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PubMed2026

In Vitro comparison of herbal and conventional antifungals against Candida strains in Oral candidiasis: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review and meta-analyze the in vitro antifungal activity of herbal and conventional antifungals against Candida strains. DESIGN: In vitro studies were identified through PubMed, Embase, Scopus, and Web of Science up until May 2026. This review is registered with Prospero (CRD420251128404). Eligibility was determined using the Population, Intervention, Comparison, and Outcome (PICO) framework, with specific inclusion and exclusion criteria focused on in vitro antifungal investigations comparing herbal antifungals with conventional antifungals. The risk of bias was assessed using the modified Quality Assessment Tool for In Vitro Studies (QUIN Tool). A meta-analysis was performed, with the primary outcome measure being the ratio of means (RoM). RESULTS: The systematic review included twenty-five articles. Most studies showed different results in inhibition zones or minimum inhibitory concentrations between herbal and conventional agents. The meta-analysis indicates that certain herbal antifungals are equally effective as or more effective than conventional antifungals against Candida dubliniensis, Candida lusitaniae, and Candida tropicalis. While the efficacy of herbal antifungals for Candida albicans and Candida glabrata was modest, Piper betle L. demonstrated significant inhibitory potential. In contrast, conventional antifungals outperformed herbal antifungals against Candida krusei and Candida parapsilosis. CONCLUSIONS: This systematic review and meta-analysis highlight herbal medicine as a potential antifungal therapy for oral candidiasis, emphasizing the need for new strategies due to resistance to conventional antifungals.

Humans↗

PubMedDate not supplied

The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: a meta-analysis.

This article provides a meta-analysis of the current best evidence for the use of occupational therapy with clients with multiple sclerosis (MS). A review of the literature identified 23 articles that examined the effectiveness of occupational therapy-related treatments on clients with MS. Meta-analytic analysis suggests that occupational therapy-related treatments were effective in treating the deficits associated with MS (r = .52), particularly for outcomes in the capacity and ability (r = .52; e.g., muscle strength, range of motion, mood) and task and activity (r = .57; e.g., dressing, bathing, ambulation) levels. A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness. Further, more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.

Health Services Research↗

PubMed2005

Antibiotics for reduction of posttonsillectomy morbidity: a meta-analysis.

OBJECTIVE: To reconcile conflicting published reports regarding the clinical efficacy of postoperative antibiotics for reduction of posttonsillectomy morbidity. STUDY DESIGN: Systematic review (meta-analysis). METHODS: Meta-analysis of seven randomized controlled trials of postoperative oral antibiotics in patients undergoing tonsillectomy or adenotonsillectomy. Postoperative pain and time to return to normal activity and diet were studied as distinct end points using a random effects model with weighted mean difference (RevMan 4.2). Search strategy included electronic searches of PubMed and Cochrane library databases; cross-referencing textbooks, reviews, and original trials; and contacting experts in the field. RESULTS: Subjects treated with antibiotics experienced an earlier return to a normal diet (-1.22 days; 95% confidence interval [CI] = -1.97, -0.48; P = .001) and an earlier return to normal activity (-0.99 days; 95% CI = -1.80, -0.17; P = .02). Evaluation of mean pain visual analogue scores (VAS 0-10) over the first 5 and 7 postoperative days failed to demonstrate any significant effect of antibiotic therapy (VAS difference over 5 days = 0.41; -1.18, 2.00; P = .61) (VAS difference over 7 days = -0.64; -3.46, 2.18; P = .66). Cost analysis suggests routine therapy may be cost-effective but did not include analysis of side effects or resistance resulting from antibiotic usage. CONCLUSION: The results of this systematic meta-analysis suggest that postoperative oral antibiotics do not significantly reduce posttonsillectomy pain but result in an earlier return to normal activity and diet by approximately 1 day. Given the frequency that tonsillectomy is performed, this possible benefit should be weighed against the cost and potential side effects of routine antibiotic therapy.

Adenoidectomy↗

PubMed1999

A meta-analysis of clonidine for symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: Meta-analysis was used to review the literature on the clinical use of clonidine to treat symptoms of attention-deficit hyperactivity disorder (ADHD). METHOD: A review of the literature from 1980 to 1999 revealed 39 studies that reported clonidine's efficacy and side effects for symptoms of ADHD and comorbid conditions. Of these, 11 reports provided sufficient information to be included in a meta-analysis. RESULTS: Meta-analysis using weighted variables revealed clonidine demonstrates a moderate effect size of 0.58 +/- 0.16 (95% confidence interval = 0.27-0.89) on symptoms of ADHD in children and adolescents with ADHD and ADHD comorbid with conduct disorder, developmental delay, and tic disorders. CONCLUSIONS: Clonidine may be an effective second-tier treatment for symptoms of ADHD, but it has an effect size less than that of stimulants. Clinical use of clonidine is associated with many side effects.

Adolescent↗

PubMed1994

Effectiveness of training to prevent job-related back pain: a meta-analysis.

Data from a meta-analysis, involving six experimental studies, revealed a modest relationship between training of employees and a decrease in the occurrence of back pain or sick leave associated with this disorder. The implications for prevention of job-related back pain, and future research within this field are discussed.

Back Pain↗

PubMed2006

Antifungal prophylaxis in liver transplant patients: a systematic review and meta-analysis.

We performed a meta-analysis to determine whether antifungal prophylaxis decreases infectious morbidity and mortality in liver transplant patients. We searched for randomized trials dealing with prophylaxis with systemic antifungal agents. We used a fixed effect model, with risk ratio (RR) and 95% confidence interval (CI); we assessed study quality for heterogeneity and publication bias. Six studies (5 double-blind), for a total of 698 patients, compared fluconazole, itraconazole, or liposomal amphotericin to placebo (5 studies) or oral nystatin. Prophylaxis reduced colonization (RR, 0.45; CI, 0.37-0.55), total proven fungal infections (RR, 0.31; CI, 0.21-0.46), which included both superficial (RR, 0.27; CI, 0.16-0.45) and invasive (RR, 0.33; CI, 0.18-0.59) infections, and mortality attributable to fungal infection (RR, 0.30; CI, 0.12-0.75). Prophylaxis did not affect overall mortality (RR, 1.06; CI, 0.69-1.64) or empiric treatment for suspected fungal infection (RR, 0.80; CI, 0.39-1.67). The beneficial effect of antifungal prophylaxis was predominantly associated with the reduction of Candida albicans infection and mortality attributable to C. albicans. Compared to controls, however, patients receiving prophylaxis experienced a higher proportion of episodes of non-albicans Candida, and in particular of C. glabrata. No beneficial effect on invasive Aspergillus infection was observed. In conclusion, our analysis shows a clear, though limited, beneficial effect of antifungal prophylaxis in liver transplant patients. Concerns about the selection of triazole-resistant Candida strains, however, are realistic, and the potential disadvantages of prophylaxis should be weighed against the established benefits.

Antifungal Agents↗

PubMed1995

Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.

We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. Cancer type was stated in 1117 of 1145 patients reported (63% pancreatic, 37% nonpancreatic). A bilateral posterior approach with 15-50 mL [corrected] of 50%-100% alcohol was the most common technique. Nonradiologically guided NCPB was performed in 246 patients (32%); guidance was by computed tomography (CT) in 214 (28%), radiograph in 271 (34%), fluoroscopy in 36 (5%), or ultrasound in 7 (< 1%). Good to excellent pain relief was reported in 878/989 patients (89%) during the first 2 wk after NCPB. Long-term followup beyond 3 mo revealed persistent benefit. Partial to complete pain relief continued in approximately 90% of patients alive at 3 mo post-NCPB and in 70%-90% until death even if beyond 3 mo post-NCPB. Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.

Celiac Plexus↗

PubMed2003

Publication bias and heterogeneity in the relationship between systolic blood pressure, birth weight, and catch-up growth--a meta analysis.

OBJECTIVE: To use meta-analytic techniques to formally examine (1) publication bias, and (2) between-study heterogeneity in the reported regression coefficient of systolic blood pressure (SBP) on birth weight, adjusting for current weight. DATA IDENTIFICATION: A total of 55 separate analyses reporting on 382 514 male and female subjects ranging from 0 to 75 years, summarized in a recent systematic review. RESULTS: Some 52 of 55 analyses reported a negative regression coefficient (beta) of SBP on birth weight, adjusting for current size, and in 27 of 55 (49%) the 95% confidence interval (CI) did not include zero. A pooled estimate of the regression coefficient across studies under a random-effects model was -1.38 mmHg/kg (95% CI: -1.66 to -1.10). The magnitude of the regression coefficient was negatively correlated with the age of the study population (r = -0.44, P = 0.0007). However, there was strong evidence of publication bias with smaller studies tending to report more negative betas - the Pearson correlation between beta and its standard error (SE(beta)) was -0.55 (P < 0.0001). To examine independent effects, meta analysis regressions of beta on age and SE(beta) were run. After controlling for age, there remained strong evidence of publication bias (P = 0.002), whereas after controlling for publication bias as measured by SE(beta), the relationship between beta and age was not significant (P = 0.08). CONCLUSIONS: This analysis strongly suggests, but does not prove, that publication bias is present when systematically examining the relationship between blood pressure and birth weight. Controlling for publication bias lessens the apparent relationship between the regression coefficient and age of the study population.

Adolescent↗

PubMed1998

Comparison of meta-analysis versus analysis of variance of individual patient data.

Meta-analysis is a method of synthesizing the results of independent studies. We consider the case in which there are multiple treatments and a control, with the goal of estimating the relative effect of each treatment based on continuous outcomes. Even when all data are available, rather than only summary data, it has become common to use meta-analytic estimators of treatment contrasts. Alternatively, we could use a two-way analysis of variance model with no interaction in which one factor is study and one factor is treatment. For the unbalanced case, we obtain the surprising result that the standard meta-analysis estimates of treatment contrasts are identical to the least squares estimators of treatment contrasts in the linear model. Because a meta-analysis of individual patient data can be considerably more costly in terms of data retrieval than a meta-analysis of summary data, this equivalence provides for cost-efficient analysis.

Analysis of Variance↗

PubMed1992

Platelet monoamine oxidase in schizophrenia: a meta-analysis.

We did a meta-analysis on all publications (English and other languages) concerned with platelet monoamine oxidase (MAO) in schizophrenia. Essentially, when patients were medicated with a neuroleptic, most studies found that schizophrenics had lower platelet MAO levels than controls. Administration of neuroleptic lowers MAO levels. MAO levels in drug-free schizophrenics were similar to controls. Only a minority of studies found drug-free schizophrenics had decreased platelet MAO levels.

Antipsychotic Agents↗

PubMed1993

Polychemotherapy in advanced non small cell lung cancer: a meta-analysis.

We did a meta-analysis of all published polychemotherapy vs supportive care clinical trials in patients with non-resectable non small cell lung cancer. 7 studies with more than 700 patients were selected. We used the number of deaths at 3, 6, 9, 12, and 18 months as the endpoints because we were unable to obtain all the individual data. Our analysis showed a reduction in mortality during the first 6 months with polychemotherapy. Although small, this increase in survival, together with an improved quality of life, suggests that polychemotherapy should be recommended for patients with non-resectable non small cell lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Does treatment with essential amino acids and hypertonic glucose improve survival in acute renal failure?: A meta-analysis.

We performed a meta-analysis of four randomized trials (RCTs) and one concurrent control study which addressed the following question: Does treatment with amino acid solutions and hypertonic glucose improve survival of seriously ill patients with acute renal failure who are unable to take oral or enteral feedings? Three RCTs compared outcomes with essential amino acid solutions (EAA) and hypertonic glucose against hypertonic glucose alone, and their results were pooled. Use of EAA was associated with an absolute increase in initial survival of 0.24 as compared to glucose (confidence interval: +.015 to +.446). Without weighting the data to reflect the quality of the RCTs, this effect was significant (p = .017). Patients needing dialysis showed a significant treatment effect (p = .015), while those not requiring dialysis did not (p = .11). However, survival to hospital discharge was not significantly improved for the patient population as a whole (p = .10). Using a standardized quality assessment protocol, the four RCTs received scores ranging from .188 to .357 out of a possible 1.00. Any statistically significant treatment effects were abolished by factoring the quality scores of the studies into the data-pooling process. Sensitivity analysis was performed to determine the effect of including the nonrandomized study. Although it had more patients than the other studies combined, the nonrandomized study was of low quality (score: .032) and its inclusion did not change the outcome of data pooling once quality weighting was applied. We conclude that the efficacy of these parenteral nutritional regimens remains uncertain in this clinical setting.

Acute Kidney Injury↗

PubMed1999

Fruit and vegetables and ischaemic heart disease: systematic review or misleading meta-analysis?

In a recent meta-analysis published in this journal Law and Morris (1998) sought to quantify the association between fruit and vegetable intake and ischaemic heart disease. They estimated that for six dietary markers of fruit and vegetables the risk of ischaemic heart disease was on average reduced by 15% at the 90th centile of consumption when compared to the 10th centile. In this commentary we will argue that this figure is misleading; and that a more cautious and considered approach should be adopted when reviewing the body of evidence that is available on this issue.

Humans↗

PubMed2006

Chlamydia pneumoniae infection and the risk of multiple sclerosis: a meta-analysis.

We conducted a meta-analysis of studies comparing the presence of Chlamydia pneumoniae (Cpn) between multiple sclerosis (MS) patients and other neurological diseases patients or healthy controls. We identified 26 studies with 1332 MS patients and 1464 controls. Using random-effects methods, MS patients were found more likely to have detectable levels of Cpn DNA (OR = 3.216; 95% CI: 1.204, 8.585) in their cerebrospinal fluid, and intrathecally synthesized immunoglobulins (OR = 3.842; 95% CI: 1.317, 11.212), compared to other patients with neurological diseases. There is no evidence for increased levels of serum immunoglobulins (OR = 1.068; 95% CI: 0.745, 1.530), even though this result is confounded by the presence of studies using normal subjects as controls. Similarly, there is no evidence for association of immunoglobulins against Cpn in the cerebrospinal fluid (OR = 3.815; 95% CI: 0.715, 20.369). Up to 59.7% of the between-studies variability could be explained by the inappropriate matching of cases and controls for gender. In random-effects meta-regressions, adjusting for the confounding effect of gender differences results in stronger and statistically significant associations of MS with detectable levels of Cpn DNA, intrathecally synthesized immunoglobulins and immunoglobulins in the cerebrospinal fluid. Even though the presence of Cpn is clearly more likely in MS patients, these findings are insufficient to establish an etiologic relation.

Antibodies, Bacterial↗

PubMed2005

Influenza vaccine in healthy children: a meta-analysis.

We conducted a meta-analysis of 13 randomised clinical trials evaluating the efficacy of influenza vaccine in healthy children. Against culture-confirmed influenza the overall efficacy was 74% (95% confidence interval, CI, 57%-84%), 65% for inactivated and 80% for live-attenuated vaccine. Corresponding figures were 59% (95% CI 43%-71%), 63% and 54% for serologically-confirmed influenza, and 33% (95% CI 29%-36%), 33% and 34% for clinical illness. Influenza vaccine is effective in preventing laboratory-confirmed and clinical influenza in healthy children, with no clear difference between inactivated and live-attenuated vaccine. Data on infants and younger children were too scanty to allow separate assessment.

Adolescent↗

PubMed1998

Maternal cell-free viremia in the natural history of perinatal HIV-1 transmission: a meta-analysis.

We performed a meta-analysis of the predictive value of maternal cell-free viral load in vertical HIV-1 transmission, including 9 cohorts with 1115 mother-infant pairs (696 untreated and 419 treated women). The pooled rate of transmission in untreated women was 21.3% (95% confidence interval [CI], 18.3%-24.5%). The rates of transmission for untreated women in the <1000 copies/ml, 1000 to 9999 copies/ml, and > or = 10,000 copies/ml categories were 5% (95% CI, 2%-11%), 15% (95% CI, 11%-20%) and 37% (95% CI, 29%-46% by random effects), respectively. The area under the receiver operating characteristic (ROC) curve in individual studies ranged from 0.67 to 1.00. The predictive performance of RNA differed between cohorts in which different percentages of transmitters had RNA values >10,000 copies/ml. When 95% of transmitters have RNA values >1000 copies/ml, 77% of nontransmitters would also have values above this cutoff. Transmission rates for treated women in the 1000 to 9999 copies/ml category (7%; 95% CI, 4%-11%,) and > or = 10,000 copies/ml category (18%; 95% CI, 12%-27%) were probably lower than those for untreated women, whereas the transmission rate for treated women with <1000 copies/ml was 5% (95% CI, 2%-11 %). Thus, the risk gradient between RNA categories seems attenuated in treated women. Several aspects of the design, analysis, and reporting of research in this area may be improved in the future with attention to selection and observer biases, multivariate adjustment, and technical consistency. Maternal HIV-1 RNA is a modest predictor of transmission for individual mothers, but a strong predictor of the average risk in groups of untreated mothers. Its discriminatory power is better in untreated than in treated populations and is better in cohorts with a high prevalence of elevated viral load values than in cohorts with generally low levels of viremia.

Adult↗

PubMed1997

Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis.

OBJECTIVE: To apply meta-analysis to compare the utility of lymphangiography (LAG), computed tomography (CT), and magnetic resonance (MR) imaging for the diagnosis of lymph node metastasis in patients with cervical cancer. DATA SOURCES: MEDLINE literature search and manual reviews of article bibliographies. STUDY SELECTION: Studies selected included at least 20 patients with imaging-histologic correlation, described diagnostic criteria for lymph node metastasis, and presented data to allow calculation of contingency tables. DATA EXTRACTION: Independently by 2 investigators, stratified for stage of disease (early vs late) and for lymph node location (pelvic vs para-aortic). DATA SYNTHESIS: Seventeen studies met the inclusion criteria for LAG, 17 for CT, and 10 for MR imaging. Summary receiver operator characteristic analysis showed no significant differences in the overall performance of LAG, CT, and MR imaging. There was, however, a trend toward better performance for MR imaging than for LAG or CT, both globally and when stratified for stage of disease or for lymph node location. Bayesian analysis of clinical utility showed only moderate increases in positive posttest probability of lymph node metastasis for all methods. Negative test results had a greater impact and, depending on the clinical setting, decreased the probability of lymph node metastasis from 15% to 44% (pretest) to 3% to 18% (posttest). CONCLUSIONS: The LAG, CT, and MR imaging perform similarly in the detection of lymph node metastasis from cervical cancer. As CT and MR imaging are less invasive than LAG and also assess local tumor extent, they should be considered the preferred adjuncts to clinical evaluation of invasive cervical cancer.

Female↗

PubMed1997

The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis.

We performed a meta-analysis of studies on benign epilepsy of childhood with centrotemporal spikes (BECT) to ascertain whether clinical characteristics and outcome can be stated unequivocally. Using the Index Medicus and Medline CD+, we identified 525 publications. After applying the criteria of the International League against Epilepsy (ILAE) for BECT, 32 publications on 2,561 patients remained. After correction for inclusion bias and multiple publications on the same patient groups, 13 cohorts, comprising a total of 794 patients, were included. The aggregate proportional remission was 0.977; hence, no factors influencing outcome could be identified. Age at onset ranged from 3 months to 14 years, age at last seizure ranged from 3 to 18 years. A Kurtzke survival analysis of proportions of children in remission by age was performed; at an older age, the proportion of patients in remission was 0.9997. Publications had highly heterogeneous methodologies and population characteristics; we conclude that current knowledge on BECT has been determined mainly by retrospective studies of biased cohorts, and that the uniformity per se of BECT as an epileptic syndrome may be, at least in part, a result of selection bias. We conclude that early prediction of seizure outcome in a new patient with BECT can not be given with certainty. Prospective, population-based studies are needed to delineate the clinical and EEG characteristics of this syndrome.

Action Potentials↗