Pentraxin-3 and neonatal sepsis: a systematic review and meta-analysis.

Aim: The potential bond between pentraxin-3 levels and neonatal sepsis has been the center of research in many primary studies. The aim of the current meta-analysis is to examine whether there are differences among pentraxin-3 levels in septic and in healthy neonates.Materials and Methods: Our search strategy included the systematic search of the following databases: MEDLINE, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, using a structured algorithm. Statistical analysis of the overall outcome was done using Revman 5.4 software while leave-one-out and meta-regression analysis were done using the R software. Quality assessment of the included studies was done using the Newcastle-Ottawa scale.Results: Pentraxin-3 levels were found to be higher in newborns affected by sepsis than in healthy neonates with an MD = 7.66 [95% CI 0.89, 14.42 (p = .03, I2 = 99%)]. Subgroup analysis, based on the country of origin of the included study, led to I2 = 0 with an MD = 1.25 with 95% CI [0.82, 1.69], p < 10-5. Publication bias was assessed using the trim and fill method together with visual inspection of the funnel plots, showcasing no missing studies.Conclusion: The results of our study show that pentraxin-3 is elevated in neonates with sepsis making it a potential biomarker that needs to be assessed for its diagnostic accuracy in future cohort studies.

Vaccination Hesitancy Among Greek Orthodox Christians: Is There a Conflict Between Religion and Science?

Since the start of the COVID-19 pandemic vaccines were highly anticipated in order to help contain the spread of the virus and mitigate its impact. However, when the vaccination program began, some minorities were reluctant to get vaccinated for numerous reasons. Specifically, at that time in Greece many priests were opposed to getting vaccinated and proceeded to discourage their flock, in stark contrast to the decisions of Greek Orthodox religious leaders who endorsed the vaccination program. It is clear that the COVID-19 pandemic doesn't solely affect the health system but also other parts of society such as politics, the economy and, last but not least, religion and worship. In the current article, we aim to present the notions and attitudes that led many Greek Orthodox Christians to be hesitant about getting vaccinated or even to become a part of the movement actively against vaccination that has been growing during this pandemic.

The impact of metabolic health on non-alcoholic fatty liver disease (NAFLD). A single center experience.

BACKGROUND: The role of patients' metabolic clinical and biochemical profile in NAFLD has not been extensively explored. AIMS: The aim of the study was to assess the role of metabolic health in NAFLD patients and to examine liver disease progression in these populations. METHODS: The medical charts of 569 patients diagnosed with fatty liver were thoroughly reviewed; 344 patients were excluded because of other chronic liver diseases. Metabolically healthy people were defined as those who met none of the following criteria: blood pressure ≥ 130/85 mmHg or under hypertension treatment, fasting glucose ≥ 100 mg/dl or under diabetes treatment, serum triglycerides > 150 mg/dl, high density lipoprotein-cholesterol <40/50 mg/dl for men/women. Study participants were followed-up over a median period of 22 months. RESULTS: The present observational case-control study included 225 NAFLD patients; 14 (6.2%) were metabolically healthy. Metabolically healthy participants were younger (p = 0.006), had lower age at diagnosis (p = 0.002), lower levels of γ-GT (p = 0.013), fasting glucose (p <0.001) and triglycerides (p <0.001) and higher HDL-cholesterol (p = 0.005) compared to metabolically non-healthy. By the last follow up assessment, 8 metabolically healthy patients had developed dyslipidemia; 1 patient (14.4%) had presented liver disease progression compared to 8 patients (10.5%) from the unhealthy group (p = 0.567). In multivariate analysis, diabetes mellitus (p = 0.017) and hemoglobin levels (p = 0.009) were the sole independent predictors of disease progression. No significant difference was observed in liver disease progression-free survival rates among the two patient groups (p = 0.503). CONCLUSIONS: Metabolically healthy NAFLD patients presented with a favorable biochemical profile; however, they were diagnosed with NAFLD at a younger age and the liver disease progression risk was similar to that of metabolically unhealthy patients. These findings suggest that metabolically healthy NAFLD may not constitute a benign condition and patients could potentially be at increased risk of metabolic syndrome and liver disease progression.

Blood urea nitrogen to albumin ratio as a predictive factor for pneumonia: A meta-analysis.

Background Pneumonia remains a substantial cause of mortality worldwide. The need for markers that better categorize patients is growing. We have performed a meta-analysis of Blood Urea Nitrogen to Albumin (BUN/ALB) ratio as a predictive factor regarding patients with pneumonia. Methods Three researchers systematically searched MEDLINE (1966-2021), Clinicaltrials.gov (2008-2021), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2021), Google Scholar (2004-2021) databases using a structured algorithm. Included studies contained patients with various types of pneumonia. The articles were assessed using the Quality Assessment of Diagnostic Accuracy tool. Results For more than 1900 patients with various types of pneumonia the pooled sensitivity, specificity and AUC were: 0.551, 0.892, 0.717. The optimal cutoff point was calculated at 13.290. Specificity of BUN/ALB ratio is higher than 0.85 in all subgroups and outcomes, making this ratio a great marker for ruling in patients with high risk of poor prognosis. Poor prognosis outcomes included ICU admission or death. Conclusions Regarding CAP patients we calculated an optimal cutoff of BUN/ALB ratio at 15.946 with a sensitivity of 0.587 and a specificity of 0.926 and an AUC equal to 0.732. Future studies are needed in order to assess its value in more patients without community acquired pneumonia.

Proadrenomedullin and neonatal sepsis: a systematic review and meta-analysis of diagnostic accuracy.

The association of proadrenomedullin and neonatal sepsis has been examined in numerous studies. The object of our meta-analysis is to evaluate differences in proadrenomedullin among neonates with sepsis and health neonates. We systematically searched the following databases: MEDLINE, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and WHO (International Clinical Trials Register Platform) using a structured algorithm. Statistical analysis was conducted using Revman 5.3 and R software. Included studies in the meta-analysis were assessed using the Newcastle-Ottawa scale. Proadrenomedullin levels were found significantly higher in neonates with sepsis than healthy neonates with an SMD equal with 3.07 [95% CI 1.71, 4.42 (p < 10-5, I2 = 98%)]. The optimal cutoff point of pro-ADM was calculated at 17.559 with a sensitivity of 0.879 (0.458; 0.984) and a specificity of 0.994 (0.820; 1.000), and an AUC of 0.905. Subgroup analysis, leave-one-out meta-analysis, and meta-regression were performed in an effort to lower inter-study heterogeneity. Sensitivity analysis was conducted by excluding high risk of bias studies and those contributing to the overall heterogeneity shown by the Baujat plot. Publication bias was assessed using a funnel plot and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score.Conclusion: The findings of our meta-analysis suggest that proadrenomedullin is elevated in neonates with sepsis. However, future prospective cohort studies need to be conducted in order to assess its diagnostic accuracy. What is Known: • Proadrenomedullin has been found increased in adult patients with infectious diseases such as community acquired pneumonia. • Proadrenomedullin plays a major role in the pathophysiology of sepsis in adults. What is New: • Proadrenomedullin is increased in neonates with sepsis. • Future cohort studies need to be conducted in order to elucidate the value of proadrenomedullin in a safer way.