Surgical Modalities versus Conservative Treatment for Acute Injuries of Lateral Ligament of Ankle

Abstract Background Acute ankle sprain is a very common injury which comprises 80% of all ankle injuries. Acute ankle sprain affects almost exclusively the lateral ligamentous complex including ATFL followed by CFL, while PTFL is rarely of clinical significance. Objective To study the clinical trials in a Meta-analytical form, in order to compare surgical versus conservative treatments for the management of acute injuries of the lateral ligament complex of the ankle. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) statements. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. Results In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till April 2019. The search retrieved 702 unique records. We then retained 48 potentially eligible records for full-texts screening. Finally, 14 studies (Total No. of patients=1896) were included in the present systematic review and meta-analysis Conclusion: Starting a physiotherapy programme as early as possible is essential to control pain and swelling, to improve and maintain the range of motion, and to minimize the risk of stiffness and muscle wasting, which are the two decisive factors which delay patients from returning to their normal activities. Regardless of severity, surgery for acute ankle sprain is not recommended anymore.

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Enhanced Recovery After Colo-Rectal Surgeries (ERAS) V.S Conventional Care A systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcab097.055 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hanna Habib Hanna ◽

Sherif Abdelhalim ◽

Aboelatta Khairy ◽

Rihaj Mohammed Abdulfattah Al-Abbasi

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Web Of Science ◽

Enhanced Recovery ◽

Meta Analysis ◽

Conventional Care ◽

Controlled Trials ◽

Cochrane Central Register ◽

Central Register ◽

Meta Analyses

Abstract Background ERAS programs are not only used in abdominal surgeries, they are also used in cardiothoracic, gynecology, urology, orthopedic, and neurosurgery. Many authors and surgeons worldwide have been adapting this program, also trying to modify it due to its promising outcomes and it’s low damage toit’s continence. Objective To present an updated assessment of perioperative care in colorectal surgery from the available evidence and Enhanced Recovery After Surgery (ERAS) group recommendations. Patients and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. An electronic search was conducted from the inception till March 2019 in the following bibliographic databases: Medline via PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar to identify relevant articles. We used different combinations of the following queries: ("Colorectal Surgery"[Mesh]) AND ("Enhanced recovery" OR "conventional care"). The search have been done with no limit regarding the year publication or language. Results In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till March 2019. The search retrieved 2861 unique records. We then retained 41 potentially eligible records for full-texts screening. Finally, 28 reports of 25 RCTs were included in the present systematic review and meta-analysis Conclusion ERAS was proven to be feasible, minimally invasive, cheap, relatively easy, which is safe and effective at the same time. This program can be ideal for patients undergoing elective colo-rectal surgery, yet more studies should be conducted in Egypt to compare results regarding different approaches of this program with longer follow up and randomization of patients.

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Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽

10.1093/qjmed/hcab104.016 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ossama Abdelraoof El Shazly ◽

Mohamed Mokhtar Abdellah ◽

Mostafa Abdelnabee Abouzaid

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Plate Fixation ◽

Meta Analysis ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Superficial Infection ◽

First Metatarsophalangeal Joint ◽

Non Union ◽

Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/1060028020949125 ◽

2020 ◽

pp. 106002802094912

Author(s):

Anum Saqib Zaidi ◽

Gregory M. Peterson ◽

Luke R.E. Bereznicki ◽

Colin M. Curtain ◽

Mohammed Salahudeen

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Adverse Drug Events ◽

Data Extraction ◽

Meta Analysis ◽

Published Data ◽

Potentially Inappropriate Medications ◽

Cochrane Central Register ◽

Increased Risk ◽

Meta Analyses

Objective: To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. Data Sources: Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. Study Selection and Data Extraction: Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. Data Synthesis: The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36; 95%CI=0.79-2.35) or hospitalization (OR=1.02; 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. Relevance to Patient Care and Clinical Practice: Individuals with cognitive impairment or dementia are at increased risk of medication misadventure; based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. Conclusions: Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.

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Assessing the Association between the Methylenetetrahydrofolate Reductase (MTHFR) 677C->T Polymorphism on Blood Folate Concentrations: A Systematic Review and Meta-analysis of Trials and Observational Studies

European Journal of Nutrition & Food Safety ◽

10.9734/ejnfs/2015/21011 ◽

2015 ◽

pp. 650-651

Author(s):

Becky Tsang ◽

Amy Cordero ◽

Claire Marchetta ◽

Joseph Mulinare ◽

Patricia Mersereau ◽

...

Keyword(s):

Systematic Review ◽

Protein Binding ◽

Observational Studies ◽

Methylenetetrahydrofolate Reductase ◽

Meta Analysis ◽

Mthfr C677t ◽

Review Of Literature ◽

Binding Assays ◽

Lower Blood ◽

Meta Analyses

Objectives: The methylenetetrahydrofolate reductase (MTHFR) 677C->T polymorphism is a risk factor for neural tube birth defects (NTDs). The T allele produces an enzyme with reduced folate processing capacity, which has been shown to produce lower blood folate concentrations in some studies. Our objective was to assess the association between MTHFR C677T genotypes (CC, CT, TT) and blood folate concentrations among women aged 12-49 years. Methods: We conducted a systematic review of literature published between 1/1992-7/2013 to identify controlled trials and observational studies that reported serum, plasma, or red blood cell (RBC) folate concentrations and MTHFR C677T genotype. We applied a Bayesian random-effects model to predict differences in blood folate concentrations between MTHFR C677T genotypes, stratified by folate assay. Results: Thirty-eight studies met criteria for inclusion. Serum/plasma folate concentrations showed a consistent genotype trend with the highest concentrations for CC (CC > CT > TT) regardless of assay type. RBC folate concentrations measured by microbiologic assay also demonstrated this trend; however, this trend was reversed (CC < CT < TT) in studies using protein-binding assays. Conclusions: Meta-analyses results showed blood folate concentrations differed by assay type and genotype. Previous evidence has shown that RBC folate concentrations measured with a radioimmunoassay requires adjustment for genotype-dependent folate recovery; our results suggest that other protein-binding assays could have similar limitations. Compared to CC individuals, TT individuals have lower blood folate concentrations, which may increase a woman's risk for an NTD-affected pregnancy.

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Mortality rate and predictors of Stroke: A Meta-Analysis and Systematic Review

10.21203/rs.2.16369/v1 ◽

2019 ◽

Author(s):

Amanual Getnet Mersha ◽

Tadesse Melaku Abegaz ◽

Mohammed Assen Seid ◽

Eyob Alemayehu Gebreyohannes ◽

Akshaya Srikanth Bhagavath ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Observational Studies ◽

Meta Analysis ◽

Random Effect ◽

Stroke Mortality ◽

Stroke Event ◽

Meta Analyses ◽

Random Effect Models ◽

Overall Mortality

Abstract Background Global data on stroke mortality remained to be sparse. In light of this, we aimed to conduct a Meta-analysis and systematic review of observational studies to estimate the mortality of stroke and to identify risk factors that predispose patients for stroke-related death.Methods This study was conducted based on the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. Overall mortality, in-hospital and 30- day mortality due to stroke were the primary outcome measures of the study. The meta-analysis was performed using Stata (Version 14, Stata Corp, College Station, Texas). Random-effect models were used for estimating pooled effects.Findings Overall, thirty two studies assessed overall mortality due to stroke. A total number of 2,885, 126 patients were recruited for the study. Pooled estimate indicated that the overall mortality of stroke was reported to be 20% (19%-22%). Whereas, the 30-day and In-hospital mortality were found to be 18% (16%-20%) and 16% (16%-19%), respectively. A subgroup analysis revealed that Africa registered the highest stroke-related death 29% (23%-36%). Hypertension was found to be an important risk factor for mortality secondary to stroke 61.9% (52.8%-71.1%).Conclusion Overall mortality of stroke was estimated to be twenty percent. The burden of stroke mortality was prominent in Africa region. Hypertension remained to be an independent risk factor for stroke mortality. Mortality of stroke can be minimized by establishing stroke centers that promptly deliver emergency management of stroke event.

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TaiChi and Qigong for Depressive Symptoms in Patients with Chronic Heart Failure: A Systematic Review with Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/5585239 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Wei Jiang ◽

Shaojun Liao ◽

Xiankun Chen ◽

Cecilia Stålsby Lundborg ◽

Gaetano Marrone ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Depressive Symptoms ◽

Meta Analysis ◽

Controlled Trials ◽

Therapeutic Effects ◽

Cochrane Central Register ◽

China National Knowledge Infrastructure ◽

Beneficial Effects ◽

Meta Analyses

Background. Depression is a debilitating comorbidity of heart failure (HF) that needs assessment and management. Along with mind-body exercise to deal with HF with depression, the use of TaiChi and/or Qigong practices (TQPs) has increased. Therefore, this systematic review assesses the effects of TQPs on depression among patients with HF. Methods. Randomized controlled trials (RCTs) that examined the effect of TQPs on depression in patients with HF were searched by five databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI)). With standardized mean difference (SMD) and 95% confidence intervals (95% CI), random-effects meta-analyses of the effect of TQPs on depressive symptoms were performed. Results. Of eight included RCTs, seven (481 patients) provided data for the meta-analysis. The pooling revealed that TQPs contribute to depression remission in HF (SMD −0.66; 95% CI −0.98 to −0.33, P < 0.0001 ; I2 = 64%). Its antidepressive effect was not influenced by intervention duration or exercise setting, but rather by ejection fraction subtype, depressive severity, and depression instruments. The beneficial effects were preserved when the study with the largest effect was removed. Conclusion. This study suggests that TQPs might be a good strategy for alleviating depressive symptoms in patients with HF. And rigorous-design RCTs, which focus on the identified research gaps, are needed to further establish the therapeutic effects of TQPs for depression in HF.

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Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management: Part 6. Systematic Reviews and Meta-Analyses of Observational Studies

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/819 ◽

2008 ◽

Vol 5;12 (5;9) ◽

pp. 819-850

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Evidence Based Medicine ◽

Observational Studies ◽

Meta Analysis ◽

Evidence Based ◽

Confounding Bias ◽

Meta Analyses ◽

Based Medicine

Observational studies provide an important source of information when randomized controlled trials (RCTs) cannot or should not be undertaken, provided that the data are analyzed and interpreted with special attention to bias. Evidence-based medicine (EBM) stresses the examination of evidence from clinical research and describes it as a shift in medical paradigm, in contrast to intuition, unsystematic clinical experience, and pathophysiologic rationale. While the importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy, much of the medical research is observational. The reporting of observational research is often not detailed and clear enough with insufficient quality and poor reporting, which hampers the assessment of strengths and weaknesses of the study and the generalizability of the mixed results. Thus, in recent years, progress and innovations in health care are measured by systematic reviews and meta-analyses. A systematic review is defined as, “the application of scientific strategies that limit bias by the systematic assembly, clinical appraisal, and synthesis of all relevant studies on a specific topic.” Meta-analysis usually is the final step in a systematic review. Systematic reviews and meta-analyses are labor intensive, requiring expertise in both the subject matter and review methodology, and also must follow the rules of EBM which suggests that a formal set of rules must complement medical training and common sense for clinicians to integrate the results of clinical research effectively. While expertise in the review methods is important, the expertise in the subject matter and technical components is also crucial. Even though, systematic reviews and meta-analyses, specifically of RCTs, have exploded, the quality of the systematic reviews is highly variable and consequently, the opinions reached of the same studies are quite divergent. Numerous deficiencies have been described in methodologic assessment of the quality of the individual articles. Consequently, observational studies can provide an important complementary source of information, provided that the data are analyzed and interpreted in the context of confounding bias to which they are prone. Appropriate systematic reviews of observational studies, in conjunction with RCTs, may provide the basis for elimination of a dangerous discrepancy between the experts and the evidence. Steps in conducting systematic reviews of observational studies include planning, conducting, reporting, and disseminating the results. MOOSE, or Meta-analysis of Observational Studies in Epidemiology, a proposal for reporting contains specifications including background, search strategy, methods, results, discussion, and conclusion. Use of the MOOSE checklist should improve the usefulness of meta-analysis for authors, reviewers, editors, readers, and decision-makers. This manuscript describes systematic reviews and meta-analyses of observational studies. Authors frequently utilize RCTs and observational studies in one systematic review; thus, they should also follow the reporting standards of the Quality of Reporting of Meta-analysis (QUOROM) statement, which also provides a checklist. A combined approach of QUOROM and MOOSE will improve reporting of systematic reviews and lead to progress and innovations in health care. Key words: Observational studies, evidence-based medicine, systematic reviews, metaanalysis, randomized trials, case-control studies, cross-sectional studies, cohort studies, confounding bias, QUOROM, MOOSE

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Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

Nutrition Reviews ◽

10.1093/nutrit/nuaa101 ◽

2020 ◽

Author(s):

Mariana B de Moraes ◽

Christina Avgerinou ◽

Fernanda B Fukushima ◽

Edison I O Vidal

Keyword(s):

Systematic Review ◽

Older Adults ◽

Muscle Strength ◽

Older People ◽

Meta Analysis ◽

Nutritional Supplements ◽

Cochrane Central Register ◽

Nutritional Education ◽

Nutritional Interventions ◽

Meta Analyses

Abstract Context Although nutrition is considered an important intervention for the management of frailty, the actual effectiveness of interventions addressing nutrition in frail older people remains unclear. Objective The aim for this systematic review was to appraise the evidence regarding the effectiveness of nutritional interventions for the management of frailty in older adults. Data Extraction We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Sciences Literature databases were searched from January 2001 to November 2019. Two independent reviewers extracted relevant data. From 2370 initial records, 19 publications presenting data from 17 studies (1564 individuals; follow-up: 7–96 weeks) were included. Data Analysis None of the Bayesian random-effects meta-analyses comparing nutritional supplements with placebo regarding mortality, body mass index, weight, frailty status, muscle strength, gait speed, body composition, and cognitive function showed statistically significant differences. The same applies to a single meta-analysis comparing nutritional education with general health advice regarding muscle strength. Conclusion Our results suggest, mostly with low to very low degrees of certainty, that nutritional supplements or nutritional education delivered in isolation may not be effective for the management of frailty in older people. Review registration number CRD42018111510 (PROSPERO).

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Efficacy of Adjunctive Treatments Added to Olanzapine or Clozapine for Weight Control in Patients with Schizophrenia: A Systematic Review and Meta-Analysis

The Scientific World JOURNAL ◽

10.1155/2015/970730 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Yun-Jung Choi

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Adverse Effects ◽

Weight Reduction ◽

Weight Control ◽

Randomized Clinical Trials ◽

Psychiatric Symptoms ◽

Meta Analysis ◽

Cochrane Central Register ◽

Meta Analyses

Objectives. This study was conducted to review systematically adjunctive treatments for weight reduction in patients with schizophrenia and compare efficacies of clinical trials through meta-analysis, so as to provide effective clinical guideline regarding weight control for patients taking atypical antipsychotics.Methods. Candidate clinical trials were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, and PsycINFO. Fourteen randomized clinical trials were included for systematic review and meta-analysis from 132 potential trials. The Comprehensive Meta-Analysis version 2 was used for meta-analysis.Results. Difference in means and significances from meta-analyses regarding weight control by adjunctive treatments showed that topiramate, aripiprazole, or sibutramine was more effective than metformin or reboxetine. Psychiatric evaluations did not show statistically significant changes between treatment groups and placebo groups except topiramate adjunctive treatments. Adverse effects regarding adjunctive therapies were tolerable and showed statistically no significances compared to control groups.Conclusion. Though having several reports related to exacerbation of psychiatric symptoms, topiramate and aripiprazole are more efficacious than other medications in regard to weight reduction and less burden of critical adverse effects as well as being beneficial for clinical improvement.

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Anemia and the Risk of Cognitive Impairment: An Updated Systematic Review and Meta-Analysis

Brain Sciences ◽

10.3390/brainsci11060777 ◽

2021 ◽

Vol 11 (6) ◽

pp. 777

Author(s):

Woon-Man Kung ◽

Sheng-Po Yuan ◽

Muh-Shi Lin ◽

Chieh-Chen Wu ◽

Md. Mohaimenul Islam ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Observational Studies ◽

Web Of Science ◽

Meta Analysis ◽

The Elderly ◽

Previous Evidence ◽

Increased Risk ◽

Meta Analyses ◽

Risk Ratios

Background: Cognitive impairment is one of the most common, burdensome, and costly disorders in the elderly worldwide. The magnitude of the association between anemia and overall cognitive impairment (OCI) has not been established. Objective: We aimed to update and expand previous evidence of the association between anemia and the risk of OCI. Methods: We conducted an updated systematic review and meta-analysis. We searched electronic databases, including EMBASE, PubMed, and Web of Science for published observational studies and clinical trials between 1 January 1990 and 1 June 2020. We excluded articles that were in the form of a review, letter to editors, short reports, and studies with less than 50 participants. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We estimated summary risk ratios (RRs) with random effects. Results: A total of 20 studies, involving 6558 OCI patients were included. Anemia was significantly associated with an increased risk of OCI (adjusted RR (aRR) 1.39 (95% CI, 1.25–1.55; p < 0.001)). In subgroup analysis, anemia was also associated with an increased risk of all-cause dementia (adjusted RR (aRR), 1.39 (95% CI, 1.23–1.56; p < 0.001)), Alzheimer’s disease [aRR, 1.59 (95% CI, 1.18–2.13; p = 0.002)], and mild cognitive impairment (aRR, 1.36 (95% CI, 1.04–1.78; p = 0.02)). Conclusion: This updated meta-analysis shows that patients with anemia appear to have a nearly 1.39-fold risk of developing OCI than those without anemia. The magnitude of this risk underscores the importance of improving anemia patients’ health outcomes, particularly in elderly patients.

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