Global, regional, and country seroprevalence of Toxoplasma gondii in pregnant women: a systematic review, modelling and meta-analysis.

Efficient health-care for pregnant women require accurate data on the prevalence of toxoplasmosis in pregnancy at global, regional, and country levels. In this systematic review with meta- and modelling-analysis, we searched PubMed, EMBASE, Web of Knowledge, Global Index Medicus, and Africa Journal Online to identify studies that reported enough data to compute the immunoglobulins (Ig) M or G seroprevalence estimates of Toxoplasma gondii in pregnant women up to December 31st, 2018, without any language restriction. The global and regional estimates were done using a random-effects meta-analysis. We included 250 studies with 723,655 pregnant women. The global IgM seroprevalence was 1.9% (95%CI: 1.7-2.3). At the regional level, Eastern Mediterranean had the highest IgM seroprevalence (4.1%, 95%CI: 2.8-5.5) and The Americas, the lowest (1.1%, 0.8-1.4), with a statistically significant difference between WHO regions (p < 0.0001). The global IgG seroprevalence was 32.9% (95%CI: 29.4-36.4). Among WHO regions, The Americas had the highest prevalence (45.2%, 95%CI: 33.4-53.4) and Western Pacific the lowest (11.2%, 7.8-15.1), with a statistically significant difference between regions (p < 0.0001). This study presents a high toxoplasma seropositivity in pregnant women at global, regional and country levels, with a consequential high risk of maternal and congenital toxoplasmosis.

Global, regional and national estimates of Toxoplasma gondii seroprevalence in pregnant women: a protocol for a systematic review and modelling analysis.

INTRODUCTION: To set priorities for public health policy, funding for public health interventions, and healthcare planning which will ultimately contribute in bending the burden of toxoplasmosis towards maternal and neonatal health, it is necessary to have accurate data on the prevalence of toxoplasmosis in pregnancy. Therefore, we aimed to estimate the seroprevalence of Toxoplasma gondii infection in pregnant women by countries, WHO regions and globally. METHODS AND ANALYSIS: We will search multiple databases to identify studies that reported the prevalence (or enough data to compute this estimate) of Toxoplasma gondii in the global population of pregnant women up till December 31, 2018 without any language restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently by three pairs of investigators. For each country, we will estimate the prevalence based on empirical studies if there is either one nationally representative study, or two or more not nationally representative studies. Then, we will perform a country-specific random-effects meta-analyses. The heterogeneity will be evaluated using the χ² test on Cochrane's Q statistic and quantified with H and I² statistics. For countries with one or no empirical studies or where the meta-analysis will result in a wide CI of 0%-100%, we will predict the country's prevalence by using a Bayesian generalised non-linear multilevel model. The model will have a hierarchical structure in which estimates for each country will be informed by its own data, if available, or by data from other countries in the same WHO region. ETHICS AND DISSEMINATION: Since this study will be based on published data, it does not require any ethical approval. Its findings will be published in a scientific peer-reviewed journal. They will also be presented at scientific conferences and to relevant public health sectors. PROSPERO REGISTRATION NUMBER: CRD42019125572.

Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients.

OBJECTIVE: We conducted the first systematic review and meta-analysis to estimate the specific prevalence of apparent treatment-resistant, pseudo-resistant and true-resistant hypertension among treated patients with hypertension globally. METHODS: We conducted a search in PubMed, EMBASE, Web of Science and Global Index Medicus to identify articles published from inception to 30 September 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the prevalence of resistant hypertension across studies and heterogeneity was assessed via the χ² test on Cochran's Q statistic. RESULTS: We included 91 studies published between 1991 and 2017 reporting data of a pooled sample of 3 207 911 patients with hypertension on antihypertensive drugs globally. Most of the studies (n=64, 70%) only used office blood pressure (BP) measurement. In the general, population of treated patients with hypertension, the prevalence of true-resistant, apparent treatment-resistant and pseudo-resistant hypertension were 10.3% (95% CI 7.6% to 13.2%), 14.7% (95% CI 13.1% to 16.3%) and 10.3% (95% CI 6.0% to 15.5%). The prevalence of true-resistant hypertension was 22.9% (95% CI 19.1% to 27.0%), 56.0% (95% CI 52.7% to 59.3%) and 12.3% (95% CI 1.7% to 30.5%) in chronic kidney disease, renal transplant and elderly patients, respectively. CONCLUSIONS: This study shows a high prevalence of true-resistant hypertension. This prevalence is lower than that of apparent treatment-resistant hypertension, demonstrating the importance to exclude causes of pseudo-resistant hypertension including white-coat hypertension with the use of ambulatory BP measurement. The burden of resistant hypertension is highest in patients with chronic kidney disease. New treatments for resistant hypertension are highly needed, considering the disastrous complications of the disease.

Abstracts reporting of HIV/AIDS randomized controlled trials in general medicine and infectious diseases journals: completeness to date and improvement in the quality since CONSORT extension for abstracts.

BACKGROUND: Sufficiently detailed abstracts of randomized controlled trials (RCTs) are important, because readers often base their assessment of a trial solely on information in the abstract. We aimed at comparing reporting quality of RCTs in HIV/AIDS medicine before and after the publication of the 2008 CONSORT extension for abstracts and to investigate factors associated with better reporting quality. METHODS: We searched PubMed/Medline for HIV/AIDS RCTs published between 2006-07 (Pre-CONSORT) and 2014-15 (Post-CONSORT) in 40 leading general medicine and infectious diseases journals. Two investigators extracted data and scored abstracts. The primary outcome was the adjusted mean number of items reported among the 17 required. Proportions of abstracts reporting each of 17 items were considered as secondary outcome. The adjustment was done for journal field, CONSORT endorsement, abstract format, type of intervention, journal impact factor and authorship. This study received no funding. RESULTS: The adjusted mean number of reported items was 7.2 (95 % CI 6.6-7.7) in pre-CONSORT (n = 159) and 7.8 (95 % confidence interval [CI] 7.3-8.4) in post-CONSORT (n = 153) (mean difference 0.7; 95 % CI 0.1-1.2). Journal high impact factor (adjusted incidence rate ratio 2.16; 95 % CI 1.83-2.54), abstract with 13 authors or more (1.39; 95 % CI 1.07-1.79) and non-pharmacological intervention (1.19; 95 % CI 1.03-1.37) were independent factors for better reporting quality. There were significant improvements in reporting on participants, randomization, outcome results, registration and funding; regression for author contact; and no change for other items: title, design, interventions, objective, primary outcome, blinding, number randomized, recruitment, number analyzed, harms and conclusions. CONCLUSIONS: After the publication of the CONSORT extension for abstracts, the reporting quality of HIV/AIDS RCT abstracts in general medicine and infectious diseases journals has suboptimally improved. Thus, stricter adherence to the CONSORT for abstract are needed to improve the reporting quality of HIV/AIDS RCT abstracts.

Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis.

OBJECTIVE: Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa. DESIGN: A systematic review and meta-analysis. PARTICIPANTS: HIV-infected African people residing in Africa. OUTCOME: Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation. DATA SOURCES: Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction. RESULTS: Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%-23%). LIMITATIONS: Only 3 studies were found eligible from 3 regions of the African continent. CONCLUSIONS: The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa. TRIAL REGISTRATION NUMBER: Review registration number PROSPERO CRD42016033863.

HIV related pulmonary arterial hypertension: epidemiology in Africa, physiopathology, and role of antiretroviral treatment.

The development of HIV related pulmonary arterial hypertension (PAH) reduces the probability of survival by half as compared with HIV-infected individuals without HIV related PAH. HIV infected patients have a greater incidence of PAH compared to general population and have a 2500-fold increased risk of developing PAH. It is therefore important to have a recent overview of the problem in Africa, the most HIV affected part of the world (70 % of all HIV infection in the world). First, we discussed the epidemiology of HIV-related PAH in Africa. Second, the current understanding of the HIV-related PAH pathogenesis has been covered. Third, role of highly active antiretroviral therapy on HIV-related PAH has been revisited. There are few data concerning epidemiology of HIV related pulmonary hypertension in Africa leading to necessity to conduct further prospective large studies. The prevalence of PAH among HIV infected people in Africa varies from 5 to 13 %. The prevalence of HIV-related PAH in Africa is notably high compared to those in developed countries and in general population. The pathogenesis of PAH is clearly complex, and probably results from the interaction of multiple modulating genes with environmental factors. The physiopathology includes cytokines secretion increase which induces dysregulation of endothelial and vascular smooth muscle cell growth and imbalance of endogenous vasodilators and constrictors; HIV viral proteins which induces vascular oxidative stress, smooth myocyte proliferation and migration, and endothelial injury and genetic predisposition due to some major histocompatibility complex alleles, particularly HDL-DR6 and HLA-DR5. Histologically, HIV related PAH has the same characteristics with other types PAH. Antiretroviral therapy have a beneficial effect on the outcome of HIV related pulmonary hypertension, but it lacks evidence from large prospective studies.

Association of academic performance of premedical students to satisfaction and engagement in a short training program: a cross sectional study presenting gender differences.

BACKGROUND: It is important that students have a high academic engagement and satisfaction in order to have good academic achievement. No study measures association of these elements in a short training program. This study aimed to measure the correlation between academic achievement, satisfaction and engagement dimensions in a short training program among premedical students. METHODS: We carried out a cross sectional study, in August 2013, at Cercle d'Etudiants, Ingénieurs, Médecins et Professeurs de Lycée pour le Triomphe de l'Excellence (CEMPLEX) training center, a center which prepares students for the national common entrance examination into medical schools in Cameroon. We included all students attending this training center during last examination period. They were asked to fill out a questionnaire on paper. Academic engagement was measured using three dimensions: vigor, dedication and absorption. Satisfaction to lessons, for each learning subject was collected. Academic achievement was calculated using mean of the score of all learning subjects affected with their coefficient. Pearson coefficient (r) and multiple regression models were used to measure association. A p value < 0.05 was statistically significant. RESULTS: In total, 180 students were analyzed. In univariate linear analysis, we found correlation with academic achievement for vigor (r = 0.338, p = 0.006) and dedication (r = 0.287, p = 0.021) only in male students. In multiple regression linear analysis, academic engagement and satisfaction were correlated to academic achievement only in male students (R2 = 0.159, p = 0.035). No correlation was found in female students and in all students. The independent variables (vigor, dedication, absorption and satisfaction) explained 6.8-24.3% of the variance of academic achievement. CONCLUSION: It is only in male students that academic engagement and satisfaction to lessons are correlated to academic achievement in this short training program for premedical students and this correlation is weak.