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Archives of Dermatological Research Aug 2023Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia;... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia; however, this association is not widely understood and may result in delayed diagnosis and treatment and possible increase in morbidity and mortality.
OBJECTIVE
To systematically review and perform a meta-analysis regarding the association between HS and anemia, and to characterize the subtypes of anemia associated with HS.
DATA SOURCES
A search of the EMBASE, Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from the time of database inception to September 25, 2022, yielded 313 unique articles.
STUDY SELECTION
All observational studies and randomized controlled trials published in English that examined the odds ratio (OR) of anemia in patients with HS were screened by 2 independent reviewers. Case reports were excluded. Among 313 unique articles, 7 were deemed eligible.
DATA EXTRACTION AND SYNTHESIS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines facilitated data extraction. The Newcastle-Ottawa Scale (NOS) was used to analyze risk of bias of included studies. In addition to OR and 95% confidence intervals, relevant data on patient demographics and anemia subtypes were also extracted.
MAIN OUTCOMES AND MEASURES
The primary outcome was the OR of anemia in HS patients. This study also attempted to characterize anemia subtypes associated with HS.
RESULTS
In total, 2 case-control and 5 cross-sectional studies featured a total of 11,693 patients. Among the studies, 4 of 7 demonstrated a statistically significant positive association between anemia and HS (ORs, 2.20 [1.42-3.41], 2.33 [1.99-2.73], 1.87 [1.02-3.44], and 1.50 [1.43-1.57]), with macrocytic and microcytic subtypes being most common. After adjusting for publication bias, meta-analysis with random effects revealed HS to be associated with increased odds of anemia compared to non-HS groups (OR 1.59 [1.19, 2.11]).
CONCLUSIONS AND RELEVANCE
There is a statistically significant positive association between HS and anemia, particularly for the aforementioned subtypes. Patients with HS should be screened for anemia. In case of lower hemoglobin concentration, the anemia of HS patients should be subdivided according to mean corpuscular volume of the red blood cells and further investigated depending on subtype.
Topics: Humans; Hidradenitis Suppurativa; Cross-Sectional Studies; Comorbidity; Anemia
PubMed: 36781458
DOI: 10.1007/s00403-023-02559-9 -
Experimental and Therapeutic Medicine Apr 2022Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years)...
Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years) patients. Although the majority of patients are asymptomatic, some patients may experience bone pain due to local periosteal involvement or osteoarthritic lesions in the spine; in addition, limb deformities may lead to secondary gait problems or degenerative joint changes. Anemia has an overall prevalence of 12-17% in elderly adults (>65 years old), with macrocytic anemia being the less common type. Megaloblastic anemia is a macrocytic anemia characterized by the presence of large, immature, nucleated cells (megaloblasts) in the blood, with the most common cause being a deficiency of folate and/or vitamin B12. We herein report the rare case of a 72-year-old male patient exhibiting both these conditions, with the aim of discussing the possible association between the two and, most importantly, the clinical management of the patient in a real-life setting over a period of 10 years. The patient was diagnosed based on clinical symptoms (bone pain), radiological imaging and specific laboratory tests, and received discontinuous courses of bisphosphonates and cyanocobalamin supplementation therapy, based mainly on aggravated symptomatology. A systematic literature review was also performed and revealed not only the scarcity of reports on similar cases, but also the mechanisms that may underlie the possible association of PDB with macrocytic anemia due to vitamin B12 deficiency in elderly patients.
PubMed: 35251335
DOI: 10.3892/etm.2022.11195 -
Cobalamin deficiency presenting with thrombotic microangiopathy (TMA) features: A systematic review.Transfusion and Apheresis Science :... Feb 2018Cobalamin deficiency may result in hematologic characteristics similar to thrombotic microangiopathy (TMA). To facilitate diagnosis, we reviewed reported cases of... (Review)
Review
INTRODUCTION
Cobalamin deficiency may result in hematologic characteristics similar to thrombotic microangiopathy (TMA). To facilitate diagnosis, we reviewed reported cases of acquired cobalamin deficiency presenting with TMA features (c.def-TMA).
METHODS
A literature search identified reports of c.def-TMA. Deficiency was defined as B12 levels of <118 pmol/L. Corrected reticulocyte counts and reticulocyte production indexes were calculated. Clinical features were presented as proportion abnormal and results summarized as medians and interquartile ranges (IQR).
RESULTS
Patient level data was extracted from 41 identified cases. Median age (years) was 43 (30-55) with 21/41 (51%) being female. Cobalamin deficiency was noted in 35/40 (87.5%) but fold increases in MMA and HC were 30 and 6, respectively. The etiology was pernicious anemia in 28/41 (68%) cases. Anemia was both universal and severe, with hemoglobin levels of 55 g/L (4.7-6.6). Hypersegmented neutrophils were noted in 23/37 (62%), schistocytes in 29/38 (76%) and median LDH levels 3981 U/L (2004-5467). The RPI was <3.0% in all patients. Thrombocytopenia occurred in 33/41 (80.5%) with a median platelet count of 91 × 10/L (42-112). Plasma infusion or exchange was initiated in 14/41 (34%) with associated complications in 2 cases.
CONCLUSION
Reticulocytopenia (RPI of <3.0%) was a universal finding that aids in differentiating c.def-TMA from other causes of hemolysis. C.def-TMA was associated with severe anemia, generally mild-moderate thrombocytopenia, and significant elevations in LDH.
Topics: Adult; Anemia, Pernicious; Female; Humans; Male; Middle Aged; Neutrophils; Plasma Exchange; Platelet Count; Thrombotic Microangiopathies; Vitamin B 12 Deficiency
PubMed: 29454538
DOI: 10.1016/j.transci.2018.01.003 -
PloS One 2016Lenalidomide could effectively induce red blood cell (RBC) transfusion independence (TI) in patients with lower-risk (Low/Intermediate-1) myelodysplastic syndrome (MDS)... (Meta-Analysis)
Meta-Analysis Review
Efficacy and Safety of Lenalidomide for Treatment of Low-/Intermediate-1-Risk Myelodysplastic Syndromes with or without 5q Deletion: A Systematic Review and Meta-Analysis.
BACKGROUND
Lenalidomide could effectively induce red blood cell (RBC) transfusion independence (TI) in patients with lower-risk (Low/Intermediate-1) myelodysplastic syndrome (MDS) with or without 5q deletion. However whether lenalidomide ultimately improves the overall survival (OS) of lower-risk MDS patients and reduces the progression to AML remains controversial.
METHOD
A meta-analysis was conducted to examine the efficacy and safety of lenalidomide in the treatment of lower-risk MDS. Efficacy was assessed according to erythroid hematologic response (HI-E), cytogenetic response (CyR), OS and AML progression. Safety was evaluated based on the occurrence rates of grades 3-4 adverse events (AEs).
RESULTS
Seventeen studies were included consisting of a total of 2160 patients. The analysis indicated that the overall rate of HI-E was 58% with 95% confidence interval (CI) of 43-74%. The pooled estimates for the rates of CyR, complete CyR, and partial CyR were 44% (95% CI 19-68%), 21% (95% CI 13-30%) and 23% (95% CI 15-32%), respectively. The patients with 5q deletion had significantly higher rate of HI-E and CyR than those without 5q deletion (P = 0.002 and 0.001, respectively). The incidences of grades 3-4 neutropenia, thrombocytopenia, leukopenia, anemia, deep vein thrombosis, diarrhea, fatigue and rash were 51% (95% CI 30-73%), 31% (95% CI 20-42%), 9% (95% CI 5-13%), 7% (95% CI 2-12%), 3% (95% CI 2-5%), 3% (95% CI 1-5%), 2% (95% CI 1-4%) and 2% (95% CI 1-3%), respectively. Lenalidomide significantly improved OS (HR: 0.62, 95% CI 0.47-0.83, P = 0.001) and lowered the risk of AML progression in del(5q) patients (RR: 0.61, 95% CI 0.41-0.91, P = 0.014).
CONCLUSIONS
In spite of the AEs, lenalidomide could be effectively and safely used for the treatment of lower-risk MDS patients with or without 5q deletion.
Topics: Anemia, Macrocytic; Chromosome Deletion; Chromosomes, Human, Pair 5; Humans; Immunologic Factors; Lenalidomide; Myelodysplastic Syndromes; Thalidomide; Treatment Outcome
PubMed: 27824902
DOI: 10.1371/journal.pone.0165948 -
Digestive and Liver Disease : Official... Aug 2018Pernicious anaemia (PA) is associated with increased gastric cancer risk, but the evidence is conflicting regarding the associated risk of other cancers. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pernicious anaemia (PA) is associated with increased gastric cancer risk, but the evidence is conflicting regarding the associated risk of other cancers.
AIM
To systematically determine the incidence rates of gastro-intestinal cancers other than gastric cancers (GI-other-than-GC) and non-gastrointestinal cancers (non-GIC) in PA adults, globally and per tumour site, and the risk associated with PA for GI-other than GC and non-GIC.
METHODS
Studies of PA patients reporting the incidence of GI-other-than-GCs and non-GICs were identified with MEDLINE (PubMed)-EMBASE (from first date available to April 2017). A meta-analysis of annual cancer incidence rates was performed. The outcome was the cumulative incidence of GI-other-than-GCs and non-GICs (ratio between the numbers of new cancer cases identified during the follow-up period and the number of PA patients) and the incidence rate expressed as the rate of events-per-time-unit (person-years).
RESULTS
Of 82,257 PA patients, the pooled incidence rates/100 person-years for non-GCs and non-GICs of 0.27 (95% CI:0.16-0.42) and 0.23 (95% CI:0.22-0.25) were calculated by meta-analysis. Compared to the GLOBOCAN data for the general population from the countries of the included studies, the meta-analysis showed an overall relative risk (RR) of cancer in PA of 0.68 (95% CI:0.48-0.95). PA patients had a lower RR of colorectal, breast, liver, oesophageal, lung, thyroid, ovary, non-melanoma skin and kidney cancers but had a higher RR of biliary tract cancer (1.81:1.21-2.70), multiple myeloma (2.83:1.76-4.55), Hodgkin's lymphoma (3.0:1.35-6.68), non-Hodgkin's lymphoma (2.08: 1.58-2.75), and leukaemia (1.56:1.16-2.12).
CONCLUSION
An overall lower RR of cancers-other-than-gastric-cancer in PA patients but an increased RR of biliary tract cancers and haematological malignancies was observed.
Topics: Anemia, Pernicious; Humans; Incidence; Neoplasms; Risk
PubMed: 29887343
DOI: 10.1016/j.dld.2018.05.012 -
Cureus Nov 2022Gastroesophageal reflux disease (GERD) is the most common disease, for which proton pump inhibitors (PPIs) are a widely used class of drugs. Due to their efficacy and... (Review)
Review
Gastroesophageal reflux disease (GERD) is the most common disease, for which proton pump inhibitors (PPIs) are a widely used class of drugs. Due to their efficacy and relative safety profile, PPIs are used chronically by GERD patients. Although it is a safe drug, particular attention focuses on the long-term adverse effects of PPI. The association with vitamin deficiencies has received additional focus since chronic PPI treatment increases the incidence of vitamin B12 deficiency, especially in the elderly. However, numerous studies regarding the establishment of an association between PPI and vitamin B12 status revealed conflicting results. In this systematic review, we systematically examined observational studies that focused on the impact of chronic PPI effects on vitamin B12 absorption and diagnostic biomarkers of vitamin B12 deficiency. Our review showed significant changes in diagnostic biomarkers of vitamin B12 status in long-term PPI users, including elevated homocysteine and methylmalonic acid (MMA) concentration levels defining cellular vitamin B12 deficiency. Although there is uncertainty regarding the exact mechanism, it supports the concept that long-term intake of PPI can have clinical implications for vitamins.
PubMed: 36545170
DOI: 10.7759/cureus.31672 -
Frontiers in Immunology 2021Gastric cancer is one of the most common cancers worldwide, with a high mortality rate. The potential etiological role of autoimmune (AI) disorders has been described in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gastric cancer is one of the most common cancers worldwide, with a high mortality rate. The potential etiological role of autoimmune (AI) disorders has been described in gastric cancer; however, the literature is controversial. This study aims to provide a comprehensive summary of the association between autoimmune disorders and the incidence of gastric cancer.
METHODS
This study was registered on PROSPERO under registration number CRD42021262875. The systematic literature search was conducted in four scientific databases up to May 17, 2021. Studies that reported standardized incidence rate (SIR) of gastric cancer in autoimmune disorders were eligible. We calculated pooled SIRs with 95% confidence intervals (CIs) in this meta-analysis.
RESULTS
We included 43 articles describing 36 AI disorders with data of 499,427 patients from four continents in our systematic review and meta-analysis. Significantly increased incidence of gastric cancer was observed in dermatomyositis (SIR = 3.71; CI: 2.04, 6.75), pernicious anemia (SIR = 3.28; CI: 2.71, 3.96), inflammatory myopathies (SIR = 2.68; CI:1.40; 5.12), systemic lupus erythematosus (SIR = 1.48; CI: 1.09, 2.01), diabetes mellitus type I (SIR = 1.29; CI:1.14, 1,47), and Graves' disease (SIR = 1.28; CI: 1.16, 1.41). No significant associations could be found regarding other AI disorders.
CONCLUSIONS
Pernicious anemia, Graves' disease, dermatomyositis, diabetes mellitus type I, inflammatory myopathies, and systemic lupus erythematosus are associated with higher incidence rates of gastric cancer. Therefore, close gastroenterological follow-up or routinely performed gastroscopy and application of other diagnostic measures may be cost-effective and clinically helpful for patients diagnosed with these autoimmune diseases.
Topics: Anemia, Pernicious; Autoimmune Diseases; Dermatomyositis; Diabetes Mellitus, Type 1; Female; Graves Disease; Humans; Incidence; Lupus Erythematosus, Systemic; Male; Myositis; Risk Factors; Stomach Neoplasms
PubMed: 34887857
DOI: 10.3389/fimmu.2021.750533