Meta-analysis reveals protective effects of vitamin B on stroke patients

AbstractStroke is the loss of brain function due to a disturbance in the blood supply to the brain resulting from either ischemia or hemorrhage. Previous studies have evaluated the clinical importance of nutritional interventions such as vitamin B supplementation in the management of acute strokes. However, it is still inconclusive whether or not vitamin B supplementation will benefit patients with acute strokes. Therefore, a meta-analysis was performed to assess the efficacy of vitamin B supplementation in the treatment of stroke patients. Medline, Embase, Scopus, and Cochrane Library databases were searched (from 1960 to June 2015) and forest plots were generated to illustrate the treatment effects. A systemic review of the electronic databases yielded 12 eligible studies consisting of 7474 patients. Forest plots from the meta-analyses of the included studies illustrated that vitamin B supplementation significantly lowered the plasma concentration of total homocysteine (SMD = -0.82; 95% CI: -0.77; Z = -29.06, p < 0.0001) and resulted in significant reduction in stroke recurrence (OR = 0.86%; 95% CI: 0.76, 0.97; Z = -2.41; p = 0.016) as well as a combined incidence of vascular events, including recurrent strokes, myocardial infarctions and vascular deaths (OR = 0.87%; 95% CI: 0.79, 0.96; Z= -2.73; p = 0.0063). Additionally, the nearly-symmetrical funnel plot (Egger’s test, t = −1.705, p = 0.1224) indicated the absence of publication bias regarding the meta-analysis that examined the effect of vitamin B supplementation on the plasma levels of homocysteine in acute stroke patients. These findings suggested that vitamin B supplementation presents a potential addition to the armamentarium for the management of acute stroke patients.

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Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000510751 ◽

2020 ◽

Vol 49 (5) ◽

pp. 531-539

Author(s):

Shogo Shima ◽

Yasunari Niimi ◽

Yosuke Moteki ◽

Osamu Takahashi ◽

Shinsuke Sato ◽

...

Keyword(s):

Systematic Review ◽

Hospital Mortality ◽

Hospital Stay ◽

Acute Stroke ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Cochrane Library ◽

Inclusion Criteria ◽

Stroke Patients

Objective: Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. Results: Of 835 studies, 15 studies met the inclusion criteria (n = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). Conclusions: The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

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The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

Healthcare ◽

10.3390/healthcare9121764 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1764

Author(s):

Seoyon Yang ◽

Yoo Jin Choo ◽

Min Cheol Chang

Keyword(s):

Acute Stroke ◽

Meta Analysis ◽

Cochrane Library ◽

Inclusion Criteria ◽

Preventive Effect ◽

Stroke Patients ◽

Early Screening ◽

Funnel Plot ◽

Significant Difference

(1) Background: Dysphagia is common in acute stroke patients and is a major risk factor for aspiration pneumonia. We investigated whether the early detection of dysphagia in stroke patients through screening could prevent the development of pneumonia and reduce mortality; (2) Methods: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published up to November 2021. We included studies that performed dysphagia screening in acute stroke patients and evaluated whether it could prevent pneumonia and reduce mortality rates. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool, and publication bias was evaluated by the funnel plot and Egger’s test; (3) Results: Of the 6593 identified studies, six studies met the inclusion criteria for analysis. The screening group had a significantly lower incidence of pneumonia than the nonscreening group did (odds ratio (OR), 0.60; 95% confidence interval (CI), 0.42 to 0.84; p = 0.003; I2, 66%). There was no significant difference in mortality rate between the two groups (OR, 0.61; 95% CI, 0.33 to 1.13; p = 0.11; I2, 93%); (4) Conclusions: Early screening for dysphagia in acute stroke patients can prevent the development of pneumonia.

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Micro-embolic signal monitoring in stroke subtypes: A systematic review and meta-analysis of 58 studies

European Stroke Journal ◽

10.1177/23969873211060819 ◽

2021 ◽

pp. 239698732110608

Author(s):

Pachipala Sudheer ◽

Shubham Misra ◽

Manabesh Nath ◽

Pradeep Kumar ◽

Deepti Vibha ◽

...

Keyword(s):

Systematic Review ◽

Cerebral Ischemia ◽

Acute Stroke ◽

Functional Outcome ◽

Meta Analysis ◽

Cochrane Library ◽

Stroke Recurrence ◽

Stroke Subtypes ◽

Pooled Prevalence ◽

New Onset

Introduction Micro-embolic signals (MESs) detected using transcranial Doppler (TCD) help in risk stratification in stroke patients. A systematic review and meta-analysis were performed to estimate the prevalence of MES and its association with stroke recurrence, functional outcome, and mortality in different stroke subtypes. Methods A comprehensive literature search was conducted before 26th January 2021 in PubMed, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov . Studies were identified that used TCD to detect MES in stroke/TIA patients. Pooled prevalence and odds ratio (OR) along with 95% confidence interval (95% CI) were calculated for different outcome measures. The entire statistical analysis was conducted in R version 3.6.2. Findings Fifty-eight studies involving 5123 patients (1329 MES+, 3794 MES−) were included in our meta-analysis. The pooled prevalence of MES among all acute stroke/TIA patients was 30% (95% CI 25-34%). The pooled prevalence adjusted after the trim-and-fill analysis among all acute stroke/TIA patients was 18% (95% CI 14-23%). The prevalence of MES was high among all stroke subtypes except in patients with small vessel disease (SVD). In patients with new-onset stroke/TIA, the presence of MES was associated with a high risk of recurrence of cerebral ischemia (OR 4.03; 95% CI 2.38-6.82). Although no significant association was observed for the presence of MES with increased mortality (OR 2.37; 95% CI 0.75-7.50) and poor functional outcome (OR 2.11; 95% CI 0.20-22.50) among patients with new-onset stroke/TIA, this could only be determined in a smaller sample size of 477 patients. Conclusions Our meta-analysis showed a 30% prevalence of MES following acute stroke/TIA. The presence of MES increased the chance of recurrence of cerebral ischemia but was not associated with poor functional outcomes and mortality in the studied subgroup.

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Acupuncture Efficacy on Acute Stroke Patients: A Meta-analysis

Rehabilitation Medicine ◽

10.3724/sp.j.1329.2018.03062 ◽

2018 ◽

Vol 28 (3) ◽

pp. 62

Author(s):

Jiaqing LIU ◽

Tongyan LIU ◽

Yun XIANG ◽

Ning ZHAO ◽

Hong ZHANG

Keyword(s):

Acute Stroke ◽

Meta Analysis ◽

Stroke Patients

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Benefits and safety of transdermal glyceryl trinitrate in acute stroke: a systematic review and meta-analysis of randomised trials (protocol)

BMJ Open ◽

10.1136/bmjopen-2020-043591 ◽

2021 ◽

Vol 11 (1) ◽

pp. e043591

Author(s):

Beng Leong Lim ◽

Wei Feng Lee ◽

Wei Ming Ng ◽

Wei Ling Tay ◽

Wui Ling Chan

Keyword(s):

Systematic Review ◽

Ischaemic Stroke ◽

Glyceryl Trinitrate ◽

Acute Stroke ◽

Meta Analysis ◽

Cochrane Review ◽

Cochrane Library ◽

Placebo Control ◽

Randomised Trials ◽

Patient Subgroup

IntroductionHigh blood pressure (BP) in acute stroke has adverse outcomes. Transdermal glyceryl trinitrate (GTN) has beneficial properties in controlling BP. The 2016 meta-analysis and 2017 Cochrane review showed that transdermal GTN was beneficial in a small patient subgroup with stroke onset ≤6 hours. Larger studies focusing on this patient subgroup have since been conducted. We report the protocol for an updated systematic review and meta-analysis on the safety and benefits of transdermal GTN in acute stroke.Methods and analysisWe will search Medline, Pubmed, Embase, CINAHL and Cochrane Library from inception until June 2020 for randomised trials that report the efficacy and safety of transdermal GTN versus placebo/control therapy among adult patients with acute stroke. Primary outcomes include in-hospital mortality, BP lowering and late functional status. Secondary outcomes include early, late, resource utilisation and surrogate outcomes. Safety outcomes include reported adverse events. Reviewers will first screen titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, they will extract data, assess risk of bias (RoB) using a modified Cochrane RoB tool and quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Disagreement will be resolved by discussion and consultation with an external reviewer if necessary. Using a random-effects model, we will report effect sizes using relative risks and 95% CIs. We will perform predefined subgroup analyses: intracerebral haemorrhage versus ischaemic stroke; minor (NIHSS (National Institutes of Health Stroke Scale) ≤five) versus major (NIHSS >five) ischaemic stroke; ischaemic stroke with versus without thrombolysis; prehospital versus non-prehospital settings; time from stroke to randomisation ≤6 versus >6 hours and high versus low overall RoB studies. We will also perform trial sequential analysis for the primary outcomes.Ethics and disseminationEthics board approval is unnecessary. PROSPERO registration has been obtained. The results will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020173093.

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Effects of Early Hypertension Control after Ischaemic Stroke on the Outcome: A Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000441097 ◽

2015 ◽

Vol 40 (5-6) ◽

pp. 270-278 ◽

Cited By ~ 10

Author(s):

Shuping Liu ◽

Chengyan Li ◽

Tao Li ◽

Jing Xiong ◽

Xueqing Zhao

Keyword(s):

Ischaemic Stroke ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Good Choice ◽

Stroke Recurrence ◽

Hypertension Control ◽

Vascular Events ◽

Haemorrhagic Transformation ◽

Review Manager

Background: Accumulating evidence suggests that high blood pressure (BP) increases the risk of cerebral oedema and haemorrhagic transformation of the ischaemic stroke (IS), and that low BP in acute ischaemic stroke (AIS) is associated with a poor prognosis. The best possible management of hypertension after AIS is still uncertain. Materials and Methods: English databases were searched to identify relevant randomized controlled trials assessing the effects of early BP lowering (started within the first 48 h) after IS on outcome from January 1990 to August 2015. We set strict inclusion criteria and used the Review Manager 5.2 software from Cochrane Collaboration to calculate the combined risk ratio (RR). Result: Eight studies met our criteria. Early BP lowering after AIS did not significantly affect the risk of early and long-term death (RR 1.22; 95% CI 0.69-2.16 and RR 1.03; 95% CI 0.62-1.71), early and long-term dependency (RR 1.02; 95% CI 0.94-1.10 and RR 1.07; 95% CI 0.84-1.36), early and long-term death or dependency (RR 1.04; 95% CI 0.94-1.19 and RR 1.00; 95% CI 0.95-1.05), long-term stroke recurrence (RR 0.74; 95% CI 0.49-1.11), long-term myocardial infarction (RR 0.99; 95% CI 0.27-3.61), and long-term vascular events (RR 0.97; 95% CI 0.72-1.31). Conclusion: Our results revealed neither support nor opposition to early BP lowering (started within 48 h) after AIS; individualized BP management based on the patients' condition may be a good choice.

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Abstract P391: Marine N-3 Fatty Acids Reduce Atherosclerosis Cardiovascular Disease: A Systemic Review and Meta-analysis of Clinical Trials

Circulation ◽

10.1161/circ.127.suppl_12.ap391 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Akira Sekikawa ◽

Nobutake Hirooka ◽

Abhishek Vishnu ◽

Vashudha Ahuja ◽

Emmanuel Sampene ◽

...

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Imaging Techniques ◽

Meta Analysis ◽

Quantitative Information ◽

Systemic Review ◽

Cochrane Library ◽

Cardiac Imaging Techniques

Introduction: Although marine n-3 fatty acids are believed to be cardioprotective through their anti-arrhythmic, anti-thrombotic, anti-atherogenic and other effects, results from recent meta-analyses of marine n-3 fatty acids on cardiovascular disease (CVD) are controversial. We performed a meta-analysis of marine n-3 fatty acids on CVD outcomes in randomized clinical trials (RCTs) to test the hypothesis that marine n-3 fatty acids are anti-atherogenic. We also tested the hypothesis that such benefit is dose-dependent. Methods: A systematic review of English language articles using PubMed, EMBASE and Cochrane Library through Aug 2012 was performed selecting RCTs evaluating the effect of marine n-3 fatty acids intake for 2 years or more on cardiovascular diseases, coronary disease, arteriosclerosis, cardiac imaging techniques, and carotid artery ultrasound. Descriptive and quantitative information was extracted. Odds ratios were calculated for cardiac event outcome. Correlation coefficients were obtained from studies of which outcome is intima-media thickness (IMT) and coronary lumen diameter (CD). We converted the estimates into a single effect size; the log odds ratio and its corresponding standard error. Results: Of 14,236 citations retrieved, 13 studies were selected, including studies reporting IMT (n=3) and CD (n=2) and major CVD events (n=8). Overall, marine n-3 fatty acids significantly reduced atherosclerotic CVD (RR 0.94: 95%CI 0.90 to 0.99, p<0.05). There was no evidence of heterogeneity (p=0.65) or publication bias (p=0.37, Begg’s test). A sub-analysis among 8 studies of major CVD events showed the similar results (RR 0.94: 95% CI 0.89 to 0.99, p<0.05). Another sub-analysis among 4 studies excluding sudden cardiac death as an outcome showed RR of 0.91 (95% CI 0.82 to 1.02, p=0.097). A meta-regression analysis shows that dose of marine n-3 fatty acids was inversely associated with CVD outcome, although the association was not statistically significant (p=0.06). Conclusions: The result of our meta-analysis supports a modest anti-atherogenic effect of marine n-3 fatty acids. This benefit may be proportional to the amount of marine n-3 fatty acids consumed.

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Prevalence of pneumonia and its associated factors among under five children in East Africa. Meta-analysis and systemic review

10.21203/rs.2.23015/v1 ◽

2020 ◽

Author(s):

Biruk Beletew Abate ◽

Melaku Getahun Bimrew ◽

Ayelign Mengesha Kasie ◽

Mesfin Kassaw Wudu ◽

Molla Azmeraw

Keyword(s):

East Africa ◽

Associated Factors ◽

Meta Analysis ◽

Eastern Africa ◽

Systemic Review ◽

Cochrane Library ◽

Under Five ◽

Under Five Children ◽

The Impact ◽

National Prevalence

Abstract Introduction Pneumonia is defined as an acute inflammation of the Lungs’ parenchymal structure. It is a major public health problem and the leading cause of morbidity and mortality in under-five children especially in developing countries. In 2015, it was estimated that about 102 million cases of pneumonia occurred in under-five children, of which 0.7 million were end up with death. Different primary studies in Eastern Africa showed the burden of pneumonia. However, inconsistency among those studies was seen and no review has been conducted to report the amalgamated magnitude and associated factors. Therefore, this review aimed to estimate the national prevalence and associated factors of neonatal sepsis in Eastern Africa. Objective The aim of this systematic review and meta-analysis was to assess the magnitude of pneumonia and its associated factors among under-five children in East Africa. Methods Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of pneumonia from PubMed, Cochrane library, and Google Scholar. Heterogeneity across the studies was evaluated using the Q and the I 2 test. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by country, study design, and year of publication. A funnel plot and Egger’s regression test were used to see publication bias. Sensitivity analysis was also done to identify the impact of studies. Result A total of 34 studies with 87, 984 participants were used for analysis. The pooled prevalence of hypothermia in East Africa was 34% (95%CI; 23.80–44.21). Use of wood as fuel source (AOR= 1.53; 95%CI:1.30-1.77; I 2 = 0.0% ;P=0.465), cook food in living room (AOR= 1.47;95%CI:1.16-1.79; I 2 = 0.0% ;P=0.58), caring of a child on mother during cooking (AOR= 3.26; 95%CI:1.80-4.72; I 2 = 22.5% ;P=0.26), Being unvaccinated (AOR= 2.41; 95%CI:2.00-2.81; I 2 = 51.4% ;P=0.055), Child history of ARTI(AOR= 2.62; 95%CI:1.68-3.56; I 2 = 11.7% ;P=0.337) were identified factors of pneumonia. Conclusions The prevalence of pneumonia in Eastern Africa remains high. This review will help policy-makers and program officers to design pneumonia preventive interventions.

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The safety and efficacy of SDLT-2 (Sodium-glucose co-transporter 2) inhibitor versus placebo in the treatment of heart failure in patients with or without T2DM (Type 2 diabetes mellitus): A Systemic Review and Meta-analysis.

10.21203/rs.3.rs-16652/v1 ◽

2020 ◽

Author(s):

Qian Zhang ◽

Xiaofei Wang ◽

Peipei Ge ◽

Aizhen Hu ◽

Xuexun Li

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Sglt2 Inhibitor ◽

Systemic Review ◽

Cochrane Library ◽

Volume Depletion ◽

Patients With Heart Failure ◽

Safety Outcomes

Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitor which is a type of drug used for the treatment of diabetes mellitus, has been reported by many trials that it could be beneficial for patients with established heart failure. A meta-analysis on this subject could obtain more reliable estimates of the efficacy and safety outcomes. Methods A systematic review and meta-analysis of randomized, placebo-controlled trials of SGLT2 inhibitor in patients with heart failure was conducted. We searched PubMed, Cochrane Library, and Web of Science for trials published from inception to March, 2018. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to conduct the review. For quality assessment of included studies. The methodological quality of the included trials was assessed using the Cochrane tool for assessing randomized clinical trials (RCT). Efficacy outcomes included hospitalization for heart failure and all-cause death. Safety outcomes consisted of serious adverse event (SAE) and volume depletion. Results We included data from 5 identified studies and 8775 patients (aged 64.9, female 29.8%). A total of 3930 (44.8%) patients were known to have diabetes mellitus. Compared with placebo, SGLT2 inhibitor decrease the incidence of hospitalization for heart failure (RR 0.692; 95%CI, 0.611-0.784 P<0.001), and all-cause death (RR 0.824; 95%CI, 0.736-0.922 P=0.001). The incidence of SAE in patients with a treatment of SGLT2 inhibitor was low (RR 0.869; 95%CI, 0.779-0.970 P=0.012). SGLT2 inhibitor didn’t increase the incidence of volume depletion (RR1.165, 95%CI, 0.977-1.390 P=0.089). Conclusion Our results confirm that SGLT2 inhibitor is effective and safe for patients with heart failure regardless of presence of diabetes mellitus.

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The Role of L-ornithine-L-aspartate in the Management of Minimal Hepatic Encephalopathy among Patients with Liver cirrhosis: a Systemic review and Meta-analysis

Acta Medica Philippina ◽

10.47895/amp.v52i1.487 ◽

2018 ◽

Vol 52 (1) ◽

Author(s):

Henry Winston C. Li ◽

Maria Ana Louise M. Naidas ◽

Karen Anjela M. Mondragon ◽

Ruter M. Maralit

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Meta Analysis ◽

Block Design ◽

Cochrane Collaboration ◽

Minimal Hepatic Encephalopathy ◽

Systemic Review ◽

Cochrane Library ◽

P Value ◽

Picture Completion

Objective. To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) in improving minimal hepatic encephalopathy in adult patients with liver cirrhosis. Methods. A search in PubMed, Cochrane Library, Google Scholar, and Medline was made obtaining four qualified randomized controlled trials. Studies included adult cirrhotic patients with minimal hepatic encephalopathy measured by the number connection test (NCT-A, B), figure connection test (FCT-A, B), picture completion, block design test, and critical flicker frequency (CFF) testing with a cut-off score of <39Hz. Methodologic assessment of studies was performed using Cochrane Collaboration Risk of Bias Tool and Review Manager (RevMan) version 5.3 for statistical analysis. Results. Of the 29 studies identified, 4 fulfilled the inclusion criteria, which entailed analysis of 238 participants (LOLA: 116, Control: 122). Three out of the four studies were used in meta-analysis and one study was analyzed separately due to a difference in the neuropsychometric measure. The metaanalysis favored experimental group (LOLA), with a mean difference of 2.29 (95% CI 0.72 – 3.86), p-value = 0.004, and an I2 of 18%. Conclusion. LOLA provided great potential in managing encephalopathy since treating earlier related to better survival and prevention of disease progression. The results of our study supported such evidence and its use may be encouraged.

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