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Inflammatory Bowel Diseases Jul 2024Inflammatory bowel disease (IBD) can lead to long-term complications that significantly impact patients' quality of life and healthcare resource utilization. Prior... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Inflammatory bowel disease (IBD) can lead to long-term complications that significantly impact patients' quality of life and healthcare resource utilization. Prior studies have demonstrated improved short-term outcomes to early exposure of biologics in patients with Crohn's disease (CD) but not in patients with ulcerative colitis (UC). However, there are conflicting data on impact of early intervention on longer-term adverse events. Therefore, we conducted a systematic review and meta-analysis assessing the impact of early biologic treatment on rates of IBD-related surgery.
METHODS
A systematic search was conducted in April 2022. Studies were included if biologic initiation was compared between patients starting early (<3 years of diagnosis or top-down treatment) vs later (>3 years of diagnosis or step-up treatment). Studies with <1 year of follow-up were excluded. The outcomes were colectomy and CD-related surgery for patients with UC and CD, respectively. Random-effects analyses were conducted to compare rates of IBD surgery between early and late biologic treatment.
RESULTS
Eighteen studies were included in the meta-analysis. Three studies included patients with UC and 15 studies included patients with CD. In patients with CD, early biologic therapy was associated with lower odds of surgery (odds ratio, 0.63; 95% confidence interval, 0.48-0.84) compared with late treatment. Conversely, in patients with UC, the odds of colectomy were increased (odds ratio, 2.86; 95% confidence interval, 1.30-6.30).
CONCLUSIONS
Early biologic treatment is associated with lower rates of surgery in patients with CD. In contrast, early biologic therapy appears to be associated with higher rates of colectomy in patients with UC, which may be confounded by disease severity.
Topics: Humans; Crohn Disease; Colitis, Ulcerative; Colectomy; Biological Products; Quality of Life; Biological Therapy
PubMed: 37506265
DOI: 10.1093/ibd/izad149 -
Genetics in Medicine : Official Journal... Sep 2023Elevated serum phenylalanine (Phe) levels due to biallelic pathogenic variants in phenylalanine hydroxylase (PAH) may cause neurodevelopmental disorders or birth defects...
PURPOSE
Elevated serum phenylalanine (Phe) levels due to biallelic pathogenic variants in phenylalanine hydroxylase (PAH) may cause neurodevelopmental disorders or birth defects from maternal phenylketonuria. New Phe reduction treatments have been approved in the last decade, but uncertainty on the optimal lifespan goal Phe levels for patients with PAH deficiency remains.
METHODS
We searched Medline and Embase for evidence of treatment concerning PAH deficiency up to September 28, 2021. Risk of bias was evaluated based on study design. Random-effects meta-analyses were performed to compare IQ, gestational outcomes, and offspring outcomes based on Phe ≤ 360 μmol/L vs > 360 μmol/L and reported as odds ratio and 95% CI. Remaining results were narratively synthesized.
RESULTS
A total of 350 studies were included. Risk of bias was moderate. Lower Phe was consistently associated with better outcomes. Achieving Phe ≤ 360 μmol/L before conception substantially lowered the risk of negative effect to offspring in pregnant individuals (odds ratio = 0.07, 95% CI = 0.04-0.14; P < .0001). Adverse events due to pharmacologic treatment were common, but medication reduced Phe levels, enabling dietary liberalization.
CONCLUSIONS
Reduction of Phe levels to ≤360 μmol/L through diet or medication represents effective interventions to treat PAH deficiency.
Topics: Pregnancy; Female; Humans; United States; Genetics, Medical; Phenylalanine; Phenylketonurias; Phenylalanine Hydroxylase; Phenylketonuria, Maternal; Genomics
PubMed: 37470789
DOI: 10.1016/j.gim.2022.12.005 -
European Journal of Gastroenterology &... Oct 2023Accumulating evidence suggests a potential relationship between non-alcoholic fatty liver disease (NAFLD) and fatty pancreas, as both conditions are associated with fat... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Accumulating evidence suggests a potential relationship between non-alcoholic fatty liver disease (NAFLD) and fatty pancreas, as both conditions are associated with fat deposition in the liver and pancreas, respectively. The meta-analysis aimed to investigate the bidirectional association between NAFLD and fatty pancreas, as well as their respective effects on disease severity.
METHODS
A systematic search of the EMBASE and MEDLINE databases, from inception to August 2022, was conducted to identify observational studies examining the association between NAFLD and fatty pancreas, as well as their impact on disease severity. The pooled odds ratio (OR) with a 95% confidence interval (CI) was estimated using a random-effects model.
RESULTS
Our analysis included 26 case-control or cross-sectional studies, comprising 67,803 participants. We observed a significant association between NAFLD and an increased odds of having fatty pancreas (OR, 6.18; 95% CI, 4.49-8.51; I2 = 92%). Similarly, fatty pancreas was significantly associated with an increased odds of having NAFLD (OR, 9.56; 95% CI, 5.09-17.95; I2 = 83%). Furthermore, the presence of fatty pancreas was associated with a 1.75-fold increased risk of severe NAFLD based on ultrasonographic classification (95% CI, 1.46-2.10; I2 = 0%). Among NAFLD patients, the coexistence of fatty pancreas was associated with a trend towards increased odds of having non-alcoholic steatohepatitis (OR, 3.52; 95% CI, 0.65-18.93; I2 = 82%) and advanced fibrosis (OR, 2.47; 95% CI, 0.52-11.80; I2 = 76%).
CONCLUSION
This meta-analysis discloses a bidirectional association between NAFLD and fatty pancreas, emphasizing the importance of understanding the intricate relationship between these two conditions.
Topics: Non-alcoholic Fatty Liver Disease; Pancreatic Diseases; Humans; Liver Cirrhosis; Risk Factors; Case-Control Studies; Cross-Sectional Studies
PubMed: 37665612
DOI: 10.1097/MEG.0000000000002625 -
Oral Diseases Oct 2023This study aimed to assess the frequency of temporomandibular disorders (TMDs) in patients with axial spondyloarthritis (axSpA) compared with the healthy individuals. We... (Meta-Analysis)
Meta-Analysis Review
This study aimed to assess the frequency of temporomandibular disorders (TMDs) in patients with axial spondyloarthritis (axSpA) compared with the healthy individuals. We systematically searched PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar databases from their inception until 2022, without language restriction. A standardized dataset was used to extract data from the observational studies. Patients were required to have axial spondyloarthritis and clinical and/or radiographic evidence of temporomandibular joint dysfunction. Meta-analysis was performed with a random effects model. A systematic review was registered under number CRD42020206283. We identified seven relevant studies, which provided data for 745 patients and 216 temporomandibular disorders events. The combined odds ratio (OR) showed that the risk of temporomandibular disorders in individuals with axial spondyloarthritis was higher than the control group (pooled OR = 5.26, 95% CI 2.50-11, 06; p < 0.02; I = 58%). Also, these individuals do not appear to refer possible temporomandibular joint symptoms to the rheumatologist or dentist. The results of this systematic review and meta-analysis suggest that patients with axial spondyloarthritis have an increased frequency of temporomandibular disorders. TMDs seem to be secondary to postural alterations rather than direct involvement of the temporomandibular joints (TMJs).
Topics: Humans; Temporomandibular Joint Disorders; Temporomandibular Joint; Axial Spondyloarthritis; Odds Ratio
PubMed: 36578234
DOI: 10.1111/odi.14490 -
Postgraduate Medical Journal Aug 2023Previous studies evaluating the impact of antibiotic timing on mortality in sepsis have shown conflicting results. We performed a meta-analysis to evaluate the... (Meta-Analysis)
Meta-Analysis
PURPOSE
Previous studies evaluating the impact of antibiotic timing on mortality in sepsis have shown conflicting results. We performed a meta-analysis to evaluate the association between door-to-antibiotic time (each hour of delay) and mortality in sepsis.
METHODS
We searched PubMed and Embase through 10 November 2022 to identity cohort studies that evaluated the adjusted association between door-to-antibiotic time (each hour of delay) and mortality in adult patients with sepsis. The primary outcome was mortality. Analysis was based on inverse-variance weighting using a fixed-effects model. The variances were derived from the logarithms of the reported confidence intervals (CIs) for associations. We estimated the odds ratio, 95% CI, and number needed to treat for the pooled data.
RESULTS
Fifteen cohort studies involving 106 845 patients were included in the meta-analysis. Door-to-antibiotic time (each hour of delay) was associated with increased risk of mortality (odds ratio: 1.07; 95% CI: 1.06-1.08; P < 0.0001; number needed to treat = 91), with high heterogeneity (I2 = 82.2%). The association was robust in sensitivity analyses and consistent in subgroup analyses. No publication bias was found.
CONCLUSION
In adult patients with sepsis, each hour of delay in antibiotic administration is associated with increased odds of mortality. Key messages What is already known on this topic Sepsis is a common and lethal syndrome that affects millions of people worldwide. The updated 2018 Surviving Sepsis Campaign guidelines recommended initiating empirical broad-spectrum antibiotic coverage within 1 hour of identification of sepsis and septic shock. Delay in antibiotic administration may increase the risk of mortality in patients with sepsis. What this study adds This meta-analysis evaluates and quantifies the association between door-to-antibiotic time (each hour of delay) and mortality in patients with sepsis. Each hour of delay in antibiotic administration is associated with increased odds of mortality in sepsis. The number needed to treat (NNT) with delayed antibiotic administration for one additional death was 91. How this study might affect research, practice, or policy: More efforts should be made to speed up the diagnosis of sepsis or sepsis shock.
Topics: Humans; Anti-Bacterial Agents; Sepsis; Shock, Septic
PubMed: 36917816
DOI: 10.1093/postmj/qgad024 -
Alpha Psychiatry Mar 2024To explore the association between malnutrition and risk of depression in the elderly. (Review)
Review
OBJECTIVE
To explore the association between malnutrition and risk of depression in the elderly.
METHODS
Relevant studies were searched in PubMed, Web of Science, the Cochrane Library, Scopus, and Embase from the establishment of the database to August 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 software was used for meta-analysis.
RESULTS
A total of 8 observational studies were identified with 11 112 participants, of which 2771 elderly patients had depression. The meta-pooled results showed a significant correlation between nutritional status and depression risk (odds ratio (OR) = 2.03, 95% CI = (1.47, 2.81), < 0.001). Subgroup analysis found that the malnutrition scores of different study types and the diagnostic methods of depression and malnutrition were correlated with the risk of depression.
CONCLUSION
Malnutrition was associated with depression risk in the elderly. Further large-scale multicenter studies should be conducted to test and verify the results.
PubMed: 38798803
DOI: 10.5152/alphapsychiatry.2024.231336 -
Nutrients Sep 2023Available results on the association between the Mediterranean diet (MD) and gastric cancer (GC) incidence are controversial. The present study aimed to determine the... (Meta-Analysis)
Meta-Analysis Review
Available results on the association between the Mediterranean diet (MD) and gastric cancer (GC) incidence are controversial. The present study aimed to determine the correlation between different subtypes of GC and MD adherence. This meta-analysis was registered on PROSPERO (CRD42021284432). We searched Embase, PubMed, Cochrane Library, and Web of Science from inception through 22 April 2023 to retrieve relevant studies. A random-effects model was used to pool odds ratios (ORs) with 95% confidence intervals (CIs). Eleven studies were included in the meta-analysis. Pooled analyses revealed that adherence to the MD was inversely associated with GC risk (OR, 0.43; 95% CI, 0.29 to 0.63; OR, 0.84; 95% CI, 0.77 to 0.92). Higher MD adherence was significantly associated with a reduced GC risk in male (OR, 0.78; 95% CI, 0.65 to 0.93; OR, 0.81; 95% CI, 0.65 to 1.01), but not in female (OR, 0.83; 95% CI, 0.68 to 1.01; OR, 1.04; 95% CI, 0.82 to 1.31). Furthermore, adherence to the MD possibly decreased the risk of gastric cardia adenocarcinoma (GCA) (OR, 0.64; 95% CI, 0.49 to 0.83; OR, 0.88; 95% CI, 0.76 to 1.02) and gastric non-cardia adenocarcinoma (GNCA) (OR, 0.68; 95% CI, 0.59 to 0.79; OR, 0.85; 95% CI, 0.78 to 0.94). Our results indicate that adherence to the MD reduces the risk of GC and its subtypes.
Topics: Female; Male; Humans; Stomach Neoplasms; Diet, Mediterranean; Adenocarcinoma; Odds Ratio; PubMed
PubMed: 37686858
DOI: 10.3390/nu15173826 -
Eye & Contact Lens Sep 2023To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effects of orthokeratology for slowing myopia progression in children. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effects of orthokeratology for slowing myopia progression in children.
METHODS
We performed a specific search on PubMed, Embase, Cochrane Library, Clinical Trials, CNKI, SinoMed, and Wanfang Data for RCTs conducted up to October 1, 2022. We pooled the weighted mean difference (WMD) between the orthokeratology and control groups for axial length (AL) elongation and the odds ratio (OR) for rates of adverse events and dropout.
RESULTS
Seven RCTs involving 655 eyes were included. There were significant differences in the effects of orthokeratology versus control in slowing AL elongation with WMD of -0.11 mm (95% confidence interval (CI), -0.13 to -0.08; P <0.01) at 6 months, -0.16 mm (95% CI, -0.18 to -0.13; P <0.01) at 12 months, -0.23 mm (95% CI, -0.29 to -0.18; P <0.01) at 18 months, and -0.28 mm (95% CI, -0.38 to -0.19; P <0.01) at 24 months, respectively. Myopia control rate declined, with 64%, 53%, 50%, and 47% recorded for 6, 12, 18, and 24 months, respectively. There was no statistical significance for adverse events between orthokeratology and control groups (OR=2.63, 95% CI, 0.72-9.61; P =0.11).
CONCLUSION
Orthokeratology can effectively slow myopia progression in children, and the efficacy of myopia control decreases with time.
Topics: Child; Humans; Randomized Controlled Trials as Topic; Myopia; Axial Length, Eye; Odds Ratio; Orthokeratologic Procedures; Refraction, Ocular
PubMed: 37284749
DOI: 10.1097/ICL.0000000000001006 -
The Aging Male : the Official Journal... Dec 2023This study aimed to determine whether the C-reactive protein-to-albumin ratio (CAR) can serve as a prognostic marker in patients with sepsis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to determine whether the C-reactive protein-to-albumin ratio (CAR) can serve as a prognostic marker in patients with sepsis.
METHODS
Chinese and English databases were searched to retrieve the included literature. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) with their 95% confidence interval (CI) were calculated using the bivariate model. Moreover, the hazard ratio (HR) and 95% CI were calculated using the random effect model.
RESULTS
Nine articles comprising 3224 patients with sepsis were included in the meta-analysis. The pooled SEN was 0.73 (95% CI 0.65-0.80), the pooled SPE was 0.78 (95% CI 0.69-0.84), the pooled PLR was 3.29 (95% CI 2.15-5.03), the pooled NLR was 0.35 (95% CI 0.24-0.49), and the pooled DOR was 9.50 (95% CI 4.38-20.59). The AUC under the SROC was 0.82 (95% CI 0.78-0.85) for the prognostic meta-analysis. The pooled HR was 1.10 (95% CI 1.02-1.18).
CONCLUSIONS
This meta-analysis suggests that a high CAR level is associated with increased mortality and a poor prognosis.
Topics: Humans; C-Reactive Protein; Prognosis; Albumins; Sepsis; Area Under Curve
PubMed: 37752726
DOI: 10.1080/13685538.2023.2261540 -
Is bruxism associated with temporomandibular joint disorders? A systematic review and meta-analysis.Evidence-based Dentistry Sep 2023The aim of this review is to examine and quantify the association between bruxism and temporomandibular joint disorders in a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this review is to examine and quantify the association between bruxism and temporomandibular joint disorders in a systematic review and meta-analysis.
METHODS
Electronic searches were performed in PubMed/Medline, Embase, Cochrane, Wiley, ProQuest, Web of Science, and Scopus databases for articles published up to March 2022. Two independent reviewers assessed the quality of the studies using the Newcastle-Ottawa Scale. A random-effects model was used to estimate the pooled odds ratio (OR) and its corresponding 95% confidence interval (CI) for each study.
RESULTS
The search retrieved 1651 studies, and 20 studies were eligible for meta-analysis. The results of the study showed that there is a significant relationship between bruxism and TMD, with the presence of bruxism increasing the odds of TMD by 2.25 times (OR = 2.25, 95% CI (1.94-2.56)). Based on the type of bruxism, awake bruxism was found to increase the odds of TMD by 2.51 times (OR = 2.51, 95% CI: (2.02-2.99)), while sleep bruxism increased the odds of TMD by 2.06 times (OR = 2.06, 95% CI: (1.82-2.30)). Analysis of the results from studies that reported both types of bruxism showed that bruxism increases the odds of TMD by 2.17 times (OR = 2.17, 95% CI: (2.30-3.05)).
CONCLUSION
The available data demonstrate a positive relationship between bruxism and TMD, with the presence of bruxism increasing the likelihood of developing TMD in the future.
Topics: Humans; Temporomandibular Joint Disorders; Sleep Bruxism
PubMed: 37474733
DOI: 10.1038/s41432-023-00911-6