Vitamin D & its analogues in type 2 diabetic nephropathy: a systematic review.

Nephropathy is one of the major complications of diabetes often leading to chronic kidney disease (CKD). Inflammation and oxidative stress are associated with pathogenesis of diabetic nephropathy (DN) and found to be regulated by nuclear receptors such as vitamin D receptors (VDR). Vitamin D and its analogues have been effectively used in patients with CKD. The review attempts to summarize the available evidence on the role of vitamin D in DN. Electronic databases (MEDLINE, EMBASE, and Cochrane Library) were searched for studies assessing the role of vitamin D or its analogues on kidney function in type 2 diabetic patients. Studies evaluating kidney functions (urinary albumin/protein creatinine ratio, albuminuria and eGFR) were included and quality and risk of bias assessment performed. Additionally effect on 25 (OH) vitamin D, calcium and HbA1c were evaluated. The mean or its % change along with their standard deviation (SD) was used for reporting our results. RevMan (V5.2) was used for data analysis. Six studies included in this review evaluated the role of cholecalciferol, calcitriol and paricalcitol in patients with DN. Study designs differed (three randomized, one non-randomized and two uncontrolled trials) with varying degree of quality and risk of biases. Vitamin D analogues showed significant improvement in kidney function in two randomized studies. None of the studies reported significant incidences of hypercalcemia. Vitamin D analogues show significant improvement of kidney function in DN. Randomized controlled trials with longer duration, comparing the efficacy of vitamin D and its analogues are needed.

Maternal Smokeless Tobacco Use in Pregnancy and Adverse Health Outcomes in Newborns: A Systematic Review.

BACKGROUND: Perinatal morbidity and mortality are important indicators of maternal health and the future health of the child. Smokeless tobacco (ST) use during pregnancy is associated with low birth weight (LBW), preterm births, stillbirths, and small for gestation age (SGA). This study systematically reviews and summarizes evidence on the association of maternal ST use with these adverse health outcomes in newborns. METHODS: Electronic databases (Medline, Embase, Lilacs) were searched in July 2013 using appropriate keywords complemented with reference list searching. Observational studies of maternal ST use and these outcomes were considered; LBW, preterm, stillbirth, SGA. A comprehensive assessment of quality and risk of bias in all included studies was performed. RevMan software was used for data analysis. Results are expressed as crude odds ratios with 95% confidence intervals. Chi-square and I(2) tests checked for heterogeneity and quantified inconsistency between results. RESULTS: There were 9 studies (16 reports) included (7 cohort-studies, 1 case-control study, and 1 cross-sectional study). They were clinically and methodologically diverse. Significant associations with ST use were seen in 5/7 studies for LBW, in 3/6 studies for preterm, in all 4 studies for stillbirth and in 1/2 studies assessing SGA. Heterogeneity between results was moderate for LBW (I(2) = 44%) and stillbirth (I(2) = 52%), and high for preterm (I(2) = 87%) and SGA (I(2) = 65%). Meta-analysis was considered inappropriate due to risk of bias and confounding. CONCLUSIONS: Although most studies show an association between ST use in pregnancy and adverse health effects in newborns, these results may be limited by confounding and bias. Quality observational studies are needed to strengthen this evidence base.

Reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia.

BACKGROUND: To evaluate the reliability and validity of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-30) in Saudi Arabia. METHODS: A convenience sample of 200 subjects was approached, of which 177 agreed to participate giving a response rate of 88.5%. Rapid Estimate of Adult Literacy in Dentistry (REALD-99), was translated into Arabic to prepare the longer and shorter versions of Arabic Rapid Estimate of Adult Literacy in Dentistry (AREALD-99 and AREALD-30). Each participant was provided with AREALD-99 which also includes words from AREALD-30. A questionnaire containing socio-behavioral information and Arabic Oral Health Impact Profile (A-OHIP-14) was also administered. Reliability of the AREALD-30 was assessed by re-administering it to 20 subjects after two weeks. Convergent and predictive validity of AREALD-30 was evaluated by its correlations with AREALD-99 and self-perceived oral health status, dental visiting habits and A-OHIP-14 respectively. Discriminant validity was assessed in relation to the educational level while construct validity was evaluated by confirmatory factor analysis (CFA). RESULTS: Reliability of AREALD-30 was excellent with intraclass correlation coefficient of 0.99. It exhibited good convergent and discriminant validity but poor predictive validity. CFA showed presence of two factors and infit mean-square statistics for AREALD-30 were all within the desired range of 0.50 - 2.0 in Rasch analysis. CONCLUSIONS: AREALD-30 showed excellent reliability, good convergent and concurrent validity, but failed to predict the differences between the subjects categorized based on their oral health outcomes.