Risk of pregnancy-related hypertension within 5 years of exposure to drinking water contaminated with Escherichia coli O157:H7

The authors evaluated the risk for pregnancy-related hypertension among previously healthy women who conceived within 5 years of exposure to drinking water contaminated with Escherichia coli O157.H7 in Walkerton, Canada (2000). Chronic hypertension was defined as systolic/diastolic blood pressure ≥140/90 mm Hg before 20 weeks gestation; gestational hypertension was defined as new onset systolic/diastolic blood pressure ≥140/90 mm Hg ≥20 weeks gestation. The incidence of hypertension was compared between women who were asymptomatic during the outbreak to those who experienced acute gastroenteritis. Blood pressure data were available for 135 of 148 eligible pregnancies. The adjusted relative risks for chronic and gestational hypertension were 1.5 (95% confidence interval [CI]: 0.3-7.7) and 1.0 (95% CI: 0.4-2.5), respectively. Mean arterial pressure before 20 weeks gestation was 2.7 mm Hg higher in women who had acute gastroenteritis (95% CI: 0.05-5.4). A trend toward higher chronic hypertension and mean arterial pressure in early pregnancy was observed among women who experienced gastroenteritis after exposure to bacterially-contaminated drinking water. © 2010 Wiley Periodicals, Inc

Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis

Abstract Background Allergic rhinitis is the most common form of allergy worldwide. The accuracy of skin testing for allergic rhinitis is still debated. Our primary objective was to evaluate the diagnostic accuracy of skin-prick testing for allergic rhinitis using the nasal provocation as the reference standard. We also evaluated the diagnostic accuracy of intradermal testing as a secondary objective. Methods We searched EBM Reviews from 2005 to March 2015; Embase from 1980 to March 2015; and Ovid MEDLINE(R) from 1946 to until March 2015. We included any study with at least 10 subjects including children. We excluded non-English studies. We performed data extraction and quality assessment using the QUADAS-2 tool. Results We meta-analysed seven studies assessing the accuracy of skin-prick testing using the bivariate random-effects model, including a total of 430 patients. The pooled estimate for sensitivity and specificity for skin-prick testing was 85 and 77 % respectively. We did not pool results for intradermal testing due to few number of studies (n = 4), each with very small sample size. Of these, two evaluated the accuracy of intradermal testing in confirming skin-prick testing results, with sensitivity ranging from 27 to 50 % and specificity ranging from 60 to 100 %. The other two evaluated the accuracy of intradermal testing as a stand-alone test for diagnosing allergic rhinitis with sensitivity ranging from 60 to 79 % and specificity ranging from 68 to 69 %. Conclusions Findings from this review suggest that skin-prick testing is accurate in discriminating subjects with or without allergic rhinitis

Optimal Method of Coronary Revascularization in Patients Receiving Dialysis: Systematic Review

Background and objectives: Patients receiving dialysis have a high burden of cardiovascular disease. Some receive coronary artery revascularization but the optimal method is controversial

Erratum to pre-operative use of aspirin in patients undergoing coronary artery bypass grafting: a systematic review and updated meta-analysis

[This corrects the article DOI: 10.21037/jtd.2018.05.187.]

Pre-operative use of aspirin in patients undergoing coronary artery bypass grafting: a systematic review and updated meta-analysis

Background: Aspirin therapy improves saphenous vein graft (SVG) patency in patients undergoing coronary artery bypass graft (CABG), however, its use in the pre-operative period remains controversial. Therefore, we conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) to update the evidence about risk and benefits of pre-operative aspirin therapy in patients undergoing CABG.Methods: Electronic databases (Medline, Embase, PubMed, Cochrane Library, and Scopus) were searched to identify RCTs evaluating the effect of aspirin versus placebo/control before CABG. Two investigators independently and in duplicate screened citations and extracted data and rated the risk of bias. The strength of evidence was appraised using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Meta-analysis was performed using a random-effects model. The main outcomes of interest were 30-day mortality, peri-operative myocardial infarction (MI), chest tube drainage and SVG occlusion.Results: A total of 13 RCTs involving 4,377 participants (2,266/2,111 pre-operative aspirin/control) met the inclusion criteria. Pre-operative aspirin reduced the risk of SVG occlusion [risk ratio (RR): 0.69, 95% confidence interval (CI): 0.49-0.97, P=0.03, I-2=16%], but no differences in mortality (RR: 1.41, 95% Cl: 0.73-2.74, I-2=0%) and MI (RR: 0.84, 95% CI: 0.69-1.03, I-2=0%) were found. However, pre-operative aspirin increased chest tube drainage (MD: 100.40 mL, 95% CI: 24.32-176.47 mL, P=0.01, I-2=84%) and surgical re-exploration (RR: 1.52, 95% CI: 1.02-2.27, P=0.04, I-2=8%), with no significant difference in RBC transfusion (RR: 1.06, 95% CI: 0.90-1.25, I-2=35%).Conclusions: Based on trials where the rated body of evidence was of low to very-low quality, pre-operative aspirin improves SVG patency but increases chest tube drainage and need for surgical re-exploration