Introduction: We aimed to compare the efficacy of pancreas transplantation, islet transplantation, and insulin therapy in patients with type 1 diabetes mellitus (T1DM) undergoing renal transplantation. Methods: We conducted a systematic search across three databases on November 26, 2024 for studies on simultaneous pancreas-kidney transplant (SPKT), pancreas-after-kidney (PAK), simultaneous islet-kidney (SIK), islet-after-kidney (IAK), and kidney transplant alone with insulin (KTA-I) in T1DM. We analyzed changes in glycated hemoglobin (HbA1c %) from baseline, as well as other glucose metabolism, renal, and cardiovascular parameters. Pooled single means or mean differences (MD) were calculated with 95% confidence intervals (CIs). Overall survival (OS) and graft survival were assessed using the restricted mean survival time, derived from Kaplan-Meier curves at the truncated time. Results: We included 286 studies in the systematic review and 142 in the meta-analysis. We found that SPKT offers a greater reduction in HbA1c than KTA-I (MD:-3·2; CI:-5·26, -1·14) after 3 years. At 12 months, mean C-peptide (ng/mL) levels were higher after SPKT than after SIK/IAK (2·76 CI:2·49, 3·02 vs. 1·54 CI:0·16, 2·92). At 60 months after transplantation, OS was similar for SPKT, PAK, and KTA-I, whereas SIK/IAK was associated with the lowest OS (P=0·0095). At 120 months, overall and kidney graft survival were higher in LDK than DDK, and LDK was not inferior to SPKT. Pancreas graft survival was higher after SPKT than PAK (P=0·0018). Interpretation: Pancreas transplantation provides the best glucose metabolism. LDK offers higher graft survival than DDK and is comparable to SPKT, which in turn offers better pancreas graft survival than PAK. Islet transplantation is associated with the lowest OS.

PURPOSE:To create a model of residual cholesteatoma growth rate that can be used to estimate optimal timing of follow-up imaging. METHODS:Following the recommendations of the PRISMA-IPD guideline and after registering our study protocol on PROSPERO (CRD42023465320), a systematic search was completed in September 2023 and updated in July 2024, conducted in PubMed, Web of Science, Embase, and Cochrane Library. Reference lists of the resulting articles were also searched for potential inclusions. Our search yielded 11,274 articles. Studies with patients of any age and sex diagnosed with residual cholesteatoma were included if data on cholesteatoma size at follow-up were available, collected from imaging results or through second-stage surgery. For statistical analysis, a Monte Carlo simulation approach was applied, and a baseline random-intercept mixed-effects model was fitted. RESULTS:We included 11 articles reporting individual data from 163 patients. All but one of these articles proved to be high risk of bias. Our simulation models suggest that 95% of cholesteatomas reach or grow past the size of 3 millimetres (threshold for imaging) after 28-35 months and 95% of reach or grow past the size of 5 millimetres (threshold for intraoperative identification) after 47-58 months. CONCLUSION:Analyzing previously published data suggests that residual cholesteatoma may only be radiologically detectable on non-EPI DWI MRI after 28-35 months postoperatively in 95% of patients, indicating delayed follow-up for average risk patients compared to current clinical practice. However, this simulation model, based on retrospective data, aims to uncover growth patterns rather than posing as a new guideline.

IMPORTANCE:Endometriosis is a disease often associated with chronic pelvic pain. It affects around 190 million females of reproductive age globally. OBJECTIVE:To investigate the effect of physiotherapy techniques (PTs) in relieving endometriosis-associated pain. DESIGN:This systematic review and meta-analysis followed the PRISMA 2020 and Cochrane Handbook guidelines. The study protocol was followed and registered on PROSPERO (CRD42023474231). SETTING:A systematic search was conducted in 3 databases: PubMed, Embase, and Cochrane. PARTICIPANTS:We used the following PICO strategy: population, women with endometriosis-associated pelvic pain; intervention, PTs; comparator, non-PTs; outcome, pelvic pain changes. The article selection was conducted by 2 independent reviewers. MAIN OUTCOME(S) AND MEASURE(S):Two authors extracted data independently from the eligible articles. For continuous outcomes, the mean difference (MD) in change scores between intervention and control groups was used as an effect size with a 95% confidence interval (CI). Within-group correlation of before- and after-treatment was assumed to be equal across groups and studies. RESULTS:Out of 8 eligible studies identified in our selection, 7 were included in the quantitative analysis. PTs were effective in reducing pain compared to non-PTs (MD -1.97, CI -2.99 to -0.95), and physiotherapy modalities (electrotherapy and laser devices) had the greatest reduction in pain levels (MD -2.03, CI -3.9 to -0.14) among all studies. Additionally, locally applied techniques resulted in greater pain reduction than the generally applied techniques. CONCLUSION AND RELEVANCE:Physiotherapy techniques are effective in reducing pain in women with endometriosis, especially when applied locally.

Background/Objectives: Nabiximols, a standardized extract of Cannabis sativa, has been approved as an add-on therapy for patients with moderate to severe spasticity associated with multiple sclerosis (MS). Moreover, current Italian treatment algorithms suggest that cannabis-based therapies may have further relevance in the management of MS. The aim of our systematic review and meta-analysis was to assess the effectiveness of nabiximols in relieving symptoms other than spasticity in adult MS patients. Methods: A systematic search was conducted in Web of Science, MEDLINE (via PubMed), Cochrane CENTRAL and Embase on September 10, 2025. Study selection was performed according to the predefined PROSPERO protocol (CRD42022329952). Data were combined into a common denominator and examined using a random-effects model with meta-regression expressed as mean difference (MD) and a 95% confidence interval (CI). Risk of bias was assessed using the Cochrane risk of bias instrument (RoB2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: Of the 49 eligible articles, 25 were included in the statistical analysis (2949 patients). Significant improvements in spasm quality (MD = −16.87; 95% CI = (−29.75)–(−3.99)), bladder function (MD = −16.38; 95% CI = (−22.18)–(−10.58)), sleep disruption (MD = −15.75; 95% CI = (−22.02)–(−9.49)) and gait function (timed walk MD(s) = −5.31; 95% CI(s) = (−9.88)–(−0.74)) were observed. Time-dependency was not significant. The subject global impression of change (SGIC) improved significantly after the first month (odds ratio (OR) = 1.69; 95% CI = (1.30)–(2.18)). Conclusion: Beyond spasticity, nabiximols may represent a signal of benefit for bladder function, sleep disruption, spasm quality, and gait function in MS, in line with the “spasticity-plus” concept. However, the evidence certainty was low to very low, and these findings should be considered exploratory.

Background: Gastrointestinal endoscopy is crucial for diagnosing colorectal cancer and inflammatory bowel diseases, but its effectiveness can be impacted by peristalsis, poor bowel preparation, and inadequate withdrawal time. Conventional antispasmodics, though effective, may not be suitable for elderly patients or those with comorbidities. L-menthol, derived from peppermint oil, has emerged as a safer alternative. Through calcium channel blockade, L-menthol promotes GI smooth muscle relaxation. This study evaluated L-menthol’s efficacy and safety as a potential alternative to antispasmodic agents in endoscopy. Methods: Following PRISMA2020 guidelines and the Cochrane Handbook, we conducted a systematic review and meta-analysis of randomized controlled trials involving adults undergoing endoscopy, comparing L-menthol to placebo. The primary outcome was the adenoma detection rate, with secondary outcomes, including severity of peristalsis, safety, withdrawal time, and ease of examination. We searched five databases on 31 May 2023, with updates on 20 October 2024. Results: Fourteen studies were included. L-menthol reduced peristalsis during colonoscopy and upper endoscopy, achieving a suppression rate of 55.9% (560/1002 patients; odds ratio (OR) = 3.88, 95% confidence interval (95% CI): 2.13–7.07), which improved mucosal visualization. It improved ease of examination (OR = 2.53, 95% CI: 1.35–4.73), allowing endoscopists to perform procedures with less technical difficulty. However, L-menthol had no significant impact on the adenoma detection rate (OR = 1.06, 95% CI: 0.69–1.64), indicating no added benefit for lesion detection, and did not prolong withdrawal time (MD = 3.24 s, 95% CI: −101.05–107.53). Adverse event rates remained low and comparable to placebo (OR = 0.97, 95% CI: 0.74–1.27). Conclusions: L-menthol reduces peristalsis and enhances ease of examination without adverse events. Although its effect on the adenoma detection rate remains inconclusive, its antispasmodic properties make it a promising alternative for patients who cannot tolerate conventional agents.

BACKGROUND AND OBJECTIVE:Small-cell bladder cancer (SCBC) is an aggressive and rare malignancy for which there is no clear optimal treatment strategy. This systematic review and meta-analysis aimed to compare the median overall survival (OS) of patients with limited-stage (LS) SCBC treated with either cystectomy-based multimodal therapy (CBMMT) or radiation-based multimodal therapy (RBMMT). METHODS:A comprehensive search of PUBMED, Embase, and Scopus databases was performed for studies published before January 2024 according to the PRISMA guidelines. Studies have assessed LS-SCBC disease and provided survival data for subgroups of patients undergoing radical surgery or bladder-preserving approaches to be deemed eligible. Data extraction and quality assessment were independently conducted by 2 authors. KEY FINDINGS AND LIMITATIONS:Five studies comprising 1041 patients were analyzed. The pooled median OS for patients receiving RBMMT was 34.6 months (95% CI, 25.5-43.7), compared to 29.7 months (95% CI, 18.2-41.1) for those undergoing CBMMT. The main limitations are the retrospective nature of the included studies and the potential bias. CONCLUSIONS AND CLINICAL IMPLICATIONS:This meta-analysis indicates that RBMMT may provide comparable outcomes to CBMMT in LS-SCBC patients, supporting the consideration of bladder-preserving approaches in selected cases. RBMMT may offer a potential clinical benefit in terms of organ preservation for appropriately selected patients, although survival differences were not statistically significant.

Alloplastic implants used in pelvic organ prolapse (POP) surgery can achieve good anatomical outcomes; however, concerns about complications such as vaginal wall erosion (VWE) have led to restrictions on their use. This systematic review and meta-analysis aimed to identify risk factors for VWE. A comprehensive search of three major databases (PubMed, Embase, and Central) was conducted on June 19, 2023. Eligible studies examined risk factors for VWE and reported the event rate with and without these risk factors. Odds ratios (OR) of VWE were calculated with 95% confidence intervals (CIs) for each risk factor following POP surgeries using vaginal implants. A total of 36 articles were included in the analysis. The results identified a history of smoking and concomitant hysterectomy as risk factors for VWE following POP surgeries. This information is crucial when selecting the type of surgical approach. However, further well-designed comparative studies are necessary to provide more accurate and comprehensive recommendations.

The path to becoming a veterinarian often begins well before university education, so understanding students’ career choices is essential. This study aimed to identify motivational characteristics of Hungarian high school students interested in veterinary medicine. Between December 2022 and March 2023, a questionnaire was distributed during high school career days, university open days, and via online platforms to collect data on students’ backgrounds, motivations, childhood animal exposure, and alternative career options. Recursive conditional Classification and Regression Tree (CART) models were used to identify motivational characteristics predicting veterinary career intentions. Among 428 respondents (74.1% female; mean age 17.8 years), a fondness for animals emerged as the predominant motivational factor; 97.4% had childhood pets, most commonly dogs. Human medicine was the main alternative career, followed by agriculture and veterinary nursing. Most students were interested in small animal medicine, while horse-related experience strongly predicted interest in equine practice. Interest in agriculture predicted preference for farm animal care. Students inclined toward non-clinical roles showed stronger interest in natural sciences and decided on a veterinary career later in life. These findings suggest that many students commit to veterinary medicine before age 12, highlighting the need for early engagement through competitions, camps, and extracurricular activities.

Despite the broadening spectrum of heart rhythm monitoring techniques, there is no wide consensus on the most appropriate modality and duration to detect atrial fibrillation (AF). Two-dimensional (2D) speckle tracking for left atrial (LA) strain analysis seems feasible to detect atrial cardiomyopathy, which might represent a substrate for AF. We aimed to perform a meta-analysis on the differences in baseline global longitudinal left atrial strain (GLAS) values as a primary outcome, measured exclusively in sinus rhythm (SR) between patients who developed AF in the future and patients who remained in SR during follow-up (FU). Random-effect model was used. We calculated weighted mean differences (WMD) of baseline GLAS values of future AF patients and of those remaining in SR. A risk for bias was also assessed of the eligible studies. 6 articles were eligible for quantitative GLAS analysis in 1106 patients. Baseline parameters of the future AF and SR patients were comparable in most of the papers. Pooled WMD value of GLAS between the future AF and SR group was -5.55 %, with a 95% confidence interval (CI) of -7.06 to -4.03 %, and a prediction interval of -8.02 to - 3.07%. On assessment, 33% of the studies had a moderate risk for bias. Baseline GLAS values of future AF patients were significantly lower than that of patients remained in SR during FU. GLAS is a quite sensitive parameter derived from simple, readily-available apical 2D echo images, which can be incorporated in a predictive clinical model of AF. GLAS could have a potential to separate those patients in SR who need prolonged rhythm monitoring from those who need anticoagulation even without AF detected at baseline.

BACKGROUND:Postpartum depression (PPD) is a prevalent and debilitating disorder that occurs in 14% of women after giving birth. OBJECTIVES:We aimed to assess the efficacy and safety of perioperative esketamine for preventing PPD in women undergoing cesarean section. SEARCH STRATEGY:We performed a systematic literature search in five medical databases - MEDLINE, Cochrane Library, Embase, Scopus, and Web of Science on the 12th of January 2025. SELECTION CRITERIA:We searched for trials on the efficacy and safety of esketamine for preventing PPD. DATA COLLECTION AND ANALYSIS:We collected data on rates of PPD, Edinburgh Postnatal Depression Scale (EPDS) scores, and adverse effects. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS:Our systematic search provided 2681 records; we screened 1336 duplicate-free records. A total of 17 eligible studies were identified after title, abstract, and full-text selection. Esketamine administration was associated with a lower rate of PPD at postpartum days 3-7 and 28-42 (OR = 0.43; 95% CI: 0.31-0.59 and OR = 0.59; 95% CI: 0.39-0.87, respectively). Esketamine administration was associated with significantly lower EPDS scores at postpartum days 3-7 (MD = -1.32; 95% CI: 1.84 to -0.80). CONCLUSIONS:Our findings suggest that perioperative administration of esketamine was associated with lower PPD rates and lower scores on the EPDS questionnaire and was considered safe compared to placebo/standard care.

COVID-19 is a disease in which early prognosis of severity is critical for desired patient outcomes and for the management of limited resources like intensive care unit beds and ventilation equipment. Many prognostic statistical tools have been developed for the prediction of disease severity, but it is still unclear which ones should be used in practice. We aim to guide clinicians in choosing the best available tools to make optimal decisions and assess their role in resource management and assess what can be learned from the COVID-19 scenario for development of prediction models in similar medical applications. Using the five major medical databases: MEDLINE (via PubMed), Embase, Cochrane Library (CENTRAL), Cochrane COVID-19 Study Register, and Scopus, we conducted a comprehensive systematic review of prediction tools between 2020 January and 2023 April for hospitalized COVID-19 patients. We identified both the relevant confounding factors of tool performance using the MetaForest algorithm and the best tools—comparing linear, machine learning, and deep learning methods—with mixed-effects meta-regression models. The risk of bias was evaluated using the PROBAST tool. Our systematic search identified eligible 27,312 studies, out of which 290 were eligible for data extraction, reporting on 430 independent evaluations of severity prediction tools with ~ 2.8 million patients. Neural Network-based tools have the highest performance with a pooled AUC of 0.893 (0.748–1.000), 0.752 (0.614–0.853) sensitivity, 0.914 (0.849–0.952) specificity, using clinical, laboratory, and imaging data. The relevant confounders of performance are the geographic region of patients, the rate of severe cases, and the use of C-Reactive Protein as input data. 88% of studies have a high risk of bias, mostly because of deficiencies in the data analysis. All investigated tools in use aid decision-making for COVID-19 severity prediction, but Machine Learning tools, specifically Neural Networks clearly outperform other methods, especially in cases when the basic characteristics of severe and non-severe patient groups are similar, and without the need for more data. When highly specific biomarkers are not available—such as in the case of COVID-19—practitioners should abandon general clinical severity scores and turn to disease specific Machine Learning tools.

INTRODUCTION:Although the relationship between the use of oral contraceptives and reduced endometrial cancer risk has now long been established, the need for female patients to be informed on this matter based on the latest results of scientific research remains. To help the evidence-based decision-making of women when choosing contraception methods, we aimed to provide them with an up-to-date overview and summary of past and recent findings on the association between the use of oral contraceptives and endometrial cancer risk. MATERIAL AND METHODS:This study was registered in PROSPERO: CRD42022379871. PubMed, Embase, and Cochrane Library databases were searched on the December 5, 2022, to identify eligible articles. We included all experimental and observational studies that reported the number of users and non-users of oral contraceptives among patients diagnosed or not with endometrial cancer. Data were extracted, and random-effects meta-analysis was performed to obtain summary odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity across studies was assessed using Higgins & Thompson's I2 statistic. RESULTS:Fifty-six studies were eligible for qualitative synthesis, of which twenty-five were eligible for quantitative analysis. The use of oral contraceptives was inversely associated with the odds of having endometrial cancer (OR = 0.61, CI: 0.46-0.80). The long-term use of oral contraceptives led to the greatest odds reduction in having endometrial cancer (≥10 years: OR = 0.31, CI: 0.13-0.70), while shorter periods were also associated with a significant decrease in these odds, although to a lesser extent (≥5 years: OR = 0.39, CI: 0.23-0.64; <5 years: OR = 0.66, CI: 0.48-0.91). CONCLUSIONS:The administration of oral contraceptives is time dependently associated with lower odds of having endometrial cancer, suggesting a protective association between the use of oral contraceptives and endometrial cancer.

Oncoplastic breast-conserving surgery (OBCS) comprises diverse techniques aimed at enhancing aesthetic outcomes and safety in breast cancer treatment. However, a knowledge gap exists in understanding the comprehensive assessment of safety factors and satisfaction rates associated with OBCS techniques. This systematic review and meta-analysis aim to compare volume displacement (VD) and volume replacement (VR) techniques concerning oncological safety, complication rates and patient satisfaction. A systematic literature search was conducted in three databases-PubMed, Embase, and Cochrane Library (CENTRAL)-up to November 2023. Original articles with quantitative satisfaction rates, recurrence, re-excision, margin status, and complications (hematoma, seroma, wound infection, fat necrosis). The systematic search identified 17,374 records, with 80 eligible studies and 46 providing quantitative data. Results showed comparable oncological safety between VD and VR techniques, including similar recurrence (Prop: 0.02; CI 0.02-0.03) and re-excision rates (Prop: 0.05; CI 0.04-0.07). VR techniques had a higher incidence of fat necrosis (Prop: 0.07; CI 0.04-0.12). Overall satisfaction was high (Prop: 0.83; CI 0.78-0.87), with VD yielding the highest satisfaction (Prop: 0.93; CI 0.85-0.97). Oncoplastic breast-conserving surgery emerges as a successful approach for treating early-stage breast cancer, characterized by low associated risks and high satisfaction rates.

Despite the broadening spectrum of heart rhythm-monitoring techniques, the most appropriate modality and duration to detect atrial fibrillation (AF) are not consensual. Two-dimensional speckle tracking for left atrial strain analysis seems feasible to detect atrial cardiomyopathy, which represents a substrate for AF. We aimed to perform a systematic review and meta-analysis on peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) differences as primary outcomes measured in sinus rhythm (SR) between patients with and without future AF during follow-up (FU). Random-effect model was used. For continuous outcomes, we calculated weighted mean differences (WMD) to compare the two groups We identified eight eligible articles consisting of 1230 patients. Six articles were eligible for quantitative PALS analysis, while three were eligible regarding pLAct. The baseline parameters of the future AF and SR patients were comparable in most of the papers. The PALS value in patients developing future AF was significantly lower compared to patients with no AF (WMD: -5.55% 95% CI -7.06 to -4.03%). Pooled WMD of pLAct between the groups was -0.44 1/s, 95% CI: -0.56 to -0.33 1/s. Baseline PALS and pLAct values of future AF patients were significantly lower than those who remained in SR during FU. PALS and pLAct seem to be sensitive parameters which can be implemented in a predictive model for AF enabling us to find patients who need prolonged heart rhythm-monitoringand it can be also a guidance for oral anticoagulation indication setting.

Introduction The respiratory microbiome has a vital role in maintaining respiratory health and preventing pathogen colonisation, but traditional diagnostic methods fail to capture a complete picture of it. Metagenomic sequencing has improved our understanding of microbial ecosystems in both acute and chronic pathologies. However, its results have not been systematically compared between different respiratory sampling techniques, as has been done with traditional methods. Our study aims to compare the microbial diversity in bronchoalveolar lavage (BAL) and tracheal samples using microbiome sequencing.Methods A systematic search was conducted in Medline, Embase and CENTRAL databases to identify studies where lower respiratory tract microbiome specimens were collected simultaneously using BAL and tracheal sampling and diversity was analysed postsequencing. Risk of bias was assessed with our specifically tailored tool. A random-effects model was used for data synthesis, analysing pooled Shannon, Chao1 and Simpson indices.Results We screened 1050 potentially relevant publications, 10 of which were included. No significant difference was found in microbial alpha diversity between BAL and tracheal samples. The subgroup analysis of tracheal sample types, including sputum and endotracheal aspirate, revealed no significant differences compared with BAL.Conclusions Tracheal sampling methods offer a viable and less invasive alternative to BAL for characterising microbiome alpha diversity in clinical or research settings where segmental sampling is not required. However, further high-quality comparative studies are needed to confirm these findings.PROSPERO registration number CRD42023436934.

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the benefits of continuous remote telemonitoring (RTM) compared to the in-person visit (IPV) in reducing all-cause mortality, heart failure hospitalizations (HFH), cardiovascular (CV) deaths, and the occurrence of inappropriate therapy. Methods: The study comprised a systematic review and meta-analysis of randomized controlled trials (RCTs) testing RTM (device-related or other non-invasive telemonitoring systems) vs. IPV for the management of HF patients. The main endpoints were all-cause and CV mortality. Risk of bias and level of evidence were assessed. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched, and only randomized controlled studies were included. Results: Sixteen RCTs were identified, comprising a total of 11,232 enrolled patients. Seven studies evaluated all-cause mortality, resulting in an OR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, the RTM group showed a significant benefit compared to the IPV group (OR 0.81, 95% CI 0.67 to 0.97). The risk of bias ranged from “low” to “some concerns” for most outcomes, and the certainty was low to moderate depending on the specific outcomes. Conclusions: RTM proved to be superior in reducing all-cause and CV mortality compared to IPV; however, there is a clear need to have standardized alert actions to achieve the mortality benefit.

Abstract Introduction Leadless pacemaker (LP) is a novel technology designed to reduce lead-related, including pocket infections, associated with traditional pacemakers. LP can be used in patients with high-degree AV block, sinus node dysfunction, and bradycardia with syncope. We conducted a systematic review and meta-analysis to examine the long-term safety of intra-cardiac leadless pacemakers compared with traditional pacemakers. Methods Our protocol was registered in advance on PROSPERO. Studies were eligible if they compared complications, revision, cardiac perforation, infections, and all-cause mortality between patients who received leadless pacemakers versus traditional pacemakers. The systematic search was conducted in five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, Scopus) without restriction. The random-effect model was implemented to calculate pooled odds ratio (OR) with a 95% confidence interval (CI). Also, the Mantel-Haenszel method, Paule-Mandel estimator for tau^2, Q-Profile method for the confidence interval of tau^2 and tau, and Hartung-Knapp adjustment for random effects model methods were used for the prediction of data extracted directly from the curves. ROBINS-I tool was used for the risk of bias assessment, and the certainty of the evidence was evaluated with the GRADE approach. Results Of 6450 studies screened, we identified 21 observational studies of Nanostim and Micra leadless pacemakers. The pooled incidence of complications of leadless versus traditional pacemakers at 1, 6, 12-24 months show the odds are clinically and statistically different (OR=0.66, 95% CI: 0.42–1.02; OR=0.44, 95% CI: 0.22–0.86; OR=0.41, 95% CI: 0.32–0.53 respectively). The pooled incidence of infection rate at 6, 12-24 months is lower in patients with LP (OR=0.37, 95% CI: 0.31–0.44; OR=0.20, 95% CI: 0.00–97.31). The studies comparing all-cause mortality during 6, 12-24 months in leadless versus traditional pacemakers did not show statistically significant differences in these outcomes (OR=1.26, 95% CI: 0.88–1.81; OR=0.86, 95% CI: 0.25–2.92 respectively. Conclusion Our results show that complications and infections occur less frequently in patients with leadless pacemakers than in patients with conventional pacemakers with no difference in all-cause mortality. However, there is a need for high-quality randomized clinical trials and propensity score-matched studies focusing on this clinically relevant question.Complication Forest plotsInfection Forest plots

Background: Delivering contraceptive hormones through a transdermal patch or a vaginal ring might have advantages over the traditional oral route. Objectives: To compare the effectiveness, compliance, and side effect profile of oral and parenteral drug administration methods. Methods: We performed a systematic literature search in four medical databases—MEDLINE (via PubMed), Cochrane Library (CENTRAL), Embase, and Scopus—from inception to 20 November 2022. Randomized controlled trials assessing the efficacy, compliance, and adverse event profile of combined parenteral and oral hormonal contraceptives were included. Results: Our systematic search provided 3952 records; after duplicate removal, we screened 2707 duplicate-free records. A total of 13 eligible studies were identified after title, abstract, and full-text selection. We observed no significant difference in contraceptive efficacy (Pearl Index) between oral and parenteral drug administration (MD = −0.06, CI: −0.66–0.53; I2 = 0%). We found significant subgroup differences between parenteral methods in terms of compliance (χ2 = 4.32, p =0.038, I2 = 80%) and certain adverse events: breast discomfort (χ2 = 19.04, p =0.001, I2 = 80%), nausea (χ2 = 8.04, p =0.005, I2 = 75%), and vomiting (χ2 = 9.30, p =0.002; I2 = 72%). Conclusion: Both parenteral and oral contraceptives can be used as an effective contraceptive method, and the route of administration should be tailored to patient needs and adverse event occurrence.