Showing papers by "Jean Jacques Noubiap published in 2020"

A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19)

Abstract: Prognostic factors for the Coronavirus disease 2019 (COVID1–9) are not well established. This study aimed to summarize the available data on the association between the severity of COVID-19 and common hematological, inflammatory and biochemical parameters. EMBASE, MEDLINE, Web of sciences were searched to identify all published studies providing relevant data. Random-effects meta-analysis was used to pool effect sizes. The bibliographic search yielded 287 citations, 31 of which were finally retained. Meta-analysis of standardized mean difference (SMD) between severe and non-severe COVID-19 cases showed that CK-MB (SMD = 0.68,95%CI: 0.48;0.87; P-value:< 0.001), troponin I (SMD = 0.71, 95%CI:0.42;1.00; P-value:< 0.001), D-dimer (SMD = 0.54,95%CI:0.31;0.77; P-value:< 0.001), prothrombin time (SMD = 0.48, 95%CI:0.23;0.73; P-value: < 0.001), procalcitonin (SMD = 0.72, 95%CI: 0.34;1,11; P-value:< 0.001), interleukin-6 (SMD = 0.93, 95%CI: 0.25;1.61;P-value: 0.007),C-reactive protein (CRP) (SMD = 1.34, 95%CI:0.83;1.86; P-value:< 0.001), ALAT (SMD = 0.53, 95%CI: 0.34;0,71; P-value:< 0.001), ASAT (SMD = 0.96, 95%CI: 0.58;1.34; P-value: < 0.001), LDH (SMD = 1.36, 95%CI: 0.75;1.98; P-value:< 0.001), CK (SMD = 0.48, 95%CI: 0.10;0.87; P-value:0.01), total bilirubin (SMD = 0.32, 95%CI: 0.18;0.47;P-value: < 0.001), γ-GT (SMD = 1.03, 95%CI: 0.83;1.22; P-value: < 0.001), myoglobin (SMD = 1.14, 95%CI: 0.81;1.47; P-value:< 0.001), blood urea nitrogen (SMD = 0.32, 95%CI: 0.18;0.47;P-value:< 0.001) and Creatininemia (SMD = 0.18, 95%CI: 0.01;0.35; P-value:0.04) were significantly more elevated in severe cases, in opposition to lymphocyte count (SMD = -0.57, 95%CI:-0.71; − 0.42; P-value: < 0.001) and proportion of lymphocytes (SMD = -0.81, 95%CI: − 1.12; − 0.49; P-value:< 0.001) which were found to be significantly lower in severe patients with other biomarker such as thrombocytes (SMD = -0.26, 95%CI: − 0.48; − 0.04; P-value:0.02), eosinophils (SMD = − 0.28, 95%CI:-0.50; − 0.06; P-value:0.01), haemoglobin (SMD = -0.20, 95%CI: − 0.37,-0.03; P-value:0.02), albuminemia (SMD-1.67,95%CI -2.40; − 0.94; P-value:< 0.001), which were also lower. Furthermore, severe COVID-19 cases had a higher risk to have lymphopenia (RR =1.66, 95%CI: 1.26;2.20; P-value:0.002), thrombocytopenia (RR = 1.86, 95%CI: 1.59;2.17; P-value: < 0.001), elevated procalcitonin level (RR = 2.94, 95%CI: 2.09–4.15; P-value:< 0.001), CRP (RR =1.41,95%CI: 1.17–1.70; P-value:0.003), ASAT(RR =2.27, 95%CI: 1.76;2.94; P-value:< 0.001), CK(RR = 2.61, 95%CI: 1.35;5.05; P-value: 0.01), Creatininemia (RR = 3.66, 95%CI: 1.53;8.81; P-value: 0.02) and LDH blood level (RR = 2.03, 95%CI: 1.42;290; P-value: 0.003). Some inflammatory (procalcitonin, CRP), haematologic (lymphocyte, Thrombocytes), and biochemical (CK-MB, Troponin I, D-dimer, ASAT, ALAT, LDH, γ-GT) biomarkers are significantly associated with severe COVID-19. These biomarkers might help in prognostic risk stratification of patients with COVID-19.

Prevalence of High-risk Plaques and Risk of Stroke in Patients With Asymptomatic Carotid Stenosis: A Meta-analysis.

Abstract: Importance There is an ongoing debate regarding the management of asymptomatic carotid stenosis. Previous studies have reported imaging features of high-risk plaques that could help to optimize the risk-benefit ratio of revascularization. However, such studies have not provided an accurate estimate of the prevalence of high-risk plaques and the associated annual incidence of ipsilateral ischemic cerebrovascular events to inform the design of clinical trials using a risk-oriented selection of patients before randomization. Objective To assess the relevance and feasibility of risk-oriented selection of patients for revascularization. Data Sources A systematic search of PubMed and Ovid Embase from database inception to July 31, 2019, was performed. Study Selection Prospective observational studies that reported prevalence of high-risk plaques and incidence of ipsilateral ischemic cerebrovascular events were included. Data Extraction and Synthesis Aggregated data were pooled using random-effects meta-analysis. Data were analyzed from December 16, 2019, to January 15, 2020. Main Outcomes and Measures Prevalence of high-risk plaques and annual incidence of ipsilateral ischemic events. Results Overall, 64 studies enrolling 20 751 participants aged 29 to 95 years (mean age range, 55.0-76.5 years; proportion of men, 45%-87%) were included in the meta-analysis. Among all participants, the pooled prevalence of high-risk plaques was 26.5% (95% CI, 22.9%-30.3%). The most prevalent high-risk plaque features were neovascularization (43.4%; 95% CI, 31.4%-55.8%) in 785 participants, echolucency (42.3%; 95% CI, 32.2%-52.8%) in 12 364 participants, and lipid-rich necrotic core (36.3%; 95% CI, 27.7%-45.2%) in 3728 participants. The overall incidence of ipsilateral ischemic cerebrovascular events was 3.2 events per 100 person-years (22 cohorts with 10 381 participants; mean follow-up period, 2.8 years; range, 0.7-6.5 years). The incidence of ipsilateral ischemic cerebrovascular events was higher in patients with high-risk plaques (4.3 events per 100 person-years; 95% CI, 2.5-6.5 events per 100 person-years) than in those without high-risk plaques (1.2 events per 100 person-years; 95% CI, 0.6-1.8 events per 100 person-years), with an odds ratio of 3.0 (95% CI, 2.1-4.3;I2 = 48.8%). In studies focusing on severe stenosis (9 cohorts with 2128 participants; mean follow-up period, 2.8 years; range, 1.4-6.5 years), the incidence of ipsilateral ischemic cerebrovascular events was 3.7 events per 100 person-years (95% CI, 1.9-6.0 events per 100 person-years). The incidence of ipsilateral ischemic cerebrovascular events was also higher in patients with high-risk plaques (7.3 events per 100 person-years; 95% CI, 2.0-15.0 events per 100 person-years) than in those without high-risk plaques (1.7 events per 100 person-years; 95% CI, 0.6-3.3 events per 100 person-years), with an odds ratio of 3.2 (95% CI, 1.7-5.9;I2 = 39.6%). Conclusions and Relevance High-risk plaques are common in patients with asymptomatic carotid stenosis, and the associated risk of an ipsilateral ischemic cerebrovascular event is higher than the currently accepted estimates. Extension of routine assessment of asymptomatic carotid stenosis beyond the grade of stenosis may help improve risk stratification and optimize therapy.

Mapping disparities in education across low- and middle-income countries

Abstract: Educational attainment is an important social determinant of maternal, newborn, and child health. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.

Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis

Abstract: BACKGROUND This meta-analysis was conducted to estimate the global burden of hepatitis B virus (HBV) infection in people living with human immunodeficiency virus (PLWH). METHODS We searched multiple databases for studies published between January 1990 and December 2017. HBV infection (hepatitis B surface antigen) was diagnosed with serological assays. A random-effects meta-analysis served to pool data. RESULTS We included 358 studies (834 544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval [CI], 7.9%-8.8%), among which 26.8% (95% CI, 22.0%-31.9%) was positive to hepatitis B e antigen. HBV prevalence (with 95% CIs) differed according to region: West and Central Africa, 12.4% (11.0%-13.8%); Middle East and North Africa, 9.9% (6.0%-14.6%); Asia and the Pacific, 9.8% (8.7%-11.0%); Eastern and Southern Africa, 7.4% (6.4%-8.4%); Western and Central Europe and North America, 6.0% (5.5%-6.7%); and Latin America and the Caribbean, 5.1% (4.2%-6.2%) (P 1% (P < .0001). Globally, we estimated that there were 3 136 500 (95% CI, 2 952 000-3 284 100) cases of HBV in PLWH, with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia and the Pacific. CONCLUSIONS This study suggests a high burden of HBV infection in PLWH, with disparities according to region, level of development, and country HIV prevalence.

Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis.

Abstract: Background Although HIV infection and antiretroviral therapy (ART) increase the risk for hypertension in people living with HIV (PLHIV), the global and regional burden of hypertension in PLHIV is not well characterized. Methods In this systematic review and meta-analysis, we searched multiple databases for studies reporting on hypertension in PLHIV and conducted between 2007 and 2018. Meta-analysis through random-effect models served to obtain the pooled prevalence estimates. Heterogeneity was assessed via the χ test on Cochran's Q statistic. Results We included 194 studies (396 776 PLHIV from 61 countries). The global prevalence of hypertension was 23.6% [95% confidence interval (95% CI: 21.6-25.5)] with substantial heterogeneity. The regional distribution was Western and Central Europe and North America [28.1% (95% CI: 24.5-31.9)], West and Central Africa [23.5% (16.6-31.0)], Latin America and the Caribbean [22.0% (17.8-26.5)], Eastern and Southern Africa [19.9% (17.2-22.8)], and Asia and Pacific [16.5% (12.5-21.0)]; P = 0.0007. No study originated from the Middle East and North Africa, and Eastern Europe and Central Asia regions. The prevalence was higher in high-income countries than others (P = 0.0003) and higher in PLHIV taking ART than those ART-naive (P = 0.0003). The prevalence increased over time (mainly driven by Eastern and Southern Africa) and with age. There was no difference between men and women. We estimated that in 2018, there were 8.9 (95% CI: 8.3-9.6) million cases of hypertension in PLHIV globally, among whom 59.2% were living in Sub-Saharan Africa. Conclusion Cost-effective strategies to curb the dreadful burden of hypertension among PLHIV are needed.

An overview of heart failure in low- and middle-income countries.

Abstract: Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease.

Abstract: Objective: To estimate the incidence, prevalence, and correlates of atrial fibrillation (AF) in a global population with rheumatic heart disease (RHD). Methods: Bibliographic databases were searched to identify all published studies providing data on AF in patients with RHD. Random-effects meta-analysis method was used to pool estimates. Results: Eighty-three studies were included, reporting data from 75,637 participants with RHD in 42 countries. The global prevalence of AF in RHD was 32.8% (range: 4.3%–79.9%). It was higher in severe valvular disease (30.8% vs 20.7%, p = 0.009), in severe mitral valve disease compared to severe aortic disease (30.4% vs 6.3%, p = 0.038). The global cumulative incidence of AF in patients with RHD was 4.8%, 11.4%, 13.2%, and 30.8% at 1, 2, 5, and 10 years of follow-up, respectively. From comparison between patients with and without AF, AF was associated with increased age (mean difference [MD]: 9.5 years; 95% CI: 7.8–1.3), advanced heart failure (odds ratio [OR]: 4.4; 95% CI 2.1–9.3), tricuspid valve involvement (OR: 4.0; 95% CI: 3.0–5.3), history of thromboembolism (OR: 6.2; 95% CI: 3.4–11.4), highly sensitive C-reactive protein (MD: 5.5 mg/dL; 95% CI: 1.2–9.8), systolic pulmonary arterial pressure (MD: 3.6 mmHg; 95% CI: 0.8–6.3), right atrium pressure (MD: 1.5 mmHg; 95% CI: 1.0–2.0), and left atrium diameter (MD: 8.1 mm; 95% CI: 5.5–10.7). Conclusions: About one-third of patients with RHD have AF, with an incidence which almost triples every five years after diagnosis. Factors associated with AF include age, advanced heart failure, thromboembolism, and few cardiac hemodynamics parameters.

Hearing Impairment Overview in Africa: the Case of Cameroon.

Abstract: The incidence of hearing impairment (HI) is higher in low- and middle-income countries when compared to high-income countries. There is therefore a necessity to estimate the burden of this condition in developing world. The aim of our study was to use a systematic approach to provide summarized data on the prevalence, etiologies, clinical patterns and genetics of HI in Cameroon. We searched PubMed, Scopus, African Journals Online, AFROLIB and African Index Medicus to identify relevant studies on HI in Cameroon, published from inception to 31 October, 2019, with no language restrictions. Reference lists of included studies were also scrutinized, and data were summarized narratively. This study is registered with PROSPERO, number CRD42019142788. We screened 333 records, of which 17 studies were finally included in the review. The prevalence of HI in Cameroon ranges from 0.9% to 3.6% in population-based studies and increases with age. Environmental factors contribute to 52.6% to 62.2% of HI cases, with meningitis, impacted wax and age-related disorder being the most common ones. Hereditary HI comprises 0.8% to 14.8% of all cases. In 32.6% to 37% of HI cases, the origin remains unknown. Non-syndromic hearing impairment (NSHI) is the most frequent clinical entity and accounts for 86.1% to 92.5% of cases of HI of genetic origin. Waardenburg and Usher syndromes account for 50% to 57.14% and 8.9% to 42.9% of genetic syndromic cases, respectively. No pathogenic mutation was described in GJB6 gene, and the prevalence of pathogenic mutations in GJB2 gene ranged from 0% to 0.5%. The prevalence of pathogenic mutations in other known NSHI genes was <10% in Cameroonian probands. Environmental factors are the leading etiology of HI in Cameroon, and mutations in most important HI genes are infrequent in Cameroon. Whole genome sequencing therefore appears as the most effective way to identify variants associated with HI in Cameroon and sub-Saharan Africa in general.

Geriatric syndromes in an urban elderly population in Cameroon: a focus on disability, sarcopenia and cognitive impairment.

Abstract: INTRODUCTION: geriatric syndromes are multifactorial conditions that are associated with substantial disability, poor quality of life and mortality in the elderly. The patterns of these conditions are poorly described in sub-Saharan Africa. This study aimed to determine the prevalence and correlates of common geriatric syndromes in Cameroon. METHODS: we conducted a cross-sectional study in the geriatrics unit of a university hospital in Cameroon. All people aged ≥55 who attended a health promotion and screening campaign in September 2019 were included. Geriatric syndromes including functional decline, cognitive impairment and sarcopenia were assessed. We also examined sociodemographic characteristics and comorbidities. RESULTS: overall, 104 participants were enrolled with median age of 65 (IQR: 62.2 - 70.8). About 67% of participants presented at least one geriatric syndrome. Disability in activities of daily living and instrumental activities of daily living were present in 10% and 38% of participants respectively and associated factors were male gender (OR 4.7, p=0.005), age 75 and above (OR 5.7, p=0.027), osteoarthritis (OR 3.3, p=0.055) and polypharmacy (OR 7.7, p=0.012). Sarcopenia occurs in 26% with female gender (OR 3.1, p=0.029) and SARC-F ≥4 (OR 4.9, p=0.002) as associated factors. Cognitive impairment was present in 20% of participants and associated with illiteracy (p=0.008). CONCLUSION: our study shows a high prevalence of geriatric syndromes in older adults in an urban area. Geriatric principles and frailty awareness should be considered in clinical care of older adults in our setting.

Epidemiology of hypertensive crisis in the Buea Regional Hospital, Cameroon

Abstract: Hypertensive crisis (HC) includes hypertensive urgency (HU) and hypertensive emergency (HE). There is scarcity of data on the epidemiology of patients presenting with HC in Cameroon. The aim of this study was to determine the prevalence, clinical characteristics, and outcome of HU and HE. We conducted a cross-sectional study from June 2018 until June 2019. The criteria to define a hypertensive crisis were systolic and/or diastolic blood pressure ≥180/110 mm Hg. We compared HU vs HE. Out of the 1536 patients admitted, 95(6.2%) had a HC. There were 49(51.6%) men and 56 (58.9%) had a HE. The mean age was 51.1 ± 14.9 years. A history of hypertension was found in 75.3% of the patients but only 24.2% were on treatment. 33.7% consumed alcohol and 24.2% had chronic kidney disease. Headache (34.7%), dyspnea (34.7%), and neurological deficit (23.2%) were the most common symptoms. Patients with HE had higher systolic and diastolic blood pressures though the difference was not significant. The most frequent forms of HE were acute left ventricular failure with pulmonary edema (44.6%), intracerebral hemorrhage (21.4%), and cerebral infarction (16.1%). The most commonly prescribed medication was labetalol (44.2%). Mean length of hospital stay was 8.4 days. Patients with HE had a longer hospital stay (9.8 vs 6.3 days, P < .001). In-hospital case fatality was 6.3%. Hypertensive crisis accounted for 6.2% of admissions in the medical unit with HE being more common than HU. Acute left ventricular failure with pulmonary edema and stroke were the most frequent target organ lesions in HE.

Hypertension prevalence, associated factors, treatment and control in rural Cameroon: a cross-sectional study.

Abstract: Introduction Sub-Saharan Africa is experiencing a surge in the burden of hypertension, and rural communities are increasingly affected by the epidemic. Objectives We aimed to determine the prevalence of and factors associated with hypertension in rural communities of the Baham Health District (BHD), Cameroon. In addition, we sought to assess awareness, treatment and control rates of hypertension among community members. Design A community-based cross-sectional study. Setting Participants from five health areas in the BHD were recruited from August to October 2018. Participants Consenting participants aged 18 years and above were included. Results We included 526 participants in this study. The median age of the participants was 53.0 (IQR=35–65) years and 67.1% were female. The crude prevalence of hypertension was 40.9% (95% CI=36.7–45.1) with no gender disparity. The age-standardised prevalence of hypertension was 23.9% (95% CI=20.3–27.5). Five-year increase in age (adjusted OR (AOR)=1.34; 95% CI=1.23–1.44), family history of hypertension (AOR=2.22; 95% CI=1.37–3.60) and obesity (AOR=2.57; 95% CI=1.40–4.69) were associated with higher odds of hypertension after controlling for confounding. The rates of awareness, treatment and control of hypertension were 37.2% (95% CI=31.0–43.9), 20.9% (95% CI=16.0–26.9) and 22.2% (95% CI=12.2– 37.0), respectively. Conclusion The high prevalence of hypertension in these rural communities is associated with contrastingly low awareness, treatment and control rates. Age, family history of hypertension and obesity are the major drivers of hypertension in this community. Veracious policies are needed to improve awareness, prevention, diagnosis, treatment and control of hypertension in these rural communities.

Changes in smoking patterns after HIV diagnosis or antiretroviral treatment initiation: a global systematic review and meta-analysis.

Abstract: Tobacco consumption is more life-threatening in people living with human immunodeficiency virus (HIV) than within the general population; therefore, people living with HIV (PLWH) should be highly motivated to take action towards quitting smoking at or after HIV diagnosis. The aim of this systematic review with meta-analysis was to investigate changes in smoking habits among PLWH over time. We considered prospective and retrospective cohort studies including PLWH aged 15 years and above, which have measured the prevalence of tobacco smoking (current, former or never) at study initiation and completion, and published between January 1, 2000 and April 15, 2018 without language or geographical restriction. We searched PubMed, EMBASE, Web of Science, Africa Journal Online, and Global Index Medicus. We used a random-effects model to pool data. Nine studies were included. The proportion of current and former smokers decreased slightly over time, around 2.5 and 3.8%, respectively. However, the proportion of never smokers decreased sharply by 22.5%, and there were 2.1 and 1.5% PLWH who shifted from never and former smoking to current smoking, respectively. On the other hand, 10.5% PLWH shifted from current to former smoking, 7.1% tried to quit tobacco consumption but failed, and 10.1% stayed in the “never smoking” category over time. PLWH seem not to change positively their smoking habits towards quitting tobacco consumption. There is urgent need to increase actions aimed at helping this vulnerable population to quit tobacco consumption, including individually tailored therapeutic education, psychosocial and pharmacologic supports.

The Follow-Up and Well-Being of Geriatric Outpatients During COVID-19 Pandemic in Cameroon: Insights From the Yaounde Central Hospital

Abstract: Although total confinement has not been adopted by the government of Cameroon, the COVID-19 pandemic is keeping geriatric patients out of hospital, despite a decline in their health status. In addi...

The impact of social networking services on the coronavirus disease 2019 (Covid-19) pandemic in sub-saharan africa

Abstract: Social networking services played a crucial role in the management of previous outbreaks around the world African populations are increasingly using social networks and this may have benefits but also harmful consequences, especially at this time of coronavirus disease 2019 pandemic This paper concisely discusses of these consequences which include the propagation of “fake news” and the misinterpretation of messages pertaining to the prevention and the treatment of the disease Moreover, our commentary provides some ways to alleviate them, chiefly represented by a framed and practical communication by health authorities We suggest for instance the systematic sharing of correct messages through official Facebook and Twitter accounts and the conception of tailored web tools dedicated to the verification of circulating information © Francky Teddy Endomba et al

A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy.

Abstract: Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.