Antibiotics for eradicating meningococcal carriages: Network meta-analysis and investigation of evidence inconsistency

AIM: To compare different antibiotics for eradicating the carriage of Neisseria meningitidis, and to investigate heterogeneity and evidence inconsistency.  METHODS: From a search of PubMed and published systematic reviews, we identified 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis. We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and interventions evaluated.  RESULTS: Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly (P<0.05) more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Significant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofloxacin (P<0.01), which may be caused by different types of carriers and different doses of ciprofloxacin.  CONCLUSION: A range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics (ciprofloxacin or rifampin) recommended by the current guidelines

Comparison of serum cystatin C and creatinine based methods in detection of early renal dysfunction in critically ill patients

Early detection of renal dysfunction is of importance inthe care of critically ill patients. Cystatin C was proposedto be superior to serum creatinine in estimation of renal function. This work aimed to compare serum cystatin Cto serum creatinine and creatinine based formulae indetection of early decline in renal function at a singlepoint in critically ill patients. Fifty critically ill patientsadmitted to Cairo University Hospitals ICUs - Egypt wereincluded. Patients with chronic renal disease,thyroid disease, malignancy, patients receivingcorticosteroid therapy, with serum creatinine &gt; 1.4 mg/dland patients receiving diuretics or large volumes of IVfluids were excluded. Serum creatinine, serum cystatinC, adjusted creatinine clearance (Adj Ccr), estimatedGFR (eGFR) by modification of diet in renal disease(MDRD), abbreviated MDRD (abb MDRD) andCockcroft-Gault (CG) formulae were measured. Patientswith renal dysfunction (adj Ccr &lt; 80 ml/min/1.73m2)were 26 (52%) in number. Patients with renaldysfunction and high serum creatinine were 12/26(46.2%) while those with high cystatin C were 23/26(88.5%). Cystatin C was found to be significantlycorrelated with serum creatinine, adj Ccr and eGFR by all studied formulae. Using receiver operatingcharacteristic (ROC) analysis; AUC for Cystatin C(0.976) was more than that for eGFR by abb MDRD(AUC=0.839), MDRD (AUC=0.822), CG formulae(AUC=0.808) and serum creatinine (AUC=0.710)respectively. In conclusion; cystatin C was found to bebetter than serum creatinine, eGFR by abb MDRD,MDRD and CG formulae in detection of early renaldysfunction at a single point in critically ill patients

Dietary polyunsaturated fat for prevention and treatment of inflammatory bowel disease:Protocol

Published in PROSPERO international prospective register of systematic review

Creation of a database to assess effects of omega-3, omega-6 and total polyunsaturated fats on health: methodology for a set of systematic reviews

Objective To create a database of long-term RCTs comparing higher with lower omega-3, omega-6 or total PUFA, regardless of reported outcomes, and develop methods to assess effects of increasing omega-6, ALA, LCn3 and total PUFA on health outcomes. Design Systematic review search, methodology and meta-analyses. Data Sources Medline, Embase, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews. Eligibility Criteria Randomised controlled trials (RCTs) of ≥24 weeks duration assessing effects of increasing alpha-linolenic acid (ALA), long-chain omega-3 (LCn3), omega-6 or total polyunsaturated fats (PUFA), regardless of outcomes reported Data Synthesis Methods included random-effects meta-analyses, sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline diabetes risk and use of diabetic medications, trial duration and dose. Quality of evidence was assessed using GRADE. Results Electronic searches generated 37,810 hits, de-duplicated to 19,772 titles and abstracts. We assessed 2155 full text papers, conference abstracts and trials registry entries independently in duplicate. Included studies were grouped into 363 RCTs comparing higher with lower omega-3, omega-6 and/or total PUFA intake of at least 6 months duration – the Database. Of these 363 included RCTs, 216 RCTs were included in at least one of our reviews of health outcomes, data extracted and risk of bias assessed in duplicate (Dataset 1, Supplementary File 1). Ninety five RCTs were included in the database but not included in our current reviews (Dataset 2, Supplementary File 2). Of these 311 completed trials, 27 altered ALA intake, 221 altered LCn3 intake, and 16 trials altered omega-3 intake without specifying whether ALA or LCn3. Forty one trials altered omega-6 fats and 59 total PUFA. The remaining 52 trials (Dataset 3, Supplementary File 3) are ongoing though 13 (25%) appear to be outstanding, or constitute missing data. Conclusions This extensive database of trials is available to allow assessment of further health outcomes

The relationship between omega-3, omega-6 and total polyunsaturated fat and musculoskeletal health and functional status in adults: a systematic review and meta-analysis of RCTs

Purpose : We conducted a systematic review and meta-analysis to assess effects of increasing dietary omega-3, omega-6 and mixed polyunsaturated fatty acids (PUFA) on musculoskeletal health, functional status, sarcopenia and risk of fractures. Methods : We searched Medline, Embase, The Cochrane library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) databases for Randomised Controlled Trials (RCTs) of adults evaluating effects of higher versus lower oral omega-3, omega-6 or mixed PUFA for ≥ 6 months on musculoskeletal and functional outcomes. Results : We included 28 RCTs (7288 participants, 31 comparisons), 23 reported effects of omega-3, one of omega-6 and four of mixed total PUFA. Participants and doses were heterogeneous. Six omega-3 trials were judged at low summary risk of bias.  We found low-quality evidence that increasing omega-3 increased lumbar spine BMD by 2.6% (0.03 g/cm2, 95% CI -0.02 to 0.07, 463 participants). There was also the suggestion of an increase in femoral neck BMD (of 4.1%), but the evidence was of very low-quality. There may be little or no effect of omega-3 on functional outcomes and bone mass, effects on other outcomes were unclear. Only one study reported on effects of omega-6 with very limited data. Increasing total PUFA had little or no effect on BMD or indices of fat free (skeletal) muscle mass (low-quality evidence); no data were available on fractures, BMD or functional status and data on bone turnover markers were limited. Conclusions : Trials assessing effects of increasing omega-3, omega-6 and total PUFA on functional status, bone and skeletal muscle strength are limited with data lacking or of low quality. While there is an indication that omega-3 may improve BMD, high quality RCTs are needed to confirm this and effects on other musculoskeletal outcomes

Omega-3, omega-6 and total dietary polyunsaturated fat on cancer incidence: systematic review and meta-analysis of randomised trials

Background: The relationship between long-chain omega-3 (LCn3), alpha-linolenic acid (ALA), omega-6 and total polyunsaturated fatty acid (PUFA) intakes and cancer risk is unclear. Methods: We searched Medline, Embase, CENTRAL and trials registries for RCTs comparing higher with lower LCn3, ALA, omega-6 and/or total PUFA, that assessed cancers over ≥12 months. Random-effects meta-analyses, sensitivity analyses, subgrouping, risk of bias and GRADE were used. Results: We included 47 RCTs (108,194 participants). Increasing LCn3 has little or no effect on cancer diagnosis (RR1.02, 95% CI 0.98–1.07), cancer death (RR0.97, 95% CI 0.90–1.06) or breast cancer diagnosis (RR1.03, 95% CI 0.89–1.20); increasing ALA has little or no effect on cancer death (all high/moderate-quality evidence). Increasing LCn3 (NNTH 334, RR1.10, 95% CI 0.97–1.24) and ALA (NNTH 334, RR1.30, 95% CI 0.72–2.32) may slightly increase prostate cancer risk; increasing total PUFA may slightly increase risk of cancer diagnosis (NNTH 125, RR1.19, 95% CI 0.99–1.42) and cancer death (NNTH 500, RR1.10, 95% CI 0.48–2.49) but total PUFA doses were very high in some trials. Conclusions: The most extensive systematic review to assess the effects of increasing PUFAs on cancer risk found increasing total PUFA may very slightly increase cancer risk, offset by small protective effects on cardiovascular diseases

The effect of food elimination and probiotic supplementation in asthmatic children with food allergy

Background: Both bronchial asthma and food allergy are comorbidities of increase prevalence and growing concern worldwide. Objectives: to detect the prevalence of food allergy in children with bronchial asthma, the effect of food elimination and probiotic supplementation on the clinical outcome of asthma and the quality of life (QOL). Methods: This randomized controlled trial included 226 children aged from 4 to 18, suffering from bronchial asthma, 88 of whom had associated food allergy. Patients who suffered food allergy as diagnosed by history, prick to prick test food elimination and oral food challenge test, were randomly divided into four groups, each comprised 22 children. Group (1): received pharmacological treatment only, group (2): received pharmacological treatment and probiotic supplementation, group (3): practiced food elimination and received pharmacotherapy, and Group (4): practiced food elimination and received probiotic supplementation and pharmacological therapy. For patients in all groups, grading of asthma severity, measurement of total IgE and Pediatric Asthma quality of life questionnaire (PAQLQ) were performed before and after 6 months at the end of the study. Results: There were significant statistical improvements of severity of asthma, total serum IgE level and QOL for all groups before and after intervention. The best outcome was achieved in children who practiced avoidance of food allergen(s) and took probiotic supplementation in addition to the pharmacological therapy (p &lt;0.001). Conclusion: Diagnosis of food allergy in asthmatic children is mandatory and combining pharmacological therapy, avoidance of the offended food allergen and intake of probiotics are encourage

High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern- a systematic review

A Mediterranean style dietary pattern (MDP) is considered beneficial for health. The MD Score (MDS) definition has evolved, resulting in considerable variability in the foods and nutrients associated with MDS adherence. We systematically investigated food and nutrient composition of the MD between studies, countries, and methods of classifying the MDS. We searched Embase for MD systematic reviews and selected observational studies reporting intakes of foods, macronutrients, or micronutrients by categories of MDS adherence. The percentage differences in food and nutrient intakes between categories of high and low adherence to the MDS were calculated for each study. A total of 369 full-text primary papers were reviewed from the included systematic reviews and 74 papers selected (66 adults, 8 children). We found considerable differences in MDS definitions and scoring criteria. Between-study variation in food intake between high- and low-adherence MDS adherence categories ranged from a mean of −23% for meat, to 119% for fruit, and 278% for fish. Greater variability was evident in non-Mediterranean than Mediterranean regions. We conclude that few studies report food and nutrient intakes across the range of the MDP in adults and even fewer in children. The considerable variability in the foods and nutrients reported makes comparison of results from studies and translation into dietary guidelines difficult. We recommend that future publications of MD studies include full details of the range of food and nutrient intakes across the distribution of MD adherence in order to facilitate translation into health policy and practice