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Context Nonalcoholic fatty liver disease (NAFLD) is considered the leading cause of chronic liver disease worldwide. To date, no confirmed medication is available for the treatment of NAFLD. Previous studies showed the promising effects of gut microbiome–targeted therapies; however, the results were controversial and the strength of the evidence and their clinical significance remained unclear. Objectives This umbrella study summarizes the results of meta-analyses investigating the effects of probiotics, prebiotics, and synbiotics on liver enzymes in the NAFLD population. Data Source A comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was done up to December 20, 2022, to find meta-analyses on randomized control trials reporting the effects of gut microbial therapy on patients with NAFLD. Data Extraction Two independent investigators extracted data on the characteristics of meta-analyses, and any discrepancies were resolved by a third researcher. The AMSTAR2 checklist was used for evaluating the quality of studies. Data Analysis A final total of 15 studies were included in the analysis. Results showed that microbiome-targeted therapies could significantly reduce levels of alanine aminotransferase (ALT; effect size [ES], −10.21; 95% confidence interval [CI], −13.29, −7.14; P < 0.001), aspartate aminotransferase (AST; ES, −8.86; 95%CI, −11.39, −6.32; P < 0.001), and γ-glutamyltransferase (ES, −5.56; 95%CI, −7.92, −3.31; P < 0.001) in patients with NAFLD. Results of subgroup analysis based on intervention showed probiotics could significantly reduce levels of AST (ES, −8.69; 95%CI, −11.01, −6.37; P < 0.001) and ALT (ES, −9.82; 95%CI, −11.59, −8.05; P < 0.001). Synbiotics could significantly reduce levels of AST (ES, −11.40; 95%CI, −13.91, −8.88; P < 0.001) and ALT (ES, −11.87; 95%CI, −13.80, −9.95; P < 0.001). Prebiotics had no significant effects on AST and ALT levels (ES, −2.96; 95%CI, −8.12, 2.18, P = 0.259; and ES, −4.69; 95%CI, −13.53, 4.15, P = 0.299, respectively). Conclusion Gut microbiome–targeted therapies could be a promising therapeutic approach in the improvement of hepatic damage in patients with NAFLD. However, more studies are needed to better determine the best bacterial strains, duration of treatment, and optimum dosage of gut microbiome–targeted therapies in the treatment of the NAFLD population. Systematic Review Registration PROSPERO registration no. CRD42022346998. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a significant risk factor for non-alcoholic fatty liver disease (NAFLD). Increased fasting blood sugar (FBS), fasting insulin (FI), and insulin resistance (HOMA-IR) are observed in patients with NAFLD. Gut microbial modulation using prebiotics, probiotics, and synbiotics has shown promise in NAFLD treatment. This meta-umbrella study aimed to investigate the effects of gut microbial modulation on glycemic indices in patients with NAFLD and discuss potential mechanisms of action. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library until March 2023 for meta-analyses evaluating the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD. Random-effect models, sensitivity analysis, and subgroup analysis were employed. Results: Gut microbial therapy significantly decreased HOMA-IR (ES: −0.41; 95%CI: −0.52, −0.31; P < 0.001) and FI (ES: −0.59; 95%CI: −0.77, −0.41; P < 0.001). However, no significant effect was observed on FBS (ES: −0.17; 95%CI: −0.36, 0.02; P = 0.082). Subgroup analysis revealed prebiotics had the most potent effect on HOMA-IR, followed by probiotics and synbiotics. For FI, synbiotics had the most substantial effect, followed by prebiotics and probiotics. Conclusion: Probiotics, prebiotics, and synbiotics administration significantly reduced FI and HOMA-IR, but no significant effect was observed on FBS. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. Methods: A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. Results: Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86–9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85–6.65), 3.58 (95% CI 2.75–4.66), and 2.85 (95% CI 2.13–3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17–0.37), ES: 0.25 (95% CI 0.13–0.50), ES: 0.26 (95% CI 0.17–0.41), and ES: 0.39 (0.28–0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05). Conclusion: NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN. [ABSTRACT FROM AUTHOR]

Background: Smoking poses a significant risk for colorectal cancer (CRC), considered the third leading reason for cancer-related deaths worldwide. However, there has been limited research on the relationship between smoking and CRC in the Eastern Mediterranean Regional Office (EMRO). Therefore, a meta-analysis was conducted to combine available data and gain a comprehensive understanding of the relationship between smoking and CRC in EMRO. Methods: Two independent researchers searched PubMed, Scopus, and Web of Science until December 2022. The included studies were checked for risk of bias administering the Newcastle-Ottawa scale. Heterogeneity was evaluated using I2 statistics and the Cochrane test. Publication bias was determined through funnel plot analysis and Egger's regression test. Additionally, a meta-regression analysis explored the impact of a country's Human Development Index (HDI) on the relationship between smoking and CRC. Results: The final analysis included 26 studies, revealing a significant association between smoking and CRC (OR = 1.40; 95% CI: 1.11 - 1.78; P = 0.004). Moreover, smoking had a more pronounced adverse effect on CRC in countries with higher HDIs compared to those with lower HDIs (OR = 1.30; 95% CI: 0.99 - 1.71; P = 0.054). Conclusions: Our findings underscore the importance of implementing smoking cessation programs and policies in EMRO countries, as they demonstrate a positive relationship between smoking and the risk of CRC. Furthermore, the results suggest that a country's level of human development may influence the association between smoking and CRC. Further research is needed to investigate this potential connection and develop targeted public health interventions. [ABSTRACT FROM AUTHOR]

Background: Bronchiectasis is a condition characterized by abnormal and permanent bronchial constriction that leads to sputum production and bronchial infection. The current study was done to evaluate the effects of symbiotic probiotics on the clinical manifestations and exacerbation of bronchiectasis. Materials and Methods: 26 patients in the placebo group (A) and 24 patients in the probiotic group (B) were allocated. In group A, patients took the placebo capsules two times daily for six months. In group B, patients took the LactoCare two times daily for six months. Results: The mean age of patients was 55.73±13.62 (group A) and 54.5±12.59 years (group B). Most of the patients had consumed azithromycin in both groups. The current study demonstrated there was no statistically significant difference between the decreased rate of pulmonary exacerbations in both groups. However, a decreasing trend was shown in the rate of pulmonary exacerbations without hospitalization (P=0.610). Also, there was a decreasing trend in the rate of pulmonary exacerbations leading to hospitalization (P=0.956). The most frequent etiologic pathogen was Pseudomonas sp. FEV1 and FVC/FEV1 ratios were higher in group B than in group A. However, there was no statistically significant difference between groups A and B (P=0.908 vs 0.403). Conclusion: The symbiotic probiotics were not effective in the clinical improvement of bronchiectasis, consumption of antibiotics, the rate of pulmonary exacerbations with or without hospitalization, FEV1 and FEV1/FVC, and microbiological pattern. [ABSTRACT FROM AUTHOR]

Background: The introduction of ChatGPT by OpenAI has garnered significant attention. Among its capabilities, paraphrasing stands out., Objective: This study aims to investigate the satisfactory levels of plagiarism in the paraphrased text produced by this chatbot., Methods: Three texts of varying lengths were presented to ChatGPT. ChatGPT was then instructed to paraphrase the provided texts using five different prompts. In the subsequent stage of the study, the texts were divided into separate paragraphs, and ChatGPT was requested to paraphrase each paragraph individually. Lastly, in the third stage, ChatGPT was asked to paraphrase the texts it had previously generated., Results: The average plagiarism rate in the texts generated by ChatGPT was 45% (SD 10%). ChatGPT exhibited a substantial reduction in plagiarism for the provided texts (mean difference -0.51, 95% CI -0.54 to -0.48; P<.001). Furthermore, when comparing the second attempt with the initial attempt, a significant decrease in the plagiarism rate was observed (mean difference -0.06, 95% CI -0.08 to -0.03; P<.001). The number of paragraphs in the texts demonstrated a noteworthy association with the percentage of plagiarism, with texts consisting of a single paragraph exhibiting the lowest plagiarism rate (P<.001)., Conclusions: Although ChatGPT demonstrates a notable reduction of plagiarism within texts, the existing levels of plagiarism remain relatively high. This underscores a crucial caution for researchers when incorporating this chatbot into their work., (© Soheil Hassanipour, Sandeep Nayak, Ali Bozorgi, Mohammad-Hossein Keivanlou, Tirth Dave, Abdulhadi Alotaibi, Farahnaz Joukar, Parinaz Mellatdoust, Arash Bakhshi, Dona kuriyakose, Lakshmi Polisetty, Mallika Chimpiri, Ehsan Amini-Salehi. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background: The COVID-19 pandemic highlighted the need to study oral fungal carriage and its potential impact. In oral fungal environments, factors like changes in respiratory epithelium, increased pathogen attachment, local inflammation, and virulence factors could influence COVID-19 severity. The authors conducted a study to explore oral fungal carriage in COVID-19 patients and compare it to a healthy control group., Methods: The authors executed a case-control investigation including 144 COVID-19 patients and an equivalent number of 144 healthy controls. The matching criteria encompassed age, sex, body mass index, and the history of antibiotic and antiviral medication intake. This research was performed over a span of 12 months from May 2021 to May 2022. The mouth area was sampled with a cotton-tipped swab. Subsequently, all the samples underwent fungal culture and PCR-sequencing procedures., Results: In COVID-19 patients, oral fungal carriage was three times higher compared to healthy controls. Candida was the exclusive genus found in both groups, with Candida albicans being the most frequently isolated species (90.79%). Among COVID-19 patients, Candida species showed significantly higher esterase, proteinase, and hemolysin activity compared to healthy individuals. Both groups exhibited elevated levels of C. albicans virulence factors compared to non-albicans species., Conclusions: It is crucial to understand the way that virulence factors of oral fungal carriage act in COVID-19 patients in order to come up with novel antifungal medications, identify the contributing factors to drug resistance, and manage clinical outcomes., Competing Interests: The authors have no conflict of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Measles, a highly contagious and vaccine-preventable disease, continues to present global public health challenges. This retrospective study focused on measles outbreaks in Hormozgan province, southern Iran, spanning from 2014 to 2019., Methods: Between 2014 and 2019, patients suspected of having measles, as reported by medical centers in Hormozgan, were subject to a comprehensive evaluation. The diagnosis of measles was conclusively established through the use of real-time polymerase chain reaction (RT-PCR) testing. A detailed collection of pertinent data was undertaken. SPSS software, version 21, was employed for statistical analysis., Results: In the current study, out of 1291 clinically suspected measles cases, 151 were PCR-confirmed, with an average age of 16.77 years (±10.46), comprising 50.9% males and 49.1% females. The annual distribution showed varied incidence: 8.4% in 2014, peaking at 18.8% in 2015, then fluctuating to 11.4% in 2016, 0.8% in 2017, and 17.9% in 2018, with no cases in 2019. Among confirmed cases, 16.5% were vaccinated, while 68.2% were not, and 15.23% had unknown vaccination status., Conclusion: This retrospective study highlights the ongoing challenge of measles in Hormozgan province, Iran, from 2014 to 2019. Despite measles being preventable by vaccination, a significant number of cases were confirmed among both vaccinated and unvaccinated individuals, indicating gaps in immunization coverage and effectiveness. The fluctuating annual incidence, with a peak in 2015 and no cases in 2019, suggests variable success in disease control efforts. This underscores the need for enhanced surveillance, improved vaccination strategies, and public health interventions to effectively combat measles outbreaks in this region., Competing Interests: The authors have no conflict of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Aim: Modulating the gut microbiota population by administration of probiotics, prebiotics, and synbiotics has shown to have a variety of health benefits in different populations, particularly those with metabolic disorders. Although the promising effects of these compounds have been observed in the management of patients with non-alcoholic fatty liver disease (NAFLD), the exact effects and the mechanisms of action are yet to be understood. In the present study, we aimed to evaluate how gut microbiota modulation affects anthropometric indices of NAFLD patients to achieve a comprehensive summary of current evidence-based knowledge., Methods: Two researchers independently searched international databases, including PubMed, Scopus, and Web of Science, from inception to June 2023. Meta-analysis studies that evaluated the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD were entered into our umbrella review. The data regarding anthropometric indices, including body mass index, weight, waist circumference (WC), and waist-to-hip ratio (WHR), were extracted by the investigators. The authors used random effect model for conducting the meta-analysis. Subgroup analysis and sensitivity analysis were also performed., Results: A total number of 13 studies were finally included in our study. Based on the final results, BMI was significantly decreased in NAFLD patients by modulation of gut microbiota [effect size (ES): -0.18, 05% CI: -0.25, -0.11, P <0.001]; however, no significant alteration was observed in weight and WC (ES: -1.72, 05% CI: -3.48, 0.03, P =0.055, and ES: -0.24, 05% CI: -0.75, 0.26, P =0.353, respectively). The results of subgroup analysis showed probiotics had the most substantial effect on decreasing BMI (ES: -0.77, 95% CI: -1.16, -0.38, P <0.001) followed by prebiotics (ES: -0.51, 95% CI: -0.76, -0.27, P <0.001) and synbiotics (ES: -0.12, 95% CI: -0.20, -0.04, P =0.001)., Conclusion: In conclusion, the present umbrella meta-analysis showed that although modulation of gut microbiota by administration of probiotics, prebiotics, and synbiotics had promising effects on BMI, no significant change was observed in the WC and weight of the patients. No sufficient data were available for other anthropometric indices including waist-to-hip ratio and waist-to-height ratio and future meta-analyses should be done in this regard., Competing Interests: The authors declare that they have no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The third most frequent reason for hospitalized acute kidney injury is contrast-induced nephropathy (CIN). Percutaneous coronary intervention (PCI) and coronary angiography (CAG) are two interventions that can result in CIN. In this study, we sought to determine how well gamma-glutamyl transferase (GGT) can predict CIN following CAG and PCI., Method: Two researchers searched through PubMed, Scopus, and Web of Science in November 2022 to find articles that examined GGT levels in CIN patients following PCI or CAG. To rate the quality of the studies, the Joanna Briggs Institute Critical Appraisal Checklist was employed. The Cochran test and I 2 statistics were utilized to assess study heterogeneity. To calculate the number of participants required to reject the null hypothesis, power analysis was used. We evaluated the epidemiologic strength of the results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The authors used Comprehensive Meta-analysis Version 3 to summarize the results., Results: GGT was shown to be considerably greater in patients with CIN according to the meta-analysis's findings (odds ratio: 3.21, 95% CI: 1.26-8.15, P =0.014); nevertheless, the findings were accompanied by significant heterogeneity (I 2 =91.93%, P <0.001). Although the relationship between CIN and GGT was power full regarding power analysis (1- β =1, number of effect sizes=4, the average number per group=336), very low quality of evidence was observed regarding GRADE criteria., Conclusions: These results suggest the GGT level may be a predictor of contrast-induced nephropathy in patients having cardiac catheterization; however, more research is required to prove the epidemiological validity., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Bronchiectasis is a condition characterized by abnormal and permanent bronchial constriction that leads to sputum production and bronchial infection. The current study was done to evaluate the effects of symbiotic probiotics on the clinical manifestations and exacerbation of bronchiectasis., Materials and Methods: 26 patients in the placebo group (A) and 24 patients in the probiotic group (B) were allocated. In group A, patients took the placebo capsules two times daily for six months. In group B, patients took the LactoCare two times daily for six months., Results: The mean age of patients was 55.73±13.62 (group A) and 54.5±12.59 years (group B). Most of the patients had consumed azithromycin in both groups. The current study demonstrated there was no statistically significant difference between the decreased rate of pulmonary exacerbations in both groups. However, a decreasing trend was shown in the rate of pulmonary exacerbations without hospitalization (P=0.610). Also, there was a decreasing trend in the rate of pulmonary exacerbations leading to hospitalization (P=0.956). The most frequent etiologic pathogen was Pseudomonas sp . FEV1 and FVC/FEV1 ratios were higher in group B than in group A. However, there was no statistically significant difference between groups A and B (P=0.908 vs 0.403)., Conclusion: The symbiotic probiotics were not effective in the clinical improvement of bronchiectasis, consumption of antibiotics, the rate of pulmonary exacerbations with or without hospitalization, FEV1 and FEV1/FVC, and microbiological pattern., Competing Interests: Conflicts of interest The authors have no conflicts of interests., (Copyright© 2023 National Research Institute of Tuberculosis and Lung Disease.)

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Andalib, Faghani, Zia Ziabari, Shenagari, Salehiniya, Keivanlou and Rafat.)