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Cureus Nov 2023Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels, severity continues to rise worldwide. This systematic review seeks... (Review)
Review
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels, severity continues to rise worldwide. This systematic review seeks to examine the prevalence of diabetes and its associated comorbid conditions, aiming to provide insights into the multifaceted impact of diabetes on a broader scale. DM exhibits a positive correlation with advancing age, and it's strongly influenced by genetic predisposition. In recent years, there has been a discernible global increase in the prevalence of type 1 diabetes (T1D), as evidenced by extensive epidemiological studies. Individuals with DM frequently have a positive familial history, and the presence of DM in both parents or solely the mother significantly amplifies genetic susceptibility. Moreover, non-genetic factors, such as acute psychological stressors, obesity, pregnancy, and smoking play a pivotal role in the development of DM. Notably, urinary tract infections (UTIs) are a common comorbidity in patients with type 2 diabetes (T2D) and all patients with T1D. T2D is prevalent, particularly among females, and its incidence rises with age. UTIs are prevalent among individuals with diabetes, particularly females, with Escherichia coli (E. coli) isolates being the primary etiological agents responsible for UTI inflammation. Insulin resistance is a common feature in both prediabetes and prehypertension, serving as a precursor to these conditions. The increasing incidence of T2D in regions with high tuberculosis (TB) prevalence emphasizes the significance of understanding DM as a substantial TB risk factor. DM is associated with a threefold elevation in TB risk and a twofold increase in unfavorable outcomes during TB treatment. Notably, the global prevalence of DM has led to a larger population of TB patients with comorbid DM than TB patients coinfected with HIV. Diabetes and sepsis contribute significantly to worldwide morbidity and mortality, with diabetic individuals experiencing more post-sepsis complications and increased mortality. The coexistence of hypertension and T2D is a common comorbidity, with hypertension incidence being twice as high among individuals with diabetes compared to those without, often linked to insulin resistance and a heightened risk of diabetes onset.
PubMed: 38146555
DOI: 10.7759/cureus.49374 -
PloS One 2023Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia.
METHODS
To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model.
RESULTS
Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia.
CONCLUSIONS
When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.
Topics: Pregnancy; Female; Humans; Adult; Pre-Eclampsia; Ethiopia; Risk Factors; Maternal Age; Hypertension; Prevalence
PubMed: 37963147
DOI: 10.1371/journal.pone.0287038 -
Nutrients Sep 2023Although gestational diabetes mellitus (GDM) has several short- and long-term adverse effects on the mother and the offspring, no medicine is generally prescribed to... (Meta-Analysis)
Meta-Analysis Review
Although gestational diabetes mellitus (GDM) has several short- and long-term adverse effects on the mother and the offspring, no medicine is generally prescribed to prevent GDM. The present systematic review and meta-analysis aimed to investigate the effect of inositol supplementation in preventing GDM and related outcomes. Systematic search was performed in CENTRAL, MEDLINE, and Embase until 13 September 2023. Eligible randomized controlled trials (RCTs) compared the efficacy of inositols to placebo in pregnant women at high risk for GDM. Our primary outcome was the incidence of GDM, whereas secondary outcomes were oral glucose tolerance test (OGTT) and maternal and fetal complications. (PROSPERO registration number: CRD42021284939). Eight eligible RCTs were identified, including the data of 1795 patients. The incidence of GDM was halved by inositols compared to placebo (RR = 0.42, CI: 0.26-0.67). Fasting, 1-h, and 2-h OGTT glucose levels were significantly decreased by inositols. The stereoisomer myoinositol also reduced the risk of insulin need (RR = 0.29, CI: 0.13-0.68), preeclampsia or gestational hypertension (RR = 0.38, CI: 0.2-0.71), preterm birth (RR = 0.44, CI: 0.22-0.88), and neonatal hypoglycemia (RR = 0.12, CI: 0.03-0.55). Myoinositol decrease the incidence of GDM in pregnancies high-risk for GDM. Moreover, myoinositol supplementation reduces the risk of insulin need, preeclampsia or gestational hypertension, preterm birth, and neonatal hypoglycemia. Based on the present study 2-4 g myoinositol canbe suggested from the first trimester to prevent GDM and related outcomes.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Diabetes, Gestational; Premature Birth; Pre-Eclampsia; Hypertension, Pregnancy-Induced; Randomized Controlled Trials as Topic; Hypoglycemia; Insulin; Inositol
PubMed: 37836508
DOI: 10.3390/nu15194224 -
Acta Neurochirurgica Sep 2022Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is... (Review)
Review
INTRODUCTION
Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is that the intracranial volume could relevantly expand during flight and lead to elevated intracranial pressure. The aim of this systematic review was to identify and summarise models and case reports with confirmed pre-flight pneumocephalus.
METHODS
The terms (pneumocephalus OR intracranial air) AND (flying OR fly OR travel OR air transport OR aircraft) were used to search the database PubMed on 30 November 2021. This search returned 144 results. To be included, a paper needed to fulfil each of the following criteria: (i) peer-reviewed publication of case reports, surveys, simulations or laboratory experiments that focussed on air travel with pre-existing pneumocephalus; (ii) available in full text.
RESULTS
Thirteen studies met the inclusion criteria after title or abstract screening. We additionally identified five more articles when reviewing the references. A notion that repeatedly surfaced is that any air contained within the neurocranium increases in volume at higher altitude, much like any extracranial gas, potentially resulting in tension pneumocephalus or increased intracranial pressure.
DISCUSSION
Relatively conservative thresholds for patients flying with pneumocephalus are suggested based on models where the intracranial air equilibrates with cabin pressure, although intracranial air in a confined space would be surrounded by the intracranial pressure. There is a discrepancy between the models and case presentations in that we found no reports of permanent or transient decompensation secondary to a pre-existing pneumocephalus during air travel. Nevertheless, the quality of examination varies and clinicians might tend to refrain from reporting adverse events. We identified a persistent extracranial to intracranial fistulous process in multiple cases with newly diagnosed pneumocephalus after flight. Finally, we summarised management principles to avoid complications from pneumocephalus during air travel and argue that a patient-specific understanding of the pathophysiology and time course of the pneumocephalus are potentially more important than its volume.
Topics: Air Travel; Humans; Intracranial Hypertension; Intracranial Pressure; Pneumocephalus
PubMed: 35794427
DOI: 10.1007/s00701-022-05297-5 -
Journal of the ASEAN Federation of... 2023Myo-inositol has emerged as one of the preventive therapies for the development of gestational diabetes mellitus in at-risk populations. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
The Efficacy and Safety of Myo-inositol Supplementation for the Prevention of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women: A Systematic Review and Meta-Analysis.
BACKGROUND
Myo-inositol has emerged as one of the preventive therapies for the development of gestational diabetes mellitus in at-risk populations. This systematic review and meta-analysis was conducted to determine the efficacy and safety of myo-inositol in decreasing the incidence of gestational diabetes in overweight and obese pregnant women.
METHODOLOGY
This meta-analysis was conducted using the standard Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Inclusion criteria were randomized controlled trials (RCTs) that enrolled overweight and obese pregnant women and used myo-inositol supplementation. The primary outcome was the incidence of gestational diabetes mellitus at 24-28 weeks. Secondary outcomes included cesarean section rate, the incidence of pregnancy-induced hypertension, macrosomia and preterm delivery. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for dichotomous data.
RESULTS
Six RCTs were included. Compared to standard micronutrient supplementation, standard dose of myo-inositol (4 g) may reduce the incidence of GDM (RR 0.54; CI [0.30, 0.96]; n = 887 women), but the certainty of evidence is low to very low. With low-dose myo-inositol however, evidence is uncertain about its benefit on the incidence of gestational diabetes mellitus in overweight and obese women with RR 0.71; CI [0.14, 3.50]. No adverse effects were noted. For the secondary outcomes, standard dose myo-inositol appears to reduce the incidence of pregnancy-induced hypertension and preterm delivery, but the certainty of evidence is low to very low.
CONCLUSION
Current evidence is uncertain on the potential benefit of myo-inositol supplementation in overweight and obese pregnant women. While studies show that 4 g myo-inositol per day may decrease the incidence of GDM, pregnancy-induced hypertension and pre-term birth with no associated risk of serious adverse events, the certainty of evidence is low to very low. Future high-quality trials may provide more compelling evidence to support practice recommendations.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Diabetes, Gestational; Vitamin B Complex; Overweight; Pregnant Women; Premature Birth; Hypertension, Pregnancy-Induced; Inositol; Obesity; Dietary Supplements; Randomized Controlled Trials as Topic
PubMed: 38045667
DOI: 10.15605/jafes.038.02.11 -
Hypertension (Dallas, Tex. : 1979) Feb 2023Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes.
METHODS
Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias.
RESULTS
For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; <0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; <0.01).
CONCLUSIONS
Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted.
Topics: Pregnancy; Female; Humans; Hypertension, Pregnancy-Induced; Dementia, Vascular; Pre-Eclampsia; Risk Factors; Cohort Studies; Observational Studies as Topic
PubMed: 36345823
DOI: 10.1161/HYPERTENSIONAHA.122.19399 -
American Journal of Obstetrics and... Sep 2023Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke.
DATA SOURCES
PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022.
STUDY ELIGIBILITY CRITERIA
Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke.
METHODS
Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment.
RESULTS
The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19).
CONCLUSION
In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
Topics: Pregnancy; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Hemorrhagic Stroke; Stroke; Ischemic Stroke
PubMed: 36990309
DOI: 10.1016/j.ajog.2023.03.034 -
Journal of Clinical Medicine Mar 2022Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to... (Review)
Review
Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials.
PubMed: 35407552
DOI: 10.3390/jcm11071944 -
BMJ Open Sep 2020The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
General population of Bangladesh.
DATA SOURCES
PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed.
RESULTS
Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference.
CONCLUSIONS
This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population.
PROSPERO REGISTRATION NUMBER
CRD42019148205.
Topics: Bangladesh; Diabetes Mellitus; Humans; Hypertension; Prediabetic State; Prevalence
PubMed: 32907898
DOI: 10.1136/bmjopen-2019-036086 -
Maternal and Child Health Journal Dec 2022A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.
METHODS
Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case-control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran's Q statistic.
RESULTS
Thirty studies including six cohort- and twenty-four case-control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 - 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).
CONCLUSIONS
Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Periodontitis; Pregnancy Outcome; Periodontal Diseases; Odds Ratio
PubMed: 36209308
DOI: 10.1007/s10995-022-03556-6