Meta-analysis: hepatitis B reactivation in patients receiving biological therapy.

BACKGROUND: The use of biologics poses a moderate to high risk for hepatitis B virus reactivation (HBVr) in chronic carriers. AIM: To determine the prevalence of HBVr with TNF alpha inhibitors, ustekinumab and vedolizumab METHOD: We followed the MOOSE guidelines and conducted a comprehensive literature search. We conducted a systematic search of EMBASE (Ovid), MEDLINE (Ovid) and PubMed. The studies included patients who were chronic and occult HBV carriers with various rheumatological, dermatological or gastroenterological conditions. We used a random effects model using pooled estimates (prevalence of HBVr with 95% confidence intervals (CI)). RESULTS: We included 29 studies with 1409 patients infected with HBV. The prevalence of HBVr in chronic carriers of HBV was 17.1% (95% CI: 7.0-35.9, n = 5), 16.6% (95% CI: 9.5-27.5%, n = 6), 40.5% (95% CI: 20.3-64.5%, n = 4) and 19.1% (95% CI: 7.3-41.2%, n = 2), respectively, for adalimumab, etanercept, infliximab and ustekinumab. The respective prevalence for reactivation in patients with occult HBV infection was 5.0% (95% CI: 2.8-8.7%, number of studies: n = 18), 2.6% (95% CI: 1.4-4.7%, n = 18), 4.4% (95% CI: 2.2-8.7%, n = 12) and 6.4% (95% CI: 2.2-16.8, n = 5). There were 39 HBVr (26 in chronic HBV and 13 in the occult group) without any hepatic failure or death. In the chronic HBVr group, only three of 24 patients received antiviral prophylaxis. CONCLUSIONS: HBVr prevalence rates differ between the chronic carrier state and the occult carrier state. The uptake of prophylactic antiviral therapy in high-risk groups was low, contrary to clinical practice guidelines.

Meta-analysis: Does garlic intake reduce risk of gastric cancer?

In the past 2 decades, various epidemiological studies investigated whether garlic can positively modify the risk of gastric cancer. Garlic contains numerous sulfide compounds, including diallyl trisulfide, which have anticarcinogenic properties. We conducted a meta-analysis to determine if garlic intake reduces the risk of gastric cancer. An electronic search of MEDLINE, PubMed, and EMBASE to June 2014 was completed. There were 14 case control studies, 2 randomized controlled studies, and 1 cohort study that fulfilled our inclusion criteria. We used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs) for risk of gastric cancer with garlic consumption. Meta-analysis of a total of 8,621 cases and 14,889 controls was conducted. Significant variability in duration of garlic intake and reference categories for amount of intake was noted. High, low, and any garlic intake were all associated with reduced risk of gastric cancer. High intake had the most significant risk reduction, OR = 0.49 (95% CI: 0.38-0.62). Heterogeneity was low (I² = 30.85, P = 0.17). A more modest risk reduction was associated with low intake, OR = 0.75 (95% CI: 0.58-0.97). Half of the studies did not separate garlic intake into high or low amounts, intake was only noted as consumption vs. non-consumption. Any amount of consumption still showed a risk reduction similar to low intake, OR = 0.77 (95% CI: 0.60-1.00). Low and any amount of consumption showed moderate heterogeneity (58% and 45%, respectively). Garlic intake appears to be associated with reduced risk of gastric cancer. Further high quality studies are required to confirm this finding and to assess the amount of garlic that needs to be consumed for protective effect.

Vitamin D level and sustained virologic response to interferon-based antiviral therapy in chronic hepatitis C: a systematic review and meta-analysis.

BACKGROUND & AIMS: The baseline 25-hydroxyvitamin D (25[OH]D) level has recently been reported to be an independent predictor of sustained virologic response (SVR) to treatment with pegylated interferon (PEG-IFN) plus ribavirin (RBV) for chronic hepatitis C virus (HCV) infection. However, studies have yielded inconsistent results. Thus, we conducted a systematic review and meta-analysis to clarify any association between baseline 25(OH)D level and SVR in HCV therapy. METHODS: Two reviewers searched four electronic databases (Medline, Embase, PubMed, and Cochrane trials register) and relevant international conference proceedings up to March 2014 for studies treating chronic HCV infection with PEG-IFN plus RBV where baseline 25(OH)D level was tested. Studies involving patients with HIV co-infection, previous liver transplantation or those receiving vitamin D supplementation were excluded. The mean baseline 25(OH)D level was compared between those who achieved and those who failed to achieve SVR. Pooled standard difference in mean 25(OH)D level, odds ratios (OR) and 95% confidence intervals (CI) were calculated with the Comprehensive Meta-Analysis software (version 2.0) using a random effects model. RESULTS: 11 studies comprising 2605 patients were included in the meta-analysis. There was no significant association between the baseline mean 25(OH)D level and SVR (OR 1.44, 95% CI 0.92-2.26; p=0.11), either in patients infected with genotypes 1/4/5 (OR 1.48, 95% CI 0.94-2.34; p=0.09) or genotypes 2/3 (OR 1.51, 95% CI 0.26-8.87; p=0.65). CONCLUSIONS: The baseline 25(OH)D level is not associated with SVR to PEG-IFN plus RBV therapy in chronic HCV infection, regardless of genotype. Any effect of vitamin D supplementation on SVR is yet to be definitively determined.

Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis.

BACKGROUND: The overall effect of exercise on falls and fracture prevention in long term care facilities remains controversial. In this study, we aimed to analyze the impact and the characteristics of the most effective physical exercise regime to prevent falls and fractures in this particular setting. METHODS: Our search looked for randomized controlled trials published in English language between January 1974 and June 2012 in electronic databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Occupational Therapy Seeker that specifically tested the effect of exercise on falls and/or fractures in long term care residents. Two investigators independently extracted data and assessed study quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied throughout the systematic review and meta-analysis. RESULTS: Twelve studies were selected that included 1292 participants. Most of the participants were women (68%) with a mean age of 83.9 ± 9 years. The intervention period was between 3 and 24 months, and the most commonly performed intervention were balance and resistance training exercises. Meta-analysis showed that exercise has a preventive effect on falls (risk ratio [RR] = 0.77, 95% confidence interval [CI], 0.64-0.92; I(2) = 72.18, P < .001). This effect was stronger when mixing several types of exercises (RR = 0.71, 95% CI, 0.55-0.90; I(2) = 72.07, P < .001), for at least 1-3 months (RR = 0.65, 95% CI, 0.43-0.98; I(2) = 61.821; P < .001) or for more than 6 months (RR = 0.70, 95% CI, 0.56-0.87; I(2) = 68.407; P < .001), with a frequency of at least 2-3 times per week (RR = 0.74, 95% CI, 0.60-0.91; I(2) = 68.092; P < .001). Physical exercise did not show any effect on fracture prevention (RR = 0.57, 95% CI, 0.21-1.57; I(2) = 48.805). CONCLUSIONS: Combined, frequent and long-term exercise programs are effective to prevent falls in long term care facilities. No effect of exercise on fracture prevention was observed in this population.

Oral opium: an unusual cause of lead poisoning.

INTRODUCTION: The number of cases of lead poisoning (LP), a widely known disease with various aetiologies, being reported globally has decreased over the years due to both limited domestic applications of lead and enforcement of stringent safety measures. However, a new presentation of lead poisoning, lead-contaminated opium (LCO), is gradually emerging in our region. This study aimed to determine the prevalence and clinical effects of lead toxicity associated with opium use. METHODS: Between November 2006 and December 2007, all patients diagnosed with LP at a central laboratory in Tehran, Iran, were assessed for potential causes of poisoning. Patients with a history of LCO abuse were evaluated and recruited for the study. RESULTS: Overall, there were 240 patients with LP, and poisoning from LCO was diagnosed in 25 patients. The duration of addiction was between three months and 40 years, and the duration of symptoms was 28.1 ± 17.7 days. Mean blood lead levels of the patients were 145 ± 61 (range 61-323) µg/dL. The average creatinine and haemoglobin levels were 77.4 ± 8.1 µmol/L and 105 ± 25 g/L, respectively. The association between the duration of addiction and levels of lead in blood was not statistically significant (r = -0.142, p = 0.54). The most common symptoms were gastrointestinal complaints, followed by musculoskeletal complaints with muscle weakness (92%). Anorexia was also a leading complaint. CONCLUSION: The results of our study suggest that the possibility of LP should be considered with high suspicion among opium users presenting with acute abdominal symptoms.

Traditional Chinese medicinal herbs in the treatment of patients with esophageal cancer: a systematic review.

Traditional Chinese medicines are sometimes used as an adjunct to radiotherapy or chemotherapy for esophageal cancer. These medicines may have a benefit on the survival and quality of life of patients who have advanced esophageal cancer. Evidence from current studies appears weak due to methodological limitations. Due to conflicting reports, it is difficult to argue for or against the use of traditional Chinese medicines as a treatment for esophageal cancer.

Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis.

BACKGROUND: Fish oils have been widely reported as a useful supplement to reduce fasting blood triglyceride levels in individuals with hyperlipidemia. We performed an updated meta-analysis to quantitatively evaluate all the randomized trials of fish oils in hyperlipidemic subjects. METHODS: We conducted a systematic literature search using several electronic databases supplemented by manual searches of published reference lists, review articles and conference abstracts. We included all placebo-controlled randomized trials of parallel design that evaluated any of the main blood lipid outcomes: total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol or triglycerides (TG). Data were pooled using DerSimonian-Laird's random effects model. RESULTS: The final analysis comprised of 47 studies in otherwise untreated subjects showed that taking fish oils (weighted average daily intake of 3.25 g of EPA and/or DHA) produced a clinically significant reduction of TG (-0.34 mmol/L, 95% CI: -0.41 to -0.27), no change in total cholesterol (-0.01 mmol/L, 95% CI: -0.03 to 0.01) and very slight increases in HDL (0.01 mmol/L, 95% CI: 0.00 to 0.02) and LDL cholesterol (0.06 mmol/L, 95% CI: 0.03 to 0.09). The reduction of TG correlated with both EPA+DHA intake and initial TG level. CONCLUSION: Fish oil supplementation produces a clinically significant dose-dependent reduction of fasting blood TG but not total, HDL or LDL cholesterol in hyperlipidemic subjects.

Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis.

BACKGROUND: Whether calcium supplementation can reduce osteoporotic fractures is uncertain. We did a meta-analysis to include all the randomised trials in which calcium, or calcium in combination with vitamin D, was used to prevent fracture and osteoporotic bone loss. METHODS: We identified 29 randomised trials (n=63 897) using electronic databases, supplemented by a hand-search of reference lists, review articles, and conference abstracts. All randomised trials that recruited people aged 50 years or older were eligible. The main outcomes were fractures of all types and percentage change of bone-mineral density from baseline. Data were pooled by use of a random-effect model. FINDINGS: In trials that reported fracture as an outcome (17 trials, n=52 625), treatment was associated with a 12% risk reduction in fractures of all types (risk ratio 0.88, 95% CI 0.83-0.95; p=0.0004). In trials that reported bone-mineral density as an outcome (23 trials, n=41 419), the treatment was associated with a reduced rate of bone loss of 0.54% (0.35-0.73; p<0.0001) at the hip and 1.19% (0.76-1.61%; p<0.0001) in the spine. The fracture risk reduction was significantly greater (24%) in trials in which the compliance rate was high (p<0.0001). The treatment effect was better with calcium doses of 1200 mg or more than with doses less than 1200 mg (0.80 vs 0.94; p=0.006), and with vitamin D doses of 800 IU or more than with doses less than 800 IU (0.84 vs 0.87; p=0.03). INTERPRETATION: Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation).