Effectiveness of indoor allergen reduction in asthma management: A systematic review

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Cryptococcus and cryptococcosis in Iran during 1969–2019: A systematic review and meta-analysis

ObjectiveLimited data are available on the epidemiology and etiology of cryptococcal infections in the Middle East. We aimed to conduct the systematic review and meta-analysis to summarize the epidemiological data on prevalence of Cryptococcus species complexes in trees and their surroundings, bird guano and secretions, animals, and highlight the reported episodes of cryptococcosis in Iran.Materials and methodsTwelve databases, including PubMed, Science Direct, Scopus, Proquest, Google Scholar, Embase, and the ISI Web of Science, as well as the national databases, from January 1969 to October 2019 were searched. Furthermore, gray literature (e.g., thesis, congress abstracts) was evaluated using Iran Doc and www.thesis.research.ac.ir. Search process was accomplished on English or Persian language articles using the following keywords: “Cryptococcus”, “Cryptococcosis”, “invasive fungal infection”, “Humans”, “Birds”, “Pigeon”, “Animals”, “Tree”, “Eucalyptus”, and “Iran”, both alone and in combination.ResultsOverall 36 studies were eligible regarding Cryptococcus and cryptococcosis in Iran. The total prevalence rates of Cryptococcus species in the tree was 4.7% (95% CI: 2.3–7.8), and in bird guano was 20.4% (95% CI: 10.7–32.2). Cryptococcosis in animal, and human were 1.7% (95% CI: 0.01–5.1), and 2.8% (95% CI: 0.7v6.1), respectively. The highest prevalence of Cryptococcus in the trees (14.6%), and bird guano (89.4%) in Khorasan, animals (8.9%) in Chaharmahal and Bakhtiari, and human (4.4%) in Mazandaran provinces were reported.ConclusionsGiven the significant risk of Cryptococcus species for susceptible humans, mainly HIV-infected patients, it seems quite necessary to adopt concrete preventive strategies to pinpoint the environmental habitats of this yeast.     

Computerized cognitive training in Parkinson’s disease: A systematic review and meta-analysis

Cognitive impairment is a central non-motor symptom of Parkinson’s disease (PD), and there are no established treatments. Computerized cognitive training (CCT) is a safe and efficacious strategy but its efficacy in PD is unclear. We aimed to investigate the efficacy of CCT on cognitive, psychosocial and daily function, and assess potential effect moderators in people with PD without dementia. Randomized controlled trials of CCT were included in multivariate meta-analyses and meta-regressions. Seventeen studies (16 trials) encompassing 679 participants were included. The pooled effect of CCT relative to control was small and statistically significant for overall cognitive function (g=0.16; 95% CI 0.02–0.29). There was robust evidence for benefit on clinical measures of global cognition across 10 trials (g=0.33; 95% CI 0.19–0.48), especially in PD with mild cognitive impairment (PD-MCI), as well as on individual cognitive domains. Greater CCT dose and PD-MCI population were associated with larger effect sizes, but no statistically significant differences were found between subgroups. There was no significant difference in the efficacy of home-based compared to supervised training. Our findings suggest that CCT is associated with cognitive benefits in PD, including when delivered remotely. Larger, well-powered trials are warranted to examine what specific CCT regimens are most likely to promote cognitive and everyday functioning in the long-term.     

Retinal biomarkers in Alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis

BackgroundRetinal changes may reflect the pathophysiological processes in the central nervous system and can be assessed by imaging modalities non-invasively. We aim to localize candidate retinal biomarkers in Alzheimer’s disease (AD), mild cognitive impairment (MCI), and preclinical AD.MethodsWe systematically searched PubMed, EMBASE, Scopus, and Web of Science from inception to January 2021 for observational studies that investigated retinal imaging and electrophysiological markers in AD, MCI, and preclinical AD. Between-groups standardized mean differences (SMDs) with 95 % confidence intervals were computed using random-effects models.ResultsOf 19,727 citations identified, 126 articles were eligible for inclusion. Compared with healthy controls, the thickness of peripapillary retinal nerve fiber layer (pRNFL; SMD = -0.723, p < 0.001), total macular (SMD = -0.612, p < 0.001), and subfoveal choroid (SMD = -0.888, p < 0.001) were significantly reduced in patients with AD. Compared with healthy controls, patients with MCI also had lower thickness of pRNFL (SMD = -0.324, p < 0.001), total macular (SMD = -0.302, p < 0.001), and subfoveal choroid (SMD = -0.462, p = 0.020). Other candidate biomarkers included the optic nerve head morphology, retinal amyloid deposition, microvascular morphology and densities, blood flow, and electrophysiological markers.ConclusionsRetinal structural, vascular, and electrophysiological biomarkers hold great potential for the diagnosis, prognosis and risk assessment of AD and MCI. These biomarkers warrant further development in the future, especially in diagnostic test accuracy and longitudinal studies.     

Pain perception in Parkinson’s disease: A systematic review and meta-analysis of experimental studies

While hyperalgesia (increased pain sensitivity) has been suggested to contribute to the increased prevalence of clinical pain in Parkinson’s disease (PD), experimental research is equivocal and mechanisms are poorly understood. We conducted a meta-analysis of studies comparing PD patients to healthy controls (HCs) in their response to experimental pain stimuli. Articles were acquired through systematic searches of major databases from inception until 10/2016. Twenty-six studies met inclusion criteria, comprising 1292 participants (PD = 739, HCs = 553). Random effects meta-analysis of standardized mean differences (SMD) revealed lower pain threshold (indicating hyperalgesia) in PD patients during unmedicated OFF states (SMD = 0.51) which was attenuated during dopamine-medicated ON states (SMD = 0.23), but unaffected by age, PD duration or PD severity. Analysis of 6 studies employing suprathreshold stimulation paradigms indicated greater pain in PD patients, just failing to reach significance (SMD = 0.30, p = 0.06). These findings (a) support the existence of hyperalgesia in PD, which could contribute to the onset/intensity of clinical pain, and (b) implicate dopamine deficiency as a potential underlying mechanism, which may present opportunities for the development of novel analgesic strategies.     

Is a tourniquet beneficial in total knee replacement surgery?: A meta-analysis and systematic review

Proponents of tourniquets postulate that they optimise intra-operative visibility and reduce blood loss. This study compared the outcomes of tourniquet assisted to non-tourniquet assisted total knee replacement (TKR). A systematic review was undertaken of the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. The evidence-base was critically appraised using a tool from the Cochrane Bone, Joint and Muscle Trauma Group. Fifteen studies were identified evaluating 16 outcome measures and parameters of 1040 TKRs in 991 patients. There was a significantly greater intra-operative blood loss in non-tourniquet compared to tourniquet assisted surgery (p = 0.004). There was no significant difference between the groups for total blood loss or transfusion rate (p = 0.22; p = 0.48). There was a trend for greater complications in tourniquet compared to non-tourniquet patients. There was no difference between the groups for any other outcome measure assessed. In conclusion, this systematic review has found that there is no advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements.     

Prospective biomarkers of Alzheimer’s disease: A systematic review and meta-analysis

ObjectiveAlzheimer’s disease (AD) involves a series of pathological changes and some biomarkers were reported to assist in monitoring and predicting disease progression before the emergence of clinical symptoms. We aimed to identify prospective biomarkers and quantify their effect on AD progression.MethodsPubMed, EMBASE and Web of Science databases were searched for prospective cohort studies published up to October 2021. Eligible studies were included, and the available data were extracted. Meta-analyses were conducted based on random-effect models. Relative risk (RR) with 95% confidence interval (CI) was adopted as the final effect size.ResultsTotally 48,769 articles were identified, of which 84 studies with 20 prospective biomarkers were included in meta-analyses. In the present study, 15 biomarkers were associated with AD progression, comprising CSF Aβ42 (RR=2.49, 95%CI=1.68–3.69), t-tau (RR=1.88, 95%CI=1.49–2.37), p-tau (RR=1.74, 95%CI=1.37–2.21), tau/Aβ42 ratio (RR=5.11, 95%CI=2.01–13.00); peripheral blood Aβ42/Aβ40 (RR=1.26, 95%CI=1.05–1.51), t-tau (RR=1.33, 95%CI=1.08–1.64), NFL (RR=1.75, 95%CI=1.07–2.87); whole, left and right hippocampal volume (HV) (whole: RR=1.65, 95%CI=1.39–1.95; left: RR=2.60, 95%CI=1.02–6.64; right: RR=1.43, 95%CI=1.23–1.66), entorhinal cortex (EC) volume (RR=1.69, 95%CI=1.24–2.30), medial temporal lobe atrophy (MTA) (RR=1.52, 95%CI=1.33–1.74), 18 F-FDG PET (RR=2.24, 95%CI=1.29–3.89), 11 C-labeled Pittsburgh Compound B PET (11 C-PIB PET) (RR=3.91, 95%CI=1.06–14.41); APOE ε4 (RR=2.16, 1.83–2.55). A total of 70 articles were included in the qualitative review, in which 61 biomarkers were additionally associated with AD progression.ConclusionCSF Aβ42, t-tau, p-tau, tau/Aβ42; peripheral blood t-tau, Aβ42/Aβ40, NFL; whole, left and right HV, EC volume, MTA, 18 F-FDG PET, 11 C-PIB PET; APOE ε4 may be promising prospective biomarkers for AD progression.     

Blood fatty acids in Alzheimer’s disease and mild cognitive impairment: A meta-analysis and systematic review

Plasma fatty acids have been reported to be dysregulated in mild cognitive impairment (MCI) and Alzheimer’s disease (AD), though outcomes are not always consistent, and subject numbers often small. Our aim was to use a meta-analysis and systematic review approach to identify if plasma fatty acid dysregulation would be observed in case control studies of AD and MCI. Six databases were searched for studies reporting quantified levels of fatty acids in MCI and/or AD individuals, relative to cognitively normal controls. Docosahexaenoic (DHA) and vaccenic acids were significantly lower and higher respectively in MCI relative to controls. Total fatty acids were 27.2% lower in AD relative to controls, and this was reflected almost uniformly in all specific fatty acids in AD. Changes to plasma/serum fatty acids were identified in both MCI and AD relative to age and gender matched controls. Differences were greatest in AD, in both total number of fatty acids significantly altered, and the degree of change. Docosahexaenoic acid was lower in both MCI and AD, suggesting that it may be a driver of pathology.     

Cerebral blood flow in mild cognitive impairment and Alzheimer’s disease: A systematic review and meta-analysis

BackgroundReduced cerebral blood flow (CBF) contributes to the pathophysiology of Alzheimer’s disease (AD). However, it is unclear whether there is a spatial-temporal-specific pattern of changed CBF in AD progression.MethodsWe systematically screened literature databases for cross-sectional and longitudinal studies reporting resting CBF or CBF velocity (CBFv) among patients with AD, mild cognitive impairment (MCI), and healthy controls (HCs). Standardised mean differences (SMDs) for CBF and mean differences (MDs) for CBFv were calculated. Quality assessments, meta-analysis, subgroup analysis, and meta-regression were subsequently performed (PROSPERO: CRD42020207548).ResultsOverall, 244 studies comprising 13,644 participants and 60 regions were included. Compared with HCs, AD subjects had decreased resting CBF throughout the brain (SMD range: -1.87 to -0.32), especially within the posterior cingulate and temporal-parietal regions. However, MCI subjects presented decreased CBF in ten regions with modest effects (SMD range: -0.86 to -0.25), especially in the precuneus. We identified the decreased CBF in the temporal, parietal, and hippocampal regions was associated with the lower AD Mini-Mental State Examination scores.ConclusionsOur findings suggest that the spatial-temporal pattern of CBF decreased from the precuneus, posterior cingulate and temporal-parietal regions to broader areas with progression from HC to MCI to AD, supporting the incorporation of CBF into the AD research framework.     

Are worksite interventions effective in increasing physical activity? A systematic review and meta-analysis

Abstract

Worksite interventions have the potential to reach a broad and captive audience and overcome one of the most widely cited barriers to increasing physical activity (PA), namely, a lack of time. A systematic review and random effects, meta-analysis assessed the effectiveness of worksite interventions to enhance PA. Thirty-seven intervention evaluations reporting 55 unique interventions met our inclusion criteria. Results indicate that, overall, worksite interventions have small, positive effects on PA and this effect is smaller when fitness, as opposed to self-report, outcome measures are reported (ds = 0.15 versus 0.23). Worksite interventions targeting PA specifically as opposed to general lifestyle change were found to be more effective whether evaluated in terms of increased fitness (0.29 versus 0.08) or increased self-reported PA (0.27 versus 0.14). Those promoting walking as opposed to other forms of PA were also more effective (0.54 versus 0.16). Interventions providing individually tailored information or instructions were not found to be more effective, but there was evidence that specific goal setting and goal review techniques may enhance fitness gains.     

Beta-adrenergic drugs and risk of Parkinson’s disease: A systematic review and meta-analysis

BackgroundParkinson’s Disease (PD) is a neurodegenerative disorder manifested by rest tremor, rigidity, bradykinesia, and postural instability. Recent pharmaco-epidemiological studies evaluating beta-adrenergic drug use and risk of PD have reported conflicting findings.ObjectivesThis systematic review and meta-analyses evaluate the association between beta-adrenergic (agonists and antagonists) drugs’ use and PD.MethodsAn electronic literature search of eight databases was performed from inception to July 2021 to identify pharmaco-epidemiological studies (case-control and cohort) reporting the risk of PD in beta-adrenergic users compared to non-users. We used the generic inverse variance method and RevMan (5.3.5) to estimate pooled adjusted risk ratios (aRRs) of PD using a random-effects model.ResultsOf 3168 records, 15 studies (10 case-control; five cohort) with 6508,877 participants, including 87,011 PD cases, were included. In the pooled analysis (n = 10) including any beta-antagonist users, compared with non-users, the aRR for PD was 1.19 (CI: 1.05,1.35); for any beta-agonist users (n = 8) aRR for PD was 0.87 (CI: 0.78,0.97). Propranolol users had a significantly increased risk of PD (aRR:1.91; CI:1.20,3.06), whereas salbutamol use was associated with reduced risk of PD (aRR:0.95; CI:0.92,0.99). Significant heterogeneity (I² >87%) was observed, but the majority (n = 13) of the studies were of high quality, based on the JBI tool.ConclusionsBeta-antagonist use was associated with a modestly increased risk of PD, whereas beta-agonist use was associated with a modest decreased risk of PD. Future epidemiological studies should address the issues of protopathic bias and indirect association using appropriate epidemiological methods.     

Exercise interventions in Alzheimer’s disease: A systematic review and meta-analysis of randomized controlled trials

AimsTo assess the potential multi-domain benefits of exercise interventions on patients with Alzheimer’s disease (AD), as well as to determine the specific effects of different exercise modalities (aerobic, strength, or combined training).MethodsA systematic search was conducted in PubMed and Web of Science until March 2021 for randomized controlled trials assessing the effect of exercise interventions (compared with no exercise) on patients with AD. Outcomes included cognitive function (mini-mental state examination [MMSE] test), physical function (e.g., 6-minute walking test [6MWT]), functional independence (Barthel index), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). A random-effects meta-analysis was conducted.Results28 studies (total n = 1337 participants, average age 79–90 years) were included in the systematic review, of which 21 could be meta-analyzed. Although considerable heterogeneity was found, exercise interventions induced several significant benefits, including in Barthel index (n = 147 patients, mean difference [MD]=8.36 points, 95% confidence interval [CI]=0.63–16.09), 6MWT (n = 369, MD=84 m, 95% CI=44–133)), and NPI (n = 263, MD=−4.4 points, 95% CI=−8.42 to −0.38). Benefits were also found in the MMSE test, albeit significance was only reached for aerobic exercise (n = 187, MD=2.31 points, 95% CI 0.45–4.27).ConclusionsExercise interventions appear to exert multi-domain benefits in patients with AD.