scholarly journals Are probiotics and prebiotics safe for use during pregnancy and lactation? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Hauna Sheyholislami ◽  
Kristin L. Connor
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
English Language ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Potential Health ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
Synbiotic Supplementation

AbstractProbiotic and prebiotic products are increasingly popular due to their potential health benefits, including in pregnancy where probiotic supplementation has been associated with prevention of gestational diabetes and mastitis. The incidence of adverse effects in pregnant people and their infants associated with probiotic, prebiotic and/or synbiotic product intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic and/or synbiotic supplementation before and during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of pre-pregnant, pregnant and lactating people. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. 11/70 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. Only one study reported increased risk of vaginal discharge and changes in stool consistence (Relative Risk [95% CI]: 3.67 [1.04, 12.2]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

scholarly journals Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2382
Author(s):  
Hauna Sheyholislami ◽  
Kristin L. Connor
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
English Language ◽  
Clinical Decision Making ◽  
Lactobacillus Rhamnosus ◽  
Potential Health ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
Adverse Pregnancy ◽  
Synbiotic Supplementation

Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic, and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. In total, 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk [95% CI]: 3.67 [1.04, 13.0]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

scholarly journals Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Nyan Lynn Tun ◽  
Waqas Haque ◽  
Marie Gilbert Majella ◽  
Ranjith Kumar Sivakumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
English Language ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Data Extraction ◽  
Meta Analysis ◽  
Severe Disease ◽  
Factors Associated ◽  
Risk Of Mortality

Background: Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods: We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results: Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45; 95%CI 1.23,1.71), dyspnea (RR 2.55; 95%CI 1.88,2.46), diabetes (RR 1.59; 95%CI 1.41,1.78), hypertension (RR 1.90; 95%CI 1.69,2.15). Congestive heart failure (OR 4.76; 95%CI 1.34,16.97), hilar lymphadenopathy (OR 8.34; 95%CI 2.57,27.08), bilateral lung involvement (OR 4.86; 95%CI 3.19,7.39) and reticular pattern (OR 5.54; 95%CI 1.24,24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion: Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta-analysis

2019 ◽  
Vol 161 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Eric L. Wu ◽  
William C. Harris ◽  
Casey M. Babcock ◽  
Bailin H. Alexander ◽  
Charles A. Riley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Relative Risk ◽  
English Language ◽  
Meta Analysis ◽  
Included Study ◽  
Pubmed Central ◽  
Intranasal Corticosteroids ◽  
Language Studies ◽  
Increased Risk

Objective Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs. Data Sources Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases. Review Methods Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS. Results Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity. Conclusions While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.

scholarly journals Association between health literacy and mortality: a systematic review and meta-analysis

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Zhao-ya Fan ◽  
Yuan Yang ◽  
Fan Zhang
Keyword(s):  
Systematic Review ◽  
Health Literacy ◽  
English Language ◽  
Meta Analysis ◽  
Correlation Coefficients ◽  
Functional Health ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Increased Risk ◽  
Newcastle Ottawa Scale

Abstract Background To identify the relationship between health literacy (HL) and mortality based on a systematic review and meta-analysis. Methods Literature published from database inception until July 2020 was searched using the PubMed and Web of Science databases, using relevant keywords and clear inclusion and exclusion criteria. The search was limited to English language articles. Two reviewers independently selected studies and extracted data. Pooled correlation coefficients and their 95% confidence intervals (CI) between HL and mortality were estimated using Stata 15.0 software. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. Quality of the original studies that were included in the meta-analysis was evaluated using the Newcastle–Ottawa Scale. A funnel plot and Egger’s test were used to determine whether significant publication bias was present. Results Overall, 19 articles were included, reporting on a total of 41,149 subjects. Eleven were prospective cohort studies, and all articles were considered “good” quality. The most used screening instruments were the short Test of Functional Health Literacy (S-TOFHLA) in Adults and the Brief Health Literacy Screen (BHLS). Among 39,423 subjects (two articles did not report the number of patients with low HL), approximately 9202 (23%) had inadequate or marginal HL. The correlation coefficient between HL and mortality was 1.25 (95%CI = 0.25–0.44). Conclusion Lower HL was associated with an increased risk of death. This finding should be considered carefully and confirmed by further research.

scholarly journals Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Wenxia Li ◽  
Miaomiao Hou ◽  
Zhibin Ding ◽  
Xiaolei Liu ◽  
Yuan Shao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Value ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Sensitivity Analyses ◽  
Systematic Research ◽  
Stroke Patients ◽  
Lymphocyte Ratio ◽  
Increased Risk

Background: Stroke has become a major problem around the world, which is one of the main causes of long-term disability. Therefore, it is important to seek a biomarker to predict the prognosis of patients with stroke. This meta-analysis aims to clarify the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of stroke patients.Methods: This study was pre-registered in PROSPERO (CRD42020186544). We performed systematic research in PubMed, Web of Science, and EMBASE databases for studies investigating the prognostic value of NLR. Based on the enrolled studies, patients were divided into the low-NLR cohort and the high-NLR cohort. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted and analyzed by the Review Manager 5.3 and Stata 12.0 software. Heterogeneity was estimated by using Cochran's Q test and I2 value. Sensitivity analyses and subgroup analyses were also performed to explore the potential sources of heterogeneity. Publication bias was assessed with funnel plots and assessed by Egger's tests.Results: Forty-one studies with 27,124 patients were included. In the overall analysis, elevated NLR was associated with an increased mortality in acute ischemic stroke (AIS) patients (OR = 1.12, 95% CI = 1.07–1.16) and in acute hemorrhagic stroke (AHS) patients (OR = 1.23, 95% CI = 1.09–1.39), poorer outcomes in AIS patients (OR = 1.29, 95% CI = 1.16–1.44), and in AHS patients (OR = 1.11, 95% CI = 1.03–1.20). While in terms of hemorrhagic transformation (HT), elevated NLR was associated with an increased incidence of HT in AIS patients (OR = 1.15, 95% CI = 1.08–1.23).Conclusions: This study demonstrated that elevated NLR was significantly associated with poor prognosis of stroke patients. High NLR is associated with a 1.1- to 1.3-fold increased risk of poor outcomes of AIS/AHS patients. NLR could be helpful as a potential prognostic biomarker to guide clinical decision making.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186544.

scholarly journals Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241541 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Nyan Lynn Tun ◽  
Waqas Z. Haque ◽  
Marie Gilbert Majella ◽  
Ranjith Kumar Sivakumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
English Language ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Data Extraction ◽  
Meta Analysis ◽  
Severe Disease ◽  
Factors Associated ◽  
Risk Of Mortality

Background Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23–1.71), dyspnea (RR 2.55, 95%CI 1.88–2.46), diabetes (RR 1.59, 95%CI 1.41–1.78), hypertension (RR 1.90, 95%CI 1.69–2.15). Congestive heart failure (OR 4.76, 95%CI 1.34–16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57–27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19–7.39) and reticular pattern (OR 5.54, 95%CI 1.24–24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

scholarly journals Risk of Colorectal Cancer in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Qing Zhou ◽  
Zhao-Feng Shen ◽  
Ben-sheng Wu ◽  
Cheng-biao Xu ◽  
Zhong-qi He ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Ulcerative Colitis ◽  
English Language ◽  
Disease Duration ◽  
Meta Analysis ◽  
Disease Extent ◽  
Increased Risk ◽  
History Of ◽  
Scientific Meetings

Background. Ulcerative colitis (UC) patients have an increased risk for the development of colorectal cancer (CRC). Our aim was to assess the risk of CRC in UC patients compared with disease extent, disease duration, and geographic variation. Methods. In this systematic review and meta-analysis, we searched PubMed, scientific meetings, and the bibliographies of identified articles, with English language restrictions for studies published from 1988 to 2018, and assessed the risk of CRC in UC patients. Patients with Crohn’s disease, family history of CRC, and colorectal adenomatous polyp (CAP) were excluded from this research. The study was registered with PROSPERO, number CRD42018102213. Findings. We included 58 studies that included 267566 UC patients. Extensive UC and left-sided UC had a higher risk of CRC than proctitis UC. Geography also played a role in UC-associated CRC development. The time of malignant transformation in Asian UC patients started after 10-20 years of this disease duration. North American UC-associated CRC patients significantly increased in more than 30 years of this disease duration. Conclusion. In a systematic review of the literature, we found that disease extent, disease duration, and geography were strong, independent risk factors in UC-associated CRC development.

scholarly journals Dioxins Exposure and the Risk of Breast Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Nematollah Jaafarzadeh Haghighi ◽  
Amal Saki Malehi ◽  
Zeinab Ghaedrahmat
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Breast Cancer Mortality ◽  
Positive Association ◽  
Great Distance ◽  
Organic Chemical ◽  
Significant Positive Association ◽  
Increased Risk

Context: Dioxins and dioxin-like chemicals composed of 419 compounds are a large group of compounds, including polychlorinated di-benzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and biphenyls (PCBs). Dioxins are extremely persistent in the environment and disperse in a great distance from the emission source, and bioaccumulation in the food chain is one of their critical properties. The incidence of breast cancer among Iranian women is about 30 to 35 per 100,000 cases. The present study is a systematic review of published studies in English language to discover the relationship between exposure to dioxin compounds and breast cancer. Methods: We conducted a comprehensive literature review utilizing PubMed, Embase, Scopus, and ISI web of science databases. The MeSH-based keywords used included Organic Chemical (MeSH) OR Dioxins (MeSH) AND cancer (MeSH) OR Breast cancer (MeSH) AND Breast disease (MeSH). Results: The review of the literature indicated a significant positive association between dioxins exposure and the risk of breast cancer. Only in one study, breast cancer mortality rate was reported in terms of exposure to dioxins, and standardized mortality rates (SMRs) were determined. Conclusions: Although there were limitations in this study, statistical analyses in various epidemiological studies demonstrated that dioxins exposure is linked to an increased risk of breast cancer.

scholarly journals Hypertensive disorders of pregnancy and risk of asthma in offspring: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e035145 ◽  
Author(s):  
Ping Li ◽  
Tao Xiong ◽  
Yong Hu
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Published Data ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Hypertensive Disorders ◽  
Increased Risk

IntroductionHypertensive disorders of pregnancy (HDP), one of the most common obstetrical complications, has been reported to have a controversial relationship with the increased risk of asthma in offspring. No systematic review of this topic has been performed. The aim of this systematic review will be to summarise the available evidence examining the association between HDP and the risk of asthma in offspring.Methods and analysisWe will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. A systematic search of the PubMed, Embase, Cochrane and Web of Science databases will be performed using a detailed search strategy from database inception through 31 December 2019. Cohort, case-control and cross-sectional studies that report a diagnosis of maternal HDP and asthma in offspring will be included. Studies will be limited to the English language and include only human participants. Two independent reviewers will conduct the study selection, data extraction and risk of bias assessments using a standardised data extraction form. A meta-analysis will be performed to calculate overall pooled estimates using the generic inverse variance method. The data will be synthesised by either fixed-effect or random effects models according to heterogeneity tests. All analyses will be performed in Stata 14 and RevMan 5.3. High-quality evidence of the relationship between HDP and the risk of asthma in exposed offspring will be identified through the synthesis of current studies. In addition, the results of subgroup analyses and related secondary outcomes will be reported. The following will be concluded: (i) whether HDP increases the risk of asthma in offspring, (ii) whether HDP affects the severity of asthma in exposed offspring and (iii) whether possible differences in the risk of asthma among different HDP subgroups exist.Ethics and disseminationThere is no requirement for ethics approval because the meta-analysis and systematic review will be based on published data. It is anticipated that the dissemination of results will take place at conferences and through publication in a peer-reviewed journal.

Risk of gastrointestinal and hepatic toxicities in patients with hormone receptor-positive HER2-negative breast cancer treated with CDK 4/6 inhibitors: A systematic review and meta-analysis of randomized controlled trials.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18284-e18284
Author(s):  
Aung Tun ◽  
Kyaw Zin Thein ◽  
Yu Yu Thar ◽  
Asha Nayak ◽  
Elizabeth Guevara
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
High Grade ◽  
Randomized Controlled ◽  
Hormone Receptor Positive ◽  
Relative Risks ◽  
Increased Risk

e18284 Background: CDK4/6 inhibitors are proven to be beneficial in patients with hormone receptor-positive HER2-negative breast cancer. Studies have suggested an increased risk of gastrointestinal (GI) events. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the risk of GI and hepatic toxicities. Methods: We systematically conducted a comprehensive literature search using MEDLINE and EMBASE databases through January 1, 2017. RCTs that mention GI symptoms and/or elevation of liver enzymes as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Results: Five RCTs with a total of 2021 patients were eligible for analysis. The study arm used palbociclib-letrozole, palbociclib-fulvestrant, and ribociclib-letrozole while the control arm used placebo with letrozole or fulvestrant. The relative risks of all-grade elevated AST was 2.6 (95% CI: 1.15–5.86; p = 0.02); all-grade elevated ALT: 2.82 (95% CI: 1.25–6.36; p = 0.01); all-grade stomatitis: 3.32 (95% CI: 2.09-5.28; p < 0000.1); all-grade nausea: 1.79 (95%CI: 1.25-2.58; p = 0.002); all-grade vomiting:1.55 (95% CI: 0.92-2.63; p = 0.10); and all-grade diarrhea: 1.59 (95% CI 1.28-1.98; p < 0.0001). The relative risks of high-grade elevated AST was 3.08 (95% CI: 1.42–6.67; p = 0.004); high-grade elevated ALT: 7.2 (95% CI: 2.81–18.43; p < 0.0001); high-grade stomatitis: 2.01 (95% CI: 0.22-18.02; p = 0.53); high-grade nausea: 0.76 (95%CI: 0.12-4.78; p = 0.77); high-grade vomiting: 0.88 (95% CI: 0.19-4.13; p = 0.87); and high-grade diarrhea: 1.23 (95% CI 0.52-2.92; p = 0.64). Conclusions: Our meta-analysis demonstrated that CDK 4/6 inhibitor-based regimens are associated with a higher risk of all-grade and high-grade elevated AST and ALT. Moreover, the regimen is associated with increased risk of all-grade stomatitis, nausea and diarrhea. Recognizing these adverse effects may help clinicians in delivering proper supportive care and thereby enhancing patients’ quality of life.

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