The Effect of Physical Exercise After a Concussion: A Systematic Review and Meta-analysis

2017 ◽  
Vol 46 (3) ◽  
pp. 743-752 ◽  
Author(s):  
Avtar Lal ◽  
Stephanie A. Kolakowsky-Hayner ◽  
Jamshid Ghajar ◽  
Maya Balamane
Keyword(s):  
Systematic Review ◽  
Physical Exercise ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cognitive Testing ◽  
Symptom Scale ◽  
Standard Mean Difference ◽  
Before And After

Background: Data evaluating the role of exercise in patients with a concussion are contradictory. Studies have reported improvement in the Post-Concussion Symptom Scale (PCSS) score, whereas others showed no effect on the PCSS score. Purpose: To conduct a systematic review and meta-analysis on the role of physical exercise on different outcomes in patients with a concussion. Study Design: Systematic review and meta-analysis. Methods: A search of 5 databases from the earliest available date to September 30, 2016, and a hand search of a few articles were performed. Trial registries were reviewed, and authors of multiple studies were contacted to find additional published or unpublished studies. Randomized controlled trials (RCTs), cohort studies, and before and after (pre-post) studies evaluating the effect of physical exercise, compared with control, in patients with a concussion or mild traumatic brain injury were included. Results: The search generated 1096 studies. Of these, 14 studies (5 RCTs, 1 propensity score matching study, 3 cohort studies, and 5 before and after studies) met our inclusion criteria. Exercise significantly decreased the PCSS score (mean difference, −13.06; 95% CI, −16.57 to −9.55; P < .00001; I2 = 44%), percentage of patients with symptoms of a concussion (risk ratio, 0.74; 95% CI, 0.63 to 0.86; P = .0001; I2 = 0%), and days off work (17.7 days vs 32.2 days, respectively; P < .05) compared with control. Exercise improved the reaction time (standard mean difference, –0.43; 95% CI, −0.80 to −0.06; P = .02) component of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) score without affecting the Balance Error Scoring System (BESS) score and neuropsychological parameters. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) scores were moderate for the PCSS, symptoms, ImPACT, BESS, and neuropsychological tests. Conclusion: Physical exercise appears to improve the PCSS score and symptoms in patients with a concussion. A high-quality RCT evaluating different intensities of exercise at different time points, for different durations after a concussion, for different races/ethnicities, and for sex needs to be conducted to evaluate a clear effect of exercise in patients with a concussion.

Effect of Exposure to Cats and Dogs on the Risk of Asthma and Allergic Rhinitis: A Systematic Review and Meta-analysis

2020 ◽  
Vol 34 (5) ◽  
pp. 703-714
Author(s):  
Xiaoping Gao ◽  
Mei Yin ◽  
Pei Yang ◽  
Xia Li ◽  
Lingling Di ◽  
...  
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Protective Role ◽  
Case Control ◽  
Favorable Effect ◽  
Case Control Studies

Background Controversies persist regarding whether exposure to cat or dog increases the risk of asthma and allergic rhinitis. Objective This meta-analysis aimed to assess the associations between exposure to cats or dogs and the development of asthma and allergic rhinitis. Methods A systematic review was performed to identify case-control and cohort studies before May 2019, evaluating the association between exposure to cats and dogs and the risk of asthma and rhinitis. The risk of bias was assessed using the Newcastle–Ottawa Scale. The odds ratios (ORs) and risk ratios (RRs) were pooled for case-control and cohort studies, respectively. Subgroup analyses were performed on prespecified study-level characteristics. Results The meta-analysis of 34 cohort studies showed a protective role of exposure to cats [RR: 0.88, 95% confidence interval (CI): 0.77–0.99] or dogs (RR: 0.85, 95% CI: 0.73–0.97) in the development of asthma. The subgroup analysis of birth cohort (RR: 0.74, 95% CI: 0.56–0.93) and children population (RR: 0.83, 95% CI: 0.70–0.96) also suggested a favorable role of exposure to dogs in the development of asthma. Pooled evidence from 13 case-control studies indicated no significant impact of cats (OR: 1.66, 95% CI: 0.39–2.94) and dogs (OR: 1.22, 95% CI: 0.92–1.52) on the development of asthma. A pooled analysis of five cohort studies showed a favorable effect of exposure to cats (RR: 0.60, 95% CI: 0.33–0.86) or dogs (RR: 0.68, 95% CI 0.44–0.90) on the development of allergic rhinitis. Conclusion The findings indicated a protective effect of exposure to cats and dogs, especially ownership, on the development of asthma and allergic rhinitis.

scholarly journals Laboratory Tests and Outcome for Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 5 (5) ◽  
pp. 1038-1049 ◽  
Author(s):  
Anne Alnor ◽  
Maria B Sandberg ◽  
Charlotte Gils ◽  
Pernille J Vinholt
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
Laboratory Tests ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Severe Disease ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Routine Laboratory ◽  
Standard Mean Difference

Abstract Background Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19) and poses substantial challenges for healthcare systems. With a vastly expanding number of publications on COVID-19, clinicians need evidence synthesis to produce guidance for handling patients with COVID-19. In this systematic review and meta-analysis, we examine which routine laboratory tests are associated with severe COVID-19 disease. Content PubMed (Medline), Scopus, and Web of Science were searched until March 22, 2020, for studies on COVID-19. Eligible studies were original articles reporting on laboratory tests and outcome of patients with COVID-19. Data were synthesized, and we conducted random-effects meta-analysis, and determined mean difference (MD) and standard mean difference at the biomarker level for disease severity. Risk of bias and applicability concerns were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. Summary 45 studies were included, of which 21 publications were used for the meta-analysis. Studies were heterogeneous but had low risk of bias and applicability concern in terms of patient selection and reference standard. Severe disease was associated with higher white blood cell count (MD, 1.28 ×109/L), neutrophil count (MD, 1.49 ×109/L), C-reactive protein (MD, 49.2 mg/L), lactate dehydrogenase (MD, 196 U/L), D-dimer (standardized MD, 0.58), and aspartate aminotransferase (MD, 8.5 U/L); all p &lt; 0.001. Furthermore, low lymphocyte count (MD −0.32 × 109/L), platelet count (MD −22.4 × 109/L), and hemoglobin (MD, −4.1 g/L); all p &lt; 0.001 were also associated with severe disease. In conclusion, several routine laboratory tests are associated with disease severity in COVID-19.

scholarly journals Effectiveness of Ginger on Pain and Function in Knee Osteoarthritis: A PRISMA Systematic Review and Meta-Analysis

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. E151-E163
Author(s):  
Felipe Araya-Quintanilla
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Knee Function ◽  
Mean Difference ◽  
Eligibility Criteria ◽  
Standard Mean Difference ◽  
And Function

Background: Ginger has been proposed as a complementary treatment for musculoskeletal pain. However, efficacy, type, and safety remains unclear. Objectives: To determine the effectiveness of consumption or topical application of ginger for pain relief and knee function improvement in patients with knee osteoarthritis. Study Design: Systematic review with meta-analysis of randomized clinical trials. Methods: An electronic search was performed on Medline, Central, CINAHL, PEDro, SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included clinical trials that compared consumption and/or topical ginger with placebo or other interventions for the pain relief and knee function in patients with medical diagnosis of knee osteoarthritis. Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4 studies were included. For the comparison capsules versus placebo, mean difference for pain was −7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean difference for knee function was −1.61 points; 95% CI, −4.30 to −1.09 (P = 0.24). For the comparison of topical ginger versus standard treatment, standard mean difference for pain was 0.79 mm; 95% CI, −1.97 to 0.39 (P = 0.19), and standard mean difference for knee function was −0.51 points; 95% CI, −1.15 to 0.13 (P = 0.12). Limitations: The current evidence is heterogeneous and has a poor methodologic quality. Conclusions: There is insufficient evidence to support the use of oral ginger compared with placebo in the pain relief and function improvement in patients with knee osteoarthritis. For other comparisons, no statistically significant differences were found. Key words: Osteoarthritis, knee osteoarthritis, ginger, pain, randomized clinical trial, systematic review

scholarly journals A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ramy Mohamed Ghazy ◽  
Abdallah Almaghraby ◽  
Ramy Shaaban ◽  
Ahmed Kamal ◽  
Hatem Beshir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Mean Difference ◽  
In Vivo Studies ◽  
Published Data ◽  
Duration Of Hospital Stay ◽  
Standard Mean Difference ◽  
Clinical Worsening

AbstractMany recent studies have investigated the role of either Chloroquine (CQ) or Hydroxychloroquine (HCQ) alone or in combination with azithromycin (AZM) in the management of the emerging coronavirus. This systematic review and meta-analysis of either published or preprint observational studies or randomized control trials (RCT) aimed to assess mortality rate, duration of hospital stay, need for mechanical ventilation (MV), virologic cure rate (VQR), time to a negative viral polymerase chain reaction (PCR), radiological progression, experiencing drug side effects, and clinical worsening. A search of the online database through June 2020 was performed and examined the reference lists of pertinent articles for in-vivo studies only. Pooled relative risks (RRs), standard mean differences of 95% confidence intervals (CIs) were calculated with the random-effects model. Mortality was not different between the standard care (SC) and HCQ groups (RR = 0.99, 95% CI 0.61–1.59, I2 = 82%), meta-regression analysis proved that mortality was significantly different across the studies from different countries. However, mortality among the HCQ + AZM was significantly higher than among the SC (RR = 1.8, 95% CI 1.19–2.27, I2 = 70%). The duration of hospital stay in days was shorter in the SC in comparison with the HCQ group (standard mean difference = 0.57, 95% CI 0.20–0.94, I2 = 92%), or the HCQ + AZM (standard mean difference = 0.77, 95% CI 0.46–1.08, I2 = 81). Overall VQR, and that at days 4, 10, and 14 among patients exposed to HCQ did not differ significantly from the SC [(RR = 0.92, 95% CI 0.69–1.23, I2 = 67%), (RR = 1.11, 95% CI 0.26–4.69, I2 = 85%), (RR = 1.21, 95% CI 0.70–2.01, I2 = 95%), and (RR = 0.98, 95% CI 0.76–1.27, I2 = 85% )] respectively. Exposure to HCQ + AZM did not improve the VQR as well (RR = 3.23, 95% CI 0.70–14.97, I2 = 58%). The need for MV was not significantly different between the SC and HCQ (RR = 1.5, 95% CI 0.78–2.89, I2 = 81%), or HCQ + AZM (RR = 1.27, 95% CI 0.7–2.13, I2 = 88%). Side effects were more reported in the HCQ group than in the SC (RR = 3.14, 95% CI 1.58–6.24, I2 = 0). Radiological improvement and clinical worsening were not statistically different between HCQ and SC [(RR = 1.11, 95% CI 0.74–1.65, I2 = 45%) and (RR = 1.28, 95% CI 0.33–4.99), I2 = 54%] respectively. Despite the scarcity of published data of good quality, the effectiveness and safety of either HCQ alone or in combination with AZM in treating COVID-19 cannot be assured. Future high-quality RCTs need to be carried out.PROSPERO registration: CRD42020192084.

scholarly journals Intravenous Iron Decreases Rehospitalizations but Does not Change mortality in Patients Admitted with Acute Heart Failure and Iron Deficiency: A Systematic review and Meta-analysis

2021 ◽  
Author(s):  
Nischit Baral ◽  
Nabin Raj Karki ◽  
Imran Akram ◽  
Ashiya Khan ◽  
Govinda Adhikari ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Iron Deficiency ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Placebo Control ◽  
Hospitalization Rates ◽  
Iv Iron ◽  
Overall Mortality

Introduction: The role of intravenous (IV) iron in chronic heart failure has been well studied, however, its role in acute heart failure (AHF) is less well-known. Including the recent AFFIRM-HF trial, we performed a systematic review and meta-analysis to highlight the role of IV iron in AHF with iron deficiency. Hypothesis: We hypothesized that IV iron does not change mortality or heart failure re-hospitalization rates in patients with AHF with iron deficiency. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies published from inception till June 30, 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), and Cochrane database including only RCTs and Cohort studies. We also included one prospective and one retrospective Cohort studies and two RCTs in our meta-analysis. Eligible studies included adults with AHF, left ventricular ejection fraction less than 40%-50%, and able to receive IV iron therapy. Outcomes included re-hospitalization rates and overall mortality from 30 days to 52 weeks post randomization (in one RCT). We used random-effects model calculating Risk Ratio (RR) with 95% confidence interval (95% CI) using Review Manger 5.4 software. I2statistics was used to assess heterogeneity. Results: There were total 1561 participants in both groups (IV iron and placebo/control) of four studies. The controls were comparable in both cohort studies and both the RCTs were well matched. Our results showed re-hospitalization in 278 of 833 (33.37%) patients in the IV iron/exposure group and 337 of 728 (0.46%) patients in the placebo/control group. The pooled result showed that the risk of re-hospitalization was comparable across both groups (RR 0.85, 95%CI 0.62-1.17; I2=45%, P=0.14). However, subgroup analysis, including RCTs only showed that IV iron decreases re-hospitalization rate by 28% compared to placebo (RR 0.72, 95% CI: 0.64, 0.82, I2=0%, P<0.00001) but did not improve mortality when compared to placebo (RR 0.97, 95% CI: 0.73, 1.30, I2 =0%). Conclusions: IV iron showed significant improvement in re-hospitalization rate for AHF hospitalizations in iron deficient patients but did not improve overall mortality. We need larger RCTs to further validate its effect on mortality.

scholarly journals Electroacupuncture for post-thoracotomy pain: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254093
Author(s):  
Sohyeon Park ◽  
Yee Ran Lyu ◽  
So Jung Park ◽  
Min Seok Oh ◽  
In Chul Jung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Total Dose ◽  
Meta Analysis ◽  
Opioid Analgesics ◽  
Sham Acupuncture ◽  
Mean Difference ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Standard Mean Difference

Background Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain. Methods The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157. Results Eleven randomized controlled trials were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. Conclusion Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.

scholarly journals Malondialdehyde concentrations in obsessive–compulsive disorder: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Amir Hossein Mohammadi ◽  
Ebrahim Balandeh ◽  
Alireza Milajerdi
Keyword(s):  
Systematic Review ◽  
Obsessive Compulsive Disorder ◽  
Inflammatory Responses ◽  
Current Knowledge ◽  
Meta Analysis ◽  
Mean Difference ◽  
Healthy Controls ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Standard Mean Difference

Abstract Background This meta-analysis aimed to investigate serum and plasma malondialdehyde (MDA) levels in patients with obsessive–compulsive disorder (OCD) in comparison to healthy controls. Methods Following the PRISMA protocol, we searched for the relevant studies through the databases of Scopus, PubMed, Google Scholar, and web of science until September 2019 with no time restriction. Overall, nine studies were included in the current meta-analysis. Data were pooled using a random-effects model; in addition, standard mean difference (SMD) and/or weight mean difference (WMD) was calculated. Cochran’s Q test and I-square (I2) statistics were used to evaluate between-study heterogeneity. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of the included studies. Statistical analyses were done using the STATA version 14. Results Our systematic review included nine case–control studies (including 367 cases and 337 controls). Pooling findings from these studies showed a significantly higher MDA level in OCD patient compared to control groups (SMD = 1.62; 95% CI [0.53, 2.72]; I2 = 96.9%; Pheterogeneity (Ph) < 0.001). This finding remained unchanged among studies which reported MDA in the same unit (WMD = 1.93; 95% CI [0.27, 3.59]; I2 = 99.2%; Ph < 0.001). Subgroup analysis by the study location and sample size revealed findings that were also significant. Conclusion We found that MDA levels are higher in OCD patients than healthy controls. This finding highlights the importance of inflammatory responses in OCD patients that should be considered for future investigations. Further studies are recommended to expand current knowledge on this issue.

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