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Advances in Respiratory Medicine Mar 2024COPD is the third leading cause of death worldwide. Its diagnosis can be made with spirometry, which is underused due to its limited accessibility. Portable spirometry... (Review)
Review
How to Enhance the Diagnosis of Early Stages of Chronic Obstructive Pulmonary Disease (COPD)? The Role of Mobile Spirometry in COPD Screening and Diagnosis-A Systematic Review.
COPD is the third leading cause of death worldwide. Its diagnosis can be made with spirometry, which is underused due to its limited accessibility. Portable spirometry holds promise for enhancing the efficacy of COPD diagnoses. The study aimed to estimate COPD prevalence diagnosed with a portable spirometer in high-risk patients and compare it with COPD prevalence based on data from conventional, on-site spirometry. We also evaluated the strategy of a proactive approach to identify COPD in high-risk individuals. We conducted a systematic review of original studies on COPD targeted screening and diagnosis with portable and conventional spirometers selected from 8496 publications initially found in three databases: Cochrane, PubMed, and Embase. The inclusion criteria were met by 28 studies. COPD prevalence evaluated with the use of portable spirometers reached 20.27% and was lower compared to that estimated with the use of conventional spirometers (24.67%). In 11 included studies, postbronchodilator tests were performed with portable spirometers, which enabled a bedside COPD diagnosis. Portable spirometers can be successfully used in COPD targeted screening and diagnosis and thus enhance the detection of COPD at early stages.
Topics: Pulmonary Disease, Chronic Obstructive; Humans; Spirometry; Mass Screening; Early Diagnosis
PubMed: 38666812
DOI: 10.3390/arm92020018 -
Blood Coagulation & Fibrinolysis : An... Jun 2024The article aimed to compare the efficiency and safety of aspirin with low-molecular-weight heparin (LMWH) for thromboprophylaxis in orthopaedic surgery patients.... (Meta-Analysis)
Meta-Analysis
The article aimed to compare the efficiency and safety of aspirin with low-molecular-weight heparin (LMWH) for thromboprophylaxis in orthopaedic surgery patients. According to the inclusion and exclusion criteria, PubMed, Embase and Cochrane Library database were searched for studies comparing aspirin and LMWH in venous thromboembolism (VTE) prophylaxis until 25 April 2023. The outcome measures included deep venous thrombosis(DVT)/Pulmonary embolism(PE) events, major bleeding events, wound complications, wound infection and death. Six studies met the requirements of our meta-analysis, including 12 470 patients in the aspirin group and 10 857 patients in the LMWH group. The meta-analysis showed that results showed that LMWH was superior to aspirin in preventing VTE events (odds ratio (OR) 1.44, 95% CI 1.24-1.68, P < 0.00001), whereas there was no significant difference between them in bleeding events (OR 0.95, 95% CI 0.86-1.05, P = 0.33), wound complication (OR 0.58, 95% CI 0.28-1.17, P = 0.13), wound infection (OR 1.12, 95% CI 0.86-1.47, P = 0.39) and mortality (OR 1.04, 95% CI 0.70-1.55, P = 0.83). In addition, subgroup analysis showed that compared with aspirin, LMWH was more likely to reduce the incidence of DVT events in orthopaedic surgery patients (OR 1.59, 95% CI 1.33-1.91, P < 0.00001), whereas there was no advantage in reducing the incidence of PE events (OR 1.22, 95% CI 0.62-2.40, P = 0.56). Despite the similar safety profiles, this meta-analysis showed that LMWH was significantly superior to aspirin in thromboprophylaxis after orthopaedic surgery. LMWH was still the first-line drug for thrombosis prevention in patients who underwent major orthopaedic surgeries.
Topics: Humans; Heparin, Low-Molecular-Weight; Aspirin; Orthopedic Procedures; Venous Thromboembolism; Anticoagulants; Pulmonary Embolism; Venous Thrombosis; Postoperative Complications
PubMed: 38652521
DOI: 10.1097/MBC.0000000000001300 -
Ultrasound in Obstetrics & Gynecology :... Apr 2024To assess and quantify the association between pre-pregnancy maternal overweight and obesity, and the risk of congenital heart defects (CHDs) in offspring. (Review)
Review
Maternal prepregnancy weight as an independent risk factor for congenital heart defects: systematic review and meta-analysis stratified by cardiac defect subtypes and severity.
OBJECTIVES
To assess and quantify the association between pre-pregnancy maternal overweight and obesity, and the risk of congenital heart defects (CHDs) in offspring.
METHODS
This systematic review and meta-analysis included searches of PubMed, Medline, Web of science, and Scopus up to April 20th, 2023. Risk estimates were abstracted or calculated for rising body mass index categories (overweight, obesity, moderate and severe obesity) compared to normal weight (reference). Fixed-effects or random-effects models were used to combine individual study risk estimates based on the degree of heterogeneity. Sensitivity analyses were conducted to weight pooled estimates for relevant moderators, particularly diabetes prior and during pregnancy. Subgroup analyses for specific congenital heart defects were conducted if there were at least two studies with accessible data. The findings were presented in two ways: as groups of defects, categorized using severity and topographic-functional criteria, and as individual defects. The certainty of the evidence for each effect estimate was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.
RESULTS
Twenty studies for a total of 4,861,693 patients and 86,136 CHDs cases were included. The risk for CHDs progressively increases from moderate to severe obesity (pooled odds ratio (OR), respectively: 1.15, 95% confidence interval (CI), 1.11-1.20, and 1.39, 95% CI, 1.27-1.53). Sensitivity analysis indicated that this effect persists independently of maternal diabetes status before or during pregnancy. In subgroup analysis, obesity was associated with up to a 1.5-fold increase in the risk of severe CHDs (pooled OR, 1.48; 95% CI, 1.03-2.13). Specifically, severe obesity was found to be associated with an even higher risk, increasing up to 1.8 times for specific CHDs including tetralogy of Fallot (pooled OR, 1.72; 95% CI, 1.38-2.16), pulmonary valve stenosis (pooled OR, 1.79; 95% CI, 1.39-2.30), and atrial septal defects (pooled OR, 1.71; 95% CI, 1.48-1.97).
CONCLUSIONS
Maternal weight emerged as a crucial modifiable risk factor for preventing CHDs, particularly the severe forms. Future research is needed to investigate whether weight management prior to pregnancy might serve as a preventive measure against CHDs. Additionally, for pregnant women with obesity, fetal echocardiography ought to be a routine diagnostic procedure. This article is protected by copyright. All rights reserved.
PubMed: 38629488
DOI: 10.1002/uog.27659 -
BMJ Supportive & Palliative Care Apr 2024Precise prognostic information, if available, is very helpful for guiding treatment decisions and resource allocation in patients with non-cancer non-communicable...
BACKGROUND
Precise prognostic information, if available, is very helpful for guiding treatment decisions and resource allocation in patients with non-cancer non-communicable chronic diseases (NCDs). This study aimed to systematically review the existing evidence, examining prognostic models and factors for identifying end-of-life non-cancer NCD patients.
METHODS
Electronic databases, including Medline, Embase, CINAHL, Cochrane Library, PsychINFO and other sources, were searched from the inception of these databases up until June 2023. Studies published in English with findings mentioning prognostic models or factors related to identifying end-of-life in non-cancer NCD patients were included. The quality of studies was assessed using the Quality in Prognosis Studies tool.
RESULTS
The analysis included data from 41 studies, with 16 focusing on chronic obstructive pulmonary diseases (COPD), 10 on dementia, 6 on heart failure and 9 on mixed NCDs. Traditional statistical modelling was predominantly used for the identified prognostic models. Common predictors in COPD models included dyspnoea, forced expiratory volume in 1 s, functional status, exacerbation history and body mass index. Models for dementia and heart failure frequently included comorbidity, age, gender, blood tests and nutritional status. Similarly, mixed NCD models commonly included functional status, age, dyspnoea, the presence of skin pressure ulcers, oral intake and level of consciousness. The identified prognostic models exhibited varying predictive accuracy, with the majority demonstrating weak to moderate discriminatory performance (area under the curve: 0.5-0.8). Additionally, most of these models lacked independent external validation, and only a few underwent internal validation.
CONCLUSION
Our review summarised the most relevant predictors for identifying end-of-life in non-cancer NCDs. However, the predictive accuracy of identified models was generally inconsistent and low, and lacked external validation. Although efforts to improve these prognostic models should continue, clinicians should recognise the possibility that disease heterogeneity may limit the utility of these models for individual prognostication; they may be more useful for population level health planning.
PubMed: 38580395
DOI: 10.1136/spcare-2023-004656 -
Frontiers in Oncology 2024Sarcopenia, marked by a reduction in skeletal muscle mass and function, is a condition that can manifest in elderly patients with cancer and has been recognized as a...
BACKGROUND
Sarcopenia, marked by a reduction in skeletal muscle mass and function, is a condition that can manifest in elderly patients with cancer and has been recognized as a possible adverse factor affecting the survival of individuals diagnosed with malignant tumors. This systematic review and meta-analysis aimed to examine the prevalence of sarcopenia in individuals with cholangiocarcinoma while concurrently investigating the potential correlations between the presence of sarcopenia and various critical factors, including survival outcomes and postoperative complications.
METHODS
A comprehensive search was conducted across multiple databases, including EMBASE, PubMed, Web of Science, Cochrane Library, and CNKI, employing keywords such as sarcopenia, cholangiocarcinoma, and prognosis. This research explored the prognostic value of sarcopenia on the survival of cholangiocarcinoma. The findings of this meta-analysis were presented using forest plots and a summarized effects model. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the quality of the studies included in the analysis.
RESULTS
A total of 33 articles from five databases were in in the quantitative analysis. A comprehensive meta-analysis revealed that the overall prevalence of sarcopenia among individuals diagnosed with cholangiocarcinoma was43%. Moreover, the analysis revealed a significant and noteworthy correlation between sarcopenia and key clinical parameters such as overall survival (OS), Recurrence-Free Survival (RFS), and Disease-Free Survival (DFS) in patients with cholangiocarcinoma. Subgroup analysis revealed that, when categorized by various ethnicities, diagnostic techniques, and tumor locations, sarcopenia consistently retained its status as a negative predictive factor. Furthermore, sarcopenia has emerged as a risk factor for postoperative complications. All included studies had an NOS score greater than 5, indicating a high quality of evidence.
CONCLUSION
The results suggest that sarcopenia is significantly related to survival outcomes and postoperative complications in cholangiocarcinoma. Appropriate diagnosis and treatment of sarcopenia should be implemented to improve the prognosis of individuals with cholangiocarcinoma.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479866, identifier CRD42023479866.
PubMed: 38571501
DOI: 10.3389/fonc.2024.1363843 -
Journal of Global Health Mar 2024This study was designed to evaluate the effects of body mass index (BMI) and weight change on the risk of developing cancer overall and cancer at different sites. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study was designed to evaluate the effects of body mass index (BMI) and weight change on the risk of developing cancer overall and cancer at different sites.
METHODS
We searched PubMed and other databases up to July 2023 using the keywords related to 'risk', 'cancer', 'weight', 'overweight', and 'obesity'. We identified eligible studies, and the inclusion criteria encompassed cohort studies in English that focused on cancer diagnosis and included BMI or weight change as an exposure factor. Multiple authors performed data extraction and quality assessment, and statistical analyses were carried out using RevMan and R software. We used random- or fixed-effects models to calculate the pooled relative risk (RR) or hazard ratio along with 95% confidence intervals (CIs). We used the Newcastle-Ottawa Scale to assess study quality.
RESULTS
Analysis included 66 cohort studies. Compared to underweight or normal weight, overweight or obesity was associated with an increased risk of endometrial cancer, kidney cancer, and liver cancer but a decreased risk of prostate cancer and lung cancer. Being underweight was associated with an increased risk of gastric cancer and lung cancer but not that of postmenopausal breast cancer or female reproductive cancer. In addition, weight loss of more than five kg was protective against overall cancer risk.
CONCLUSIONS
Overweight and obesity increase the risk of most cancers, and weight loss of >5 kg reduces overall cancer risk. These findings provide insights for cancer prevention and help to elucidate the mechanisms underlying cancer development.
REGISTRATION
Reviewregistry1786.
Topics: Male; Female; Humans; Body Mass Index; Overweight; Thinness; Obesity; Cohort Studies; Breast Neoplasms; Lung Neoplasms; Weight Loss
PubMed: 38547495
DOI: 10.7189/jogh.14.04067 -
Euro Surveillance : Bulletin Europeen... Mar 2024BackgroundIn countries with a low TB incidence (≤ 10 cases/100,000 population), active pulmonary tuberculosis (PTB) mostly affects vulnerable populations with...
BackgroundIn countries with a low TB incidence (≤ 10 cases/100,000 population), active pulmonary tuberculosis (PTB) mostly affects vulnerable populations with limited access to healthcare. Thus, passive case-finding systems may not be successful in detecting and treating cases and preventing further transmission. Active and cost-effective search strategies can overcome this problem.AimWe aimed to review the evidence on the cost-effectiveness (C-E) of active PTB screening programmes among high-risk populations in low TB incidence countries.MethodsWe performed a systematic literature search covering 2008-2023 on PubMed, Embase, Center for Reviews and Dissemination, including Database of Abstracts of Reviews of Effects (DARE), National Health Services Economic Evaluation Database (NHS EED), Global Index Medicus and Cochrane Central Register of Controlled Trials (CENTRAL).ResultsWe retrieved 6,318 articles and included nine in this review. All included studies had an active case-finding approach and used chest X-ray, tuberculin skin test, interferon-gamma release assay and a symptoms questionnaire for screening. The results indicate that screening immigrants from countries with a TB incidence > 40 cases per 100,000 population and other vulnerable populations as individuals from isolated communities, people experiencing homelessness, those accessing drug treatment services and contacts, is cost-effective in low-incidence countries.ConclusionIn low-incidence countries, targeting high-risk groups is C-E. However, due to the data heterogenicity, we were unable to compare C-E. Harmonisation of the methods for C-E analysis is needed and would facilitate comparisons. To outline comprehensive screening and its subsequent C-E analysis, researchers should consider multiple factors influencing screening methods and outcomes.
Topics: Humans; Cost-Benefit Analysis; Incidence; Tuberculosis; Tuberculin Test; Tuberculosis, Pulmonary; Mass Screening
PubMed: 38516785
DOI: 10.2807/1560-7917.ES.2024.29.12.2300614 -
Cureus Feb 2024The aim of this meta-analysis was to scrutinize the prevalence, characteristics, and outcomes of obstructive sleep apnea (OSA) in individuals with ideopathic pulmonary... (Review)
Review
The aim of this meta-analysis was to scrutinize the prevalence, characteristics, and outcomes of obstructive sleep apnea (OSA) in individuals with ideopathic pulmonary fibrosis (IPF). We carried out this systematic review and meta-analysis in accordance with the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Two independent researchers systematically searched major databases, including MEDLINE/PubMed, EMBASE, and the Cochrane Library, from January 1, 2000, until December 31, 2023. We included all studies involving adult patients (age >18 years) with IPF that assessed the prevalence and characteristics of OSA in IPF patients. A total of seven studies involving a pooled sample of 411 patients were included in this meta-analysis. The pooled prevalence of OSA among individuals with IPF was found to be 70% (95% CI: 59 to 82%). Individuals with OSA exhibited a significantly higher mean body mass index (BMI) compared to their counterparts. While individuals with both IPF and OSA exhibited higher scores on the Epworth Sleepiness Scale (ESS) compared to those with IPF alone, the OSA group also showed lower oxygen saturation during sleep in comparison to non-OSA patients. In summary, OSA is a prevalent coexisting condition among individuals with IPF. This presence could worsen the nighttime oxygen saturation. Consequently, there is a need for more extensive studies involving more uniform participant groups.
PubMed: 38516439
DOI: 10.7759/cureus.54562 -
JACC. CardioOncology Feb 2024Current guidelines recommend several direct oral anticoagulant agents (DOACs) equally for managing cancer-associated venous thromboembolism (VTE).
BACKGROUND
Current guidelines recommend several direct oral anticoagulant agents (DOACs) equally for managing cancer-associated venous thromboembolism (VTE).
OBJECTIVES
The aim of this study was to assess the efficacy and safety of DOACs in patients with active cancer.
METHODS
Literature searches were conducted in PubMed, Embase, and Cochrane Central in November 2022. Randomized controlled trials investigating anticoagulation strategies (vitamin K antagonists, parenteral anticoagulation [eg, low-molecular weight heparin], and DOACs) for VTE in patients with active cancer were identified for network meta-analysis. The outcomes included recurrent VTE, recurrent pulmonary embolism, recurrent deep venous thrombosis, major bleeding, clinically relevant nonmajor bleeding (CRNMB), and a composite outcome of major bleeding or CRNMB. Pooled HRs and 95% CIs were estimated using either the HR or relative risk provided from each study. Random-effects models were used for all the analyses.
RESULTS
Seventeen randomized controlled trials involving 6,623 patients with active cancer were included. No significant differences were found among the DOACs for efficacy outcomes (recurrent VTE, pulmonary embolism, and deep venous thrombosis). In terms of major bleeding, apixaban was similarly safe compared with dabigatran and rivaroxaban but was associated with a decreased risk compared with edoxaban (HR: 0.38; 95% CI: 0.15-0.93). Regarding CRNMB, edoxaban was similarly safe compared with apixaban but was associated with a decreased risk compared with rivaroxaban (HR: 0.31; 95% CI: 0.10-0.91). Compared with parenteral anticoagulation, apixaban was associated with a reduced risk for recurrent VTE (HR: 0.60; 95% CI: 0.38-0.93) without increasing bleeding, edoxaban was associated with an increased risk for major bleeding or CRNMB (HR: 1.35; 95% CI: 1.02-1.79), and rivaroxaban was associated with an increased risk for CRNMB (HR: 3.76; 95% CI: 1.43-9.88).
CONCLUSIONS
DOACs demonstrate comparable efficacy but exhibit different safety profiles. Apixaban may confer an antithrombotic benefit without an increased risk for bleeding, distinguishing it from other contemporary anticoagulation strategies in patients with active cancer and VTE.
PubMed: 38510285
DOI: 10.1016/j.jaccao.2023.10.009 -
Aging Clinical and Experimental Research Mar 2024Individuals with chronic obstructive pulmonary disease (COPD) are prone to malnutrition and sarcopenia as a result of nutritional deficiencies and increased energy... (Meta-Analysis)
Meta-Analysis
Individuals with chronic obstructive pulmonary disease (COPD) are prone to malnutrition and sarcopenia as a result of nutritional deficiencies and increased energy metabolism. However, the effects of nutrient supplements (NS) on treating sarcopenia in patients with COPD are not well established from systematic evidence. This meta-analysis examined the effect of NS on sarcopenia in patients with COPD. A systematic search of multiple databases was conducted, and 29 randomized controlled trials involving 1625 participants (age, mean [SD] = 67.9 [7.8] years) were analyzed. NS demonstrated significant improvements in body weight (MD,1.33 kg; 95% CI, 0.60, 2.05 kg; P = 0.0003; I = 87%), fat-free mass index (MD, 0.74 kg/m; 95% CI, 0.21, 1.27 kg/m; P = 0.007; I = 75%), and 6-min walk test (MD, 19.43 m; 95% CI, 4.91, 33.94 m; P = 0.009; I = 81%) compared with control. However, NS had nonsignificant effects on handgrip strength (SMD, 0.36; 95% CI, - 0.15, 0.88; P = 0.16; I = 87%) and quadriceps muscle strength (SMD, 0.11; 95% CI, - 0.06, 0.27; P = 0.20; I = 25%) compared with the control. In conclusion, NS may be an effective treatment for improving body composition and physical performance in COPD. Future studies should explore the effects of intervention durations, specific NS types, or combined training in patients with COPD and sarcopenia.
Topics: Humans; Sarcopenia; Hand Strength; Quality of Life; Pulmonary Disease, Chronic Obstructive; Muscle Strength
PubMed: 38483650
DOI: 10.1007/s40520-024-02722-w