Effect of thiamine supplementation on glycaemic outcomes in adults with type 2 diabetes: a systematic review and meta-analysis Arti Muley, Ritin Fernandez, Heidi Green, Prasad Muley BMJ Open, 2022 BackgroundPatients with type 2 diabetes mellitus (T2DM) have been shown to have thiamine deficiency. Dietary supplementation is an economic strategy to control blood glucose. Objective: To evaluate effectiveness of thiamine supplementation on glycaemic outcomes in patients with T2DM.MethodsEligibility criteria: Studies that assessed effect of thiamine supplementation in adults with T2DM which measured glycaemic outcomes—HbA1c, fasting blood glucose (FBG) and/or postprandial blood glucose (PPG) were included. Information sources: PUBMED, Tripdatabase, the Cochrane Central Register, National Institute of Health Clinical Database and Google Scholar were searched until December 2021 for RCTs. Risk of bias: It was assessed using standardised critical appraisal instruments from the Joanna Briggs Institute for RCTs. Synthesis of results: Where possible, studies were pooled in a meta-analysis. Results were presented in a narrative format if statistical pooling was not possible.ResultsIncluded studies: Six trials involving 364 participants. Synthesis of results: No significant beneficial effects were observed on glycaemic outcomes with 100–900 mg/day of thiamine or benfotiamine for up to 3 months (HbA1c: MD, −0.02%, 95% CI: −0.35 to 0.31; FBG: MD,−0.20 mmol/L; 95% CI: −0.69 to 0.29; PPG: MD, – 0.20 mmol/L, 95% CI: −2.05 to 1.65 (mean difference, MD)). There was a significant increase in high-density lipoprotein (HDL) (MD, 0.10; 95% CI: 0.10 to 0.20) at 3-month follow-up. Benfotiamine reduced triglyceride level (MD, −1.10; 95% CI: −1.90 to –0.30) in 120 mg/day dose as compared with placebo 150 mg/day, however this was not demonstrated in higher doses.DiscussionLimitations of evidence: Inclusion of single-centre trials published only in English, small sample sizes of included studies, lack of trials investigating outcomes for same comparisons and varying follow-up periods. Interpretation: Thiamine supplementation does not affect glycaemic outcomes, however reduces triglycerides while increasing HDL. Multicentre well-designed RCT with higher doses of thiamine and a follow-up period of 1–2 years will provide better evidence.PROSPERO registration numberCRD42020170520.
Effect of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus: A systematic review Arti Muley, Ritin Fernandez, Laura Ellwood, Prasad Muley, Monali Shah Jbi Evidence Synthesis, 2021 OBJECTIVE The objective of this review was to synthesize the best available research evidence regarding the effectiveness of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus. INTRODUCTION There has been an increase in the use of complementary therapy, particularly botanical products, for management of type 2 diabetes mellitus. It has been reported that increasing mono- and polyunsaturated fatty acids in diet effectively lowers the risk of development of type 2 diabetes mellitus. Hence, it was hypothesized that consumption of nuts, which are high in polyunsaturated fatty acids and mono-unsaturated fatty acids, may aid in preventing diabetes and reducing levels of blood glucose by reducing glycemic load by displacing dietary carbohydrates present in diet. INCLUSION CRITERIA This systematic review included randomized controlled trials that compared the consumption of any type and form of tree nut with a placebo or any other intervention in adults with type 2 diabetes mellitus. Trials were included if they measured fasting blood glucose, post prandial blood glucose, and/or glycated hemoglobin. Trials that assessed triglyceride levels and weight post intervention were also considered for inclusion. Trials were restricted to the English language. METHODS A three step search of PubMed, CINAHL, Embase, Tripdatabase, and Cochrane Central Register of Controlled Trials (CENTRAL) was done in July 2019. To find unpublished studies, the National Institute of Health Clinical Database and Google Scholar were searched. Studies from the search were uploaded to EndNote X8 and reviewed against the inclusion criteria by two reviewers. The JBI critical appraisal checklist for randomized controlled trials was used to assess the potential studies for methodological quality. A meta-analysis and subgroup analysis was conducted among trials with the same type of intervention and outcome measures. Results are presented in a narrative format where statistical pooling was not possible. The a priori protocol was registered in PROSPERO (CRD42019133558). RESULTS Fifteen trials were included with a total sample size of 667. Consumption of pistachios demonstrated a significant reduction in triglyceride levels (mmol/L) at three months or earlier follow-up (MD -0.28; CI -0.33, -0.23; P = <0.00001). The meta-analysis including all tree nuts combined showed reduction in both fasting blood glucose and glycated hemoglobin (MD -0.26 mmol/L and -0.11% respectively) at three months or earlier follow-up. The subgroup analysis demonstrated mean difference of -0.45, -0.16, and -0.90 mmol/L in fasting blood glucose following ingestion of walnuts, almonds, and hazelnuts, and -0.17% in glycated hemoglobin following ingestion of walnuts for three months or earlier follow-up. Although not clinically significant, these figures give an indication that further research with larger sample sizes and longer follow-up may show encouraging results. CONCLUSIONS The authors found that pistachio consumption for three months or fewer significantly reduced triglycerides. Other tree nuts (walnuts, almonds, and hazelnuts) reduced fasting blood glucose and glycated hemoglobin by varying degrees. Further robust randomized controlled trials with power calculation based sample size, comparing same type, dose, and method of nut intervention will provide more evidence. For now, clinical decisions should be based on standard practice local guidelines.
Etiology of bacteremia in young infants in six countries Davidson H. Hamer, Gary L. Darmstadt, John B. Carlin, Anita K. M. Zaidi, Kojo Yeboah-Antwi, Samir K. Saha, Pallab Ray, Anil Narang, Eduardo Mazzi, Praveen Kumar, Arti Kapil, Prakash M. Jeena, Ashok Deorari, A.K. Azad Chowdury, Andrés Bartos, Zulfiqar A. Bhutta, Yaw Adu-Sarkodie, Miriam Adhikari, Emmanuel Addo-Yobo, Martin W. Weber Pediatric Infectious Disease Journal, 2015 Background: Neonatal illness is a leading cause of death worldwide; sepsis is one of the main contributors. The etiologies of community-acquired neonatal bacteremia in developing countries have not been well characterized. Methods: Infants <2 months of age brought with illness to selected health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa were evaluated, and blood cultures taken if they were considered ill enough to be admitted to hospital. Organisms were isolated using standard culture techniques. Results: Eight thousand eight hundred and eighty-nine infants were recruited, including 3177 0–6 days of age and 5712 7–59 days of age; 10.7% (947/8889) had a blood culture performed. Of those requiring hospital management, 782 (54%) had blood cultures performed. Probable or definite pathogens were identified in 10.6% including 10.4% of newborns 0–6 days of age (44/424) and 10.9% of infants 7–59 days of age (39/358). Staphylococcus aureus was the most commonly isolated species (36/83, 43.4%) followed by various species of Gram-negative bacilli (39/83, 46.9%; Acinetobacter spp., Escherichia coli and Klebsiella spp. were the most common organisms). Resistance to second and third generation cephalosporins was present in more than half of isolates and 44% of the Gram-negative isolates were gentamicin-resistant. Mortality rates were similar in hospitalized infants with positive (5/71, 7.0%) and negative blood cultures (42/557, 7.5%). Conclusions: This large study of young infants aged 0–59 days demonstrated a broad array of Gram-positive and Gram-negative pathogens responsible for community-acquired bacteremia and substantial levels of antimicrobial resistance. The role of S. aureus as a pathogen is unclear and merits further investigation.
ALA, fatty fish or marine n-3 fatty acids for preventing DM?: A systematic review and meta-analysis Arti Muley, Prasad Muley, Monali Shah Current Diabetes Reviews, 2014 Diabetes mellitus (T2DM) has become a global problem. Role of n-3 FA in its prevention is still not completely understood. We carried out this systematic review and meta-analysis to assess the relation of dietary intake of fish and n-3PUFA with risk of diabetes. We searched PUBMED, EMBASE and GOOGLE with cross references to identify relevant articles. Since no RCTs were available, we searched for prospective cohort studies. Sixteen studies with 6,79,763 participants which assessed the association of dietary intake of fish and n-3 PUFA (marine or alpha-linolenic acid) with incidence of T2DM in > 18 years population and provided relative risk (RR) or hazard ratio (HR) with the corresponding 95% confidence interval (CI) of T2DM for each category of fish or n-3 PUFA intake were included. Three independent reviewers reviewed all eligible studies and abstracted the relevant information from individual studies. Meta-analysis confirmed the previous finding that marine n-3 FA increased risk of T2DM in Americans but reduced the same in Asians. We observed that two and seven times increased intake of ALA and fatty fish respectively reduced the risk of T2DM significantly and ALA did not increase the risk in Americans. We concluded that ALA may have some role in preventing T2DM, but is not studied widely. Hence, it should be studied in greater details (with higher degrees of intake; more than two times) to aid in developing effective preventive strategies against diabetes.
Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: A systematic review Monali Shah, Arti Muley, Prasad Muley Journal of Maternal Fetal and Neonatal Medicine, 2013 Objective: To confirm effectiveness of nonsurgical periodontal treatment during pregnancy on pregnancy outcome in terms of preterm birth and low birth weight (LBW). Method: We searched for Randomized controlled trials in MEDLINE, CINAHL and EMBASE. from January 2000 to October 2012. References of included studies were hand searched. Studies which measured incidence of either preterm labor (PTL), LBW or both were included. Information on study design, population, risk of bias, periodontal parameters, time and type of periodontal treatment given and pregnancy outcome were abstracted independently by three reviewers. Results: Total thirteen studies were included. Five studies had low risk of bias. Conclusive results could not be obtained for incidence of PTL or LBW because of heterogeneity in results due to various reasons, but all studies which assessed PTL and LBW combined showed significant difference in incidence of same in group which received non surgical periodontal treatment. Conclusion: Our study suggests that treatment of periodontitis during gestation improves pregnancy outcome in terms of PTLBW, a fact which may be used for health and economical benefits but better RCTs with adequate sample size are required for conclusive evidence.
Safety of inhaled fluticasone propionate therapy for pediatric asthma - A systematic review Prasad Muley, Monali Shah, Arti Muley Current Drug Safety, 2013 CONTEXT AND AIM Asthma is a common problem in paediatric population. International treatment guidelines recognize the role of inhaled corticosteroids for asthma in young children. Inhaled fluticasone propionate is reported to have greater systemic effects like other corticosteroids. Limited data is available on safety of this drug when used for longer duration. So, we conducted a systematic review to study the effect of inhaled fluticasone propionate on adrenal suppression, growth and bone mineral density in paediatric patients. DESIGN A systematic review. METHODS We searched for Randomized controlled trials in MEDLINE from January 2000 to December 2012. References of included study were hand searched. Information on study design, study population, drugs and dosage used, follow up period, measures used to evaluate safety and outcomes was abstracted independently by three reviewers. DETAILS OF INCLUDED STUDIES: In all included studies, participants were asthmatic children below 18 years and treated with fluticasone propionate. Minimum follow up considered was three months and should have measured HPA suppression or growth velocity or bone mineral density. RESULTS Total ten studies were included. Studies which had monitored HPA function varied in dosage of drug, mode of administration and duration. Inspite of that it has been observed that serum cortisol level is affected by fluticasone propionate, no significant effect on bone mineral density was reported with fluticasone propionate, but the sample size was inadequate and dietary calcium intake was not recorded. None of the studies reported any significant reduction in growth when inhaled fluticasone propionate was used for the treatment of asthma, but the baseline growth and final adult height attained were not assessed. LIMITATION This systematic review included only free full text articles published in English. Only randomized controlled trials were included. Cohort studies were not included. CONCLUSION With available evidences, the safety of inhaled fluticasone propionate cannot be questioned. This systematic review could not derive any significant adverse effect on HPA function, growth and bone mineral density in asthmatic children when used for long duration and followed for up to three months.
The association of positive chest radiograph and laboratory parameters with community acquired pneumonia in children Dhairya Lakhani Journal of Clinical and Diagnostic Research, 2013 CONTEXT This study was designed to compare the sensitivities of different investigations for the diagnosis of Community Acquired Pneumonia (CAP). A prospective study was carried out which compared the sensitivities of the chest radiographs, CRP, TLC, ESR and the blood cultures in sixty-six patients who were diagnosed with WHO defined CAP. METHOD AND MATERIAL The chest radiographs, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total leucocyte count (TLC) and blood cultures were determined in sixty-six patients who were amongst the age group of one month to five years of age, who were diagnosed with WHO defined CAP. STATISTICAL ANALYSIS It was carried out by calculating the proportion, mean, standard deviation (SD) and the sensitivity of the test/.able RESULTS The chest radiographs were found to be positive in 93.9% (n=62) patients, CRP was positive in 90.9% (n=60) patients, ESR was positive in 72.7% (n=42) patients, TLC was positive in 48.5% (n=38) patients and the blood cultures were positive in 6.1% (n=4) patients. Hence, the sensitivity of the chest radiograph, CRP, ESR, TLC and the blood culture in the diagnosis of CAP were 93.9%, 90.9%, 72.7%, 48.5% and 6.1%. CONCLUSION In view of the high sensitivity of CRP, which is almost similar to that of chest X-Ray in detecting CAP, CRP can be used as an alternative test to the chest radiographs at peripheral centres, where X-ray machines are not available.
Constipation in children - is it always benign? P. Muley, R. V. Mhapsekar, R. M. Kumar Colorectal Disease, 2012 A 10-year-old boy presented to our institution with complaint of abdominal pain in the periumbilical region and left iliac fossa with difficulty in defaecation for 20 days. The pain was colicky, non-radiating and relieved by defaecation. The stool was hard in consistency, yellow in colour and without blood or mucus. There was no history of vomiting, weight loss or Koch’s contact. Pain was associated with a lump in the left iliac fossa which usually disappeared after defaecation. There were in total five members (two siblings and parents) in the family with no history of any type of cancer. No other incidence of similar disease was noted in the area. On abdominal examination, a non-tender, irregular, soft and mobile lump was palpable in the left iliac fossa before defaecation. Rectal examination and the rest of the systemic examination were normal. Full blood, urea and electrolytes and liver function test were normal. Ultrasound of the abdomen revealed thickened rectal mucosa with no proximal bowel loop dilatation or intussusception. Barium enema was normal but contrast CT of the abdomen revealed a stricture in the sigmoid colon (possibly a normal loop of intestine overshadowed the abnormal region during the barium enema). Sigmoidoscopy showed normal rectal mucosa but the scope could not be introduced beyond 25 cm. Colonoscopic biopsy was inconclusive. Meanwhile the patient developed an acute intestinal obstruction. Emergency exploratory laparotomy revealed a strictured growth at the rectosigmoid junction which was resected completely and an end to end anastomosis was fashioned. Histopathology revealed a signet cell adenocarcinoma of the colon (tumour–node–metastasis stage T3 N2 Mx) (Figure 1). The diagnosis was made 6 weeks after the initial presentation. The patient was referred for chemotherapy.
Clinico-epidemiological profile and validation of symptoms and signs of severe illness in young infants (<60 days) reporting to a district hospital Indian Pediatrics, 2007
