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Journal of Managed Care & Specialty... Dec 2023People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications... (Meta-Analysis)
Meta-Analysis
BACKGROUND
People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications incur decreases in areal bone mineral density (aBMD) and higher fracture risk in this population.
OBJECTIVE
To investigate the effects of commonly used medications on aBMD and fracture risk among people with MS.
METHODS
MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from their inception until February 5, 2023. We included randomized controlled trials as well as cross-sectional, retrospective, and prospective studies investigating whether glucocorticoids, immunomodulators, antidepressants, anticonvulsants, anxiolytics, opioids, or antipsychotics influenced aBMD or fracture risk in people with MS. Data were pooled using random effects meta-analyses to determine hazard ratios (HRs) and 95% CIs.
RESULTS
We included 22 studies (n = 18,193). Six studies were included in the meta-analyses of glucocorticoid use and aBMD, whereas 2 studies were included in the medication use and fracture risk meta-analyses. No studies assessed the effect of antidepressants, anxiolytics, anticonvulsants, opioids, and antipsychotics on aBMD, and no studies assessed the effect of immunomodulators on fracture risk. Glucocorticoid use was significantly negatively associated with femoral neck aBMD (correlation = -0.21 [95% CI = -0.29 to -0.13]), but not with lumbar spine aBMD (correlation = -0.21 [95% CI = -0.50 to 0.12]). There were no differences in fracture risk between users of glucocorticoids (HR = 1.71 [95% CI = 0.04 to 76.47]), antidepressants (HR = 1.84 [95% CI = 0.09 to 38.49]), or anxiolytics (HR = 2.01 [95% CI = 0.06 to 64.22]), compared with nonusers.
CONCLUSIONS
The available evidence is insufficient to support a relationship between greater fracture risk for people with MS taking glucocorticoid, antidepressant, or anxiolytic medication, compared with nonusers, and it is unclear whether these medications are associated with bone loss in people with MS, beyond that in the general population. Additional high-quality studies with homogenous methodology exploring how medications influence aBMD and fracture risk in people with MS are required.
Topics: Humans; Bone Density; Prospective Studies; Anticonvulsants; Anti-Anxiety Agents; Retrospective Studies; Cross-Sectional Studies; Glucocorticoids; Multiple Sclerosis; Fractures, Bone; Antidepressive Agents; Immunologic Factors
PubMed: 38058136
DOI: 10.18553/jmcp.2023.29.12.1331 -
European Journal of Pediatrics Feb 2024To quantify the tracking of apolipoprotein B (apoB) levels from childhood and adolescence and compare the tracking of apoB with low-density lipoprotein (LDL)... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
To quantify the tracking of apolipoprotein B (apoB) levels from childhood and adolescence and compare the tracking of apoB with low-density lipoprotein (LDL) cholesterol, a systematic search of MEDLINE, Embase, Web of Science, and Google Scholar was performed in October 2023 (PROSPERO protocol: CRD42022298663). Cohort studies that measured tracking of apoB from childhood/adolescence (< 19 years) with a minimum follow-up of 1 year, using tracking estimates such as correlation coefficients or tracking coefficients, were eligible. Pooled correlations were estimated using random-effects meta-analysis. Risk of bias was assessed with a review-specific tool. Ten studies of eight unique cohorts involving 4677 participants met the inclusion criteria. Tracking of apoB was observed (pooled r = 0.63; 95% confidence interval [CI] = 0.53-0.71; I = 96%) with no significant sources of heterogeneity identified. Data from five cohorts with tracking data for both lipids showed the degree of tracking was similar for apoB (pooled r = 0.59; 95% CI = 0.55-0.63) and LDL cholesterol (pooled r = 0.58; 95% CI = 0.47-0.68). Study risk of bias was moderate, mostly due to attrition and insufficient reporting.
CONCLUSION
ApoB levels track strongly from childhood, but do not surpass LDL cholesterol in this regard. While there is strong evidence that apoB is more effective at predicting ASCVD risk than LDL cholesterol in adults, there is currently insufficient evidence to support its increased utility in pediatric settings. This also applies to tracking data, where more comprehensive data are required.
WHAT IS KNOWN
• Apolipoprotein B is a known cause of atherosclerotic cardiovascular disease. • Apolipoprotein B levels are not typically measured in pediatric settings, where low-density lipoprotein cholesterol remains the primary lipid screening measure.
WHAT IS NEW
• This meta-analysis of 10 studies showed apolipoprotein B levels tracked strongly from childhood but did not exceed low-density lipoprotein cholesterol in this regard. • More comprehensive tracking data are needed to provide sufficient evidence for increased utility of apolipoprotein B in pediatric settings.
Topics: Adult; Humans; Adolescent; Child; Cholesterol, LDL; Apolipoproteins B; Cholesterol; Atherosclerosis; Cohort Studies; Cholesterol, HDL
PubMed: 38051379
DOI: 10.1007/s00431-023-05350-0 -
PLoS Neglected Tropical Diseases Dec 2023The impact of climate change has led to variations in various biological processes, leading to altered transmission dynamics of infectious diseases, including...
BACKGROUND
The impact of climate change has led to variations in various biological processes, leading to altered transmission dynamics of infectious diseases, including snail-borne diseases (SBDs). Fascioliasis is one of the neglected zoonotic tropical snail-borne diseases caused by the trematode of the genus Fasciola. This review focused on laboratory experimental and model studies that evaluate the potential effect of temperature change on the ecology and biology of the intermediate host snails (IHS) of Fasciola.
METHODS
A literature search was conducted on Google Scholar, EBSCOhost, and PubMed databases using predefined medical subject heading terms, Boolean operators, and truncation symbols in combination with direct keywords: Fasciolosis AND Temperature, Lymnaea OR Austropeplea OR Radix OR Galba OR Fossaria OR Pseudosuccinea AND growth, fecundity, AND survival at the global scale. Other search terms used were (Fascioliasis AND Temperature), (Lymnaea AND Temperature), (Austropeplea AND Temperature), (Fossaria AND Temperature), (Galba AND Temperature), (Pseudosuccinea AND Temperature), and (Radix AND Temperature).
RESULTS
The final synthesis included thirty-five published articles. The studies reviewed indicated that temperature rise may alter the distribution, and optimal conditions for breeding, growth, and survival of IHS, ultimately resulting in changing the transmission dynamics of fascioliasis. The literature also confirmed that the life history traits of IHS and their interaction with the liver fluke parasites are driven by temperature, and hence climate change may have profound outcomes on the population size of snails, parasite density, and disease epidemiology.
CONCLUSION
We concluded that understanding the impact of temperature on the growth, fecundity, and survival of IHS may broaden our knowledge of the possible effects of climate change and hence inform fascioliasis control programs.
Topics: Animals; Fascioliasis; Life History Traits; Temperature; Fasciola hepatica; Fasciola
PubMed: 38048345
DOI: 10.1371/journal.pntd.0011812 -
Cureus Oct 2023With the advent of modern antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been modified into a chronic manageable condition, prolonging... (Review)
Review
With the advent of modern antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been modified into a chronic manageable condition, prolonging the lifespan of people living with HIV (PLHIV). This has resulted in an increased non-AIDS-related morbidity in the HIV-infected population. Our aim is to study the role of contemporary ART in tackling the risk of atherosclerosis and cardiovascular disease (CVD) in PLHIV. We searched through the databases of PubMed, PubMed Central, and Cochrane Library for pertinent articles using the medical subject headings (MeSH) "HIV infection", "Atherosclerosis", and "Antiretroviral agents". The articles published in the past five years were retrieved, screened for relevance, and assessed for quality before being included in the review. This review was performed following the PRISMA 2020 guidelines. The results indicate that the incidence of dyslipidemia with integrase strand transfer inhibitors (INSTIs) is greater than with non-nucleoside reverse transcriptase inhibitors (NNRTIs) and lesser than with protease inhibitors (PIs). INSTIs are indispensably associated with weight gain and obesity. High triglyceride (TG) and oxidized low-density lipoproteins to low-density lipoproteins (oxLDL/LDL) ratio levels and low high-density lipoprotein (HDL) levels are seen in patients taking PIs. A higher incidence of hypertension and metabolic syndrome (MetS) was noticed with INSTIs compared to NNRTIs. PI intake for >5 years increases the risk of subclinical atherosclerosis. Increased risk of myocardial infarction with INSTIs was observed in a study, while another study reported decreased risk. HIV infection independently increases the risk for atherosclerosis and CVD. Although contemporary ART decreases this enhanced risk, it inherently increases the risk for abnormal lipid profile, MetS, weight gain, and obesity. Further research into the risk of atherosclerosis and CVD with newer ART drugs is essential for decoding the underlying mechanisms and preventing adverse cardiac outcomes in PLHIV.
PubMed: 38021858
DOI: 10.7759/cureus.47730 -
BMC Ophthalmology Nov 2023Refractive errors are one of the most common ocular conditions among children and adolescents, with myopia showing an increasing prevalence and early onset in this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Refractive errors are one of the most common ocular conditions among children and adolescents, with myopia showing an increasing prevalence and early onset in this population. Recent studies have identified a correlation between refractive errors and ocular biometric parameters.
METHODS
A systematic search was conducted in electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Medline from January 1, 2012, to May 1, 2023. Various ocular biometric parameters were summarized under different refractive states, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal curvature (CC), Corneal curvature radius (CR),axial length-to-corneal radius ratio (AL/CR ratio), choroidal thickness (ChT), retinal thickness (RT), retinal nerve fiber layer thickness (RNFL), and retinal blood density (VD). The differences in these parameters among different refractive states were analyzed using Stata software with fixed or random-effects models, taking into account the assessed heterogeneity level.
RESULTS
This meta-analysis included a total of 69 studies involving 128,178 eyes, including 48,795 emmetropic eyes, 60,691 myopic eyes, 13,983 hyperopic eyes, 2,040 low myopic eyes, 1,201 moderate myopic eyes, and 1,468 high myopic eyes. The results of our study demonstrated that, compared to the control group (emmetropic group), the myopic group and low, moderate, and high myopic groups showed significant increases in AL, AL/CR ratio, and ACD, while the hyperopic group exhibited significant decreases. Compared to the control group, the myopic group had a significantly increase for CC, while CR, CCT, perifoveal RT, subfoveal ChT, foveal ChT, parafoveal ChT, perifoveal (except nasal) ChT, and pRNFL (except temporal) significantly decreased. Compared to the control group, the hyperopic group had a significantly increase for subfoveal ChT, foveal ChT, parafoveal ChT, perifoveal ChT, and nasal pRNFL. Compared to the control group, the low and moderate myopic groups had a significantly decreases for the CCT, parafoveal RT (except nasal), perifoveal RT (except nasal), and pRNFL (except superior and temporal). Compared to the control group, the high myopic group had a significantly increase for CR, while LT, perifoveal ChT (except nasal), parafoveal RT, perifoveal RT, and pRNFL (except temporal) had significant decreased.
CONCLUSION
The changes of ocular biometric parameters in children and adolescents are closely related to refractive errors. Ocular biometric parameters devices, as effective non-invasive techniques, provide objective biological markers for monitoring refractive errors such as myopia.
Topics: Humans; Child; Adolescent; Tomography, Optical Coherence; Refractive Errors; Myopia; Retina; Refraction, Ocular; Hyperopia; Biometry
PubMed: 37990308
DOI: 10.1186/s12886-023-03222-7 -
Journal of Global Health Nov 2023Low-and-middle-income countries, especially in Africa, lack the capacity to adequately invest in health systems to attain universal health coverage (UHC). As such,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Low-and-middle-income countries, especially in Africa, lack the capacity to adequately invest in health systems to attain universal health coverage (UHC). As such, countries must improve efficiency and provide more services within the available resources. This systematic review synthesised evidence on the efficiency of health systems in the African region and its drivers.
METHODS
We conducted a systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Related studies were grouped and meta-analysed, while others were descriptively analysed. We employed a qualitative content synthesis for synthesising the drivers of efficiency.
RESULTS
Overall, 39 studies met a predetermined inclusion criterion and were included from a possible 4 609 records retrieved through a rigorous search and selection process. Using a random effects restricted maximum likelihood method, the pooled efficiency score for the Africa region was estimated to be 0.77, implying that on the flip side, health system inefficiency across countries in the African region was approximately 23%. Across 22 studies that used data envelopment analysis to examine efficiency at the level of health facilities and sub-national entities, the efficiency level was 0.67. Facility-level studies tended to estimate low levels of efficiency compared to health system-level studies. Across the 39 studies, 21 significant drivers of inefficiency were reported, including population density of the catchment area, governance, health facility ownership, health facility staff density, national economic status, type of health facility, education index, hospital size and bed occupancy rate.
CONCLUSION
With approximately 23% of the inefficiency of health systems in Africa, improving efficiency alone will yield an average of 34% improvement in resource availability, assuming all countries are performing similarly to the frontier countries. However, with the low level of health expenditure per capita in Africa, the efficiency gains alone will be insufficient to meet the minimum funding requirement for UHC.
REGISTRATION
PROSPERO: CRD42022318122.
Topics: Humans; Africa; Health Expenditures; Health Facilities; Socioeconomic Factors
PubMed: 37934959
DOI: 10.7189/jogh.13.04131 -
BMC Cardiovascular Disorders Oct 2023Metabolic disorders were a health problem for many adults with congenital heart disease, however, the differences in metabolic syndrome-related metabolite levels in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Metabolic disorders were a health problem for many adults with congenital heart disease, however, the differences in metabolic syndrome-related metabolite levels in adults with congenital heart disease compared to the healthy population were unknown.
METHODS
We collected 18 studies reporting metabolic syndrome-associated metabolite levels in patients with congenital heart disease. Data from different studies were combined under a random-effects model using Cohen's d values.
RESULTS
The results found that the levels of total cholesterol (Cohen's d -0.68, 95% CI: -0.91 to -0.45), high-density lipoprotein cholesterol (Cohen's d -0.63, 95% CI: -0.89 to -0.37), and low-density lipoprotein cholesterol (Cohen's d -0.32, 95% CI: -0.54 to -0.10) were significantly lower in congenital heart disease patients compared with controls. Congenital heart disease patients also had a lower body mass index (Cohen's d -0.27, 95% CI: -0.42 to -0.12) compared with controls. On the contrary, congenital heart disease patients had higher levels of hemoglobin A1c (Cohen's d 0.93, 95% CI: 0.17 to 1.70) than controls. Meanwhile, there were no significant differences in triglyceride (Cohen's d 0.07, 95% CI: -0.09 to 0.23), blood glucose (Cohen's d -0.12, 95% CI: -0.94 to 0.70) levels, systolic (Cohen's d 0.07, 95% CI: -0.30 to 0.45) and diastolic blood pressure (Cohen's d -0.10, 95% CI: -0.39 to 0.19) between congenital heart disease patients and controls.
CONCLUSIONS
The lipid levels in patients with congenital heart disease were significantly lower than those in the control group. These data will help in the health management of patients with congenital heart disease and guide clinicians.
PROSPERO REGISTRATION NUMBER
CRD42022228156.
Topics: Humans; Adult; Metabolic Syndrome; Triglycerides; Heart Defects, Congenital; Cholesterol, HDL; Cholesterol, LDL
PubMed: 37891491
DOI: 10.1186/s12872-023-03455-w -
Alternative Therapies in Health and... Feb 2024Many randomized controlled trials (RCTs) have reported the effect of probiotics on reducing plasma lipids with inconsistent results. An explicit systematic review and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Many randomized controlled trials (RCTs) have reported the effect of probiotics on reducing plasma lipids with inconsistent results. An explicit systematic review and meta-analysis were conducted in this study to evaluate the effect of probiotics on the lipid profile of healthy and hyperlipidemia participants.
METHODS
A comprehensive literature search of RCTs was conducted using PubMed, Embase, World Health Organization (WHO) Global Index Medicus, WHO clinical trial registry, and Clinicaltrials.gov. Inclusion criteria included RCTs comparing the use of any strain of a specified probiotic with the placebo control group. The change in lipid profiles was analyzed.
RESULTS
The probiotics can decrease the total cholesterol (TC) level in hyperlipidemia participants but not healthy persons (MD = -0.43, 95% CI -0.60 - -0.25, P < .01; MD = -0.09, 95% CI -0.26 - 0.08, P > .05). Probiotics did not reduce high-density lipoprotein cholesterol (HDL-C) in patients with hyperlipidemia or healthy people (MD = -0.01, 95% CI -0.09 - 0.07, P > .05; MD = 0.02, 95% CI -0.04 - 0.09, P > .05). Furthermore, probiotics can reduce the low-density lipoprotein cholesterol (LDL-C) level both in hyperlipidemia and healthy persons (MD = -0.34, 95% CI -0.43 - -0.26, P < .01; MD = -0.15, 95% CI -0.28 - -0.02, P < .05). Lastly, the effect of probiotics on reducing triglyceride (TG) levels was significant in hyperlipidemia persons but not in the healthy population (MD = -0.20, 95% CI -0.37 - -0.04, P < .01; MD = -0.01, 95% CI -0.02 - 0.04, P > .05).
CONCLUSIONS
Through our analysis, the effect of probiotics on lowering plasma lipid was more obvious in hyperlipidemia participants than healthy population. However, further studies are required to confirm the findings due to pronounced clinical heterogeneity.
Topics: Humans; Healthy Volunteers; Cholesterol, LDL; Hyperlipidemias; Probiotics; Health Status
PubMed: 37856800
DOI: No ID Found -
The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis.Environmental Research Jan 2024The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes.
METHODS
On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality.
RESULTS
A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM. The meta-analyses revealed that a 1 μg/m increase in PM was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO), ozone (O), sulphur dioxide (SO), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality.
CONCLUSION
This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.
Topics: Humans; COVID-19; SARS-CoV-2; Exposome; Pandemics; Air Pollutants; Environmental Pollutants; Particulate Matter
PubMed: 37852458
DOI: 10.1016/j.envres.2023.117351 -
Endokrynologia Polska 2023The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to...
INTRODUCTION
The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to reliably assess its antifracture activity.
MATERIAL AND METHODS
The electronic databases PubMed, Medline, Embase, Web of Science, and Cochrane Library were searched to identify clinical trials evaluating the antifracture efficacy of vitamin D in adults. We compared the protocols of the trials against the opinions of the American Society for Bone and Mineral Research (ASBMR), International Society for Clinical Densitometry (ISCD), National Osteoporosis Foundation (NOF), European Medicines Agency (EMEA) experts, and the consensus statement from the 2nd International Conference on Controversies in Vitamin D, and against the protocols of the trials of the medications with proven antifracture efficacy (bisphosphonates, teriparatide, abaloparatide, raloxifene, denosumab, romosozumab). We assessed the prospective character, study design, group description, number of patients, study duration, and vitamin D (serum examination and dosage) supplementation. A description of the desired characteristics of the study protocol was presented.
RESULTS
Thirteen eligible trials were identified. All but 2 were conducted in the elderly population only. Nine trials were included in the final analysis. Serum 25-hydroxy vitamin D (25OHD) was not measured in a representative number of subjects before (except in 2 studies), during, or after treatment in any study.
CONCLUSIONS
The analysed studies did not conclusively assess the vitamin D antifracture efficacy in patients with prestudy low serum vitamin levels, due to the lack of assessment of whether sufficient doses of vitamin D were used. They informed about the relevant doses and preparations of vitamin D in particular groups (specific fracture risk, age, place of residence) only.
Topics: Humans; Adult; Aged; Prospective Studies; Vitamin D; Osteoporosis; Vitamins; Fractures, Bone; Bone Density Conservation Agents
PubMed: 37779375
DOI: 10.5603/ep.95639