Sriwijaya Journal of Neurology

Clinical and Cerebrospinal Fluid Predictors of Sensorineural Hearing Loss in Adults with Acute Bacterial Meningitis: A Systematic Review and Meta-Analysis

2026-07-21T05:54:02+00:00

Background: Sensorineural hearing loss (SNHL) is the most frequent neurological sequela of acute bacterial meningitis (ABM) in adults, yet its admission-available clinical and cerebrospinal fluid (CSF) determinants have not been synthesised for adults specifically.

Objective: To pool the prevalence and predictors of hearing loss after adult ABM and to quantify its variation by causative pathogen.

Methods: PubMed, Scopus and Web of Science were searched for cohort studies and randomized trials reporting hearing loss in adults with ABM. Eleven studies were eligible; six non-overlapping cohorts (1,640 adults assessed for hearing) were pooled using a DerSimonian–Laird random-effects model on logit-transformed proportions, with pathogen subgroups and sensitivity analyses. Pooled proportions and odds ratios were used for this dichotomous outcome.

Results: The pooled prevalence of hearing loss was 35.2% (95% CI 19.0–55.7; I²=98.0%; prediction interval 2.4–92.4%), with a marked pathogen gradient: Streptococcus suis 66.4%, mixed ABM 42.2%, Streptococcus pneumoniae 36.3% and Neisseria meningitidis 6.6%. Hearing-loss-specific predictors included advanced age (OR 3.65), otitis media (OR 2.58) and a virulent epf strain (OR 3.42), while serotype 23F was protective (OR 0.36); low CSF glucose and high CSF protein were associated with hearing loss. Adjunctive dexamethasone was associated with lower odds (OR 0.43; 95% CI 0.29–0.65).

Conclusion: About one in three adult ABM survivors develops hearing loss, peaking in S. suis meningitis. Older age, otitis, virulent pathogens and severe CSF derangement mark high risk, and early dexamethasone appears protective, supporting structured audiological surveillance.

Circulating Tumour Necrosis Factor-Alpha and Interleukin-6 in Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis

2026-07-21T06:11:13+00:00

Background: Chronic low-grade inflammation is increasingly implicated in diabetic peripheral neuropathy (DPN). Tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) have been proposed as circulating correlates of nerve injury, yet the evidence is inconsistent, a previous synthesis addressed TNF-α alone, and no pooled estimate has ever been reported for IL-6.

Objective: To determine whether circulating TNF-α and IL-6 concentrations differ between diabetic patients with and without peripheral neuropathy, and to quantify the magnitude, precision, and consistency of any difference.

Methods: Four databases were searched for observational studies reporting serum or plasma TNF-α and/or IL-6 in diabetic patients with versus without neuropathy. Standardised mean differences (SMD, Hedges g) were pooled using a random-effects model, with Hartung–Knapp adjustment, restricted maximum-likelihood re-estimation, cluster-collapsed and leave-one-out analyses, and a prediction interval. Risk of bias used the Newcastle–Ottawa Scale and certainty the GRADE framework.

Results: Four studies (476 participants; 249 with DPN, 227 without) provided seven cytokine comparisons. The overall SMD was 0.70 (95% CI 0.22–1.18; p = 0.005; I² = 91%), robust across all sensitivity analyses. The effect was driven by IL-6, which was significantly and homogeneously elevated (SMD 0.65, 95% CI 0.42–0.87; I² = 2%). Pooled TNF-α was higher but non-significant and heterogeneous (SMD 0.71, 95% CI −0.18–1.60; I² = 95%), owing to one statin-treated cohort; excluding it raised the estimate to 0.88. Certainty was low for IL-6 and very low for TNF-α.

Conclusion: DPN is associated with higher circulating pro-inflammatory cytokines, with IL-6 the most consistent correlate and the first for which a pooled estimate is available. IL-6 merits prospective evaluation as a biomarker of neuropathy risk. Findings are hypothesis-generating.

Predictors of Mortality in Adults with Human Immunodeficiency Virus-Associated Tuberculous Meningitis: A Systematic Review and Meta-Analysis

2026-08-03T02:47:33+00:00

Background: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis, and human immunodeficiency virus (HIV) co-infection is its single most important risk factor. The magnitude of mortality specific to HIV-associated TBM, and the factors that predict death, have not been synthesised quantitatively.

Objective: To estimate the pooled all-cause mortality of adults with HIV-associated TBM and to identify its determinants.

Methods: PubMed/MEDLINE and Europe PMC were systematically searched for cohort studies and randomised controlled trials reporting mortality in adults with HIV-associated TBM; this was a two-database, single-reviewer review with full-text verification. All-cause mortality was pooled as a proportion (random-effects, DerSimonian-Laird, logit transformation); adjusted ratio measures for one predictor domain reported by at least three studies were pooled on the log scale. Certainty was rated with GRADE.

Results: Twelve studies (3,442 adults, 1,303 deaths) were included. In clinically ascertained cohorts and trials (k=11) pooled mortality was 47.0% (95% CI 41.4–52.7; I²=83.9%); the exploratory all-study estimate was 44.2% (95% CI 34.5–54.4; I²=96.4%; prediction interval 14.0–79.4%), heterogeneity being explained almost entirely by one national-registry cohort (17.3%). Advanced MRC/BMRC disease grade was the strongest predictor of death (pooled adjusted ratio 4.15, 95% CI 3.19–5.41; I²=0%). Mortality did not decline over the study period, and no small-study effect was detected.

Conclusion: Approximately one in two adults with HIV-associated TBM died, without improvement despite expanding antiretroviral access, although the wide prediction interval and very low certainty demand caution. Advanced disease grade at presentation was the dominant predictor, underscoring the value of earlier diagnosis.

Admission Mean Platelet Volume and Poor Functional Outcome After Reperfusion Therapy for Acute Ischaemic Stroke: A Systematic Review and Meta-Analysis

2026-08-07T04:22:30+00:00

Background: Mean platelet volume (MPV), an inexpensive index of platelet activation from the routine admission full blood count, has been linked to poor outcome in unselected ischaemic stroke, but its prognostic value in reperfusion-treated patients is uncertain and conflicting.

Objective: To quantify the association between admission MPV and poor functional outcome after reperfusion therapy, and to test whether it depends on treatment modality and MPV operationalisation.

Methods: PubMed was searched for cohort or case–control studies reporting admission MPV against poor functional outcome (modified Rankin Scale 3–6) in adults with acute ischaemic stroke treated with intravenous thrombolysis and/or mechanical thrombectomy. Odds ratios (OR) were pooled using DerSimonian–Laird random-effects models, with a-priori subgroups by modality and MPV metric and leave-one-out, adjusted-only and Hartung–Knapp sensitivity analyses. This review was not registered in a public registry.

Results: Ten studies were included and seven (1,597 patients) pooled. Higher MPV was associated with poor outcome (OR 1.62, 95% CI 1.22–2.16; I²=68.5%). The effect was strong with dichotomised MPV after thrombectomy (OR 2.56, 95% CI 1.60–4.08) but modest with continuous or quartile MPV in broad reperfusion (OR 1.27, 95% CI 1.08–1.49); the between-subgroup difference was significant (p=0.005) yet not robust to removing the most weighted study per arm.

Conclusion: Higher admission MPV was associated with poor functional outcome after reperfusion therapy, but its magnitude depended on modality and measurement; certainty was low (GRADE). MPV is a promising, essentially free supplementary marker best used within multivariable models, requiring confirmation in standardised prospective studies.

Nicotinamide, Vitamin B3 Exposure and Inner Retinal Function in Glaucomatous Neurodegeneration: A Systematic Review and Meta-Analysis of Randomised Trials and Longitudinal Cohorts

2026-08-07T04:31:55+00:00

Background: Glaucoma is a neurodegeneration of the optic nerve in which retinal ganglion cell axons fail metabolically before they die. Nicotinamide, the amide form of vitamin B3, is the most advanced candidate neuroprotectant in this disease, but its clinical evidence has never been pooled.

Objective: To determine whether nicotinamide supplementation improves inner retinal function in glaucoma, whether higher vitamin B3 exposure is associated with lower glaucoma risk, and whether vitamin B3 deficiency is demonstrable in patients.

Methods: PubMed/MEDLINE was searched with four pre-specified queries. Randomised and observational studies of vitamin B3 exposure in glaucoma or ocular hypertension were eligible, appraised with RoB 2.0 and ROBINS-E. Outcomes were pooled as Hedges' g or log-ratios using DerSimonian-Laird random-effects models.

Results: Fifteen studies (19 reports) were included; 11 pooled. Across all three existing trials, all on continued pressure-lowering therapy, nicotinamide improved inner retinal function (Hedges' g 0.41, 95% CI 0.14 to 0.69). On identical constructs, absolute photopic negative response amplitude replicated (g 0.33, 0.03 to 0.63) but the b-wave-normalised ratio did not (g 0.11, −0.37 to 0.58), so selective ganglion cell rescue was not shown. Visual field mean deviation was null in all trials. Highest versus lowest vitamin B3 exposure gave a pooled odds or hazard ratio of 0.44 (0.33 to 0.59), and each extra mg/day of dietary niacin 0.94 (0.92 to 0.97). Plasma nicotinamide was lower in glaucoma (g 0.70, 0.29 to 1.11) but dietary intake was not. All outcomes were GRADE low or very low.

Conclusion: Nicotinamide improved inner retinal amplitude in every randomised trial to date, but not visual field; selective ganglion cell rescue remains unproven. Trial doses exceeded dietary quartile differences fifty-fold, so observational and interventional findings describe different interventions.