Prevalence and burden of dengue infection in Europe: A systematic review and meta‐analysis

Imported dengue cases are thought to be important source for transmission of autochthonous dengue in Europe. We aimed to investigate the prevalence of dengue in Europe, its severity, and factors associated with it. Out of 5287 reports resulting from the search of nine electronic search engines, we included 174 reports. Meta‐analysis was performed by pooling the event rate and 95% confidence interval (CI). Subgroup meta‐analyses were performed to test the effect of the covariates. Among 20 284 reported cases, 130 autochthonous dengue cases were reported in eight countries with the highest number of cases reported in Israel (n = 41). The highest number of imported dengue cases was in Germany (n = 6638) then France (n = 6610). Most cases were imported from Southeast Asia (n = 2533) especially Thailand. Dengue infection cases increased with time, with 4157 cases reported in 2010. Second dengue infection and dengue serotype 2 were positively associated with dengue severity. The proportion of autochthonous dengue infection increased with time to reach 14.8% (95% CI, 7.6‐26.9) in 2015. The pooled proportion of severe dengue was 6.18% (95% CI, 2.7‐13.3). The United Kingdom and France had the highest rate of severe dengue (25%; 95% CI, 6.3‐62.3, and 21.4%; 95% CI, 24.5‐18.7, respectively). This change may be due to the surveillance efforts instead of true biological phenomenon; thus, the lack of surveillance is an obvious limitation. In conclusion, imported and autochthonous dengue has been increasing in Europe. Severe dengue began to increase recently in Europe. European health authorities should pay more attention for the diagnosis and control of dengue infection among returning travelers, especially the travelers with fever of unknown origin.     

Volatile organic compounds in asthma diagnosis: a systematic review and meta‐analysis

We aimed to assess the value and classification rate of exhaled volatile organic compounds (VOCs) in asthma diagnosis. A PRISMA‐oriented systematic search for published studies regarding exhaled VOCs in asthma diagnosis was conducted based on predefined criteria. Studies presenting sensitivity and specificity values for the test were included in the meta‐analysis. Pooled diagnosis odds ratios (DOR), area under the curve (AUC) and positive and negative likelihood ratios (LR) for exhaled VOC profiles were calculated; and publication bias, threshold effect and heterogeneity were estimated. Eighteen studies were selected for the qualitative analysis and six met the criteria for inclusion in the quantitative analysis. Mean (95% CI) pooled DOR, positive and negative LR were 49.3 (15.9–153.3), 5.86 (3.07–11.21) and 0.16 (0.10–0.26), respectively. The AUC value was 0.94. Only three of the 18 reviewed studies performed an external validation of the model using a different data set. The results from the revised studies suggest that exhaled VOCs are promising biomarkers for asthma diagnosis and that several compounds, mainly alkanes, may be significantly associated with asthma inflammation. However, there are still various constraints associated with standardization and externally validated studies are needed to introduce exhaled VOC profiling in a clinical scenario.     

Three months of COVID‐19: A systematic review and meta‐analysis

The pandemic of 2019 novel coronavirus (SARS‐CoV‐2019), reminiscent of the 2002‐SARS‐CoV outbreak, has completely isolated countries, disrupted health systems and partially paralyzed international trade and travel. In order to be better equipped to anticipate transmission of this virus to new regions, it is imperative to track the progress of the virus over time. This review analyses information on progression of the pandemic in the past 3 months and systematically discusses the characteristics of SARS‐CoV‐2019 virus including its epidemiologic, pathophysiologic, and clinical manifestations. Furthermore, the review also encompasses some recently proposed conceptual models that estimate the spread of this disease based on the basic reproductive number for better prevention and control procedures. Finally, we shed light on how the virus has endangered the global economy, impacting it both from the supply and demand side.     

Obesity aggravates COVID‐19: A systematic review and meta‐analysis

Obesity and COVID‐19 are both worldwide epidemics now. There may be some potential relationships between them, but little is known. This study was done to explore this relationship through literature search, systematic review, and meta‐analysis. Pubmed, Embase, WOS, Cochrane, CNKI, Wanfang, and Sinomed databases were searched to collect literature concerning obesity and COVID‐19. Systematic review and meta‐analysis were conducted after literature screening, quality assessment, and data extraction. A total of 180 articles were initially searched after duplicate removal, and 9 were finally included in our analysis. Results show that severe COVID‐19 patients have a higher body mass index than non‐severe ones (WMD = 2.67; 95% CI, 1.52‐3.82); COVID‐19 patients with obesity were more severely affected and have a worse outcome than those without (OR = 2.31; 95% CI, 1.3‐4.12). Obesity may aggravate COVID‐19.     

The prevalence of os acromiale: A systematic review and meta‐analysis

Os acromiale (OA) results from a failure of consolidation between the ossification centers of the acromial epiphysis. Its prevalence and its interactions with ancestry, gender, laterality, and side have been variously reported in the literature. The aims of this review are to provide an accurate estimate of OA prevalence and to investigate its association with other variables in an attempt to comprehend its etiology. Twenty‐three studies met the inclusion criteria. The results of meta‐analyses of large‐sample studies revealed: (a) a crude overall prevalence of 7.0%, (b) a crude cadaveric prevalence of 7.6%, (c) a crude archeological (skeletal) prevalence of 5.6%, (d) a crude radiological prevalence of 4.2%, (e) a true anatomical prevalence of 9.6%, (f) a significantly higher frequency in persons of black ancestry than in persons of white, Native American and Middle Eastern ancestries (OR ≈ 3), (g) significantly higher unilateral and bilateral frequencies in black ancestry (OR of 2 and 4, respectively), (h) nonsignificant interactions of OA frequency with gender and side. The commonest type of OA was the meso‐acromion type (76.6%). Degenerative changes were present in 66.6% of OAs. The results of this evidence‐based anatomical review support a genetic basis for OA rather than the mechanical trauma‐induction hypothesis. Clin. Anat. 610–621, 2014. © 2013 Wiley Periodicals, Inc.     

Birth prevalence of achondroplasia: A systematic literature review and meta‐analysis

Achondroplasia is a genetic disorder that results in disproportionate short stature. The true prevalence of achondroplasia is unknown as estimates vary widely. This systematic literature review and meta‐analysis was conducted to better estimate worldwide achondroplasia birth prevalence. PubMed, Embase, Scielo, and Google Scholar were searched, complemented by manual searching, for peer‐reviewed articles published between 1950 and 2019. Eligible articles were identified by two independent researchers using predefined selection criteria. Birth prevalence estimates were extracted for analysis, and the quality of evidence was assessed. A meta‐analysis using a quality effects approach based on the inverse variance fixed effect model was conducted. The search identified 955 unique articles, of which 52 were eligible and included. Based on the meta‐analysis, the worldwide birth prevalence of achondroplasia was estimated to be 4.6 per 100,000. Substantial regional variation was observed with a considerably higher birth prevalence reported in North Africa and the Middle East compared to other regions, particularly Europe and the Americas. Higher birth prevalence was also reported in specialized care settings. Significant heterogeneity (Higgins I² of 84.3) was present and some indication of publication bias was detected, based on visual asymmetry of the Doi plot with a Furuya‐Kanamori index of 2.73. Analysis of pooled data from the current literature yields a worldwide achondroplasia birth prevalence of approximately 4.6 per 100,000, with considerable regional variation. Careful interpretation of these findings is advised as included studies are of broadly varying methodological quality.     

Clinical prevalence of palmaris longus agenesis: A systematic review and meta‐analysis

We report a systematic review and a proportion meta‐analysis of prevalence studies evaluating the prevalence of palmaris longus agenesis (PLA) in the literature. The overall PLA rate was defined to be the primary outcome. Secondary outcomes were rates of PLA in relation to ethnicity, laterality, side, gender, age, and hand dominance. We identified 26 articles which met the inclusion criteria. Meta‐analyses showed an overall PLA pooled rate of 20.25%, higher than the commonly reported overall rate of 15%. Our results also showed significantly lower pooled rates in Africans (11.3%) and East Asians (4.5%) when compared to Arab Middle Eastern population (41.7%). A subgroup analysis of the African group showed a pooled rate of 2.71%, the lowest, in the East and South East African population. The pooled rate was 26.3% among Caucasians, 26.16% among South and Southeast Asians and 34.13% among Turkish. In discordance with the literature, PLA was statistically more predominant on the right side. No significant differences in PLA rates were found for laterality, gender, the combination of gender and side or the combination of gender and laterality. The lowest rate of PLA found in East and South East African populations might be indicative of the subsequent phylogenetic degeneration of the palmaris longus muscle in modern humans after the “Out of Africa” migration. Clin. Anat. 26:709–718, 2013. © 2013 Wiley Periodicals, Inc.     

No effects of short‐term sleep restriction,in a controlled feeding setting,on lipid profiles in normal‐weight adults

Short sleep has been associated with cardiovascular risk. The aim of this study was to determine the impact of short‐term sleep restriction on lipid profiles and resting blood pressure factors in young, normal‐weight individuals (14 men, 13 women). Participants were randomized to five nights of either habitual (9 h) or short (4 h) sleep in a cross‐over design separated by a 3‐week washout period. There was no sleep × day interaction on lipid profile and blood pressure. Short‐term sleep restriction does not alter lipid profiles and resting blood pressure in healthy, normal‐weight individuals. The association between short sleep and increased cardiovascular risk reported in the epidemiological literature may be the result of long‐term sleep restriction and poor lifestyle choices.     

Expression of interleukin‐17 in primary Sjögren's syndrome and the correlation with disease severity: A systematic review and meta‐analysis

The aberrant expression of interleukin‐17 (IL‐17) has been reported in primary Sjögren's syndrome (pSS). Abnormalities in IL‐17 can promote the production of pro‐inflammatory cytokines and aggravate autoimmune disorders. The aim of this study was to investigate alterations of IL‐17 in patients with pSS and explore the correlation between IL‐17 and disease severity. Eight databases were searched for original studies reporting the expression of IL‐17 in patients with pSS and controls. Eligible reports were included in the pooled analysis, and subgroup evaluations were performed according to different types of controls and IL‐17 measurement methods. Newcastle‐Ottawa Scale criteria were used to assess the risk of bias of the included studies. In total, 45 articles are included in the meta‐analysis. The expression of IL‐17 is significantly increased in patients with pSS compared to controls. Furthermore, patients with pSS without immunosuppressive treatment show markedly higher IL‐17 levels. In addition, patients with pSS with positive rheumatoid factors tend to express a higher level of IL‐17 than patients with negative rheumatoid factors. Negative correlations between IL‐17 levels and ocular parameters are also found in patients with pSS. The results are similar after adjustment by “trim and fill” methods. In conclusion, the expression of IL‐17 is obviously increased in patients with pSS, especially among those without immunosuppressive treatment. In addition, IL‐17 level correlates with the disease severity of pSS. These findings demonstrate the significance of IL‐17 overexpression in patients with pSS and may provide insights for the development of therapeutic interventions targeting IL‐17 for pSS.     

The clinical characteristics of pediatric inpatients with SARS‐CoV‐2 infection: A meta‐analysis and systematic review

Millions of people were infected with the coronavirus disease 2019 (COVID‐19) all over the world. Data on clinical symptoms of pediatric inpatients with COVID‐19 infection were unclear. The aim of study was to investigate the clinical features of pediatric inpatients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. PubMed, EMBASE, and the Cochrane Library were searched to seek for studies providing details on pediatric inpatients with SARS‐CoV‐2 infection which were published from 1st January to 21st April 2020. Studies with more than five pediatric inpatients were included in our meta‐analysis.This study was registered in the PROSPERO database (CRD42020183550). As the results shown, fever (46%) and cough (42%) were the main clinical characters of pediatric inpatients with SARS‐CoV‐2 infection and the other clinical characters, such as diarrhea, vomiting, nasal congestion, and fatigue account for 10% in pediatric inpatients. The proportion of asymptomatic cases was 0.42 (95% confidence interval [CI]: 0.27‐0.59) and severe cases was 0.03 (95% CI: 0.01‐0.06). For the laboratory result, leukopenia (21%) and lymphocytosis (22%) were the mainly indicators for pediatric inpatients, followed by high aspartate aminotransferase (19%), lymphopenia (16%), high alanine aminotransferase (15%), high C‐reactive protein (17%), leukocytosis (13%), high D‐dimer (12%) and high creatine kinase‐MB (5%). Regard to chest imaging features, unilateral and bilateral accounts for 22% in pediatric inpatients, respectively. In conclusion, compared with adult inpatients with SARS‐CoV‐2 infection, the pediatric inpatients had mild clinical characters, lab test indicators, and chest imaging features. More clinical studies focus on the pediatric patients with SARS‐CoV‐2 infection in other countries should be conducted.     

50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis

Objective

Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive‐behavioral therapy. Existing reviews on REBT are overdue by 10 years or more. We aimed to summarize the effectiveness and efficacy of REBT since its beginnings and investigate the alleged mechanisms of change.

Method

Systematic search identified 84 articles, out of which 68 provided data for between‐group analyses and 39 for within‐group analyses.

Results

We found a medium effect size of REBT compared to other interventions on outcomes (d = 0.58) and on irrational beliefs (d = 0.70), at posttest. For the within‐group analyses, we obtained medium effects for both outcomes (d = 0.56) and irrational beliefs (d = 0.61). Several significant moderators emerged.

Conclusion

REBT is a sound psychological intervention. Directions for future studies are outlined, stemming from the limitations of existing ones.

     

Detection of human papillomavirus in esophageal papillomas: systematic review and meta‐analysis

Since first suggested (in 1982), etiological role for human papillomavirus (HPV) in esophageal papillomas has aroused increasing interest. The objective of this study was to perform systematic review and formal meta‐analysis of the literature reporting on HPV detection in esophageal squamous cell papillomas (ESCP). Literature was searched through May 2012. The effect size was calculated as event rates (95% CI), with homogeneity testing using Cochran's Q and I² statistics. Meta‐regression was used to test the impact of study‐level covariates (HPV detection method, geographic origin) on effect size, and potential publication bias was estimated using funnel plot symmetry. Thirty nine studies were eligible, covering 427 ESCPs from different geographic regions. Altogether, 132 (30.9%) cases tested HPV positive; effect size 0.375 (95% CI 0.319–0.434) using the fixed‐effects (FE) model and 0.412 (95% CI 0.295–0.540) using the random‐effects model. In meta‐analysis stratified by (i) HPV detection technique and (ii) geographic study origin, the between‐study heterogeneity was not significant (p = 0.071 and p = 0.105, respectively). In meta‐regression, HPV detection method (p = 0.260) and geographic origin (p = 0.436) were not significant study‐level covariates accounting for the heterogeneity in HPV prevalence. Some evidence for publication bias was found only for PCR‐based studies, with a marginal impact on summary effect size estimates. In sensitivity analysis, all meta‐analytic results were robust to all one‐by‐one study removals. In stratified meta‐analysis and formal meta‐regression, the variability in HPV detection rates in ESCPs is not explained by the HPV detection method or geographic origin of the study.     

The prevalence of the sesamoid bones of the hand: A systematic review and meta‐analysis

The literature contains various estimates of the prevalence and distribution of the sesamoid bones in the hands. The aims of this systematic review are to provide a better estimate of the frequency of hand sesamoids and its association with variables such as ancestry, gender, and side. Nineteen studies met the inclusion criteria. The pooled rates of the sensitive meta‐analyses from large‐sample studies in adults showed: (a) true overall rates of 99.9% for the metacarpophalangeal (MCP) joint of the thumb (MCP‐I), 53% for the interphalangeal joint (IP‐I), 43.4% for the MCP of the index (MCP‐II), 1.47% for the MCP of the medius finger (MCP‐III), 0.6% for the MCP of the ring finger (MCP‐IV), and 67.7% for the MCP of the auricular finger (MCP‐V); (b) true radiological rates of 99.9% for the radial thumb sesamoid, 99.6% for the ulnar thumb sesamoid, 47.8% for IP‐I, 40% for MCP‐II, 1.3% for MCP‐III, 0.8% for MCP‐VI, and 62.8% for MCP‐V. Black, Middle Eastern, and European ancestries conferred significantly higher sesamoid frequencies at IP‐I, MCP‐II, and MCP‐V, respectively. There was a significant association with female gender at MCP‐II, MCP‐IV, and MCP‐V, with ORs of 1.53, 4, and 1.3, respectively, and a nonsignificant “female” trend for the other locations. There was no significant association with hand side. The pooled rates of hand sesamoids in children aged 10–17 years were 92.7, 42.2, 33.8, 0.5, 0.3, and 36.5% for MCP‐I, IP‐I, MCP‐II, MCP‐III, MCP‐IV, and MCP‐V, respectively. The findings of this evidence‐based anatomical review provide quantitative evidence that the incidence of sesamoid bones in human hands depends on genetic rather than functional factors. Clin. Anat. 27:1291–1303, 2014. © 2014 Wiley Periodicals, Inc.     

Gastrointestinal and hepatic abnormalities in patients with confirmed COVID‐19: A systematic review and meta‐analysis

Although not common, gastrointestinal and liver symptoms have reportedly been the initial presentation of coronavirus disease‐2019 (COVID‐19) in a large group of patients. Therefore, knowing the frequency and characteristics of these manifestations of COVID‐19 is important for both clinicians and health policy makers. A systematic review and meta‐analysis of the available data on the gastrointestinal and liver manifestations of patients with COVID‐19 was performed. PubMed and Scopus databases and Google Scholar search engine were searched for published and unpublished preprint articles up to 10 April 2020. Original studies providing information on clinical digestive symptoms or biomarkers of liver function in patients with polymerase chain reaction confirmed diagnosis of COVID‐19 were included. After quality appraisal, data were extracted. Prevalence data from individual studies were pooled using a random‐effects model. Overall, 67 studies were included in this systematic review and meta‐analysis, comprising a pooled population of 13 251 patients with confirmed COVID‐19. The most common gastrointestinal symptoms were anorexia (10.2%, 95% confidence interval [CI] = 6.2%‐16.4%), diarrhea (8.4%, 95% CI = 6.2%‐11.2%), and nausea (5.7%, 95% CI = 3.7%‐8.6%), respectively. Decreased albumin levels (39.8%, 95% CI = 15.3%‐70.8%), increased aspartate aminotransferase (22.8%, 95% CI = 18.1%‐28.4%), and alanine aminotransferase (20.6%, 95% CI = 16.7%‐25.1%) were common hepatic findings. After adjusting for preexisting gastrointestinal (5.9%) and liver diseases (4.2%), the most common gastrointestinal findings were diarrhea (8.7%, 95% CI = 5.4%‐13.9%), anorexia (8.0%, 95% CI = 3.0%‐19.8%), and nausea (5.1%, 95% CI = 2.2%‐14.3%). Gastrointestinal and liver manifestations are not rare in patients with COVID‐19, but their prevalence might be affected by preexisting diseases. Diarrhea and mild liver abnormalities seem to be relatively common in COVID‐19, regardless of comorbidities