Prevalence of human papillomavirus in head and neck cancer patients in India: a systematic review and meta-analysis.

BACKGROUND: Human papillomavirus (HPV) is increasingly recognized as a significant risk factor in the development of head and neck cancers (HNCs), with varying prevalence and impact. This study aims to systematically review and analyze the prevalence of HPV in HNCs in India, providing insights into regional variations. METHODS: A comprehensive literature search was carried out using PubMed, Embase, and Web of Science up to November 10, 2023. Inclusion criteria focused on original research reporting HPV-positive cases among HNC patients in India. We used Nested-Knowledge software, for screening, and data extraction. The modified Newcastle-Ottawa Scale was used for quality assessment of included studies. We pooled the prevalence of HPV among HNC patients and performed a random-effects model meta-analysis using R software (version 4.3). RESULTS: The search yielded 33 studies, encompassing 4654 HNC patients. The pooled prevalence of HPV infection was found to be 33% (95% CI: 25.8-42.6), with notable heterogeneity (I² = 95%). Analysis of subgroups according to geographical location indicated varying prevalence rates. Specifically, the prevalence was 47% (95% CI: 32.2-62.4) in the eastern regions and 19.8% (95% CI: 10.8-33.4) in the western regions. No evidence of publication bias was detected. CONCLUSION: The observed considerable regional disparities on the prevalence of HPV in HNC patients in India emphasizes the need for integrated HPV vaccination and screening programs in public health strategies. The findings underline the necessity for further research to explore regional variations and treatment responses in HPV-associated HNCs, considering the impact of factors such as tobacco use and the potential benefits of HPV vaccination.

Smokeless tobacco consumption among women of reproductive age: a systematic review and meta-analysis.

Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I2 statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I2 = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn't resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies.

Comparison of PIRO, APACHE IV, and SOFA Scores in Predicting Outcome in Patients with Sepsis Admitted to Intensive Care Unit: A Two-year Cross-sectional Study at Rural Teaching Hospital.

Introduction: Though many scoring systems for prognostication of sepsis are available in the intensive care set-up, predisposition, insult, response, and organ dysfunction (PIRO) score helps to assess each patient and evaluate response to therapy. There are few studies comparing the efficacy of PIRO score with other sepsis scores. Hence, our study was planned to compare PIRO score with acute physiology and chronic health evaluation IV (APACHE IV) score and sequential (sepsis-related) organ failure assessment (SOFA) score in predicting the mortality of intensive care patients with sepsis. Materials and methods: This prospective cross-sectional study was done in the medical intensive care unit (MICU) from August 2019 to September 2021 among patients above 18 years of age with the diagnosis of sepsis. Predisposition, insult, response, and organ dysfunction score, SOFA score, and APACHE IV score on admission and at day 3 were calculated and statistically analyzed in the terms of outcome. Results: A total of 280 patients fulfilling the inclusion criteria were included in the study, the mean age was 59.38 ± 15.9 years. There was a significant association of PIRO score, SOFA score, and APACHE IV score on admission and at day 3 with mortality (p-value <0.05). Among all three parameters, the PIRO score on admission and at day 3 was the best predictor of mortality at cut-off points of >14 and >16 with 92.50% and 96.50% chances of correctly predicting mortality, respectively. Conclusion: Predisposition, insult, response, and organ dysfunction score can be considered as a strong predictor of prognostication of patients with sepsis admitted to the intensive care unit (ICU) and predict mortality. It should be routinely used as it is a simple and comprehensive score. How to cite this article: Dronamraju S, Agrawal S, Kumar S, Acharya S, Gaidhane S, Wanjari A, et al. Comparison of PIRO, APACHE IV, and SOFA Scores in Predicting Outcome in Patients with Sepsis Admitted to Intensive Care Unit: A Two-year Cross-sectional Study at Rural Teaching Hospital. Indian J Crit Care Med 2022;26(10):1099-1105.

Ghrelin as a Promising Therapeutic Option for Cancer Cachexia.

Cachexia is a devastating complication of cancer and an important cause of morbidity and mortality and can have a great effect on quality of life, and sense of self-esteem. Unfortunately; there is no standard cure available for cancer cachexia. Ghrelin; a 28 amino acid orexigenic gut hormone and its mimetics have shown potential benefits in reversing the breakdown of protein and weight loss in catabolic states like cancer cachexia. Ghrelin has effects on several vital pathways in the regulation of appetite, and composition of the body. It increases the secretion of growth hormone and reduces energy expenditure. It plays an important role in regulation of processes associated with cancer and antagonizing protein breakdown in catabolic conditions such as cancer cachexia. Additionally, ghrelin has anti-inflammatory, anti-apoptotic and anxiolytic effects. Administration of ghrelin for short-term has been found to be well-tolerated and safe. These versatile actions of ghrelin and its safety can render it as a potentially useful novel therapy for patients with cancer cachexia. However; there is a need to generate more evidence to support the use of ghrelin in the management of cancer cachexia.

Ghrelin for the management of cachexia associated with cancer.

BACKGROUND: Cancer sufferers are amongst the most malnourished of all the patient groups. Studies have shown that ghrelin, a gut hormone can be a potential therapeutic agent for cachexia (wasting syndrome) associated with cancer. A variety of mechanisms of action of ghrelin in people with cancer cachexia have been proposed. However, safety and efficacy of ghrelin for cancer-associated cachexia have not been systematically reviewed. The aim of this review was to assess whether ghrelin is associated with better food intake, body composition and survival than other options for adults with cancer cachexia. OBJECTIVES: To assess the efficacy and safety of ghrelin in improving food intake, body composition and survival in people with cachexia associated with cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase without language restrictions up to July 2017. We also searched for ongoing studies in trials registers, performed handsearching, checked bibliographic references of relevant articles and contacted authors and experts in the field to seek potentially relevant research. We applied no restrictions on language, date, or publication status. SELECTION CRITERIA: We included randomised controlled (parallel-group or cross-over) trials comparing ghrelin (any formulation or route of administration) with placebo or an active comparator in adults (aged 18 years and over) who met any of the international criteria for cancer cachexia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility. Two review authors then extracted data and assessed the risk of bias for individual studies using standard Cochrane methodology. For dichotomous variables, we planned to calculate risk ratio with 95% confidence intervals (CI) and for continuous data, we planned to calculate mean differences (MD) with 95% CI. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS: We screened 926 individual references and identified three studies that satisfied the inclusion criteria. Fifty-nine participants (37 men and 22 women) aged between 54 and 78 years were randomised initially, 47 participants completed the treatment. One study had a parallel design and two had a cross-over design. The studies included people with a variety of cancers and also differed in the dosage, route of administration, frequency and duration of treatment.One trial, which compared ghrelin with placebo, found that ghrelin improved food intake (very low-quality evidence) and had no adverse events (very low-quality evidence). Due to unavailability of data we were unable to report on comparisons for ghrelin versus no treatment or alternative experimental treatment modalities, or ghrelin in combination with other treatments or ghrelin analogues/ghrelin mimetics/ghrelin potentiators. Two studies compared a higher dose of ghrelin with a lower dose of ghrelin, however due to differences in study designs and great diversity in the treatment provided we did not pool the results. In both trials, food intake did not differ between participants on higher-dose and lower-dose ghrelin. None of the included studies assessed data on body weight. One study reported higher adverse events with a higher dose as compared to a lower dose of ghrelin.All studies were at high risk of attrition bias and bias for size of the study. Risk of bias in other domains was unclear or low.We rated the overall quality of the evidence for primary outcomes (food intake, body weight, adverse events) as very low. We downgraded the quality of the evidence due to lack of data, high or unclear risk of bias of the studies and small study size. AUTHORS' CONCLUSIONS: There is insufficient evidence to be able to support or refute the use of ghrelin in people with cancer cachexia. Adequately powered randomised controlled trials focusing on evaluation of safety and efficacy of ghrelin in people with cancer cachexia is warranted.

Outcome Predictors of Acute-on-Chronic Liver Failure: A Narrative Review.

Complications of acute-on-chronic liver failure (ACLF) include increased short-term mortality. Extrahepatic organ failures result from chronic liver disease and acute hepatic injury. This combination characterizes end-stage liver disease. Its rapid progression makes it challenging for hepatologists and intensivists to treat. The varied definitions of this condition lead to varied clinical presentations. Hepatic or extrahepatic failures are more prevalent in chronic hepatitis B or cirrhosis patients who receive an additional injury. Numerous intensity parameters and prognosis ratings, including those for hepatitis B virus (HBV), have been developed and verified for various patients and causes of the disease. Liver regeneration, liver transplantation (LT), or antiviral therapy for HBV-related ACLF are the main treatment aims for various organ failures. LT is the best treatment for HBV-ACLF. In some HBV-related ACLF patients, nucleos(t)ide analogs and artificial liver assistance may enhance survival. Combining epidemiological and clinical studies, this review updates our understanding of HBV-ACLF's definition, diagnosis, epidemiology, etiology, therapy, and prognosis.

Silent Storm Unveiled: Lupus Nephritis and Cerebral Vasculitis in Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder known for its intricate clinical manifestations, spanning a spectrum of symptoms, including neuropsychiatric SLE (NPSLE) and lupus nephritis (LN). This condition predominantly affects young women of childbearing age, presenting a diverse array of symptoms that pose challenges in both diagnosis and treatment. Diagnosing central nervous system (CNS) involvement in SLE remains notably difficult despite being rooted in an autoimmune inflammatory response driven by cytokine surges. There exists no single definitive test for diagnosis, necessitating a thorough evaluation of clinical presentations, neurological indicators, and specific antibody detection. LN typically evades diagnosis until the patient progresses to a state of advanced renal insufficiency, demanding aggressive therapeutic interventions. In this discourse, we examine a case marked by generalized tonic-clonic seizures. While epilepsy might be initially suspected, in this instance, the underlying cause lay deeper, concealed within the complexities of autoimmune dysregulation. Additional symptoms included generalized edema, sun-exposed rash, oral ulcers, and recurrent fever over the past six months. The puzzle pieces eventually coalesced through meticulous examination of each clinical manifestation, coupled with laboratory analyses, neuroimaging studies, and renal biopsy, revealing a complex scenario of cerebral vasculitis concurrent with LN in a case of SLE.

Navigating Nutritional Strategies: A Comprehensive Review of Early and Delayed Enteral Feeding in Acute Pancreatitis.

This review critically examines enteral feeding strategies in managing acute pancreatitis, focusing on the contrasting early and delayed initiation approaches. Acute pancreatitis, marked by pancreatic inflammation, poses complex challenges, and nutritional interventions are pivotal in patient outcomes. Early enteral feeding, initiated within 24-48 hours, is associated with positive outcomes such as shortened hospital stays and reduced complications. However, controversies persist, with studies questioning its universal benefits. Conversely, delayed enteral feeding, employing a cautious approach, gains prominence in high-risk and severe cases. The identification of high-risk patients becomes paramount in decision-making. Practical recommendations for clinicians advocate an individualized approach, considering the severity of pancreatitis and regular monitoring. As the landscape of acute pancreatitis management evolves, staying abreast of emerging guidelines is essential. This review aims to provide a comprehensive understanding of critical findings, offering practical insights to guide clinicians in navigating the complexities of enteral feeding decisions in acute pancreatitis.

Unveiling Dermatomyositis: A Tragic Tale of Mortality in a 23-Year-Old.

Dermatomyositis represents a rare inflammatory myopathy that induces inflammation in the muscles or related tissues, including the blood vessels supplying these muscles. The precise pathogenesis of this condition remains unknown. Diagnosis typically relies on clinical indicators such as skin rashes, progressive muscle weakness, elevated serum muscle enzymes, abnormal electromyogram results, and muscle biopsy. In this case study, we report a fatal case of dermatomyositis in a 23-year-old female patient who succumbed to complications of dermatomyositis, causing mortality without any evidence of malignancy.

Estimation of the Parasitic Burden of Soil-Transmitted Helminths Among Pregnant Women in the Maharashtra State of India Using qPCR: A Community-Based Study.

Background: Soil-transmitted helminth (STH) infections are widespread in developing countries with inadequate sanitation facilities. These infections can lead to malnutrition, anemia, and other complications that can negatively impact both the mother's and fetus's health during pregnancy. This study aimed to estimate the burden of STH by Kato-Katz microscopy and quantitative polymerase chain reaction (qPCR) in pregnant women from rural India. The diagnostic accuracy of these two methods was also compared. Material and Methods: A community-based cross-sectional study was conducted in rural areas of Wardha district of Maharashtra state. We randomly selected and interviewed 688 pregnant women. A total of 534 (77.61%) participants gave stool samples. Two containers (60 mL) labeled with a unique identification number were given to pregnant women to collect stool samples for Kato-Katz microscopy and qPCR. Stool specimens were transported to an accredited lab and examined within 24 hours. Suitable examinations were conducted to compare sensitivity between two tests. Results: The results are presented for 534 participants who gave stool samples. The prevalence of any STH by Kato-Katz stool microscopy was 6.55% (95%CI 4.46-12.19), and that by qPCR was 20.41 (95%CI 17.53-29.40). The sensitivity of Kato-Katz microscopy was 29.17% compared to sensitivity of 90.83% by qPCR (P = 0.001). Pregnant women with STH infection have a significantly lower weight gain during pregnancy, and the majority were either mild or moderate anemic compared to those without STH. Conclusion: The study highlighted significant differences in prevalence of STH among pregnant women by Kato-Katz microscopy and qPCR. The sensitivity of qPCR for detecting STH was higher than that of Kato-Katz microscopy.

Global outbreaks of foodborne hepatitis A: Systematic review and meta-analysis.

Hepatitis A Virus (HAV) is a significant threat in terms of food safety. A systematic literature search with the research question "What are the clinical outcomes of foodborne Hepatitis A virus infections?" was conducted. The pooled estimate of the outcomes-mortality, hospitalization, and severity rates, along with a 95% confidence interval (CI), was estimated. After screening, 33 studies were included for the data extraction and meta-analysis. The pooled prevalence of hospitalization among the HAV-positive patients was estimated to be 32% (95% CI 21-44), with high heterogeneity (I2 = 98%, p < 0.01). Australia had the highest hospitalization rate, with 82%, followed by Europe (42%). The hospitalization rate showed a significantly increasing trend (beta = 0.015, p=0.002) over the period. The pooled prevalence of mortality among the HAV-positive patients was estimated to be <1%, with low heterogeneity (I2 = 5%, p = 0.39). A wide range of food products were linked with the HAV outbreaks.

Understanding noma: WHO's recognition and the path forward in global health.

The World Health Organization's (WHO) designation of noma as a neglected tropical disease (NTD) on 15 December 2023 marks a crucial advancement in global health efforts. This move sheds light on a condition predominantly affecting undernourished children in isolated regions of sub-Saharan Africa. Recognized as the 21st NTD, noma, or cancrum oris, is a serious condition leading to orofacial gangrene. The disease largely impacts young children and those with compromised immune systems, including individuals with human immunodeficiency virus or leukaemia. Determining the exact prevalence of noma is complex, hindered by rapid disease progression, societal stigma and a lack of reporting, especially in impoverished areas. The WHO's acknowledgment is a significant step, emphasizing the need for more in-depth research and resources to address this overlooked disease. It highlights the critical role of multifaceted prevention strategies, including economic empowerment, improved nutrition and enhanced vaccination efforts. This recognition is pivotal in guiding international health initiatives towards better outcomes for some of the most at-risk populations globally.

Association of neighborhood deprivation and hypertension: A systematic review and meta-analysis.

BACKGROUND: Hypertension impacts nearly one billion individuals and is a primary health challenge. While traditional perspectives have focused on individual behavior and genetics as principal risk factors, recent research underscores the profound influence of socioeconomic factors within neighborhoods on the risk of hypertension. This systematic review and meta-analysis is aimed to elucidate the association between neighborhood deprivation and the risk of hypertension. METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science from inception until December 25, 2023. Observational studies defining neighborhood deprivation and reporting hypertension incidence were included. Nested Knowledge software was used for screening and data extraction, with study quality assessed using the Newcastle-Ottawa Scale. Statistical analysis was performed with R software (V 4.3), using a random-effects model to calculate the pooled relative risk (RR). RESULTS: Twenty-six studies were included in the qualitative analysis and 22 in the meta-analysis, covering over 62 million participants. The pooled RR was 1.139 (95% CI: 1.006 - 1.290), p=0.04, indicating a higher hypertension risk in deprived neighborhoods. Subgroup analyses showed variability by country and deprivation assessment methods. RR varied from 1.00 in Japan (95% CI: 0.93-1.08) to 1.60 (95% CI: 1.07-2.39) in France and 1.57 (95% CI: 0.67-3.70) in Germany, with significant heterogeneity observed in measures of neighborhood deprivation. CONCLUSION: Our analysis confirms a significant association between neighborhood deprivation and hypertension, underscoring the importance of socioeconomic factors in public health. It highlights the need for targeted local assessments and interventions. Future research should explore the causal mechanisms and effectiveness of interventions addressing neighborhood deprivation.

Cardiovascular consequences of financial stress: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular diseases (CVD), notably coronary artery disease (CAD) and coronary heart disease (CHD), are predominant contributors to global morbidity and mortality. Financial stress is recognized as a non-traditional risk factor for CVD. The objective of this study is to conduct a systematic review and meta-analysis on the association between financial stress and the incidence of major cardiac outcomes. METHODS: A literature search was conducted across multiple databases up until September 20, 2023. Primary studies reporting the association between financial stress and the incidence of CAD, CHD, or major cardiovascular outcomes were included. The quality of the incorporated studies was evaluated using the Newcastle-Ottawa Scale. Statistical analysis was performed using R version 4.3, employing a random-effects model. RESULTS: Out of 2,740 identified studies, seven satisfied the inclusion criteria, displaying a diverse range in design, settings, and participant demographics. A significant association was found between financial stress and major cardiac outcomes, with a combined hazard ratio (HR) of 1.191 (95% CI: 1.00 to 1.47), p<0.001 from five studies. Possible publication bias and variations in definitions and measurements of financial stress were noted among the studies. CONCLUSION: The available literature substantiates an association between financial stress and the incidence of CAD/CHD or major cardiac outcomes, underscoring an urgent need for standardized definitions and measurements of financial stress. Our findings support the integration of financial stress assessments in patient care and the development of health policies emphasizing economic strains to enhance cardiovascular health outcomes and overall well-being.

Association of cardiovascular disease with severe dengue: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) and dengue are both significant global health concerns, and their intersection presents a growing clinical challenge. Emerging evidence suggests that individuals with pre-existing CVD may face an elevated risk of severe dengue outcomes. The present study aims to perform a systematic review to assess the relationship between CVD and the severity of dengue. METHODS: We conducted a literature search across multiple databases from inception to November 25, 2023. Primary studies reporting the number of dengue patients with CVD in severe dengue and non-severe dengue groups were included. Quality assessment was performed using the Newcastle-Ottawa Scale, and a meta-analysis was conducted using R software version 4.2 to determine the pooled Relative Risk (RR). The study protocol has been registered in PROSPERO. RESULTS: Based on data from 5 studies involving 274,576 dengue patients, our meta-analysis revealed a significant association between CVD and an increased risk of severe dengue, with a calculated RR of 2.71 (95  % CI: 1.03 to 7.10). However, substantial heterogeneity was observed among the included studies (I2 = 79  %). CONCLUSION: The current evidence suggests an association between CVD and severe dengue, emphasizing the importance of closely monitoring individuals with pre-existing cardiovascular disease and providing them with targeted interventions upon dengue diagnosis to mitigate the risk of severe outcomes.

Effect of IV ferric carboxy maltose for moderate/severe anemia: a systematic review and meta-analysis.

Introduction: Anemia remains a prevalent global health issue with varying severity. Intravenous iron supplementation, particularly with ferric carboxymaltose (FCM), has appeared as a possible therapeutic intervention for individuals with moderate to severe anemia. The study aimed to assess the efficacy and safety of ferric carboxymaltose (FCM) in reducing anemia. Methods: We searched electronic databases, registries, websites, e-libraries, reference lists of reviews, citations, etc. We included randomized control trials (RCTs), non-RCTs, and single-arm studies, while observational studies, case series, and case studies were excluded. Two reviewers independently screened the studies and extracted the data. We included studies of moderate-to-severely anemic Indians and excluded Indians with other comorbidities. We assessed the risk of bias and the overall quality of evidence (QoE) using GRADE GDT. Result: We identified 255 studies and included 14 studies (11 RCT, one non-RCT, and two single-arm studies) with 1,972 participants for qualitative analysis and 10 studies in the meta-analysis. All the included studies detailed the use of FCM for anemia. The primary outcomes assessed in the included studies were anemia, hemoglobin, and adverse events. The outcomes assessed ranged from 2 weeks to 12 weeks. The risk of bias varied across different studies with different outcomes. FCM is consistent with a fewer number of adverse events as compared to other interventions and provides "moderate" to "very low" QoE. Conclusion: A slow single infusion of 1 gram of FCM is well-tolerated, safe, and effective in treating iron deficiency anemia (IDA) and surpasses other interventions (Iron Sucrose Complex (ISC), Iron sucrose, and ferrous ascorbate) in elevating hemoglobin levels and replenishing iron stores. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459363, CRD42023459363.

Osseous implications of proton pump inhibitor therapy: An umbrella review.

Background: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide for acid-related disorders. While their short-term efficacy and safety are well-established, concerns regarding their long-term effects on bone health have emerged. This umbrella review aimed to synthesize the available findings on the associations between PPI use and bone metabolism outcomes. Methods: An electronic search was conducted using PubMed, Web of Science, Embase, and the Cochrane Database up to September 16, 2023. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) and observational studies that evaluated the relationship between PPIs and bone metabolism outcomes were included. Data extraction, quality appraisal, and synthesis were performed in line with the Joanna Briggs Institute and PRISMA guidelines. The strength of the evidence was graded using the GRADE criteria. Statistical analysis was performed in R version 4.3. Results: Out of 299 records, 27 studies met the inclusion criteria. The evidence indicated a statistically significant increased risk of fractures, notably hip, spine, and wrist fractures, in PPI users. PPI use was associated with changes in Bone Mineral Density (BMD) across various bones, though the clinical relevance of these changes remains uncertain. Furthermore, PPI-induced hypomagnesemia, which can influence bone health, was identified. A notable finding was the increased risk of dental implant failures in PPI users. However, the certainty of most of the evidence ranged from very low to low based on GRADE criteria. Conclusion: The long-term use of PPIs may be associated with adverse bone health outcomes, including increased fracture risk, alterations in BMD, hypomagnesemia, and dental implant failure. While these findings highlight potential concerns for long-term PPI users, the current evidence's low certainty underscores the need for robust, high-quality research to clarify these associations.

Efficacy and safety of stem cell therapy in patients with dilated cardiomyopathy: An umbrella review of systematic reviews.

BACKGROUND: Stem cell therapy (SCT) has emerged as a potential therapeutic avenue, with various cell types being explored for their efficacy in treating DCM. However, the safety and efficacy of these therapies have been the subject of numerous systematic reviews. This umbrella review aims to consolidate the existing evidence on stem cell interventions for DCM, providing a comprehensive overview of the current research landscape. METHODS: This review was conducted following the JBI and PRISMA guidelines. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the safety and efficacy of SCT for DCM were included. Outcomes such as 6MWT, LVEDD, LVEF, MACE, NYHA, and QoL, among others, were considered. A literature search was executed across databases like PubMed, Embase, Web of Science, and Cochrane Database up to October 07, 2023. The quality of the included reviews was assessed using the JBI Checklist for Systematic Reviews and Research Syntheses. Data synthesis was carried out in both narrative and tabular formats, with the GRADE criteria guiding the determination of evidence certainty. RESULTS: Nine systematic reviews met the inclusion criteria. LVEF found to be significantly improved with SCT. LVEDD and LVEDV assessments yielded mixed results, with some reviews observing significant changes. LVESV showed consistent reductions across multiple studies. BNP concentrations post-interventions were explored in several studies, with mixed findings. Health-related quality of life (HRQL) showed varied results, with some studies noting improvements and others finding no significant differences. NYHA classifications and 6-MWT results indicated potential benefits from stem cell treatments. SCT was observed to be generally safe. The certainty of evidence was low or very low for most of outcomes. CONCLUSION: SCT showed has shown promise in treating DCM, with many studies highlighting its safety and potential benefits. Nonetheless, the existing data has its limitations due to biases in the RCTs studies. To truly establish the benefits of SCT for DCM, future high quality RCTS, are crucial.