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Clinical and Experimental Medicine Aug 2023Plasmatic presepsin (PSP) is a novel biomarker reported to be useful for sepsis diagnosis and prognosis. During the pandemic, only few studies highlighted a possible... (Meta-Analysis)
Meta-Analysis Review
Plasmatic presepsin (PSP) is a novel biomarker reported to be useful for sepsis diagnosis and prognosis. During the pandemic, only few studies highlighted a possible correlation between PSP and COVID-19 severity, but results remain inconsistent. The present study aims to establish the correlation between PSP and COVID-19 severity. English-language papers assessing a correlation between COVID-19 and PSP from MEDLINE, PubMed, Google Scholar, Cochrane Library, MeSH, LitCovid NLM, EMBASE, CINAHL Plus and the World Health Organization (WHO) website, published from January 2020 were considered with no publication date limitations. Two independent reviewers performed data abstraction and quality assessment, and one reviewer resolved inconsistencies. The protocol was registered on PROSPERO (CRD42022325971).Fifteen articles met our eligibility criteria. The aggregate study population included 1373 COVID-19 patients who had undergone a PSP assessment. The random-effect meta-analysis was performed in 7 out of 15 selected studies, considering only those reporting the mean PSP levels in low- and high-severity cases (n = 707).The results showed that the pooled mean difference of PSP levels between high- and low-severity COVID-19 patients was 441.70 pg/ml (95%CI: 150.40-732.99 pg/ml).Our data show that presepsin is a promising biomarker that can express COVID-19 severity.
Topics: Humans; COVID-19; Prognosis; Biomarkers; Pandemics; Sepsis; Peptide Fragments; Lipopolysaccharide Receptors
PubMed: 36380007
DOI: 10.1007/s10238-022-00936-8 -
Clinical Hypertension Sep 2023In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies... (Review)
Review
In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit. One thing for sure is pre- and post-dialysis BP measurements should not be used alone to diagnose and manage hypertension in dialysis patients. The exact target of BP and the relationship between BP and all-cause mortality or cause-specific mortality are unclear in this population. Many observational studies with HD cohorts have almost universally reported a U-shaped or even an L-shaped association between BP and all-cause mortality, but most of these data are based on the BP measured in HD units. Some data with ABPM have shown a linear association between BP and mortality even in HD patients, similar to the general population. Supporting this, the results of meta-analysis have shown a clear benefit of BP reduction in HD patients. Therefore, further research is needed to determine the optimal target BP in the dialysis population, and for now, an individualized approach is appropriate, with particular emphasis on avoiding excessively low BP. Maintaining euvolemia is of paramount importance for BP control in dialysis patients. Patient heterogeneity and the lack of comparative evidence preclude the recommendation of one class of medication over another for all patients. Recently, however, β-blockers could be considered as a first-line therapy in dialysis patients, as they can reduce sympathetic overactivity and left ventricular hypertrophy, which contribute to the high incidence of arrhythmias and sudden cardiac death. Several studies with mineralocorticoid receptor antagonists have also reported promising results in reducing mortality in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated before their use.
PubMed: 37653470
DOI: 10.1186/s40885-023-00240-x -
Diagnostics (Basel, Switzerland) Jul 2023Deep learning and diagnostic applications in oral and dental health have received significant attention recently. In this review, studies applying deep learning to... (Review)
Review
Deep learning and diagnostic applications in oral and dental health have received significant attention recently. In this review, studies applying deep learning to diagnose anomalies and diseases in dental image material were systematically compiled, and their datasets, methodologies, test processes, explainable artificial intelligence methods, and findings were analyzed. Tests and results in studies involving human-artificial intelligence comparisons are discussed in detail to draw attention to the clinical importance of deep learning. In addition, the review critically evaluates the literature to guide and further develop future studies in this field. An extensive literature search was conducted for the 2019-May 2023 range using the Medline (PubMed) and Google Scholar databases to identify eligible articles, and 101 studies were shortlisted, including applications for diagnosing dental anomalies ( = 22) and diseases ( = 79) using deep learning for classification, object detection, and segmentation tasks. According to the results, the most commonly used task type was classification ( = 51), the most commonly used dental image material was panoramic radiographs ( = 55), and the most frequently used performance metric was sensitivity/recall/true positive rate ( = 87) and accuracy ( = 69). Dataset sizes ranged from 60 to 12,179 images. Although deep learning algorithms are used as individual or at least individualized architectures, standardized architectures such as pre-trained CNNs, Faster R-CNN, YOLO, and U-Net have been used in most studies. Few studies have used the explainable AI method ( = 22) and applied tests comparing human and artificial intelligence ( = 21). Deep learning is promising for better diagnosis and treatment planning in dentistry based on the high-performance results reported by the studies. For all that, their safety should be demonstrated using a more reproducible and comparable methodology, including tests with information about their clinical applicability, by defining a standard set of tests and performance metrics.
PubMed: 37568875
DOI: 10.3390/diagnostics13152512 -
Seizure Jul 2023The late onset myoclonic epilepsy in Down Syndrome (LOMEDS) is a peculiar epilepsy type characterized by cortical myoclonus and generalized tonic-clonic seizures (GTCS),... (Review)
Review
INTRODUCTION
The late onset myoclonic epilepsy in Down Syndrome (LOMEDS) is a peculiar epilepsy type characterized by cortical myoclonus and generalized tonic-clonic seizures (GTCS), in people suffering from cognitive decline in Down syndrome (DS). In this review, we analyzed available data on the diagnostic and therapeutic management of individuals with LOMEDS.
METHODS
We performed a systematic search of the literature to identify the diagnostic and therapeutic management of patients with LOMEDS. The following databases were used: PubMed, Google Scholar, EMBASE, CrossRef. The protocol was registered on PROSPERO (registration code: CRD42023390748).
RESULTS
Data from 46 patients were included. DS was diagnosed according to the patient's clinical and genetic characteristics. Diagnosis of Alzheimer's dementia (AD) preceded the onset of epilepsy in all cases. Both myoclonic seizures (MS) and generalized tonic-clonic seizures (GTCS) were reported, the latter preceding the onset of MS in 28 cases. EEG was performed in 45 patients, showing diffuse theta/delta slowing with superimposed generalized spike-and-wave or polyspike-and-wave. A diffuse cortical atrophy was detected in 34 patients on neuroimaging. Twenty-seven patients were treated with antiseizure medication (ASM) monotherapy, with reduced seizure frequency in 17 patients. Levetiracetam and valproic acid were the most used ASMs. Up to 41% of patients were unresponsive to first-line treatment and needed adjunctive therapy for seizure control.
CONCLUSIONS
AD-related pathological changes in the brain may play a role in LOMEDS onset, although the mechanism underlying this phenomenon is still unknown. EEG remains the most relevant investigation to be performed. A significant percentage of patients developed a first-line ASM refractory epilepsy. ASMs which modulate the glutamatergic system may represent a good therapeutic option.
Topics: Humans; Down Syndrome; Epilepsy; Epilepsies, Myoclonic; Levetiracetam; Seizures; Alzheimer Disease; Electroencephalography; Anticonvulsants; Epilepsy, Generalized
PubMed: 37267668
DOI: 10.1016/j.seizure.2023.05.017 -
ESC Heart Failure Aug 2023The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction... (Meta-Analysis)
Meta-Analysis Review
The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction (HFpEF) and to pose clues in the field of scientific and clinical practice. Electronic databases of PubMed, Web of Science, Cochrane Library, and Embase were systematically searched. Studies investigating the use of the HFA-PEFF score to diagnose HFpEF were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative Likelihood Ratio (NLR), diagnostic odds ratio (DOR), area under the curve of summary receiver operating characteristic, and superiority index were calculated. Five studies with 1521 participants were included in this meta-analysis. In the pooled analysis of the 'Rule-out' approach, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.98 (0.94, 1.00), 0.33 (0.08, 0.73), 1.5 (0.8, 2.5), 0.05 (0.02, 0.17), and 28 (6, 127). In the pooled analysis of the 'Rule-in' approach, the pooled sensitivity and specificity, PLR, NLR, and DOR were 0.69 (0.62, 0.75), 0.87 (0.64, 0.96), 5.5 (1.8, 16.9), 0.35 (0.30, 0.41), and 16 (5, 50). This meta-analysis indicates that the HFA-PEFF algorithm showed acceptable specificity and sensitivity for the diagnosis and exclusion of HFpEF. More relevant studies on the diagnostic validity of the HFA-PEFF score are needed in the future.
Topics: Humans; Heart Failure; Stroke Volume; Sensitivity and Specificity; ROC Curve; Algorithms
PubMed: 37292053
DOI: 10.1002/ehf2.14421 -
International Journal of Molecular... Jun 2023Despite the high incidence and burden of stroke, biological biomarkers are not used routinely in clinical practice to diagnose, determine progression, or prognosticate... (Review)
Review
Despite the high incidence and burden of stroke, biological biomarkers are not used routinely in clinical practice to diagnose, determine progression, or prognosticate outcomes of acute ischemic stroke (AIS). Because of its direct interface with neural tissue, cerebrospinal fluid (CSF) is a potentially valuable source for biomarker development. This systematic review was conducted using three databases. All trials investigating clinical and preclinical models for CSF biomarkers for AIS diagnosis, prognostication, and severity grading were included, yielding 22 human trials and five animal studies for analysis. In total, 21 biomarkers and other multiomic proteomic markers were identified. S100B, inflammatory markers (including tumor necrosis factor-alpha and interleukin 6), and free fatty acids were the most frequently studied biomarkers. The review showed that CSF is an effective medium for biomarker acquisition for AIS. Although CSF is not routinely clinically obtained, a potential benefit of CSF studies is identifying valuable biomarkers from the pathophysiologic microenvironment that ultimately inform optimization of targeted low-abundance assays from peripheral biofluid samples (e.g., plasma). Several important catabolic and anabolic markers can serve as effective measures of diagnosis, etiology identification, prognostication, and severity grading. Trials with large cohorts studying the efficacy of biomarkers in altering clinical management are still needed.
Topics: Humans; Ischemic Stroke; Proteomics; Stroke; Biomarkers; Fatty Acids, Nonesterified
PubMed: 37446092
DOI: 10.3390/ijms241310902 -
BMC Infectious Diseases Sep 2023Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus...
BACKGROUND AND OBJECTIVES
Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE.
METHODS
Case series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.
RESULTS
Out of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management.
DISCUSSION
Consecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process.
FUNDING
The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380).
REGISTRATION
This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).
Topics: Humans; Echinococcosis; Electrocardiography; Heart; Heart Diseases
PubMed: 37705012
DOI: 10.1186/s12879-023-08576-3 -
Cardiovascular Diabetology Nov 2023There is uncertainty regarding the role of obesity in type 1 diabetes development. The aim of this systematic review and meta-analysis was to collect and synthesize... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is uncertainty regarding the role of obesity in type 1 diabetes development. The aim of this systematic review and meta-analysis was to collect and synthesize evidence regarding BMI and the risk of developing type 1 diabetes.
METHODS
A systematic review and meta-analysis were conducted to assess the association between BMI and incident type 1 diabetes. Databases were searched up to June 2022. Cohort studies were included reporting the association between overweight and/or obesity, as measured by BMI after age 2 years, with incident type 1 diabetes. Independent reviewers extracted data and assessed study quality. Risk estimates were pooled using a random-effects model.
RESULTS
Ten cohort studies met the inclusion criteria. The seven studies that classified BMI into categories were of high quality and involved 1,690,660 individuals and 1979 incident type 1 diabetes cases. The pooled risk ratio (RR) for type 1 diabetes was 1.35 (95% CI 0.93-1.97) among people with overweight (3 studies); 2.17 (95% CI 1.75-2.69) among people with obesity (5 studies); and 1·87 (95% CI 1.52-2.29) among people with overweight/obesity (two studies merged the categories). These point estimates persisted in sensitivity analyses that addressed the duration of follow-up, variability in baseline risk for incident type 1 diabetes, and potential misclassifications related to exposure or outcome definitions. People with overweight/obesity had a 2.55 (95% CI 1.11-5.86) greater risk for incident type 1 diabetes with positive islet autoantibodies.
CONCLUSION
This systematic review and meta-analysis of high-quality observational cohort studies indicated an association between high BMI and the risk of type 1 diabetes, in a graded manner.
Topics: Humans; Child, Preschool; Overweight; Diabetes Mellitus, Type 1; Body Mass Index; Obesity; Cohort Studies
PubMed: 37919779
DOI: 10.1186/s12933-023-02007-y -
Neurology(R) Neuroimmunology &... May 2024Susac syndrome (SuS) is an orphan microangiopathic disease characterized by a triad of encephalopathy, visual disturbances due to branch retinal artery occlusions, and... (Review)
Review
Susac syndrome (SuS) is an orphan microangiopathic disease characterized by a triad of encephalopathy, visual disturbances due to branch retinal artery occlusions, and sensorineuronal hearing loss. Our previous systematic review on all cases of SuS reported until 2012 allowed for a better understanding of clinical presentation and diagnostic findings. Based on these data, we suggested diagnostic criteria in 2016 to allow early diagnosis and treatment of SuS. In view of the accumulation of new SuS cases reported in the last 10 years and improved diagnostic tools, we here aimed at updating the demographic and clinical features of SuS and to review the updated ancillary tests being used for SuS diagnosis. Therefore, based on the 2016 criteria, we systematically collected and evaluated data on SuS published from January 2013 to March 2022.
Topics: Humans; Susac Syndrome; Magnetic Resonance Imaging; Brain Diseases; Vision Disorders; Diagnosis, Differential
PubMed: 38364193
DOI: 10.1212/NXI.0000000000200209 -
International Journal of Molecular... Sep 2023Blood biomarkers hold potential for the early diagnosis of ischaemic stroke (IS). We aimed to evaluate the current weight of evidence and identify potential biomarkers... (Meta-Analysis)
Meta-Analysis Review
Blood biomarkers hold potential for the early diagnosis of ischaemic stroke (IS). We aimed to evaluate the current weight of evidence and identify potential biomarkers and biological pathways for further investigation. We searched PubMed, EMBASE, the Cochrane Library and Web of Science, used R package meta4diag for diagnostic meta-analysis and applied Gene Ontology (GO) analysis to identify vital biological processes (BPs). Among 8544 studies, we included 182 articles with a total of 30,446 participants: 15675 IS, 2317 haemorrhagic stroke (HS), 1798 stroke mimics, 846 transient ischaemic attack and 9810 control subjects. There were 518 pooled biomarkers including 203 proteins, 114 genes, 108 metabolites and 88 transcripts. Our study generated two shortlists of biomarkers for future research: one with optimal diagnostic performance and another with low selection bias. Glial fibrillary acidic protein was eligible for diagnostic meta-analysis, with summary sensitivities and specificities for differentiating HS from IS between 3 h and 24 h after stroke onset ranging from 73% to 80% and 77% to 97%, respectively. GO analysis revealed the top five BPs associated with IS. This study provides a holistic view of early diagnostic biomarkers in IS. Two shortlists of biomarkers and five BPs warrant future investigation.
Topics: Humans; Stroke; Brain Ischemia; Ischemic Stroke; Hemorrhagic Stroke; Early Diagnosis; Biomarkers
PubMed: 37762122
DOI: 10.3390/ijms241813821