Clostridioides difficile Infection in the Elderly: Trend Analysis from 2000 to 2019.

Background/Objective: Clostridioides difficile infection (CDI) is a common healthcare-associated ailment, presenting major health and economic challenges, especially for the elderly. Despite its prevalence, comprehensive data about CDI's impact on the elderly are limited. Methods: This study used the Global Burden of Disease Study 2019 data to analyze CDI trends from 2000 to 2019, considering factors like sex, region, and sociodemographic index (SDI). Results: This study revealed that CDI caused approximately 18,181 deaths and 252,709 disability-adjusted life years (DALYs) among the elderly worldwide. The Americas showed the highest CDI burden, while the Eastern Mediterranean saw the steepest rate increase from 2000 to 2019. Regions with a high SDI also displayed substantial CDI impact. Conclusions: The escalating burden of CDI in the elderly, especially in high-SDI areas and the Americas, emphasizes an urgent need for targeted public health strategies.

The growing trend of vascular intestinal disorder in young individuals: a 20-year analysis.

Background: Vascular intestinal disorder (VID) is a condition with a low incidence, but a high mortality risk. The increasing prevalence of substance abuse and metabolic syndrome among young individuals could impact the burden of VID. This study aimed to evaluate the impact of VID on young individuals. Methods: Our study harnessed data from the Global Burden of Disease study, spanning 2000 to 2019. With this extensive dataset, we conducted a comprehensive analysis of the prevalence, mortality rates, and impact on disability-adjusted life years (DALYs) related to VID among young individuals aged 15 to 49 years. Results: Globally, there were an estimated 32,628 cases, 3869 deaths, and 201,099 million DALYs attributed to VID in young individuals. Geographically, the regions of America had the highest burden of VID in young individuals. From 2000-2019, there was an increasing prevalence in all areas, with the most pronounced change observed in Southeast Asia (annual percentage change [APC] +2.17%, P<0.001). Over the study period, there was a more rapid increase in prevalence in males (APC +0.82%, P<0.001) than in females (APC +0.59%, P<0.001). Rates of death and DALYs declined in most regions, except for the Eastern Mediterranean region, where there was a slight increase (APC +0.85%, P<0.001 and 0.88%, P<0.001, respectively). Conclusion: Over the past decade, the burden of VID in young individuals has been increasing, particularly in Southeast Asia and the Eastern Mediterranean region, necessitating immediate and inclusive measures to tackle the rising burden.

Impact of colon cancer on outcomes in hospitalized patients with Clostridioides difficile infection: a national inpatient analysis.

Background and aim: Clostridioides difficile infection (CDI) burdens hospitalized patients, particularly those with comorbidities. Colon cancer may worsen CDI severity and outcomes. We aimed to assess CDI outcomes in hospitalized colon cancer patients. Methods: A retrospective analysis of 2016 to 2020 National Inpatient Survey data identified adults with CDI, categorized by the presence of colon cancer. Hospitalization characteristics, comorbidities, and outcomes were compared between groups. Primary outcomes included in-hospital mortality, length of stay, and total hospital charges. The secondary outcomes were CDI complications. Multivariate logistic regression analysis was performed, with P values ≤0.05 indicating statistical significance. Results: Among 1,436,860 CDI patients, 14,085 had colon cancer. Patients with colon cancer had a longer length of stay (10.77 vs 9.98 days; P < 0.001). After adjustment for confounders, colon cancer patients exhibited higher odds of acute peritonitis (adjusted odds ratio [aOR] 2.37; P = 0.009), bowel perforation (aOR 5.49; P < 0.001), paralytic ileus (aOR 2.12; P = 0.003), and colectomy (aOR 36.99; P < 0.001), but lower risks of mortality, sepsis, septic shock, acute kidney injury, cardiac arrest, and mechanical ventilation (all P < 0.001). Conclusion: Colon cancer significantly impacts CDI outcomes in hospitalized patients, highlighting the need for improved management strategies to reduce morbidity and mortality.

Immunotherapy-induced colitis in metastatic colorectal cancer: a systematic review and meta-analysis.

Colorectal cancer (CRC) presents significant mortality risks, underscoring the urgency of timely diagnosis and intervention. Advanced stages of CRC are managed through chemotherapy, targeted therapy, immunotherapy, radiotherapy, and surgery. Immunotherapy, while effective in bolstering the immune system against cancer cells, often carries toxic side effects, including colitis. This study aimed to evaluate the incidence of colitis in patients with metastatic CRC (mCRC) undergoing various immunotherapy treatments. Through a systematic search of Google Scholar and PubMed databases from inception until November 2023, nine relevant studies were identified. Subgroup analyses revealed a higher incidence of colitis, particularly in patients treated with anti-cytotoxic T-lymphocyte-associated molecule-4 (anti-CTLA-4) and combination therapies compared to monotherapy with programmed cell death receptor-1 (PD-1) or programmed cell death ligand receptor-1 (PDL-1) inhibitors. Notably, naive-treated metastatic CRC patients exhibited elevated colitis incidences compared to those previously treated. In conclusion, anti-CTLA-4 and combination therapies, such as nivolumab plus ipilimumab, were associated with increased colitis occurrences in metastatic CRC patients, highlighting the need for vigilant monitoring and management strategies, especially in immunotherapy-naive individuals.

The Burden of Overweight and Obesity-Associated Gastrointestinal Cancers in Low and Lower-Middle-Income Countries: A Global Burden of Disease 2019 Analysis.

INTRODUCTION: Obesity is associated with cancer, including gastrointestinal (GI). Data from low (LICs) and lower-middle-income countries (MICs) are limited. METHODS: We utilized data from the Global Burden of Disease Study 2019 to determine the mortality from GI cancer risk of high body mass index (BMI) in these countries. RESULTS: Mortality rates of GI cancers from high BMI increased in LICs and lower MICs, while burdens decreased or remained stable in high and middle-income countries. DISCUSSION: The GI cancer-related burden from high BMI increased in LICs and lower MICs, necessitating a concerted effort to tackle the obesity pandemic.

Determining the association between systematic lupus erythematosus and the occurrence of primary biliary cirrhosis: a systematic review and meta-analysis.

BACKGROUND: Autoimmune diseases often coexist; however, the concomitant occurrence of systemic lupus erythematosus (SLE) and primary biliary cirrhosis (PBC) is rare. Therefore, this study aims to provide a comprehensive summary of evidence regarding the co-occurrence of SLE and PBC. METHODS: PubMed, Web of Science, ScienceDirect, and Google Scholar databases were systematically and comprehensively searched for records published up to February 2024. Full-text articles that aligned with the study's aim were included, while those published in languages other than English and those designed as case reports, reviews, conference abstracts, or editorials were excluded. Statistical analyses were performed using Comprehensive Meta-Analysis software, and methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Only 14 studies that met the inclusion criteria with 3944 PBC and 9414 SLE patients were included for review and analysis. Pooled data analysis revealed that approximately 1.1% of SLE patients have concomitant PBC (range: 0.02-7.5%), while around 2.7% of PBC patients concurrently have SLE (range: 1.3-7.5%). Furthermore, qualitative data analysis indicated that the prevalence of PBC in SLE patients presenting with hepatic dysfunction or abnormal liver enzymes ranges from 2 to 7.5%. CONCLUSION: Although the concomitant occurrence of SLE and PBC is rare, the small proportion of patients where these diseases coexist warrants close monitoring by clinicians. This underscores the importance of surveillance to prevent their co-occurrence.

Global epidemiology of alcohol-associated liver disease in adolescents and young adults.

BACKGROUND AND AIMS: The objective of the study was to analyse the prevalence, incidence, and death of alcohol-associated liver disease (ALD) among adolescents and young adults globally, continentally, and nationally, focusing on trends over time. METHODS: The study analysed data from the Global Burden of Disease (GBD) study between 2000 and 2019. It examined ALD's prevalence, incidence, and death in adolescents and young adults aged 15-29, segmented by region, nation, and sociodemographic index. The analysis utilised Joinpoint regression modelling to calculate the annual per cent change (APC) in the rate of these parameters over time. RESULTS: In 2019, there were 281,450 ALD prevalences, 18,930 incidences, and 3190 deaths among adolescents and young adults globally. From 2000 to 2019, the age-adjusted prevalence rate per 100,000 increased in the 25-29 age group (APC: +0.6%, p = 0.003), remained stable among ages 20-24 (p = 0.302) and ages 15-19 (p = 0.160). Prevalence increased significantly from age 15-19 to 20-24 (19-fold increase) and from age 20-24 to 25-29 (2.5-fold increase). ALD prevalence rates increased in all age groups in adolescents and young adults in Africa and the Eastern Mediterranean region. Around three-quarters of countries and territories experienced an increase in ALD incidence rates in young adults. CONCLUSION: Over two decades, the burden of ALD among adolescents and young adults has increased globally. The study emphasises the importance of public health policies aimed at reducing alcohol consumption and preventing ALD among younger populations.

Association of mildly elevated pulmonary vascular resistance with major cardiovascular events in pulmonary hypertension and chronic kidney disease: A retrospective cohort analysis.

Pulmonary hypertension (PH) is associated with adverse outcomes in chronic kidney disease (CKD) patients. Our study suggests mildly elevated pulmonary vascular resistance ( > 2 to ≤ 3) is independently associated with major adverse cardiovascular events at 1-year follow-up. Early diagnosis of precapillary PH in CKD patients can potentially improve clinical outcomes.

Cardiovascular outcomes of sodium-glucose Co-transporter 2 inhibitors use after myocardial infarction: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Patients who had acute myocardial infarction are at high risk of negative cardiac outcomes and previous SGLT2i landmark trials excluded these patients. It therefore remains unclear if SGLT2i is safe and confers beneficial cardiovascular outcomes after acute myocardial infarction. METHODS: We systematically reviewed randomized controlled trials that evaluated the outcomes of adding SGLT2i to conventional post-myocardial infarction care. Random-effects model meta-analysis via RevMan 5.4 was done on data extracted from pooled 11,204 patients. RESULTS: SGLT2i use after acute myocardial infarction was significantly associated with reduced heart failure hospitalization (OR: 0.77, 95%CI: 0.62-0.96, p=0.02), but was not associated with a reduction in all-cause mortality (OR: 1.05, 95%CI: 0.77-1.43, p=0.75), cardiac-related death (OR: 1.04, 95%CI: 0.83-1.30, p=0.76), or major adverse cardiac events (OR: 0.90, 95%CI: 0.77-1.05, p=0.18). CONCLUSION: SGLT2 inhibitor therapy after acute myocardial infarction is safe and is associated with a reduced risk of heart failure hospitalization, but not with all-cause mortality.

The burden of alcohol-related cardiovascular complications in young and middle-aged adults: rising burden of atrial fibrillation and hypertensive heart disease.

BACKGROUND AND AIMS: The burden of alcohol-related complications is high and rising. However, there are notable deficiencies in comprehensive epidemiological study focusing on cardiovascular complications from alcohol, especially among young and middle-aged adults. We thus aimed to determine the burden of these conditions in young and middle-aged adults globally. METHODS AND RESULTS: We used data from the Global Burden of Disease Study 2019 and analysed the mortality and disability-adjusted life years of alcohol-associated cardiovascular complications in young and middle-aged adults. The findings were classified by sex, region, country, and Sociodemographic Index (SDI). The highest age-standardized death rates (ASDR) were observed in stroke 0.84 (95% UI 0.60-1.09), followed by alcoholic cardiomyopathy 0.57 (95% UI 0.47-0.66) per 100,000 population. The overall burden of alcohol-associated cardiovascular complications decreased globally but increased in atrial fibrillation and hypertensive heart disease. Regionally, most regions underwent a decrease in ASDR, but an increase was observed in Southeast Asia (+2.82%), Western Pacific (+1.48%), low-middle (+1.81%), and middle SDI (+0.75%) countries. Nevertheless, the ASDR and ASDALYs were highest in Europe. CONCLUSIONS: The impact of alcohol-associated atrial fibrillation and hypertensive heart disease has increased over the last decades. Regarding region, the burden in Europe and the rising burden in Asia, require immediate public health policy to lessen these cardiovascular complications from alcohol in young and middle-aged adults.

Evaluating Kaposi Sarcoma in Kidney Transplant Patients: A Systematic Review and Meta-Analysis.

Kaposi's sarcoma (KS) is a malignancy that commonly appears as lesions on the skin or mucosal surfaces but can also develop in other organs. This cancer is usually caused by the human herpesvirus 8 (HHV-8), recently known as Kaposi's sarcoma-associated herpesvirus (KSHV). KS is rare in the general population but can develop in kidney transplant recipients with varying incidence due to immunocompromised status from immunosuppression. The main aim of the present systematic review was to identify the prevalence and treatment of KS in kidney transplant patients. PubMed, Cochrane Library, and Google Scholar databases were searched for studies until October 2023. Full-text studies with similar research objectives were included, while non-English articles, reviews, case reports, ongoing clinical trials, and studies evaluating KS in HIV patients or after other solid organ transplants were excluded. All studies were observational; therefore, methodological quality was assessed using the Newcastle-Ottawa Scale. The statistical analyses were performed with the Comprehensive Meta-Analysis (CMA) software (Biostat, Inc. Englewood, NJ). The pooled analysis from the 15 studies included showed that KS develops in 1.5% of kidney transplant recipients and is more prevalent in African (1.7%) and Middle Eastern (1.7%) recipients than in Western recipients (0.07%). KS was also significantly more prevalent among male recipients than female recipients (OR: 2.36; p < 0.0001). Additionally, cyclosporine-based immunosuppression accounts for most KS incidences (79.6%) compared to azathioprine-based immunosuppression (28.2%). Furthermore, reduction or withdrawal of immunosuppression alone resulted in 47.8% KS complete remissions. Post-kidney transplantation KS is more frequent among males and patients of Middle Eastern and African origin. However, the gender difference may be attributed to most patients undergoing kidney transplants being male. Therefore, if gender balance is considered in future studies, then the difference might be insignificant. Based on our results, we can concur that the mainstay treatment for post-transplant KS is reduction or withdrawal of immunosuppression. However, the patients should be closely monitored to avoid KS recurrence and kidney rejection. Furthermore, there is an increased risk for KS with the use of cyclosporine-based immunosuppression. However, this does not mean that the withdrawal of this immunosuppression agent might result in improved KS outcomes because the withdrawal of azathioprine with or without cyclosporine reduction has also led to improved outcomes.

Bone Mineral Density in Neurofibromatosis Type 1: A Systematic Review and Meta-Analysis.

To assess BMD in patients with neurofibromatosis type 1 (NF1) using systematic review and meta-analysis technique. Potentially eligible studies were identified from Medline and EMBASE databases from inception to February 2023 using search strategy that comprised terms for "Bone mineral density" and Neurofibromatosis type 1″. Eligible study must include adult or pediatric patients with NF1. The study must report mean Z-score with variance of total body, lumbar spine, femoral neck or total hip BMD of the studied patients. Point estimates with standard errors were retrieved from each study and were combined using the generic inverse variance method. A total of 1,165 articles were identified. After systematic review, 19 studies were included. The meta-analysis revealed that patients with NF1 had negative mean Z-scores for total body BMD (pooled mean Z-score -0.808; 95%CI, -1.025 to -0.591) and BMD at lumbar spine (pooled mean Z-score -1.104; 95%CI, -1.376 to -0.833), femoral neck (pooled mean Z-score -0.726; 95%CI, -0.893 to -0.560) and total hip (pooled mean Z-score -1.126; 95%CI, -2.078 to -0.173). The subgroup meta-analysis in pediatric patients aged < 18 years revealed that patients with NF1 had negative mean Z-scores for lumbar spine BMD (pooled mean Z-score -0.938; 95%CI, -1.299 to -0.577) and femoral neck BMD (pooled mean Z-score -0.585; 95%CI, -0.872 to -0.298). The current meta-analysis found that patients with NF1 had low Z-scores although the degree of low BMD may not be of clinical significance. The results do not support the role of early BMD screening in children and young adults with NF1.

Risk of atrial fibrillation among patients with premature ventricular complexes: a systematic review and meta-analysis of cohort studies.

INTRODUCTION: Atrial fibrillation (AF) is more likely found in patients with premature ventricular complexes (PVCs). Nonetheless, the outcomes of previous investigations remain inconclusive. To evaluate the link between PVCs and the risk of AF, we did a systematic review and meta-analysis. EVIDENCE ACQUISITION: Potentially eligible studies were found by searching for published publications indexed in the MEDLINE and EMBASE databases from inception to April 13, 2021, looking for studies that assessed the risk of AF in patients with PVCs vs. those who did not have PVCs. Dersimonian and Laird's random-effect, generic inverse variance technique was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI). EVIDENCE SYNTHESIS: The meta-analysis includes 6 cohort studies (1 prospective and 5 retrospective cohort studies) with a total of 9,662,088 individuals. We found that patients with PVCs have a significantly higher risk of AF than individuals without PVCs with the pooled RR of 1.90 (95% CI: 1.51-2.39, I2=83%). CONCLUSIONS: PVCs are significantly related with a 1.90-fold higher incidence of AF, according to the present systematic review and meta-analysis. Nonetheless, further research is needed to determine how this connection should be treated in clinical practice if it is causal.

EQUAL Candida score, an effective tool for predicting the outcomes of Candida tropicalis candidaemia: A retrospective cohort study.

BACKGROUND: Candida tropicalis is the most common non-albicans Candida species found in Asia-Pacific countries, including Thailand. The pathogen is known for its great virulence, which causes a high case-fatality rate. Associations between case fatality and patient characteristics, infectious disease unit consultation and EQUAL Candida score were investigated. METHODS: This retrospective cohort study was conducted with 160 cases of C. tropicalis bloodstream infection between 2015 and 2019 at a single, large, tertiary centre in Thailand. Clinical characteristics, clinical presentations, patient outcomes (30-day case-fatality rate) and independent predictive factors were analysed. RESULTS: The 30-day case-fatality rate was 68.1%. The median of the EQUAL Candida score was 8. Independent factors for the prediction of case fatality were septic shock (hazard ratio, 1.84), the use of mechanical ventilation (hazard ratio, 2.03) and the EQUAL Candida score (hazard ratio, 0.75). CONCLUSIONS: The predictive factors for 30-day case fatality were septic shock, mechanical ventilation use and the EQUAL Candida score. It is recommended that the EQUAL score be considered for patients infected with C. tropicalis candidaemia to reduce the case-fatality rate.

Association Between Chronic Hepatitis C Virus Infection and Esophageal Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is associated with increased risk of hepatobiliary tract cancer. However, whether chronic HCV infection is also associated with elevated risk of other types of cancer is still unknown. This systematic review and meta-analysis was conducted in order to investigate whether chronic HCV infection is positively associated with esophageal cancer. METHODS: A systematic review was conducted using Embase and MEDLINE databases from inception to November 2019, with a search strategy that comprised the terms for "hepatitis C virus" and "cancer." Eligible studies were cohort studies consisting of patients with chronic HCV infection and comparators without HCV infection, and followed them for incident esophageal cancer. Hazard risk ratio, incidence rate ratio, relative risk or standardized incidence ratio of this association were extracted from each eligible study along with their 95% confidence intervals and were combined to calculate the pooled effect estimate using the random effect, generic inverse variance method. RESULTS: A total of 20,459 articles were identified using this search strategy. After 2 rounds of independent review, 7 studies satisfied the inclusion criteria and were included in the meta-analysis. Chronic HCV infection was significantly associated with a higher incidence of esophageal cancer with the pooled relative risk of 1.61 (95% confidence interval: 1.19-2.17; I2=39%). The funnel plot was relatively symmetric which was not suggestive of publication bias. CONCLUSION: This systematic review and meta-analysis demonstrated that there is a modest association between chronic HCV and incident esophageal cancer. However, more studies are needed to investigate the causality of this association.

1,25-dihydroxyvitamin D-mediated hypercalcemia associated with solid organ malignancy: a systematic review.

BACKGROUND: A growing amount of evidence has suggested that 1,25-dihydroxyvitamin D [1,25(OH)2D]-mediated hypercalcemia can be found not only in lymphoma and granulomatous disorders, but also in solid organ malignancies. Using systematic review technique, we aimed to summarize all available evidence of possible 1,25(OH)2D-mediated hypercalcemia in patients with solid organ malignancies. METHODS: Potentially eligible articles were identified from MEDLINE and EMBASE databases from inception to December 2020 using search strategy consisting of terms related to "Vitamin D", "Hypercalcemia" and "Malignancy". Eligible article must be either case report or case series that reports individual level data of a patient or patients with hypercalcemia associated with solid organ malignancy and elevated 1,25(OH)2D without concomitant conditions that may otherwise explain 1,25(OH)2D-mediated hypercalcemia. Characteristics of the patients were extracted from each study. Eligible cases were categorized into three groups, including "definite", "probable" and "possible" cases, using the criteria to assess the strength of evidence that hypercalcemia observed in the eligible cases was caused by the presence of tumor that resulted in the increased production of 1,25(OH)2D. RESULTS: A total of 1,673 articles were identified. After systematic review, 17 articles reporting 17 patients with 11 different types of solid organ malignancies associated with hypercalcemia secondary to elevated 1,25(OH)2D were identified. Based on the criteria to assess the strength of evidence of hypercalcemia mediated by tumor-associated increased production of 1,25(OH)2D, there were 4 definite cases and 13 probable cases. CONCLUSIONS: This systematic review of case reports and case series revealed 17 patients with 11 different types of solid organ malignancies associated with hypercalcemia and elevated 1,25(OH)2D.

Atopic Dermatitis is a Risk Factor for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

BACKGROUND: It is still unclear whether patients with atopic dermatitis (AD) have an increased risk of developing rheumatoid arthritis (RA). OBJECTIVE: We aimed to investigate the association between AD and risk of RA using systematic review and meta-analysis. METHODS: We searched Medline and EMBASE up to April 2021 using search strategy, including terms for "atopic dermatitis" and "rheumatoid arthritis." Eligible cohort study must compare the incidence of RA between patients with AD and comparators without AD. Eligible case-control study must recruit cases with RA and controls without RA. Then, the study must compare the prevalence of AD between the groups. Point estimates with standard errors from each study were combined using the generic inverse variance method. RESULTS: The meta-analysis found that AD patients had a significantly higher risk of incident RA than individuals without AD with a pooled odds ratio (OR) of 1.30 (95% confidence interval [CI], 1.17-1.44; I2, 48%). Subgroup analysis revealed a significantly higher risk of RA in cohort study subgroup (pooled OR, 1.37; 95% CI, 1.25-1.50; I2, 63%) but not case-control study subgroup (pooled OR, 0.99; 95% CI, 0.77-1.28; I2, 10%). CONCLUSIONS: This study found a significantly higher risk of incident RA among AD patients.

Hepatitis B virus infection and risk of gastric cancer: a systematic review and meta-analysis.

INTRODUCTION: Hepatitis B virus (HBV) infection is a well-established risk factor for hepatocellular carcinoma. Recent studies have also suggested a higher risk of several extrahepatic cancers in patients with chronic HBV infection, including gastric cancer, even though the results are somewhat inconsistent. The current study was conducted to comprehensively investigate whether patients with HBV infection are at a higher risk of incident gastric cancer compared with individuals without HBV infection using systematic review and meta-analysis technique. EVIDENCE ACQUISITION: Systemic literature review was conducted using EMBASE and MEDLINE database up to December 2019. Eligible studies had to be cohort studies that consisted of one group of patients with HBV infection and another group of individuals without HBV infection. Relative risk of incident gastric cancer between the groups must be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. EVIDENCE SYNTHESIS: A total of 36,812 articles were identified. After two rounds of review, five articles with six cohorts of 120,995 HBV infected patients were included into the meta-analysis. The pooled analysis found that patients with HBV infection had a significantly higher risk of incident gastric cancer than individuals without HBV infection with the pooled risk ratio of 1.49 (95% CI, 1.20 - 1.85; I2=38%). CONCLUSIONS: A significantly increased risk of incident gastric cancer among patients with chronic HBV infection was observed in this systematic review and meta-analysis.

Association of premature ventricular complexes and risk of ischemic stroke: A systematic review and meta-analysis.

Recent studies have suggested that patients with premature ventricular complexes (PVCs) may have a higher risk of ischemic stroke. However, the data are limited and inconclusive. We conducted a systematic review and meta-analysis to investigate the association between PVCs and the risk of ischemic stroke. A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through September 25, 2020, to identify studies that compared the risk of ischemic stroke between patients with PVCs and individuals without PVCs. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of Dersimonian and Laird. A total of four observational studies (2 prospective and 2 retrospective cohort studies) with 42 677 participants met the eligibility criteria and were included in the meta-analysis. We found that patients with PVCs have a significantly higher risk of ischemic stroke than individuals without PVCs with the pooled RR of 1.31 (95% CI, 1.07-1.60, I2 = 43%). From our systematic review and meta-analysis, we found that PVCs are associated with a higher risk of ischemic stroke. Whether this association is causal and how it should be addressed in clinical practice require further investigations.

The association between allergic rhinitis and risk of rheumatoid arthritis: A systematic review and meta-analysis.

OBJECTIVE: To investigate the association between allergic rhinitis (AR) and the risk of rheumatoid arthritis (RA). METHODS: Potentially eligible studies were identified from MEDLINE and EMBASE databases from inception to November 2019. Eligible cohort study must report relative risk with 95% confidence intervals (95% CIs) of incident RA between AR patients and comparators. Eligible case-control studies must include cases with RA and controls without RA, and must explore their history of AR. Odds ratio with 95% CIs of the association between AR and RA must be reported. Point estimates with standard errors from each study were combined using the generic inverse variance method. RESULTS: A total of 21,824 articles were identified. After two rounds of the independent review by three investigators, two cohort studies and 10 case-control studies met the eligibility criteria. The pooled analysis showed no association between AR and risk of RA (RR = 0.94; 95% CI, 0.73 to 1.20; I2   = 84%). However, when we conducted a sensitivity analysis including only studies with acceptable quality, defined as Newcastle-Ottawa score of seven or higher, we found that patients with AR had a significantly higher risk of RA (RR = 1.36; 95% CI, 1.12 to 1.65; I2  = 45%). CONCLUSIONS: The current systematic review and meta-analysis could not reveal a significant association between AR and RA. However, when only studies with acceptable quality were included, a significantly higher risk of RA among patients with AR than individuals without AR was observed.