Mohaimenul Islam

Exploring association between statin use and breast cancer risk: an updated meta-analysis

PurposeThe benefits of statin treatment for preventing cardiac disease are well established. However, preclinical studies suggested that statins may influence mammary cancer growth, but the clinical evidence is still inconsistent. We, therefore, performed an updated meta-analysis to provide a precise estimate of the risk of breast cancer in individuals undergoing statin therapy.MethodsFor this meta-analysis, we searched PubMed, the Cochrane Library, Web of Science, Embase, and CINAHL for published studies up to January 31, 2017. Articles were included if they (1) were published in English; (2) had an observational study design with individual-level exposure and outcome data, examined the effect of statin therapy, and reported the incidence of breast cancer; and (3) reported estimates of either the relative risk, odds ratios, or hazard ratios with 95% confidence intervals (CIs). We used random-effect models to pool the estimates.ResultsOf 2754 unique abstracts, 39 were selected for full-text review, and 36 studies reporting on 121,399 patients met all inclusion criteria. The overall pooled risks of breast cancer in patients using statins were 0.94 (95% CI 0.86–1.03) in random-effect models with significant heterogeneity between estimates (I2xa0=xa083.79%, pxa0=xa00.0001). However, we also stratified by region, the duration of statin therapy, methodological design, statin properties, and individual stain use.ConclusionsOur results suggest that there is no association between statin use and breast cancer risk. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variable. Therefore, more research is needed.

Risk factors for ectopic pregnancy in the Taiwanese population: a retrospective observational study

ObjectiveThe aim of this study is to explore the risk factors for ectopic pregnancy (EP) in the Taiwanese population and to identify any unknown risk factors for EP that could assist awareness and diagnosis.MethodsThis retrospective case–control study utilizes Taiwan’s National Health Insurance Research Database (NHIRD). Analysis was conducted with a one million sample database representative of the country’s population. The case group comprised of 6637 individuals in the database that coded for EP using the ICD-9 classification system from January 2003 to December 2011. The control group comprised of 13,270 females matched by age that were never diagnosed with EP during the study period.ResultsThis study provides an analysis of the risk factors of EP utilizing NHIRD. Among the 6637 people diagnosed with EP, logistic regression with age adjustment showed that the highest risk factor was endometriosis (ORxa0=xa08.84, CI 5.13–15.23), followed by polycystic ovary (ORxa0=xa07.74, CI 3.37–17.79) and benign neoplasm of the ovary (6.01, CI 2.18–16.54). All odds ratios were determined to be statistically significant at pxa0<xa00.001.ConclusionThis study has identified the diagnosis of endometriosis and polycystic ovaries as the two largest risk factors for EP in Taiwan, and has also newly identified benign neoplasm of ovary and uterine leiomyoma as risk factors for EP.

Psychotropic medications prescribing trends in adolescents: A nationwide population-based study in Taiwan

ObjectivenTo describe psychotropic medications prescription patterns among adolescents in Taiwan; focusing on age, gender, duration of treatments and various classes of psychotropic medications.nnnDesignnA retrospective description analysis.nnnSettingnTaiwan National Health Insurance Database.nnnParticipantsnTwelve to seventeen years patients treated with psychotropic medications.nnnInterventionnNone.nnnMain Outcome Measure(s)nPercentage and duration of treatment with psychotropic medications during the study periods by medication classes and age groups were calculated. In addition, top three prescribed psychotropic medications were also determined.nnnResultsnA total of 3,120 patients were prescribed psychotropic drugs. The percentage of adolescent patients that received anxiolytics and antidepressants in 2002-2012 were 2.89% and 2.15%, respectively. Also, 851 patients (1.21%) were prescribed hypnotics and 638 (0.91%) were given sedatives. The prevalence rate of the prescription of psychotropic drugs increased steadily with age and females were more treated than males except antipsychotic. Among psychotropic drugs, antidepressants (mean: 8.6 times) were refilled more but antipsychotics (mean 188 days) were the long-term treatment drugs. Additionally, the trend of hospital visits fluctuated over the year while May and December showed a higher rate of visits.nnnConclusionsnThese findings show that the prevalence of psychotropic drug prescriptions in Taiwanese adolescents is even low but increasing trends in the prescription of these medications raises some concern. As the evidence of psychotropic drug safety and effectiveness in adolescents is still inadequate; we recommend that healthcare providers should consider psychotropic drugs therapy, continuously monitor for outcomes and empower their patients to improve their knowledge, therapeutic outcomes and quality of life.

Gout drugs use and risk of cancer: A case-control study

OBJECTIVEnFirm conclusion about whether short and long-term gout medications use has an impact on cancer risk remain inconclusive. The aim of this study was to investigate the association between gout drugs use and risk of cancer.nnnMETHODSnWe conducted a retrospective longitudinal population-based case-control study in Taiwan. Cases were identified all patients who were aged 20years or above, and had a first time diagnosis of cancers for the period between 2001 and 2011. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated by using conditional logistic regression.nnnRESULTSnWe examined 601,733 cases and 2,406,932 matched controls. The adjusted odd ratio for any gout drugs use and overall cancer risk was 1.007 (95% CI: 0.994-1.020). There was a significant risk of leukemia (AOR: 1.34, 95% CI: 1.20-1.50), endometrial cancer (AOR: 1.33, 95% CI: 1.12-1.57), non-Hodgkins (AOR: 1.24, 95% CI: 1.13-1.35), female breast cancer (AOR: 1.21, 95% CI: 1.13-1.29), cervical cancer (AOR: 1.21, 95% CI: 1.07-1.37). However, no association was observed in male group (AOR: 0.97, 95% CI: 0.95-0.98) but female showed a significantly increased risk of cancer at any site (AOR: 1.107, 95% CI: 1.08-1.13).nnnCONCLUSIONnIn summary, our results suggest that gout drugs increase risk of the most common cancers, particularly in leukemia, non-Hodgkins, endometrial, breast and cervical cancer.

Exploring the Association between Statin Use and the Risk of Parkinson’s Disease: A Meta-Analysis of Observational Studies

Background: Parkinson’s disease (PD) is a progressive disorder of the central nervous system. The prevalence of PD varies considerably by age group; it has a higher prevalence in patients aged 60 years and more. Several studies have shown that statin, a cholesterol-lowering medication, reduces the risk of developing PD, but evidence for this is so far inconclusive. The objective of this study is to evaluate the association between statin use and the risk of developing PD. Methods: PubMed, EMBASE, and the bibliographies of articles were searched for studies published between January 1, 1990, and January 1, 2017, which reported on the association between statin use and PD. Articles were included if they (1) were published in English, (2) reported patients treated with statin, and the outcome of interest was PD, (3) provided OR/HR with 95% CI or sufficient information to calculate the 95% CI. All abstracts, full-text articles, and sources were reviewed, with duplicate data excluded. Summary relative risk (RRs) with 95% CI was pooled using a random-effects model. Subgroup and sensitivity analyses were also conducted. Results: We selected 16 out of 529 unique abstracts for full-text review using our selection criteria, and 13 out of these 16 studies, comprising 4,877,059 persons, met all of our inclusion criteria. The overall pooled RR of PD was 0.70 (95% CI 0.58–0.84) with significant heterogeneity between estimates (I2 = 93.41%, p = 0.000) for the random-effects model. In subgroup analysis, the greater decreased risk was found in studies from Asia (RR 0.62 95% CI 0.51–0.76), whereas a moderate reduction was observed in studies from North America (RR 0.69 95% CI 0.47–1.00), but less reduction was observed in studies from Europe (RR 0.86 95% CI 0.80–0.92). Also, long-term statin use, simvastatin, and atorvastatin showed a higher rate of reduction with significance heterogeneity. Conclusion: Our results showed that statin use is significantly associated with a lower risk of developing PD. Physicians should consider statin drug therapy, monitor its outcomes, and empower their patients to improve their knowledge, therapeutic outcomes, and quality of life. However, preventive measures and their associated mechanisms must be further assessed and explored.

The concomitant association of thyroid disorders and Myasthenia gravis

Abstract Background Some of the thyroid disorders (TD) and Myasthenia gravis (MG) are autoimmune related disease. The purpose of the study to evaluate the relationship of MG with all morphological and functional thyroid disorders. Methods: We constructed a population-based cohort study during the period from January 2000-December 2002 by using reimbursement data from the Bureau National Health Insurance (NHI) system in Taiwan. Patients with TD and MG were identified by referring to the ICD-9-CM codes. (ICD-10-CM as reference) .The association of TD with MG occurred only in the same person within the study period. The Q value was used to measure the strength of disease-disease associations. Results We obtained 520628 TD and 7965 MG records for analysis. Diffuse toxic goiter had highest association rate, followed by nontoxic nodular goiter, simple goiter, chronic lymphocytic thyroiditis, thyroid cancer, and toxic nodular goiter. Female and older patients had a higher rate than their male and younger counterparts, respectively. Functional abnormalities revealed higher incidence of thyrotoxicosis and hypothyroidism in both sexes. We also found the strongest association in men with chronic thyroiditis, diffuse toxic goiter, thyrotoxicosis, acquired hypothyroidism, thyroid cancer, and simple goiter. While an intermediate association was observed in female with diffuse toxic goiter, in a male with toxic and nontoxic nodular/multinodular goiters, in female with thyrotoxicosis, thyroid cancer and acquired hypothyroidism. Conclusion This population based cohort study showed potential association of all types of TD with MG, and observed a higher association rate in female autoimmune TD whereas males showed a higher strength of association.

Applications of machine learning in fatty live disease prediction

: Fatty liver disease (FLD) is considered the most prevalent form of chronic liver disease worldwide. The prediction of fatty liver disease is an important factor for effective treatment and reduce serious health consequences. We, therefore construct a prediction model based on machine learning algorithms. A dataset was developed with ten attributes that included 994 liver patients in which 533 patients were females and others were male. Random Forest (RF), Support Vector Machine (SVM), Artificial Neural Network (ANN), and Logistic Regression (RF) data mining technique with 10-fold cross-validation was used in the proposed model for the prediction of fatty liver disease. The performances were evaluated with accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. In this proposed model, logistic regression technique provides a better result (Accuracy 76.30%, sensitivity 74.10%, and specificity 64.90%) among all other techniques. This study demonstrates that machine learning models particularly logistic regression model provides a higher accurate prediction for fatty liver diseases based on medical data from electronic medical. This model can be used as a valuable tool for clinical decision making.

Increased Risk of Dementia in Patients with Antidepressants: A Meta-Analysis of Observational Studies

Antidepressants are the most commonly and widely used medication for its effectiveness in the treatment of anxiety and depression. A few epidemiological studies have documented that antidepressant is associated with increased risk of dementia so far. Here, our aim is to assess the association between antidepressant use and risk of dementia in elderly patients. We searched articles through MEDLINE, EMBASE, Google, and Google Scholar from inception to December 1, 2017, that reported on the association between antidepressant use and dementia risk. Data were collected from each study independently, and study duplication was checked by at least three senior researchers based on a standardized protocol. Summary relative risk (RR) with 95% CI was calculated by using a random-effects model. We selected 9 out of 754 unique abstracts for full-text review using our predetermined selection criteria, and 5 out of these 9 studies, comprising 53,955 participants, met all of our inclusion criteria. The overall pooled RR of dementia was 1.75 (95% CI: 1.033–2.964) for SSRIs whereas the overall pooled RR of dementia was 2.131 (95% CI: 1.427–3.184) for tricyclic use. Also, MAOIs showed a high rate of increase with significant heterogeneity. Our findings indicate that antidepressant use is significantly associated with an increased risk of developing dementia. Therefore, we suggest physicians to carefully prescribe antidepressants, especially in elder patients. Additionally, treatment should be stopped if any symptoms related to dementia are to be noticed.

Levothyroxine use and the risk of breast cancer: a nation-wide population-based case–control study

PurposeTo investigate whether the use of levothyroxine was associated with breast cancer risk.MethodsWe conducted a population-based case–control study in Taiwan. Cases consisted of all patients who were aged 20xa0years and older, and had a first-time diagnosis of breast cancer for the period between 2001 and 2011. The controls were matched to the cases by age, sex, year, and month of diagnosis. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were estimated by a conditional logistic regression.ResultsWe examined 65,491 breast cancer cases and 261,964 controls. We found that use of levothyroxine was associated with a significant increase in breast cancer risk (ORu20091.24, 95% CIu20091.15–1.33; Pu2009<u20090.001). Compared with no use levothyroxine, the adjusted odd ratio was 1.22 (95% CIu20091.11–1.35; Pu2009=u20090.01) for the group having been prescribed levothyroxine 2xa0months to 1xa0year, and 1.26 (95% CIu20091.12–1.41; Pu2009<u20090.01) for the group with more than 1xa0year. When stratified by age, the adjusted odd ratio was 1.45 (95% CIu20091.23–1.71; Pu2009<u20090.01) for the patients aged 65xa0years or more and 1.19 (95% CIu20091.09–1.29, Pu2009<u20090.01) for the patients aged less than 65xa0years.ConclusionThe results of the present study are the first to suggest that levothyroxine use increased the risk of breast cancer. However, a larger long-term prospective randomized-controlled trial specifically designed to assess the effect of levothyroxine use on the risk of developing breast cancer is needed.

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy: A population-based study

Abstract The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders. We analyzed the data acquired from Taiwans Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR). A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80). The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.