Do cerebral microbleeds increase the risk of dementia? A systematic review and meta-analysis.

Background: Dementia is a neurological disorder that commonly affects the elderly. Cerebral microbleeds (CMBs) are small, tiny lesions of the cerebral blood vessels and have been suggested as a possible risk factor for dementia. However, data about the association between CMBs and dementia risk are inconsistent and inconclusive. Therefore, we conducted this systematic review and meta-analysis to investigate the association between CMBs and dementia and highlight the possible explanations. Methods: We followed the standard PRISMA statement and the Cochrane Handbook guidelines to conduct this study. First, we searched medical electronic databases for relevant articles. Then, we screened the retrieved articles for eligibility, extracted the relevant data, and appraised the methodological quality using the Newcastle-Ottawa Scale. Finally, the extracted data were pooled as risk ratios (RR) and hazard ratios (HR) in the random-effects meta-analysis model using the Review Manager software. Results: We included nine studies with 14,221 participants and follow-up periods > 18 months. Overall, CMBs significantly increased the risk of developing dementia (RR 1.84, 95% CI [1.27-2.65]). This association was significant in the subgroups of studies on high-risk populations (RR 2.00, 95% CI [1.41-2.83], n = 1657 participants) and those in the general population (RR 2.30, 95% CI [1.25-4.26], n = 12,087 participants) but not in the memory clinic patients. Further, CMBs increased the risk of progressing to incident dementia over time (HR 2, 95% CI [1.54-2.61]). Conclusion: Individuals with CMBs have twice the risk of developing dementia or progressing to MCI than those without CMBs. The detection of CMBs will help identify the population at higher risk of developing dementia. Physicians should educate individuals with CMBs and their families on the possibility of progressing to dementia or MCI. Regular cognitive assessments, cognitive training, lifestyle modifications, and controlling other dementia risk factors are recommended for individuals with CMBs to decrease the risk of cognitive decline and dementia development.

Biosimilars: Science, Implications, and Potential Outlooks in the Middle East and Africa.

Biosimilars are biological products that efficiently replicate the function of the originator products. They have changed the prognosis of millions of patients with many serious conditions. The main engine beyond their development is to bring competition into the marketplace, accordingly further the healthcare systems' sustainability. Furthermore, by lowering financial obstacles to biological treatments, biosimilars play a critical role in budgetary redistribution and, hence, promote better allocation of scarce healthcare resources. Today, biosimilars have become a substantial component of effective biological therapies anywhere in the world. Alike, most Middle East and African countries are encouraging the domestic biosimilars industry, and the whole region is aware of the biosimilars' importance. However, constraints to increasing biosimilars uptake should be addressed.

Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION AND HYPOTHESIS: Most vaginal births are associated with trauma to the perineum. The morbidity associated with perineal trauma can be significant, especially when it leads to third- and fourth-degree perineal tears. We hypothesized that antenatal perineal massage could decrease the incidence of perineal trauma, particularly severe perineal tears and other postpartum complications. METHODS: We searched four different databases from inception until August 2019 for the available trials. We included randomized controlled trials (RCTs) which assessed the effect of antenatal perineal massage (intervention group) versus control group (no antenatal perineal massage) in perineal trauma patients. Data were extracted from eligible studies and meta-analyzed using RevMan software. Primary outcomes were the risk of episiotomies and perineal tears. Secondary outcomes were perineal pain, second stage of labor duration, wound healing, anal incontinence, and Apgar scores at 1 and 5 min. RESULTS: Eleven RCTs with 3467 patients were analyzed. Women who received antenatal perineal massage had significantly lower incidence of episiotomies (RR = 0.79, 95% CI [0.72, 0.87], p < 0.001) and perineal tears (RR = 0.79, 95% CI [0.67, 0.94], p = 0.007), particularly the risk of third- and fourth-degree perineal tears (p = 0.03). Better wound healing and less perineal pain were evident in the antenatal perineal massage group. Antenatal perineal massage reduced the second stage of labor duration (p = 0.005) and anal incontinence (p = 0.003) with significant improvement in Apgar scores at 1 and 5 min (p = 0.01 and p = 0.02). CONCLUSIONS: Antenatal perineal massage is associated with a lower risk of severe perineal trauma and postpartum complications.

The effect of inhalation aromatherapy in patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The goal of this study was to synthesize evidence regarding the efficacy of inhalation aromatherapy in patients undergoing cardiac surgery. METHODS: We conducted an electronic search of four authentic databases. Randomized controlled trials (RCTs), which compared inhalation aromatherapy versus control in patients undergoing cardiac surgery, were included. Data were extracted from eligible studies and pooled in a meta-analysis model. We sought to evaluate anxiety, pain, stress, and vital signs including heart rate, systolic and diastolic blood pressure. RESULTS: Nine RCTs were included in this study with a total of 656 patients. Our analysis showed inhalation aromatherapy was significantly effective in reducing anxiety (MD= -3.11, 95 % CI [-5.26, -0.96], p = 0.005), and pain (MD= -0.83, 95 % CI [-1.59, -0.07], p = 0.03) in patients undergoing cardiac surgery. Additionally, inhalation aromatherapy significantly reduced heart rate compared to control group (MD= -5.49, 95 % CI [-9.07, -1.81], p = 0.003). However, no significant differences were found between both groups in mental stress, systolic and diastolic blood pressure. CONCLUSION: Inhalation aromatherapy administration especially with lavender can significantly reduce anxiety, pain, and heart rate in patients performed cardiac surgery. However, it is not associated with significant differences in systolic and diastolic blood pressure. Further studies are needed to confirm our results.