Preoperative Third Ventricle Floor Bowing is Associated with Increased Surgical Success Rate in Patients Undergoing Endoscopic Third Ventriculostomy - A Systematic Review and Meta-analysis.

Background: Endoscopic third ventriculostomy (ETV) is a procedure that involves devising an opening in the third ventricle floor, allowing cerebrospinal fluid to flow into the prepontine cistern and the subarachnoid space. Third ventricular floor bowing (TVFB) serves as an indicator of intraventricular obstruction in hydrocephalus and existence of pressure gradient across third ventricular floor, which is the prerequisite of a successful ETV. Objective: In this systematic review and meta-analysis, we aimed to synthesize the latest evidence on the TVFB as a marker for surgical success in patients undergoing ETV. Material and Methods: We performed a comprehensive search on topics that assesses the association of TVFB with the surgical success in patients undergoing ETV from several electronic databases. Results: There was a total of 568 subjects from six studies. TVFB was associated with 85% (81-88%) ETV success. TVFB was associated with OR 4.13 [2.59, 6.60], P < 0.001; I2: 6% for ETV success. Subgroup analysis on pediatric patients showed 86% (82-91%) success rate. In terms of value for ETV success compared to ETV Success Score (ETVSS), a high ETVSS does not significantly differ (P = 0.31) from TVFB and TVFB was associated with OR 3.14 [1.72, 5.73], P < 0.001; I2: 69% compared to intermediate/moderate ETVSS. Funnel plot analysis showed an asymmetrical funnel plot due to the presence of an outlier. Upon sensitivity analysis by removing the outlier, the OR was 3.62 [2.22, 5.89], P < 0.001; I2: 0% for successful surgery in TVFB. Conclusions: TVFB was associated with an increased rate of successful surgery in adults and children undergoing ETV.

Decompression Alone Compared to Decompression With Fusion in Patients With Lumbar Spondylolisthesis: Systematic Review, Meta-Analysis, and Meta-Regression.

BACKGROUND: We aimed to synthesize the latest evidence on the efficacy and safety of decompression alone compared to decompression with fusion in patients with lumbar spondylolisthesis. We also aimed to evaluate factors affecting the efficacy and complications. METHODS: A systematic literature search was conducted using PubMed, Scopus, Europe PMC, Cochrane Central Database, and ClinicalTrials.gov. The main outcome was improvement in Oswestry Disability Index (ODI). The secondary outcome was back pain and leg pain improvement, complications, reoperation rate, duration of surgery, length of hospital stay, and blood loss. RESULTS: There were 3993 patients from 13 studies. Decompression with fusion was associated with greater reduction in ODI (mean difference 4.04 [95% CI 0.95, 7.13], P = 0.01) compared to decompression alone. Greater reduction in back (standardized mean difference [SMD] 0.27 [95% CI 0.00, 0.53], P = 0.05) and leg pain (SMD 0.13 [95% CI 0.06, 0.21], P < 0.001) was observed in the decompression with fusion group. Complications were similar in the 2 groups (OR 0.60 [95% CI 0.34, 1.04], P = 0.07). The reoperation rate was similar in both groups (P = 0.54). Decompression alone resulted in shorter duration of surgery (mean difference -85.18 minutes [95% CI -122.79, -47.57], P < 0.001), less blood loss (mean difference -262.65 mL [95% CI -313.45, -211.85], P < 0.001), and shorter hospital stay (mean difference -2.64 days [95% CI -3.58, -1.70], P < 0.001). Empirical Bayes random-effects meta-regression showed that the rate of complication was influenced by age (coefficient 0.172, P = 0.004). CONCLUSION: Decompression with fusion had greater efficacy than decompression alone but was associated with more blood loss, lengthier surgery, and hospitalization. In terms of complications, decompression alone may be beneficial in younger patients. (PROSPERO CRD42020211904) LEVEL OF EVIDENCE: 2A.

Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis.

In this systematic review and dose-response meta-analysis, we aimed to assess whether coffee and tea consumption is related to the risk of glioma. We performed a systematic literature search using PubMed, Embase, Scopus and the EuropePMC from the inception of database up until 1 October 2020. Exposures in the present study were coffee and tea consumption, the main outcome was the incidence of glioma. The present study compares the association between the exposure of coffee and tea with the incidence of glioma, and the results are reported in relative risks (RR). There are 12 unique studies comprising of 1 960 731 participants with 2987 glioma cases. Higher coffee consumption was associated with a statistically non-significant trend towards lower risk of glioma (RR 0·77 (95 % CI 0·55, 1·03), P= 0·11; I2:75·27 %). Meta-regression showed that the association between coffee and glioma was reduced by smoking (P= 0·029). Higher tea consumption was associated with a lower risk of glioma (RR 0·84 (95 % CI 0·71, 0·98), P= 0·030; I2:16·42 %). Sensitivity analysis by removal of case-control studies showed that higher coffee consumption (RR 0·85 (95 % CI 0·72, 1·00), P= 0·046; I2:0 %) and higher tea consumption (RR 0·81 (95 % CI 0·70, 0·93), P= 0·004; I2:0 %, Pnon-linearity = 0·140) were associated with lower risk of glioma. Dose-response meta-analysis showed that every one cup of coffee per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 0·99), P= 0·016, Pnon-linearity = 0·054) and every one cup of tea per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 1·00), P= 0·048). This meta-analysis showed apparent association between coffee and tea intake and risk of glioma.

The association between triglyceride-glucose index and the incidence of type 2 diabetes mellitus-a systematic review and dose-response meta-analysis of cohort studies.

ABSTARCT: AIMS: We aimed to assess the dose-response relationship between triglyceride-glucose (TyG) index and the incidence of type 2 diabetes mellitus (T2DM). METHODS: We performed a comprehensive systematic literature search using PubMed, Scopus, and Embase for records published from inception until 9 February 2021. The effect estimates were reported as relative risks (RRs). RESULTS: 270,229 subjects from 14 studies were included in this systematic review and meta-analysis. The pooled incidence of T2DM was 9%. Meta-regression analysis indicates that baseline age (coefficient: 0.67, p = 0.026), drinking (coefficient: 0.03, p = 0.035), and HDL (coefficient: -0.89, p = 0.035) affected the incidence of T2DM in future. High TyG index was associated with increased incidence of T2DM in pooled unadjusted (RR 4.68 [3.01, 7.29], p < 0.001; I2: 96.6%) and adjusted model (adjusted RR 3.54 [2.75, 4.54], p < 0.001; I2: 83.7%). Dose-response meta-analysis for the adjusted RR showed that the linear association analysis was not significant per 0.1 increase in TyG index (RR 1.01 [0.99, 1.03], p = 0.223). There is a non-linear trend (p < 0.001) for the association between TyG index and incidence of T2DM. The dose-response curve became increasingly steeper at TyG index above 8.6. CONCLUSIONS: TyG index was associated with the incidence of T2DM in a non-linear fashion.

Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis.

BACKGROUND AND AIMS: Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. METHODS: We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). RESULTS: There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p < 0.001; I2: 0%) and TFA (mean difference 64.6 cm2 [26.2, 103.1], p = 0.001; I2: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm2 [-4.9, 23.4], p = 0.199; I2: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I2: 49.3%). CONCLUSION: Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not. PROSPERO ID: CRD42020215876.

Delirium and Mortality in Coronavirus Disease 2019 (COVID-19) - A Systematic Review and Meta-analysis.

INTRODUCTION: Older adults are indisputably struck hard by the coronavirus disease 2019 (COVID-19) pandemic. The main objective of this meta-analysis is to establish the association between delirium and mortality in older adults with COVID-19. METHODS: Systematic literature searches of PubMed, Embase, and Scopus databases were performed up until 28 November 2020. The exposure in this study was the diagnosis of delirium using clinically validated criteria. Delirium might be in-hospital, at admission, or both. The main outcome was mortality defined as clinically validated non-survivor/death. The effect estimates were reported as odds ratios (ORs) and adjusted odds ratios (aORs). RESULTS: A total of 3,868 patients from 9 studies were included in this systematic review and meta-analysis. The percentage of patients with delirium was 27% [20%, 34%]. Every 1 mg/L increase in CRP was significantly associated with 1% increased delirium risk (OR 1.01 [1.00. 1.02], p=0.033). Delirium was associated with mortality (OR 2.39 [1.64, 3.49], p<0.001; I2: 82.88%). Subgroup analysis on delirium assessed at admission indicate independent association (OR 2.12 [1.39, 3.25], p<0.001; I2: 82.67%). Pooled adjusted analysis indicated that delirium was independently associated with mortality (aOR 1.50 [1.16, 1.94], p=0.002; I2: 31.02%). Subgroup analysis on delirium assessed at admission indicate independent association (OR 1.40 [1.03, 1.90], p=0.030; I2: 35.19%). Meta-regression indicates that the association between delirium and mortality were not significantly influenced by study-level variations in age, sex [reference: male], hypertension, diabetes, and dementia. CONCLUSION: The presence of delirium is associated with increased risk of mortality in hospitalized older adults with COVID-19.

Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association. METHODS: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19. RESULTS: There were 9 studies with 3,663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], p=0.010; I2: 56.7%, p=0.018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], p=0.008; I2: 57.4%, p=0.029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, p=0.033), male gender (coefficient: -0.03, p=0.042), and hypertension (coefficient: -0.02, p=0.033), but not diabetes (coefficient: -0.24, p=0.135) and cardiovascular diseases (coefficient: -0.01, p=0.506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (p=0.206). CONCLUSION: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension. PROSPERO REGISTRATION NUMBER: CRD42020213491.

Minimal Invasive Surgery Instrumented Fusion versus Conventional Open Surgical Instrumented Fusion for the Treatment of Spinal Metastases: A Systematic Review and Meta-analysis.

OBJECTIVE: In this study, we aimed to compare the minimally invasive surgery (MIS) instrumented fusion ± decompression versus conventional open surgery (COS) instrumented fusion ± decompression for the treatment of spinal metastases. METHODS: We performed a systematic literature search through PubMed, Scopus, Europe PMC (PubMed Central), and Cochrane Central Database using the keywords "minimal invasive surgery" OR "minimally invasive surgery" OR "mini-open" AND "conventional open surgery" OR "traditional open surgery" OR "open surgery" AND "spinal metastasis". The outcomes of interest were complications, neurologic improvement, length of stay, intraoperative blood loss, transfusion rate, and operative duration. RESULTS: There were a total of 8 studies comprising 486 patients. Complications were less frequent in MIS compared with COS (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.84; P = 0.01; I2 = 0%). Major complications related to surgery were less in the MIS group (OR, 0.42; 95% CI, 0.21-0.84; P = 0.01; I2 = 0%). The rate of neurologic improvement was similar in both groups (OR, 1.01; 95% CI, 0.64-1.59; P = 0.95; I2 = 0%). MIS was associated with less blood loss (mean difference, -690.00 mL; 95% CI, -888.31 to -491.69; P < 0.001; I2 = 56%), and lower transfusion rate compared with COS (OR, 0.27; 95% CI, 0.11-0.66; P = 0.004; I2 = 50%). Length of surgery was similar in both groups (mean difference, -12.49 minutes; 95% CI, -45.93 to 20.95; P = 0.46; I2 = 86%). MIS resulted in shorter length of stay compared with COS (mean difference -3.58 days; 95% CI, -6.90 to -0.26; P = 0.03; I2 = 89%). CONCLUSIONS: MIS was associated with lower complications, blood loss, transfusion rate, and shorter length of stay with a similar rate of neurologic improvement and length of surgery compared with COS.

The role of probucol preventing contrast-induced nephropathy in patients undergoing invasive coronary procedures - Systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this meta-analysis was to synthesize the latest evidence on the effect of probucol on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG)/percutaneous coronary intervention (PCI). METHODS: A systematic literature search of PubMed, ScienceDirect, EuropePMC, ProQuest, and Clinicaltrials. gov was performed to retrieve studies that assessed probucol and CIN in CAG/PCI. RESULTS: Four studies that compared probucol with hydration alone, comprising 1270 subjects, were identified and analyzed. There was no significant difference between probucol and control groups in the baseline level of creatinine and at 48 hours; however, a significant difference was observed at 72 hours (mean difference: -3.87 µmol/L; 95% confidence interval [CI]: -6.58, -1.15; p=0.005). The meta-analysis indicated that probucol did not reduce the CIN incidence (odds ratio [OR]: 0.46; 95% CI: 0.20, 1.08; p=0.08). After performing a leave-one-out sensitivity analysis, removal of a study resulted in a lower risk of CIN (OR: 0.33; 95% CI: 0.19, 0.56; p<0.001). Probucol did not reduce the CIN incidence in a pooled adjusted effect estimate (OR: 0.75; 95% CI: 0.15, 3.87; p=0.73). There was no significant difference in the rate of major adverse events between the 2 groups (OR: 0.39; 95% CI: 0.05, 3.05; p=0.37). Funnel plot results were asymmetrical, indicating possible publication bias. Grading of Recommendations, Assessment, Development and Evaluations qualification demonstrated a low and very low certainty of evidence in unadjusted and adjusted effect estimates, respectively. CONCLUSION: Probucol did not reduce the incidence of CIN; however, due to the low certainty of evidence, further study is required for a definite conclusion. Although the p value was not significant, the confidence interval showed a nonsignificant trend toward benefit. However, this trend might have been due to publication bias.

Statin reduces the incidence of diabetic retinopathy and its need for intervention: A systematic review and meta-analysis.

PURPOSE: We aimed to perform a systematic literature search on the latest evidence of the role of statin in reducing diabetic retinopathy and its need for intervention. METHODS: A comprehensive search on cohort studies/clinical trials that assess statins and diabetic retinopathy up until August 2019 was performed. The outcome measured was the incidence of diabetic retinopathy and its need for intervention. RESULTS: There were 558.177 patients from six studies. Statin was associated with a lower incidence of diabetic retinopathy (hazard ratio: 0.68 (0.55, 0.84), p < 0.001; I2: 95%). For the subtypes of diabetic retinopathy, statin lowers the incidence of proliferative diabetic retinopathy (hazard ratio: 0.69 (0.51, 0.93), p = 0.01; I2: 90%), non-proliferative diabetic retinopathy (hazard ratio: 0.80 (0.66, 0.96), p = 0.02; I2: 93%), and diabetic macular edema (hazard ratio: 0.56 (0.39, 0.80), p = 0.002; I2: 82%). Statin was associated with a reduced need for retinal laser treatment with a hazard ratio of 0.70 (0.64, 0.76) (p < 0.001; I2: 0%), intravitreal injection with a hazard ratio of 0.82 (0.79, 0.85) (p < 0.001; I2: 0%), and vitrectomy with a hazard ratio of 0.64 (0.48, 0.85) (p < 0.001; I2: 75%). Overall, statin was associated with a reduced need for intervention for diabetic retinopathy with a hazard ratio of 0.72 (0.64, 0.80) (p < 0.001; I2: 73%). The regression-based Egger's test showed statistically significant small-study effects for non-proliferative diabetic retinopathy (p = 0.011) outcomes. CONCLUSION: Statin was associated with a decreased risk of diabetic retinopathy and its subtypes. Statin also reduced the need for intervention with retinal laser treatment, intravitreal injection, and vitrectomy.

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis.

INTRODUCTION: National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use. METHODS: We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model. RESULTS: There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I2: 77.3%). The dose-response relationship was linear (Pnon-linearity=0.116). The funnel-plot analysis was asymmetrical; Trim-and-fill analysis by the imputation of two studies on the left side resulted in OR of 1.10 [1.03, 1.19]. CONCLUSION: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.

Intralesional measles-mumps-rubella is associated with a higher complete response in cutaneous warts: a systematic review and meta-analysis of randomized controlled trial including GRADE qualification.

INTRODUCTION: Warts can be difficult to treat and progressing to chronic and resistant disease. Several studies have reported the successful application of mumps-measles-rubella (MMR) vaccine resulting in clearance of warts via immunomodulation and induction of immune system. METHODS: We performed a comprehensive search on the role of intralesional MMR in warts from several electronic databases. Complete response is defined as complete clearance of warts lesion. RESULTS: There were a total of 425 subjects from five studies. Intralesional injection of MMR was associated with an increased complete response (OR 9.43 [5.78, 15.37], p < .001; I2: 5%, p = .38). Subgroup analysis on patients receiving injection for every 2 weeks for a maximum of five injections revealed an OR of 11.70 [6.40, 21.38], p < .001; I2: 20%, p = .29. Patients receiving intralesional MMR were associated with a lower partial response (OR 0.54 [0.33, 0.88], p = .01; I2: 0%, p = .66). Intralesional MMR was associated with a reduced no-response (OR 0.16 [0.06, 0.43], p < .001; I2: 69%, p = .01). Funnel plot analysis for complete response was asymmetrical, indicating the risk of publication bias. There were statistically significant small-study effects for intralesional MMR on complete response upon analysis using Harbord's test (p = .047). Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment showed that intralesional MMR injection has high level of certainty (quality of evidence) for complete response in warts with an absolute increase of 505 per 1000. CONCLUSION: Intralesional MMR injection was associated with a higher complete response and lower no-response with a high level of certainty.

Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure - systematic review and meta-analysis.

BACKGROUND: Recent evidence showed that the characteristics and outcome of those with de novo heart failure (HF) and acutely decompensated chronic heart failure (ADCHF) were different. We aimed to perform a comprehensive search on the clinical characteristics and outcome of patients with de novo HF and ADCHF. METHODS: We performed a comprehensive search on de novo/new onset acute HF vs ADCHF from inception up until December 2019. RESULTS: There were 38320 patients from 15 studies. De novo HF were younger and, had less prevalent hypertension, diabetes mellitus, ischaemic heart disease, chronic obstructive pulmonary disease, atrial fibrillation, and history of stroke/transient ischaemic attack compared to ADCHF. Five studies showed a lower NT-proBNP in de novo HF patients, while one study showed no difference. Valvular heart disease as aetiology of heart failure was less frequent in de novo HF, and upon sensitivity analysis, hypertensive heart disease was more frequent in de novo HF. As for precipitating factors, ACS (OR 2.42; I2:89%) was more frequently seen in de novo HF, whereas infection was less frequently (OR 0.69; I2:32%) in ADCHF. De novo HF was associated with a significantly lower 3-month mortality (OR 0.63; I2:91%) and 1-year (OR 0.59; I2:59%) mortality. Meta-regression showed that 1-year mortality did not significantly vary with age (p = .106), baseline ejection fraction (p = .703), or HF reduced ejection fraction (p = .262). CONCLUSION: Risk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF.

Elevated De Ritis Ratio Is Associated With Poor Prognosis in COVID-19: A Systematic Review and Meta-Analysis.

Objective: This meta-analysis aims to assess whether elevated De Ritis ratio is associated with poor prognosis in patients with coronavirus 2019 (COVID-19). Methods: A systematic literature search was performed using PubMed, Embase, and EuropePMC databases up until September 17, 2021. De Ritis ratio is also known as Aspartate aminotransferase/alanine transaminase (AST/ALT) ratio. The main outcome was poor prognosis, a composite of mortality, severity, the need for ICU care, and intubation. The effect measure was odds ratios (ORs) and mean differences. We generated sensitivity and specificity, negative and positive likelihood ratio (NLR and PLR), diagnostic odds ratio (DOR), and area under curve (AUC). Results: There were eight studies with 4,606 patients. De Ritis ratio was elevated in 44% of the patients. Patients with poor prognosis have higher De Ritis ratio [mean difference 0.41 (0.31, 0.50), p < 0.001; I 2: 81.0%] and subgroup analysis showed that non-survivors also have higher De Ritis Ratio [mean difference 0.47 (0.46, 0.48), p < 0.001; I 2: 0%]. Elevated De Ritis ratio was associated with poor prognosis [OR 3.28 (2.39, 4.52), p < 0.001; I 2: 35.8%]. It has a sensitivity of 55% (36-73), specificity of 71% (52-85), PLR 1.9, NLR.63, DOR of 3 (2-4), and AUC of.67 (0.63-0.71). The posterior probability of poor prognosis was 38% if De Ritis is elevated, while 17% if De Ritis is not elevated. Conclusion: Elevated De Ritis ratio is associated with poor prognosis in patients with COVID-19. Systematic Review Registration: PROSPERO ID: CRD42020216634.

Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association. METHODS: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19. RESULTS: There were 9 studies with 3663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], P = .010; I 2: 56.7%, P = .018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], P = .008; I 2: 57.4%, P = .029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, P = .033), male gender (coefficient: -0.03, P = .042), and hypertension (coefficient: -0.02, P = .033), but not diabetes (coefficient: -0.24, P = .135) and cardiovascular diseases (coefficient: -0.01, P = .506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (P = .206). CONCLUSION: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension.PROSPERO Registration Number: CRD42020213491.

Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm-A systematic review and meta-analysis.

OBJECTIVE: PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. METHOD: We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. RESULTS: There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%-94%) and 91% (95% CI, 85%-96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%-56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%-72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%-37%) of aneurysms immediately after coiling, and 25% (17-33) after six-month follow-up. Complications occur in 5% (95% CI, 1%-8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. CONCLUSIONS: PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: Systematic review and meta-analysis.

PURPOSE: Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases. RESULTS: There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13, I2: 0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76, I2: 0%) and ⩾15 letters (OR 2.78, I2: 0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months' follow up (mean difference -0.15, I2: 64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference -2.92, I2: 89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08, I2: 0%). Cataract formation and/or progression was less in RNB (OR 0.53, I2: 75%). The need for rescue laser was similar the two groups. CONCLUSION: Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.

The efficacy and safety of oral paracetamol versus oral ibuprofen for patent ductus arteriosus closure in preterm neonates - A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of oral acetaminophen compared to oral ibuprofen for patent ductus arteriosus (PDA) in preterm infants. METHODS: We performed a systematic literature search on topics that assesses the use of oral paracetamol compared to oral ibuprofen in preterm neonates diagnosed with PDA from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, ClinicalTrials.gov, and hand-sampling from potential articles. RESULTS: There were 1547 subjects from 10 selected studies. Primary closure rate was similar in both groups. Subgroup analysis on studies enrolling neonates with ≤30 weeks gestational age showed that ibuprofen was superior (OR 0.52 [0.31, 0.90], I2: 0%). On the other hand, paracetamol was superior neonates with ≤34 weeks gestational age (OR 1.73 [1.01, 2.94], I2: 30%). Reopening rate, surgical closure rate, mortality, intraventricular hemorrhage, and necrotizing enterocolitis were similar in both groups. Rate of renal dysfunction (OR 0.27 [0.10, 0.77], I2: 0%) and gastrointestinal bleeding (OR 0.31 [0.11, 0.88], I2: 0%) were lower in paracetamol group. Subgroup analysis of randomized controlled studies (RCTs) showed similar results. Meta-regression analysis showed that the primary closure rate was not influenced by gestational age, birth weight, and gender. GRADE demonstrates a low level of certainty for primary closure and mortality. Renal dysfunction and gastrointestinal bleeding havea moderate level of certainty. CONCLUSION: There was no significant difference between the efficacy of oral paracetamol and oral ibuprofen. However, the rate of renal dysfunction and gastrointestinal bleeding were higher in oral ibuprofen.

Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension-Systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: This systematic review and meta-analysis aimed to assess the latest evidence on the use of renal denervation (RDN) + pulmonary vein isolation (PVI) compared to PVI alone for treating atrial fibrillation (AF) with hypertension. METHODS: A systematic literature search from several electronic databases was performed up until January 2020. The primary outcome was AF recurrence defined as AF/atrial flutter (AFL)/atrial tachycardia (AT) ≥30 seconds at 12-month follow-up and the secondary outcome was procedure-related complications. RESULTS: There were 568 subjects from five studies. AF recurrence was 90/280 (32.1%) in the RDN + PVI group and 142/274 (51.8%) in the PVI group. RDN + PVI was associated with a lower incidence of AF recurrence (RR 0.62 [0.51, 076], P < .001; I 2: 0%). Pooled analysis of HR showed that RDN + PVI was associated with reduced AF recurrence (HR 0.51 [0.38, 0.70], P < .001; I 2: 0%). Complications were 7/241 (2.9%) in the RDN + PVI group and 8/237 (3.4%) in the PVI group. The rate of complications between the groups was similar (RR 0.87 [0.33, 2.29], P = .77; I 2: 0%). In the subgroup analysis of paroxysmal AF, RDN + PVI was shown to reduce AF recurrence (RR 0.64 [0.49, 0.82], P < .001; I 2: 0% and HR 0.56 [0.38, 0.82], P = .003; I 2: 0%) compared to PVI alone. RDN + PVI has a moderate certainty of evidence in the reducing AF recurrence with an absolute reduction of 197 fewer per 1000 (from 254 fewer to 124 fewer). CONCLUSION: RDN in addition to PVI, is associated with reduced 12-month AF recurrence and similar procedure-related complications compared to PVI alone.