Clinical outcomes of opioid administration in acute and chronic heart failure: A meta-analysis

Background and aimsOpioid use in heart failure (HF) management is controversial, and whether rapid symptomatic relief outweighs the risks of opioid use in HF remains unknown. This study aimed to explore the clinical outcomes of opioid administration in patients with acute or chronic HF.MethodsA systematic search for eligible studies was conducted in databases (MEDLINE, Scopus, Web of Science, EBSCO) and registries (ClinicalTrials.gov, WHO Clinical Trial Registry) until June 8, 2022. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) or standardized MD were quantified for binary and continuous outcomes, respectively. Meta-regression was performed using the restricted maximum likelihood method.ResultsA total of 20 studies (154,736 participants) were included. In acute HF, opioid use presented a high risk for in-hospital mortality (OR = 2.35; 95% confidence interval (CI): 1.03–5.38; I² = 97%), invasive (OR = 2.78; 95%CI: 1.17–6.61; I² = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06–8.28; I² = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11–4.21; I² = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94–3.32; I² = 63%). In chronic HF New York Heart Association (NYHA) Class II/III, opioid use improved ventilatory efficiency (MD = ?3.16; 95%CI: (?4.78)–(?1.54); I² = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11–128.37; I² = 89%).ConclusionsOpioids are not recommended for acute HF management; however, they showed an advantage in exercise testing by improving ventilatory efficiency, chemosensitivity, and exercise test duration in stable patients with chronic HF NYHA Class II/III. Nonetheless, larger randomized controlled trials and individual patient-level data meta-analyses are warranted.     

Prevalence and risk factors of falls in adults with rheumatoid arthritis: A systematic review and meta-analysis

BackgroundDespite the fact that the estimated prevalence and risk factors of falls in adults with rheumatoid arthritis (RA) are widely reported, these results have not been synthesized. The systematic review and meta-analysis aimed to investigate the prevalence and risk factors of falls in adults with RA.MethodsPubMed, EMBASE, Web of Science, the Cochrane Library, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until July 4, 2022. Stata 15.0 Software was used to perform the meta-analysis. For the prevalence of falls in adults with RA and risk factors that were investigated in at least 2 studies in a comparable way, we calculated pooled incidence and odds ratios (ORs) using random-effects models, with a test for heterogeneity. A study protocol was registered in PROSPERO (CRD42022358120).ResultsA total of 6,470 articles were screened and data from 34 studies involving 24,123 subjects were used in meta-analysis. The pooled prevalence of any falls was 34% (95% confidence interval, CI: 29% to 38%, I²=97.7%, P<0.001), and 16% for recurrent falls (95% CI: 12% to 20%, I²=97.5%, P<0.001). 25 risk factors were considered, including sociodemographic, medical and psychological, medication, and physical function. The strongest associations were found for history of falls (OR=3.08, 95%CI: 2.32 to 4.08, I²=0.0%, P = 0.660), history of fracture (OR=4.03, 95%CI: 3.12 to 5.21, I²=97.3%, P<0.001), walking aid use (OR=1.60, 95%CI: 1.23 to 2.08, I²=67.7%, P = 0.026), dizziness (OR=1.95, 95%CI: 1.43 to 2.64, I²=82.9%, P = 0.003), psychotropic medication use (OR=1.79, 95%CI: 1.39 to 2.30, I²=22.0%, P = 0.254), antihypertensive medicine/diuretic (OR=1.83, 95%CI: 1.37 to 2.46, I²=51.4%, P = 0.055), taking four or more medicine(OR=1.51, 95%CI: 1.26 to 1.81, I²=26.0%, P = 0.256), and HAQ score(OR=1.54, 95%CI: 1.40 to 1.69, I²=36.9%, P = 0.135).ConclusionsThis meta-analysis provides a comprehensive evidence-based assessment of the prevalence and risk factors for falls in adults with RA, confirming their multifactorial etiology. Understanding the risk factors of falls can provide healthcare personnel with a theoretical basis for the management and prevention of RA patients.     

The effectiveness of pistachio on glycemic control and insulin sensitivity in patients with type 2 diabetes,prediabetes and metabolic syndrome: A systematic review and meta-analysis

Background and aimsPistachio nuts have been considered to improve dysglycemia. However, there are controversial results. This systematic review and meta-analysis carried out to evaluate the effects of pistachio nuts on glycemic control and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM), prediabetes, and metabolic syndrome.MethodsMedline/PubMed, ProQuest, Web of Knowledge, Scopus, Cochrane library, and ScienceDirect were systematically searched to find randomized controlled trials (RCTs). Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist was used to conduct the study.ResultsSix RCTs were included in the review. Treatment with pistachio nuts exerted a significant reduction in fasting blood glucose (FBG) level (OR = 1.7, 95% CI; 1.2–2.4, P = 0.002, I² = 0.0%, P = 0.731) and homeostasis model assessment of insulin resistance (HOMA-IR) index (OR = 1.5, 95% CI; 1.0–2.4, P = 0.043, I² = 0.0%, P = 0.617), but no significant improvement was observed in regard to hemoglobin A1c (HbA1c) level (OR = 1.4, 95% CI; 0.9–2.1 P = 0.089, I² = 0.0%, P = 0.957) and fasting plasma insulin (FPI) level (OR = 1.3, 95% CI; 0.9–1.9, P = 0.133, I² = 0.0%, P = 0.776).ConclusionsPistachio nuts might cause a significant reduction in FBG and HOMA-IR, although HbA1c and FPI might not significantly improve in patients suffering from or at risk of T2DM.     

Effectiveness and safety of 1-L PEG-ASC versus other bowel preparations for colonoscopy: A meta-analysis of nine randomized clinical trials

Background and aimsA 1-L polyethylene glycol plus ascorbate (PEG-ASC) preparation has been recently developed to improve patients’ experience in colonoscopy. This meta-analysis aimed to evaluate the effectiveness and safety of 1-L PEG-ASC compared with those of other bowel preparations for colonoscopy.MethodsMEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials comparing 1-L PEG-ASC with other bowel preparations published through July 2022. A random-effects model was applied for pooling the results; heterogeneity was expressed as I².ResultsNine studies met the inclusion criteria and were included. The analysis showed significantly higher cleansing success (CS) (OR = 1.50; 95% CI = 1.25–1.81; p < 0.01, I² = 0%) and right-colon high-quality cleansing (HQC) (OR = 1.67; 95% CI = 1.21–2.31; p < 0.01, I² = 43%) with 1-L PEG-ASC compared to the other preparations.The pooled estimate of the adenoma detection rate (ADR) did not significantly differ between the two groups either in the overall (OR = 1.02; 95% CI = 0.87–1.20; p = 0.79, I² = 0%) or split-dosing regimen subgroup analysis (OR = 0.99; 95% CI = 0.84–1.18; p = 0.94, I² = 0%).A significantly higher pooled estimate of the number of patients with adverse events (AEs) (OR = 1.51; 95% CI = 1.23–1.84; p<0.01, I² = 0%) and incidence of AEs (IRR=1.33; 95% CI = 1.11–1.58; p<0.01, I² = 71%) was observed with 1-L PEG-ASC than with the other preparations. No serious AEs or deaths occurred.ConclusionsCompared to other preparations, 1-L PEG-ASC yielded higher overall CS, higher right-colon HQC rates, and similar ADR. The number of patients with AEs and incidence of the total AEs were significantly higher with 1-L PEG-ASC in the absence of serious AEs.     

Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: A systematic review and meta-analysis

Introduction and aimPortal vein thrombosis (PVT) is associated with a higher risk of liver-related complications. Recent guidelines recommend direct-acting anticoagulants (DOAC) in patients with cirrhosis and non-tumoral PVT. However, data on the efficacy and safety of DOAC in these patients remain limited. We aim to investigate the efficacy and safety of DOAC compared to vitamin K antagonists (VKA) to treat non-tumoral PVT in patients with cirrhosis.MethodsWe performed a systematic search of six electronic databases using MeSH term and free text. We selected all studies comparing the use of DOACs with vitamin K antagonist to treat PVT in cirrhosis. The primary outcome was PVT recanalization. Secondary outcomes were and PVT progression, major bleeding, variceal bleeding and death.ResultsFrom 944 citations, we included 552 subjects from a total of 11 studies (10 observational and 1 randomized trial) that fulfilled the inclusion criteria. We found that DOAC were associated with a higher pooled rate of PVT recanalization (RR = 1.67, 95%CI: 1.02, 2.74, I² = 79%) and lower pooled risk of PVT progression (RR = 0.14, 95%CI: 0.03–0.57, I² = 0%). The pooled risk of major bleeding (RR = 0.29, 95%CI: 0.08–1.01, I² = 0%), variceal bleeding (RR = 1.29, 95%CI: 0.64–2.59, I² = 0%) and death (RR = 0.31, 95%CI: 0.01–9.578, I² = 80%) was similar between DOAC and VKA.ConclusionFor the treatment of PVT in patients with cirrhosis, the bleeding risk was comparable between DOAC and VKA. However, DOAC were associated with a higher pooled rate of PVT recanalization. Dedicated randomized studies are needed to confirm these findings.     

Efficacy and safety of novel dual glucokinase activator dorzagliatin in type-2 diabetes A meta-analysis

Background & aimsGlucokinase has a critical role in regulating glucose homeostasis in humans, and has been a target for diabetes drug development since 1990s. Dorzagliatin is a novel allosteric dual glucokinase activator targeting both pancreatic and hepatic glucokinase. No meta-analysis has analysed the efficacy and safety of dorzagliatin in type-2 diabetes (T2DM). We undertook this meta-analysis to address this knowledge-gap.MethodsElectronic databases were searched for RCTs involving T2DM patients receiving dorzagliatin in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in blood glucose parameters, lipids, insulin-resistance and adverse events.ResultsFrom initially screened 17 articles, data from 3 RCTs (1333 patients) was analysed. Over 12–24 weeks use, dorzagliatin had significantly higher lowering of HbA1c [MD -0.66% (95%CI: ?0.74 to ?0.59); P < 0.01; I² = 99%], fasting glucose [MD -32.03 mg/dl (95%CI: 45.12 to ?18.94); P < 0.01; I² = 100%], 2-h post-prandial glucose [MD -43.49 mg/dl (95%CI: ?46.26 to ?40.72); P < 0.01; I² = 90%] along with greater number of patients achieving HbA1c<7% [OR 6.01 (95% CI: 2.50–14.46); P < 0.01; I² = 83%], as compared to placebo. Dorzagliatin was associated with significant elevation of triglycerides [MD 0.43 mmol/L (95%CI:0.30–0.56); P < 0.01; I² = 0%], greater occurrence of hyperlipidaemia [RR 1.52 (95% CI:1.05–2.18); P = 0.03; I² = 0%], and increase in body-weight [MD 0.40 kg (95%CI:0.06–0.75); P = 0.03; I² = 0%], compared to placebo. The occurrence of total-adverse-events [RR 1.43 (95%CI:1.11–1.83); P < 0.01; I² = 0%] but not severe adverse-events [RR 0.92 (95%CI:0.54–1.57); P = 0.76; I² = 0%] was significantly higher with dorzagliatin.ConclusionDorzagliatin has good glycaemic efficacy and well tolerated over 6-months use. Mild increase in body-weight, serum triglycerides and overall adverse events remain issues of concern warranting further evaluation in longer clinical trials with active controls.     

Efficacy and safety of novel thiazolidinedione lobeglitazone for managing type-2 diabetes a meta-analysis

Background and aimsNo meta-analysis has analysed the safety and efficacy of lobeglitazone in type-2 diabetes (T2DM). We undertook this meta-analysis to address this knowledge-gap.MethodsElectronic databases were searched for RCTs involving type-2 diabetes patients receiving lobeglitazone in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in glucose, lipids and adverse events.ResultsFrom initially screened 65 articles, data from 4 RCTs (828 patients) which fulfilled all criteria was analysed. Over 24 weeks, when compared to sitagliptin 100 mg/d and half maximal pioglitazone dose (15 mg/d), lobeglitazone 0.5 mg/day had comparable impact on HbA1c [MD 0.03% (95%CI: 0.11–0.17); P = 0.65; I² = 0%], fasting glucose [MD 1.47 mg/dl (95%CI: 4.66–7.60); P = 0.64; I² = 0%], triglycerides [MD-9.96 mg/dl (95%CI: 43.55–23.62); P = 0.56; I² = 81%], LDL-cholesterol [MD0.74 mg/dl (95%CI: 4.60–6.09); P = 0.79; I² = 0%] and HDL-cholesterol [MD1.55 mg/dl (95%CI: 3.72–6.82); P = 0.56]. Occurrence of treatment-emergent adverse events (AEs) [RR 1.07 (95% CI:0.78–1.47); P = 0.67; I² = 0%] and severe AEs [RR 1.05(95%CI: 0.42–2.65); P = 0.91; I² = 0%] were similar. Edema and weight gain were significantly higher with lobeglitazone compared to controls [RR 2.58 (95%CI: 1.08–6.17); P = 0.03; I² = 0%]. Lobeglitazone 0.5 mg/d compared to half-maximal pioglitazone (15 mg/d), had similar edema and weight gain [RR 1.65 95% CI: 0.78–1.47)]. BMD percent changes at neck of femur was comparable in both groups [MD 0.07% (95%CI: 0.19–0.33); P = 0.60; I² = 91%]. Low dose lobeglitazone (0.25 mg/d) was inferior to high dose lobeglitazone (0.5 mg/d) with regards to glycaemic efficacy with advantage of lower weight gain and edema.ConclusionThe current evidence makes lobeglitazone unlikely to replace pioglitazone as the preferred thiazolidinedione in T2DM.     

Efficacy and safety of long-acting growth hormone in adult growth hormone deficiency: A systematic review and meta-analysis

Background & aimsNo meta-analysis has analysed efficacy and safety of long-acting growth hormone (GH) therapy in adult GH deficiency. We undertook this meta-analysis to address this gap in knowledgeMethodsElectronic databases were searched for RCTs involving adult GH deficiency patients receiving weekly long-acting GH as compared to daily GH/placebo controls. Primary outcome was to evaluate changes in body-composition parameters. Secondary outcomes were to evaluate alterations in glycaemia and adverse-events.ResultsData from 5 studies involving 648 patients were analysed (4 studies having daily GH as active controls; 1 study having placebo as passive controls). Over 24–34 weeks clinical use, patients receiving long-acting GH had comparable change in lean mass [MD-0.28 kg (95%CI: 0.94 – 0.38); P = 0.41; I² = 29% (low heterogeneity)] and fat mass [MD-0.10 kg (95%CI: 1.97–1.78); P = 0.92; I² = 77%(considerable heterogeneity)] as compared to daily GH injections. Long-acting GH use was associated with significantly lower visceral adipose tissue [MD-1.75 cm²(95%CI: 2.14 to ?1.35); P < 0.01; I² = 0% (low heterogeneity)] and higher gynoid fat-mass [MD 0.14 kg(95%CI:0.02–0.26); P = 0.03] compared to daily GH injections. Total adverse events [Risk ratio (RR) 1.65 (95% CI: 0.83–3.29); P = 0.15; I² = 68%] and severe adverse events [RR 0.60 (95% CI: 0.30–1.19); P = 0.14; I² = 0%] were not significantly different in long-acting GH group compared to controls. Occurrence of headache, arthralgia, nasopharyngitis, new onset diabetes, anti-GH antibodies were comparable among groups. Long-acting GH users had significantly higher treatment adherence compared to controls [OR 4.80 (95%CI:3.58–6.02); P < 0.01; I² = 0%].ConclusionLong-acting GH has comparable beneficial impact on body composition parameters in adult GH deficiency, is well tolerated without any increased adverse events.     

Predictors of same-admission cholecystectomy in mild,acute, biliary pancreatitis

BackgroundFailure to perform same-admission cholecystectomy (SA-CCY) for mild, acute, biliary pancreatitis (MABP) is a recognized risk factor for recurrence and readmission. However, rates of SA-CCY are low and factors associated with these low rates require elucidation.MethodsPrimary MAPB admissions were pooled from NIS 2000–2014 (weighted n = 578 258). Patients with chronic pancreatitis, pancreatic masses, alcohol-related disorders, hypertriglyceridemia, acute cholecystitis and AP-related organ dysfunction or complications were excluded. Annual rates of SA-CCY were calculated. Regression model for prediction of SA-CCY was built on 2010–2011 subset (weighted n = 74 169), yielding 96.3% of complete observations.ResultsNationwide rate of SA-CCY in the U.S. was 40.8%. In multivariate analysis, SA-CCY was positively associated with BMI>30 (OR = 1.4, 95%CI 1.2–1.6), Asian ethnicity (vs. Black; OR = 1.2, 95%CI 1.0–1.5), private insurance (vs. Medicare; OR = 1.1, 95%CI 1.0–1.3), large (vs. small; OR = 1.3, 95%CI 1.2–1.4) urban hospitals (vs. rural; OR = 1.5 95%CI 1.3–1.7) of the South (vs. Northeast; OR = 1.5, 95%CI 1.3–1.7), as well as with chronic cholecystitis (OR = 17.0, 95%CI 15.4–18.7) and abdominal-wall hernias (OR = 5.2; 95%CI 3.0–8.9); the latter two predictors were not included in the final model. SA-CCY was negatively associated with age >40 (OR = 0.72; 95%CI 0.66–0.79), male gender (OR = 0.86, 95%CI 0.80–0.93), dementia (OR = 0.88, 95%CI 0.72–1.1), chronic comorbidities (OR = 0.64; 95%CI 0.54–0.77) and ostomies (OR = 0.51; 95%CI 0.31–0.86).ConclusionAdherence to SA-CCY guidelines for MABP remains inadequate. Independent geographic variation in SA-CCY rates may be related to reimbursement differences, ownership of AP patients, accessibility to surgical care, or cultural characteristics of the patient population.     

Dairy product consumption and risk of non-alcoholic fatty liver disease: A systematic review and meta-analysis of observational studies

Background and aimsIt is unclear whether regular consumption of dairy products is associated with the risk of developing non-alcoholic fatty liver disease (NAFLD). Thus, we conducted a systematic review followed by a meta-analysis of studies reporting on the association of dairy consumption with NAFLD risk.Methods and resultsWe comprehensively searched PubMed, Web of Science, and Scopus for observational studies that evaluated the association between dairy intake and NAFLD likelihood that were published before September 1, 2022. The reported odds ratios (ORs) of fully adjusted models and their 95% confidence intervals (CIs) were pooled using a random-effects model for the meta-analysis. Out of 1206 articles retrieved, 11 observational studies, including 43,649 participants and 11,020 cases, were included. Pooled OR indicated a significant association between dairy intake and NAFLD (OR = 0.90; 95% CI: 0.83, 0.98; I² = 67.8%, n = 11). Pooled ORs revealed that milk (OR: 0.86; 95% CI: 0.78, 0.95; I² = 65.7%, n = 6), yogurt (OR: 0.88; 95% CI: 0.82; I² = 0.0%, n = 4), and high-fat dairy (OR: 0.38; 95% CI: 0.19, 0.75; I² = 0.0%, n = 5) consumption was inversely associated with NAFLD while cheese was not linked to NAFLD risk.ConclusionWe observed that consumption of dairy products is linked to a reduced risk of developing NAFLD. Overall, the data in the source articles is of low to moderate quality; therefore, further observational studies are required to support the current findings (PROSPERO Reg. number: CRD42022319028).     

Impact of semaglutide on biochemical and radiologic measures of metabolic-dysfunction associated fatty liver disease across the spectrum of glycaemia: A meta-analysis

Background and aimsNo meta-analysis has analysed efficacy and safety of semaglutide in metabolic-dysfunction associated fatty-liver disease (MAFLD).MethodsElectronic databases were searched for RCTs involving people with MAFLD and/or type-2 diabetes (T2DM) receiving semaglutide. Primary outcome was to evaluate changes in alanine aminotransferase (ALT). Secondary outcomes were to evaluate alterations in other measures of NAFLD, glycaemia, lipids and adverse-events.ResultsData from 4 RCTs (2115 patients) was analysed. A greater lowering with injectable semaglutide 0.4mg/0.5 mg once weekly was seen with regards to ALT [MD -3.89U/L (95%CI: ?5.41 to ?2.36); P < 0.01; I² = 0%; 2050 patients], liver stiffness (fibroscan®) [MD -3.19 kPa (95%CI: ?3.26 to ?3.12); P < 0.01; 162 patients], steatosis [MD -13.40 dB/m (95%CI: 20.56 to ?6.24); P < 0.01; 162 patients], triglycerides [MD -21.43 mg/dl (95% CI: 41.63 to ?1.23); P = 0.04; I² = 99%; 2050 patients], total cholesterol [MD -5.53 mg/dl (95% CI: ?8.45 to ?2.61); P < 0.01; I² = 0%; 1888 patients], LDL-cholesterol [MD -3.55 mg/dl (95% CI: ?5.87 to ?1.23); P < 0.01; I² = 0%; 1888 patients], percent-weight [MD -8.99% (95%CI: ?14.64 to ?3.34); P = 0.002; I² = 100%; 2115 patient] and HbA1c [MD -0.77% (95%CI: 1.10 to ?0.45); P = 0.002; I² = 100%; 2115 patients]. Number of patients inadequate to comment on histopathologic measures of MAFLD. Occurrence of treatment-emergent adverse-events [RR 2.31 (95% CI: 0.76–7.06); P = 0.14; I² = 82%] and severe adverse events [RR 1.07 (95%CI: 0.69–1.65); P = 0.77; I² = 33%] were comparable. Adverse-events leading to trial discontinuation [RR 2.37 (95% CI: 1.33–4.22); P = 0.003; I² = 24%], diarrhea [RR 2.05 (95%CI: 1.17–3.60); P = 0.01; I² = 66%], nausea [RR 4.98 (95%CI: 3.23–7.67); P < 0.001; I² = 0%] and vomiting [RR 3.90 (95%CI: 1.75–8.68); P < 0.01; I² = 54%] were higher with semaglutide.ConclusionThis meta-analysis provides reassuring data on efficacy of low dose semaglutide injections in improving ALT and certain radiologic features in MAFLD. Current conclusions are limited by small number of patients evaluated. Urgent need remains for larger studies focussing on liver biopsy.     

Effect of colchicine on mortality in patients with COVID-19 – A systematic review and meta-analysis

Background and aimThis systematic review and meta-analysis aimed to evaluate the latest evidence on the association between colchicine and mortality in patients with COVID-19.MethodsWe performed a comprehensive literature search from the PubMed, Scopus, Embase, EuropePMC, and Clinicaltrials.gov up until 02 January 2022. We include randomized controlled trials (RCTs) and observational studies reporting colchicine use in patients with COVID-19 and mortality within 30 days. The intervention group was patients given colchicine during the course of treatment. The control group was patients given placebo or standard of care at the respective institutions. The outcome was mortality. The effect estimate was reported as risk ratio (RR).ResultsThere were 12 studies comprising of 6953 patients included in this meta-analysis. Mortality rate was 0.18 [95%CI 0.10, 0.26] in the colchicine group and 0.26 [95%CI 0.15, 0.38] in the control group. Colchicine was associated with reduction in mortality (RR 0.66 [95%CI 0.53, 0.83], p < 0.001; I²: 42%). Sensitivity analysis using fixed-effect model (RR 0.73 [95%CI 0.63, 0.83], p < 0.001; I²: 42%. Subgroup analysis on the four RCTs showed non-significant result (RR 0.81 [95%CI 0.54, 1.20], p = 0.29; I²: 10%). Meta-regression showed that the association between colchicine and reduced mortality was not affected by age (p = 0.613) [Fig. 3], sex (p = 0.915), diabetes (p = 0.795), and hypertension (p = 0.403).ConclusionThough the meta-analysis showed decreased mortality with colchicine in patients with COVID-19, the meta-analysis of randomized trials did not show any significant effect of colchicine on mortality.     

Pre-Procedural Hyperglycemia Increases the Risk of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Systematic Review and Meta-Analysis

BackgroundContrast-induced nephropathy (CIN) frequently occurs following coronary angiography (CAG) and is associated with worse outcomes, including both short and long-term mortality. Previous studies reported an association between procedural hyperglycemia (PH) and CIN, with or without diabetes mellitus (DM). We performed a systematic review and meta-analysis to explore the association of PH and CIN in patients undergoing CAG.MethodsWe searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies investigated CIN incidence in patients undergoing CAG. Data from each study were combined using the random-effects model.ResultsA total of eight studies were included in this meta-analysis. We found that PH was associated with an increased risk of CIN following CAG (pooled OR = 1.71, 95%CI:1.35–2.16, where PH was defined as ≥140 mg/dl; and pooled OR = 2.07, 95%CI:1.80–2.37, where PH was defined as ≥200 mg/dl). In subgroup analysis of non-diabetic patients and STEMI patients undergoing primary percutaneous coronary intervention, we found that PH was associated with an increased risk of CIN in both subgroups, where PH was defined as ≥140 mg/dl and ≥200mg/dl (p-value < 0.05).ConclusionsOur meta-analysis demonstrated that PH significantly increases the risk of CIN following CAG, in both diabetic and non-diabetic populations. Further studies are needed to evaluate whether strict blood glucose control can reduce the incidence of CIN in this population.     

Primary biliary cholangitis in pregnancy: A systematic review with meta-analysis

BackgroundThe outcomes and disease associations in pregnant women with primary biliary cholangitis (PBC) have not been largely explored. This study aimed to determine the level of evidence associated with maternal and fetal outcomes and other disease associations in female patients with PBC.Data sources:A comprehensive literature search was conducted. Maternal and fetal outcomes were obtained from patients with a previous, current or subsequent diagnosis of PBC. A random-effects model was employed, using odds ratios (ORs) with 95% confidence intervals (CIs).ResultsEleven studies, with 2179 female PBC patients were included. Pregnant women with PBC were significantly more likely to have a miscarriage (OR = 1.27, 95% CI: 1.02-1.58; P = 0.03), and a history of abortion (OR = 1.50, 95% CI: 1.09-2.07; P = 0.01), with absent heterogeneity (I² = 0%). PBC pregnant women were significantly more likely to deliver via vaginal birth (OR = 1.69, 95% CI: 1.33-2.14; P < 0.001) with low level heterogeneity (I² < 0.001%). Patients had a statistically significant increased likelihood of lifetime smoking (OR = 1.95, 95% CI: 1.17-3.23; P = 0.01). Egger's regression revealed no evidence of publication bias.ConclusionsThis meta-analysis provides pooled evidence that a PBC pregnancy is associated with fetal morbidity and maternal lifestyle associations that may influence pregnancy outcomes. More studies are needed to establish disease associations that may directly affect pregnancy outcomes. These data are essential for clinicians managing these patients before, during or after pregnancy.     

Triglyceride to high-density lipoprotein cholesterol ratio and cardiovascular events in the general population: A systematic review and meta-analysis of cohort studies

AimsThe ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) has been regarded as a novel surrogate indicator of insulin resistance and the atherogenic index of plasma. This meta-analysis aimed to evaluate the association between the TG/HDL-C ratio and the incidence of cardiovascular events in the general population.Data synthesisCohort studies reporting the association between the TG/HDL-C ratio and cardiovascular events in the general population were obtained by a systematic literature search of PubMed, Embase and Web of Science databases until April 11, 2021. 13 cohort studies with a total of 207,515 participants were included in this meta-analysis. In a random-effects model, compared with those with the lowest category of the TG/HDL-C ratio, participants with the highest category were independently associated with a higher risk of cardiovascular events (pooled HR: 1.43, 95%CI: 1.26–1.62, I² = 72.9%). For the presence of publication bias detected by the Egger's test (p = 0.011), correction for publication bias using the trim-and-fill method reduced the HR to 1.26 (95%CI: 1.11–1.44). This result was consistent with the finding of the TG/HDL-C ratio analyzed as a continuous variable (pooled HR per unit increment of the TG/HDL-C ratio: 1.08, 95%CI: 1.04–1.12, I² = 67.0%). Subgroup analyses indicated that population gender, geographical region, duration of follow-up, adjustment for other lipid parameters, adjustment for diabetes and categorical number did not significantly vary the relationship.ConclusionElevated TG/HDL-C ratio may be independently associated with an increased risk of cardiovascular events in the general population. More well-designed studies are needed to confirm the current findings.Registration number in PROSPEROCRD42021244583.     

Prevalence and risk factors of hypertension among Hui population in China: A systematic review and meta-analysis based on 30,565 study participants

Background:Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population.Methods:PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case–control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package.Results:Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%–32%, I² = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%–33%, I² = 97.6%, P < .001) for males and 30% (95%CI: 23%–37%, I² = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%–6%, I² = 70.6%, P = .065), 10% (95%CI: 3%–17%, I² = 83.7%, P < .001), 22% (95%CI: 12%–32%, I² = 87.9%, P < .001), 37% (95%CI: 20%–53%, I² = 94.0%, P < .001), 39% (95%CI: 24%–54%, I² = 97.7%, P < .001) and 42% (95%CI: 29%–56%, I² = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%–29%, I² = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%–30%, I² = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03–5.13, I² = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60–4.71, I² = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61–2.09, I² = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26–2.39, I² = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04–3.54, I² = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81–2.66, I² = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10–1.51, I² = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66–0.88, I² = 62.7%, P < .001) was protective factor.Conclusions:The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.     

Vitamin D and histologic severity of nonalcoholic fatty liver disease: A systematic review and meta-analysis

BackgroundNAFLD and vitamin D deficiency often coexist and epidemiologic evidence has shown that both of these conditions share several risk factors. Recent studies investigating the relationship between vitamin D levels and severity of NAFLD showed conflicting results. Thus we conducted a systematic review and meta-analysis to evaluate association between vitamin D and NAFLD histologic severity.MethodsA comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through November 2016. Observational studies compared serum vitamin D levels among NAFLD patients with high and low histologic severity, which was determined by NAFLD activity score (NAS) and fibrosis score. We calculated pooled mean difference (MD) of 25-hydroxyvitamin D levels with 95% confidence intervals (CI) using random-effects model.ResultsData were extracted from 6 studies involving 974 NAFLD patients. There was no difference in 25-hydroxyvitamin D levels among NAFLD patients with high NAS (score of ≥5) versus low NAS (pooled MD = −0.93, 95%CI −2.45 to 0.58, I² = 0%) and also high fibrosis score (score of ≥3) versus low fibrosis score (pooled MD = 0.88, 95%CI −2.65 to 4.42, I² = 64%).ConclusionsDespite evidence implicating vitamin D in NAFLD pathogenesis, serum 25-hydroxyvitamin D may not be associated with NAFLD histologic severity.     

Safety of SARS-CoV-2 vaccination in patients with inflammatory bowel disease: A systematic review and meta-analysis

IntroductionRisk of adverse effects and flare of inflammatory bowel disease (IBD) are frequently cited reasons for COVID-19 vaccine hesitancy.MethodsElectronic databases were searched to identify studies reporting the use of COVID-19 vaccine in IBD. We selected studies reporting the incidence of various adverse effects (local or systemic) and flares of IBD after COVID-19 vaccination. The pooled incidence rates for various adverse effects, stratified for the dose and the type of vaccine (adenoviral or mRNA) were estimated.ResultsNine studies (16 vaccination cohorts) were included. The pooled incidence rate of overall adverse events was 0.55 (95%CI, 0.45–0.64, I²= 95%). The pooled incidence rate of local adverse events was 0.64 (0.47–0.78, I²= 100%). The pooled incidence rates of fatigue, headache, myalgia, fever and chills were 0.30 (0.21–0.40, I²= 99%), 0.23 (0.17–0.30, I²= 99%), 0.18 (0.13–0.24, I²= 99%), 0.10 (0.06–0.17, I²= 98%) and 0.15 (0.06–0.3, I²= 86%), respectively. The pooled incidence rates of severe adverse events, adverse events requiring hospitalization and flares of IBD following COVID-19 vaccination were 0.02 (0.00–0.12, I²= 97%), 0.00 (0.00–0.01, I²= 27%) and 0.01 (0.01–0.03, I²= 45%), respectively.ConclusionCOVID-19 vaccination in patients with IBD appears to be safe with only mild adverse events. Flares of IBD and severe adverse events requiring hospitalization were infrequent.     

Association of transferrin G258A and transferrin receptor A82G polymorphisms with the risk of Parkinson disease in certain area

Background:It has been reported that polymorphisms of transferrin (TF) G258A and transferrin receptor (TFR) A82G might be associated with susceptibility to Parkinson disease (PD).Objective:Owing to limitation of sample size and inconclusive results, we conducted a meta-analysis to clarify the association.Methods:By searching PubMed, Embase, Chinese National Knowledge Infrastructure, China Biological Medicine Database, and Wanfang Databases, the published articles about studies of the association of the TF G258A, TFR A82G gene polymorphisms with the risk of PD were collected. Q-statistics and I² statistics were calculated to examine heterogeneity and summary odds ratios (ORs) and 95% confidence intervals (95%CI) were evaluated the association.Results:Five studies assessed the relationship between TF G258A and risk of PD. A significant increased protective of A allele and AA genotype was observed in allele model and recessive model (the allele model A vs G: OR = 0.54, 95%CI 0.40–0.72, P < .001; the recessive model AA vs GA + GG: OR = 0.32, 95%CI 0.20–0.52, P < .001). The remaining models of the TF G258A genotype showed no significant association with PD risk, while the protective tendency were increased (the heterozygote model GA vs GG: OR = 0.93, 95%CI 0.61–1.43, P = .75; the homozygous model AA vs GG: OR = 0.47, 95%CI 0.21–1.04, P = .06; the dominant model GA + AA vs GG: OR = 0.75, 95%CI 0.50–1.11, P = .15). There was also a lack of association between TFR A82G polymorphism and PD (the allele model G vs A: OR = 0.92, 95%CI 0.75–1.13, P = .43; the heterozygote model AG vs AA: OR = 1.17, 95%CI 0.79–1.71, P = .43; the homozygous model GG vs AA: OR = 0.91, 95%CI 0.60–139, P = .66; the dominant model AG + GG vs AA: OR = 1.05, 95%CI 0.73–1.49, P = .81; the recessive model GG vs AG +AA: OR = 0.80, 95%CI 0.59–1.09, P = .16).Conclusion:Our study suggests that TF G258A polymorphism may be associated with PD, while TFR A82G polymorphism may not contribute to PD based on the current evidence.     

Maternal pre‐pregnancy obesity and child neurodevelopmental outcomes: a meta‐analysis

This review examined evidence of the association between maternal pre‐pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta‐analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I² = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I² = 79.63). Pre‐pregnancy obesity increased the risk of attention deficit–hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I² = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I² = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I² = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I² = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.