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Botulinum Toxin (BTX) has been found to have anti-spasm and analgesic effects. The utility of BTX after conventional hemorrhoidectomy remains unclear. Thus, a systematic review and meta-analysis are required to find out its utility after conventional hemorrhoidectomy. Using specific keywords, we comprehensively go through the potential articles on PubMed, ClinicalTrials.gov, and Europe PMC sources until March 27th, 2022. All published studies on botulinum toxin anal sphincter injection after conventional hemorrhoidectomy were collected. We were using Review Manager 5.4 software to conduct statistical analysis. Five clinical trial studies with a total of 260 patients undergoing hemorrhoidectomy were included in the analysis Our pooled analysis revealed that BTX injection after hemorrhoidectomy was associated with lower VAS at 24 h post-operative [Mean Difference −1.35 (95% CI −1.90, −0.80), p < 0.00001, I2 = 0%] and shorter time to return work [Mean Difference −8.94 days (95% CI −12.57, −5.30), p < 0.00001, I2 = 0%]. However, BTX injection did not differ significantly from placebo in terms of time to first defecation (p = 0.22), fecal incontinence (p = 0.91) and urinary retention incidence (p = 0.18). BTX sphincter injection may offer some benefit after conventional hemorrhoidectomy in reducing pain from the first day after the procedure and promoting wound healing without complication. Further randomized clinical trials are still needed to confirm the results of our study. [ABSTRACT FROM AUTHOR]

• Obesity was associated with mortality and severity in patients with COVID-19. • Dose–response meta-analysis demonstrate an increase of 5% risk for poor outcome for every 5 kg/mg2 increase in body mass index. • The relationship departed from linearity and became steeper from 30–35 kg/mg2 onwards. There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated. This meta-analysis aims to evaluate the dose–response relationship between body mass index (BMI) and poor outcome in patients with COVID-19. A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity. A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P < 0.001; I 2: 55.6%), mortality (OR 1.55 [1.16, 2.06], P = 0.003; I 2: 74.4%), and severity (OR 1.90 [1.45, 2.48], P < 0.001; I 2: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P < 0.001; I 2: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P = 0.002; I 2: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P < 0.001; I 2: 11.7%). The dose–response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P < 0.001 for every 5 kg/m2 increase in BMI (P non-linearity < 0.001). The curve became steeper with increasing BMI. Dose–response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19. [ABSTRACT FROM AUTHOR]