This article introduces a concise 10-step guide tailored for researchers engaged in systematic reviews within the field of medicine and health, aligning with the imperative for evidence-based healthcare. The guide underscores the importance of integrating research evidence, clinical proficiency, and patient preferences. It emphasizes the need for precision in formulating research questions, utilizing tools such as PICO(S)(Population Intervention Comparator Outcome), PEO (Population Exposure Outcome), SPICE (setting, perspective, intervention/exposure/interest, comparison, and evaluation), and SPIDER (expectation, client group, location, impact, professionals, service and evaluation), and advocates for the validation of research ideas through preliminary investigations. The guide prioritizes transparency by recommending the documentation and registration of protocols on various platforms. It highlights the significance of a well-organized literature search, encouraging the involvement of experts to ensure a high-quality search strategy. The critical stages of screening titles and abstracts are navigated using different tools, each characterized by its specific advantages. This diverse approach aims to enhance the effectiveness of the systematic review process. In conclusion, this 10-step guide provides a practical framework for the rigorous conduct of systematic reviews in the domain of medicine and health. It addresses the unique challenges inherent in this field, emphasizing the values of transparency, precision, and ongoing efforts to improve primary research practices. The guide aims to contribute to the establishment of a robust evidence base, facilitating informed decision-making in healthcare.

Systematic reviews and meta-analyses are essential tools in medical research. Systematic reviews are a type of literature review that uses a systematic process to identify and assess all available literature on a specific research question. A meta-analysis is a statistical method of synthesizing the results of a systematic review by quantitatively combining data. The process begins with formulating a well-defined research question using frameworks. Comprehensive literature searches across multiple databases, including PubMed, Embase, and Cochrane, to ensure the inclusion of diverse studies. Tools like EndNote and Covidence streamline reference management and study selection, enhancing efficiency and accuracy. Quality assessment using tools like the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale is crucial to evaluate the methodological rigor. Data extraction, using standardized forms to ensure consistent information capture. Qualitative synthesis is one method that integrates the results of a systematic review focusing on textual data. Meta-analysis employs statistical software such as R and RevMan to compute effect sizes, confidence intervals, and assess heterogeneity. Visual representations, including forest and funnel plots, facilitate the interpretation of results. Challenges such as publication bias and heterogeneity are addressed using statistical methods like Egger regression and the trim-and-fill technique. Sensitivity analyses further validate the robustness of findings. Common errors, including data entry mistakes and inappropriate pooling, are mitigated through rigorous methodological adherence and critical self-evaluation. Meticulously conducted, systematic reviews and meta-analyses represent the pinnacle of the evidence hierarchy, driving advancements in medical research and practice.

Heritable thoracic aortic disease is due to altered genes that confer a highly penetrant risk for thoracic aortic aneurysm and dissection, and a subset of these genes also cause aneurysms and dissections of peripheral arteries beyond the aorta. Arterial aneurysms, dissections, and ruptures are associated with pathogenic variants (PVs) in COL3A1, which is responsible for vascular Ehlers-Danlos syndrome, but arterial events are rare in Marfan syndrome due to PVs in FBN1, and poorly characterized in Loeys-Dietz syndrome due to PVs in the transforming growth factor (TGF)-β pathway genes. This study sought to define the relative risk of arterial and aortic events in individuals with PVs in FBN1, COL3A1, and TGF-β pathway genes. The Montalcino Aortic Consortium provided a retrospective cohort of 1,780 individuals with PVs in COL3A1 (n = 125), FBN1 (n = 1028), and the TGF-β pathway genes (TGFBR1, n = 137; TGFBR2, n = 168; SMAD3, n = 196; TGFB2, n = 126). Arterial events were defined as dissections, ruptures, or aneurysms in arteries beyond the aorta requiring open or endovascular repair, and aortic events were defined by aortic dissections or repair of an aortic aneurysm. Arterial events were identified in 83 individuals, with the highest prevalence in COL3A1 (20.8%), followed by TGFBR2 (7.7%), TGFBR1 (7.3%), TGFB2 (6.4%), SMAD3 (5.6%), and FBN1 (1.5%). Kaplan-Meier curves identified significant gene differences, with COL3A1 having the most and earliest arterial events when compared with TGF-β genes and FBN1. For TGF-β genes and FBN1, aortic events were significantly earlier and more penetrant than arterial events, whereas this difference was not present with COL3A1. Sex impacts arterial events; males with COL3A1 had earlier and more arterial events compared with males with TGF-β genes, and these differences were not observed in females. Arterial events in FBN1 cases occur primarily in men. There are significant gene- and sex-specific differences in the prevalence and age of onset of arterial events associated with these heritable thoracic aortic disease genes, highlighting the importance of tailored counseling and surveillance based on the causative gene. Furthermore, smoking cessation and hypertension control should be emphasized in these patients to reduce the risk of arterial events.

Silymarin, extracted from milk thistle (Silybum marianum), is esteemed for its antioxidative, anti-inflammatory, and antifibrotic properties, notably within liver-related contexts. Nevertheless, a comprehensive grasp of its effects on liver enzymes remains elusive. This systematic review aims to scrutinize the influence of silymarin supplements on liver enzyme levels, elucidating its potential for hepatoprotection. Following PRISMA 2020 guidelines, we systematically reviewed pertinent studies in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online). Our inclusion criteria comprised randomized clinical trials (RCTs) published between 1992 and 2023, accessible in English, with a primary focus on liver enzyme levels. Non-original research, ambiguously defined studies, and those lacking essential data were excluded. Of the 1,707 initially identified articles, 29 RCTs met the inclusion criteria, encompassing 3,846 participants with diverse underlying conditions. Silymarin dosages ranged from 140 mg to 420 mg, administered for various durations. Results revealed that 65.5% of the studies reported reduced liver enzyme levels, 20.7% exhibited no significant change, and 13.8% observed elevated liver enzymes. The systematic review implies a potential advantageous influence of silymarin on liver enzyme levels, indicating its hepatoprotective potential. Nevertheless, outcome disparities may stem from comorbidities, suboptimal doses, and underlying diseases. Notably, silymarin's impact on liver enzymes could be context-dependent, with varying responses among different conditions, with the decrease of liver enzyme levels in patients with non-alcoholic fatty liver disease. Silymarin supplements exhibit potential for hepatoprotection by ameliorating liver enzyme levels across diverse conditions. Further research should ascertain optimal dosages and contexts, accounting for individual patient characteristics and underlying diseases.

Arsenic exposure is a significant public health issue, with harmful effects caused by its use in commercial products such as car batteries, pesticides, and herbicides. Arsenic has three main compounds: inorganic, organic, and arsine gas. Inorganic arsenic compounds in water are highly toxic. The daily intake of arsenic from food and beverages is between 20 and 300 mcg/day. Arsenic is known for its carcinogenic properties and is classified as a human carcinogen by different institutions. Exposure can lead to oxidative stress, DNA damage, and epigenetic deregulation, which can cause endocrine disorders, altered signal transduction pathways, and cell proliferation. In addition, arsenic can easily cross the placenta, making it a critical concern for maternal and fetal health. Exposure can lead to complications such as gestational diabetes, anemia, low birth weight, miscarriage, and congenital anomalies. Female babies are particularly vulnerable to the negative impact of arsenic exposure, with a higher risk of low weight for gestational age and congenital cardiac anomalies. Therefore, it is crucial to monitor and regulate the levels of arsenic in drinking water and food sources to prevent these adverse health outcomes. Further research is necessary to fully understand the impact of arsenic exposure on human health, especially during pregnancy and infancy, by implementing preventative measures and monitoring the levels of arsenic in the environment.

Background: Alzheimer's disease (AD) is the most common cause of dementia worldwide. Omega‐3 fatty acids (n‐3‐PUFA) are essential to normal neural development and function. Souvenaid®, a medical supplement that contains n‐3‐PUFA's: eicosatetraenoic acid (EPA) and docosahexaenoic acid (DHA), has emerged as an alternative, slowing cognitive decline in AD patients. In this study, we investigated the effect of dietary supplementation with n‐3‐PUFA, EPA, DHA, and Souvenaid® in AD patients.Aim: This systematic review and meta‐analysis aim to establish the relationship between n‐3‐PUFA, EPA, DHA, and Souvenaid® with cognitive effects, ventricular volume and adverse events in AD patients.Methods: A systematic search of randomized control trials (RCT), cohorts, and case–control studies was done in PubMed, Scopus, Web of Science, Cochrane, and Embase for AD adult patients with dietary supplementation with n‐3‐PUFA, EPA, DHA, or Souvenaid® between 2003 and 2024.Results: We identified 14 studies with 2766 subjects aligned with our criteria. Most publications described positive cognitive outcomes from supplements (58%). The most common adverse events reported were gastrointestinal symptoms. CDR scale showed reduced progression of cognitive decline (SMD = −0.4127, 95% CI: [−0.5926; −0.2327]), without subgroup differences between different dietary supplement interventions. ADCS‐ADL, MMSE, ADAS‐cog, adverse events, and ventricular volume did not demonstrate significant differences. However, Souvenaid® showed a significant negative effect (SMD = −0.3593, 95% CI: −0.5834 to −0.1352) in ventricular volumes.Conclusions: The CDR scale showed reduced progression of cognitive decline among patients with n‐3‐PUFA supplemental interventions, with no differences between different n‐3‐PUFA supplements.