The role of vitamin D in outcomes of critical care in COVID-19 patients: Evidence from an umbrella meta-analysis of interventional and observational studies

OBJECTIVES

Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with SARS-CoV-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients.

DESIGN

Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase.

SETTINGS

Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated.

PARTICIPANTS

Adult patients suffering from COVID-19 were studied.

RESULTS

Overall, 13 meta-analyses summarizing data from 4 RCTs and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES= 0.42; 95% CI: 0.10, 0.75, p <0.001; I2 = 20.4%, p=0.285) and observational studies (ES= 1.99; 95% CI: 1.37, 2.62, p <0.001; I2 = 00.0%, p=0.944). Also, vitamin D deficiency increased risk of infection and disease severity among patients.

CONCLUSION

Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to ICU and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.

Insulin Receptor Substrates Regulation and Clinical Responses Following Vanadium-Enriched Yeast Supplementation in Obese Type 2 Diabetic Patients: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Increasing evidence suggests that organic vanadium compounds are bioavailable and safe therapeutic agents with insulin-mimetic and insulin-enhancing features. The objective of the current study was to examine the effect of vanadium-enriched yeast (VEY) supplementation on the gene expression level of insulin receptor substrates and clinical manifestations of obese type 2 diabetic mellitus (T2DM) patients. In this randomized, double-blind, placebo-controlled clinical trial, 44 obese T2DM patients were randomly allocated into either VEY (0.9 mg/day vanadium pentoxide) or placebo group for 12 weeks. The mRNA expression level of protein tyrosine phosphatase 1B (PTP1B), phosphatase and tensin homolog (PTEN), mitogen-activated protein kinase (MAPK), ribosomal protein S6 kinase (S6K), and nuclear factor kappa-light-chain-enhancer of activated B cells (NFƘB) genes in the peripheral blood mononuclear cells, serum levels of metabolic parameters, anthropometric indices, as well as the quality of life, and dietary intake were collected at pre- and post-intervention phases. Analysis of covariance was performed to obtain the corresponding effect size. Results showed that VEY administration significantly decreased anthropometric indices and glycemic parameters and increased insulin sensitivity after adjusting for potential covariates (p < 0.05), in comparison to the placebo group. Additionally, VEY supplementation was significantly effective on MAPK, PTP1B, and NFƘB gene expression level, compared to the placebo group. No significant changes were noticed for dietary intake, quality of life, and lipid profile in the VEY group, compared to the placebo group. Overall, VEY supplementation can be considered as a promising safe adjunct therapy for improving anthropometric indices and glycemic parameters in T2DM patients.

The Impact of Vitamin D Supplementation on Improving Blood Pressure: Evidence Obtained From an Umbrella Meta-analysis

PURPOSE

The results of meta-analyses regarding the effect of vitamin D on blood pressure are conflicting. The present umbrella meta-analysis was conducted to provide definite and conclusive results.

METHODS

Systematically, Scopus, EMBASE, PubMed, and Web of Science databases and Google Scholar were searched for relevant literature published up to July 2022. All meta-analyses of clinical trials addressing the effect of vitamin D on blood pressure were included. Random effects analysis was performed to obtain the overall effect size based on the standardized mean differences (SMDs) and weighted mean differences (WMDs) separately. The quality of included meta-analyses was assessed by using the Measurement Tool for Assessing Multiple Systematic Reviews 2 questionnaire.

FINDINGS

Overall, 21 meta-analyses were enrolled in the umbrella review. The results indicated that systolic blood pressure was significantly reduced after the intervention based on WMD effect size analysis (ESWMD = -0.69 mm Hg; 95% CI, -1.35 to -0.04 [P < 0.038]; I2 = 46.7%, P = 0.021); however, no considerable impact was observed based on analysis of SMD effect sizes (ESSMD = -0.05 mm Hg; 95% CI, -0.24 to 0.14; P = 0.615). Also, vitamin D supplementation indicated a significant improvement in diastolic blood pressure based on WMD effect sizes (ESWMD = -0.66 mm Hg; 95% CI, -1.05 to -0.27 [P < 0.001]; I2 = 56.4%, P = 0.004) but not SMD analysis (ESSMD = -0.04 mm Hg; 95% CI, -0.13 to 0.04 [P = 0.328]; I2 = 53.4%, P = 0.057).

IMPLICATIONS

Based on obtained evidence, vitamin D could be considered an efficient adjuvant for improving blood pressure.

Alleviating effects of coenzyme Q10 supplements on biomarkers of inflammation and oxidative stress: results from an umbrella meta-analysis

Introduction: Although several meta-analyses support the positive effect of coenzyme Q10 (CoQ10) on biomarkers of oxidative stress and inflammation, the results of some other studies reject such effects. Methods: Therefore, in this umbrella meta-analysis, we performed a comprehensive systematic search in such databases as Web of Science, PubMed, Scopus, Embase, and Google Scholar up to January 2023. Results: Based on standardized mean difference analysis, CoQ10 supplementation significantly decreased serum C-reactive protein (CRP) (ESSMD = -0.39; 95% CI: 0.77, -0.01, p = 0.042) and malondialdehyde (MDA) (ESSMD = -1.17; 95% CI: 1.55, -0.79, p < 0.001), while it increased the total antioxidant capacity (TAC) (ESSMD = 1.21; 95% CI: 0.61, 1.81, p < 0.001) and serum superoxide dismutase (SOD) activity (ESSMD = 1.08; 95% CI: 0.37, 1.79, p = 0.003). However, CoQ10 supplementation had no significant reducing effect on tumor-necrosis factor-alpha (TNF- α) (ESSMD = -0.70; 95% CI: 2.09, 0.68, p = 0.320) and interleukin-6 (IL-6) levels (ESSMD = -0.85; 95% CI: 1.71, 0.01, p = 0.053). Based on weighted mean difference analysis, CoQ10 supplementation considerably decreased TNF-α (ESWMD = -0.46, 95% CI: 0.65, -0.27; p < 0.001), IL-6 (ESWMD = -0.92, 95% CI: 1.40, -0.45; p < 0.001), and CRP levels (effect sizes WMD = -0.28, 95% CI: 0.47, -0.09; p < 0.001). Discussion: The results of our meta-analysis supported the alleviating effects of CoQ10 on markers of inflammation cautiously. However, CoQ10 had antioxidant effects regarding the improvement of all the studied antioxidant and oxidative stress biomarkers. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323861, identifier CRD42022323861.

Effects of probiotics supplementation on blood pressure: An umbrella meta-analysis of randomized controlled trials

AIMS

Several meta-analyses have revealed that probiotics could lower blood pressure (BP), but the findings were inconsistent. In this regard, an umbrella meta-analysis was carried out to provide a more accurate estimate of the overall impacts of probiotics supplementation on BP.

DATA SYNTHESIS

We searched the following international databases till November 2021: PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. A random-effects model was applied to evaluate the effects of probiotics on BP. Sensitivity analysis was performed by using the leave-one-out method. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence. Pooled effect size of 14 meta-analyses with 15,494 participants indicated significant decreases in both systolic (Weighted mean difference (WMD) = -1.96 mmHg; 95% confidence interval (CI): -2.78, -1.14, p < 0.001, and standardized mean difference (SMD) = -2.62; 95% CI: -4.96, -0.28, p < 0.001) and diastolic BP (WMD = -1.28 mmHg; 95% CI: -1.76, -0.79, p < 0.001, and SMD = -0.60 mmHg; 95% CI: -1.08, -0.12, p = 0.014) following probiotics supplementation. Greater effects on SBP were revealed in trials with a mean age of >50 years and the duration of intervention ≤10 weeks. DBP was also more reduced in studies with a dosage of ≥10¹⁰ colony forming unit (CFU), and SBP was decreased in patients with hypertension or diabetes analyzing WMD.

CONCLUSION

The present umbrella meta-analysis suggests probiotics supplementation to improve BP and claims that probiotics could be used as a complementary therapy for controlling high BP.

PROSPERO ID

CRD42022306560.

Vitamin D protects against depression: Evidence from an umbrella meta-analysis on interventional and observational meta-analyses

Meta-analyses of interventional and observational studies investigating the efficacy and the relationship between vitamin D and depression provided inconsistent results. The current umbrella meta-analysis was conducted to assess the available evidence and provide a conclusive outcome in this regard. The following international databases were systematically searched till March 2022: PubMed, Scopus, Embase, Web of Science, and Google Scholar. Random-effects model was carried out to calculate the pooled point estimates and their respective 95 % confidence intervals (CI). Ten meta-analyses of randomised controlled trials (RCTs) revealed significant reduction in depression symptoms comparing participants on vitmain D supplements to those on placebo (Pooled standardised mean difference: - 0.40; 95 % CI: - 0.60, - 0.21, p < 0.01: I² = 89.1 %, p < 0.01). Four meta-analyses of cohort studies (with one having two subgroups) revealed that participants with lower levels of serum vitamin D were at increased odds of depression than those with higher levels of serum vitamin D (Pooled odds ratio: 1.60; 95 % CI: 1.08, 2.36, p < 0.01; I² = 91.3 %, p < 0.01). The present umbrella meta-analysis confirms the potential benefits of vitamin D supplementation and higher serum vitamin D levels in reducing the development and symptoms of depression.

Vitamin D supplementation positively affects anthropometric indices: Evidence obtained from an umbrella meta-analysis

Despite the growing evidence from meta-analyses on vitamin D’s anti-obesity properties, their results are controversial. The current umbrella review was performed to assess the available evidence and provide a conclusive explanation in this regard. The international databases PubMed, Scopus, Embase, Web of Science and Google Scholar were systematically searched till March, 2022. A random-effects model was used to run the meta-analysis. All meta-analyses that examined the effect of vitamin D supplementation on BW, BMI, WC, and fat mass were included. Findings of 14 meta-analyses revealed that vitamin D supplementation reduced body mass index (BMI) (ES: −0.11 kg/m²; 95% CI: −0.18, −0.05, p?0.001; I² = 61.0%, p < 0.001), and waist circumference (WC) (ES = −0.79 cm; 95% CI: −1.20, −0.37; p < 0.001; I² = 46.5%, p = 0.096) in comparison to control group. However, the effects of vitamin D on body weight (ES = −0.16 kg, 95% CI: −0.36, 0.04; p = 0.125; I² = 57.0%, p = 0.017), and fat mass (ES: 0.02, 95% CI: −0.20, 0.24, p = 0.868; I² = 0.0%, p = 0.531) were not considerable. Vitamin D supplementation significantly improved levels of obesity indices such as BMI, and WC.

Vanadium and biomarkers of inflammation and oxidative stress in diabetes: A systematic review of animal studies

Background: Oxidative stress has a significant role in the commencement and development of hyperglycemia. Vanadium, as a transitional metal with redox properties, enters the redox process, produces free radicals, and distracts the pro-antioxidant balance. The present animal systematic review aimed to assess the effect of vanadium supplementation on inflammation and oxidative stress biomarkers in diabetes-induced animals. Methods: A systematic search was conducted using the PubMed, Scopus, and web of science databases from 1990 to 2021, according to the inclusion and exclusion criteria. The search strategy was based on the guidelines for systematic review of animal experiments and Preferred Reporting Items for Systematic Reviews (PRISMA). Criteria for eligibility were animal-based studies, evaluating the therapeutic effects of vanadium on inflammatory and oxidative stress biomarkers in diabetes. The Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool was used for assessing the methodological quality of included studies. Results: In the present study, 341 articles were evaluated out of which 42 studies were eligible for inclusion. The majority of the studies confirmed the advantageous properties of vanadium on inflammatory and oxidative stress biomarkers. A minor risk of bias was reported, based on the SYRCLE's tool. Conclusion: According to the findings, well-designed clinical trials are warranted to assess the long-lasting effects of various vanadium compounds on inflammatory and oxidative stress biomarkers.

Vanadium and diabetic dyslipidemia: A systematic review of animal studies

BACKGROUND

Diabetic dyslipidemia is caused by hyperglycemia and excessive mobilization of storage lipids, leading to increasing concentrations of triglycerides and total cholesterol. Due to the insulin-mimetic or insulin-enhancer features of vanadium, it has been recognized as a regulator of cell metabolism with hypoglycemic and hypolipidemic properties. The purpose of the current animal systematic review was to evaluate the effect of vanadium administration on diabetic dyslipidemia in diabetic animals.

METHODS

This is, to our knowledge, the first systematic review with the aim of investigating the relationship between vanadium and diabetic dyslipidemia among diabetes induced animals. Searches were performed in PubMed, Scopus, and web of science databases for animal studies examining the effect of vanadium on diabetic dyslipidemia in diabetic animals.

RESULTS

Of 124 full-text articles assessed, 48 animal studies were included in the present study with minor risk of bias. The majority of the studies confirmed the beneficial effects of different vanadium compounds in at least one of the parameters of lipid profile, especially regarding triglyceride and total cholesterol.

CONCLUSION

Current findings lend support to assess the long-term effects of different forms and doses of vanadium on lipid profile through well-designed clinical trials.

Mandibular reconstruction system reliability analysis using probabilistic finite element method

The aim of this study was to design for mandibular reconstruction of large lateral defect with minimum target reliability with designated confidence interval under bite force range of 300 ± 102 N. The performance of the models has been evaluated by numerical analysis considering the uncertainty of input parameters. Computer-Aided design was used to develop the models of three designs according to the patient's anatomy and to achieve to near symmetry of the mandible. Stress-strength modeling was utilized for the probabilistic physics of failure analysis under assumption of a quasi-static load. Monte-Carlo simulation was also applied for probabilistic finite element analysis and reliability assessment. The sensitivity analysis of the models was developed to reflect the significance of the variables in the models. The deterministic stress analysis shows that the highest stress and the second maximum stress are 110 MPa and 85 MPa for cortical bone around the screws, respectively. Also, it is determined that the maximum plate stress of the titanium conventional plate model is 580 MPa. The reconstruction system success rate was improved in all models by observing the anatomy of the patient's mandible in the plate designs by computer-aided design and additive manufacturing techniques. Based on the results, the reliability of plate strength and pull-out screws strength are 99.99% and 96.71% for the fibula free flap model, respectively, and 99.99% and 94.17%, respectively, for the customized prosthesis model. Probability sensitivity factors showed that uncertainty in the elastic modulus of the cortical bone has the greatest effect on the probability of screws loosening.

Behavioural Patterns of Physical Activity and Nutritional Habits among Urban and Rural Students

Background:

Adolescence is considered as one of the most vulnerable periods. The deficiencies and poor nutritional habits and lack of physical activity will have irreparable consequences in adulthood. This study was aimed to determine the behavioural patterns of nutritional and physical activity among the urban and rural students in Urmia, Iran.

Methods:

The present study was designed and implemented using a sectional and descriptive-analytic approach. Using a stratified random sampling method, 194 males and 191 female high school students were chosen to participate. Health-Promoting Lifestyle Profile II (HPLPII) was used for data collection. The overall average score of physical activity in students was 55.57 ± 4.88, and in the aspect of nutritional behaviour it was equal to 64.04 ± 3.67.

Results:

No significant difference was observed between physical activity, nutritional behaviours and socio-demographic variables (gender, type of school, place of residence, parental education). Based on multivariate regression analysis, there was a significant relationship between physical activity and the field of education. Furthermore, a significant relationship was found between children’s nutritional behaviour and mothers’ education.

Conclusion:

Considering importance of mothers’ role in upbringing adolescents and forming their healthy behavioural patterns and the significant relationship of mothers’ education and healthy behaviours, training and increasing health literacy level of this class of population can be an imperative step in promoting the mental and physical health of adolescents.

The "Cooperative-Supportive" Intervention for Improving Mental Health Status among Pregnant Women

Introduction: Maternal mental health during pregnancy has a major impact on fetal growth and consequently, child health. The objective of this study was to assess the effect of "Cooperative-Supportive" Intervention Program on Pregnancy.

Methods: The present before and after interventional research was conducted on 114 pregnant women referring to Khoy health centers in 2014. Pregnant women were randomly divided into intervention (n=57) and control groups (n=57). The data collection tool in this research was the researcher-made questionnaire based on the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model which assessed the participants’ predisposing, enabling, and reinforcing factors. The educational interventions for enhancing pregnant women’s stress controlling skills were conducted and also practical pacifying lessons were held for the intervention group during five weeks with relaxation exercises. In order to assess health status among pregnant women, knowledge, attitude, depression, anxiety and self-efficacy were investigated by applying different scales and questioners. The questionnaires were completed before and after the interventional program. The data were analyzed, using suitable statistical tests.

Results: After the intervention, the mean score of PRECEDE major components significantly increased and the total anxiety and depression scores decreased in the intervention group in comparison to those of the control group.

Conclusion: The present study showed the positive impact of educational intervention programs based on PRECEED model and major components on reducing anxiety and depression, and finally mental health promotion in the studied population.

Assessing the Effect of High Performance Inulin Supplementation via KLF5 mRNA Expression in Adults with Type 2 Diabetes: A Randomized Placebo Controlled Clinical Trail

Purpose: The worldwide prevalence of metabolic disorders such as diabetes is increasing rapidly. Currently, the complications of diabetes are the major health concern. The aim of this study was to investigate the effect of high performance (HP) inulin supplementation on glucose homeostasis via KLF5 mRNA expression in adults with type 2 diabetes.

Methods: In the present clinical trial conducted for a duration of 6 weeks, 46 volunteers diabetic patients referring to diabetes clinic in Tabriz, Iran, were randomly assigned into intervention (n= 23, consuming 10 gr/d HP inulin) and control groups (n= 23, consuming 10 gr/ d starch). We assessed glycemic and anthropometric indices, blood lipids and plasmatic level of miR-375 as well as KLF5 mRNA expression before and after the intervention.

Results: Findings indicated that inulin supplementation significantly decreased fasting plasma glucose (FPG) in comparison to the placebo group (P<0.001). Also Intra-group and between group results showed that inulin supplementation resulted in significant decrease in KLF5 mRNA expression in peripheral blood mononuclear cells (PBMCs) (Fold change: 0.61± 0.11; P-value= 0.001) and significant increase in plasmatic level of miR-375 (Fold change: 3.75± 0.70; P-value=0.004).

Conclusion: Considering the improvements of FPG level in diabetic patients, it seems that HP inulin supplementation may be beneficial in controlling diabetes via the expression of some genes. However, further studies are needed to achieve concise conclusions.

Image based modeling of tumor growth

Tumors are a main cause of morbidity and mortality worldwide. Despite the efforts of the clinical and research communities, little has been achieved in the past decades in terms of improving the treatment of aggressive tumors. Understanding the underlying mechanism of tumor growth and evaluating the effects of different therapies are valuable steps in predicting the survival time and improving the patients' quality of life. Several studies have been devoted to tumor growth modeling at different levels to improve the clinical outcome by predicting the results of specific treatments. Recent studies have proposed patient-specific models using clinical data usually obtained from clinical images and evaluating the effects of various therapies. The aim of this review is to highlight the imaging role in tumor growth modeling and provide a worthwhile reference for biomedical and mathematical researchers with respect to tumor modeling using the clinical data to develop personalized models of tumor growth and evaluating the effect of different therapies.

Theoretical prediction of the hemodynamic performance of slow resorbing polyester protein impregnated arterial prostheses after implantation: a plea for fast resorption of the coating

The clinical literature cites cases where slow, incomplete, or nonuniform protein resorption from protein impregnated arterial prostheses produces undesirable localized internal capsule proliferation leading to a significant reduction of the internal diameter of the prosthesis. In an attempt to describe the hemodynamic response to this phenomenon, the blood flow in such stenotic regions was simulated and characterized numerically using FIDAP computational fluid dynamics software to determine the Navier-Stokes and continuity equations for simple channel flow. To simulate various stages of internal capsule development, numeric computations were made in an idealized tubular expansion at stenosis ratios ranging from 0.9 to 0.5 and stenosis length ratios from 10 to 40. The results indicated that a triangular annular ring vortex was formed immediately distal to the stenosis at all Reynolds numbers (Re) studied. The size of the vortex increased almost linearly with the Reynolds number. The pressure drop through the stenosis was affected by blood flow rate, severity, and stenosis length. When the stenosis ratio was low, the pressure drop through the stenosis increased gradually and almost linearly with blood flow rate. In a severe stenosis, the pressure drop was no longer a linear function of flow rate, but increased significantly with increasing flow rate. In conclusion, satisfactory healing of the internal capsule requires fast resorption of any impregnated protein. If the resorption is slow, incomplete, or nonuniform, there is a tendency for the lumen to narrow, causing stenosis, an increased pressure drop through the narrowed graft and disturbed flow distal to the stenosis. This phenomenon therefore constitutes a major limitation for using this type of graft in small diameter arterial reconstruction.

Low Reynolds number turbulence modeling of blood flow in arterial stenoses

Moderate and severe arterial stenoses can produce highly disturbed flow regions with transitional and or turbulent flow characteristics. Neither laminar flow modeling nor standard two-equation models such as the kappa-epsilon turbulence ones are suitable for this kind of blood flow. In order to analyze the transitional or turbulent flow distal to an arterial stenosis, authors of this study have used the Wilcox low-Re turbulence model. Flow simulations were carried out on stenoses with 50, 75 and 86% reductions in cross-sectional area over a range of physiologically relevant Reynolds numbers. The results obtained with this low-Re turbulence model were compared with experimental measurements and with the results obtained by the standard kappa-epsilon model in terms of velocity profile, vortex length, wall shear stress, wall static pressure, and turbulence intensity. The comparisons show that results predicted by the low-Re model are in good agreement with the experimental measurements. This model accurately predicts the critical Reynolds number at which blood flow becomes transitional or turbulent distal an arterial stenosis. Most interestingly, over the Re range of laminar flow, the vortex length calculated with the low-Re model also closely matches the vortex length predicted by laminar flow modeling. In conclusion, the study strongly suggests that the proposed model is suitable for blood flow studies in certain areas of the arterial tree where both laminar and transitional/turbulent flows coexist.