Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis

Background: A number of observational studies have found an association between low vitamin D levels and risk of sepsis. We conducted a systematic review and meta-analysis to determine the overall estimate of risk. Methods: This was a systematic review and meta-analysis conducted by online searches (CENTRAL, PubMed/MEDLINE, and EMBASE) was registered in PROSPERO (CRD42014014767). Primary outcome was incidence, prevalence, relative risk or odds ratio of having sepsis or bloodstream infection between patients with vitamin D deficiency and controls. Results: The initial search yielded 647 articles. Twenty-one articles underwent full-length review and data were extracted from 10 observational studies. Pooled odds ratio of sepsis in participants with vitamin D deficiency was 1.78 (95 % confidence interval [CI] = 1.55 to 2.03, p < 0.01) compared with controls in studies that reported participant numbers and was 1.45 (95 % CI = 1.26 to 1.66, p < 0.01) in studies that reported an adjusted odds ratio of vitamin D deficiency for developing sepsis. Statistical between-study heterogeneity was low (I² = 0 % and 5 %, respectively). Standardized mean difference of 25-hydroxyvitamin D levels in patients with sepsis and controls was −0.24 (95 % CI = −0.49 to 0.00, p = 0.05) and lower in the sepsis group compared with non-sepsis or control participants. The statistical between-study heterogeneity (I²) was 0 %. Conclusion: Vitamin D deficiency were associated with an increased susceptibility of sepsis

Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Background: HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD. Materials and Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR <60 ml/min/1.73 m²) not requiring dialysis. The primary outcome was the differences in the change of eGFR. We also examined change of protein concentration in urine as a secondary outcome. A meta-analysis comparing statin and its control groups and a subgroup analysis examining intensity of statin were performed. Results: From 142 full-text articles, 10 studies were included in the meta-analysis. Overall, there was a significant difference in rate of eGFR change per year favoring statin group (mean difference (MD) = 0.10 ml/min/1.73 m², 95% CI: 0.09 to 0.12). In our subgroup analysis, those who received high-intensity statins had a significant difference in eGFR with a MD of 3.35 (95% CI: 0.91 to 5.79) ml/min/1.73 m² compared to control. No significant change in eGFR was found with moderate- and low-intensity statin therapy. Compared with the control group, the statin group did not have a difference in reduction of proteinuria with MD in change of proteinuria of 0.19 gm/day (95% CI: -0.02 to 0.40). Conclusion: Overall, there was a difference in change of eGFR between the statin and control group. High-intensity statins were found to improve a decline in eGFR in population with CKD not requiring dialysis compared with control, but moderate- and low-intensity statins were not. Statins were not found to decrease proteinuria in patients with CKD

Management practices influence the competitive potential of weed communities and their value to biodiversity in South African vineyards.

Weeds have negative impacts on crop production but also play a role in sustaining biodiversity in agricultural landscapes. This trade‐off raises the question of whether it is possible to promote weed communities with low competitive potential but high value to biodiversity. Here, we explored how weed communities respond to different vineyard management practices in South Africa's Western Cape, aiming to identify whether any specific practices are associated with more beneficial weed communities. Eight weed community characteristics representative of abundance, diversity and functional composition were used as indicators of competitive potential and biodiversity value. We explored how these responded to farm management strategy (organic, low input or conventional) and weed management practices (herbicides, tillage, mowing or combinations of these) using ordination and mixed models. Mown sites were associated with weed communities of high biodiversity value, with higher weed cover in both winter and summer, higher diversity and more native weeds. Mowing also promoted shorter weeds than either tillage or herbicides, considered to be less competitive with grapevines. However, high summer weed cover may be problematic where competition for water is critical, in which case tillage offers a method to limit summer weed cover that did not adversely affect diversity or native weeds. In contrast, herbicide‐treated sites had characteristics indicative of a lower biodiversity value and higher potential for competitiveness with few native weeds, lower diversity and relatively tall, small‐seeded weeds. Mowing in winter combined with tillage in spring may thus optimise the biodiversity benefits and production costs of Western Cape vineyard weeds

IMPACT OF WEED MANAGEMENT PRACTICES ON GRAPEVINE GROWTH, YIELD COMPONENTS, PLANT AND ARTHROPOD ABUNDANCE, AND CARABID SEED PREDATION IN PASO ROBLES VINEYARD

In the Central Coast of California, USA, wine grape growers are making efforts to identify weed control practices that promote biodiversity in their vineyards while maintaining yields. A field study was conducted in Paso Robles, CA in 2006 and 2007 evaluating the effect on Zinfandel grape-vine growth and production, groundcover plant, and ground dwelling arthropod communities of five weed control practices: 1) flumioxazin, 2) simazine, 3) cultivation, 4) cover crop, and 5) untreated control. The herbicide treatments had the lowest weed biomass followed by the cultivation, being approximately 10 and 2 times lower than the weed biomass of either the cover crop or untreated control treatments respectively. However, the differences in grape yield were not as evident. In 2006, a rainy year, the herbicides and cultivation treatments did not differ in grape yield, but the cover crop and untreated control had a reduction of approximately 20% compared with the other treatments. In 2007, a dry year, in comparison to the herbicide treatments, the grape yield reductions of cultivation were around 22%, and of the cover crop and untreated control around 48%. Although the cover crop reduced grape yield, it suppressed weed species considered important such as horseweed, panicle willowherb, scarlet pimpernel, and sowthistle. The cover crop, cultivation and untreated control had 4 to 50 times higher plant density and more than 15 times higher plant diversity compared to the herbicide treatments. The arthropod abundance differed among treatments only in 2007 being higher in the cover crop and untreated control. Also, there was a positive relationship between plant and arthropod diversity (r2 = 0.42, P = 0.02 in 2006; r2 = 0.64, P \u3c 0.001 in 2007). Laboratory seed predation tests of the two most frequently captured carabid beetles, Calathus ruficollis and Tanystoma maculicolle, indicated their preferences for Brassica nigra and Capsella bursa-pastoris, which are considered common weed species in the region. Under field conditions, treatments with higher plant diversity and biomass favoured arthropod seed predation of these weeds, which was 20-40% in the cover crop and untreated control, doubling the predation observed in the herbicide treatments. The cultivation treatment balanced the benefits of promoting diversity while minimizing yield reductions due to weed competition. Our data indicated that the critical period of weed competition for Zinfandel grape vines occurred during budbreak-bloom period. Also, it was concluded that vines can tolerate a certain amount of weed competition, and that properly timing one pass post-emergence control tactics (e.g. cultivation or POST herbicides) could provide the necessary level of control to obtain the desired yields. However, under limited soil moisture conditions, the use of PRE herbicides could prove important to maintain vine yield and vigor. The results also illustrate how weed management practices that promote higher plant diversity and density have the potential to yield ecological services within vineyards by favoring the diversity and activity of other organisms

Psoriasis increases risk of new-onset atrial fibrillation: a systematic review and meta-analysis of prospective observational studies

Background: Psoriasis is a common chronic immune-mediated dermatological disease that increases the risk of cardiovascular disease. We conducted a systematic review and meta-analysis to evaluate the association between psoriasis and atrial fibrillation from prospective observational studies. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through November 2015. The inclusion criterion was the prospective observational study that assessed the risk of new-onset atrial fibrillation in adults with psoriasis. Outcome was the adjusted hazard ratio (HR) of atrial fibrillation comparison between patients with psoriasis and controls. Pooled HR and 95% confidence intervals (CI) were calculated using a random-effects model. Results: The initial search yielded 176 articles. Fifteen articles underwent full-length review and data were extracted from 4 observational studies. Incidence of atrial fibrillation was ascertained by cardiologist-reviewed electrocardiograms. There was a significant increased risk of new-onset atrial fibrillation in patients with psoriasis compared to controls with a pooled HR 1.42 (95%CI 1.22–1.65). Conclusion: Our meta-analysis of prospective studies demonstrated that patients with psoriasis have increased risk of new-onset atrial fibrillation. Future interventional studies addressing the impact of psoriasis treatment and prevention of atrial fibrillation should be performed

Association between psoriasis and Helicobacter pylori infection: A systematic review and meta-analysis

Background/Purpose: Helicobacter pylori infection has been suggested as a culprit of various extragastrointestinal (GI) disorders. It is debatable whether H. pylori infection exacerbates or triggers the pathogenesis of psoriasis. This meta-analysis aimed to explore the association between psoriasis and H. pylori infection. Materials and Methods: A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through October 2017. The inclusion criterion was observational studies evaluating the association between psoriasis and H. pylori infection. The pooled odds ratio (OR) of H. pylori infection and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between psoriasis patients and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. Results: Data were extracted from nine observational studies involving 1546 individuals. Pooled result demonstrated an increased H. pylori infection in psoriasis compared with controls (OR=1.58; 95% CI: 1.02–2.46, P=0.04, I2=64%). Subgroup analysis showed an increased risk of H. pylori infection in psoriasis measured with H. pylori IgG enzyme-linked immunosorbent assay (OR=3.11; 95% CI: 1.85–5.20, P<0.01, I2=10%) but not active infection measured with urea breath test (OR=0.88; 95% CI: 0.61–1.27, P=0.49, I2=0%). Conclusion: This meta-analysis has shown an increased H. pylori infection in patients with psoriasis. H. pylori infection in the past could play a role in the abnormal immunological cascade in the pathogenesis of psoriasis. Further studies to elucidate the inflammatory response in the pathogenesis of psoriasis are warranted

Association between NSAIDs and Clostridium difficile-Associated Diarrhea: A Systematic Review and Meta-Analysis

Objective. Clostridium difficile infection is a leading cause of nosocomial diarrhea in developed countries. Studies evaluating the associations of increased risk of community-acquired CDAD and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results. We conducted a systematic review and meta-analysis to compare the odds of NSAID exposure in patients with CDAD versus patients without CDAD in both community-based and healthcare-associated settings. Methods. Relevant observational studies indexed in PubMed/MEDLINE and EMBASE up to February 2015 were analyzed and data were extracted from nine studies. Of these, eight studies were included in the meta-analysis. Results. A search of the databases resulted in 987 articles. The nine studies from which data were extracted involved over 39,000 subjects. The pooled odds ratio for history of NSAID use in participants with CDAD compared with controls was 1.41 (95% CI 1.06–1.87; p < 0.01), indicating a significant increased odds of CDAD among patients exposed to NSAIDs. Conclusions. To the best of our knowledge, this is the first study of its nature to demonstrate the association between the use of NSAIDs and increased risk of CDAD. Further studies to evaluate if any specific types of NSAIDs can increase the risk of CDAD are warranted

Outcome of phlebotomy for treating nonalcoholic fatty liver disease: A systematic review and meta-analysis

Background/Aims: No medications have been approved for managing nonalcoholic fatty liver disease (NAFLD). Lifestyle intervention is the mainstay for its treatment. Hyperferritinemia, which appears to be associated with the severity of liver injury and insulin resistance, is frequently observed in patients with NAFLD. Patients and Methods: We conducted a systematic review and meta-analysis of the outcomes of four interventional trials regarding the effect of phlebotomy in patients with NAFLD versus the outcomes of NAFLD patients who did not undergo phlebotomy. Primary outcome was the pooled mean difference (MD) of the homeostasis model assessment of insulin resistance (HOMA-IR). The secondary outcomes were the changes in liver enzymes and the lipid profile. Results: Four interventional studies involving 438 participants were included in the meta-analysis. HOMA-IR was lower in patients who underwent phlebotomy, with an MD of 0.84 [95% confidence interval (CI) 0.01 to 1.67, I2 = 72%]. Phlebotomy also significantly reduced the alanine aminotransferase (MD = 10.05, 95% CI 7.19–12.92, I2 = 34%) and triglyceride (MD = 9.89, 95% CI 4.96–14.83, I2 = 22%) levels and increased the high-density cholesterol level (MD = 3.48, 95% CI 2.03–4.92, I2 = 18%). Conclusion: Phlebotomy decreased insulin resistance and liver transaminase levels in patients with NAFLD. In addition, it improved their lipid profile

Testosterone, Sex Hormone-Binding Globulin and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Introduction and aim: Endogenous sex hormones are associated with the risk of diabetes and metabolic syndrome. Recent studies suggested the role of these hormones in nonalcoholic fatty liver disease (NAFLD). We conducted a systematic review and meta-analysis of observational studies investigating the association between sex hormones and NAFLD. Material and Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through April 2016. The inclusion criterion was the observational studies that assessed the association of serum total testosterone (TT) and sex-hormone binding globulin (SHBG) and NAFLD. We calculated pooled effect estimates of TT and SHBG with 95% confidence intervals (CI) comparing between subjects with and without NAFLD by using random-effects model. Results: Sixteen trials comprising 13,721 men and 5,840 women met the inclusion criteria. TT levels were lower in men with NAFLD (MD = -2.78 nmol/l, 95%CI -3.40 to -2.15, I2 = 99%) than in those without. Men with higher TT levels had lower odds of NAFLD whereas higher TT levels increased the odds of NAFLD in women. In both sexes, SHBG levels were lower in patients with NAFLD than controls and this inverse association was stronger in women than men and higher SHBG levels were associated with reduced odds of NAFLD. Conclusion: Our meta-anal-ysis demonstrated a sex-dependent association between TT and NAFLD. Lower TT levels are associated with men with NAFLD and inversely associated with women with NAFLD, whereas higher SHBG levels are associated with lower NAFLD odds in both men and women

Risk of ischemic stroke in patients with systemic sclerosis: A systematic review and meta-analysis

<div><p><i>Background.</i> Several chronic inflammatory disorders, such as rheumatoid arthritis and idiopathic inflammatory myositis, have been shown to increase risk of ischemic stroke but the data on systemic sclerosis (SSc) remains unclear.</p><p><i>Methods.</i> We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of ischemic stroke in patients with SSc versus non-SSc participants. Pooled risk ratio and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.</p><p><i>Results.</i> Four retrospective cohort studies were identified and included in our data analysis. We found a statistically significant elevated ischemic stroke risk in patients with SSc with a pooled risk ratio of 1.68 (95% CI, 1.26–2.24). The statistical heterogeneity was moderate with an I² of 69%.</p><p><i>Conclusions.</i> Our study demonstrated a statistically significant increased ischemic stroke risk among patients with SSc.</p></div