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 Cleaning products and respiratory health outcomes in occupational cleaners: a systematic review and meta-analysis

2020 ◽  
pp. oemed-2020-106776
Author(s):  
Olia Archangelidi ◽  
Sean Sathiyajit ◽  
Dario Consonni ◽  
Debbie Jarvis ◽  
Sara De Matteis
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Health Effects ◽  
Respiratory Health ◽  
Meta Analysis ◽  
Atopic Asthma ◽  
Chronic Obstructive ◽  
Lung Function Decline ◽  
Cleaning Products ◽  
Increased Risk

There is consistent evidence of increased respiratory symptoms in occupational cleaners; however, uncertainty remains on type of respiratory health effects, underlying causal agents, mechanisms and respiratory phenotypes. We aimed to conduct a systematic review and if possible, a meta-analysis of the available literature to characterise and quantify the cleaning-related respiratory health effects. We searched MEDLINE and EMBASE databases and included studies that evaluated the association of any respiratory health outcome with exposure to cleaning occupation or products in occupational cleaners. A modified GRADE was used to appraise the quality of included studies. We retrieved 1124 articles, and after applying our inclusion criteria, 39 were selected for the systematic review. We performed a meta-analysis of the 21 studies evaluating asthma which showed a 50% increased pooled relative risk in cleaners (meta-relative risk (RR)=1.50; 95% CI 1.44 to 1.56). Population-based cross-sectional studies showed more stable associations with asthma risk. No evidence of atopic asthma as dominant phenotype emerged. Also, we estimated a 43% increased risk (meta-RR=1.43; 95% CI 1.31 to 1.56) of chronic obstructive pulmonary disease. Evidence for associations with bronchial-hyper-responsiveness, lung function decline, rhinitis, upper and lower respiratory tract symptoms was weaker. In our systematic review and meta-analysis, we found that working as a cleaner is associated with an increased risk of reversible and even irreversible obstructive airway diseases. All studies lacked quantitative exposure assessment to cleaning products; this would help elucidate underlying causal agents and mechanisms. Exposure control and respiratory surveillance among cleaners is warranted to prevent the associated respiratory health burden. Trial registration number: CRD4201705915.

Effect of Intranasal Corticosteroids on Secondary Sinonasal Symptoms: A Systematic Review of Randomized Trials

2019 ◽  
Vol 33 (5) ◽  
pp. 601-607
Author(s):  
Neal Deot ◽  
Jeremy Barr ◽  
Nicholas Mankowski ◽  
Jacob Brunner ◽  
Edward D. McCoul
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Facial Pain ◽  
English Language ◽  
Meta Analysis ◽  
Included Study ◽  
Specific Symptom ◽  
Postnasal Drip ◽  
Pressure Headache ◽  
Sinonasal Symptoms

Background Intranasal corticosteroid (INCS) sprays are indicated for use in the treatment of seasonal and perennial allergic rhinitis and include aqueous and nonaqueous formulations. Secondary symptoms of rhinitis include postnasal drip, facial pain/pressure, headache, cough, and ear fullness. The effectiveness of INCS on these specific symptoms, as well as the comparative effectiveness of aqueous and nonaqueous formulations, is poorly defined. Objective To evaluate the effectiveness of aqueous versus nonaqueous INCS formulations on less common sinonasal symptoms. Methods A systematic review was conducted of English-language, randomized controlled trials, with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard. Studies that did not provide quantitative data on relief of postnasal drip, facial pain/pressure, headache, cough, and ear fullness were excluded. An itemized assessment of the risk of bias was conducted for each included study. Results Of the 118 studies identified, 9 met the criteria for qualitative analysis. An effect on postnasal drip was reported in 5 studies, facial pain/pressure in 2 studies, and cough in 2 studies. A reduction in a specific symptom was reported in about half of these studies, with heterogenous outcome measures. Only 1 study reported the effect of a nonaqueous formulation on a specific symptom. No studies reported an effect on aural fullness. Conclusions Limited data are available regarding the effectiveness of aqueous or nonaqueous INCS on secondary symptoms in adult patients with rhinitis. Further study is needed using homogenous outcome measures and direct comparison of INCS formulations.

scholarly journals Olfactory and gustatory dysfunction in 2019 novel coronavirus: An updated systematic review and meta-analysis

2020 ◽  
Author(s):  
Marzieh Esmaeili ◽  
Fatemeh Abdi ◽  
Gita Shafiee ◽  
Hadis Rastad ◽  
Hamid Asayesh ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Random Effect ◽  
Eligibility Criteria ◽  
Language Studies ◽  
Pooled Prevalence ◽  
Comprehensive Search ◽  
Novel Coronavirus

Abstract BackgroundEvidence showed that partial or complete loss of smell and taste might be a possible primary symptom of the 2019 novel coronavirus (COVID-19). This study aimed to systematically review and pool all available evidence on the olfactory and gustatory dysfunction in COVID-19 patients. MethodsIn this systematic review, a comprehensive search was carried out systematically through e-databases including PubMed, EMBASE, Scopus, and Web of Science (WoS); that was limited to English-language studies published from 2019 up to 6th May 2020. Afterward, all studies reported the taste and smell dysfunction in the COVID-19 patients were included. The quality of the studies was assessed by the Mixed Methods Appraisal Tool (MMAT). The pooled prevalence of olfactory and gustatory dysfunction was estimated using the random effects meta-analysis method.ResultsAmong 28 eligible included studies in this systematic review, finally, 22 studies met the eligibility criteria and were included in the meta-analysis. According to the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of any olfactory dysfunction, anosmia, and hyposmia was 55% (40%-70%), 40% (22%-57%), and 40% (20%-61%) respectively. The pooled estimated prevalence of any gustatory dysfunction, ageusia, and dysgeusia was 41% (23%-59%), 31% (3%-59%), and 34% (19%-48%) respectively. ConclusionOlfactory and gustatory dysfunction is prevalent among COVID-19 patients. Therefore, olfactory and gustatory dysfunction seems to be part of important symptoms and notify for the diagnosis of COVID-19, especially in the early phase of the infection.

scholarly journals Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
pp. e001776
Author(s):  
Unjali P Gujral ◽  
Ram Jagannathan ◽  
Siran He ◽  
Minxuan Huang ◽  
Lisa R Staimez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
English Language ◽  
Meta Analysis ◽  
Glycosylated Hemoglobin ◽  
Language Studies ◽  
Risk Of Mortality ◽  
Cochrane Database ◽  
Design And Methods

IntroductionWe conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.Research design and methodsWe identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.ResultsImpaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110–125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100–125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%–6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%–6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).ConclusionPrediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.

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 The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Jamie YE Park ◽  
Alyssa M Howren ◽  
Enav Z Zusman ◽  
John M Esdaile ◽  
Mary A De Vera
Keyword(s):  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Meta Analysis ◽  
Included Study ◽  
Depression And Anxiety ◽  
Random Effects Models ◽  
Cochrane Database ◽  
Increased Risk ◽  
Multivariable Regression ◽  
Psychiatric Complications

Abstract Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.

scholarly journals Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Natasha Wehner-Hewson ◽  
Paul Watts ◽  
Richard Buscombe ◽  
Nicholas Bourne ◽  
David Hewson
Keyword(s):  
Systematic Review ◽  
Ethnic Groups ◽  
English Language ◽  
Meta Analysis ◽  
Community Dwelling ◽  
Racial And Ethnic Differences ◽  
Use Of Resources ◽  
Language Studies ◽  
Risk Of Falls ◽  
Meta Analyses

Abstract The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.

Tobacco smoking and the risk of atrial fibrillation: A systematic review and meta-analysis of prospective studies

2018 ◽  
Vol 25 (13) ◽  
pp. 1437-1451 ◽  
Author(s):  
Dagfinn Aune ◽  
Sabrina Schlesinger ◽  
Teresa Norat ◽  
Elio Riboli
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Relative Risk ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Adjusted Relative Risk ◽  
Case Control Studies ◽  
Increased Risk ◽  
Former Smokers ◽  
Summary Relative Risk

Background Epidemiological studies on smoking and atrial fibrillation have been inconsistent, with some studies showing a positive association while others have found no association. It is also unclear whether there is a dose–response relationship between the number of cigarettes smoked or pack-years and the risk of atrial fibrillation. We conducted a systematic review and meta-analysis to clarify the association. Design Systematic review and meta-analysis. Methods We searched the PubMed and Embase databases for studies of smoking and atrial fibrillation up to 20 July 2017. Prospective studies and nested case–control studies within cohort studies reporting adjusted relative risk estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with smoking were included. Summary relative risks (95% CIs) were estimated using a random effects model. Results Twenty nine prospective studies (22 publications) were included. The summary relative risk was 1.32 (95% CI 1.12–1.56, I2 = 84%, n = 11 studies) for current smokers, 1.09 (95% CI 1.00–1.18, I2 = 33%, n = 9) for former smokers and 1.21 (95% CI 1.12–1.31, I2 = 80%, n = 14) for ever smokers compared to never smokers. Comparing current versus non-current smokers the summary relative risk was 1.33 (95% CI 1.14–1.56, I2 = 78%, n = 10). The summary relative risk was 1.14 (95% CI 1.10–1.20, I2 = 0%, n = 3) per 10 cigarettes per day and 1.16 (95% CI 1.09–1.25, I2 = 49%, n = 2) per 10 pack-years and there was no evidence of a non-linear association for cigarettes per day, Pnon-linearity = 0.17. Conclusions The current meta-analysis suggests that smoking is associated with an increased risk of atrial fibrillation in a dose-dependent matter, but the association is weaker among former smokers compared to current smokers.

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