Systematic Review Of Cohort Studies Research Articles

Incidence of Sudden Cardiac Death in Low- and Middle-Income Countries: A Systematic Review of Cohort Studies.

Sudden cardiac death (SCD) is a leading cause of mortality worldwide and, in recent years, has become an urgent public health concern in low- and middle-income countries (LMICs). Data from LMICs, however, remains limited. As such, the aim of this article is to systematically review the current literature on the incidence of SCD in LMICs to inform policymakers and identify potential research gaps. A search of PubMed and Embase was utilized to capture the targeted condition, outcome, and setting. Only peer-reviewed cohort studies in LMICs reporting SCD incidence estimates in the general population of individuals aged ≥1 year were eligible for selection. Papers providing incidence data for specific types of SCD, including sudden coronary death or death from sudden cardiac arrest, were also included. After deduplication, 1941 citations were identified and screened. Seven studies representing four countries-Cameroon, China, India, and Iran-met the criteria for inclusion and were considered in our analysis. The crude incidence rate for SCD ranged from 19.9 to 190 cases per 100,000 person-years, while age-adjusted rates ranged from 33.6 to 230 cases per 100,000 person-years. There was notable variability in methods utilized to ascertain SCD cases. These findings suggest that the incidence of all-cause SCD in LMICs and may exceed that of high-income countries; however, observed disparities may be partly attributable to differences in case ascertainment methods. Additional research is needed to better understand the true incidence of SCD in developing countries. It is crucial that future studies across regions utilize standard diagnostic criteria and methodology for identifying SCD, which would provide a framework by which to compare outcomes between settings.

Cognitive impairment increases in older people living with HIV: a systematic review of cohort studies

The progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914).

Effect of SARS-CoV-2 infection during pregnancy on maternal and perinatal mortality: A systematic review of cohort studies

Effect of SARS-CoV-2 infection during pregnancy on maternal and perinatal mortality: A systematic review of cohort studies

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review.

(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.

Incidence of cancer for patients after bariatric surgery: evidence from 33 cohort studies

BackgroundWith the rising prevalence of severe obesity, bariatric surgery has emerged as a crucial treatment option. As the number of surgeries performed worldwide increases, there has been growing interest in the impact of bariatric surgery on cancer incidence. While several studies have examined this relationship, the topic remains controversial. ObjectivesWe conducted this systematic review of cohort studies with meta-analysis to evaluate the effect of bariatric surgery versus nonsurgical treatment on overall cancer incidence. However, the effects may vary when focusing on specific cancer types, surgical procedures, or gender, so we conducted additional subgroup analyses. SettingA meta-analysis. University hospital. MethodsThe Cochrane, Embase, PubMed, and Web of Science databases were searched for studies from 1 January 2000 to 1 December 2022. Meta-analysis was conducted to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, operation type, and sex. ResultsAll cohort studies were included in this meta-analysis from 18,216 studies. The overall cancer incidence demonstrated a significant decrease in the group with bariatric surgery (odds ratios [OR] = .56, P = .000, 95% CI .46 to .68). In subgroup analysis, similar decrease effect was found in 9 cancers. Furthermore, the incidence of cancer decreased significantly in male (OR = .66, P = .001, 95% CI .51 to .85) and female patients (OR = .63, P = .000, 95% CI .57 to .69) and patients undergoing gastric bypass (OR = .46, P = .000, 95% CI .33 to .63) or sleeve gastrectomy (OR = .44, P = .001, 95% CI .27 to .70). ConclusionsIn the overall analysis, bariatric surgery could reduce the incidence of cancer significantly. Further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence.

Association between childhood obesity and infertility in later life: a systematic review of cohort studies

BackgroundThe global prevalence of childhood obesity has exhibited a troubling surge in recent years. Due to the raised questions regarding its potential correlation with infertility in adulthood, this systematic review has been undertaken to explore the relationships between childhood obesity, and infertility later in life.MethodsA comprehensive search was performed in three international databases (PubMed, Web of Science, and Scopus). All cohort (retrospective or prospective), case-cohort, and nested case-control studies until April 2022 which assessed the association of obesity in children and adolescents with male and female infertility indicators in later life were included. The quality of the included studies was assessed by Newcastle-Ottawa quality assessment checklists.ResultOut of the initial 32,501 documents, eleven eligible studies with a total sample size of 498,980 participants were included. Five studies focused on the number of offspring and indicated that obesity, especially in adolescence had an association with later life lower number of children, nulliparity, and childlessness in both men and women. Concerning conceiving problems, two studies showed that obesity before age 12 increased the risk of female fertility problems in the future. Two studies reported that obesity in early life raised the risk of impaired female reproductive system such as menstrual or ovulatory problems. As well as females, a study discovered that obesity in men during their 20s was linked to an elevated risk of low sperm motility and poor sperm morphology. Another study has reported men with higher pre-pubertal BMI had lower sex hormone-binding globulin; however, the same association was not seen between childhood BMI and semen quality.ConclusionThe evidence suggests a positive association between childhood obesity with infertility indicators in later life. Childhood weight reduction strategies are suggested to be implemented in societies in order to reduce infertility rates in later life.

Effects of Preoperative Chronic Steroid Use on Postoperative Outcomes in Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Higher rates of postoperative complications have been found in preoperative chronic steroid users. However, the effects of preoperative chronic steroid use on outcomes in orthopedic surgery were unclear. We performed a systematic review of cohort studies examining the effects of chronic steroid use on postoperative outcomes following orthopedic surgery and searched PubMed, Embase, and CENTRAL through 29 April 2023. We included 17 studies with 1,546,562 patients. No increase in 30-day mortality (adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 0.64-3.09) and composite thromboembolic events (aOR 1.61, 95% CI 0.99-2.63) but increases in 30-day overall complications (aOR 1.42, 95% CI 1.16-1.75), wound dehiscence (aOR 2.91, 95% CI 1.49-5.66), infectious complications (any infection (aOR 1.61, 95% CI 1.44-1.80), sepsis (aOR 2.07, 95% CI 1.34-3.21), superficial surgical site infection (SSI) (aOR 1.73, 95% CI 1.03-2.89) and deep SSI (aOR 1.96, 95% CI 1.26-3.05)), re-admission (aOR 1.62, 95% CI 1.48-1.77), both 30-day (aOR 1.28, 95% CI 1.03-1.59) and 1-year re-operation (aOR 1.78, 95% CI 1.09-2.92), pulmonary embolism (aOR 5.94, 95% CI 1.52-23.29), and deep vein thrombosis (aOR 2.07, 95% CI 1.24-3.46) were detected in preoperative steroid users. An increased risk of adverse outcomes following orthopedic surgery in chronic steroid users was found.

The irony of drinking to health and happiness

In testing the relationship between alcohol consumption in young people and depression in young adulthood, in The Lancet Psychiatry, Gemma Hammerton and colleagues 1 Hammerton G Lewis G Heron J Fernandes G Hickman M Lewis G The association of alcohol dependence and consumption during adolescence with depression in young adulthood, in England: a prospective cohort study. Lancet Psychiatry. 2023; (published online June 1.)https://doi.org/10.1016/S2215-0366(23)00138-4 Google Scholar address a very important question. Depression causes an enormous public health burden. WHO identifies depression as affecting more than 4% of the world's population and causing substantial disability. 2 WHODepression and other common mental disorders: global health estimates. World Health Organization, Geneva2017 Google Scholar Understanding how modifiable risk factors, such as alcohol consumption, influence the onset of depression in adulthood is therefore a crucial question for epidemiology to tackle. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a highly appropriate data resource to use to address this question. ALSPAC is well placed in the UK's catalogue of large birth cohort studies, sitting between the 1970 British Cohort Study and the Millennium Cohort Study, uniquely assessing the development of children born in the 1990s. I was involved in a systematic review of available evidence on the adult outcomes of late adolescent alcohol consumption, 3 McCambridge J McAlaney J Rowe R Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies. PLoS Med. 2011; 8e1000413 Crossref PubMed Scopus (313) Google Scholar which concluded that the area needed more high-quality prospective cohort studies, and Hammerton and colleagues' work strongly contributes to this need. The association of alcohol dependence and consumption during adolescence with depression in young adulthood, in England: a prospective cohort studyPsychosocial or behavioural interventions that reduce the risk of alcohol dependence during adolescence could contribute to preventing depression in young adulthood. Full-Text PDF Open Access

Pulmonary Tuberculosis Coinfected with COVID-19 Compounded by Bacterial Superinfection: A Case Report and Critical Appraisal of The Evidence Regarding Its Mortality

Background: The WHO has declared COVID-19 as a global pandemic. However, Indonesia is also challenged by high burden of tuberculosis (TB). In this study, reported an active pulmonary TB case coinciding with COVID-19 but deceased due to bacterial infection. There is a need to further explore this new problem in developing countries to determine the prognosis of COVID-19 patients with tuberculosis infection.Methods: A comprehensive literature search was conducted by using databases such as The Cochrane Library, PubMed, Google Scholar, EBSCO-Host, and Scopus, including systematic reviews of cohort studies, cohorts, and case controls. As many as 309 studies were identified, after screening for duplicates and against the inclusion and exclusion criteria, three studies were included for critical appraisal.Results: The meta-analysis by Gao et al included two studies with an odds ratio (OR) of 1.4 [95% CI=0.1-18.93], the cohort study by Sy et al reported a relative risk (RR) of 2.17 [95% CI=1.4-3.37], and Motta et al showed that COVID-19 patients with tuberculosis had a mortality rate of 11.8% [95% CI=7.75-15.45]. Conclusion: TB has yet to be an identified as a major predictor of increased mortality in COVID-19 patients but can be considered a predictor of increased severity in COVID-19 patients. Studies with a bigger sample size and better study design are suggested to obtain new evidence.

Are health behaviors associated with mental health among tertiary education students? A systematic review of cohort studies

Objective To evaluate the association between health behaviors with mental health among tertiary education students. Methods Six databases were searched until September 2021 for prospective cohort studies evaluating the association between health behavior(s) (dietary intake, physical activity, sedentary behavior, alcohol intake, sleep, smoking or illicit drug use) and mental health. Two independent reviewers screened records for inclusion, extracted data and completed risk of bias assessments. Results 33 studies were included (14 assessed sleep, 14 alcohol intake, 13 physical activity, 8 smoking, 6 sedentary behavior, 4 diet, 1 illicit drug use). A consistent association between poor sleep, and physical inactivity with increased risk of poor psychological wellbeing, and between poor sleep and increased mental ill-health related outcomes was demonstrated. Conclusion Findings suggest interventions to address poor sleep and physical inactivity among students may positively impact mental health. Further research of other health behaviors, and their association with mental health, is required.

Risk Factors for Early Sexual Intercourse in Adolescence: A Systematic Review of Cohort Studies.

This systematic review provides a comprehensive assessment of risk factors related to early sexual intercourse (ESI) among adolescents. We used PRISMA guidelines to identify eligible cohort studies published between January 1999 and December 2020. We searched on three databases: PubMed, Embase and LILACS. Studies were screened for quality and eligibility. Of 2787 identified studies, seven met our inclusion criteria. The studies examined a range of factors, which were organized into four dimensions - individual, family, social and environmental, and sociodemographic. Risk factors with strong associations for ESI were: adolescent and parental substance use, aggression and conduct disorders, family attachment, school achievement, family living situation, and maternal education. Three studies were birth cohorts. This review demonstrates the important roles of substance use, family attachment and academic factors in shaping adolescents' sexual behavior. A strength of this review is its focus on longitudinal studies, enabling exploration of exposures collected before initiation of sexual intercourse.

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

BackgroundPrevention of pregnancy-related alloimmunization and the management of hemolytic disease of the fetus and newborn (HDFN) has significantly improved over the past decades. Considering improvements in HDFN care, the objectives of this systematic literature review were to assess the prenatal treatment landscape and outcomes of Rh(D)- and K-mediated HDFN in mothers and fetuses, to identify the burden of disease, to identify evidence gaps in the literature, and to provide recommendations for future research.MethodsWe performed a systematic search on MEDLINE, EMBASE and clinicaltrials.gov. Observational studies, trials, modelling studies, systematic reviews of cohort studies, and case reports and series of women and/or their fetus with HDFN caused by Rhesus (Rh)D or Kell alloimmunization. Extracted data included prevalence; treatment patterns; clinical outcomes; treatment efficacy; and mortality.ResultsWe identified 2,541 articles. After excluding 2,482 articles and adding 1 article from screening systematic reviews, 60 articles were selected. Most abstracted data were from case reports and case series. Prevalence was 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. Most commonly reported antenatal treatment was intrauterine transfusion (IUT; median frequency [interquartile range]: 13.0% [7.2–66.0]). Average gestational age at first IUT ranged between 25 and 27 weeks. weeks. This timing is early and carries risks, which were observed in outcomes associated with IUTs. The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.8% (range, 0–50%) and 39.2% in K-mediated HDFN. Overall mean ± SD fetal mortality rate that was found to be 19.8%±29.4% across 19 studies. Mean gestational age at birth ranged between 34 and 36 weeks.ConclusionThese findings corroborate the rareness of HDFN and frequently needed intrauterine transfusion with inherent risks, and most births occur at a late preterm gestational age. We identified several evidence gaps providing opportunities for future studies.

Risk of Heart Failure between Different Metabolic States of Health and Weight: A Meta-Analysis of Cohort Studies.

We conducted a systematic review of cohort studies comparing the risk of heart failure in people with differing metabolic health and obesity statuses. We searched three electronic databases (PubMed, Web of Science, Scopus), where the studies of the relationships of metabolic health and obesity statuses with heart failure were included. Fixed-effects or random-effects models were used to estimate the summary relative risks [RRs]. Ten cohort studies were selected. Compared with individuals with normal metabolic health and body mass, the pooled RRs (95% confidence intervals) for heart failure were 1.23 (1.17, 1.29) for metabolic healthy overweight individuals, 1.52 (1.40, 1.64) for metabolic healthy individuals with obesity, 1.56 (1.30, 1.87) for metabolically unhealthy normal-weight individuals, 1.75 (1.55, 1.98) for metabolically unhealthy overweight individuals, and 2.28 (1.96, 2.66) for metabolic unhealthy individuals with obesity. A sensitivity analysis suggested that no single study had a substantial effect on the results. The Egger's and Begg's tests showed no evidence of publication bias. People with overweight or obesity were at a higher risk of heart failure, even if metabolically healthy. In addition, compared with metabolically healthy normal-weight individuals; metabolically unhealthy normal-weight individuals, and those with overweight or and obesity, were at higher risk of heart failure.

Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review.

"Windswept" deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. II -Systematic review of cohort studies.

226 (PB-050) Poster - Racial disparity and time to treatment initiation effects on survival differences in breast cancer: a DAGs-based review protocol for a systematic review of cohort studies

Background: Racial disparity is a fundamental predictor of many poor health outcomes, including in breast cancer. There is a need to synthesize knowledge on the impact of variations in race/ethnicity and initiation of treatments on health-related outcomes to support mitigating interventions; however, in the literature, there are various ways the causation between racial disparities and outcomes is conceptualized, and the implications of different studies depend strongly on these different conceptualizations.

Predictors of Persistent Somatic Symptoms in the General Population: A Systematic Review of Cohort Studies.

Up to 10% of the general population experiences persistent somatic symptoms (PSS). Numerous studies in a variety of health domains are dedicated to identifying factors that are associated with PSS onset. The present study aimed to provide an overview of predictors for PSS onset in the general population and the related health domains. A systematic search was performed identifying longitudinal cohort studies that examined factors associated with PSS onset in the general population. Included studies measured potential predictors before PSS onset and were categorized according to the dynamic biopsychosocial model. Four levels of evidence were discerned for predictors, based on the number of studies and percentage of consistent findings. In the 154 articles eligible for analysis, 27 PSS subtypes were studied, with primary focus on fibromyalgia (25.0%) and irritable bowel syndrome (23.3%). Of the >250 predictors of PSS onset, 46 were investigated more than once and showed consistent results. Strong evidence identifies biological (e.g., infections, body weight-related metrics), psychological (e.g., sleep problems, psychopathology), interpersonal (life events, childhood/interpersonal stress), contextual (employment), and health behavioral (health care utilization) predictors. The results provide strong evidence for factors from all dynamic biopsychosocial domains, although interpersonal and health behavioral factors are relatively under investigated. Thus, evidence suggests that reduction of predictors of PSS onset to a specific factor/domain may be too restrictive. There is no evidence that this differs per PSS subtype. Exploring all domains and measuring common factors across subtypes are essential to improve the clinical course of PSS.

Consumption of Dairy Products and the Risk of Overweight or Obesity, Hypertension, and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis and Systematic Review of Cohort Studies.

Dairy products have been suggested to be related to the prevention of overweight or obesity, hypertension, and type 2 diabetes mellitus (T2DM). These associations are currently controversial, however, and a systematic quantitative meta-analysis is lacking. In this study, we examined the associations between dairy products and the risk of overweight or obesity, hypertension, and T2DM and tested for dose-response relations. We comprehensively searched PubMed, Embase, and Web of Science up to April 2021. Cohort studies were included if dairy food consumption was reported at a minimum of 3 levels or as continuous variables, and the associations were assessed with overweight or obesity, hypertension, and T2DM. Summary RRs and 95% CIs were estimated for the dose-response association. Restricted cubic splines were used to evaluate the linear or nonlinear relations. Among the 9887 articles retrieved, 42 articles were included. For overweight or obesity, a linear association was observed for total dairy, milk, and yogurt. The risk decreased by 25%, 7%, and 12% per 200-g/d increase for total dairy, high-fat dairy, and milk, respectively, and by 13% per 50-g/d increment of yogurt. For hypertension, a nonlinear association was observed with total dairy, whereas significant inverse associations were found for low-fat dairy (RR: 0.94; 95% CI: 0.90, 0.98) and milk (RR: 0.94; 95% CI: 0.92, 0.97) per 200-g/d intake increase. For T2DM, all types of dairy food consumption except for milk and low-fat dairy products showed nonlinear associations, with total dairy and yogurt intake associated with 3% and 7% lower risk per 200-g/d and 50-g/d intake increase, respectively. In conclusion, our study suggests that total dairy is associated with a low risk of overweight or obesity, hypertension, and T2DM, especially milk and yogurt for overweight or obesity, low-fat dairy and milk for hypertension, and yogurt for T2DM.

Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Pregnant Women: A Systematic Review of Cohort Studies

AimsThe aim of this systematic review is to identify and appraise pharmacological options available for management of ADHD in pregnant women and adverse effects of ADHD medications on pregnancy and foetus (malformations or long-term effects).MethodsSystematic review of prospective or retrospective cohort studies, available on this topic till September 2021 after PubMed and MEDLINE search, carried out by 2 reviewers independently. The preliminary search was conducted in March 2021, though the reviewers carried out timely cross-referencing as required. All cohort studied except those with ambiguous methodology were included. The data were further extracted using Microsoft excel after Quality Assessment was completed using NewCastle Ottawa Scale. A narrative synthesis was undertaken as meta-analysis was not feasible owing to heterogeneity between studies included.ResultsEighteen Cohort studies were included (N = 28227 pregnant women with ADHD) of which 16 were deemed as good quality. Multiple confounders were identified.The review noted that use of stimulants/non-stimulants reduced symptoms and improved functionality in these expectant mothers. Findings from our review overall indicate low risk of developing malformations with ADHD medications, with only Methylphenidate (notably cardiac) and Modafinil showing slightly increased though statistically significant risk. We also noted slightly increased risk for reduced Apgar scores, abortions on maternal request, pre-eclampsia and preterm births. There was no conclusive association noted between neuro-developmental delay or future ADHD in baby/child.ConclusionA case-by-case approach needs to be adopted for every patient, looking at how ADHD affects daily functioning and balancing that against adverse pregnancy outcomes. Also, innovative practices like drug holidays, as required medications, drug free trial while planning pregnancy etc. will help practitioners streamline the treatment of this group of patients better. Issues like research being restricted to certain countries, small sample size, record-based analysis, issues in ascertaining adherence, confounding factors, ethical conundrums etc. were noted.

MO494: The Prospective Roles of Urinary Dickkopf-3 for Detecting Renal Function Deterioration and Monitoring Chronic Kidney Disease Progression: Systematic Review of Cohort Studies

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is a worldwide health problem whose incremental prevalence. Early detection and proper monitoring of renal dysfunction can decrease morbidity and mortality among CKD patients. Estimated glomerular filtration rate (eGFR) and albuminuria have been used for monitoring CKD progression. Unfortunately, substantial CKD patients’ proportion might undergo CKD progression through non-proteinuric pathways. Dickkopf-3 (DKK3), stress-induced renal tubular epithelial-derived glycoprotein, is a key driver of tubulointerstitial fibrosis through the canonical Wnt/β-catenin signaling pathway. This study aims to evaluate the role of DKK3 in detecting and monitoring renal dysfunction and CKD progression. METHOD Comprehensive literature searching was performed through the online databases of PubMed, EMBASE, ScienceDirect and The Cochrane Library. This study followed the PRISMA guidelines. The inclusion criteria are all cohort studies that assess the correlation and clinical implications of increased urinary DKK3 with CKD progression. The quality of included studies was accessed by using the Newcastle–Ottawa Scale. RESULTS Six cohort studies matched the inclusion criteria. Urinary DKK3-to-creatinine >4000 pg/mg was independently associated with annual eGFR decline among early CKD stages. A multivariate analysis study suggested that 24-h urinary DKK3 was independently associated with the annual Kt/V decline among peritoneal dialysis patients. Increased urinary DKK3 was associated with a significant eGFR decline in 6 months among IgA nephropathy patients. A cohort study suggested that populations with microalbuminuria were significantly susceptible to prevalent cardiovascular diseases, prevalent CKD, and new-onset CKD risks. Urinary DKK3 was associated with significant incremental risks for declining eGFR and proteinuria as well as CKD progression risks in chronic obstructive pulmonary disease (COPD) patients. In a study, involving CKD patients who underwent coronary angiography, the baseline urinary DKK3-to-creatinine ratio was superior to serum cystatin-C and serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), predicting both acute kidney injury (AKI) and persistent renal dysfunction. A cardiac surgery study showed that high urinary DKK3-to-creatinine ratio >471 pg/mg was significantly associated with AKI, persistent renal dysfunction and dialysis dependency. CONCLUSION Dickkopf-3 shows promising prospective roles for detecting early renal dysfunction and monitoring CKD progression. Nevertheless, further studies are warranted to confirm its promising prospective role.

Metabolic disorders and the risk of head and neck cancer: a protocol for a systematic review and meta-analysis

IntroductionHead and neck cancer squamous cell carcinoma (HNSCC) is the sixth most common cancer internationally. Established risk factors include smoking, alcohol and presence of human papillomavirus (HPV). The incidence rate...