Prevalence of Depressive Symptoms Among University Students in Pakistan: A Systematic Review and Meta-Analysis

Background: In Pakistan, almost 30% population is between 15 to 29 years of age, with university enrollment rates of 10–15%. Although there is a growing concern on mental health of university students across the globe, studies from low and middle income countries such as Pakistan are scarce. We conducted a systematic review and meta-analysis of prevalence of depressive symptoms among Pakistani university students.Methods: PubMed, Web of Science, PsycInfo and Google Scholar were searched between 15 to 30th January 2020. Cross-sectional and longitudinal studies, published till 31st December 2019 were included. Data on study characteristics and prevalence of depressive symptoms were extracted. Meta-analysis was conducted using random effects models. To estimate subgroup difference based on study characteristics, meta-regression and sub-group analyses were conducted.Results: In total, 26 studies involving 7,652 participants were included in review. Overall prevalence of depressive symptoms was 42.66% (95% CI: 34.82% to 50.89%), with significant heterogeneity among studies. Subgroup analyses revealed a significant difference in prevalence estimates based on depression screening instrument and study major. Statistically significant differences were observed among studies employing different psychometric scales (test for subgroup differences, Q = 21.92, p < 0.05) and between students from different study majors (test for subgroup differences, Q = 3.76, p = 0.05).Conclusion: Our study found that overall prevalence of depressive symptoms among university students in Pakistan was 42.66%, however, findings should be interpreted with caution. Large scale epidemiological surveys using valid and reliable tools are needed to better estimate prevalence of depression among Pakistani university students.

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The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis

Parasites & Vectors ◽

10.1186/s13071-021-04792-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Aongart Mahittikorn ◽

Frederick Ramirez Masangkay ◽

Kwuntida Uthaisar Kotepui ◽

Giovanni De Jesus Milanez ◽

Manas Kotepui

Keyword(s):

Systematic Review ◽

Mixed Infection ◽

Subgroup Analysis ◽

Initial Treatment ◽

Meta Analysis ◽

Antimalarial Drugs ◽

Secondary Outcome ◽

Significant Heterogeneity ◽

Pooled Prevalence ◽

Significant Difference

Abstract Background Malaria mixed infections are often unrecognized by microscopists in the hospitals, and a delay or failure to treat Plasmodium-mixed infection may lead to aggravated morbidity and increased mortality. The present study aimed to quantify the pooled proportion and risk of malarial recurrences after the treatment of Plasmodium-mixed infection. The results of the study may provide benefits in the management of Plasmodium-mixed infection in co-endemic regions. Methods This systematic review and meta-analysis searched the international Prospective Register of Systematic Reviews (PROSPERO; ID = CRD42020199709), MEDLINE, Web of Science, and Scopus for potentially relevant studies in any language published between January 1, 1936, and July 20, 2020, assessing drug efficacy in patients with Plasmodium-mixed infection. The primary outcome was the pooled prevalence of Plasmodium parasitemia after initiating antimalarial treatment for Plasmodium-mixed infection. The secondary outcome was the pooled risk ratio (RR) of malarial recurrence in Plasmodium-mixed infection compared with those in Plasmodium falciparum and Plasmodium vivax mono-infection. The pooled analyses were calculated by random-effects meta-analysis. After the initial treatment in different days of recurrences (≤ 28 days or > 28 days), the risk of Plasmodium parasitemia was compared in subgroup analysis. Results Out of 5217 screened studies, 11 were included in the meta-analysis, including 4390 patients from six countries. The pooled prevalence of all recurrences of Plasmodium-mixed parasitemia was 30% (95% confidence interval (CI) 16–43; I2: 99.2%; 11 studies). The RR of malarial recurrence within 28 days after the initial treatment (clinical treatment failure) of Plasmodium-mixed parasitemia compared with the treatment of P. falciparum was 1.22 (p: 0.029; 95% CI 1.02–1.47; Cochran Q: 0.93; I2: 0%; six studies), while there was no significant difference in the risk of recurrence 28 days after initial treatment compared with the treatment of P. falciparum (p: 0.696, RR: 1.14; 95% CI 0.59–2.18; Cochran Q < 0.05; I2: 98.2%; four studies). The subgroup analysis of antimalarial drugs showed that significant malarial recurrence within 28 days was observed in patients treated with artemisinin-based combination therapies (ACTs) with no significant heterogeneity (p: 0.028, RR: 1.31; 95% CI 1.03–1.66; Cochran Q: 0.834; I2: 0%). Conclusions The present findings showed a high prevalence of malarial recurrence after the initial treatment of Plasmodium-mixed infection. Moreover, significant malaria recurrence of mixed infection occurred within 28 days after treatment with ACTs. Graphic Abstract

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The Incidence of Parkinson's Disease: A Systematic Review and Meta-Analysis

Neuroepidemiology ◽

10.1159/000445751 ◽

2016 ◽

Vol 46 (4) ◽

pp. 292-300 ◽

Cited By ~ 171

Author(s):

Lauren Hirsch ◽

Nathalie Jette ◽

Alexandra Frolkis ◽

Thomas Steeves ◽

Tamara Pringsheim

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neurodegenerative Disorder ◽

Meta Analysis ◽

Age Groups ◽

Significant Heterogeneity ◽

International Studies ◽

Significant Difference ◽

And Gender

Background: Parkinson's disease (PD) is a common neurodegenerative disorder. Epidemiological studies on the incidence of PD are important to better understand the risk factors for PD and determine the condition's natural history. Objective: This systematic review and meta-analysis examine the incidence of PD and its variation by age and gender. Methods: We searched MEDLINE and EMBASE for epidemiologic studies of PD from 2001 to 2014, as a previously published systematic review included studies published until 2001. Data were analyzed separately for age group and gender, and meta-regression was used to determine whether a significant difference was present between groups. Results: Twenty-seven studies were included in the analysis. Meta-analysis of international studies showed rising incidence with age in both men and women. Significant heterogeneity was observed in the 80+ group, which may be explained by methodological differences between studies. While males had a higher incidence of PD in all age groups, this difference was only statistically significant for those in the age range 60-69 and 70-79 (p < 0.05). Conclusion: PD incidence generally increases with age, although it may stabilize in those who are 80+.

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Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-017173 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017173 ◽

Cited By ~ 83

Author(s):

Jinghui Wang ◽

Xiaohang Wu ◽

Weiyi Lai ◽

Erping Long ◽

Xiayin Zhang ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Meta Analysis ◽

Significant Proportion ◽

Depression Scale ◽

Developed Countries ◽

Self Report ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Prevalence Of Depression

ObjectivesDepression and depressive symptoms are common mental disorders that have a considerable effect on patients’ health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaThe PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2tests and the I2statistic. The study protocol has been registered with PROSPERO under number CRD42017054738.ResultsEighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ2=25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%).ConclusionOur study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.

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Pregnancy-related complications and incidence of atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽

10.1093/europace/euab116.145 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

T Al Bahhawi ◽

A Aqeeli ◽

S L Harrison ◽

D A Lane ◽

I Buchan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Cohort Studies ◽

Observational Studies ◽

Large Scale ◽

Data Extraction ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Random Effects Models ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Pregnancy-related complications have been previously associated with incident cardiovascular disease. However, data are scarce on the association between pregnancy-related complications and incident atrial fibrillation (AF). This systematic review examines associations between pregnancy-related complications and incident AF. Methods A systematic search of the literature utilising MEDLINE and EMBASE (Ovid) was conducted from 1990 to 6 April 2020. Observational studies examining the association between pregnancy-related complications including hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, low birth weight, small-for-gestational-age and stillbirth, and incidence of AF were included. Screening and data extraction were conducted independently by two reviewers. Inverse-variance random-effects models were used to pool hazard ratios. Results: Six observational studies met the inclusion criteria one case-control study and five retrospective cohort studies, with four studies eligible for meta-analysis. Sample sizes ranged from 1,839-1,303,365. Mean/median follow-up for the cohort studies ranged from 7-36 years. Most studies reported an increased risk of incident AF associated with pregnancy-related complications. The pooled summary statistic from four studies reflected a greater risk of incident AF for HDP (hazard ratio (HR) 1.47, 95% confidence intervals (CI) 1.18-1.84; I2 = 84%) and from three studies for pre-eclampsia (HR 1.71, 95% CI 1.41-2.06; I2 = 64%; Figure). Conclusions The results of this review suggest that pregnancy-related complications particularly pre-eclampsia appear to be associated with higher risk of incident AF. The small number of included studies and the significant heterogeneity in the pooled results suggest further large-scale prospective studies are required to confirm the association between pregnancy-related complications and AF. Abstract Figure.

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The Seroprevalence of SARS-CoV-2 in Europe: A Systematic Review

10.1101/2021.04.12.439425 ◽

2021 ◽

Author(s):

Natasha Marcella Vaselli ◽

Daniel Hungerford ◽

Ben Shenton ◽

Arwa Khashkhusha ◽

Nigel A. Cunliffe ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Age Groups ◽

Significant Heterogeneity ◽

Community Studies ◽

Past Infection ◽

Significant Difference ◽

The Impact

AbstractBackgroundA year following the onset of the COVID-19 pandemic, new infections and deaths continue to increase in Europe. Serological studies, through providing evidence of past infection, can aid understanding of the population dynamics of SARS-CoV-2 infection.ObjectivesThis systematic review of SARS-CoV-2 seroprevalence studies in Europe was undertaken to inform public health strategies including vaccination, that aim to accelerate population immunity.MethodsWe searched the databases Web of Science, MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews and grey literature sources for studies reporting seroprevalence of SARS-CoV-2 antibodies in Europe published between 01/12/2019 - 30/09/20. We provide a narrative synthesis of included studies. Studies were categorized into subgroups including healthcare workers (HCWs), community, outbreaks, pregnancy and children/school. Due to heterogeneity in other subgroups, we only performed a random effects meta-analysis of the seroprevalence amongst HCWs stratified by their country.Results109 studies were included spanning 17 European countries, that estimated the seroprevalence of SAR-CoV2 from samples obtained between November 2019 – August 2020. A total of 53/109 studies included HCWs with a reported seroprevalence among HCWs ranging from 0.7% to 45.3%, which did not differ significantly by country. In community studies significant heterogeneity was reported in the seroprevalence among different age groups and the majority of studies reported there was no significant difference by gender.ConclusionThis review demonstrates a wide heterogeneity in reported seroprevalence of SARS-CoV-2 antibodies between populations. Continued evaluation of seroprevalence is required to understand the impact of public health measures and inform interventions including vaccination programmes.

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Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-38054/v1 ◽

2020 ◽

Author(s):

Nan Hu ◽

Ke Xu ◽

Chao Gong ◽

Xizhen Xu

Keyword(s):

Systematic Review ◽

Tooth Loss ◽

Meta Analysis ◽

Cross Sectional ◽

Incident Hypertension ◽

Bidirectional Association ◽

Significant Difference ◽

Study Characteristics ◽

Cross Sectional Studies ◽

Oral Complication

Abstract Background: To investigate the bidirectional association between tooth loss and hypertensionMethods: PubMed, EMBASE, OVID were searched through May, 2020. Longitudinal and cross-sectional studies reporting the association between tooth loss and hypertension were included. We quantitatively analyzed the basic framework and study characteristics, and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included studies using random-effects meta-analysis.Results: This systematic review included sixteen studies involving about 188,000 participants. Quantitatively summarized results suggested, compared to individuals who have lost fewer than ten teeth, there was no significantly difference in the incidence of hypertension among participants who lost more than ten teeth (OR: 1.09, 95%CI: 0.93,1.28). Besides, there is no significant difference of incident hypertension between individuals who ever lost teeth and never lost teeth (OR:1.03, 95% CI: 0.85,1.25). There was a significant association between hypertension and incidence of tooth loss (OR: 1.33, 95% CI: 1.04,1.70). Subgroup analysis by study design, age, gender ratio and religion showed statistically significant association between hypertension and incidence of tooth loss in specific subgroups.Conclusions: This meta-analysis identified hypertension as a significantly risk factor of tooth loss while tooth loss was not an efficient predictor for incident hypertension. Considering the limited number of available researches and drawback of cross-sectional studies, more high-quality prospective studies of large sample sizes are needed to understand details of this bidirectional association. Since both tooth loss and hypertension are worldwide problems, our study provides new and comprehensive evidence for the prevention in oral complication of hypertensive patients.

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Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-048975 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048975

Author(s):

Huan Wang ◽

Jianxin Guo ◽

Tianze Wang ◽

Kai Wang ◽

Zhuojun Wu ◽

...

Keyword(s):

Systematic Review ◽

Large Scale ◽

Meta Analysis ◽

Progression Free Survival ◽

Optimal Dose ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Free Survival ◽

Significant Difference ◽

Clinical Centre

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.

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Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BMC Surgery ◽

10.1186/s12893-021-01461-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liping Gou ◽

Zhenghao Wang ◽

Ye Zhou ◽

Xiaofeng Zheng

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Operative Time ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Bladder Stones ◽

Randomized Controlled ◽

Significant Difference

Abstract Background A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS). Methods The PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement. Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups. Conclusions In conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

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Auricular Plaster Therapy for Comorbid Insomnia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/7120169 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17 ◽

Cited By ~ 2

Author(s):

Huimin Zhao ◽

Dan Li ◽

Ying Yang ◽

Yueting Liu ◽

Jie Li ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Large Scale ◽

Meta Analysis ◽

Effective Rate ◽

Sensitivity Analyses ◽

Controlled Trials ◽

Comorbid Insomnia ◽

Randomized Controlled ◽

Significant Difference

Background. Although the effectiveness of auricular plaster therapy (APT) on primary insomnia has been systematically reviewed, no systematic review of studies has focused on the effect on comorbid insomnia. Objective. To evaluate the efficacy and safety of APT for comorbid insomnia. Methods. Fifteen databases were searched from inception to July 2018. Randomized controlled trials (RCTs) of APT as an exclusive intervention for comorbid insomnia against Western medications, sham APT or no treatment were identified. Results. Fourteen studies involving 928 participants were identified. The pooled outcomes revealed that APT was superior to control conditions for the global score on PSQI (SMD = -1.13, and 95% CI = -1.48—-0.78) and the effective rate (RR = 1.24, 95% CI = 1.13—1.36, NNT = 5, and 95% CI =4—7). Furthermore, the results of subgroup analyses were similar to the pooled results. Additionally, the pooled results were verified to be stable by sensitivity analyses. Regarding safety, no significant difference was identified between APT and Western medications. Conclusions. APT appears to be an effective and safe treatment for comorbid insomnia. However, the benefits of APT for comorbid insomnia could not be ascertained due to the paucity of the quantity and quality of the included studies. Large-scale studies using proper methodology are needed to yield a firm conclusion.

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The Clinical Efficacy and Adverse Effects of Entecavir plus Thymosin alpha-1 Combination Therapy versus Entecavir Monotherapy in HBV-related Cirrhosis: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-17344/v2 ◽

2020 ◽

Author(s):

Dan Peng ◽

Hai-Yan Xing ◽

Chen Li ◽

Xian-Feng Wang ◽

Min Hou ◽

...

Keyword(s):

Systematic Review ◽

Combination Therapy ◽

Loss Rate ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Efficacy And Safety ◽

Significant Difference ◽

Thymosin Alpha 1

Abstract Background Previous studies have demonstrated the benefits of thymosin alpha-1 (Tα1) in anti-virus, immunological enhancement and anti-inflammation. However, it is controversial about the efficacy and safety of entecavir (ETV) plus T α1 combination therapy versus ETV monotherapy in cirrhotic patients with hepatitis B virus (HBV) infection. Methods The systematic review and meta-analysis of randomized clinical trials (RCTs) were performed to evaluate the efficacy and safety of ETV plus Tα1 combination therapy versus ETV monotherapy in HBV -related patients with cirrhosis. We performed a systematic literature search on seven databases. Relative risk (RR) and standardized mean difference (SMD) with a fixed- or random- effect model were calculated. Heterogeneity was assessed through a Cochrane Q-test and I 2 values. Results Seven RCTs involving 1144 subjects were included in the systematic review and meta-analysis. Compared with ETV monotherapy, ETV plus Tα1 combination therapy led to a higher complete response. In post treatment for 24 weeks, the HBV DNA undetectable rate and HBeAg loss rate were higher in ETV plus Tα1 group than in ETV alone group. However, after 48 and 52 weeks of treatment, there was no significant difference between the combination therapy and ETV monotherapy. At week 52 of treatment, the HBsAg loss rate of ETV plus Tα1 group was no significance with that of ETV alone group. In comparison with ETV alone, the some biochemical parameters and liver fibrosis were obviously improved by ETV plus Tα1 , and there was significant heterogeneity. In addition, the number of adverse events was significantly reduced by ETV plus Tα1, compared to ETV alone. Conclusions ETV plus Tα1 might lead to a higher clinical response and a lower comprehensive adverse reaction rate in HBV-related patients with cirrhosis, compared to ETV alone. However, the whole patients included in this meta-analysis were from Chinese mainland, so that more worldwide RCTs with a larger sample size are needed to verify the current findings.

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