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Global Pediatric Health 2023Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common...
Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common contributing factors for the death. Nevertheless, there is no aggregate evidence on the prevalence and patterns of neonatal birth trauma in Ethiopia. Therefore, this study aimed to assess the pooled prevalence and patterns of neonatal birth trauma in Ethiopia. Searching databases including PubMed, MEDLINE, Popline, SCOPUS, Web of Science, EMBASE, CINHAL (EBSCO), Google, Google Scholar, and lists of references were used to search literatures in Ethiopia. STATA version 14 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for and -values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias. A total of 6 studies with a sample size of 3663 were included in this study. The overall prevalence of neonatal birth trauma was 15% (95% CI: 13-16). Subgaleal hemorrhage (39%), cephalohematoma (27%), and caput succedaneum (24%) were the most common neonatal birth trauma in Ethiopia. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios, and the funnel plots did not show publication bias. This systematic review and meta-analysis revealed a high prevalence of neonatal birth trauma in Ethiopia. Moreover, most of the neonatal birth injuries were severe and life-threatening that need medical attention to safe the neonates and its life long complications.
PubMed: 37602141
DOI: 10.1177/2333794X231191982 -
BMJ Open Aug 2023The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE (via PubMed), Web of Science, Sri Lankan Journals online and Google Scholar were searched for relevant articles published between January 1990 and June 2022 investigating the prevalence of pre-diabetes and diabetes in Sri Lanka.
METHODS
Random effect meta-analyses were conducted to derive the pooled prevalence of pre-diabetes and diabetes and their 95% CIs. Heterogeneity was explored by subgroup and meta-regression analyses. Sensitivity analyses were used to evaluate the impact of any single study on the pooled estimates. Two authors screened articles, extracted data and evaluated the quality of selected studies.
RESULTS
A total of 479 articles were reviewed, and 15 studies (n=30 137 participants) were selected in the final analysis. The overall pooled prevalence of diabetes was 12.07% (95% CI, 8.71% to 15.89%; prediction interval: 1.28-31.35). The pooled pre-diabetes prevalence was 15.57% (95% CI, 9.45% to 22.88%; prediction interval: 0.02-49.87). The pooled type 2 diabetes prevalence was the highest in the latest period of 2011-2021 (17.25%) than in the period of 2000s (11.84%) and 1990s (5.62%).
CONCLUSIONS
The growing trend of diabetes and pre-diabetes over the last 30 years is alarming in Sri Lanka. The government of Sri Lanka needs to take steps to improve diabetes education, screening, diagnosis and treatment.
PROSPERO REGISTRATION NUMBER
CRD42021288591.
Topics: Humans; Diabetes Mellitus, Type 2; Prediabetic State; Prevalence; Sri Lanka
PubMed: 37640460
DOI: 10.1136/bmjopen-2022-068445 -
ESC Heart Failure Jun 2024Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by...
AIMS
Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by vaccination.
METHODS AND RESULTS
We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts.
CONCLUSIONS
TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.
Topics: Humans; Takotsubo Cardiomyopathy; COVID-19 Vaccines; COVID-19; Vaccination; SARS-CoV-2; Echocardiography
PubMed: 38344896
DOI: 10.1002/ehf2.14719 -
Diagnostics (Basel, Switzerland) May 2024The study aimed to assess the prevalence of COVID-19 and spp. coinfection across continents. Conducted following PRISMA guidelines, a systematic review utilized PubMed,... (Review)
Review
The study aimed to assess the prevalence of COVID-19 and spp. coinfection across continents. Conducted following PRISMA guidelines, a systematic review utilized PubMed, Embase, SCOPUS, ScienceDirect, and Web of Science databases, searching for literature in English published from December 2019 to December 2022, using specific Health Sciences descriptors. A total of 408 records were identified, but only 50 were eligible, and of these, only 33 were included. Thirty-three references were analyzed to evaluate the correlation between COVID-19 and spp. infections. The tabulated data represented a sample group of 8741 coinfected patients. The findings revealed notable disparities in co-infection rates across continents. In Asia, 23% of individuals were infected with , while in Europe, the proportion of co-infected patients stood at 15%. Strikingly, on the African continent, 43% were found to be infected with , highlighting significant regional variations. Overall, the proportion of co-infections among COVID-positive individuals were determined to be 19%. Particularly concerning was the observation that 1 in 6 ICU coinfections was attributed to , indicating its substantial impact on patient outcomes and healthcare burden. The study underscores the alarming prevalence of co-infection between COVID-19 and , potentially exacerbating the clinical severity of patients and posing challenges to treatment strategies. These findings emphasize the importance of vigilant surveillance and targeted interventions to mitigate the adverse effects of bacterial coinfections in the context of the COVID-19 pandemic.
PubMed: 38893674
DOI: 10.3390/diagnostics14111149 -
Journal of Clinical Medicine Nov 2023(1) Background: Telemetry units allow the continuous monitoring of vital signs and ECG of patients. Such physiological indicators work as the digital signatures and... (Review)
Review
(1) Background: Telemetry units allow the continuous monitoring of vital signs and ECG of patients. Such physiological indicators work as the digital signatures and biomarkers of disease that can aid in detecting abnormalities that appear before cardiac arrests (CAs). This review aims to identify the vital sign abnormalities measured by telemetry systems that most accurately predict CAs. (2) Methods: We conducted a systematic review using PubMed, Embase, Web of Science, and MEDLINE to search studies evaluating telemetry-detected vital signs that preceded in-hospital CAs (IHCAs). (3) Results and Discussion: Out of 45 studies, 9 met the eligibility criteria. Seven studies were case series, and 2 were case controls. Four studies evaluated ECG parameters, and 5 evaluated other physiological indicators such as blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature. Vital sign changes were highly frequent among participants and reached statistical significance compared to control subjects. There was no single vital sign change pattern found in all patients. ECG alarm thresholds may be adjustable to reduce alarm fatigue. Our review was limited by the significant dissimilarities of the studies on methodology and objectives. (4) Conclusions: Evidence confirms that changes in vital signs have the potential for predicting IHCAs. There is no consensus on how to best analyze these digital biomarkers. More rigorous and larger-scale prospective studies are needed to determine the predictive value of telemetry-detected vital signs for IHCAs.
PubMed: 38068481
DOI: 10.3390/jcm12237430 -
Systematic Reviews Feb 2024The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates... (Review)
Review
BACKGROUND
The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes.
METHODS
Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors.
RESULTS
Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour.
CONCLUSIONS
This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number: CRD42020156535.
Topics: Adolescent; Child; Child, Preschool; Humans; Young Adult; Diet; Life Style; Pediatric Obesity; Randomized Controlled Trials as Topic; Schools; Middle East
PubMed: 38355590
DOI: 10.1186/s13643-024-02475-7 -
Reviews on Environmental Health Nov 2023Worldwide, insects are declining at an alarming rate. Among other causes, the use of pesticides and modern agricultural practices play a major role in this. Cumulative... (Review)
Review
Worldwide, insects are declining at an alarming rate. Among other causes, the use of pesticides and modern agricultural practices play a major role in this. Cumulative effects of multiple low-dose toxins and the distribution of toxicants in nature have only started to be investigated in a methodical way. Existing research indicates another factor of anthropogenic origin that could have subtle harmful effects: the increasingly frequent use of electromagnetic fields (EMF) from man-made technologies. This systematic review summarizes the results of studies investigating the toxicity of electromagnetic fields in insects. The main objective of this review is to weigh the evidence regarding detrimental effects on insects from the increasing technological infrastructure, with a particular focus on power lines and the cellular network. The next generation of mobile communication technologies, 5G, is being deployed - without having been tested in respect of potential toxic effects. With humanity's quest for pervasiveness of technology, even modest effects of electromagnetic fields on organisms could eventually reach a saturation level that can no longer be ignored. An overview of reported effects and biological mechanisms of exposure to electromagnetic fields, which addresses new findings in cell biology, is included. Biological effects of non-thermal EMF on insects are clearly proven in the laboratory, but only partly in the field, thus the wider ecological implications are still unknown. There is a need for more field studies, but extrapolating from the laboratory, as is common practice in ecotoxicology, already warrants increasing the threat level of environmental EMF impact on insects.
PubMed: 37990587
DOI: 10.1515/reveh-2023-0072 -
The Lancet. Psychiatry Jul 2024Antidepressant discontinuation symptoms are becoming an increasingly important part of clinical practice, but the incidence of antidepressant discontinuation symptoms... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Antidepressant discontinuation symptoms are becoming an increasingly important part of clinical practice, but the incidence of antidepressant discontinuation symptoms has not been quantified. An estimate of antidepressant discontinuation symptoms incidence could inform patients and clinicians in the discontinuation of treatment, and provide useful information to researchers in antidepressant treatments. We aimed to assess the incidence of antidepressant discontinuation symptoms in patients discontinuing both antidepressants and placebo in the published literature.
METHODS
We systematically searched Medline, EMBASE, and CENTRAL from database inception until Oct 13, 2022 for randomised controlled trials (RCTs), other controlled trials, and observational studies assessing the incidence of antidepressant discontinuation symptoms. To be included, studies must have investigated cessation or tapering of an established antidepressant drug (excluding antipsychotics, lithium, or thyroxine) or placebo in participants with any mental, behavioural, or neurodevelopmental disorder. We excluded studies in neonates, and those using antidepressants for physical conditions such as pain syndromes due to organic disease. After study selection, summary data extraction, and risk of bias evaluation, data were pooled in random-effects meta-analyses. The main outcome was the incidence of antidepressant discontinuation symptoms after discontinuation of antidepressants or placebo. We also analysed the incidence of severe discontinuation symptoms. Sensitivity and meta-regression analyses tested a selection of methodological variables.
FINDINGS
From 6095 articles screened, 79 studies (44 RCTs and 35 observational studies) covering 21 002 patients were selected (72% female, 28% male, mean age 45 years [range 19·6-64·5]). Data on ethnicity were not consistently reported. 16 532 patients discontinued from an antidepressant, and 4470 patients discontinued from placebo. Incidence of at least one antidepressant discontinuation symptom was 0·31 (95% CI 0·27-0·35) in 62 study groups after discontinuation of antidepressants, and 0·17 (0·14-0·21) in 22 study groups after discontinuation of placebo. Between antidepressant and placebo groups of included RCTs, the summary difference in incidence was 0·08 [0·04-0·12]. The incidence of severe antidepressant discontinuation symptoms after discontinuation of an antidepressant was 0·028 (0·014-0·057) compared with 0·006 (0·002-0·013) after discontinuation of placebo. Desvenlafaxine, venlafaxine, imipramine, and escitalopram were associated with higher frequencies of discontinuation symptoms, and imipramine, paroxetine, and either desvenlafaxine or venlafaxine were associated with a higher severity of symptoms. Heterogeneity of results was substantial.
INTERPRETATION
Considering non-specific effects, as evidenced in placebo groups, the incidence of antidepressant discontinuation symptoms is approximately 15%, affecting one in six to seven patients who discontinue their medication. Subgroup analyses and heterogeneity figures point to factors not accounted for by diagnosis, medication, or trial-related characteristics, and might indicate subjective factors on the part of investigators, patients, or both. Residual or re-emerging psychopathology needs to be considered when interpreting the results, but our findings can inform clinicians and patients about the probable extent of antidepressant discontinuation symptoms without causing undue alarm.
FUNDING
None.
Topics: Humans; Antidepressive Agents; Incidence; Substance Withdrawal Syndrome; Randomized Controlled Trials as Topic
PubMed: 38851198
DOI: 10.1016/S2215-0366(24)00133-0 -
Neurotrauma Reports 2023Pediatric traumatic brain injury (pTBI) represents a major cause of child injuries in the Middle East and North Africa (MENA) region. This review aims to assess pTBIs in...
Pediatric Traumatic Brain Injury in the Middle East and North Africa Region: A Systematic Review and Meta-Analysis to Assess Characteristics, Mechanisms, and Risk Factors.
Pediatric traumatic brain injury (pTBI) represents a major cause of child injuries in the Middle East and North Africa (MENA) region. This review aims to assess pTBIs in the MENA region and reports their clinical severity and outcomes. A search was conducted using major electronic databases, including Medline/Ovid, PubMed, EMBASE, Web of Science, and SCOPUS. Abstracts were screened independently and in duplicate to detect original research. The objective and study findings for each article were recorded, along with the mechanism of pTBI, patient age and sex, injury assessment tool(s) used, and outcome. A total of 1345 articles were retrieved, of which 152 met the criteria for full-text review, and 32 were included in this review. Males predominantly suffered from pTBIs (78%). Motor vehicle accidents, followed by child abuse, were the leading causes of pTBI. Overall, 0.39% of cases were mild, 0.58% moderate, 16.25% severe, and 82.27% unclassified. The mortality rate was 13.11%. Most studies used the computed tomography scan, Glasgow Coma Scale, Abbreviated Injury Scale, and Injury Severity Score as investigation methods. This review reports on the alarming rate of child-abuse-related pTBI and offers further understanding of pTBI-associated risk factors and insight into the development of strategies to reduce their occurrence, as well as policies to promote child well-being.
PubMed: 37908319
DOI: 10.1089/neur.2023.0007 -
Critical Care (London, England) Jan 2024A recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates in patients with acute kidney injury... (Meta-Analysis)
Meta-Analysis
The effects of higher versus lower protein delivery in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.
BACKGROUND
A recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates in patients with acute kidney injury (AKI) receiving higher protein. These alarming findings highlighted the urgent need to conduct an updated systematic review and meta-analysis to inform clinical practice.
METHODS
From personal files, citation searching, and three databases searched up to 29-5-2023, we included randomized controlled trials (RCTs) of adult critically ill patients that compared higher vs lower protein delivery with similar energy delivery between groups and reported clinical and/or patient-centred outcomes. We conducted random-effect meta-analyses and subsequently trial sequential analyses (TSA) to control for type-1 and type-2 errors. The main subgroup analysis investigated studies with and without combined early physical rehabilitation intervention. A subgroup analysis of AKI vs no/not known AKI was also conducted.
RESULTS
Twenty-three RCTs (n = 3303) with protein delivery of 1.49 ± 0.48 vs 0.92 ± 0.30 g/kg/d were included. Higher protein delivery was not associated with overall mortality (risk ratio [RR]: 0.99, 95% confidence interval [CI] 0.88-1.11; I = 0%; 21 studies; low certainty) and other clinical outcomes. In 2 small studies, higher protein combined with early physical rehabilitation showed a trend towards improved self-reported quality-of-life physical function measurements at day-90 (standardized mean difference 0.40, 95% CI - 0.04 to 0.84; I = 30%). In the AKI subgroup, higher protein delivery significantly increased mortality (RR 1.42, 95% CI 1.11-1.82; I = 0%; 3 studies; confirmed by TSA with high certainty, and the number needed to harm is 7). Higher protein delivery also significantly increased serum urea (mean difference 2.31 mmol/L, 95% CI 1.64-2.97; I = 0%; 7 studies).
CONCLUSION
Higher, compared with lower protein delivery, does not appear to affect clinical outcomes in general critically ill patients but may increase mortality rates in patients with AKI. Further investigation of the combined early physical rehabilitation intervention in non-AKI patients is warranted.
PROSPERO ID
CRD42023441059.
Topics: Adult; Humans; Critical Illness; Randomized Controlled Trials as Topic; Acute Kidney Injury; Databases, Factual; Odds Ratio; Multicenter Studies as Topic
PubMed: 38184658
DOI: 10.1186/s13054-023-04783-1