451 research outputs found
Cholangiocarcinoma and sclerosing cholangitis: clinical characteristics and effect on survival after liver transplantation.
The role of statins in prevention and treatment of community acquired pneumonia: a systematic review and meta-analysis.
BACKGROUND: Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications.
PURPOSE: Performed a systematic review to address the role of statins in the prevention or treatment of CAP.
DATA SOURCE: Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies.
STUDY SELECTION: Two authors independently reviewed studies that examined the role of statins in CAP.
DATA EXTRACTION: Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted.
DATA SYNTHESIS: Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I(2) = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I(2) = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder.
CONCLUSIONS: Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.
Abstract
Introduction
Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).
Methods
Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings.
Results
We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year.
Conclusions
In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship
3DEX: a code for fast spherical Fourier-Bessel decomposition of 3D surveys
High-precision cosmology requires the analysis of large-scale surveys in 3D
spherical coordinates, i.e. spherical Fourier-Bessel decomposition. Current
methods are insufficient for future data-sets from wide-field cosmology
surveys. The aim of this paper is to present a public code for fast spherical
Fourier-Bessel decomposition that can be applied to cosmological data or 3D
data in spherical coordinates in other scientific fields. We present an
equivalent formulation of the spherical Fourier-Bessel decomposition that
separates radial and tangential calculations. We propose the use of the
existing pixelisation scheme HEALPix for a rapid calculation of the tangential
modes. 3DEX (3D EXpansions) is a public code for fast spherical Fourier-Bessel
decomposition of 3D all-sky surveys that takes advantage of HEALPix for the
calculation of tangential modes. We perform tests on very large simulations and
we compare the precision and computation time of our method with an optimised
implementation of the spherical Fourier-Bessel original formulation. For
surveys with millions of galaxies, computation time is reduced by a factor 4-12
depending on the desired scales and accuracy. The formulation is also suitable
for pre-calculations and external storage of the spherical harmonics, which
allows for additional speed improvements. The 3DEX code can accommodate data
with masked regions of missing data. 3DEX can also be used in other
disciplines, where 3D data are to be analysed in spherical coordinates. The
code and documentation can be downloaded at http://ixkael.com/blog/3dex.Comment: 6 pages plus appendices. Revised version accepted by A&A. The code
and documentation can be downloaded at http://ixkael.com/blog/3de
The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.
Background
Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.
Purpose
We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.
Data source
We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.
Study selection
Two authors independently reviewed the studies for eligibility.
Data extraction
Data about studies characteristics, adjusted effect estimates and quality were extracted.
Data synthesis
Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).
Conclusion
In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics
Spherical 3D Isotropic Wavelets
Future cosmological surveys will provide 3D large scale structure maps with
large sky coverage, for which a 3D Spherical Fourier-Bessel (SFB) analysis in
spherical coordinates is natural. Wavelets are particularly well-suited to the
analysis and denoising of cosmological data, but a spherical 3D isotropic
wavelet transform does not currently exist to analyse spherical 3D data. The
aim of this paper is to present a new formalism for a spherical 3D isotropic
wavelet, i.e. one based on the SFB decomposition of a 3D field and accompany
the formalism with a public code to perform wavelet transforms. We describe a
new 3D isotropic spherical wavelet decomposition based on the undecimated
wavelet transform (UWT) described in Starck et al. 2006. We also present a new
fast Discrete Spherical Fourier-Bessel Transform (DSFBT) based on both a
discrete Bessel Transform and the HEALPIX angular pixelisation scheme. We test
the 3D wavelet transform and as a toy-application, apply a denoising algorithm
in wavelet space to the Virgo large box cosmological simulations and find we
can successfully remove noise without much loss to the large scale structure.
We have described a new spherical 3D isotropic wavelet transform, ideally
suited to analyse and denoise future 3D spherical cosmological surveys, which
uses a novel Discrete Spherical Fourier-Bessel Transform. We illustrate its
potential use for denoising using a toy model. All the algorithms presented in
this paper are available for download as a public code called MRS3D at
http://jstarck.free.fr/mrs3d.htmlComment: 9 pages + appendices. Public code can be downloaded at
http://jstarck.free.fr/mrs3d.html Corrected typos and updated references.
Accepted for publication in Astronomy and Astrophysic
Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases
Analysis of prosthetic joint infections following invasive dental procedures in England
Importance
Dentists in the United States are under pressure from orthopaedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis (AP) before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of AP efficacy, cost of providing AP, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance.
Objective
Our objective was to quantify if there is any temporal association between IDP and subsequent LPJI.
Design
A case-crossover and time trend study of any potential association between IDP and LPJI.
Setting
The population of England (55 million) was chosen because AP has never been recommended to prevent LPJI in England and any association between IDP and LPJI would therefore be fully exposed.
Participants
All patients admitted to hospital in England for LPJI from December 25th, 2011, through March 31st, 2017, for whom dental records were available. Analyses were performed between May 2018 and June 2021.
Exposures
Exposure to IDP
Main Outcomes and Measures
A case-crossover analysis comparing the incidence IDP in the 3-months before LPJI hospital admission (case-period) with the incidence in the 12-months before that (control-period).
Results
We identified 9,427 LPJI hospital admissions with dental records (mean age 67), including 4,897 (52%) men. Of these, 2,385 (25.3%) had hip, 3,168 (33.6%) knee, 259 (2.8%) other and 3,615 (38.4%) unknown prosthetic joint types. Despite having sufficient statistical power to detect a clinically significant association, our analysis identified no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the three months prior to LPJI (incidence rate ratio = 0.89, 95% confidence interval 0.82 to 0.96, p=0.002).
Conclusions and Relevance
In the absence of a significant positive association between IDP and LPJI, there is no rationale to administer AP before IDP in patients with prosthetic joints. Maintenance of good oral hygiene, however, may be important in preventing the small number of LPJI cases where oral bacterial species are implicated
Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019 : Update From the GBD 2019 Study
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases
Infective endocarditis following invasive dental procedures: IDEA case-crossover study
Background
Infective endocarditis is a heart infection with a first-year mortality rate of ≈ 30%. It has long been thought that infective endocarditis is causally associated with bloodstream seeding with oral bacteria in ≈ 40–45% of cases. This theorem led guideline committees to recommend that individuals at increased risk of infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures. However, to the best of our knowledge, there has never been a clinical trial to prove the efficacy of antibiotic prophylaxis and there is no good-quality evidence to link invasive dental procedures with infective endocarditis. Many contend that oral bacteria-related infective endocarditis is more likely to result from daily activities (e.g. tooth brushing, flossing and chewing), particularly in those with poor oral hygiene.
Objective
The aim of this study was to determine if there is a temporal association between invasive dental procedures and subsequent infective endocarditis, particularly in those at high risk of infective endocarditis.
Design
This was a self-controlled, case-crossover design study comparing the number of invasive dental procedures in the 3 months immediately before an infective endocarditis-related hospital admission with that in the preceding 12-month control period.
Setting
The study took place in the English NHS.
Participants
All individuals admitted to hospital with infective endocarditis between 1 April 2010 and 31 March 2016 were eligible to participate.
Interventions
This was an observational study; therefore, there was no intervention.
Main outcome measure
The outcome measure was the number of invasive and non-invasive dental procedures in the months before infective endocarditis-related hospital admission.
Data sources
NHS Digital provided infective endocarditis-related hospital admissions data and dental procedure data were obtained from the NHS Business Services Authority.
Results
The incidence rate of invasive dental procedures decreased in the 3 months before infective endocarditis-related hospital admission (incidence rate ratio 1.34, 95% confidence interval 1.13 to 1.58). Further analysis showed that this was due to loss of dental procedure data in the 2–3 weeks before any infective endocarditis-related hospital admission.
Limitations
We found that urgent hospital admissions were a common cause of incomplete courses of dental treatment and, because there is no requirement to record dental procedure data for incomplete courses, this resulted in a significant loss of dental procedure data in the 2–3 weeks before infective endocarditis-related hospital admissions. The data set was also reduced because of the NHS Business Services Authority’s 10-year data destruction policy, reducing the power of the study. The main consequence was a loss of dental procedure data in the critical 3-month case period of the case-crossover analysis (immediately before infective endocarditis-related hospital admission), which did not occur in earlier control periods. Part of the decline in the rate of invasive dental procedures may also be the result of the onset of illness prior to infective endocarditis-related hospital admission, and part may be due to other undefined causes.
Conclusions
The loss of dental procedure data in the critical case period immediately before infective endocarditis-related hospital admission makes interpretation of the data difficult and raises uncertainty over any conclusions that can be drawn from this study.
Future work
We suggest repeating this study elsewhere using data that are unafflicted by loss of dental procedure data in the critical case period.
Trial registration
This trial is registered as ISRCTN11684416.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 28. See the NIHR Journals Library website for further project information
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