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BMJ Paediatrics Open Jan 2023Biomarkers may enhance diagnostic capability for common paediatric infections, especially in low- and middle-income countries (LMICs) where standard diagnostic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Biomarkers may enhance diagnostic capability for common paediatric infections, especially in low- and middle-income countries (LMICs) where standard diagnostic modalities are frequently unavailable, but disease burden is high. A comprehensive understanding of the diagnostic capability of commonly available biomarkers for neonatal sepsis in LMICs is lacking. Our objective was to systematically review evidence on biomarkers to understand their diagnostic performance for neonatal sepsis in LMICs.
METHODS
We conducted a systematic review and meta-analysis of studies published in English, Spanish, French, German, Dutch, and Arabic reporting the diagnostic performance of C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and procalcitonin (PCT) for neonatal sepsis. We calculated pooled test characteristics and the area under the curve (AUC) for each biomarker compared with the reference standards blood culture or clinical sepsis defined by each article.
RESULTS
Of 6570 studies related to biomarkers in children, 134 met inclusion criteria and included 23 179 neonates. There were 80 (59.7%) studies conducted in LMICs. CRP of ≥60 mg/L (AUC 0.87, 95% CI 0.76 to 0.91) among 1339 neonates and PCT of ≥0.5 ng/mL (AUC 0.87, 95% CI 0.70 to 0.92) among 617 neonates demonstrated the greatest discriminatory value for the diagnosis of neonatal sepsis using blood culture as the reference standard in LMICs.
CONCLUSIONS
PCT and CRP had good discriminatory value for neonatal sepsis in LMICs. ESR and WBC demonstrated poor discrimination for neonatal sepsis in LMICs. Future studies may incorporate biomarkers into clinical evaluation in LMICs to diagnose neonatal sepsis more accurately.
PROSPERO REGISTRATION NUMBER
CRD42020188680.
Topics: Humans; Infant, Newborn; Biomarkers; C-Reactive Protein; Calcitonin; Developing Countries; Neonatal Sepsis; Procalcitonin
PubMed: 36649385
DOI: 10.1136/bmjpo-2022-001627 -
International Journal of Nursing Studies May 2024Practices related to umbilical cord clamping at birth should be evidence-based. Deferred cord clamping, compared to immediate cord clamping, shows benefits for preterm... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Practices related to umbilical cord clamping at birth should be evidence-based. Deferred cord clamping, compared to immediate cord clamping, shows benefits for preterm neonates but this may also apply to healthy term neonates. Different blood sampling techniques are used to measure effect of deferred and immediate cord clamping.
OBJECTIVE
To assess the statistical and effect size differences between blood biomarkers from umbilical cord and capillary blood samples of healthy term neonates following either immediate or deferred cord clamping.
DESIGN
Systematic review and meta-analysis.
METHODS
The databases PubMed, Medline, CENTRAL, CINAHL and EMBASE were systematically searched. We included studies with a randomised clinical trial design comparing deferred and immediate cord clamping among healthy term neonates born by a spontaneous vaginal birth, reporting on blood biomarkers. Studies including caesarean births and premature births/neonates were excluded. Study attributes, sampling technique, blood biomarkers, mean differences, and standard deviations were extracted. The standardised mean differences (SMD) and sampling errors were calculated for effect size estimation. Meta-analyses were performed if ≥2 studies reported the same outcome using RevMan 5. Subgroup analyses distinguished effects from umbilical cord and capillary blood samples. Moderator tests and publication bias analyses were performed using JASP.
RESULTS
Fifteen studies were included for analysis. The biomarkers haematocrit, haemoglobin, and bilirubin were reported in ≥2 studies and thus eligible for pooling. No differences were found in haemoglobin (SMD -0.04, 95%CI -0.57 to 0.49) or bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) between umbilical cord blood samples collected after deferred or immediate cord clamping. Deferred cord clamping led to lower haematocrit values (SMD -0.3, 95%CI -0.53 to -0.07). Higher haematocrit (SMD 0.67, 95%CI 0.37 to 0.97) and haemoglobin values (SMD 0.76, 95%CI 0.56 to 0.97) from capillary blood samples, collected 2 to 72 h postpartum, showed when cord clamping was deferred. No effect was found on bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) irrespective of the sampling technique.
CONCLUSIONS
Blood collected after deferred umbilical cord clamping showed increased haemoglobin and haematocrit values up to 72 h after birth, opposed to bilirubin values. Clinical evaluation of blood biomarkers from the umbilical cord shows different values compared to capillary blood. Sampling time and technique therefore seem essential in estimating the effects of deferred cord clamping.
TWEETABLE ABSTRACT
This meta-analysis shows that sampling time and technique are essential in estimating the effects of deferred cord clamping on neonatal blood values.
Topics: Humans; Infant, Newborn; Umbilical Cord Clamping; Fetal Blood; Biomarkers; Umbilical Cord; Hemoglobins; Bilirubin; Pregnancy; Female
PubMed: 38417349
DOI: 10.1016/j.ijnurstu.2024.104718 -
Nutrients May 2020Coffee contains bioactive compounds with anti-inflammatory properties, and its consumption may reduce c-reactive protein (CRP) levels, a biomarker of chronic... (Meta-Analysis)
Meta-Analysis
Coffee contains bioactive compounds with anti-inflammatory properties, and its consumption may reduce c-reactive protein (CRP) levels, a biomarker of chronic inflammation. A previous meta-analysis reported no overall association between blood CRP level and coffee consumption by modeling the coffee consumption in categories, with substantial heterogeneity. However, the coffee cup volume was not considered. We conducted a systematic review and dose-response meta-analysis investigating the association between coffee consumption and CRP levels reported in previous observational studies. A dose-response meta-analysis was conducted by mixed-effects meta-regression models using the volume of coffee consumed as metric. Eleven studies from three continents were identified using the PubMed database, totaling 61,047 participants. Three studies with the largest sample sizes observed a statistically significant association between coffee and CRP levels, which was inverse among European and United States (US) women and Japanese men (1.3%-5.5% decrease in CRP per 100 mL of coffee consumed) and positive among European men (2.2% increase). Other studies showed no statistically significant associations. When all studies were combined in the dose-response meta-analysis, no statistically significant associations were observed among all participants or when stratified by gender or geographic location, reflecting the conflicting associations reported in the included studies. Further studies are warranted to explore these inconsistent associations.
Topics: Beverages; Biomarkers; C-Reactive Protein; Chronic Disease; Coffee; Cross-Sectional Studies; Eating; Europe; Female; Humans; Inflammation; Japan; Male; Nutritional Physiological Phenomena; United States
PubMed: 32397288
DOI: 10.3390/nu12051349 -
Ecotoxicology and Environmental Safety Jan 2024Disinfection by-products (DBPs), including trihalomethanes (THMs) and haloacetic acids (HAAs), have attracted attention due to their carcinogenic properties, leading to... (Meta-Analysis)
Meta-Analysis Review
Disinfection by-products (DBPs), including trihalomethanes (THMs) and haloacetic acids (HAAs), have attracted attention due to their carcinogenic properties, leading to varying conclusions. This meta-analysis aimed to evaluate the dose-response relationship and the dose-dependent effect of DBPs on cancer risk. We performed a selective search in PubMed, Web of Science, and Embase databases for articles published up to September 15th, 2023. Our meta-analysis eventually included 25 articles, encompassing 8 cohort studies with 6038,525 participants and 10,668 cases, and 17 case-control studies with 10,847 cases and 20,702 controls. We observed a positive correlation between increased cancer risk and higher concentrations of total trihalomethanes (TTHM) in water, longer exposure durations, and higher cumulative TTHM intake. These associations showed a linear trend, with relative risks (RRs) and 95 % confidence intervals (CIs) being 1.02 (1.01-1.03), 1.04 (1.02-1.06), and 1.02 (1.00-1.03), respectively. Gender-specific analyses revealed slightly U-shaped relationships in both males and females, with males exhibiting higher risks. The threshold dose for TTHM in relation to cancer risk was determined to be 55 µg/L for females and 40 µg/L for males. A linear association was also identified between bladder cancer risk and TTHM exposure, with an RR and 95 % CI of 1.08 (1.05-1.11). Positive linear associations were observed between cancer risk and exposure to chloroform, bromodichloromethane (BDCM), and HAA5, with RRs and 95 % CIs of 1.02 (1.01-1.03), 1.33 (1.18-1.50), and 1.07 (1.03-1.12), respectively. Positive dose-dependent effects were noted for brominated THMs above 35 µg/L and chloroform above 75 µg/L. While heterogeneity was observed in the studies for quantitative synthesis, no publication bias was detected. Exposure to TTHM, chloroform, BDCM, or HAA5 may contribute to carcinogenesis, and the risk of cancer appears to be dose-dependent on DBP exposure levels. A cumulative effect is suggested by the positive correlation between TTHM exposure and cancer risk. Bladder cancer and endocrine-related cancers show dose-dependent and positive associations with TTHM exposure. Males may be more susceptible to TTHM compared to females.
Topics: Male; Female; Humans; Disinfection; Chloroform; Trihalomethanes; Urinary Bladder Neoplasms; Water Pollutants, Chemical; Disinfectants
PubMed: 38183752
DOI: 10.1016/j.ecoenv.2023.115925 -
International Journal of Environmental... Jul 2022Firefighters are intermittently exposed to complex, mixed pollutants in random settings. Of those pollutants, PAHs (polycyclic aromatic hydrocarbons) are the most... (Meta-Analysis)
Meta-Analysis Review
Firefighters are intermittently exposed to complex, mixed pollutants in random settings. Of those pollutants, PAHs (polycyclic aromatic hydrocarbons) are the most commonly studied and best understood. PAH exposure can occur via multiple routes; therefore, the levels of hydroxylated metabolites of PAHs in urine have been used as a biomonitoring tool for risk assessment. We performed a systematic review and meta-analysis of the literature to estimate the levels of urinary hydroxylated PAH (OHPAH) among firefighters, determine risk attributions, and, finally, evaluate the scope of preventive efforts and their utility as diagnostic tools. The meta-regression confirmed increases in OHPAH concentrations after fire activities by up to 1.71-times (p-values: <0.0001). Samples collected at a time point of 2−4 h after a fire suppression showed a consistent, statistically significant pattern as compared with baseline samples. The National Fire Protection Association (NFPA) standard 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments lists various health examinations, including a urinalysis for occupational chemical exposure if indicated and medical screening for cancers and cardiovascular diseases. Biomonitoring is a valuable screening tool for assessing occupational exposure and the results of this meta-analysis support their inclusion in regular health screenings for firefighters.
Topics: Air Pollutants, Occupational; Environmental Monitoring; Firefighters; Humans; Occupational Exposure; Polycyclic Aromatic Hydrocarbons
PubMed: 35886320
DOI: 10.3390/ijerph19148475 -
Ecotoxicology and Environmental Safety Jun 2023This study aimed to conduct on the concentration of nitrate/nitrite (mg kg) in vegetables and fruits with a special emphasize on the effect of climate condition. The... (Meta-Analysis)
Meta-Analysis Review
This study aimed to conduct on the concentration of nitrate/nitrite (mg kg) in vegetables and fruits with a special emphasize on the effect of climate condition. The highest concentration (mean and 95%CI) of nitrate/nitrite was determined in Rocket (4825.15; 3044.14-6606.16), Mizuna (3500; 2702.48-4297.52), and Bok choy (3407.40; 2841.39-3973.42) in vegetable group and in wolfberry (2395.83; 1611.89-3179.77), Jack fruit (237.8; 202.88-272.71) and Cantaloupe (220.32; -224.53 to 665.19) in fruits group. Brazil (2816.77), Estonia (2133.76), Republic of China, Taiwan (2118.28) were the nations with the highest average concentration of nitrate/nitrite in all samples taken from these nations across the globe. Furthermore, Chinese fruits contain the highest concentrations of nitrates/nitrites of other countries (500.57; 416.74-584.41). Nitrate is present in greater quantities in fruits (44.02; 42.12-45.93) and vegetables (438.31; 422.51-454.11) than nitrite; however, the quantity of nitrite has a relatively similar content in both. Our findings revealed that increase in humidity (> 60%), annual rainfall (> 1500 mm), average temperature (> 10 °C) and application of fertilizers lead to significant increase in accumulation of nitrate/nitrite composition of vegetables and fruits (p < 0.05). According to the results of rating countries using the Food Security Index (GFSI), countries with high scores-like Poland and Portugal, which have GFSI scores of 75.5 and 78.7 and average contamination levels of 8.26 and 11.08, respectively-have a trend of average nitrate/nitrite levels of fruit and vegetable products that is significantly decreasing (p = 0.00). Although GFSI levels and other environmental variables can influence nitrate/nitrite levels, fertilizer usage (kg ha) is one of the most significant controllable and impactful factors in contaminants residue, which should be manage. The result of our study, will serve as a basis to estimate the dietary exposure to nitrates and nitrites from fruits and vegetables among populations around the world based on climatology and monitor the related health outcomes.
Topics: Fruit; Nitrates; Nitrites; Temperature; Vegetables
PubMed: 37084661
DOI: 10.1016/j.ecoenv.2023.114934 -
BMC Oral Health Mar 2024Recurrent Aphthous Stomatitis (RAS) known as recurrent aphthous ulcer is a common and painful ulcerations in oral cavity. It has been suggested that hematological... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Recurrent Aphthous Stomatitis (RAS) known as recurrent aphthous ulcer is a common and painful ulcerations in oral cavity. It has been suggested that hematological parameters seems to be considered as an etiologic factor. So, this meta-analysis and systematic review was aimed to examine the relationship between RAS and hematological parameters.
METHODS
Relevant studies were found using online international databases including Scopus, Science direct, Web of science (ISI), PubMed, and Google Scholar search engine between 2000 and October 2023. The quality of all papers was determined by NOS checklist. Heterogeneity between the results of primary studies was evaluated with I-square index and publication bias was performed by Egger's test and funnel plots. Also, sensitivity analysis was done to check the effect of each of the primary studies on the overall estimate. Also, the statistical analyses were done using Stata software Ver. 11.
RESULTS
By combining the results of primary studies, the standardized mean difference (SMD) of vitamin B12, ferritin, folic acid, hemoglobin, iron and zinc indices with a 95% confidence interval (CI) between the case (patients with RAS) and control (Healthy) groups were estimated -0.52(-0.89, -0.14), -0.20(-0.51, 0.11), -0.42(-0.95, 0.11), -0.58(-0.90, -0.27), 0.01(-0.12, 0.15), -0.33(-0.81, 0.14) respectively. The patients with vitamin B12, ferritin, folic acid, and iron deficiencies and reduced hemoglobin (Hb) level reported 2.93(2.28, 3.78), 2.50(1.48, 4.22), 1.51(0.53, 4.29), 1.46(0.70, 3.03), and 2.14(1.38, 3.32), times more susceptible to develop RAS than healthy individuals.
CONCLUSION
The results of the meta-analysis indicated that the SMD of vitamin B12 serum and Hb levels in the case group was 52%. Our result have also showed that the odds ratio of vitamin B12, ferritin deficiencies, and decreased Hb level in case group was 2.93, 2.50, and 2.14 times more than healthy group.
Topics: Humans; Stomatitis, Aphthous; Vitamin B 12 Deficiency; Folic Acid Deficiency; Folic Acid; Vitamin B 12; Hemoglobins; Ferritins
PubMed: 38493289
DOI: 10.1186/s12903-024-04072-5 -
Clinical Nutrition (Edinburgh, Scotland) Apr 2024The escalating prevalence of diabetes mellitus may benefit from add-on therapeutic approaches. Given the recognized need for an updated synthesis of the literature, this... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
The escalating prevalence of diabetes mellitus may benefit from add-on therapeutic approaches. Given the recognized need for an updated synthesis of the literature, this systematic review and meta-analysis aimed to synthesize and critically assess the available randomized controlled trials (RCTs) that investigate the efficacy of probiotics and synbiotics on glycemic control in patients with Type 1 (T1DM) and Type 2 (T2DM) diabetes mellitus.
METHODS
Comprehensive searches were conducted on PubMed, Embase, CINAHL, Scopus, and Web of Science, focusing on adults with T1DM or T2DM. All comparators were deemed eligible. Primary outcomes included changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and insulin levels. Only RCTs were included, and the Cochrane RoB2 tool assessed the risk of bias. Random-effect models facilitated data analysis, supplemented by sensitivity, subgroup analyses, and meta-regressions.
RESULTS
A total of 537 records were screened, resulting in 41 RCTs for analysis, which comprises 2991 (54% females) patients with diabetes. The meta-analysis revealed statistically significant improvements in HbA1c (standardized mean difference (SMD) = -0.282, 95% CI: [-0.37, -0.19], p < 0.001), FPG (SMD = -0.175, 95% CI: [-0.26, -0.09], p < 0.001), and insulin levels (SMD = -0.273, 95% CI: [-0.35, -0.20], p < 0.001). A medium degree of heterogeneity between studies was found in HbA1c (I = 62.5%), FPG (I = 71.5%), and insulin levels (I = 66.4%) analyses. Subgroup analyses indicated that the efficacy varied based on the type of strains used and the country. Multispecies strains were particularly effective in improving HbA1c levels.
CONCLUSION
The study findings suggest that probiotics and synbiotics may be effective as complementary therapies for managing diabetes. Additionally, the study underscores the need for further tailored research that considers variables such as strain types and geographical factors to deepen the understanding of the role of these interventions in diabetes care.
REVIEW REGISTRATION NUMBER
PROSPERO (CRD42023396348).
Topics: Female; Humans; Male; Blood Glucose; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Glycemic Control; Insulins; Probiotics; Randomized Controlled Trials as Topic; Synbiotics
PubMed: 38527396
DOI: 10.1016/j.clnu.2024.03.006 -
Nutrients Oct 2022The clinical benefit of low carbohydrate (LC) diets compared with low fat (LF) diets for people with type 2 diabetes (T2D) remains uncertain. We conducted a... (Meta-Analysis)
Meta-Analysis Review
The clinical benefit of low carbohydrate (LC) diets compared with low fat (LF) diets for people with type 2 diabetes (T2D) remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare their efficacy and safety in people with T2D. RCTs comparing both diets in participants with T2D were identified from MEDLINE, Embase, Cochrane Library, and manual search of bibliographies. Mean differences and relative risks with 95% CIs were pooled for measures of glycaemia, cardiometabolic parameters, and adverse events using the following time points: short-term (3 months), intermediate term (6 and 12 months) and long-term (24 months). Twenty-two RCTs comprising 1391 mostly obese participants with T2D were included. At 3 months, a LC vs. LF diet significantly reduced HbA1c levels, mean difference (95% CI) of -0.41% (-0.62, -0.20). LC diet significantly reduced body weight, BMI, fasting insulin and triglycerides and increased total cholesterol and HDL-C levels at the short-to-intermediate term, with a decrease in the requirement for antiglycaemic medications at intermediate-to-long term. There were no significant differences in other parameters and adverse events. Except for reducing HbA1c levels and adiposity parameters at short-to-intermediate terms, a LC diet appears to be equally effective as a LF diet in terms of control of cardiometabolic markers and the risk of adverse events in obese patients with T2D.
Topics: Humans; Diet, Fat-Restricted; Glycated Hemoglobin; Cholesterol, LDL; Randomized Controlled Trials as Topic; Diabetes Mellitus, Type 2; Obesity; Triglycerides; Insulin; Cardiovascular Diseases
PubMed: 36297075
DOI: 10.3390/nu14204391 -
Annals of Hepatology 2017Endogenous sex hormones are associated with the risk of diabetes and metabolic syndrome. Recent studies suggested the role of these hormones in nonalcoholic fatty liver... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND AIM
Endogenous sex hormones are associated with the risk of diabetes and metabolic syndrome. Recent studies suggested the role of these hormones in nonalcoholic fatty liver disease (NAFLD). We conducted a systematic review and meta-analysis of observational studies investigating the association between sex hormones and NAFLD.
MATERIAL AND METHODS
A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through April 2016. The inclusion criterion was the observational studies that assessed the association of serum total testosterone (TT) and sex-hormone binding globulin (SHBG) and NAFLD. We calculated pooled effect estimates of TT and SHBG with 95% confidence intervals (CI) comparing between subjects with and without NAFLD by using random-effects model.
RESULTS
Sixteen trials comprising 13,721 men and 5,840 women met the inclusion criteria. TT levels were lower in men with NAFLD (MD = -2.78 nmol/l, 95%CI -3.40 to -2.15, I2 = 99%) than in those without. Men with higher TT levels had lower odds of NAFLD whereas higher TT levels increased the odds of NAFLD in women. In both sexes, SHBG levels were lower in patients with NAFLD than controls and this inverse association was stronger in women than men and higher SHBG levels were associated with reduced odds of NAFLD.
CONCLUSION
Our meta-analysis demonstrated a sex-dependent association between TT and NAFLD. Lower TT levels are associated with men with NAFLD and inversely associated with women with NAFLD, whereas higher SHBG levels are associated with lower NAFLD odds in both men and women.
Topics: Adolescent; Adult; Biomarkers; Female; Humans; Male; Middle Aged; Non-alcoholic Fatty Liver Disease; Odds Ratio; Risk Assessment; Risk Factors; Sex Factors; Sex Hormone-Binding Globulin; Testosterone
PubMed: 28425408
DOI: 10.5604/16652681.1235481