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The Journal of Nutrition, Health & Aging 2017The aim of our scoping review was to summarize the state of the art regarding micronutrients in order to identify which of them might effectively improve health status... (Review)
Review
OBJECTIVE
The aim of our scoping review was to summarize the state of the art regarding micronutrients in order to identify which of them might effectively improve health status in the areas typically impaired in older people: bone, skeletal muscle, and cognitive function.
DESIGN
Scoping review.
METHODS
The Italian Study Group on Healthy Aging by Nutraceuticals and Dietary Supplements (HANDS) performed this scoping review, based on the following steps: doing a list of micronutrients related with musculoskeletal or cognitive functions, included in dietary supplements and nutraceuticals commercialized in Italy; planning a research on PubMed, according to an evidence-based approach, in order to the most relevant positive study for each micronutrient into each of the three areas involved (bone, skeletal muscle and cognitive function); identifying the micronutrients effective in maintaining or achieving an adequate health status in older people, specifying the effective and safe daily doses, according to the selected studies.
RESULTS
In literature we found 12 relevant positive studies (1 international society guidelines/recommendations, 1 systematic review, 7 randomized controlled trials, and 3 prospective cohort studies). We showed that only 16 micronutrients resulted to have appropriate scientific evidences in terms of improving musculoskeletal health and/or cognitive function in older people: beta-alanine, calcium, creatine, fluorides, leucine, magnesium, omega-3 fatty acids, potassium, vitamin B6, vitamin B9, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K2, and zinc.
CONCLUSION
This scoping review showed that selected micronutrients in adequate doses might have an ancillary role in musculoskeletal health and cognitive functions in older people.
Topics: Aged; Amino Acids; Bone and Bones; Calcium, Dietary; Cognition; Cognition Disorders; Dietary Supplements; Fatty Acids, Omega-3; Fluorides; Humans; Italy; Magnesium; Micronutrients; Muscle, Skeletal; Musculoskeletal Diseases; Potassium; Vitamin B Complex; Vitamin D; Zinc
PubMed: 28448083
DOI: 10.1007/s12603-016-0823-x -
BMC Infectious Diseases Feb 2017Onychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Onychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The diagnostic tests for this disease are few and discordant. The objective was to evaluate the diagnostic validity, performance, and accuracy of culture, nail clipping with Periodic Acid-Schiff -PAS- staining (biopsy), and direct potassium hydroxide (KOH) examination for the study of onychomycosis.
METHODS
A systematic review was conducted via meta-analysis using 5 databases and 21 search strategies. An ex ante protocol was applied with inclusion and exclusion criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, and the sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios, receiver operating characteristic (ROC) curves, and proportion of correctly diagnosed patients were evaluated with the meta-analysis of studies of evaluations of diagnostic and screening tests (Meta-DiSc) and Epidat using a random effects model.
RESULTS
The efficiency or accuracy of the three tests is influenced by the methodological quality of the studies. These values are lower for KOH and culture and higher for biopsy in moderate quality studies.
CONCLUSION
The diagnostic tests evaluated in this meta-analysis independently showed acceptable validity, performance, and efficiency, with nail clipping with PAS staining outperforming the other two tests.
Topics: Biopsy; Foot Dermatoses; Hand Dermatoses; Humans; Hydroxides; Indicators and Reagents; Nails; Odds Ratio; Onychomycosis; Periodic Acid-Schiff Reaction; Potassium Compounds; ROC Curve; Reproducibility of Results; Sensitivity and Specificity
PubMed: 28222676
DOI: 10.1186/s12879-017-2258-3 -
International Journal of Dental Hygiene May 2017This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity (DH) and root... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity (DH) and root sensitivity (RS).
MATERIAL AND METHODS
A thorough search in MEDLINE, PubMed and Cochrane Plus Library was conducted up to February 2015. Randomized clinical trials, parallel, double-blinded and placebo-controlled, with a follow-up of at least 6 weeks, reporting changes on response to tactile stimuli, thermal/evaporative stimuli or patients' subjective assessment of the pain experienced during their daily life after the home use of desensitizing mouthwashes were considered for inclusion.
RESULTS
The screening of titles and abstracts resulted in seven publications meeting the eligibility criteria. The desensitizing agents evaluated were potassium nitrate (n = 5), aluminium lactate (n = 1) and sodium fluoride (n = 1). A meta-analysis for each of the hypersensitivity stimuli was performed. Results demonstrated statistically significant reduction in sensitivity scores favouring test group when DH was assessed by means of patients' self-reported pain experience (SMD at 8 weeks = 0.77; 95% CI [0.23; 1.31]; P = 0.005). No significant effects were detected in response to tactile or thermal/evaporative stimuli. Meta-regression analysis demonstrated a tendency towards an increased effect favouring test group for the patients' subjective perception, whereas tactile and thermal/evaporative stimuli showed a slight tendency towards a reduction in the efficacy of the test mouthwash.
CONCLUSIONS
There exists a tendency towards a decrease in DH or RS scores with time in both treatment groups, with significant differences in favour of test group when sensitivity is evaluated in terms of patients' self-reported sensitivity symptoms.
Topics: Aluminum Compounds; Dentin Desensitizing Agents; Dentin Sensitivity; Double-Blind Method; Follow-Up Studies; Lactates; Mouthwashes; Nitrates; Pain Measurement; Potassium Compounds; Randomized Controlled Trials as Topic; Self Report; Sodium Fluoride; Tooth Root
PubMed: 27762076
DOI: 10.1111/idh.12250 -
The Cochrane Database of Systematic... Aug 2016The ideal intravenous fluid for kidney transplantation has not been defined, despite the common use of normal saline during the peri-operative period. The high chloride... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The ideal intravenous fluid for kidney transplantation has not been defined, despite the common use of normal saline during the peri-operative period. The high chloride content of normal saline is associated with an increased risk of hyperchloraemic metabolic acidosis, which may in turn increase the risk of hyperkalaemia and delayed graft function. Balanced electrolyte solutions have a lower chloride content which may decrease this risk and avoid the need for dialysis due to hyperkalaemia in the immediate post-transplant period. Randomised controlled trials (RCTs) addressing this issue have used biochemical outcomes to compare fluids and have been underpowered to address patient-centred outcomes such as delayed graft function.
OBJECTIVES
To examine the effect of lower-chloride solutions versus normal saline on delayed graft function, hyperkalaemia and acid-base status in kidney transplant recipients.
SEARCH METHODS
We searched the Cochrane Kidney and Transplant's Specialised Register to 26 November 2015 through contact with the Information Specialist using search terms relevant to this review.
SELECTION CRITERIA
RCTs of kidney transplant recipients that compared peri-operative intravenous lower-chloride solutions to normal saline were included.
DATA COLLECTION AND ANALYSIS
Two independent investigators assessed studies for eligibility and risk of bias. Data from individual studies were extracted using standardised forms and pooled according to a published protocol. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.
MAIN RESULTS
Six studies (477 participants) were included in the review. All participants were adult kidney transplant recipients and 70% of participants underwent live-donor kidney transplantation. The overall risk of bias was low for selection bias and unclear for remaining domains. There was no difference in the risk of delayed graft function (3 studies, 298 participants: RR 1.03, 95% CI 0.62 to 1.70) or hyperkalaemia (2 studies, 199 participants: RR 0.48, 95% CI 0.04 to 6.10) for participants who received balanced electrolyte solutions compared to normal saline. Intraoperative balanced electrolyte solutions compared to normal saline were associated with higher blood pH (3 studies, 193 participants: MD 0.07, 95% CI 0.05 to 0.09), higher serum bicarbonate (3 studies, 215 participants: MD 3.02 mEq/L, 95% CI 2.00 to 4.05) and lower serum chloride (3 studies, 215 participants: MD -9.93 mmol/L, 95% CI -19.96 to 0.11). There were four cases of graft loss in the normal saline group and one in the balanced electrolyte solution group, and four cases of acute rejection in the normal saline group compared to two cases in the balanced electrolyte solution group.
AUTHORS' CONCLUSIONS
Balanced electrolyte solutions are associated with less hyperchloraemic metabolic acidosis compared to normal saline, however it remains uncertain whether lower-chloride solutions lead to improved graft outcomes compared to normal saline.
Topics: Adult; Delayed Graft Function; Gluconates; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Infusions, Intravenous; Isotonic Solutions; Kidney; Kidney Transplantation; Magnesium Chloride; Potassium Chloride; Ringer's Solution; Sodium Acetate; Sodium Chloride; Solutions
PubMed: 27502170
DOI: 10.1002/14651858.CD010741.pub2 -
American Journal of Physiology.... Apr 2016Inflammatory bowel disease (IBD) is a chronic inflammatory disorder with a complex pathogenesis. Diarrhea is a highly prevalent and often debilitating symptom of IBD... (Review)
Review
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder with a complex pathogenesis. Diarrhea is a highly prevalent and often debilitating symptom of IBD patients that results, at least in part, from an intestinal hydroelectrolytic imbalance. Evidence suggests that reduced electrolyte absorption is more relevant than increased secretion to this disequilibrium. This systematic review analyses and integrates the current evidence on the roles of epithelial Na(+)-K(+)-ATPase (NKA), Na(+)/H(+) exchangers (NHEs), epithelial Na(+) channels (ENaC), and K(+) channels (KC) in IBD-associated diarrhea. NKA is the key driving force of the transepithelial ionic transport and its activity is decreased in IBD. In addition, the downregulation of apical NHE and ENaC and the upregulation of apical large-conductance KC all contribute to the IBD-associated diarrhea by lowering sodium absorption and/or increasing potassium secretion.
Topics: Animals; Epithelial Cells; Epithelial Sodium Channels; Gastrointestinal Absorption; Gastrointestinal Agents; Humans; Inflammatory Bowel Diseases; Intestinal Mucosa; Ion Transport; Membrane Transport Modulators; Potassium Channels; Signal Transduction; Sodium-Hydrogen Exchangers; Sodium-Potassium-Exchanging ATPase
PubMed: 26744474
DOI: 10.1152/ajpgi.00369.2015 -
Medicine Sep 2015The presence of parietal cell antibody (PCA) in serum is a biomarker of autoimmune gastritis. PCA directly recognizes the H/K ATPase expressed in parietal cells, which... (Meta-Analysis)
Meta-Analysis
The presence of parietal cell antibody (PCA) in serum is a biomarker of autoimmune gastritis. PCA directly recognizes the H/K ATPase expressed in parietal cells, which is responsible for the active transport of hydrogen ions in exchange for potassium ions to increase the acidity of gastric secretions. Type 1 diabetes mellitus (T1DM) mainly results from pancreatic β-cell destruction due to cell-type specific autoimmunity. Considering autoimmune factors may be the common characteristics of both PCA positivity and T1DM, it is likely that both disorders may coexist within the same patient. The main objective of this meta-analysis is to provide a reliable evaluation to clarify the association between PCA positivity and T1DM by combining the raw data from all of the relevant studies.Literature databases, including the Medline, Embase, and Web of Science, were systematically queried for studies investigating the association between PCA positivity and T1DM and were published from January 1980 to December 2014. A total of 3,584 T1DM cases and 2,650 non-T1DM controls were included in this meta-analysis, which showed that PCA positivity was more prevalent in patients with T1DM than healthy controls. Publication bias testing found no significant biases and sensitivity analysis demonstrated that our statistics were relatively stable and credible.Our findings suggested that T1DM was associated with an increased risk of PCA positivity compared to control populations.
Topics: Autoantibodies; Autoimmunity; Biological Transport, Active; Diabetes Mellitus, Type 1; H(+)-K(+)-Exchanging ATPase; Humans; Parietal Cells, Gastric; Potassium; Prevalence; Protons
PubMed: 26402802
DOI: 10.1097/MD.0000000000001440 -
Journal of Dentistry Aug 2015This meta-analysis was performed to evaluate the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This meta-analysis was performed to evaluate the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment.
DATA, SOURCES AND STUDY SELECTION
An electronic systematic literature search was conducted in Cochrane Center Register of Controlled Trials, MEDLINE (PubMed) and EmBase in April, 2014 in English and without time restrictions. Study information extraction and methodological quality assessments were accomplished by two reviewers independently. Methodological quality was assessed by using the "Criteria for judging risk of bias in the 'Risk of bias' assessment tool". Dichotomous data was summarized by odds ratio (OR) with 95% confidence interval (CI) and continuous data was summarized by mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI). Statistical analyses were carried out by using Review Manager 5.2. For evaluation of percent of patients experiencing tooth sensitivity (POTS), the pooled OR of desensitizers vs. placebo was 0.45 (95% CI: 0.28-0.73, P=0.29). The pooled SMD of desensitizers vs. placebo was -0.47 (95% CI: -0.77 to -0.18, P=0.13) in evaluation of level of tooth sensitivity (LOTS). The results of shade evaluation remained inconsistent by evaluating subjective shade guide unit difference (ΔSGU or SGU) and objective colour difference (ΔE).
CONCLUSIONS
This meta-analysis was performed to evaluate the efficacy of desensitizing agents, potassium nitrate and sodium fluoride, for tooth bleaching treatments. Potassium nitrate and sodium fluoride reduce tooth sensitivity while no consistent conclusion of tooth colour change was found.
CLINICAL SIGNIFICANCE
Tooth sensitivity is a typical side effect associated with tooth bleaching procedures. Potassium nitrate and sodium fluoride are used widely to treat tooth sensitivity. This meta-analysis was performed to evaluate the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment.
Topics: Dentin Desensitizing Agents; Humans; Nitrates; Placebos; Potassium Compounds; Sodium Fluoride; Tooth Bleaching; Tooth Bleaching Agents; Treatment Outcome
PubMed: 25913140
DOI: 10.1016/j.jdent.2015.03.015 -
Journal of Clinical Periodontology Feb 2015The aim is to assess the effect of desensitizing toothpaste on dentin hypersensitivity. (Meta-Analysis)
Meta-Analysis Review
AIM
The aim is to assess the effect of desensitizing toothpaste on dentin hypersensitivity.
METHODS
We searched PubMed, CENTRAL, and Embase on December 20, 2013.
RESULTS
Out of the 626 articles searched, a total of 31 randomized controlled clinical trials were included. The Standardized mean differences (SMD) for potassium-containing toothpaste (n = 8) was -1.28 (95% Confidence interval (CI) -2.05 to -0.51; I(2) = 93%); Stannous fluoride- (n = 6) was -1.37 (95% CI, -2.30 to -0.44; I(2) = 95%); Potassium and stannous fluoride- (n = 3) was -2.50 (95% CI, -4.10 to -0.91; I(2) = 95%); Calcium sodium phosphosilicate- (n = 4) was -2.36 (95% CI, -3.72 to -1.00; I(2) = 92%); Arginine- (n = 8) was -3.25 (95% CI, -3.87 to -2.63; I(2) = 86%). The desensitizing effect was favoured in the intervention group treated with potassium-, stannous fluoride-, potassium and stannous fluoride-, calcium sodium phosphosilicate-, and arginine-containing toothpaste compared to placebo. Whereas, strontium-containing toothpaste (SMD, 0.05; 95% CI, -0.34 to 0.44; I(2) = 64%) was found to have no statistically significant desensitizing effect in the meta-analysis of four studies.
CONCLUSIONS
The study reports that there is sufficient evidence to support the use of potassium-, stannous fluoride-, potassium and stannous fluoride-, calcium sodium phosphosilicate-, and arginine-containing desensitizing toothpastes for dentin hypersensitivity, but not the use of strontium-containing desensitizing toothpaste.
Topics: Arginine; Calcium Carbonate; Dentin Desensitizing Agents; Dentin Sensitivity; Fluorides; Humans; Nitrates; Phosphates; Placebos; Potassium Compounds; Randomized Controlled Trials as Topic; Silicates; Strontium; Tin Fluorides; Toothpastes
PubMed: 25483802
DOI: 10.1111/jcpe.12347 -
The Journal of Nutrition Jun 2013Diets including food products rich in inorganic nitrate are associated with lower blood pressure (BP). The evidence for the BP-lowering effects of inorganic nitrate and... (Comparative Study)
Comparative Study Meta-Analysis Review
Diets including food products rich in inorganic nitrate are associated with lower blood pressure (BP). The evidence for the BP-lowering effects of inorganic nitrate and beetroot in randomized clinical trials has not been systematically assessed. The objective was to conduct a systematic review and meta-analysis of randomized clinical trials that examined the effects of inorganic nitrate and beetroot supplementation on BP. Medline, EMBASE, and Scopus databases were searched from inception to February 2013. The specific inclusion criteria were: 1) randomized clinical trials; 2) trials reporting effects on systolic or diastolic BP or both; and 3) trials comparing inorganic nitrate or beetroot juice supplementation with placebo control groups. Random-effects models were used to assess the pooled BP effect sizes. Sixteen trials met the eligibility criteria for the systematic review. All studies had a crossover study design. The trials were conducted between 2006 and 2012 and included a total of 254 participants with 7-30 participants/study. The duration of each intervention ranged from 2 h to 15 d. Inorganic nitrate and beetroot juice consumption were associated with greater changes in systolic BP [-4.4 mm Hg (95% CI: -5.9, -2.8); P < 0.001] than diastolic BP [-1.1 mm Hg (95% CI: -2.2, 0.1); P = 0.06]. The meta-regression showed an association between daily dose of inorganic nitrate and changes in systolic BP (P < 0.05). Inorganic nitrate and beetroot juice supplementation was associated with a significant reduction in systolic BP. These findings need to be tested in long-term trials and in individuals at greater cardiovascular risk.
Topics: Adult; Beta vulgaris; Beverages; Blood Pressure; Cross-Over Studies; Female; Humans; Hypertension; MEDLINE; Male; Nitrates; Placebos; Plant Roots; Potassium Compounds; Randomized Controlled Trials as Topic
PubMed: 23596162
DOI: 10.3945/jn.112.170233 -
The Cochrane Database of Systematic... May 2012Non-oliguric hyperkalaemia of the newborn is defined as a plasma potassium level > 6.5 mmol/L in the absence of acute renal failure. Hyperkalaemia is a common... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Non-oliguric hyperkalaemia of the newborn is defined as a plasma potassium level > 6.5 mmol/L in the absence of acute renal failure. Hyperkalaemia is a common complication in the first 48 hours of life in very low birth weight (VLBW) (birth weight < 1500 g) and/or very preterm newborns (≤32 weeks gestational age).
OBJECTIVES
To determine the effectiveness and safety of interventions for non-oliguric hyperkalaemia [for the purpose of this review defined as serum potassium > 6.0 mmol/L (the clinical setting in which interventions would likely be introduced prior to reaching a grossly abnormal level) and urine output > 0.5 ml/kg/hour] in preterm or VLBW infants during their first 72 hours of life.
SEARCH METHODS
The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2006) was searched to identify relevant randomised and quasi-randomised controlled trials. The following data bases were searched in June 2006; MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982. Search updated in June 2011.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials conducted in preterm and/or VLBW neonates with a diagnosis of non-oliguric hyperkalaemia. Interventions included were those aimed at redistributing serum potassium (sodium bicarbonate or insulin and glucose) or increasing the elimination of potassium from the body [diuretics (any type) or ion exchange resins (any type), or exchange transfusion, or peritoneal dialysis, or salbutamol, or albuterol] or counteracting potential arrhythmias from hyperkalaemia (calcium) versus placebo or no intervention; or comparing any two of these interventions. Primary outcome measure was 'All cause mortality during initial hospital stay'. Secondary outcomes included common adverse outcomes seen in preterm infants.
DATA COLLECTION AND ANALYSIS
We used the standard review methods of the Cochrane Neonatal Review Group. Two authors assessed all studies identified as potentially relevant by the literature search for inclusion in the review. Statistical methods included relative risk (RR), risk difference (RD), number needed to treat to benefit (NNTB) or number needed to treat to harm (NNTH) for dichotomous and weighted mean difference (WMD) for continuous outcomes reported with 95% confidence intervals (CI). We used a fixed effect model for meta-analysis. Heterogeneity was assessed using the I squared (I(2) ) statistic.
MAIN RESULTS
Three randomised trials, enrolling 74 preterm infants (outcome data available on 71 infants) evaluated interventions for hyperkalaemia. Urine output was ascertained in only one study (Hu 1999). In none of the trials could we ascertain that allocation to the comparison groups was concealed. The sample sizes of the three trials were very small with 12 (Malone 1991), 19 (Singh 2002) and 40 infants enrolled (Hu 1999). The intervention and the outcome assessments could not be blinded to the clinical staff in two trials (Malone 1991; Hu 1999).One study (Malone 1991), glucose and insulin, compared to cation-exchange resin, caused a reduction in all cause mortality that was of borderline statistical significance: RR 0.18 (95% CI 0.03 to 1.15); RD -0.66 (95% CI -1.09 to -0.22); NNTB 2 (95% CI 1 to 5)]. In the study of Hu (Hu 1999), the incidence of intraventricular haemorrhage ≥ grade 2 was significantly reduced [RR 0.30 (95% CI 0.10 to 0.93); RD -0.35 (95% CI -0.62 to -0.08); NNTB 3 (95% CI 2 to 13).Albuterol inhalation versus saline inhalation changed serum K+ from baseline at four hours [WMD -0.69 mmol/L (95% CI -0.87 to -0.51)] and at eight hours [WMD -0.59 mmol/L (95% CI -0.78 to -0.40)] after initiation of treatment. No differences noted in mortality or other clinical outcomes (Singh 2002).No serious side effects were noted with either the combination of insulin and glucose or albuterol inhalation. Other interventions listed in our objectives have not been studied to date.
AUTHORS' CONCLUSIONS
In view of the limited information from small studies of uncertain quality, no firm recommendations for clinical practice can be made. It appears that the combination of insulin and glucose is preferred over treatment with rectal cation-resin for hyperkalaemia in preterm infants. Both the combination of insulin and glucose and albuterol inhalation deserve further study. The two interventions could possibly be tested against each other. The effectiveness of other potentially effective interventions for non-oliguric hyperkalaemia (diuretics, exchange transfusion, peritoneal dialysis and calcium) have not been tested in randomised controlled trials.
Topics: Albuterol; Glucose; Humans; Hyperkalemia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Insulin; Polystyrenes; Potassium; Randomized Controlled Trials as Topic; Reference Values
PubMed: 22592703
DOI: 10.1002/14651858.CD005257.pub3