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European Journal of Nutrition Aug 2023The aim of this systematic review with meta-analysis was to determine whether anthocyanin-rich foods are effective to improve cardiometabolic markers in individuals with... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this systematic review with meta-analysis was to determine whether anthocyanin-rich foods are effective to improve cardiometabolic markers in individuals with metabolic syndrome (MetS), compared with placebo or control interventions.
METHODS
We searched MEDLINE, CENTRAL, Embase, LILACS, CINAHL, and Web of Science from their inception up to March 2022. We include clinical trials (randomized clinical trials, controlled clinical trials, and cross-over trials) with anthocyanin-rich foods versus placebo or control intervention that assessment cardiometabolic factors.
RESULTS
We found 14 clinical trials that met the eligibility criteria, and we included 10 studies for the quantitative synthesis. For anthocyanin-rich foods versus control interventions, the mean difference (MD) for low-density lipoprotein (LDL) was - 7.98 mg/dL (CI = - 15.20 to - 0.77, GRADE: Very low). For homeostatic model assessment for insulin resistance (HOMA-IR), the MD was 0.04 (CI = 0.08 to 0.16, GRADE: Moderate). The MD for interleukin 6 was 0.00 pg/mL (CI = - 0.01 to 0.00, GRADE: Low). For tumor necrosis factor alpha (TNF-α), the standardized mean difference (SMD) was - 0.52 pg/mL (CI = 0.85 to 0.19 GRADE: Very low) when compared with the control interventions. The certainty of the evidence for the other outcomes it is very low.
CONCLUSION
Our findings suggest that anthocyanin-rich foods could improve certain cardiometabolic markers (e.g., TC, TG, LDL, and TNF-α) among individuals with MetS (with very low quality evidence according to GRADE), compared with placebo or other control interventions.
PROSPERO REGISTRATION NUMBER
CRD42020187287.
Topics: Humans; Anthocyanins; Metabolic Syndrome; Tumor Necrosis Factor-alpha; Cardiovascular Diseases
PubMed: 37042998
DOI: 10.1007/s00394-023-03142-8 -
Disability and Rehabilitation May 2024Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this knowledge, little attention has been attributed to estimate sedentary behaviour in this population. The aims of this meta-analysis were to: (a) establish the pooled mean time spent sedentary, (b) investigate moderators of sedentary levels, and (c) explore differences with age- and gender-matched general population controls in people with fibromyalgia (PwF).
METHODS
Two independent authors searched major databases until 1 December 2022. A random effects meta-analysis was performed. The methodological quality of included studies was assessed with the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.
RESULTS
Across 7 cross-sectional studies of fair methodological quality, there were 1500 patients with fibromyalgia (age range = 43-53 years). PwF spent 545.6 min/day (95% CI = 523.7-567.5, < 0.001, = 3) engaging in sedentary behaviour. Self-reported questionnaires overestimate sedentary levels with 314.3 min/day (95% CI = 302.0-326.6, = 0.001, = 2). PwF spent 36.14 min/day (95% CI = 16.3-55.9, < 0.001) more in sedentary behaviour than general population controls.
CONCLUSIONS
PwF are more sedentary than the general population. The limited available data should however be considered with caution due to substantial heterogeneity.
Topics: Fibromyalgia; Humans; Sedentary Behavior; Cross-Sectional Studies; Middle Aged; Female; Exercise
PubMed: 37211677
DOI: 10.1080/09638288.2023.2214379 -
Medwave Dec 2020This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of cell-based therapies in the...
OBJECTIVE
This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of cell-based therapies in the treatment of patients with COVID-19.
DATA SOURCES
We conducted searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature, and in a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. All the searches covered the period until 23 April 2020 (one day before submission).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS
We adapted an already published standard protocol for multiple parallel systematic reviews to the specificities of this question. We searched for randomized trials evaluating the effectiveness and safety of cell-based therapies versus placebo or no treatment in patients with COVID-19. Anticipating the lack of randomized trials directly addressing this question, we also searched for trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and nonrandomized studies in COVID-19. Two reviewers independently screened each study for eligibility. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit this review to a peer-reviewed journal every time the conclusions change or whenever there are substantial updates.
RESULTS
We screened 1 043 records, but no study was considered eligible. We identified 61 ongoing studies, including 39 randomized trials evaluating different types of cell-based therapies in COVID-19.
CONCLUSIONS
We did not find any studies that met our inclusion criteria, and hence there is no evidence to support or refute the use of cell-based therapies for treating patients with COVID-19. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision-makers in the near future.
PROSPERO REGISTRATION NUMBER
CRD42020179711.
Topics: COVID-19; Cell- and Tissue-Based Therapy; Humans
PubMed: 33382060
DOI: 10.5867/medwave.2020.11.8078 -
Cardiovascular Diabetology Jan 2021Metformin is a first-line drug in type 2 diabetes mellitus (T2DM) treatment, yet whether metformin may increase all-cause or cardiovascular mortality of T2DM patients... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Metformin is a first-line drug in type 2 diabetes mellitus (T2DM) treatment, yet whether metformin may increase all-cause or cardiovascular mortality of T2DM patients remains inconclusive.
METHODS
We searched PubMed and Embase for data extracted from inception to July 14, 2020, with a registration in PROSPERO (CRD42020177283). This study included randomized controlled trials (RCT) assessing the cardiovascular effects of metformin for T2DM. This study is followed by PRISMA and Cochrane guideline. Risk ratio (RR) with 95% CI was pooled across trials by a random-effects model. Primary outcomes include all-cause mortality and cardiovascular mortality.
RESULTS
We identified 29 studies that randomly assigned patients with 371 all-cause and 227 cardiovascular death events. Compared with untreated T2DM patients, metformin-treated patients was not associated with lower risk of all-cause mortality (RR: 0.98; 95%CI: 0.69-1.38; P = 0.90), cardiovascular mortality (RR: 1.13; 95% CI: 0.60, 2.15; P = 0.70), macrovascular events (RR: 0.87; 95%CI: 0.70-1.07; P = 0.19), heart failure (RR: 1.02; 95% CI:0.61-1.71; P = 0.95), and microvascular events (RR: 0.78; 95% CI:0.54-1.13; P = 0.19). Combination of metformin with another hypoglycemic drug was associated with higher risk of all-cause mortality (RR: 1.49; 95% CI: 1.02, 2.16) and cardiovascular mortality (RR: 2.21; 95% CI: 1.22, 4.00) compared with hypoglycemic drug regimens with no metformin.
CONCLUSION
The combination of metformin treatment may impose higher risk in all-cause and cardiovascular mortality. This finding, at least in part, shows no evidence for benefits of metformin in combination in terms of all-cause/cardiovascular mortality and cardiovascular events for T2DM. However, the conclusion shall be explained cautiously considering the limitations from UK Prospective Diabetes Study (UKPDS).
Topics: Cardiovascular Diseases; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Heart Disease Risk Factors; Humans; Hypoglycemic Agents; Metformin; Randomized Controlled Trials as Topic; Risk Assessment; Time Factors; Treatment Outcome
PubMed: 33516224
DOI: 10.1186/s12933-020-01202-5 -
Heart Rhythm Aug 2020Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized.
OBJECTIVE
We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure.
METHODS
We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models.
RESULTS
From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78-0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83-1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (-22.5 minutes for women and -27.1 minutes for men).
CONCLUSION
CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Heart Conduction System; Humans; Pulmonary Veins; Recurrence; Sex Factors; Treatment Outcome
PubMed: 32325197
DOI: 10.1016/j.hrthm.2020.04.020 -
Frontiers in Pharmacology 2022Whether Mineralocorticoid receptor antagonists (MRA) reduce mortality and cardiovascular effects of dialysis patients remains unclear. A meta-analysis was designed to...
Whether Mineralocorticoid receptor antagonists (MRA) reduce mortality and cardiovascular effects of dialysis patients remains unclear. A meta-analysis was designed to investigate whether MRA reduce mortality and cardiovascular effects of dialysis patients, with a registration in INPLASY (INPLASY2020120143). The meta-analysis revealed that MRA significantly reduced all-cause mortality (ACM) and cardiovascular mortality (CVM). Patients receiving MRA presented improved left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF), decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP). There was no significant difference in the serum potassium level between the MRA group and the placebo group. MRA vs. control exerts definite survival and cardiovascular benefits in dialysis patients, including reducing all-cause mortality and cardiovascular mortality, LVMI, and arterial blood pressure, and improving LVEF. In terms of safety, MRA did not increase serum potassium levels for dialysis patients with safety. (https://inplasy.com/inplasy-protocol-1239-2/), identifier (INPLASY2020120143).
PubMed: 35656294
DOI: 10.3389/fphar.2022.823530 -
Global Heart 2024Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor... (Review)
Review
BACKGROUND
Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor maternal and fetal outcomes and is a significant factor in non-obstetric morbidity. Echocardiography has an emerging role in screening for RHD. We aimed to critically analyse the evidence on the use of echocardiography for screening pregnant women for RHD in high-prevalence areas.
METHODS
We searched MEDLINE and Embase to identify the relevant reports. Two independent reviewers assessed the reports against the eligibility criteria in a double-blind process.
RESULTS
The searches (date: 4 April 2023) identified 432 records for screening. Ten non-controlled observational studies were identified, five using portable or handheld echocardiography, comprising data from 23,166 women. Prevalence of RHD varied across the studies, ranging from 0.4 to 6.6% (I, heterogeneity >90%). Other cardiac abnormalities (e.g., congenital heart disease and left ventricular systolic dysfunction) were also detected <1% to 2% of cases. Certainty of evidence was very low.
CONCLUSION
Echocardiography as part of antenatal care in high-prevalence areas may detect RHD or other cardiac abnormalities in asymptomatic pregnant women, potentially reducing the rates of disease progression and adverse labor-associated outcomes. However, this evidence is affected by the low certainty of evidence, and lack of studies comparing echocardiography versus standard antenatal care.
PROSPECTIVE REGISTRATION
PROSPERO 2022 July 4; CRD42022344081 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344081.
RESEARCH QUESTION
'In areas with a high prevalence of rheumatic heart disease, should handheld echocardiography be added to routine antenatal care?'
Topics: Humans; Rheumatic Heart Disease; Female; Pregnancy; Echocardiography; Prevalence; Pregnancy Complications, Cardiovascular; Ultrasonography, Prenatal; Prenatal Care
PubMed: 38681969
DOI: 10.5334/gh.1318 -
The Lancet. Global Health Jun 2024Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic role. Standard echocardiography might not be feasible in high-prevalence regions due to its high cost, complexity, and time requirement. Handheld echocardiography might be an easy-to-use, low-cost alternative, but its performance in screening for and diagnosing acute rheumatic fever and rheumatic heart disease needs further investigation.
METHODS
In this systematic review and meta-analysis, we searched Embase, MEDLINE, LILACS, and Conference Proceedings Citation Index-Science up to Feb 9, 2024, for studies on the screening and diagnosis of acute rheumatic fever and rheumatic heart disease using handheld echocardiography (index test) or standard echocardiography or auscultation (reference tests) in high-prevalence areas. We included all studies with useable data in which the diagnostic performance of the index test was assessed against a reference test. Data on test accuracy in diagnosing rheumatic heart disease, acute rheumatic fever, or carditis with acute rheumatic fever (primary outcomes) were extracted from published articles or calculated, with authors contacted as necessary. Quality of evidence was appraised using GRADE and QUADAS-2 criteria. We summarised diagnostic accuracy statistics (including sensitivity and specificity) and estimated 95% CIs using a bivariate random-effects model (or univariate random-effects models for analyses including three or fewer studies). Area under the curve (AUC) was calculated from summary receiver operating characteristic curves. Heterogeneity was assessed by visual inspection of plots. This study was registered with PROSPERO (CRD42022344081).
FINDINGS
Out of 4868 records we identified 11 studies, and two additional reports, comprising 15 578 unique participants. Pooled data showed that handheld echocardiography had high sensitivity (0·87 [95% CI 0·76-0·93]), specificity (0·98 [0·71-1·00]), and overall high accuracy (AUC 0·94 [0·84-1·00]) for diagnosing rheumatic heart disease when compared with standard echocardiography (two studies; moderate certainty of evidence), with better performance for diagnosing definite compared with borderline rheumatic heart disease. High sensitivity (0·79 [0·73-0·84]), specificity (0·85 [0·80-0·89]), and overall accuracy (AUC 0·90 [0·85-0·94]) for screening rheumatic heart disease was observed when pooling data of handheld echocardiography versus standard echocardiography (seven studies; high certainty of evidence). Most studies had a low risk of bias overall. Some heterogeneity was observed for sensitivity and specificity across studies, possibly driven by differences in the prevalence and severity of rheumatic heart disease, and level of training or expertise of non-expert operators.
INTERPRETATION
Handheld echocardiography has a high accuracy and diagnostic performance when compared with standard echocardiography for diagnosing and screening of rheumatic heart disease in high-prevalence areas.
FUNDING
World Health Organization.
TRANSLATIONS
For the Chinese, French, Italian, Persian, Portuguese, Spanish and Urdu translations of the abstract see Supplementary Materials section.
Topics: Humans; Rheumatic Heart Disease; Echocardiography; Mass Screening; World Health Organization; Practice Guidelines as Topic; Sensitivity and Specificity
PubMed: 38762298
DOI: 10.1016/S2214-109X(24)00127-X -
Archives of Physical Medicine and... Mar 2024To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs). (Review)
Review
OBJECTIVE
To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs).
DATA SOURCES
Two authors searched Embase, CINAHL, PsycARTICLES, and PubMed up to 01/09/2023.
STUDY SELECTION
We included RCTs of exercise interventions in people with knee or hip osteoarthritis that reported dropout rates.
DATA EXTRACTION
Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related moderators.
DATA SYNTHESIS
In total, 209 RCTs involving 277 exercise arms in 13,102 participants were included (mean age at study level=64 years; median prevalence of men participants=26.8%). The trim-and-fill-adjusted prevalence of dropout across all RCTs was 17.5% (95% CI=16.7%-18.2%), which is comparable with dropout observed in control conditions (trim-and-fill-adjusted odds ratio=0.89; 95% CI=0.71-1.12, P=.37). Higher prevalence of antidepressant use at study-level predicted higher dropout (R=0.75, P=.002, N RCTs=6, n exercisers=412). Supervision by an exercise professional was associated with lower dropout rates, with a trim-and-fill-adjusted rate of 13.2% (95% CI=11.7%-14.9%) compared with 20.8% without supervision (95% CI=18.3%-23.5%) (P<.001).
CONCLUSIONS
Dropout rates for exercise in RCTs are comparable with control conditions, suggesting that exercise is a generally well-accepted intervention. However, interventions should be supervised by an exercise professional, such as a physiotherapist or exercise physiologist, to further minimize the risk of dropout. Health professionals should consider participants' use of antidepressants as a risk factor for dropout from exercise.
PubMed: 38484833
DOI: 10.1016/j.apmr.2024.02.735 -
Medwave Dec 2020Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19.
METHODS
Eligible studies were randomized trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19. All the searches covered the period until 25 August 2020. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardized form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic.
RESULTS
Our search strategy yielded 574 references. Finally, we included three randomized trials evaluating remdesivir in addition to standard care versus standard care alone. The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7, 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69, 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large increase in the incidence of adverse effects in patients with COVID-19 (RR 1.29, 95% CI 0.58 to 2.84; moderate certainty evidence).
CONCLUSIONS
The evidence is insufficient for the outcomes critical for making decisions on the role of remdesivir in the treatment of patients with COVID-19, so it is impossible to balance potential benefits, if there are any, with the adverse effects and costs.
PROSPERO REGISTRATION NUMBER
CRD42020183384.
Topics: Adenosine Monophosphate; Alanine; Antiviral Agents; COVID-19; Humans; Randomized Controlled Trials as Topic; Respiration, Artificial; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 33361753
DOI: 10.5867/medwave.2020.11.8080