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.
Background
Chronic hepatitis C virus (HCV) infection is associated with increased risk of hepatocellular carcinoma. However, whether HCV infection also increases the risk of extra-hepatic cancer is ...still not well-established. This systematic review and meta-analysis was conducted in order to investigate the relationship between chronic HCV infection and lung cancer.
Materials and Methods
A systematic review was performed using MEDLINE and EMBASE databases from inception to November 2019 with search strategy that included the terms for “hepatitis C virus” and “cancer”. Eligible studies must be cohort studies that included patients with chronic HCV infection and comparators without HCV infection, then followed them for incident lung cancer. Relative risk, incidence rate ratio, standardized incidence ratio or hazard risk ratio of this association along with associated 95% confidence interval (CI) were extracted from each eligible study and combined for the calculation of the pooled effect estimate using the random effect, generic inverse variance method.
Results
A total of 20,459 articles were identified using the aforementioned search strategy. After two rounds of review, eight studies fulfilled the inclusion criteria and were included into the meta-analysis. Chronic HCV infection was significantly associated with an increased risk of lung cancer with the pooled relative risk of 1.94 (95% CI 1.56–2.42; I
2
= 87%). Funnel plot was fairly symmetric and not suggestive of presence of publication bias.
Conclusions
The current study demonstrated that chronic HCV infection is significantly associated with a 1.94-fold increased risk of developing lung cancer. However, further studies are still needed to investigate if this association is causative.
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.
Background
Paroxysmal supraventricular tachycardia (PSVT) has been traditionally considered as a benign rhythm disorder. However, recent studies have suggested that patients with PSVT may have a ...higher risk of ischemic stroke although the data are limited and inconclusive. The current systematic review and meta‐analysis was conducted with the aims to identify all available studies and summarize their results together to better characterize the risk of ischemic stroke among patients with PSVT.
Methods
A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through November 11, 2018 to identify all observational studies that compared the risk of ischemic stroke between patients with PSVT and individuals without PSVT. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method of DerSimonian and Laird.
Results
A total 5 studies (4 cohort studies and 1 case‐control study) with 4 886 977 participants met the eligibility criteria and were included into the meta‐analysis. The risk of ischemic stroke among patients with PSVT was significantly higher than individuals without PSVT with the pooled RR of 2.03 (95% CI, 1.22‐3.38, I2 = 89%).
Conclusion
This study found that PSVT is 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.
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.
Objective:
The association of obesity status during the pre-kidney donation period with the risk of developing post-donation hypertension (HTN) is unclear. We aim to evaluate the effect of ...pre-donation obesity status on the rate of post-donation systolic and diastolic hypertension (SHTN and DHTN).
Design and method:
A retrospective cohort study using the SRTR database included living kidney donors (LKD) undergoing donation between March 2008 and July 2020. Risks for developing SHTN and DHTN defined as SBP and DBP >/ = 130 and >/ = 80 mmHg, respectively among 3 groups categorized by pre-donation obesity status (normal weight, overweight, and obesity) was examined by multiple Cox regression analysis.
Results:
Of 174,359 LKD, mean±SD age was 41±12 years and 60% were female. Pre-donation normal weight, overweight, and obesity account for 36%, 41, and 23%, respectively with median (IQR) BMI of 22.81 (21.30, 23.96), 27.35 (26.16, 28.57), and 32.19 (30.96, 33.98). SBP and DBP at 6 months, 1 year, and 2 years post-donation were 120.06/74.51, 120.08/74.63, 120.35/75.07 mmHg, respectively (PSBP and PDBP <0.001) (Figure 1). After adjusting for demographics, pre-donation SBP and DBP, pre- and post-operative creatinine, post-donation urine protein, and the interaction term between the pre-donation BMI and gender, overweight and obese groups had a significantly greater risk for developing SHTN compared to normal weight group (HRoverweight 1.32, 95%CI 1.23, 1.41; HRobese 1.70, 95%CI 1.57, 1.84; Figure 2) only in those with normotensive during pre-donation. The pattern of the association was the same for DHTN (HRoverweight 1.28, 95%CI 1.21, 1.35; HRobese 1.52, 95%CI 1.43, 1.62; Figure 3). Stratifying patients into those with and without pre-donation hypertension, gender was an effect modifier with a higher risk for developing STHN and DHTN observed in obese female patients with pre-donation normotension (Pinteraction for SHTN 0.002 and DHTN 0.019).
Conclusions:
Pre-donation overweight and obesity increase the risk of developing post-donation SHTN and DHTN. Obese female donors are at greater risk than obese male donors among those with pre-donation normotension.
Abstract
Background and Aims
Kidney disease disproportionately affects some races and ethnicities. Whether this disparity exists in living kidney donors is known. We aim to evaluate the association ...between races/ethnicities and kidney function after living kidney donation.
Method
A retrospective cohort study utilizing Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) database includes living kidney donors undergoing donation between June 1972 and September 2022. Time-to-event of >35% rising post-donation serum creatinine from pre-donation serum creatinine among different races and ethnicities was examined by multiple Cox proportional hazard regression analyses.
Results
Of 136,814 living kidney donors, the mean±SD age was 42±12 years and 61% were female. The majority were White (70%) followed by Hispanic (14%), Black (11%), Asian (4%), multiracial (0.61%), American Indian/Alaska Native (0.47%), and native Hawaiian/other Pacific islander (0.25%). Among 103,938 living kidney donors with post-donation serum creatinine, 78,344 (75%) living kidney donors had the event over a median time to follow-up of 6.27 months (interquartile range 4.07, 8.67). The incidence rate of the event was 0.09 person-months. Mean pre-donation serum creatinine was 0.85±0.19 mg/dL and post-donation serum creatinine during routine follow-up visits at 6, 12, and 24 months were 1.22±0.30, 1.194±0.30, and 1.16±0.27 mg/dL, respectively (Figure 1A). Mean percentage of elevated serum creatinine from pre-donation serum creatinine were 46, 43, and 41%, respectively (Figure 1B). Compared to White, Blacks had a significantly higher; while Hispanics and multi-racial groups had a significantly lower risk of increased post-donation serum creatinine >35% (hazard ratio (HR)Black 1.03, 95% confidence interval (CI) 1.01, 1.06, P 0.008; HRHispanic 0.95, 95%CI 0.93, 0.97, P <0.001; HRMultiracial 0.92, 95%CI 0.84, 0.99, P 0.049; Figure 2). After adjusting for age, gender, U.S. citizenship, education level, pre-donation body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, post-donation proteinuria, history of pre-donation hypertension, and the interaction term between race/ethnicity and age (<70 or ≥70), Black remained at greater risk for the event and Asians still had a lower the risk (HRBlack 1.22, 95%CI 1.13, 1.31, P <0.001; HRAsian 0. .88, 95%CI 0.83, 0.94, P <0.001. Other races/ethnic had no significant difference in the risk. Age was an effect modifier with attenuated risk for increased serum creatinine >35% observed in older Hispanic, Asian, and multiracial groups (Pinteraction 0.037, 0.001, and 0.006, respectively).
Conclusion
Blacks are at risk of increased post-donation serum creatinine >35%; while Asian is protective compared to White independent of pre- and post-donation factors. Elderly Hispanic, Asian, and multiracial living kidney donors do not have worsened kidney outcome compared to their younger living kidney donors with the same races/ethnicities.
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.
6021 Background: Currently, the landscape of treating advanced malignancies has undergone a transformative shift with the advent of immunotherapy employing immune checkpoint inhibitors (ICIs). ...Notably, several ICIs have emerged as promising therapeutic modalities for individuals with head and neck cancer (HNC). An emerging body of evidence implies a plausible link between body mass index (BMI) and the effectiveness of ICIs in the broader context of cancer patients. Nevertheless, the specific correlation within the subset of head and neck cancer patients undergoing immunotherapeutic interventions remains unclear and warrants meticulous investigation. Methods: PubMed, Web of Science, and Google Scholar databases were searched extensively for records published until January 2024. Full-text articles aligned with the research objective were included, while records published in English, case reports, reviews, editorials, and studies reporting immunotherapy combined with other cancer therapies were excluded. The data required for review and analysis was abstracted in Excel files by two independent reviewers. Additionally, statistical analyses were performed using the Review Manager software, and methodological quality was assessed using the Newcastle Ottawa scale. Results: Only six studies were eligible for review and analysis. A subgroup analysis of data from these studies showed that obese HNC patients on immunotherapy had significantly better overall survival (OS) rates than non-obese patients (HR: 0.51; 95% CI: 0.29 – 0.93; p=0.03). However, the progression-free survival (PFS) was statistically similar between obese and non-obese patients (HR: 0.72; 95% CI: 0.39 – 1.33; p=0.30). In addition, when BMI was stratified as either low or high, no significant difference was observed in the OS and PFS of HNC patients (HR: 0.99; 95% CI: 0.59 – 1.66; p=0.97 and HR: 0.93; 95% CI: 0.61 – 1.41; p=0.42, respectively). Similarly, the statistical analyses showed that overweight patients have similar OS and PFS as patients with normal BMI (HR: 0.53; 95% CI: 0.15 – 1.92; p=0.33 and HR: 0.55; 95% CI: 0.20 – 1.52; p = 0.25, respectively). In contrast, underweight patients demonstrated poor OS and PFS (HR: 2.56; 95% CI: 1.29 – 5.12; p=0.008 and HR: 2.76; 95% CI: 1.17 – 6.52; p=0.02, respectively). Conclusions: Obese HNC patients on immunotherapy tend to have improved OS than non-obese patients, while underweight patients have worse clinical prognoses than those with normal or above BMI.
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