Risk factors for hypertension in rheumatoid arthritis patients–A systematic review

IntroductionRheumatoid arthritis is frequently associated with hypertension, which has been shown to increase the risk of cardiovascular disease in these patients. The aim of this systematic review was to explore demographic, behavioural or clinical factors including medication use, associated with incident hypertension in rheumatoid arthritis.MethodsMEDLINE and Scopus were searched for eligible studies that longitudinally investigated incident hypertension or changes in blood pressure (BP) in rheumatoid arthritis patients. Publications were screened by two reviewers according to predetermined inclusion and exclusion criteria. The quality of included studies was assessed via the Newcastle Ottawa Scale and Cochrane Risk of Bias Tool.ResultsFourteen studies were deemed eligible and included in this review. The proportion of female subjects ranged from 12 to 87% and the mean age ranged from 47 to 61 years. Regular exercise was associated with a decrease in systolic BP, p = 0.021. Methotrexate was associated with decreased risk of hypertension in two studies. LEF was associated with increased BP in two studies. COX-2 inhibitors were associated with systolic BP and diastolic BP variability (p = 0.009, 0.039, respectively) in one study. Prednisone was found to increase BP and risk of hypertension in three studies. The risk of hypertension in patients taking biologic disease modifying anti-rheumatic drugs (DMARDs) is unclear as some studies report increased BP while others report no difference for biologic compared to conventional DMARDs.ConclusionDespite limited longitudinal studies exploring this topic, methotrexate and exercise were shown to protect against risk of hypertension in RA patients, while prednisone and COX-2 inhibitors may increase risk of hypertension.     

Cost–benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37–16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025–19 170) US$ per month; median savings were 38 751 (IQR 14 206–75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with <500-beds and with interventions of >6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening.     

Methicillin-resistant Staphylococcus aureus in food products: cause for concern or case for complacency?

The widespread use of antimicrobial agents, in combination with insufficient infection control measures, is the main driver of the current pandemic of antimicrobial resistance in human pathogens. The use of antimicrobials in food animal production also contributes, because resistant organisms and resistance genes can spread from animals to humans by direct contact or through the food chain. An important, traditionally human, pathogen, methicillin-resistant Staphylococcus aureus (MRSA), is currently endemic in many hospitals around the world and has also emerged in the community. Recently, a new reservoir of MRSA has been identified in food production animals and people in contact with these animals. This involves a specific clone, multilocus sequence type 398 (ST398), which has spread extensively among animals. ST398 has also been found in up to 11.9% of retail meat samples in several surveys from different parts of the world, posing a potential threat to human health.     

Risk factors for and molecular characteristics of methicillin-resistant Staphylococcus aureus nasal colonization among healthy children in southern Taiwan, 2005–2010

Background/purposeNasal colonization of Staphylococcus aureus is a well-defined risk factor for subsequent infection. This study investigated the prevalence of methicillin-resistant S. aureus (MRSA) in southern Taiwan and aimed to identify the host factors for S. aureus colonization and the virulence factor of Panton-Valentine Leukocidin (PVL) genes.MethodsIn a hospital-based study in Kaohsiung from Oct. 2005 to Dec. 2010, we performed nasal swab in the healthy children aged 2–60 months. We examined the relationship between the demographic characteristics and S. aureus nasal colonization. MRSA isolates were further analyzed for antimicrobial susceptibility and molecular characteristics.ResultsAmong 3020 healthy children, 840 (27.8%) children had S. aureus nasal colonization. Of 840 isolates, 246 (29.3%) isolates were MRSA. MRSA colonization was significantly associated with age 2–6 months, day care attendance, and influenza vaccination. Breastfeeding was a protective factor against MRSA colonization. Most MRSA isolates were susceptible to trimethoprim-sulfamethoxazole and doxycycline. Ninety-four percent of MRSA isolates carried either type IV staphylococcal cassette chromosome mec (SCCmec) or SCCmec V_T and 87% belonged to the local community strains, namely clonal complex 59/SCCmec IV or V_T. MRSA isolates with PVL-negative was associated with children with passive smoking.ConclusionsBetween 2005 and 2010, 27.8% and 8.14% of healthy children in southern Taiwan had nasal carriage of S. aureus and MRSA, respectively. Most MRSA isolates were local community strains. Several demographic factors associated with nasal MRSA colonization were identified.     

Evaluation of vancomycin MIC creep in methicillin-resistant Staphylococcus aureus infections—a systematic review and meta-analysis

ObjectivesVancomycin is currently the primary option treatment for methicillin-resistant Staphylococcus aureus (MRSA). However, an increasing number of MRSA isolates with high MICs, within the susceptible range (vancomycin MIC creep), are being reported worldwide. Resorting to a meta-analysis approach, this study aims to assess the evidence of vancomycin MIC creep.MethodsWe searched for studies in the PubMed database. The inclusion criteria for study eligibility included the possibility of retrieving the reported data values of vancomycin MIC and information concerning the applied MIC methodology.ResultsThe mean values of vancomycin MICs, of all 29 234 S. aureus isolates reported in the 55 studies included in the meta-analysis, were 1.23 mg/L (95% CI 1.13–1.33) and 1.20 mg/L (95% CI 1.13–1.28) determined by Etest and broth microdilution method, respectively. No significant differences were observed between these two methodologies. We found negative correlation between pooled mean/pooled proportion and time strata.ConclusionsWe have found no evidence of the MIC creep phenomenon.     

Risk factors for apathy in Alzheimer’s disease: A systematic review of longitudinal evidence

BackgroundApathy is frequent and persistent in Alzheimer’s disease (AD), associated with poor prognosis and carer distress; yet our knowledge of risk factors remains limited.AimsTo identify risk factors associated with apathy incidence and progression in AD over time.MethodsWe systematically reviewed evidence based on longitudinal studies assessing risk factors for apathy in AD up to June 2021. Two authors independently assessed article eligibility and rated quality.Results13,280 articles were screened, of which 13 met inclusion criteria. Studies had a mean follow-up of 2.7 years reporting on a total of 2012 participants. Most findings were based on single studies of moderate quality evidence. Risk factors increasing apathy onset were: being a carrier of the T allele of the PRND gene polymorphism, and having high levels of the IL-6 and TNFα cytokines at baseline. Risk factors for apathy worsening were: reduced inferior-temporal cortical thickness, taking antidepressants, being an ApoE ε4 carrier, living longer with AD, lower cognitive test scores, higher baseline apathy, premorbid personality traits (lower agreeableness, higher neuroticism), and higher midlife motivational abilities.ConclusionsAlthough results are limited by the small number of studies, this review identified specific genetic, neurobiological, AD specific, and dispositional factors that may increase risk of apathy onset and worsening in AD.     

The risk of systemic lupus erythematosus associated with Epstein–Barr virus infection: a systematic review and meta-analysis

Previous systematic reviews have found a higher sero-prevalence of EBV antibodies in SLE patients compared with controls. Because many studies have been published, there is a need to apply more precise systematic review methods. We examined the association between EBV and SLE patients by conducting a systematic review and meta-analysis of case–control studies that examined the prevalence of EBV antibodies and the DNA-positive rate. We searched the MEDLINE and EMBASE databases from 1966 to 2018 with no language restrictions. The Mantel–Haenszel odds ratios (OR) for EBV antibody sero-positivity were calculated, and meta-analyses were conducted. Quality assessment was performed using a modified version of the Newcastle–Ottawa scale, and 33 studies were included. Most studies found a higher sero-prevalence of VCA IgG and EA IgG in SLE patients compared with controls. Meta-analysis demonstrated a significantly higher OR for sero-positivity to VCA IgG and EA IgG for SLE cases (2.06 [95% confidence interval (CI) 1.30–3.26, p = 0.002] and 7.70, [95% CI 4.64–12.76, p < 0.001], respectively). The overall OR for the DNA-positive rate for SLE patients compared with controls was 3.86 (95% CI 1.52–9.83, p = 0.005). Other antibodies, i.e., VCA IgA/IgM, EBNA IgA, and EA IgA/IgM, also demonstrated a significant difference between SLE patients and controls. These findings support previous systematic reviews; however, publication bias cannot be excluded. The methodological conduct of studies could be improved, particularly when selecting controls and analyses of laboratory conduct.

     

Impact of source of infection and vancomycin AUC0–24/MICBMD targets on treatment failure in patients with methicillin-resistant Staphylococcus aureus bacteraemia

Despite recent controversies about toxicity and reduced efficacy, vancomycin remains the current treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. The parameter associated with treatment success is the vancomycin 24-h area under concentration-time curve to MIC ratio (AUC_0–24/MIC). We aimed to determine the utility of calculated AUCs and explore the optimal AUC_0–24/MIC targets associated with treatment success. In this single-centre retrospective observational cohort study of 127 patients with MRSA bacteraemia, forty-five (35.4%) did not respond to vancomycin treatment. Patient characteristics were essentially the same between those who did not respond to vancomycin treatment and those with treatment success, with independent predictors of treatment failure being source of bacteraemia (odds ratio (OR), 4.29; 95% confidence interval (CI), 1.50–12.26; p 0.007) and not achieving an AUC_0–24/MIC_BMD (using broth microdilution) target of ≥398 (OR, 11.4; 95% CI, 4.57–28.46; p< 0.001). Bacteraemic source-specific thresholds were observed with a higher AUC_0–24/MIC_BMD target of 440 required for high-risk sources (e.g. infective endocarditis) compared with 330 for low-risk sources (line related bacteraemia). Overall treatment success in patients with MRSA bacteraemia was associated with a vancomycin AUC_0–24/MIC_BMD target of ≥398, with source-specific targets observed. Future vancomycin practice guidelines will need to take into account MIC methodology, source of bacteraemia and patient populations prior to setting targets and monitoring recommendations.     

Pneumonia complicated with empyema in children, to operate or not? Risk factors for surgery and review of the literature

The precise indication for surgery for pleural empyema is still a controversy. With the aim of identifying the risk factors associated with surgery in pediatric patients with empyema post-pneumonia, a retrospective case control study was performed. From 1992 to 1996, 18 children underwent surgery (cases) and 12 did not (controls). The analyzed variables were those mentioned in the literature as risk factors. More than 25 days of evolution, more than three antibiotic schemes, fever, empyema organizing phase, two or more chest tubes lasting more than nine days, multiple loculations, trapped lung and paquipleura were associated with thoracostomy and decortication (p < 0.05). We conclude that a pediatric patient with a late referral to the hospital, empyema organizing phase, and multiple loculations with large purulent collections no longer susceptible to drainage and complications that impair lung expansion will probably require major surgery.     

Causes of chest pain in primary care – a systematic review and meta-analysis

Aim

To investigate the frequencies of different and relevant underlying etiologies of chest pain in general practice.

Methods

We systematically searched PubMed and EMBASE. Two reviewers independently rated the eligibility of publications and assessed the risk of bias of included studies. We extracted data to calculate the relative frequencies of different underlying conditions and investigated the variation across studies using forest plots, I², tau², and prediction intervals. With respect to unexplained heterogeneity, we provided qualitative syntheses instead of pooled estimates.

Results

We identified 11 eligible studies comprising about 6500 patients. The overall risk of bias was rated as low in 6 studies comprising about 3900 patients. The relative frequencies of different conditions as the underlying etiologies of chest pain reported by these studies ranged from 24.5 to 49.8% (chest wall syndrome), 13.8 to 16.1% (cardiovascular diseases), 6.6 to 11.2% (stable coronary heart disease), 1.5 to 3.6% (acute coronary syndrome/myocardial infarction), 10.3 to 18.2% (respiratory diseases), 9.5 to 18.2% (psychogenic etiologies), 5.6 to 9.7% (gastrointestinal disorders), and 6.0 to 7.1% (esophageal disorders).

Conclusion

This information may be of practical value for general practitioners as it provides the pre-test probabilities for a range of underlying diseases and may be suitable to guide the diagnostic process.Chest pain is a common complaint in all health care settings and can be caused by a wide range of conditions – from diseases with favorable prognosis like musculoskeletal disorders to acute and potentially life-threatening conditions like coronary heart disease (1). Most patients with chest pain are initially seen by their general practitioner (GP) who faces the challenge to triage them. To fulfill this task, GPs need to know the relevant etiologies and their respective frequencies. In an intuitive process of probabilistic reasoning GPs combine the initial likelihood for a given etiology (pre-test probability) with their findings from the patient’s history and the clinical examination in order to reach a final or at least tentative diagnosis (post-test probability) (2,3).Important information is provided by studies of symptoms, which investigate patients presenting with a defined symptom in a health care setting. In particular, they (4) aim to answer three main questions: How often do patients present with the respective symptom? What are the underlying conditions and their respective frequencies? What is the prognosis of these patients? While in the medical literature there are many studies on effects of treatment, causation of disease, or on diagnostic tests, studies of symptoms are not performed as often. As the results of single studies can show large variations, it is desirable to summarize existing information in a systematic review.Therefore, we conducted a systematic review of studies investigating the symptom of chest pain in primary care. Since knowledge of relevant etiologies and their respective frequencies has the highest practical value for clinicians, we confine the current article to the reporting on this research question.     

Accuracy of interferon-γ-induced protein 10 for diagnosing latent tuberculosis infection: a systematic review and meta-analysis

BackgroundEffective diagnostic methods for detecting latent tuberculosis infection (LTBI) are important for its eradication. A number of studies have evaluated the use of interferon-γ-induced protein 10 (IP-10), which is elevated after tuberculosis infection, as a biomarker for LTBI, but conclusive results regarding its effectiveness have not been reported.ObjectivesOur objective was to assess the diagnostic value of IP-10 for LTBI.Data sourcesWe searched the PubMed, Embase, the Cochrane Library and Web of Science databases to find eligible studies.Study eligibility criteriaWe included cohort, case–control and cross-sectional studies that evaluated IP-10 in LTBI participants in comparison with tuberculin skin tests (TST) and interferon-γ release assays (IGRA).ParticipantsIndividuals with LTBI and uninfected participants.InterventionsIP-10 (index test) compared with TST and IGRA (reference standard) for diagnosing LTBI.MethodsPubMed, Embase, the Cochrane Library, and Web of Science databases were searched up to June 2018. A hierarchical summary receiver operating characteristic (HSROC) model was used to evaluate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and HSROC curve for the diagnostic efficiency of IP-10.ResultsTwelve studies including 1023 participants and 1122 samples were included. The overall pooled sensitivity was 0.85 (95% CI 0.80–0.88), specificity was 0.89 (95% CI 0.84–0.92), PLR was 7.55 (95% CI 5.20–10.97), NLR was 0.17 (95% CI 0.13–0.22) and DOR was 44.23 (95% CI 28.86–67.79), indicating a high accuracy for diagnosing LTBI. Based on a meta-regression analysis, high-burden countries, study design, IP-10 method, reference standard and the IP-10 cut-off could not explain the heterogeneity (p >0.05).ConclusionsOur results suggested that IP-10 is a promising biomarker for the diagnosis of LTBI.     

Epidemiology of non-multiresistant methicillin-resistant Staphylococcus aureus infection in Queensland, Australia: associations with indigenous populations and Panton–Valentine leukocidin

The purpose of this study was to determine the extent of the spread of epidemic clones of non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA) and the epidemiology of resultant infections throughout the state of Queensland. We collected a sample of clinical isolates of nmMRSA from laboratories serving public hospitals and clinics throughout the state. Three hundred isolates were typed and tested for the presence of Panton–Valentine leukocidin (PVL) genes and demographic and clinical data were collected from associated cases. Fifteen percent of S. aureus isolates were nmMRSA and 69% of these belonged to PVL-positive clones, predominantly ST93 and CC30. Low numbers of USA300- and USA400-like isolates were also present. Infections due to PVL-positive strains were much less frequently acquired in hospital (3.4%) than those due to PVL-negative nmMRSA (23.7%). Thirty-seven percent of cases were in indigenous people who make up only 3.6% of the general population. The proportion of cases with PVL-positive, but non-negative isolates decreased progressively with age, suggesting that immunity to PVL might be an important determinant of protection. nmMRSA strains are present throughout Queensland and cause infections in both community and healthcare settings.     

Comparative efficacy of lithium and aducanumab for cognitive decline in patients with mild cognitive impairment or Alzheimer’s disease: A systematic review and network meta-analysis

BackgroundIn 2021, the US Food and Drug Administration granted an accelerated approval to aducanumab for patients with mild cognitive impairment (MCI) and mild dementia caused by Alzheimer’s disease (AD); however, the cost of aducanumab is high, at approximately $28,000 for one year per person. On the other hand, lithium is much cheaper at $40 a year, and has been reported to be effective for the cognitive decline observed in both patients with MCI and AD. In contrast to acetylcholinesterase inhibitors and N-methyl D-aspartate receptor antagonists, aducanumab and lithium may be disease-modifying drugs. Therefore, we focused on aducanumab and lithium and compared the effects of these drugs on the cognitive decline in MCI and AD patients using a network meta-analysis.MethodsPubMed, the Cochrane Library, CINHAL, and ClinicalTrials.gov were searched for randomized controlled trials testing lithium or aducanumab for the treatment of cognitive decline in patients with MCI or AD, up to January 31, 2022. A frequentist fixed-effect network meta-analysis was performed to estimate direct and indirect effects. The primary outcome was change scores in cognitive decline measured by Mini-Mental State Examination. This study has been registered with PROSPERO (number CRD42022304807).ResultsNetwork meta-analysis demonstrated that lithium was significantly more effective than aducanumab in the primary outcome.ConclusionAlthough there were various limitations in this study, lithium may be a more cost-effective treatment than aducanumab for MCI and AD.     

Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study

Differences between the features of invasive community-onset methicillin-resistant Staphylococcus aureus (cMRSA) and methicillin-susceptible S. aureus (cMSSA) infections are incompletely understood. Fifty-seven patients with invasive cMRSA infection were prospectively identified at two teaching hospitals; for each cMRSA case, two cases of invasive cMSSA infection acted as controls. The primary outcome was 30-day all-cause mortality. Patients with invasive cMRSA infection were more likely to be Aboriginal (25% vs. 14%, age-adjusted odds ratio [OR] 2.5, p?=?0.037), reside in a long-term care facility and/or have been hospitalised in the previous year (51% vs. 34%, p?=?0.04) and less likely to have endocarditis (2% vs. 12%, p?=?0.02) or require admission to an intensive care unit or high-dependency area (7% vs. 21%, p?=?0.02). All-cause mortality at 30 days was similar in the cMRSA and cMSSA groups (9% vs. 7%, p?=?0.68). Panton–Valentine leukocidin (PVL) genes were detected in a similar proportion of cMRSA and cMSSA isolates (32% vs. 27%, p?=?0.49) and the presence of PVL genes was associated with younger age (35 years vs. 55 years, p?<?0.001), Aboriginal ethnicity (38% vs. 10%, p?<?0.001), skin and soft-tissue infection (54% vs. 19%, p?<?0.001), lower illness severity at presentation (SAPS II score 9 vs. 21, p?=?0.001) and shorter hospitalisation (9 days vs. 24 days, p?<?0.001). Patients with “PVL-positive” and “PVL-negative” S. aureus infection had similar 30-day all-cause mortality (4% vs. 9%, p?=?0.28). Few clinical features differentiated patients with invasive cMRSA infection from those with infection caused by cMSSA. Invasive “PVL-positive” S. aureus infection was associated with less morbidity but similar mortality to “PVL-negative” infection.