analysis. / [Artículo traducido] Clavo corto versus clavo largo en la fractura intertrocantérica de cadera: metaanálisis.

OBJECTIVE: To compare short versus long intramedullary nails for intertrochanteric hip fractures in terms of efficacy and safety. METHODS: We included cohort studies and randomized clinical trials. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using the Review Manager 5.4. Heterogeneity was checked with the I2 test. A fixed effects model was adopted if there was no heterogeneity. RESULTS: Twelve studies were included. The reoperations rate was lower in the short nail group (OR: 0.58, 95%CI: 0.38-0.88) and there were no differences regarding the peri-implant fracture rate (OR: 1.77, 95%CI: 0.68-4.60). Surgery time and blood loss was significantly higher in the long nail group (MD: -12.44, 95%CI: -14.60 -10.28) (MD: -19.36, 95%CI: -27.24 -11.48). There were no differences in functional outcomes. CONCLUSIONS: The long nail showed a higher reoperation rate, blood loss and surgery time compared to the short nail. LEVEL OF EVIDENCE: III.

Prevalence of the limited vs. extensive scleroderma-related interstitial lung disease at the time of diagnosis of SSc-ILD based on Goh et al. criteria. Systematic review and meta-analysis.

INTRODUCTION: Goh et al. proposed in 2008 a classificatory algorithm of limited or extensive SSc-ILD. The prevalence of both at the time of diagnosis of SSc-ILD is not known with exactitude. METHODS: The review was undertaken by means of MEDLINE and SCOPUS from 2008 to 2023 and using the terms: "systemic", "scleroderma" or "interstitial lung disease" [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment for observational studies and the Jadad scale for clinical trials. The inverse variance-weighted method was performed. RESULTS: Twenty-seven studies were initially included in the systematic review and meta-analysis (SRMA). Of these, 17 studies had no overlapping data. They reported data from 2,149 patients, 1,369 (81.2%) were female. The mean age was 52.4 (SD 6.6) years. 45.2% of the patients had the diffuse subtype and 54.8% had the limited or sine scleroderma subtype. A total of 38.7% of the patients showed positive antitopoisomerase antibodies (ATA) and 14.2% positive anticentromere antibodies (ACA). The mean percentage of forced vital capacity (FVC) at baseline was 80.5% (SD 6.9) and of diffusing capacity of the lungs for carbon monoxide (DLco) was 59.1% (SD 9.6). Twelve studies presented SSc-ILD extension data adjusted for PFTs and were included in the meta-analysis. The 10 observational cohort studies were analyzed separately. The overall percentage of limited extension was estimated at 63.5% (95%CI 55.3-73; p < 0.001) using the random-effects model. Heterogeneity between studies (I2) was 9.8% (95%CI 0-68.2%) with the random-effects model. Extensive pulmonary involvement was estimated at 34.3% (95%CI 26-45.4; p < 0.001). Heterogeneity between studies (I2) was 0% (95%CI 0-61.6%) with the random-effects model. CONCLUSION: The overall percentage of limited SSc-ILD at the time of diagnosis of SSc-ILD was estimated at 63.5% and extensive at 34.3%.

Efectividad de las intervenciones enfermeras en la prevención de caídas en adultos mayores en la comunidad y en entornos sanitarios: una revisión sistemática y metaanálisis de ECA / Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT

Objetivo: Estimar la efectividad de los programas de prevención de caídas en mayores de 65 años en los que participan profesionales de enfermería. Métodos: Se incluyeron ensayos clínicos aleatorizados disponibles a texto completo sobre la prevención de caídas en la comunidad realizada por enfermeras en personas mayores de 65 años y que informaran de la incidencia de dichas caídas. Se analizaron 14 bases de datos en el período de 2016 a 2018 de publicaciones en inglés, francés, portugués y español. La calidad de los artículos se evaluó de manera independiente y ciega por los revisores, que trabajaron en parejas usando para ello los dominios de riesgo de riesgo de la Colaboración Cochrane. Se utilizó el cociente de riesgos como medida del tamaño de efecto. Se asumió un modelo de efectos aleatorios para los análisis estadísticos. La influencia de las variables moderadoras de los estudios sobre los tamaños de efecto se realizó mediante ANOVA con un intervalo de confianza del 95% para cada categoría. Resultados: Se seleccionaron 31 estudios con 25.551 participantes, donde la intervención más frecuente fue la educación (57,1%), seguida de los modelos multifactoriales (37,1%). La probabilidad de caídas se redujo significativamente en los grupos intervención (RR +=0,87). Las intervenciones multifactoriales (RR +=0,89) y basadas en la educación (RR=+0,84) redujeron significativamente la probabilidad de caídas. Conclusiones: Descartando el sesgo de publicación, los programas de prevención llevados a cabo por enfermeras producen una reducción significativa del 10% de las caídas. Las intervenciones basadas en la educación y multifactoriales son las más efectivas cuando son llevadas a cabo por enfermeras.(AU)

Objective: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. Methods: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016 to 2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. Results: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR +=0.87). Multifactorial (RR +=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. Conclusions: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.(AU)

Tranexamic acid in patients with traumatic brain injury: a meta-analysis.

BACKGROUND: We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI). METHODS: We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval. RESULTS: In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD -2.45; 95% CI = -4.78 to -0.12; p=0.04) and less total haematoma expansion (MD - 2.52; 95% CI = -4.85 to -0.19; p=0.03) compared to controls. There were no statistically significant differences in mortality (OR 0.94; 95% CI=0.85-1.03; p=0.18), presence of progressive haemorrhage (OR 0.75; 95% CI=0.56-1.01; p=0.06), need for neurosurgery (OR 1.15; 95% CI=0.66-1.98; p=0.63), high Disability Rating Scale score (OR 0.90; 95% CI=0.56-1.45; p=0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI=0.33-5.46; p=0.68) between TBI patients treated with TXA and controls. CONCLUSIONS: Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.

A meta-analysis of the effect of visiting zoos and aquariums on visitors' conservation knowledge, beliefs, and behavior.

Zoos and aquariums are well placed to connect visitors with the issues facing biodiversity globally and many deliver interventions that seek to influence visitors' beliefs and behaviors with respect to conservation. However, despite primary studies evaluating the effect of such interventions, the overall effect of engaging with zoos and the factors that influence this effect remain unclear. We conducted a systematic review to investigate the effect of zoo-led interventions on knowledge, beliefs (attitudes, intentions, self-efficacy, and social norms), and behavior among zoo visitors. These outcomes were identified using the Theory of Planned Behavior as a theoretical lens. We identified and described the nature of zoo-led interventions in 56 studies and used the behavior change technique (BCT) taxonomy to identify 6 specific BCTs used in interventions to date. Multilevel meta-analyses revealed a small to medium positive effect of engaging with zoo-led interventions on outcomes (d+  = 0.40, 95% confidence interval = 0.28-0.51). Specifically, visitors were more knowledgeable about conservation issues, held more favorable attitudes toward conservation, and reported being more likely to act for the benefit of biodiversity. No evidence of publication bias was present. Effect sizes were, however, heterogeneous and subgroup analyses revealed that the nature of the intervention or type of outcome did not explain this variance. Larger effects were, however, found in studies conducted at a single institution relative to research at multiple institutions and studies that used within-participant designs relative to between-participant designs. Taken together, these findings demonstrate how behavior change frameworks can be used to describe zoo-led interventions and supports the assertion that zoos and aquariums can promote changes in beliefs and behaviors that may help protect biodiversity.

Metaanálisis del efecto de la visita a acuarios y zoológicos sobre el conocimiento, creencias y comportamientos de conservación de los visitantes © 2024 by John Wiley & Sons, Inc. Resumen Los zoológicos y los acuarios están bien posicionados para conectar a los visitantes con temas mundiales de biodiversidad y varios cuentan con intervenciones que buscan influir las creencias y el comportamiento de los visitantes con respecto a la conservación. Sin embargo, con todo y los estudios primarios que evalúan el efecto de dichas intervenciones, aún no está claro el efecto general de participar en los zoológicos y los factores que influyen sobre este efecto. Realizamos una revisión sistemática para investigar el efecto de las intervenciones en los zoológicos sobre el conocimiento, creencias (actitud, intención, autosuficiencia y normas sociales) y comportamiento de sus visitantes. Usamos la teoría del comportamiento planeado como lente teórico para identificar los resultados. Identificamos y describimos la naturaleza de las intervenciones en los zoológicos en 56 estudios y usamos la taxonomía de las técnicas de modificación de conducta (TMC) para identificar seis TMC específicas que se usan hoy en día en dichas intervenciones. Los metaanálisis multinivel revelaron un efecto positivo de pequeño a mediano sobre los resultados causado por la participación en las intervenciones de los zoológicos (d+ = 0.40, 95% CI = 0.28 - 0.51). En específico, los visitantes fueron más conocedores sobre los temas de conservación, tuvieron actitudes más favorables hacia la conservación y reportaron tener mayor probabilidad de actuar en beneficio de la biodiversidad. No hubo evidencias de sesgos en las publicaciones. Sin embargo, el tamaño de los efectos fue heterogéneo y el análisis de los subgrupos reveló que la naturaleza de la intervención o el tipo de resultados no explicaban esta varianza. A pesar de esto, encontramos efectos más grandes en los estudios realizados en una sola institución en relación con la investigación realizada en varias instituciones y los estudios que usaron diseños intraparticipantes en relación a los que usaron diseños interparticipantes. Nuestra revisión demuestra cómo los marcos de modificación conductual pueden usarse para describir las intervenciones en los zoológicos y acuarios y respalda la aseveración de que estas instituciones pueden promover cambios en las creencias y el comportamiento que pueden ayudar a proteger la biodiversidad.