Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

Purpose To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies. Methods PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome. Results Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002). Conclusion Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.

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Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

Journal of Intensive Care ◽

10.1186/s40560-021-00563-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Xiao-Li Chen ◽

Bei-Lei Zhang ◽

Chang Meng ◽

Hui-Bin Huang ◽

Bin Du

Keyword(s):

Sensitivity Analysis ◽

Randomized Controlled Trials ◽

Critically Ill Patients ◽

Oxygen Therapy ◽

Primary Outcome ◽

Meta Analysis ◽

Controlled Trials ◽

Icu Patients ◽

Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

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Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.243 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

S Simantiris ◽

AS Antonopoulos ◽

A Angelopoulos ◽

P Papanikolaou ◽

EK Oikonomou ◽

...

Keyword(s):

Cardiovascular Risk ◽

Cardiovascular Events ◽

Prognostic Value ◽

Primary Outcome ◽

Meta Analysis ◽

Vascular Inflammation ◽

Composite Endpoint ◽

Imaging Biomarkers ◽

Secondary Outcome ◽

Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance. Methods We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome. Results We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D) Conclusions The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication. Abstract Figure.

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Novel oral anticoagulats for the treatment of left ventricle thrombosis: a systematic review and meta-analysis

EP Europace ◽

10.1093/europace/euab116.532 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

M Serenelli ◽

F Vitali ◽

R Pavasini ◽

E Tonet ◽

G Pompei ◽

...

Keyword(s):

Primary Outcome ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Cochrane Library ◽

Secondary Outcome ◽

Ventricular Thrombus

Abstract Funding Acknowledgements Type of funding sources: None. Background novel oral anticoagulants (NOACs) are not guideline-recommanded treatment for left ventricular thrombus. Purpose: the aim of this meta-analysis is to compare NOACs versus vitamin-K atagonsits (VKAs) efficacy in treating left ventricular thrombus (LVT). Methods: we systematically searched MEDLINE, Cochrane Library, Biomed Central, and Web of Science for trials comparing NOACs versus VKAs in the setting of LVT. Five studies, out of the 74 initially selected after first screening, were included in the meta-analysis. For the development of this meta-analysis, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The shortlisted studies were retrieved as full articles and appraised independently by two unblinded reviewers. The Mantel-Haensel method with a random effect model was used for the pooled analysis. The primary outcome was the occurrence of stroke and systemic embolism. Secondary outcome was occurrence of left ventricular thrombosis resolution during treatment. Results: 707 patients were included in the analysis for the primary outcome. Of these, 230 were treated with NOACs and 477 with VKAs. The pooled OR for the primary outcome was 0.71 (95% CI 0.18-2.86, I2 67%), thus showing similar effect in term of ischaemic protection. A total of 698 patients, 228 on NOACs and 470 on VKAs were included in the analysis of the secondary outcome. The pooled OR for the secondary outcome pooled OR 0.97, 95% CI 0.56-1.68, I2 46%. Conclusions and Relevance: NOACs seem to have a similar efficacy profile compare to VKAs and so they should be considered as an alternative treatment for left ventricular thrombosis. Large prospective randomized clinical trials are needed to confirm this exploratory finding. Abstract Figure 1

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Microbial Association with Genus Actinomyces in Primary and Secondary Endodontic Lesions, Review

Antibiotics ◽

10.3390/antibiotics9080433 ◽

2020 ◽

Vol 9 (8) ◽

pp. 433

Author(s):

Mario Dioguardi ◽

Cristian Quarta ◽

Mario Alovisi ◽

Vito Crincoli ◽

Riccardo Aiuto ◽

...

Keyword(s):

Root Canal ◽

Primary Outcome ◽

Meta Analysis ◽

Salivary Flow ◽

Secondary Outcome ◽

Microbial Association ◽

Oral Tissue ◽

Root Canal System ◽

Endodontic Infections ◽

Prevalent Species

The main reason for root canal treatment failure is the persistence of microorganisms after therapy, or the recontamination of the root canal system due to an inadequate seal. In the mouth, Actinomyces spp. constitute a significant part of the normal flora, which is indicative of their ability to adhere to oral tissue and resist cleansing mechanisms, such as salivary flow. This review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), aims to clarify the prevalence of microbial genera that are associated with the genus Actinomyces in primary and secondary endodontic infections (primary outcome), and to identify the most prevalent species of the Actinomyces genus in endodontic lesions (secondary outcome). A total of 11 studies were included in the qualitative and quantitative analysis, and a total of 331 samples were analyzed. Bacteria of the genus Actinomyces were found in 58 samples, and 46 bacterial genera were detected in association with bacteria of the genus Actinomyces. Bacteria of the genus Streptococcus and Propionibacterium were those most frequently associated with Actinomyces in the endodontic lesions considered, and Actinomyces israelii was the most frequently involved species.

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Study protocol for a network meta-analysis of digital-technology-based psychotherapies for PTSD in adults

BMJ Open ◽

10.1136/bmjopen-2020-038951 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038951

Author(s):

Longtao He ◽

Yanling Geng ◽

Yangu Pan ◽

Jinhui Tian ◽

Xinyu He ◽

...

Keyword(s):

Sensitivity Analysis ◽

Outcome Measures ◽

Digital Technology ◽

Meta Analysis ◽

Relative Effectiveness ◽

Dropout Rate ◽

Evaluation Framework ◽

Biomedical Literature ◽

Cochrane Library ◽

Secondary Outcome

IntroductionStudies on various types of digital-technology-based psychotherapies (DTPs) have indicated that they are effective for post-traumatic stress disorder (PTSD) symptom relief among adults. The intervention efficacy or effectiveness hierarchy, however, is still not clear. Therefore, we propose to conduct a network meta-analysis to assess the relative effectiveness of various types of DTPs. We aim to establish the differential effectiveness of these therapies in terms of symptom reduction and provide high-quality evidence for treating PTSD.Methods and analysesWe will search Embase, CINAHL, MEDLINE, HealthSTAR, the Cochrane Library, PsycINFO, PubMed, the Chinese Biomedical Literature Database, clinical trials (eg, ClinicalTrials.gov) and other academic platforms for relevant studies, mainly in English and Chinese (as we plan to conduct a trial on PTSD patients in Wuhan, China, based on the results of this network meta-analysis), from inception to October 2020. Randomised controlled trials (RCTs) and meta-analyses investigating the effectiveness of any DTPs for PTSD patients for any controlled condition will be included. The number of intervention sessions and the research duration are unlimited; the effects for different durations will be tested via sensitivity analysis. For this project, the primary measure of outcome will be PTSD symptoms at the end of treatment using raw scores for one widely used PTSD scale, PCL-5. Secondary outcome measures will include (1) dropout rate; (2) effectiveness at longest follow-up, but not more than 12 months and (3) patients’ functional recovery ratio (such as the return-to-work ratio or percentage of sick leave). Bayesian network meta-analysis will be conducted for all relative outcome measures. We will perform subgroup analysis and sensitivity analysis to see whether the results are influenced by study characteristics. The Grading of Recommendations, Assessments, Development, and Evaluation framework will be adopted to evaluate the quality of evidence contributing to network estimates of the primary outcome.Ethics and disseminationThe researchers of the primary trials already have had ethical approval for the data used in our study. We will present the results of this meta-analysis at academic conferences and publish them in peer-reviewed journals.PROSPERO registration numberCRD42020173253.

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Role of Preoperative Calcium and Vitamin D Therapy to prevent Post-thyroidectomy Hypocalcemia

10.21203/rs.3.rs-126282/v1 ◽

2020 ◽

Author(s):

Sunghwan suh ◽

Ju Won Seok ◽

Keunyoung Kim ◽

Mi Kyoung Park ◽

Kyoungjune Pak ◽

...

Keyword(s):

Vitamin D ◽

English Language ◽

Primary Outcome ◽

Potential Role ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Secondary Outcome ◽

Significant Difference ◽

Symptomatic Hypocalcemia

Abstract Purpose: Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia. Materials and Methods: We searched MEDLINE and EMBASE for English-language publications using the keywords “calcium”, “vitamin D”, and “thyroid cancer”. The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia. Results: Four studies that included 381 patients were eligible for this meta-analysis. The random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. The occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In combined results, preoperative calcium and vitamin D supplementation was associated with a reduced incidence of symptomatic hypocalcemia.Conclusion: We support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

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Surface Alterations Induced on Endodontic Instruments by Sterilization Processes, Analyzed with Atomic Force Microscopy: A Systematic Review

Applied Sciences ◽

10.3390/app9224948 ◽

2019 ◽

Vol 9 (22) ◽

pp. 4948 ◽

Cited By ~ 1

Author(s):

Mario Dioguardi ◽

Vito Crincoli ◽

Luigi Laino ◽

Mario Alovisi ◽

Enrica Laneve ◽

...

Keyword(s):

Atomic Force Microscopy ◽

Primary Outcome ◽

Meta Analysis ◽

Surface Characteristics ◽

Cyclic Fatigue ◽

Secondary Outcome ◽

Eligibility Criteria ◽

Force Microscopy ◽

Atomic Force ◽

Surface Alteration

Endodontic canal disinfection procedures that use sodium hypochlorite, and subsequently, heat sterilization procedures can alter the surface of endodontic instruments, described as corrosion and micropitting. These phenomena can be visualized on the surface of the instruments by SEM and atomic force microscopy analyses. The endodontic instruments used in probing, pre-enlargement, and shaping phases are made of steel alloy or nickel-titanium alloy (NiTi) and are subject to torsional, flexor, and cyclic fatigue; indeed, reuse of these instruments must be done with the knowledge that these instruments are subject to fracture following stress caused during their use. Fracture of the instrument within the canal is an eventuality that can lead to failure of the treatment, and therefore it is important to try to reduce situations that can contribute to the fracture. This review was performed based on the PRISMA protocol. Studies were identified through bibliographic research using electronic databases. A total of 1036 records were identified on the PubMed and Scopus databases. After screening the articles, restricted by year of publication (1979 to 2019), there were 946 records. With the application of the eligibility criteria (all the articles pertaining to the issue of sterilization in endodontics), there were 228 articles. There were 104 articles after eliminating overlaps. There were 50 articles that discussed the influence of sterilization procedures on the surface characteristics of endodontic instruments, and 26 articles that measured parameters on surface alteration. Applying the inclusion and exclusion criteria resulted in a total of eleven articles for quantitative analysis. Four articles were in reference to the primary outcome, eight articles to secondary outcome, and five articles to tertiary outcome. The meta-analysis showed a statistically significant surface alteration effect after five autoclaves and after immersion in the canal irrigants after 10 min.

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

BMC Ophthalmology ◽

10.1186/s12886-019-1271-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 6

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract Background The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH). Methods Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power. Results This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86). Conclusion Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

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Defining the role of the condylar–C2 sagittal vertical alignment in Chiari malformation type I

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.4.peds20113 ◽

2020 ◽

Vol 26 (4) ◽

pp. 439-444

Author(s):

Vijay M. Ravindra ◽

Rajiv R. Iyer ◽

Al-Wala Awad ◽

Robert J. Bollo ◽

Huirong Zhu ◽

...

Keyword(s):

Chiari Malformation ◽

Primary Outcome ◽

Group Versus ◽

Secondary Outcome ◽

Rank Test ◽

Upper Cervical Spine ◽

Type I ◽

Occipitocervical Fusion ◽

Chiari Malformation Type I ◽

Significant Difference

OBJECTIVEThe authors’ objective was to better understand the anatomical load-bearing relationship between the atlantooccipital joint and the upper cervical spine and its influence on the clinical behavior of patients with Chiari malformation type I (CM-I) and craniocervical pathology.METHODSIn a single-center prospective study of patients younger than 18 years with CM-I from 2015 through 2017 (mean age 9.91 years), the authors measured the occipital condyle–C2 sagittal vertebral alignment (C–C2SVA; defined as the position of a plumb line from the midpoint of the occiput (C0)–C1 joint relative to the posterior aspect of the C2–3 disc space), the pB–C2 (a line perpendicular to a line from the basion to the posteroinferior aspect of the C2 body on sagittal MRI), and the CXA (clivoaxial angle). Control data from 30 patients without CM-I (mean age 8.97 years) were used for comparison. The primary outcome was the need for anterior odontoid resection and/or occipitocervical fusion with or without odontoid reduction. The secondary outcome was the need for two or more Chiari-related operations.RESULTSOf the 60 consecutive patients with CM-I identified, 7 underwent anterior odontoid resection or occipitocervical fusion and 10 underwent ≥ 2 decompressive procedures. The mean C–C2SVA was greater in the overall CM-I group versus controls (3.68 vs 0.13 mm, p < 0.0001), as was the pB–C2 (7.7 vs 6.4 mm, p = 0.0092); the CXA was smaller (136° vs 148°, p < 0.0001). A C–C2SVA ≥ 5 mm was found in 35% of CM-I children and 3.3% of controls (p = 0.0006). The sensitivities and specificities for requiring ventral decompression/occipitocervical fusion were 100% and 74%, respectively, for C–C2SVA ≥ 5 mm; 71% and 94%, respectively, for CXA < 125°; and 71% and 75%, respectively, for pB–C2 ≥ 9 mm. The sensitivities and specificities for the need for ≥ 2 decompressive procedures were 60% and 70%, respectively, for C–C2SVA ≥ 5 mm; 50% and 94%, respectively, for CXA < 125°; and 60% and 76%, respectively, for pB–C2 ≥ 9 mm. The log-rank test demonstrated significant differences between C–C2SVA groups (p = 0.0007) for the primary outcome. A kappa value of 0.73 for C–C2SVA between raters indicated substantial agreement.CONCLUSIONSA novel screening measurement for craniocervical bony relationships, the C–C2SVA, is described. A significant difference in C–C2SVA between CM-I patients and controls was found. A C–C2SVA ≥ 5 mm is highly predictive of the need for occipitocervical fusion/ventral decompression in patients with CM-I. Further validation of this screening measurement is needed.

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DOES PRESENCE OF DOWN SYNDROME INCREASE RESPIRATORY SYNCYTIAL VIRUS (RSV) RELATED HOSPITALIZATION IN CHILDREN LESS THAN 2 YEARS OF AGE? A SYSTEMATIC REVIEW AND META-ANALYSIS

Paediatrics & Child Health ◽

10.1093/pch/pxy054.116 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e45-e46

Author(s):

Souvik Mitra ◽

Helen McCord ◽

Mohamed El Azrak ◽

Bosco Paes

Keyword(s):

Systematic Review ◽

Sensitivity Analysis ◽

Hospital Stay ◽

Congenital Heart ◽

Primary Outcome ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Assisted Ventilation ◽

Inclusion Criteria ◽

Syncytial Virus

Abstract BACKGROUND Down syndrome (DS) is associated with a number of immunologic abnormalities and congenital heart disease (CHD) which increase susceptibility to respiratory syncytial virus (RSV). However current position statements from the American Academy of Pediatrics and the Canadian Paediatric Society do not recommend routine RSV prophylaxis with Palivizumab to all infants with DS, OBJECTIVES To conduct a systematic reviewand meta-analysis of observational studies to compare RSV-related hospitalization (RSVH) rates, length of hospital stay(LOS), need for intensive care and assisted ventilation in DS children <2 years of age compared with children without DS. DESIGN/METHODS Data Sources: The authors searched MEDLINE, Embase, CINAHL, reference lists of relevant articles, abstracts and conference proceedings, results of unpublished trials, and contacted the primary authors of relevant studies. Studies were included if data was provided on RSV-related hospitalization in children <2yr of age with and without DS. Data extraction & Synthesis: Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. Data was extracted and checked in duplicate. Main outcomes & measures: The primary outcome was RSV-related hospitalization. Secondary outcomes included length of hospital stay, need for intensive care and assisted ventilation. Sensitivity analysis was conducted for the primary outcome comparing DS infants without congenital heart disease (CHD) with non-DS infants. RESULTS 19 cohort studies met the inclusion criteria. Ten studies involving 1,390,380 children were analyzed. DS-children had significantly higher RSVH compared to non-DS children (Relative Risk, 6.97; 95% CI, 6.01 to 8.08; I2=0%; Figure 1a). Among children hospitalized with RSV, need for assisted ventilation (RR, 5.82; 95% CI, 1.81 to 18.69; I2=84%; Figure 1b) and LOS (Mean difference, 2.28 days; 95% CI, 1.61 to 2.96 days; I2=0%; Figure 1c) were significantly higher in DS-children. The sensitivity analysis also confirmed that DS children without CHD had a significantly higher RSVH rate compared to non-DS children (RR, 6.31; 95% CI, 4.83 to 8.23;I2=0%; Figure 1d). CONCLUSION Compared to children without DS, RSV-related hospitalization, need for assisted ventilation and length of RSV-related hospital stay is significantly higher in children with DS in the first 2 years of life. The results of this systematic review should prompt a favorable recommendation for routine RSV prophylaxis in both healthy and medically compromised DS children aged <2years.

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