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1.
Obes Rev ; 17(6): 520-30, 2016 06.
Article in English | MEDLINE | ID: mdl-26956255

ABSTRACT

We performed a systematic review and meta-analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc dispersion (indices of ventricular repolarization). Mean difference for both QTc and QT or QTc dispersion with 95% confidence intervals (CIs) was calculated comparing obese ± overweight subjects and normal weight controls and QTc and QT or QTc dispersion before and after weight loss from diet ± exercise or bariatric surgery. A total of 22 studies fulfilled the selection criteria. Compared with normal weight controls, there was a significantly longer QTc in obese ± overweight subjects (mean difference of 21.74 msec, 95% CI: 18.76 to 22.32) and significantly longer QT or QTc dispersion (mean difference of 15.17 msec, 95% CI: 13.59 to 16.74). Weight loss was associated with a significant decrease in QTc (mean difference -25.77 msec, 95% CI: -28.33-23.21) and QT or QTc dispersion (mean difference of -13.46 msec, 95% CI: -15.60 to -11.32 in obese ± overweight subjects. Thus, obesity ± overweight is associated with significant prolongation of QTc and QT or QTC dispersion. Weight loss in obese ± overweight subjects produces significant decreases in these variables. © 2016 World Obesity.


Subject(s)
Arrhythmias, Cardiac/prevention & control , Heart Ventricles/physiopathology , Obesity/therapy , Weight Loss , Arrhythmias, Cardiac/physiopathology , Bariatric Surgery , Diet , Electrocardiography , Exercise , Humans , Overweight/therapy , Ventricular Dysfunction/physiopathology
2.
Diabet Med ; 30(9): 1026-32, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23350856

ABSTRACT

AIMS: Pioglitazone, a thiazolidinedione, was approved for treatment of Type 2 diabetes. However, several observational studies suggest an association of pioglitazone with an increased risk of bladder cancer in patients with diabetes. Therefore, we sought to perform a systematic review and meta-analysis to evaluate the magnitude of this association and the quality of the supporting evidence. METHODS: Electronic databases were queried to identify controlled studies of pioglitazone that measured the risk of bladder cancer. RESULTS: Six studies involving 215 142 patients using pioglitazone were included, with a median period of follow-up of 44 months. The hazard of developing bladder cancer was significantly higher in patients using pioglitazone (hazard ratio 1.23; 95% CI 1.09-1.39; I² = 0%) compared with control groups. The risk of bias was moderate across the six studies. Considering an incidence rate of 20.8 per 100 000 person years, the number needed to harm was five additional cases of bladder cancer per 100 000 person years. CONCLUSIONS: Patients treated with pioglitazone have a slight increased risk of bladder cancer compared to general population. Patient involvement and weighing treatment benefits versus risks should be discussed with patient toward shared decision. Patients with type 2 diabetes with risk factors, such as family history, smoking, or exposure to certain forms of chemotherapy may need to consider other anti-hyperglycemic agents. Also, pioglitazone should be discontinued in type 2 diabetes patients with newly diagnosed bladder cancer.


Subject(s)
Hypoglycemic Agents/adverse effects , Thiazolidinediones/adverse effects , Urinary Bladder Neoplasms/chemically induced , Controlled Clinical Trials as Topic , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Follow-Up Studies , Humans , Hypoglycemic Agents/therapeutic use , Pioglitazone , Risk , Thiazolidinediones/therapeutic use , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/epidemiology
3.
Aliment Pharmacol Ther ; 33(4): 487-94, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21158878

ABSTRACT

BACKGROUND: Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population. AIM: To determine among patients in secondary care, if uncomplicated diverticular disease is a common cause of colonic symptoms. METHODS: Patients aged ≥50 years attending gastroenterology out-patient clinics or scheduled for colonoscopy or barium enema in a secondary care hospital were invited to take part. Those with structural gastrointestinal diseases were excluded. Participants completed a locally validated Rome II questionnaire on colonic symptoms. Patients with diverticular disease were compared with those without. RESULTS: Seven hundred and eighty four patients with no structural pathology other than diverticular disease or benign colonic polyps completed the study. A total of 744 patients underwent colonoscopy, 40 barium enema. Of these, 281 patients had diverticular disease. Among patients with and without diverticular disease, the frequency of abdominal pain, diarrhoea, constipation and irritable bowel syndrome were 123 (44%) and 226 (46%), 44 (16%) and 80 (17%), 38 (14%) and 80 (17%) and 66 (25%) and 119 (25%), respectively (N.S.). CONCLUSION: Uncomplicated colonic diverticular disease is not a common cause of colonic symptoms among patients in secondary care.


Subject(s)
Abdominal Pain/etiology , Constipation/etiology , Diarrhea/etiology , Diverticulosis, Colonic/diagnosis , Irritable Bowel Syndrome/etiology , Abdominal Pain/physiopathology , Age Factors , Aged , Barium Sulfate , Colonoscopy , Diverticulosis, Colonic/complications , Diverticulosis, Colonic/physiopathology , Enema , Female , Humans , Irritable Bowel Syndrome/physiopathology , Male , Middle Aged , Severity of Illness Index , Statistics as Topic , Surveys and Questionnaires
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