Helicobacter pylori infection and risk of multiple sclerosis: An updated meta-analysis.

BACKGROUND: There is considerable controversy around the question as to whether Helicobacter pylori (H. pylori) infection has a protective or causative role in the development of multiple sclerosis (MS). This study evaluated published information to assess the association between H. pylori infection and MS. METHODS: We conducted a comprehensive systematic review of relevant observational studies in international databases. A random-effects model was used to calculate pooled odds ratio (OR) and 95% confidence interval (CI). I2 statistic was used to assess the between-study heterogeneity. Subgroup and meta-regression analyses were applied to identify the source of heterogeneity. RESULTS: In total, 22 studies (25 datasets) were eligible for the meta-analysis: 17 datasets had prevalence data and eight datasets had data on the mean titer of anti-H. pylori IgG. The pooled prevalence of H. pylori was 44.1% (908/2606) in the MS patients and 46.1% (1016/2200) in the controls, indicating a non-significant protective effect of H. pylori on MS (OR, 0.82; 95%CI, 0.58-1.17). In the subgroup analysis, studies that used ELISA yielded a significant protective association (OR, 0.59; 95%CI, 0.46-0.77), while a positive non-significant association (OR, 1.33; 95%CI, 0.83-2.15) was found from studies that used other serological methods; interestingly, a significant positive association (OR, 6.64; 95%CI, 2.40-13.76) was found from studies that used histological methods to detect H. pylori infection. CONCLUSIONS: Our findings do not support the hypothesis that H. pylori infection represents a protective factor against the development of MS; however, the results varied depending on the diagnostic method(s). Particularly, a significant positive association was identified when studies introduced results based on histological examination, suggesting that active H. pylori infection might be a risk factor for development of MS. Thus, further studies are needed utilizing accurate diagnostic methods to elucidate the association between active H. pylori infection and MS.

Does latent Toxoplasma infection have a protective effect against developing multiple sclerosis? Evidence from an updated meta-analysis.

Previous epidemiologic evidence suggests a protective effect of Toxoplasma gondii infection against multiple sclerosis (MS) development; however, inconsistent findings have been reported in this regard. Therefore, we performed an updated meta-analysis of observational studies to investigate the association of To. gondii infection with MS development. We searched all articles published in PubMed, Scopus, Embase and Web of Science databases as of 20 December 2021. A random effects meta-analysis model was used to generate the pooled OR at 95% CIs. The heterogeneity between studies was assessed using I2 and Cochran's Q statistics. Moreover, the likelihood of publication bias was determined by Egger's regression test. A total of 11 studies were eligible for meta-analysis, including 1172 MS cases and 1802 controls. Our findings indicated that 29.8% (95% CI 22.8 to 37.2%) of MS patients were seropositive for To. gondii infection, compared with 34.2% (95% CI 21.9 to 47.6%) of control subjects. The estimated pooled OR was 0.79 (95% CI 0.49 to 1.26), suggesting a non-significant negative association between To. gondii infection and MS development (p>0.05). The current study does not support the significant protective role of To. gondii infection on MS development. Our findings imply that further well-designed epidemiological and mechanistic studies are warranted to ascertain the possible association between To. gondii infection and MS and to exclude the potential confounders.

Toxoplasma gondii infection/exposure and the risk of brain tumors: A systematic review and meta-analysis.

BACKGROUND: Brain tumors are among the most fatal cancers with substantial morbidity and mortality worldwide. Epidemiologic evidence suggests that infectious agents, especially, protozoan parasite Toxoplasma gondii could be a possible risk factor or contributor. Here, we performed a systematic review and meta-analysis to evaluate the possible association between T. gondii infection/exposure and risk of brain tumors. METHODS: We searched the PubMed, Embase, Scopus, and Web of Science collection databases from inception through 1st of December 2021. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were generated using random effects models. We did the subgroup analysis according to tumor types. Statistical tests for heterogeneity and sensitivity analyses were applied. RESULTS: A total of seven eligible studies comprising 2323 patients diagnosed with brain tumors and 5131 healthy controls were included in the meta-analysis. T. gondii infection/exposure prevalence was 24.2% (95%CI, 12.7%-41.2) in cases and 12.9% (95%CI, 7.0-22.6%) in control subjects. Pooled analysis showed an overall OR of 1.96 (95%CI, 1.37-2.80), indicating a significant increased risk of brain tumors associated with T. gondii infection/exposure. In subgroup analysis T. gondii infection/exposure was significantly associated with gliomas (OR: 1.64, 95%CI, 1.15-2.33), meningioma (OR: 2.30, 95%CI, 1.0-5.27) and other types of brain tumors (OR: 2.19, 95%CI, 1.02-4.71). CONCLUSION: This study provides suggestive evidence for an association between T. gondii infection/exposure and brain tumors. Our findings should be further confirmed by well-designed cohort studies with strict control of confounders. Moreover, we suggest that future studies also focus on the effect of T. gondii infection/exposure to the types of brain tumors.

The role of tranexamic acid in prevention of hemorrhage in major spinal surgeries.

BACKGROUND: Blood loss that necessitates blood transfusion is one of the most frequent complications of major spinal surgeries. This study has been designed to evaluate the efficacy and safety of prophylactic tranexamic acid (TA) in decreasing perioperative blood loss. MATERIALS AND METHODS: From January to August 2011, all the patients who needed major spinal surgeries and aged between 18 and 60-year-old were divided into two groups randomly, the experimental group received 10 mg/kg of TA 20 min after inducing the anesthesia as loading dose followed by 0.5 mg/kg/h until skin closure and the control group received equal amounts of normal saline as placebo. Intraoperative blood loss was recorded by estimating blood with the suction tube plus the number of bloody gasses. The amounts compared between the 2 groups and analyzed. RESULTS: Forty patients were enrolled in this study in the first group intraoperative, the 1st and 2nd postoperative days, the mean blood loss were 574 ml, 80.5 ml, and 669.5 ml while in the second group were 797 ml, 124 ml, and 921.5 ml. CONCLUSION: TA seems to be safe and can be considered in spinal surgeries with significant excepted blood loss especially in female patients and instrumental procedures. We suggest further studies on TAs efficacy and safety in larger scales.

Effect of Ondansetron on Postoperative Shivering After Craniotomy.

INTRODUCTION: Postoperative shivering (POS) is an early complication after craniotomy. Preventive pharmacologic drugs are the mainstay of treatment. Meperidine is the drug of choice but with increased risk of apnea, nausea, and increased intracranial pressure. Some reports have suggested that ondansetron and meperidine have similar anti-shivering effects. OBJECTIVES: To assess the preventive effect of ondansetron on POS after craniotomy. METHODS: In a randomized, double-blind, placebo-controlled trial, 80 patients with American Society of Anesthesiologists status I to II between 20 and 60 years of age scheduled for elective craniotomy were enrolled in the study. Patients received either intravenous ondansetron 4 mg (n = 40) or saline (n = 40) 10 minutes before the end of surgery. RESULTS: POS was observed in 3 patients (7.5%) in the ondansetron group, significantly lower than in the control group (6 patients [15%]; P =0.048). Ondansetron decreased the relative risk of occurrence of POS after craniotomy from 4.42 (95% confidence interval [CI], 2.3-8.5; P = 0.0021) in the control group to 1.05 (95% CI, 0.76-2.20; P = 0.074). In the ondansetron group, the mean (± standard deviation) core temperature in the preoperative phase (36.6°C ± 0.66°C) was significantly higher than in the postoperative phase (34.2°C ± 0.56°C) (P = 0.001). In addition, the mean (± standard deviation) peripheral temperature in the preoperative phase (36.5°C ± 0.72°C) was significantly higher than in the postoperative phase (34.4°C ± 0.51°C) (P = 0.001). CONCLUSIONS: Ondansetron can effectively decrease POS after craniotomy. This effect is not mediated through maintenance of the core or peripheral temperature. Ondansetron probably acts by a central inhibitory mechanism on POS through 5-hydroxytryptaminergic pathways, not by changing thermoregulatory set points.