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Systematic Reviews: Understanding the Best Evidence For Clinical Decision-making in Health Care: Pros and Cons

Memon MA, Khan S, Alam K, Rahman MM, Yunus RM

Surg Laparosc Endosc Percutan Tech, 2020 Dec 04;31(2):234-240.
PMID: 33284258 DOI: 10.1097/SLE.0000000000000889

In the era of evidence-based decision-making, systematic reviews (SRs) are being widely used in many health care policies, government programs, and academic disciplines. SRs are detailed and comprehensive literature review of a specific research topic with a view to identifying, appraising, and synthesizing the research findings from various relevant primary studies. A SR therefore extracts the relevant summary information from the selected studies without bias by strictly adhering to the review procedures and protocols. This paper presents all underlying concepts, stages, steps, and procedures in conducting and publishing SRs. Unlike the findings of narrative reviews, the synthesized results of any SRs are reproducible, not subjective and bias free. However, there are a number of issues related to SRs that directly impact on the quality of the end results. If the selected studies are of high quality, the criteria of the SRs are fully satisfied, and the results constitute the highest level of evidence. It is therefore essential that the end users of SRs are aware of the weaknesses and strengths of the underlying processes and techniques so that they could assess the results in the correct perspective within the context of the research question.
The relationship between age of smoking initiation and current smoking: an analysis of school surveys in three European countries

Reidpath DD, Ling ML, Wellington E, Al-Sadat N, Yasin S

Nicotine Tob Res, 2013 Mar;15(3):729-33.
PMID: 22990215 DOI: 10.1093/ntr/nts177

INTRODUCTION: It is held that younger smoking initiates are more likely to become regular smokers. The definitions of smoking initiation (a puff, part of a cigarette, a whole cigarette) are inconsistent and raise questions about the robustness of the view. We sought to re-examine the relationship using adolescent smoking data from 3 European countries.
METHODS: A stratified secondary, logistic regression analysis of Global Youth Tobacco Survey data was conducted using a design-based analysis. Subgroup analyses were conducted of 13- to 15-year olds from Latvia (high smoking prevalence), Slovenia (moderate prevalence), and Montenegro (low prevalence) who had initiated smoking. The outcome was current smoking--smoking everyday for the past 30 days, or smoking 10 or more days in the past 30 days. Smoking initiation was operationalized as a single puff of a cigarette, and age of smoking initiation was a derived continuous measure.
RESULTS: In Latvia, there was a significant association between age of smoking initiation and current smoking for males (p < .05) and females (p < .001) when smoking was operationalized as smoking every day. It was only significant in female adolescents (p < .001) for smoking 10 or more days. In Slovenia and Montenegro, there was no significant relationship between age of smoking initiation and current smoking for either males or females.
CONCLUSIONS: The evidence about the relationship between age of smoking initiation and current smoking is not clear. Explanations for the findings may relate to a lack of power, the specificity of the measure, or problems with the theory.
Gastroesophageal reflux disease following laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass: meta-analysis and systematic review of 5-year data

Memon MA, Osland E, Yunus RM, Alam K, Hoque Z, Khan S

Dis Esophagus, 2024 Feb 29;37(3).
PMID: 37935430 DOI: 10.1093/dote/doad063

To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I2 = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I2 = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I2 = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.
Meta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP)

Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA

Surg Laparosc Endosc Percutan Tech, 2015 Jun;25(3):185-203.
PMID: 25799261 DOI: 10.1097/SLE.0000000000000142

The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.
Fulltext Validity of self-measured waist and hip circumferences: results from a community study in Malaysia

Reidpath DD, Cheah JC, Lam FC, Yasin S, Soyiri I, Allotey P

Nutr J, 2013;12:135.
PMID: 24093886 DOI: 10.1186/1475-2891-12-135

BACKGROUND: Measures of central adiposity are better predictors of adverse health events than BMI. Nonetheless, BMI is more widely used in health research. One reason for this may be the limited research supporting the self-measurement of waist and hip circumference. The lack of validity studies is particularly acute in Asia. The main objective was to establish the validity of self-measurement of waist and hip circumference in a community setting and the correlation of those measures with BMI, blood pressure, and blood glucose levels.
METHODS: A community based, cross-sectional survey. A "healthy living expo" at a shopping mall in a rural town on peninsular Malaysia One hundred and thirty six (136) individuals volunteered to participate in the study, 125 of whom met the inclusion criteria. The ethnic distribution of the participants was 80% Chinese, 17% Malay and 3% Indian. Most participants were female (60%), with participants' ages ranging from 18 to 78 years (mean, 47.2). Self and assisted measurements of waist and hip were taken. Blood pressure, non-fasting blood glucose, height, and weight were also measured. Bland Altman plots and Lin's concordance coefficient were used to measure agreement between self and assisted measures. Pearson's correlation was used to examine the association of self and assisted measures with blood pressure, blood glucose, and BMI.
RESULTS: There was a downwards bias in self measured waist (-0.81 cm) and hip (-1 cm) circumferences compared with assisted measures. The concordance for the self and assisted measures of waist, hip and the ratio of the two were, respectively, .96, .93 , and .84. The correlation between measures of central adiposity and BMI, blood pressure and blood glucose were similar for self and assisted measures.
CONCLUSION: The results provide additional support for the use of self-measurement of waist and hip circumference studies of central adiposity, but is limited by the specificity of the setting.
Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review

Osland E, Yunus RM, Khan S, Alodat T, Memon B, Memon MA

Obes Surg, 2016 Oct;26(10):2273-84.
PMID: 26894908 DOI: 10.1007/s11695-016-2101-8

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures.
METHODS: RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures.
RESULTS: Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures.
CONCLUSIONS: This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.
Fulltext The effect of laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass on gastroesophageal reflux disease: An updated meta-analysis and systematic review of 5-year post-operative data from randomized controlled trials

Memon MA, Osland E, Yunus RM, Hoque Z, Alam K, Khan S

Surg Endosc, 2024 Nov;38(11):6254-6269.
PMID: 39384655 DOI: 10.1007/s00464-024-11303-x

BACKGROUND: To evaluate 5-year effect of laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) solely based on randomized controlled trials (RCTs).
METHODS: A systematic review and meta-analysis of 5-year postoperative GERD data comparing LVSG and LRYGB in adults were undertaken. Electronic databases were searched from January 2015 to March 2024 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was applied to estimate pooled odds ratio where meta-analysis was possible. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool 2 and GRADE.
RESULTS: Five RCTs were analysed (LVSG n = 554, LRYGB n = 539). LVSG was associated with increased adverse GERD outcomes compared to LRYGB at 5 years. The odds for revisional surgery to treat GERD in LVSG patients were 11 times higher compared to LRYGB (OR 11.47, 95% CI 1.83 to 71.69; p = 0.02; I2 = 0% High level of certainty). Similarly pharmacological management for increasing GERD was significantly more frequent in LVSG patients compared to LRYGB (OR 3.89, 95% CI 2.31 to 6.55; p ≤ 0.01; I2 = 0% Moderate level of certainty). Overall, LVSG was associated with significantly more interventions (both medical and surgical) for either worsening GERD and/or development of de novo GERD compared to LRYGB (OR 5.98, 95% CI 3.48 to 10.29; p ≤ 0.01; I2 = 0%) Moderate level of certainty).
CONCLUSIONS: The development and worsening of GERD symptoms are frequently associated with LVSG compared to LRYGB at 5 years postoperatively requiring either initiation or increase of pharmacotherapy or failing that revisional bariatric surgery. Appropriate patient/surgical selection is crucial to reduce these postoperative risks of GERD.
Effect of Fish Meal Substitution with Black Soldier Fly (Hermetia illucens) on Growth Performance, Feed Stability, Blood Biochemistry, and Liver and Gut Morphology of Siamese Fighting Fish (Betta splendens)

Kari ZA, Téllez-Isaías G, Hamid NKA, Rusli ND, Mat K, Sukri SAM, et al.

Aquac Nutr, 2023;2023:6676953.
PMID: 39553242 DOI: 10.1155/2023/6676953

Insects such as black soldier fly larvae (BSFL) are gaining interest among researchers and the aquafeed industry due to the fluctuating price and supply of fish meal (FM). This study evaluated the growth performance, feed stability, blood biochemistry, and liver and gut morphology of Betta splendens using BSFL as an alternative to FM. Five formulated diets were prepared: 0% BSFL, 6.5% BSFL, 13% BSFL, 19.5% BSFL, and 24.5% BSFL. The expansion rate, pellet durability index, floatability, bulk density, and water stability of the prepared feed have been assessed. Except for the diameter of the feed, all the parameters studied differed significantly (p < 0.05) across the experimental diets. After 60 days, the fish fed with 13% BSFL had the highest final length, final weight, net weight gain, specific growth rate, weight gain, and gastrointestinal weight, with mean and standard deviation values of 3.97 ± 0.43 cm, 3.95 ± 0.1 g, 2.78 ± 0.1 g, 4.63 ± 0.17, 4.65 ± 0.13, 237.26 ± 7.9%, and 0.04 ± 0.01 mg, respectively. Similar blood haematology and biochemical properties, including corpuscular volume, lymphocytes, white blood cells, red blood cells, haematocrit, albumin, and alkaline phosphatase, were the highest (p < 0.05) in the 13% BSFL diet group compared to the other treatment groups. In addition, BSFL had a significant impact (p < 0.05) on villus length, width, and crypt depth for the anterior and posterior guts of B. splendens. The 13% BSFL diet group had an intact epithelial barrier in the goblet cell arrangement and a well-organized villus structure and tunica muscularis, compared to the other treatment groups. Furthermore, the liver cell was altered with different BSFL inclusions; the 13% FM group demonstrated better nuclei and cytoplasm structure than the other treatment groups. In conclusion, replacing 13% FM with BSFL could improve the growth performance, blood parameters, and liver and intestine morphology of B. splendens, thus providing a promising alternative diet for ornamental freshwater fish.
Fulltext Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic

Bahar Moni AS, Abdullah S, Bin Abdullah MFIL, Kabir MS, Alif SM, Sultana F, et al.

PLoS One, 2021;16(9):e0257304.
PMID: 34506576 DOI: 10.1371/journal.pone.0257304

INTRODUCTION: The COVID-19 pandemic has enormously affected the psychological well-being, social and working life of millions of people across the world. This study aimed to investigate the psychological distress, fear and coping strategies as a result of the COVID-19 pandemic and its associated factors among Malaysian residents.
METHODS: Participants were invited to an online cross-sectional survey from Aug-Sep 2020. The study assessed psychological distress using the Kessler Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, and coping strategies using the Brief Resilient Coping Scale. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders.
RESULTS: The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) years, and most of them were females (67.1%). Half of the participants had an income source, while 216 (30%) identified themselves as frontline health or essential service workers. People whose financial situation was impacted due to COVID-19 (AOR 2.16, 95% CIs 1.54-3.03), people who drank alcohol in the last four weeks (3.43, 1.45-8.10), people who were a patient (2.02, 1.39-2.93), and had higher levels of fear of COVID-19 (2.55, 1.70-3.80) were more likely to have higher levels of psychological distress. Participants who self-isolated due to exposure to COVID-19 (3.12, 1.04-9.32) and who had moderate to very high levels of psychological distress (2.56, 1.71-3.83) had higher levels of fear. Participants who provided care to a family member/patient with a suspected case of COVID-19 were more likely to be moderately to highly resilient compared to those who did not.
CONCLUSION: Vulnerable groups of individuals such as patients and those impacted financially during COVID-19 should be supported for their mental wellbeing. Behavioural interventions should be targeted to reduce the impact of alcohol drinking during such crisis period.