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RPC-142-05-21: The Effectiveness of Video Games in Reducing Preoperative Anxiety in Children: A Systematic Review and Meta-analysis

Maria Natividad Almazan, MD/Mary Joyce M. Academia/Paula Claire F. Agsaullo/Jose Rafael M. Aldaba/Aileen T. Andres/
Dame Loveliness T. Apaga/Vince Karl S Austria/Brigette L. Balaguer/Angelica C. Bandola/Carrel Kythe K. Baobao/Lorenz Angelo M. Barcelona

Brief Description / Summary
Background
Preoperative anxiety is a vague, subjective feeling of dread, uncertainty, tension, apprehension, nervousness, or worry before a surgery. It is an emotional response to a procedure that is viewed as a potential challenge or threat to reality. Complications may arise if this condition is not attenuated, especially in the pediatric age group. The staple management of preoperative anxiety is through pharmacological or behavioral therapy, but both have setbacks. Video games have gained ease of access with technological advancement and have been used as a contemporary treatment in various diseases. It has reached its utilization as potential management in pediatric preoperative anxiety.
Objectives
This meta-analysis aims to determine the effectiveness of video games in reducing preoperative anxiety in pediatric patients 2-12 years old. Particularly, it aims to compare the effectiveness of using video games versus the standard approaches in reducing preoperative anxiety levels. Secondary outcomes will include patient compliance during anesthesia induction, patient behavior during the medical procedure, the emergence delirium, length of stay in the post-anesthesia care unit (PACU), postoperative behavioral change, preoperative anxiety levels of parents or guardians, and parent/guardian satisfaction.
Methods
PubMed, HERDIN, Cochrane, Science Direct, ClinicalTrials.gov, and Google Scholar will be used for literature search. A hand-search will also be conducted to check for unpublished studies. A study will be included in this meta-analysis if it satisfies the following criteria: (1) published between 2011 and February 2021, (2) evaluated the use of video games to reduce preoperative anxiety, (3) participants were children 2-12 years old, and (4) study design consists of randomized controlled trials. The change in preoperative anxiety score (i.e., modified Yale Preoperative Anxiety Scale [m-YPAS] score) from the baseline after playing video games will be the primary outcome for this study. Secondary outcomes will consist of patient compliance during the anesthesia induction measured using the Induction Compliance Checklist (ICC), patient behavior during a stressful medical procedure assessed via the Procedural Behavior Rating Scale (PBRS), the emergence delirium evaluated using the Post Anesthesia Emergence Delirium (PAED) scale, the length of stay in the PACU reported as minutes to discharge, postoperative behavioral change assessed through the Post Hospital Behavior Questionnaire (PHBQ), preoperative anxiety levels of parents or guardians measured using the State Trait Anxiety Inventory (STAI), and parent/guardian satisfaction on the overall preoperative process using a verbal numerical rating scale (NRS).
Two separate teams will independently appraise appropriately chosen articles for congruence. Any disagreements will be settled via group consensus. A level of consensus of at least 80% will be considered as a strong agreement. Data will be analyzed using the RevMan 5.4.1 software. Subgroup analyses will be conducted according to the age of the study participants, midazolam use, use of preoperative psychological preparation, the genre of video game, type of video game, the timing of intervention, duration of intervention, and the interval between intervention and surgery.
Expected results
For dichotomous variables, relative risk ratios with a 95% confidence interval (CI) will be obtained, which will be considered significant if it does not cross the value of 1. For continuous data, the mean difference with a 95% CI will be obtained, which will be considered significant if it does not cross the value of 0. Using I2 statistics, heterogeneity will be classified as negligible (I2=0%), minimal (I2<20%), moderate (20%<I2<50%), or considerable (I2>50%). For the standard Chi-squared test, p<0.10 indicates heterogeneity. For the forest plot, the presence of heterogeneity is demonstrated by poorly overlapping confidence interval lines.

Video games; Preoperative Anxiety; Children; Systematic Review; Meta-analysis

RPC-143-05-21: The Efficacy and Safety of Sildenafil as Treatment of Sexual Arousal Disorder in Premenopausal Women: A Protocol for a Systematic Review

Aldrich Ivan Lois Burog, MD/Angeli Coleen S Bautista/Jose Gabriel C. Bautista/Jerremie L. Baybay/Aakash S. Bhagia/Dane Mickaele I. Bidayan/Kyrsten Jannae J. Bigay/Samantha Ally Bismonte/Ria Nicole D. Bondad/Iris O. Bontoyan/Carl Joshua R. Bote/Anne Geleen L. Braganza,

Background
Female sexual arousal disorder is a widespread public health issue that disturbs quality of life especially for women still capable of childbirth. Despite the high prevalence of sexual dysfunction among women, treatment has not yet been established and treatment options are limited. Currently, sildenafil is being considered as a treatment of female sexual arousal disorder.

Objectives
To compare the efficacy of sildenafil as treatment of female sexual arousal disorder vs placebo in terms of mean change in sexual function, change in the different domains of sexual dysfunction (i.e., sexual desire, arousal, lubrication, orgasm, sexual satisfaction), and adverse effects.

Data Sources
Literature search will be done to identify all potentially relevant articles using PubMed, OVID, the Cochrane Library, Science Direct, and HERDIN and websites such as Google Scholar. Unpublished studies will be identified by searching out medical libraries and by contacting experts in the field of Gynecology. Bibliographic references of all relevant studies will be reviewed for possible sources of data.

Eligibility Criteria
Randomized Controlled Trials (RCTs) published from the year 2000 to 2020 will be included in this systematic review. There will be no language restrictions in the search.

Participants
Participants will include pre-menopausal women, aged 18 years and above, clinically diagnosed with sexual arousal disorder or presenting with symptoms of which for at least 6 months, regardless of ethnicity and marital or relationship status.

Interventions
The main intervention is sildenafil 50 mg with placebo as control. Sildenafil or placebo is taken orally as needed at specific duration.

Study Appraisal and Synthesis Methods
The risk of bias in each study will be reviewed by three independent authors. Disagreements will be resolved by consulting a third author or by consensus among the authors. The outcomes of the eligible studies will be acquired if available, or otherwise be calculated. RevMan 5.4 will be used to analyze the data.

Expected Results
Sildenafil is expected to be effective as a treatment for female sexual arousal disorder in premenopausal women. Treatment with sildenafil is anticipated to cause a positive change in overall female sexual function and its different domains namely sexual desire, arousal, lubrication, orgasm, and sexual satisfaction.

Sildenafil; Efficacy; Safety; Treatment; Sexual Arousal Disorder; Premenopausal women

RPC-144-05-21: The Efficacy of Prenatal Omega-3 Supplementation in the Prevention of Asthma in the Offspring of Pregnant Women: A Systematic Review and Meta-Analysis

Dr. Ma. Luisa D. Aquino/Catherine Joyce B Brillantes/Cyrelle M. Brosoto/Zepha Marie M. Caalim/Kristian Dominic S. Cabrera/Erika Joy G. Cada/Xiara Mei S. Calderon/Pauline Mae R. Candelaria/Erika Anne M. Canonizado

Background: Asthma is a major public health problem worldwide affecting both the adult and the pediatric population. Among children, it is the most common non-communicable disease and is one of the leading chronic diseases. Its management remains focused mostly on tertiary prevention efforts including strategies to prevent its exacerbation and life-long control of symptoms, however, it has been reported that asthma development may potentially be prevented and addressed prenatally.

Objectives: This meta-analysis aims to assess the efficacy of prenatal omega-3 supplementation in the prevention of asthma development in the offspring of pregnant women. Specifically, it aims to compare the efficacy of prenatal omega-3 supplementation among pregnant women in terms of incidence of asthma development in the offspring, compliance to supplementation, and adverse effects to supplementation.

Methods: Randomized controlled trials involving prenatal supplementation of omega-3 from dietary fish and fish oil capsules, and control using placebo or no added fish in diet, to pregnant women will be included. The primary outcome is the prevention of asthma development in the offspring of pregnant women who took prenatal omega-3 supplementation. Secondary outcomes will be compliance to supplementation and incidence of adverse effects in both intervention and control groups. Literature search will be conducted based on the eligibility criteria by using databases including PubMed, Cochrane Library (CDSR, CENTRAL), Scopus, ScienceDirect, Clinical Key, and HERDIN PLUS, Philippine Journal of Obstetrics & Gynecology, and Philippine Journal of Pediatrics, and EBSCO Open Dissertations (for unpublished articles). Cross-referencing will also be conducted by screening the bibliographic references of included studies and related previous systematic reviews and meta-analysis. Data will be extracted and analyzed using Review Manager version 5.4.1. Subgroup analyses for the age of offspring at time of follow-up, timing of intervention, predominant omega-3 fatty acid used for intervention, offspring risk of asthma development, and source of omega-3 fatty acid will also be performed.

Omega-3 supplementation; Prenatal; Efficacy; Asthma prevention; Pregnant women

RPC-145-05-21: Efficacy and Safety of Ceramide-Containing Moisturizer for Barrier Repair Therapy Among Atopic Dermatitis Patients: A Protocol for a Systematic Review and Meta-analysis

Aldrich Ivan Lois Burog, MD/Alayne Carvajal/Maria Angellica Castillo/Anna Gabriele Castro/Jasmin Eliz Chua/Kevin Benedict Cristobal/Melissa Dean Cu/Carl Kevin Daniel/Princess Marielle De Leon/Patrick Joseph Del Campo/Ma. Liezel Del Mundo

Background
Atopic dermatitis (AD) is a common inflammatory disease (Kim et al., 2019) characterized by dry skin and severe pruritus (Lee et al., 2016; Weston & Howe, 2021). In the Philippines, AD cases are seen in 15-20% of children and 1-3% in adults, causing problems with school and work performance. Additionally, issues with loss of work time and poor self-esteem are also reported as indirect effects of AD (Weidenger et al., 2018; Lee & Detzel, 2015). The mainstay of treatment for atopic dermatitis is frequent moisturization alongside a topical corticosteroid (Chow et al., 2018). However, these current strategies are only to control symptoms and exacerbations (Weston & Howe, 2021). Furthermore, long-term steroid use can cause adverse effects both locally and systemically (Gupta & Fornacier, 2016). With these, alternative treatment options or adjuncts should be considered.

Ceramides play an important role in maintaining the skin barrier and preventing transepidermal water loss (Teranishi et al., 2021). A decrease in ceramide has been found to be unique in AD, accounting for their symptoms (Emmert et al., 2020; Imokawa et al., 2021; Jung et al., 2020). The role of ceramide in AD alongside a small sample size of studies on this topic calls forth a meta-analysis on ceramide’s efficacy against AD symptoms.

Objectives
This systematic review aims to assess the efficacy and safety of ceramide-containing topical agents compared to standard of care options, placebo, or no treatment, among clinically diagnosed atopic dermatitis.

Data sources
Online databases such as MEDLINE, SpringerLink, ClinicalKey, Clinicaltrials.gov, Cochrane Library, and HERDINPlus along with Google Scholar will be used to search for studies. References of relevant articles will be reviewed for possible studies.

Eligibility criteria
Randomized controlled trials published between 2001 to 2021 and investigating the effects of ceramide-containing topical moisturizes in terms of symptom severity and safety among clinically diagnosed atopic dermatitis patients will be used for this review.
Participants: clinically diagnosed atopic dermatitis patients regardless of age, ethnicity, sex, and disease severity
Intervention: ceramide-containing topic moisturizes without the use of co-interventions during the study period
Control: standard of care topical agent for atopic dermatitis, such as other moisturizer types and/or topical corticosteroids, placebo, or no treatment/intervention.

Study appraisal and synthesis methods
The characteristics of the studies that meet the inclusion criteria and pass the exclusion criteria will be tabulated. Risk of bias assessment will be done using Cochrane’s Risk of Bias tools (RoB 2) for randomized trials. Variable types of outcomes of interest will be determined and necessary data will be extracted. Available supplemental data will be used, and study authors will be contacted to address any missing data. Extracted data will be synthesized using RevMan 5.4. A fixed-effects model will be used for the forest plot. Random-effects models will be used to account for any heterogeneity. Sensitivity analysis will be performed if studies of high risk for bias are found.

Expected results
Ceramide-containing topical agents are expected to be as effective as a management option compared to standard of care therapies and more effective compared to no treatment. It is also expected to have minimal to no adverse effects.

Ceramide-containing moisturizer; Barrier repair therapy; Atopic dermatitis; efficacy and safety

RPC-146-05-21: Syzygium sp. extract for lowering blood glucose in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Gina Eubanas, MD/Majie Liza Diwa
Deanne Louise Dela Cruz/Hilerei Dela Fuente/Denisse Yans Dela Torre
Dale Joseph Dino/Kathryn Jan Domingo/Pol Vincent Dulguime
Elan Niccolo Echiverri/Jancel Patrick Evangelista
Emilio Fernandez

Brief Description / Summary
The Philippines is one of the countries with a high prevalence of diabetes worldwide. In the country, the disease has also been consistently among the top 10 causes of mortality since 1989. Despite the disease burden, diabetes care remains a challenge in the country mainly due to the out-of-pocket mechanism of medical care which may be a cause of financial burden to low- and middle-income families. The rich biodiversity of the country, however, has allowed for alternative herbal treatments to diseases such as diabetes, and has significantly played a role in addressing these health issues. Syzygium is one of the medicinal plants that is believed to have antihyperglycemic potential. However, studies are scarce with regards to its effects on humans. Thus, this systematic review aims to assess the efficacy of Syzygium plant extract in lowering blood glucose among patients with type II diabetes mellitus. Various electronic sources including PubMed, Cochrane, Google Scholar, ScienceDirect, and different academic libraries will be accessed to search for eligible studies from a set of inclusion criteria namely: (1) it must be a randomized controlled trial, (2) participants should be diagnosed with type 2 diabetes mellitus, (3) Syzygium plant extract is used as the intervention, (4) placebo is used as the control, and (5) the primary outcome being measured is fasting blood glucose (FBG). Data extracted will be entered into RevMan 5.4. and expressed as mean difference of FBG at 90% confidence interval. Fixed effects model will initially be used, and any heterogeneity will be addressed by using the random-effects model. It is expected that Syzygium plant extract will lower fasting blood glucose.

Syzygium sp. extract; lowering blood glucose; type 2 diabetes mellitus; systematic review; meta-analysis

RPC-147-05-21: Efficacy of Chamomile for Preventing Chemo- and Radiotherapy-induced Oral Stomatitis: A Meta-Analysis

Gina Eubanas, MD/Miguel D.Florendo/Gem Christine A. Fuerte/Elyssa Marie C. Galanido/Patrick Joshua T. Galura/Florezele D.G. Galvez/
Jerremiah G. Garcia/Patricia C. Garcia/Maybellyne Kyle D. Gayamos/Jaira Honey Mae Y. Go/Danya C. Gutierrez

Background
Cancer incidence and mortality is rapidly increasing worldwide. Locally, there were 153, 751 new cancer cases in 2020. Due to the complexity of this disease, it is often managed with chemo or radiotherapy. However, one of the most common debilitative side effects of these treatments is oral mucositis, affecting about 40% of patients. This prompts the need for prophylactic and palliative methods addressing oral mucositis.
Objectives
This meta-analysis aims to assess the efficacy of chamomile in preventing chemo- or radiotherapy-induced oral stomatitis among cancer patients receiving treatment, as compared to standard oral care. Specifically, this study aims to compare patients receiving prophylactic chamomile oral care compared to placebo, no treatment, other active intervention, or standard oral care, in terms of incidence, severity, and frequency of adverse events.
Methods
Literature search for randomized controlled trials and previous systematic reviews will be conducted using Science Direct, PubMed, CNKI, Lancet, Herdin, Ovid, Cochrane library, and websites such as UpToDate and Google Scholar. Randomized Controlled Trials (RCTs) and previous systematic reviews involving cancer patients scheduled for chemotherapy or radiotherapy regardless of age, sex, ethnicity, and type of cancer, who will be receiving chamomile oral preparation regardless of type, duration, and onset of administration. Studies will be appraised based on the presence of random sequence generation (selection bias), intention-to-treat analysis, completeness of follow-up, allocation concealment (selection bias), blinding of outcome assessment (detection bias), and similarity of baseline characteristics. Risk bias for each factor will be assessed as “low”, “high” or “unclear”. Results will be analyzed using Revman Software 5.4. Fixed effects models will be used for homogeneous datasets. Heterogeneity will be addressed with random-effects models. Statistical analysis will be based on chapter 10 of the Cochrane Handbook for Systematic Reviews of Interventions version 6.1.
Expected Results
The forest plot comparing the incidence, severity, duration, and adverse effects of prophylactic chamomile oral preparation and the control should all lean towards the control arm of the study. This signifies that prophylactic chamomile oral preparations reduce and ameliorate oral mucositis developing from chemo-and radiotherapy.

Korean Association for Lung Cancer International Conference
Poster Presentation
Lotte Hotel World, Seoul, Korea
Nov 10-11, 2022

RPC-148-05-21: Saffron Supplementation for Reduced Labor Duration in Term Pregnant Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Dr. Gloriosa C. Galindez/Jasmine S. Interior/Phoebe Bianca Therese B. Ipapo/Remigo Angelo A. Iringan/Ogulcan Yulugses F. Isik/Julius Marlon L. Javellana/Micah B. Javier/Paula Martini O. Javillonar/Errol John S. Jorge/Joza Jenia I. Juan/John Mike D Justiniani

A B S T R A C T

Background
Prolonged labor or failure to progress is a common problem encountered during labor and delivery that brings about various complications both to the mother and the fetus through an interplay of labor pain, anxiety, and consequent protraction or arrest. Current modalities used to induce or augment labor, both mechanical and pharmacological, while effective in some cases, are associated with their own adverse effects. These problems incite the need for further research with labor augmentation, thereby placing the spotlight on saffron (Crocus sativus L.)—a lucrative spice that has been well established in various industries since the early ages until today in medicine. It is most notably utilized by midwives as it has been shown that saffron is an effective supplement for labor augmentation due to its muscle relaxant and anxiolytic effects. As a promising adjunct for shortening labor duration, it brings an opportunity for further exploration especially in the Philippines where data on herbal medications are limited.

Objectives
The aim of this systematic review and meta-analysis is to determine the efficacy of saffron supplementation compared to placebo in reducing the duration of labor among term pregnant patients.

Methods
Data sources
Literature search will be conducted to identify all potentially relevant articles using databases such as PubMed, Clinical Key, Cochrane Library, Science Direct, Trip Database, Health Research and Development Information Network (HERDIN), BioMed Central, Index Medicus for South-East Asia Region (IMSEAR), Western Pacific Region Index Medicus (WPRIM), Google Scholar, unpublished dissertations from St. Luke’s Medical Center College of Medicine – Library and the Philippine Obstetrical and Gynecological Society, and bibliographic references.
Studies
Only randomized clinical trials focused on the efficacy of saffron supplementation in decreasing labor duration among term pregnant patients that were published from 2000 onwards will be selected. There will be no language restrictions in the search.
Participants
The systematic review will include pregnant patients of the reproductive age group (15-49 years old) with cephalic presentation, gestational age of 37 weeks or more, low-risk pregnancy, regardless of uterine contractions.
Interventions
The intervention that will be used are saffron supplements, consisting mainly of dried saffron stigma or powdered pure saffron.


Study appraisal and synthesis methods
Studies from the literature search will be screened based on titles, abstracts, and full texts. The risk of bias of the eligible studies will be independently appraised by nine independent authors. Data from the chosen studies will then be analyzed using Review Manager 5.4.
Outcomes
Primary outcomes to be measured are durations of the first and second stages of labor. Whereas secondary outcomes to be assessed include Bishop’s score, pain severity index, compliance rate, and adverse events. Additionally, subgroup and sensitivity analyses will be performed, as necessary.

Expected Results
Saffron supplementation is expected to decrease the duration of the first and second stages of labor in term pregnant patients as compared to placebo.

Saffron supplementation; Reduced labor duration; Term pregnant patients; systematic review; meta-analysis; randomized clinical trials

29th International Student Congress Of (bio)Medical Sciences th International Student Congress Of (bio)Medical Sciences
University Medical Centre Groningen, Netherlands
June 8-10 2022

RPC-149-05-21: Efficacy of Probiotics on Reducing Obesity Among Children & Adolescents: A Systematic Review and Meta-Analysis

Arlene Crisostomo, MD/Dom Nikolai R.Kalbit/Dhianne A Lapuz/Patricia Mae Lara/Nina Angeline B. Lavin/Chesca Angelica H Lazara/Ivan Jed T. Laoz/Scott Justin Q Lee/Mary Elizabeth C. Legarda/Lorenzo Gabriel Limbaga/Elizur M Maandig III

Background
Childhood obesity is one of the most serious public health concerns in the 21st century. With this, many researchers have studied the potential benefits of probiotics in reducing body weight to address obesity. However, there is currently no systematic review and meta-analysis on the efficacy of probiotics as a treatment for weight loss in the pediatric population. Moreover, individual studies in children and adolescents are limited, with small sample sizes and differences in methodology. Thus, there is a need to conduct this systematic review and meta-analysis.
Objectives
This meta-analysis aims to assess the efficacy of probiotics on weight loss anthropometric measurements and metabolic parameters in overweight and obese children and adolescents. Specifically, this study aims to compare the efficacy of probiotic treatments alone or as an adjunct to diet and/or exercise in improving anthropometric measurements and metabolic parameters in overweight children and adolescents in terms of changes in BMI, waist circumference, weight, total triglycerides, total cholesterol, HDL-C levels, and LDL-C levels.
Methods
Literature search shall be done using PubMed, Clinical Key, Cochrane, Ovid, Science Direct, HERDIN and Google Scholar. Clinicaltrials.gov shall be used to search for ongoing and completed clinical trials, which will be then crossed-referenced with published literature. Based on the Centers for Disease Control and Prevention, overweight is defined as BMI equal or greater than the 85th percentile and below the 95th percentile for children and adolescents of the same gender and age. While obese is BMI equal to greater than the 95th percentile for children and adolescents of the same gender and sex. The primary outcomes are changes in BMI (z-score), waist circumference, and weight. The secondary outcomes are changes in total triglycerides, total cholesterol, HDL-C levels, and LDL-C levels. Data shall be extracted and analyzed using RevMan (Review Manager ver. 5.4). Subgroup analysis shall be done based on the age of the participants, duration of treatment, and type of interventions conducted.
Expected Results
Probiotic administration is expected to have a higher reduction in BMI, weight, waist circumference, and metabolic parameters (TG, TC, HDL-C, LDL-C) when compared to placebo or control groups. A sizeable heterogeneity across studies is expected given the wide range of methods, probiotic strains and preparations, and study participants. Furthermore, probiotics are expected to be more efficacious when administered as an adjunct to standard management for obesity (e.g. calorie restriction, physical exercise regimens) rather than as the primary treatment in itself.

Probiotics; obesity; children; adolescents; efficacy; systematic review; meta-analysis

RPC-150-05-21: The Efficacy of Spinal Manipulation Therapy in Reducing Scoliotic Curve among Pediatric Patients with Scoliosis: A Systematic Review and Meta-Analysis

Antonio D. Ligsay, MS, MSc, DPPS/Al Khair A. Macabantog/Alyssa Camille L. Magaoay/Kathryn Grace R. Magsombol/Yasmin Athena B. Malabuyo
Eduardo C. Manalo, Jr./Genesis E. Manota/Frances Mikaela L. Manuel/Jhoellah D. Marasigan/Miko T. Marbella/Thiphany Celyn D. Mariano

Brief Description / Summary
Background: Scoliosis is a spinal condition that occurs as a sideway curvature in a normally straight alignment of the spine and is seen most often in pediatric patients during growth spurt just before the onset of puberty. The most common form general practitioners encounter is adolescent idiopathic scoliosis (AIS). Effects to the patient usually vary depending on the severity, wherein severe forms commonly present as difficulty of breathing and sleeping while mild scoliosis mostly affects the psychological well-being and self-image of the patient. Spinal manipulative therapy (SMT) continues to gain attention due to reports of significant clinical improvement that, contrary to conventional treatment, is achieved through natural, therapeutic, and non-invasive means.
Objectives: This meta-analysis aims to synthesize the available evidence and improve statistical data on effectiveness of spinal manipulation therapy on the reduction of scoliotic curve in pediatric patients diagnosed with scoliosis.
Data Sources: The use of electronic databases including PubMed, Google Scholar, ClinicalTrials.gov, HERDIN, Ovid, ScienceDirect, and Cochrane library will be used in identifying ongoing and completed studies. No restrictions on date of publication will be applied.
Study Eligibility Criteria, Participants, & Interventions: Studies included in this analysis will be restricted to randomized controlled trials, non-randomized controlled trials, and observational studies. Participants include pediatric patients clinically diagnosed with scoliosis regardless of their sex and case severity. The main intervention employed should be spinal manipulation therapy. Reduction of scoliosis curve will be determined using the Cobb’s angle.
Study Appraisal & Synthesis: From the selected electronic databases, two authors will independently search, retrieve data, and appraise identified studies. Data gathered will be analyzed using RevMan version 5.4.1 and analysis will be based on Cochrane Handbook for Systematic Review of Interventions.
Expected Results: Data on Cobb angle improvement, pain relief, and adverse effects will be synthesized.

spinal manipulation therapy; scoliotic curve; pediatrics; scoliosis; systematic review; meta-analysis

RPC-151-05-21: The Efficacy of Bifidobacterium-containing Probiotics as an Adjuvant to Triple Therapy in the Eradication of Helicobacter pylori among Patients with Helicobacter pylori Infection: a Meta-analysis

Antonio D. Ligsay, MD, MSc, PhD, DPPS/Kyle C. Marquez/Generose Christy M. Mateo/Princess Amabelle C. Mauricio/Antonio Gabriel D. Mirano
Emmanuel Manolo S. Montaño/Stephen R. Montoya/Angelo Car O. Muyot/Martin Emmanuel F. Nuque/Lyric O. Octaviano/Joshua Kyle Niño I. Oliveros

Brief Description / Summary
Background: Helicobacter pylori infection is a leading etiological cause of chronic gastric
infections, with almost half the world’s population being colonized by the bacteria. The emergence
of probiotics as a potential adjuvant therapy for H. pylori has been studied to increase the effect
of eradication and reduce side effects when combined with antibiotics. Bifidobacterium is a widely
used probiotic sold as either tablet form or in yoghurt usually in combination with other genus
Objectives: This meta-analysis aims to determine the efficacy of Bifidobacterium sp.-containing
probiotic adjunctive therapy compared to triple therapy alone to eradicate H. pylori among patients
with H. pylori-induced gastrointestinal disease
Data Sources: PubMed, Cochrane Library, HERDIN, and Google Scholar
Study Eligibility Criteria: Randomized control trials with participants diagnosed with H. pylori
infection and concomitant gastrointestinal disease treated with probiotics containing at least
Bifidobacterium as an adjuvant to triple therapy compared to triple therapy alone with or without
placebo.
Participants: Patients with H. pylori infection and concomitant peptic ulcer disease, gastritis, or
functional dyspepsia
Interventions: Probiotics as an adjuvant with triple therapy
Study Appraisal and Synthesis Methods: Cochrane's Risk of bias tool will be used to appraise
each study
Expected Results: Measure of treatment effect and adverse outcomes using risk ratios

Bifidobacterium; probiotics; adjuvant; triple therapy; Helicobacter pylori eradication; meta-analysis

RPC-156-05-21: The Safety and Efficacy of Botulinum Toxin Injection in the Relief of Chronic Low Back Pain Among Adults: A Systematic Review and Meta-Analysis

Maria Teresa Tolosa, MD/Sumaya Pangcoga/Ruth Parungao/Reymond Joseph Patricio/IG Luis Penetrante/Grace Petonio,
Sharmaine Kae Po/Maika Rabang/Ronald Cedric Rada/Rachel Anne Razo/Rafael Carlos Recomono

1.1 Background
Chronic low back pain (CLBP) is described as pain in the lower back area for at least 12
weeks, usually associated with musculoskeletal disorders. Initial management of
mechanical CLBP includes intake of analgesics, NSAIDs, muscle relaxants, or exercise
therapy. However, due to the side effects, cost-ineffectiveness, and inefficiency of these
treatments to relieve symptoms, several studies have suggested the use of a new and
more efficacious treatment, such as botulinum toxin injection which showed promising
effects of pain relief, improvement of function, and patient recovery.
1.2 Objectives
This meta-analysis aims to assess the efficacy and safety of botulinum toxin injection in
the relief of chronic low back pain among adults. Specifically, this aims to compare the
proportion of patients who are pain-free, had baseline function improvement,
experienced side effects, and had recurrence of low back pain in the intervention group
to the control group.
1.3 Methods
PubMed, MEDLINE, Google scholar, Clinical Key, and Cochrane will be used for
literature search. Only randomized controlled trials (RCTs) using botulinum toxin
injection A as the intervention and placebo injection as the control for chronic low back
pain in patients, regardless of, sex, and race/ethnicity, will be included in the study. The
primary outcomes which will be included are being pain-free and having baseline
function improvement. Secondary outcomes to be assessed include occurrence of side
effects and recurrence of low back pain. Data will be analyzed using Review Manager
(RevMan) version 5.3.
1.4 Expected results
Based on the studies, it is expected that botulinum toxin is a safe and effective treatment
for chronic low back pain among adults.

Botulinum toxin injection; chronic low back pain; adults; relief; systematic review; meta-analysis

RPC-152-05-21: The Efficacy and Safety of N-acetylcysteine in Improving Depressive Symptoms in Patients with Neuropsychiatric Diseases: A Systematic Review and Meta-Analysis

Maria Teresa S. Tolosa, MD, D Clin Epi, FPDS/Kirsten Louise L. Reyes/Lorenzo Rafael F. Rocha/Frederico Sabban/Risle Meeko C. Salva/Athea Francene B. Samson/Joanna Mae C. Santiago/Roldan M. Sardona/Kristel Catherine M. Serrano/Katrina Louise F. Sinamban/Prestine Shealtiel A. Subido,

Summary
Background
Annually, there is an increase of incidence of mental health disorders. Depressive
symptoms in particular are found in a variety of neuropsychiatric disorders. Recently, there
have been studies that looked into the potential of N-acetylcysteine (NAC) for treatment of
depressive symptoms due to it being an antioxidant, anti-inflammatory, and its ability to
regulate the glutaminergic pathway by increasing its levels. Further study on the efficacy of
NAC may aid in expanding treatment options for those with depressive symptoms and may
improve their quality of life.
Objectives
This systematic review and meta-analysis aim to assess the efficacy of NAC taken
alone or as an adjunct, compared to antidepressants alone, in improving the depressive
symptom severity of adults diagnosed with mental health disorders. Specifically, its aims are
to assess the efficacy of NAC taken alone or as an adjunct in improving the depressive
symptom severity of adults diagnosed with neuropsychiatric health disorders in terms of: (1)
Improvement in depression symptom severity scores and (2) Improvement in quality of life
and daily function. It also aims to identify any adverse effects from taking NAC.
Data Sources
Electronic search for Randomized Controlled Trials (RCTs) across databases such
as PubMed, Cochrane Library, Science Direct, Google Scholar, and UpToDate will be done.
References of gathered studies will be reviewed to retrieve possible sources of data. A
search for unpublished data will also be conducted.
Eligibility Criteria, Participants, and Interventions
The RCTs that will be collected include participants aged 18 years old and above
who are clinically diagnosed with neuropsychiatric diseases with manifestation of depressive
symptoms. These studies evaluate the efficacy of N-Acetylcysteine (NAC) in any dosage,
form, frequency, and route of administration, alone or as adjunctive treatment, in

3
Protocol Version 01 dated January 2019
comparison with standard pharmacotherapy (antidepressants), for improvement of
depressive symptoms. In these studies, measures on improvement of symptoms include
change in scores rating the severity of depressive symptoms using scales such as the
Montgomery-Asberg Depression Rating Scale (MADRS) and Hospital Anxiety Depression
Scale (HADS). In addition, improvement of psychosocial function is measured by change in
scores using scales like Range of Impaired Functioning Tool (LIFE-RIFT), Quality of Life
Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Social and Occupational
Functioning Assessment Scale.
Study appraisal and Synthesis Methods
Two members will review and assess the risk of bias of each study included
independently. Risk for bias will be evaluated using the following domains: For appraising
validity, primary criteria include: (1) random sequence generation, (2) allocation
concealment, (3) blinding of participants and personnel, (4) blinding of outcome
assessment, (5) incomplete outcome data, (6) selective reporting bias, and (7) other forms
of biases.
Expected Results
A total of n studies was collected for this meta-analysis. It was found that NAC alone
or in combination does/does not significantly improve depressive symptoms compared to
standard treatment. In addition, it also does/does not significantly improve quality of living.
As for subgroup analyses, significant/no significant mean difference was found between
NAC alone or as adjunct and standard pharmacotherapy across age group, duration of
intervention, type of intervention (whether used as main treatment or as adjunct), duration of
symptoms (acute or chronic) and types of neuropsychiatric disorders.

N-acetylcysteine; depressive symptoms; neuropsychiatric diseases; systematic review; meta-analysis

RPC-153-05-21: Cardiovascular Parameters of E-cigarette Smokers in Comparison to Traditional Tobacco Smokers: A Meta-Analysis

Dr. Josephine Yuson-Sunga/Leann F. Suiton/Jerica Erin C. Tan/Marjorie Zelina C. Tanael/Karren Cole B. Tangonan/Yssa Nicole S. Tarrazona/Bernice Nestle Mae A. Teng/Ma. Faye Ginger F. To/Theresa Camille S. Tobillo/Ivan Matthew E. Tolentino/ Czarina Rose R. Tuason

1. Brief Description / Summary
Background: Tobacco smoking is widely considered as the leading cause of preventable
cancer and various cardiovascular diseases. Despite being well-known to cause harmful
effects on the body, tobacco smoking remains rampant in many countries. This led to the
development of healthier alternatives - one of which is electronic cigarettes, or e-cigarettes.
E-cigarettes have been popularly marketed as a safer substitute for traditional tobacco
cigarettes. However, current studies on the adverse effects of e-cigarettes on cardiovascular
function, as compared to tobacco smoking, have conflicting results. Hence, there is a need
to conduct this meta-analysis.
Objectives: This study aims to compare the difference in cardiovascular function among
smokers using e-cigarettes versus those who smoke traditional tobacco cigarettes.
Specifically, it aims to compare the differences in the following cardiovascular function
parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR),
and aortic stiffness.
Data sources: This meta-analysis will utilize electronic search using PubMED, Cochrane
Library, and NCBI, and free text search, using Google Scholar to find relevant articles.
Study eligibility criteria, participants, and interventions: Randomized controlled trials
(RCTs) from 2015 onwards using e-cigarettes as the primary intervention with participants
aged 18 years old and above who are established smokers for at least 5 years and without
any pulmonary or cardiovascular health problems will be included.
Study appraisal and synthesis methods: Appraisal of the selected studies will be done
based on randomization, follow-up rate, intention-to-treat analysis, blinding of outcome
assessors, baseline similarity of characteristics, and concealment of allocation. RevMan 5.4
will be used to analyze the data. Subgroup analyses on different nicotine concentrations will
also be performed.
Expected results: The outcomes assessed in this meta-analysis are the difference in
cardiovascular function between e-cigarette users and tobacco smokers, particularly in
terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and
aortic stiffness.

Cardiovascular parameters; E-cigarette smokers; Tobacco smokers; meta-analysis

RPC-154-05-21: Virtual Reality for Upper Extremity Motor Rehabilitation in Stroke Patients: A Systematic Review and Meta-Analysis

Isaac David E. Ampil II, MD, MSc/Ma. Alexandra Nicola B. Valenzuela/Agape Shelley D. Valila/Ma. Carmel R. Villafranca/Nidelli S. Vinson/Carmela Aurora L. Vintola/Nicanor S. Vivar Jr./Esther W. Xie/Sejin B. Yoon/Jinsheen Ai-Ni M. Young/Gaius Sulpicio G. Yu III

1. Brief Description/ Summary
Background
Stroke is a leading cause of neurological impairment in adults. Despite recent advancements in
motor rehabilitation efforts for stroke patients, the high prevalence of chronic post-stroke motor
impairments interfering with activities of daily living (ADLs) calls for more efficient rehabilitation
strategies as conventional options are deemed inconvenient, time-consuming, and expensive.
Virtual reality (VR) technology creates interactive simulated environments that integrate
repetitive task-oriented routines, promoting neuroplasticity necessary for motor rehabilitation. As
VR technology becomes more accessible in the mainstream market, it shows potential as a
viable option in post-stroke motor rehabilitation.
Objectives
This meta-analysis aims to integrate data from multiple sources to assess the efficacy of
utilizing virtual reality (VR) platforms as an adjunct to standard therapy for upper extremity (UE)
motor rehabilitation in post-stroke patients. Specifically, it aims to compare changes in Fugl-
Meyer Assessment for the upper extremity (FMA-UE) scores from baseline to after therapy and
rates of compliance between the intervention and control groups.

Protocol Version 01 dated 3 May 2021
Methods
The search for literature will involve indexing PubMed, Cochrane Library, Clinical Key,
ScienceDirect, HERDIN, EmBase, clinicaltrials.gov, ICTRP, and Google Scholar, and contacting
experts and educational institutions specializing in neurology and rehabilitation medicine.
Studies to be included will be randomized controlled trials (RCTs) utilizing task-oriented VR
platforms as an adjunct to standard therapy for UE motor rehabilitation in post-stroke patients
18 years old and above, regardless of sex, ethnicity, and type of stroke. The primary outcome
will be the comparison of changes in FMA-UE scores from baseline to after-therapy between the
intervention and control groups and the secondary outcome will be the comparison of their
respective rates of compliance. All eligible studies will be appraised independently by two
authors and disagreements will be resolved via consultation with a third author or by unanimous
decision among the study authors. Extracted data will be analyzed using Review Manager 5.4
and will include a subgroup analysis on treatment duration and a sensitivity analysis on stroke
onset.
Expected Results
Virtual reality platforms used as an adjunct to standard therapy for UE motor rehabilitation in
post-stroke patients will be expected to show significantly improved changes in FMA-UE scores
from baseline when compared to those receiving standard therapy alone. Significantly higher
rates of compliance will be expected among the intervention group compared to the control
group. Greater changes in FMA-UE scores from baseline will also be expected with longer
durations of therapy in the intervention group when compared to the control group and among
patients recruited within 6 weeks of stroke onset.

Virtual reality; upper extremity motor rehabilitation; stroke patients; systematic review; meta-analysis