Sikarin Upala

Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Background HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD. Materials and Methods We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR <60 ml/min/1.73 m2) not requiring dialysis. The primary outcome was the differences in the change of eGFR. We also examined change of protein concentration in urine as a secondary outcome. A meta-analysis comparing statin and its control groups and a subgroup analysis examining intensity of statin were performed. Results From 142 full-text articles, 10 studies were included in the meta-analysis. Overall, there was a significant difference in rate of eGFR change per year favoring statin group (mean difference (MD) = 0.10 ml/min/1.73 m2, 95% CI: 0.09 to 0.12). In our subgroup analysis, those who received high-intensity statins had a significant difference in eGFR with a MD of 3.35 (95% CI: 0.91 to 5.79) ml/min/1.73 m2 compared to control. No significant change in eGFR was found with moderate- and low-intensity statin therapy. Compared with the control group, the statin group did not have a difference in reduction of proteinuria with MD in change of proteinuria of 0.19 gm/day (95% CI: -0.02 to 0.40). Conclusion Overall, there was a difference in change of eGFR between the statin and control group. High-intensity statins were found to improve a decline in eGFR in population with CKD not requiring dialysis compared with control, but moderate- and low-intensity statins were not. Statins were not found to decrease proteinuria in patients with CKD.

Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis

Background:Psoriasis is a chronic inflammatory disease of the skin with joint manifestations. Greater psoriasis severity and lower response to treatment have been linked to obesity. However, the effect of weight reduction by non-pharmacologic intervention on disease severity is still questionable. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effect of dietary and lifestyle weight loss interventions on psoriasis severity.Methods:We comprehensively searched PubMed/MEDLINE, EMBASE and CENTRAL from their inception to August 2014. Inclusion criteria were RCTs that examined lifestyle intervention by diet or exercise in overweight or obese patients with psoriasis and measured the severity of psoriasis as an outcome compared with controls. Two authors independently assessed article quality and extracted the data.Results:Out of 12 full-text articles, 7 RCTs involving 878 participants met our inclusion criteria. Five of these RCTs were included in the meta-analysis, which was based on the random-effects model. There was a greater reduction in the Psoriasis Area Severity Index (PASI) score in patients receiving weight loss intervention than in controls, with a pooled mean difference of −2.49 (95% confidence interval (CI), −3.90 to −1.08; P=0.004). More participants in the intervention group than in the control group achieved a 75% reduction in the PASI score, with a pooled odds ratio of 2.92 (95% CI, 1.39–6.13; P=0.005).Conclusion:Nonpharmacologic, nonsurgical weight loss intervention is associated with reduction in the severity of psoriasis in overweight or obese patients. However, more RCTs with more participants are needed to provide better quality of evidence.

Bariatric surgery and risk of postoperative endometrial cancer: a systematic review and meta-analysis

BACKGROUND Bariatric surgery is an essential intervention for severely obese patients who fail medical treatment. It has been linked to improvements in cardiovascular and cerebrovascular disease. However, its effect on endometrial cancer risk is still unknown. This is a systematic review and meta-analysis of available studies on bariatric surgery and risk of postoperative endometrial cancer. The objective of this study was to explore the association between bariatric surgery and endometrial cancer risk. METHODS A comprehensive search of the databases of PubMed/MEDLINE, EMBASE, and CENTRAL was performed from their dates of inception to July 2014. The inclusion criterion was articles on bariatric surgery and incidence of endometrial cancer after the procedure. Two authors independently assessed the quality of the articles and extracted the data. RESULTS From 159 full-text articles, 6 observational studies met the inclusion criterion, and 3 studies involving 890,110 participants were included in the meta-analysis based on the random effects model. There was a reduced risk of endometrial cancer postoperatively in those receiving bariatric surgery compared with controls with pooled relative risk = .40 (95% CI: .20-.79). CONCLUSIONS Bariatric surgery is associated with a reduced risk of endometrial cancer after the procedure. However, more randomized controlled studies are needed to provide better quality of evidence.

Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis

BACKGROUND Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been shown to increase venous thromboembolism (VTE) risk but the data on psoriasis is unclear. METHODS We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio or standardized incidence ratio comparing VTE risk in patients with psoriasis vs. non-psoriasis participants. Pooled risk ratio and 95% confidence intervals were calculated using a random effect, generic inverse variance method. RESULT Four studies were identified and included in our data analysis. The pooled risk ratio of VTE in patients with psoriasis was 1.46 (95% CI, 1.29-1.66). The statistical heterogeneity of this meta-analysis was high with an I(2) of 86%. CONCLUSION Our study demonstrated a statistically significant increased VTE risk among patients with psoriasis.

Risk of malignancy in patients with giant cell arteritis and polymyalgia rheumatica: A systematic review and meta-analysis

OBJECTIVE To investigate the association between giant cell arteritis (GCA)/polymyalgia rheumatica (PMR) and malignancy risk. METHODS We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, or standardized incidence ratio (SIRs) with 95% confidence comparing malignancy risk in patients with GCA/PMR versus non-GCA/PMR participants. Pooled risk ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance method. RESULT A total of six studies were identified and included in our data analysis. The pooled risk ratio of malignancy in patients with GCA/PMR was 1.14 (95% CI: 1.05-1.22). The risk was higher in the first 6-12 months after diagnosis with the pooled risk ratio of 2.16 (95% CI: 1.85-2.53). However, when we performed a sensitivity analysis that excluded one study with a potential selection bias, the pooled risk ratio decreased and did not achieve statistical significance. CONCLUSION Our study demonstrated a low but statistically significant increased malignancy risk among patients with GCA/PMR. However, when we excluded one study with potential selection bias, the new pooled risk ratio did not achieve statistical significance.

Treatment outcomes of surgery, antifungal therapy and immunotherapy in ocular and vascular human pythiosis: a retrospective study of 18 patients

OBJECTIVES Human pythiosis is a life-threatening disease for which no standard treatment protocols with proven efficacy exist. We present the results of our institutional pythiosis treatment protocol, composed of surgery, antifungal agents, iron chelator (only vascular cases) and immunotherapy. METHODS We retrospectively analysed patients with proven vascular and ocular pythiosis in King Chulalongkorn Memorial Hospital from April 2003 to May 2013. Fishers exact test and Wilcoxons rank-sum test were used. The MICs of seven antifungal agents and combination drugs were investigated in eight clinical Pythium insidiosum strains. RESULTS Eighteen patients were evaluated. Disease-free surgical margins were obtained in all surviving patients with vascular pythiosis (P = 0.08). Patients who underwent eye enucleation were significantly older than those who did not (P < 0.05). Patients with vascular or ocular pythiosis did not differ significantly in the median time from disease onset to first surgery or in the relationship between the type of P. insidiosum antigen and treatment outcomes. In vitro susceptibility profiles of all isolates demonstrated that no single agent or combination treatment was substantially more effective than the others. The highest MIC was detected for amphotericin B, followed in order by voriconazole, fluconazole, anidulafungin, caspofungin, itraconazole and terbinafine. No synergistic effects of the combination drug treatments were found. CONCLUSIONS Surgery with adequate surgical margins is a crucial determinant of survival in patients with vascular pythiosis. Itraconazole and terbinafine do not have synergistic effects on Thai P. insidiosum strains. The role of immunotherapy remains inconclusive for both vascular and ocular pythiosis.

Association between Helicobacter pylori infection and metabolic syndrome: A systematic review and meta‐analysis.

To systematically review and quantify the effect of Helicobacter pylori (H. pylori) infection on the risk of metabolic syndrome (MS) and metabolic parameters in individuals with H. pylori infection.

Association Between Hyponatremia, Osteoporosis, and Fracture: A Systematic Review and Meta-analysis

CONTEXT Hyponatremia is the most common electrolyte disorder. Recent research shows that it may associate with osteoporosis and fracture. However, whether it directly associates or is a surrogate marker of other causes is still unclear. OBJECTIVES To explore the hypothesis of an association of osteoporosis or fracture with hyponatremia. DATA SOURCES MEDLINE and EMBASE databases from inception to October 2015. STUDY SELECTION The inclusion criteria were published studies evaluating bone mineral density, risk or prevalence of osteoporosis or fracture in patients with hyponatremia. DATA EXTRACTION Both authors independently reviewed titles and abstracts of all citations that were identified. DATA SYNTHESIS A meta-analysis using a random-effects model comparing between hyponatremia and normal serum sodium groups was performed. We calculated pooled mean difference in bone mineral density, pooled hazard ratio (HR) or odds ratio (OR) of fracture and osteoporosis. Factors that may predict these associations were evaluated in subgroup analysis and meta-regression. From 29 full-text articles, 15 observational studies involving 212 889 participants met our inclusion criteria. Twelve studies were included in the meta-analysis. There was a significant association with fracture and osteoporosis in patients with hyponatremia with OR of fracture = 1.99 (95% confidence interval, 1.50–2.63; p < .001) for studies that reported OR, and increase risk of fracture with HR = 1.62 (95% confidence interval, 1.28–2.05; P < .001) for studies that reported HR. CONCLUSIONS Hyponatremia significantly associates with osteoporosis and fracture. More prospective studies evaluating osteoporosis and fracture risk reduction after hyponatremia correction should be performed.

Effects of statin therapy on arterial stiffness: A systematic review and meta-analysis of randomized controlled trial

BACKGROUND Arterial stiffness has been observed to be an independent predictor for cardiovascular events. Effects of cholesterol lowering agents (statins) on arterial stiffness are inconsistent. We conducted a systematic review with a meta-analysis of all RCTs investigating the impact of statin therapy on arterial properties. METHODS We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane from their dates of inception through April 2016. The inclusion criteria were published RCTs comparing change in arterial stiffness between statin administration and active control or placebo groups. Arterial stiffness is determined by aortic pulse wave velocity (PWV). We used a random-effects model and calculated pooled standardized mean difference (SMD) with 95% confidence intervals (CI) comparing change in PWV between the statin and control groups. RESULTS Six studies were included in the meta-analysis. Statin therapy includes simvastatin, rosuvastatin, lovastatin, fluvastatin, and atorvastatin. Compared with the active control or placebo group, the statin therapy group had lower aPWV (SMD=2.31, 95% CI: 1.15-3.45, Pheterogeneity=0.07, I2=93%). CONCLUSION Our meta-analysis demonstrates that statin therapy has a beneficial effect on aortic arterial stiffness. Further studies should be conducted to assess the effects of this therapy on arterial stiffness at various sites and conditions.

Association between Helicobacter pylori infection and multiple sclerosis: A systematic review and meta-analysis

AIM To investigate the association between Helicobacter pylori infection and multiple sclerosis. METHODS A comprehensive search of the databases including PubMed/MEDLINE and EMBASE was performed from their dates of inception to January 2016. Inclusion criteria were the observational studies in adult assessing the association between Helicobacter pylori infection and multiple sclerosis. The main outcome was the prevalence of Helicobacter pylori infection comparing between participants with multiple sclerosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I(2). RESULTS The initial search yielded 103 articles. Seventeen articles underwent full-length review and data was extracted from six observational studies involving 1902 participants. There was a statistically significant lower odds Helicobacter pylori infection in multiple sclerosis with pooled odds ratio of 0.59 (95% CI: 0.37-0.94, P=0.03, I(2)=71%). We conducted a univariate meta-regression analysis to assess potential source of heterogeneity. Age of patient and age of onset of multiple sclerosis were significant predictors of association between Helicobacter pylori infection and multiple sclerosis (beta-coefficient =-0.23, SE=0.10, p=0.02 and beta-coefficient =-0.34, SE=0.17, p=0.04, respectively). CONCLUSIONS We demonstrate a significant lower prevalence of Helicobacter pylori infection in patients with multiple sclerosis. This pathogen might be a protective factor for developing multiple sclerosis.