Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review

Background: Methotrexate is well-known in treating inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriasis (Ps), and psoriatic arthritis (PsA). Several reports have indicated a higher incidence of methotrexate (MTX)-related liver adverse events in patients with IBD. We aim to investigate the risk of liver injury in patients with IBD and those with non-IBD diseases treated with MTX.Methods: We searched PubMed, Embase, and the Cochrane Library for articles that reported liver adverse events in patients with IBD, RA, and Ps/PsA, receiving MTX therapy. Additional articles were obtained by screening the references of recent meta-analysis and reviews. Raw data from included articles were pooled to calculate the cumulative incidence of total liver injury (TLI), MTX discontinuation (MTX-D), and liver fibrosis (LF). RR (relative risk) was calculated to compare the difference between patients with IBD and those with non-IBD diseases.Results: A total of 326 articles with 128,876 patients were included. The patients with IBD had higher incidence of TLI [11.2 vs. 9.2%; relative risk (RR) = 1.22; P = 0.224] and MTX-D (2.6 vs. 1.8%; RR, 1.48; P = 0.089) than patients with non-IBD diseases. Due to the publication bias, trim-and-fill was performed. Afterwards, the patients with IBD showed significantly higher risk of TLI (11.2 vs. 3%; RR = 3.76; p < 0.001), MTX-D (3.3 vs. 0.7%; RR = 5; p < 0.001) and LF (3.1 vs. 0.1%; RR = 38.62; P = 0.001) compared with patients with non-IBD diseases.Conclusion: IBD is associated with a higher risk of MTX-related liver injury. The mechanism of MTX-induced hepatotoxicity might be different in IBD and non-IBD diseases, and needs to be verified in future research.

Luteal Presence and Ovarian Response at the Beginning of a Timed Artificial Insemination Protocol for Lactating Dairy Cows Affect Fertility: A Meta-Analysis

Progesterone (P4) concentration during follicular growth has a major impact on fertility response in timed artificial insemination (TAI) protocols. Luteal presence at the beginning of a TAI protocol and ovarian response after the first gonadotropin-releasing hormone (GnRH) injection (G1) affect P4 concentration and subsequently pregnancy per artificial insemination (P/AI). A systematic review of the literature and meta-analytical assessment was performed with the objective of evaluating the magnitude of the effect of luteal presence and ovarian response at the beginning of a TAI protocol on P/AI in lactating dairy cows. We considered only studies using synchronisation protocols consisting of GnRH and prostaglandin F 2α. The time interval between G1 and prostaglandin F 2α (PGF 2α) had to range from 5 to 7 d. The time interval between the PGF 2α injection and G2 had to range from 48 to 72 h. We used 28 controlled experiments from 27 published manuscripts including 16,489 cows with the objective of evaluating the effect size of having a functional corpus luteum (CL) at G1 on P/AI. Information regarding ovulatory response after G1 was available for 5676 cows. In a subset of cows (n = 4291), information was available for luteal presence and ovulatory response at the initiation of the TAI protocol. A functional CL at G1 increased (p < 0.001) the relative risk of conceiving (RR (relative risk) = 1.32; 95% CI = 1.21–1.45) in lactating dairy cows. Ovulation after G1 increased (p < 0.001) the relative risk of conceiving (RR = 1.29; 95% CI = 1.20–1.38) in lactating dairy cows. The effect of ovulatory response on P/AI after G1 was affected by luteal presence at G1. In summary, there was a clear benefit on P/AI for cows starting a TAI protocol with a functional CL (+10.5 percentage units) and cows ovulating at the beginning of a TAI protocol (+11.0 percentage units).

Normative patterns and factors associated with presbyopia progression in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases Study

Background/AimTo investigate normative patterns and factors associated with presbyopia progression in a multiethnic Asian population.MethodsMalay, Indian and Chinese participants aged 40–80 years who had baseline and 6-year follow-up examinations with subjective refraction data were recruited from the Singapore Epidemiology of Eye Diseases Study. Presbyopia progression was defined as an increase in near addition power of ≥+0.50 dioptre (D) from baseline to follow-up visit. Modified Poisson regression analyses were used to determine baseline factors associated with presbyopia progression.ResultsFrom the eligible 3974 eyes, 2608 eyes were included for final analysis after excluding eyes with a history of cataract surgery (929 eyes) and best-corrected distance visual acuity worse than 20/40 (342 eyes). Overall the mean near addition power change over 6 years was +0.25 D; Malays showed greater change (+0.37 D) compared with Indians (+0.23 D) and Chinese (+0.16 D). After adjusting for baseline age, gender, body mass index, hypertension, cataract, refractive error and daily hours of reading and writing, Malays were more likely to have presbyopia progression compared with Chinese (RR (relative risk)=1.67; 95% CI 1.43 to 1.95; p<0.001) and Indians (RR=1.45; 95% CI 1.25 to 1.68; p<0.001). Individuals aged 60–69 years (RR=0.77; p=0.006) and ≥70 years (RR=0.51; p<0.001) were less likely to progress in presbyopia compared with those aged 40–49.ConclusionIn this Asian population, the near addition power change over 6 years was lower than the current near addition prescription guidelines (+0.25 D vs +0.60 D). Our findings may help update near addition prescription guidelines that can be more tailored to Asians.

Immunohistochemical Determination of ATAD2 Protein Overexpression for Predicting Prognostic Value in Patients with Different Types of Cancer: A Meta-Analysis

Background: Increasing number of studies has reported that Atpase family AAA domain-containing 2 (ATAD2) is nuclear coactivator, which is associated with tumor cell proliferation and invasion. Previous studies have demonstrated conflicting results on the relationship between high ATAD2 expression and clinicopathological characteristics of the tumors or patients’ survival outcomes. Considering the discordant results of published studies, we performed a metaanalysis to evaluate the ATAD2 expression in predicting prognosis, and to assess the relationship between high ATAD2 expression and clinicopathological parameters.Methods: We systematically searched electronic database of PubMed, Web of Science and Embase, and selected all immunohistochemical studies of hepatocellular cancer specimens for ATAD2, to analyze the relationship between high ATAD2 expression and prognosis of hepatocellular cancer patients. Pooled data of eligible studies together from individual studies and analyzed data using STATA software to perform this meta-analysis.Results: A total of 5 studies with 719 liver cancer patients were included. ATAD2 protein overexpression wassignificantly correlated with poorer overall survival (HR 3.53, 95% CI: 1.87-6.63, P = 0.000). In addition, high ATAD2 expression was also negatively related with tumor stage [RR, relative risk: 1.46 (95% CI: 1.30-1.64); P < 0.001], as well as tumor size [RR: 1.23(95% CI: 1.06-1.43); P < 0.001], and tumor recurrence [RR: 1.34 (95% CI: 1.05-1.72); P < 0.001].Conclusions: These data suggested that immunohistochemical determination of ATAD2 Protein might be aprognostic biomarker for the patients of hepatocellular cancer.

Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity

Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES) and location within a city. This study aimed to examine the impacts of heatwaves on mortality outcomes in Memphis, Tennessee, a Mid-South metropolitan area top-ranked in morbidity and poverty rates, and to investigate the effects of SES and urbanicity. Mortality data were retrieved from the death records in 2008–2017, and temperature data from the Applied Climate Information System. Heatwave days were defined based on four temperature metrics. Heatwave effects on daily total-cause, cardiovascular, and respiratory mortality were evaluated using Poisson regression, accounting for temporal trends, sociodemographic factors, urbanicity, and air pollution. We found higher cardiovascular mortality risk (cumulative RR (relative risk) = 1.25, 95% CI (confidence interval): 1.01–1.55) in heatwave days defined as those with maximum daily temperature >95th percentile for more than two consecutive days. The effects of heatwaves on mortality did not differ by SES, race, or urbanicity. The findings of this study provided evidence to support future heatwave planning and studies of heatwave and health impacts at a coarser geographic resolution.

The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis

Background Investigating the association between caesarean section (SC) and childhood asthma has shown contradictory results in different studies. The present study was conducted to determine the association between SC and childhood asthma. Material and method The present study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All the steps of the study were conducted independently by two reviewers from the inception until February 1, 2019. In case of disagreement, the third reviewer resolved it. We searched international online databases, including Scopus, Cochrane Library, PubMed/Medline, Embase, Web of Science (ISI), Science Direct, and Google scholar. The results of studies were combined using random effects model, and heterogeneity was measured through I2 index and Cochran’s Q test. Comprehensive Meta-Analysis Software was used for meta-analysis. The significance level of all tests was considered to be P < 0.05. Results The heterogeneity rate was high (I2 = 67.31%, P < 0.001) in 37 studies. The results showed that SC increased the risk of childhood asthma (RR (relative risk) = 1.20 [95% CI 1.15–1.25, P < 0.001]). The association between emergency and elective SC and childhood asthma was significant with RR of 1.18 (95% CI 1.07–1.29, P < 0.001) in 13 studies and 1.23 (95% CI 1.20–1.26, P < 0.001) in 13 studies, respectively. The subgroup analysis for RR of childhood asthma in SC indicated that study design (P = 0.306), prospective/retrospective studies (P = 0.470), quality of studies (P = 0.514), continent (P = 0.757), age of diagnosis (P = 0.283) and year of publication (P = 0.185) were not effective in the heterogeneity of studies. Sensitivity analysis by removing one study at a time indicated that the overall estimate is robust. Conclusion According to the meta-analysis, SC (overall, elective, and emergency) increased the risk of childhood asthma. Therefore, it is hoped that developing clinical guidelines and implementing appropriate management plans would diminish the risk of asthma.

Hematological and Biochemistry Profile and Risk Factors Associated with Pulmonary Tuberculosis Patients in Guyana

Objective.To evaluate the hematological and biochemistry profile of patients with or without HIV-TB at the Georgetown Chest Clinic, Guyana.Methods.An observational, laboratory based study was designed to assess the relationship of PTB and HIV with patients routine biochemical and hematological values. The study was conducted during the period January 2013 to December 2014; a total sample size of 316 patients was enrolled following exclusion and inclusion criteria.Results.Mean age of study population was 40.1 ± 13.8 (95% CI 38.6–41.7) and most were between 40 and 49 age group (27.8%, 95% CI 23.2–33.0). More males were in the study 74.4% (95% CI 69.3–78.8) than females 81% (95% CI 21.1–30.7). 30% (95% CI 25.3–35.3) had a sputum smear grade of 3+ and 62.5% (95% CI 47.0–75.7) showed a CD4count <200. The study demonstrated significantly low hemoglobin (Hb) 91.7% (95% CI 78.2–97.1), low WBC 27.8% (95% CI 15.8–44.0), high indirect bilirubin 7.4% (95% CI 2.1–23.3), ALT 41.8% (95% CI 28.4–56.7), and AST 72.2% (95% CI 57.3–83.3) among TB-HIV patients. Homelessness RR (relative risk) 2.2 (95% CI 0.48–12.3), smoking RR 1.09 (95% CI 1.01–1.19), and gender (male) RR 1.2 (95% CI 0.61–2.26) were main associated risk factors.Conclusions.There is slight variation among PTB and PTB-HIV coinfected patients in some hematological and biochemistry parameters.