Publications by authors named "Patompong Ungprasert"

308 Publications

Risk of Sudden Death in a General Unbiased Epidemiological Cohort of Sarcoidosis.

J Am Heart Assoc 2022 Aug 5:e025479. Epub 2022 Aug 5.

Division of Rheumatology, Department of Internal Medicine Mayo Clinic College of Medicine and Science Rochester MN.

Background Sarcoidosis is an inflammatory, noncaseating, granulomatous disorder of unknown cause that can affect any body system and is associated with cardiovascular disease including sudden cardiac death (SCD). Cardiac involvement in sarcoidosis is associated with higher risk of SCD, but the SCD risk in the general sarcoidosis population is unknown. We aimed to determine the risk of SCD in people with sarcoidosis versus the matched general population. Methods and Results A population-based cohort of sarcoidosis and age- and sex-matched comparators from January 1, 1976 to December 31, 2013 was used; presence of other comorbidities in the comparator group was not an exclusion criterion. Mortality, including time, place, and cause of death were measured and manually adjudicated for SCD events. Incidence rates are reported per 100 000 person-years, and Cox models were used for group comparisons. Of the 345 incident cases of sarcoidosis (171 men; 50%) there were 58 reported deaths; 10 were definite/probable SCD versus 57 all-cause and 9 SCDs in comparators. Median follow-up was 12.9 years (interquartile range, 6.0-23.4 years) . Incidence rate of SCD in sarcoidosis was 192 (95% CI, 92-352) versus 155 (95% CI, 71-294) in comparators (hazard ratio [HR], 1.28 (95% CI, 0.52-3.17). Nocturnal deaths were more frequent in sarcoidosis 57 (95% CI, 12-168) versus 17 (95% CI, 0.4-95) (HR, 3.76 [95% CI, 0.39-36.47]). No significant differences were detected between the groups by sex, age, calendar year of diagnosis, or disease duration. Conclusions In a population-based cohort of patients with sarcoidosis, the risk for SCD compared with matched comparators was not increased. There were more nocturnal deaths among patients with sarcoidosis, yet this was statistically insignificant.
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http://dx.doi.org/10.1161/JAHA.122.025479DOI Listing
August 2022

Neurosarcoidosis: an update on diagnosis and therapy.

Expert Rev Neurother 2022 Aug 9:1-11. Epub 2022 Aug 9.

Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Clinically overt granulomatous involvement of the nervous system (i.e. neurosarcoidosis) can be seen in up to 10% of patients with sarcoidosis. Establishing a diagnosis of neurosarcoidosis is often challenging due to the heterogeneity of clinical presentations that are sometimes nonspecific, and inaccessibility of tissue confirmation. Recommended treatments are based on expert opinions that are derived from clinical experience and limited data from retrospective studies, as data from randomized controlled studies are limited.

Area Covered: In this article, we comprehensively review all available literature on epidemiology, clinical presentations, diagnosis, treatment, and outcomes of neurosarcoidosis. We also offer our opinions on diagnostic approach and treatment strategy.

Expert Opinion: Given the invasive nature and the limited sensitivity of biopsy of the nervous system, diagnosis of neurosarcoidosis is usually made when ancillary tests (such as magnetic resonance imaging and cerebrospinal fluid analysis) are compatible, and alternative diagnoses are reasonably excluded in patients with established extraneural sarcoidosis. Several factors must be taken into consideration to formulate the initial treatment strategy, including the extent of the disease, severity, functional impairment, comorbidities, and patient's preference. In addition, treatment regimen of neurosarcoidosis should be formulated with an emphasis on long-term strategy.
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http://dx.doi.org/10.1080/14737175.2022.2108705DOI Listing
August 2022

Food-Dependent Exercise-Induced Wheals, Angioedema, and Anaphylaxis: A Systematic Review.

J Allergy Clin Immunol Pract 2022 Jun 22. Epub 2022 Jun 22.

Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany. Electronic address:

Background: Food-dependent exercise-induced wheals, angioedema, and anaphylaxis remain insufficiently characterized.

Objective: We systematically reviewed the literature on clinical manifestations, laboratory investigations, culprit foods, triggering exercise, comorbidities, and treatment outcomes.

Methods: Using predefined search terms and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) recommendations, we searched 3 electronic databases to identify relevant literature published before July 2021.

Results: Of 722 patients (median age 25 years; 55.4% male) from 231 studies (43 cohort studies, 15 cases series, and 173 case reports), 79.6% and 3.7% had anaphylaxis with and without wheals and/or angioedema, respectively. The remaining 16.6% had wheals and/or angioedema without anaphylaxis. The duration from eating to exercising and from exercising to symptom onset ranged from 5 minutes to 6 hours (median 1 hour) and from 5 minutes to 5 hours (median 30 minutes), respectively, and virtually all patients exercised within 4 hours after eating and developed symptoms within 1 hour after exercising. Wheat was the most common culprit food. Running was the most common trigger exercise. Most patients were atopic, and 1 in 3 had a history of urticaria. Aspirin and wheat-based products were the most frequent augmenting factors. On-demand antihistamines, corticosteroids, and epinephrine were commonly used and reported to be effective. Patients who stopped eating culprit foods before exercise no longer developed food-dependent exercise-induced allergic reactions.

Conclusions: Food-dependent exercise-induced allergic reactions are heterogeneous in their clinical manifestations, triggers, and response to treatment. Patients benefit from avoidance of culprit foods before exercise, which highlights the need for allergological diagnostic workup and guidance.
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http://dx.doi.org/10.1016/j.jaip.2022.06.008DOI Listing
June 2022

Smoking & risk of advanced liver fibrosis among patients with primary biliary cholangitis: A systematic review & meta-analysis.

Indian J Med Res 2021 06;154(6):806-812

Department of Research & Development, Clinical Epidemiology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background & Objectives: Studies have suggested that smoking may accelerate the progression of fibrosis among patients with primary biliary cholangitis (PBC), although the data are limited. The current review was undertaken with the aim to comprehensively analyze this possible association by identifying all relevant studies and summarizing their results.

Methods: A comprehensive literature review on MEDLINE and EMBASE databases was performed from inception through February 2019 to identify all relevant studies. Eligible studies included cross-sectional studies that recruited patients with PBC and collected data on the smoking status and presence or absence of advanced liver fibrosis for each participant. Odds ratios (OR) with 95 per cent confidence intervals (CI) was desirable for inclusion or sufficient raw data to calculate the same for this association. Adjusted point estimates from each study were extracted and combined together using the generic inverse variance method of DerSimonian and Laird. I statistic, which quantifies the proportion of total variation across studies was used to determine the between-study heterogeneity.

Results: Three cross-sectional studies with 544 participants were included. The pooled analysis found a significantly increased risk of advanced liver fibrosis among patients with PBC who were ever-smokers compared to those who were nonsmokers with the pooled OR of 3.00 (95% CI, 1.18-7.65). Statistical heterogeneity was high with I of 89 per cent.

Interpretation & Conclusions: This meta-analysis found that smoking is associated with a significantly higher risk of advanced liver fibrosis among patients with PBC. Further prospective studies are still required to determine whether this association is causal.
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http://dx.doi.org/10.4103/ijmr.IJMR_639_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9347256PMC
June 2021

Acute kidney injury associated with non-steroidal anti-inflammatory drugs.

Eur J Intern Med 2022 Jul 6;101:21-28. Epub 2022 May 6.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.

Non-steroidal anti-inflammatory drugs (NSAIDs) are ones of the commonly prescribed drugs worldwide. They primarily inhibit cyclooxygenase (COX) enzyme which is responsible for conversion of phospholipids to various prostaglandins (PGs). Disruption in PGs production affects the kidneys in several ways, including vasoconstriction that may result in ischemic acute kidney injury (AKI) in at-risk patients. They also impair salt and water excretion, leading to edema and hypertension. Other complications include hyperkalemia, hyponatremia, nephrotic syndrome, acute interstitial nephritis and chronic kidney disease progression. AKI from NSAIDs is usually reversible with favorable prognosis after discontinuation of NSAIDs. Avoidance of NSAIDs exposure is extremely important, especially among high-risk patients.
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http://dx.doi.org/10.1016/j.ejim.2022.05.003DOI Listing
July 2022

Body mass index and risk of clostridioides difficile infection: a systematic review and meta-analysis.

Infection 2022 Jun 5;50(3):725-737. Epub 2022 Jan 5.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.

Objective: To comprehensively investigate the association between obesity/high body mass index (BMI) and risk of Clostridioides difficile infection (CDI) using systematic review and meta-analysis.

Methods: Potentially eligible studies were identified from Medline and EMBASE databases from inception to February 2021 using search strategy consisting of terms for "Body Mass Index" and "Clostridioides Difficile". We only included studies that consist of a group of individuals with CDI and another group without CDI. Then, the studies must report their BMI or history of obesity. Odds ratio (OR) and 95% CIs of the association between BMI status and CDI were retrieved from each study and combined using the generic inverse variance method. Funnel plot was used to assess publication bias.

Results: A total of 4609 articles were identified. After two rounds of systematic review, 17 studies met the eligibility criteria and were included into the meta-analysis. Pooled analysis showed that individuals with high BMI had a significantly decreased odds of CDI with the pooled OR of 0.88 (95% CI 0.80-0.97). This meta-analysis had high statistical heterogeneity with I of 74%. Funnel plot was symmetric, which was not suggestive of presence of publication bias.

Conclusion: This meta-analysis revealed a significant negative association between BMI and CDI.
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http://dx.doi.org/10.1007/s15010-021-01749-9DOI Listing
June 2022

Clinical characteristics and resource utilization of 19,130 hospitalizations of patients with ankylosing spondylitis in United States: National Inpatient Sample 2018.

Joint Bone Spine 2022 05 30;89(3):105313. Epub 2021 Nov 30.

Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.

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http://dx.doi.org/10.1016/j.jbspin.2021.105313DOI Listing
May 2022

Statins and the risk of polyneuropathy: A systematic review and two meta-analyses.

Muscle Nerve 2022 01 3;65(1):120-125. Epub 2021 Nov 3.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Introduction/aims: Previous studies have shown inconsistent data on the relationship between statin use and polyneuropathy (PN). The current systematic review and meta-analyses were conducted to comprehensively investigate the risk of incident PN among statin-users compared with non-users by identifying all available studies and summarizing their results.

Methods: A systematic review was conducted from MEDLINE and EMBASE databases from inception to October 31, 2020. We included cohort and case-control studies that compared the risk of incident PN between statin-users and non-users. Point estimates and standard errors from eligible studies were pooled together using the generic inverse variance method.

Results: Of 4968 retrieved articles, 6 studies in non-diabetic populations and 2 studies in diabetic populations fulfilled the inclusion criteria. Two meta-analyses were performed. The pooled analyses did not find a statistically significant association between the use of statins and risk of incident PN with the pooled odds ratio of 1.24 (95% confidence interval [CI], 0.88-1.76; I 74%) and 0.82 (95% CI, 0.56-1.21; I 80%) in non-diabetic and diabetic groups respectively.

Discussion: No significant association between the use of statins and the risk of PN was observed in this systematic review and these two meta-analyses. However, there was a high degree of heterogeneity of the meta-analyses.
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http://dx.doi.org/10.1002/mus.27447DOI Listing
January 2022

The association between irritable bowel syndrome and ischemic colitis: a systematic review and meta-analysis.

Minerva Gastroenterol (Torino) 2021 Sep 22. Epub 2021 Sep 22.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Studies have suggested an association between ischemic colitis and irritable bowel syndrome (IBS) although the results were inconsistent. This systematic review and meta-analysis were performed to comprehensively examine the association between IBS and ischemic colitis by identifying all available cohort and case-control studies and combining their effect estimates together.

Evidence Acquisition: EMBASE, MEDLINE and Google Scholar databases were systematically reviewed up to June 2020. Eligible study had to be either cohort or case-control studies that evaluated whether patients with IBS have a higher risk of ischemic colitis than individuals without IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird.

Evidence Synthesis: The systematic review identified three cohort and eight case-control studies. The pooled analysis found a significantly higher risk of ischemic colitis among patient with IBS with the pooled odds ratio of 2.50 (95% CI, 2.00 - 3.14; I2 57%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias.

Conclusions: A significantly increased risk of ischemic colitis among patients with IBS was observed in this systematic review and meta-analysis.
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http://dx.doi.org/10.23736/S2724-5985.21.02957-0DOI Listing
September 2021

Psoriatic Arthritis and Risk of Vertebral Fracture: A Systematic Review and Meta-Analysis.

Curr Rheumatol Rev 2022 ;18(1):64-71

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.

Objective: This study was conducted in order to determine the association between psoriatic arthritis and the risk of vertebral fracture by pooling the evidence from previous studies.

Methods: Potentially eligible studies were identified from MEDLINE and EMBASE databases from inception to March 2020 using a search strategy that comprised of terms "Psoriatic Arthritis" and "Vertebral Fracture". Studies were eligible for the meta-analysis if they were cohort studies that included psoriatic arthritis and individuals without psoriasis and followed them for incident vertebral fracture. Studies were also required to report standardized incidence ration, hazard risk ratio or relative risk with related 95% confidence intervals (CI) comparing the incidence of vertebral fracture between the two cohorts. The retrieved point estimates with standard errors from each study were pooled into the final result by the random-effect model and generic inverse variance method.

Results: A total of 26,090 articles were identified. After two rounds of independent review by three investigators, we included five cohort studies that met the eligibility criteria in the meta-analysis. PsA is significantly associated with VF with a pooled odds ratio of 2.09 (95% CI, 1.11 - 3.96; I2 70%). The funnel plot was fairly asymmetric, thus the publication bias in favor of studies may present.

Conclusion: This systematic review and meta-analysis indicates that psoriatic arthritis patients have a significantly elevated risk of developing a vertebral fracture.
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http://dx.doi.org/10.2174/1573397117666210908094349DOI Listing
April 2022

Higher zinc intake is associated with decreased risk of lung cancer.

J Evid Based Med 2021 Sep 31;14(3):185-187. Epub 2021 Aug 31.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1111/jebm.12448DOI Listing
September 2021

Atopic Dermatitis is a Risk Factor for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Dermatitis 2021 Oct;32(1S):S15-S23

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, OH.

Background: It is still unclear whether patients with atopic dermatitis (AD) have an increased risk of developing rheumatoid arthritis (RA).

Objective: We aimed to investigate the association between AD and risk of RA using systematic review and meta-analysis.

Methods: We searched Medline and EMBASE up to April 2021 using search strategy, including terms for "atopic dermatitis" and "rheumatoid arthritis." Eligible cohort study must compare the incidence of RA between patients with AD and comparators without AD. Eligible case-control study must recruit cases with RA and controls without RA. Then, the study must compare the prevalence of AD between the groups. Point estimates with standard errors from each study were combined using the generic inverse variance method.

Results: The meta-analysis found that AD patients had a significantly higher risk of incident RA than individuals without AD with a pooled odds ratio (OR) of 1.30 (95% confidence interval [CI], 1.17-1.44; I2, 48%). Subgroup analysis revealed a significantly higher risk of RA in cohort study subgroup (pooled OR, 1.37; 95% CI, 1.25-1.50; I2, 63%) but not case-control study subgroup (pooled OR, 0.99; 95% CI, 0.77-1.28; I2, 10%).

Conclusions: This study found a significantly higher risk of incident RA among AD patients.
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http://dx.doi.org/10.1097/DER.0000000000000781DOI Listing
October 2021

Modest alcohol consumption and risk of advanced liver fibrosis in nonalcoholic fatty liver disease: a systematic review and meta-analysis.

Ann Gastroenterol 2021 Jul-Aug;34(4):568-574. Epub 2021 Feb 26.

Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Patompong Ungprasert).

Background: Recent studies have suggested an association between modest alcohol consumption and a decreased risk of advanced liver fibrosis among patients with nonalcoholic fatty liver disease (NAFLD) although the results are inconsistent. The current systematic review and meta-analysis was conducted to comprehensively investigate this possible association by identifying all the relevant studies and combining their results.

Methods: A comprehensive literature review was conducted utilizing the MEDLINE and EMBASE databases through February 2019 to identify all cross-sectional studies that compared the prevalence of advanced liver fibrosis among NAFLD patients who were modest alcohol drinkers to NAFLD patients who were non-drinkers. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird.

Results: A total of 6 studies with 8,936 participants fulfilled the eligibility criteria and were included in the meta-analysis. The risk of advanced liver fibrosis among patients with NAFLD who were modest alcohol drinkers was significantly lower compared to patients with NAFLD who were non-drinkers with a pooled odds ratio of 0.51 (95% confidence interval [CI] 0.35-0.75; I 47%). The funnel plot was symmetric and was not suggestive of publication bias.

Conclusion: A significantly lower risk of advanced liver fibrosis was observed among NAFLD patients who were modest alcohol drinkers compared to non-drinkers in this meta-analysis.
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http://dx.doi.org/10.20524/aog.2021.0612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276361PMC
February 2021

Hepatitis B virus infection and risk of gastric cancer: a systematic review and meta-analysis.

Minerva Gastroenterol (Torino) 2021 Jul 9. Epub 2021 Jul 9.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA -

Introduction: Hepatitis B virus (HBV) infection is a well-established risk factor for hepatocellular carcinoma. Recent studies have also suggested a higher risk of several extrahepatic cancers in patients with chronic HBV infection, including gastric cancer, even though the results are somewhat inconsistent. The current study was conducted to comprehensively investigate whether patients with HBV infection are at a higher risk of incident gastric cancer compared with individuals without HBV infection using systematic review and meta-analysis technique.

Evidence Acquisition: Systemic literature review was conducted using EMBASE and MEDLINE database up to December 2019. Eligible studies had to be cohort studies that consisted of one group of patients with HBV infection and another group of individuals without HBV infection. Relative risk of incident gastric cancer between the groups must be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird.

Evidence Synthesis: A total of 36,812 articles were identified. After two rounds of review, five articles with six cohorts of 120,995 HBV infected patients were included into the meta-analysis. The pooled analysis found that patients with HBV infection had a significantly higher risk of incident gastric cancer than individuals without HBV infection with the pooled risk ratio of 1.49 (95% CI, 1.20 - 1.85; I2=38%).

Conclusions: A significantly increased risk of incident gastric cancer among patients with chronic HBV infection was observed in this systematic review and meta-analysis.
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http://dx.doi.org/10.23736/S2724-5985.21.02946-6DOI Listing
July 2021

Direct-acting antiviral agents decrease haemoglobin A1c level in patients with diabetes infected with hepatitis C virus: A systematic review & meta-analysis.

Indian J Med Res 2020 12;152(6):562-567

Department of Research & Development, Division of Clinical Epidemiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background & Objectives: Several epidemiologic studies have demonstrated that type 2 diabetes mellitus (T2DM) is more prevalent in patients infected with hepatitis C virus (HCV), and the eradication of HCV has been shown to decrease the risk of T2DM. This meta-analysis was undertaken to see if treatment with direct-acting antiviral (DAA) agents would improve glycaemic control among HCV-infected patients with T2DM.

Methods: A systematic review was conducted using MEDLINE and EMBASE databases since inception to February 2018. Eligible studies must be cohort studies that recruited HCV-infected patients with T2DM and received DAA therapy. The studies must report the change of haemoglobin A1c (HbA1c) level (before vs. after DAA therapy). Patients who achieved sustained virologic response (SVR) were included in the meta-analysis. The mean HbA1c level and standard deviation of participants were extracted from each study to calculate the mean difference (MD). Pooled MD was then calculated using the random effects model.

Results: Four cohort studies with 2648 patients were included. Among HCV-infected T2DM patients who achieved SVR with DAA agents, the mean HbA1c level after treatment was significantly lower than the mean HbA1c level before treatment, with the pooled MD of -0.50 per cent (95% confidence interval, -0.66 to -0.34, I = 77%). The main limitation of this study was the lack of comparison groups. Therefore, it could not be concluded that the observed decreased HbA1c level was a direct result of DAA therapy.

Interpretation & Conclusions: Treatment with DAA agents was found to be associated with a significant reduction of post-treatment HbA1c level compared with pre-treatment HbA1c level among T2DM patients who achieved SVR.
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http://dx.doi.org/10.4103/ijmr.IJMR_1088_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224154PMC
December 2020

Reply to "Proposal for a new classification of vibratory urticaria/angioedema".

J Allergy Clin Immunol Pract 2021 06;9(6):2543-2544

Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.jaip.2021.02.037DOI Listing
June 2021

The Association Between Asthma and Risk of Myasthenia Gravis: A Systematic Review and Meta-analysis.

Lung 2021 06 13;199(3):273-280. Epub 2021 May 13.

Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.

Purpose: This study aimed to investigate the association between asthma and risk of myasthenia gravis (MG) using the method of systematic review and meta-analysis.

Methods: Potentially eligible studies were identified from Medline and EMBASE databases from inception to July 2020 using search strategy that comprised terms for "Asthma" and "Myasthenia Gravis". Eligible cohort study must consist of one cohort of individuals with asthma and another cohort of individuals without asthma. Then, the study must report relative risk (RR) with 95% confidence intervals (95% CIs) of incident MG between the groups. Eligible case-control studies must include cases with MG and controls without MG. Then, the study must explore their history of asthma. Odds ratio (OR) with 95% CIs of the association between asthma status and MG must be reported. Point estimates with standard errors were retrieved from each study and were combined together using the generic inverse variance method.

Results: A total of 6,835 articles were identified. After two rounds of independent review by five investigators, two cohort studies and three case-control studies met the eligibility criteria and were included into the meta-analysis. Pooled analysis showed that asthma was significantly associated with risk of MG with the pooled risk ratio of 1.38 (95% CI 1.02-1.86). Funnel plot was symmetric, which was not suggestive of publication bias.

Conclusion: The current study found a significant association between asthma and increased risk of MG.
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http://dx.doi.org/10.1007/s00408-021-00444-8DOI Listing
June 2021

The correlation between heart failure and the risk of ischemic colitis: a systematic review and meta-analysis.

Ann Gastroenterol 2021 5;34(3):378-384. Epub 2021 Feb 5.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA (Patompong Ungprasert).

Background: Ischemic colitis is a relatively common gastrointestinal disease caused by hypoperfusion of the colon. Recently, studies have suggested an association between heart failure (HF) and ischemic colitis, even though the magnitude of the reported association varied considerably across the studies. This systematic review and meta-analysis were performed to comprehensively explore whether patients with HF are at a higher risk of ischemic colitis compared with individuals without HF by combining the results of all available observational studies.

Methods: Systematic literature review was performed using EMBASE, MEDLINE and Google Scholar database up to May 2020. Eligible studies could be any observational ones that evaluated whether patients with HF have a higher risk of ischemic colitis than individuals without HF. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird.

Results: The systematic review identified 7 case-control studies and 1 cross-sectional study. The pooled analysis found that patients with HF had a significantly higher risk of ischemic colitis with the pooled odds ratio of 3.42 (95% confidence interval 1.49-7.82; I 96%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias.

Conclusion: A significantly increased risk of ischemic colitis among patients with HF was demonstrated in this systematic review and meta-analysis.
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http://dx.doi.org/10.20524/aog.2021.0596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079878PMC
February 2021

Association Between Chronic Hepatitis C Virus Infection and Esophageal Cancer: A Systematic Review and Meta-analysis.

J Clin Gastroenterol 2022 01;56(1):55-63

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH.

Background: Chronic hepatitis C virus (HCV) infection is associated with increased risk of hepatobiliary tract cancer. However, whether chronic HCV infection is also associated with elevated risk of other types of cancer is still unknown. This systematic review and meta-analysis was conducted in order to investigate whether chronic HCV infection is positively associated with esophageal cancer.

Methods: A systematic review was conducted using Embase and MEDLINE databases from inception to November 2019, with a search strategy that comprised the terms for "hepatitis C virus" and "cancer." Eligible studies were cohort studies consisting of patients with chronic HCV infection and comparators without HCV infection, and followed them for incident esophageal cancer. Hazard risk ratio, incidence rate ratio, relative risk or standardized incidence ratio of this association were extracted from each eligible study along with their 95% confidence intervals and were combined to calculate the pooled effect estimate using the random effect, generic inverse variance method.

Results: A total of 20,459 articles were identified using this search strategy. After 2 rounds of independent review, 7 studies satisfied the inclusion criteria and were included in the meta-analysis. Chronic HCV infection was significantly associated with a higher incidence of esophageal cancer with the pooled relative risk of 1.61 (95% confidence interval: 1.19-2.17; I2=39%). The funnel plot was relatively symmetric which was not suggestive of publication bias.

Conclusion: This systematic review and meta-analysis demonstrated that there is a modest association between chronic HCV and incident esophageal cancer. However, more studies are needed to investigate the causality of this association.
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http://dx.doi.org/10.1097/MCG.0000000000001532DOI Listing
January 2022

Patients with psoriasis have a higher risk of dementia: A systematic review and meta-analysis.

Indian J Dermatol Venereol Leprol 2021 May-Jun;87(3):364-370

Department of Research and Development, Clinical Epidemiology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: Patients with psoriasis may have a higher risk of dementia because of the higher inflammatory burden, although results from previous epidemiological studies have been inconsistent.

Aims: To determine the association between psoriasis and risk of dementia by pooling the evidence from previous studies.

Methods: Potentially eligible studies were identified from Medline and EMBASE databases from inception to July 2019 using a search that comprised terms for "psoriasis" and "dementia." Studies were eligible for the meta-analysis if they were cohort studies that included psoriatic patients and individuals without psoriasis and followed them for incident dementia. Studies were also required to report standardized incidence ratio, hazard risk ratio or relative risk with related 95% confidence intervals (CI) comparing the incidence of dementia between the two cohorts. The retrieved point estimates with standard errors from each study were pooled into the final result by the random-effect model, generic inverse variance method.

Results: A total of 8,861 articles were identified. After two rounds of independent review by three investigators, we included six cohort studies that met the eligibility criteria in the meta-analysis. The risk of dementia was significantly higher among psoriatic patients than in those without psoriasis with a pooled risk ratio of 1.16 (95% CI, 1.04-1.30; I2 95%). A funnel plot was relatively symmetric and was not suggestive of the presence of publication bias.

Limitations: Limited accuracy of diagnosis of psoriasis and dementia as four included studies were coding-based studies, and high statistical heterogeneity among studies.

Conclusion: This systematic review and meta-analysis indicates that psoriatic patients have a significantly elevated risk of developing dementia.
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http://dx.doi.org/10.25259/IJDVL_732_19DOI Listing
November 2021

Clinical Characteristics of Sarcoidosis in Asian Population: A 14-year Single Center Retrospective Cohort Study from Thailand.

Sarcoidosis Vasc Diffuse Lung Dis 2020 16;37(4):e2020011. Epub 2020 Dec 16.

Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: Little is known about epidemiology and clinical characteristics of sarcoidosis in Asian population.

Objectives: This study aimed to examine the epidemiology and clinical characteristics of Thai patients with sarcoidosis, using databases of a tertiary care medical center.

Methods: Potential cases of sarcoidosis were identified from two sources, the medical record-linkage system and the pathology database of Siriraj Hospital, Mahidol University in Bangkok, Thailand. Patients with ICD-10-CM codes for sarcoidosis were identified and retrieved from the medical record-linkage system from 2005 to 2018. Patients with histopathology positive for non-caseating granuloma were identified and retrieved from the pathology database from the same time period. All potential cases underwent individual medical record review to confirm the diagnosis of sarcoidosis which required compatible clinical pictures supported by presence of non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis and exclusion of other granulomatous diseases.

Results: From 2005 to 2018, 89 confirmed cases of sarcoidosis were identified. 80.9% of them were female and mean age at diagnosis was 46.8 years (standard deviation (SD) 13.9 years). The majority of patients had intrathoracic disease (81 cases; 91.0%) but less than half had respiratory symptoms (34 cases; 41.9%). Extrathoracic disease was common in this cohort that pulmonary sarcoidosis was accompanied by extrathoracic involvement in 53 patients (65.4%). Sarcoid uveitis was the most common extrathoracic disease (35 cases; 39.3%), followed by cutaneous sarcoidosis (24 cases; 26.9%), extrathoracic lymphadenopathy (18 cases; 22.5%) and sarcoid arthropathy (4 cases; 4.5%).

Conclusion: The current study examined clinical characteristics of sarcoidosis in an Asian population and found high prevalence of uveitis and marked female predominance. .
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http://dx.doi.org/10.36141/svdld.v37i4.10136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883518PMC
June 2021

Increased prevalence of irritable bowel syndrome in migraine patients: a systematic review and meta-analysis.

Eur J Gastroenterol Hepatol 2022 01;34(1):56-63

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA.

Objective: Even though evidence showing increased prevalence of irritable bowel syndrome (IBS) among migraine patients exists, it has not been well-established and the magnitude of association varies substantially across the studies. This study aimed to comprehensively compare the prevalence of IBS among migraineurs versus nonmigraineurs using the systematic review and the meta-analysis technique.

Methods: Two authors independently conducted a literature search in MEDLINE, EMBASE and Google Scholar database up to April 2020. The eligible study must consist of two groups of participants, migraineurs and nonmigraineurs, and report the prevalence of IBS in both groups. Alternatively, an eligible study may report the odds ratio (OR) with a 95% confidence interval (CI) of the association between migraine and IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird.

Results: Of the 2531 articles identified from the three databases, 11 studies with a total of 28 336 migraineurs and 1 535 758 nonmigraineurs met the selection criteria and were included into the meta-analysis. The pooled analysis found that migraineurs had a significantly higher prevalence of IBS than nonmigraineurs with the pooled OR of 2.49 (95% CI, 2.22-2.78; I2, 42%). The funnel plot was asymmetric and suggested the presence of publication bias.

Conclusion: A significantly increased prevalence of IBS among patients with migraine was demonstrated in this study.
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http://dx.doi.org/10.1097/MEG.0000000000002065DOI Listing
January 2022

Use of dipeptidyl peptidase-4 inhibitors is associated with a lower risk of rheumatoid arthritis in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of cohort studies.

Diabetes Metab Syndr 2021 Jan-Feb;15(1):249-255. Epub 2021 Jan 8.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, United States.

Background And Aims: Case reports have described occurrence of rheumatoid arthritis (RA) after initiation of Dipeptidyl Peptidase-4 Inhibitors (DPP4i), suggesting a possible adverse effect of the medications. However, the findings from subsequent cohort studies suggest the opposite as they indicate that T2DM patients who used DPP4i tended to have a lower risk of RA. We aimed to investigate the association between use of DPP4i and incident RA in patients with type 2 diabetes mellitus (T2DM) using systematic review and meta-analysis.

Methods: Potentially eligible studies were identified from Medline and EMBASE databases from inception to May 2020 using search strategy that comprised of terms for "Dipeptidyl peptidase-4 inhibitor" and "Rheumatoid arthritis". Eligible study must be cohort study consisting of one cohort of patients with T2DM who were DPP4i users and another cohort of comparators with T2DM who did not receive DPP4i. Then, the study must report effect estimates with 95% confidence intervals (95% CIs) comparing incident RA between DPP4i users versus comparators. Point estimates with standard errors retrieved from each study were combined together using the generic inverse variance method.

Results: A total of 709 articles were identified. After systematic review, four retrospective cohort studies met the eligibility criteria and were included into the meta-analysis. DPP4i users had a significantly lower risk of incident RA compared with comparators with the pooled hazard ratio of 0.72 (95% CI, 0.54-0.96; I 75%).

Conclusion: This systematic review and meta-analysis found a significant association between DPP4i use and a lower risk of incident RA.
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http://dx.doi.org/10.1016/j.dsx.2020.12.042DOI Listing
November 2021

Statins and Risk of Cholangiocarcinoma: A Systematic Review and Meta-analysis.

J Gastrointestin Liver Dis 2020 Dec 13;29(4):629-635. Epub 2020 Dec 13.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, United States.

Background And Aims: The use of statins has been shown to be associated with a decreased risk of cholangiocarcinoma (CCA) in many studies although the results have been inconsistent. We conducted this systematic review and meta-analysis to further investigate this possible association by identifying all relevant studies and combining their results together.

Methods: A comprehensive literature review was conducted utilizing the MEDLINE and EMBASE databases through March 2020 to identify all studies that compared the risk of CCA among individuals who use statins with individuals who do not use statins. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird.

Results: A total of seven studies with 6,251,187 participants fulfilled the eligibility criteria and were included in this meta-analysis. The pooled analysis found a significantly decreased risk of CCA among individuals who use statins compared with individuals who do not use statins with the pooled odds ratio of 0.68 (95% CI: 0.52-0.89; I 2 96%).

Conclusions: The current systematic review and meta-analysis found a significant association between the use of statins and a decreased risk of CCA.
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http://dx.doi.org/10.15403/jgld-2990DOI Listing
December 2020

Association between cardiac conduction defect and nonalcoholic fatty liver disease: a systematic review and meta-analysis.

Ann Gastroenterol 2020 Nov-Dec;33(6):661-666. Epub 2020 Sep 16.

Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Patompong Ungprasert).

Background: Cardiovascular disease is a common comorbidity of patients with nonalcoholic fatty liver disease (NAFLD), particularly coronary artery disease and congestive heart failure. However, the relation between NAFLD and cardiac conduction defects has not been well studied. This systematic review and meta-analysis was conducted to identify all available studies on this association and summarize their results.

Methods: A comprehensive literature review was conducted using MEDLINE and EMBASE databases through June 2020 to identify studies that compared the risk of a cardiac conduction defect among patients with NAFLD versus those without. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird.

Results: Three cross-sectional studies with 3651 participants fulfilled the eligibility criteria and were included in this meta-analysis. The risk of a cardiac conduction defect was significantly higher among patients with NAFLD than in those without NAFLD, with a pooled odds ratio of 5.17 (95% confidence interval 1.34-20.01; 96%).

Conclusion: A significantly greater risk of cardiac conduction defects among patients with NAFLD was observed in this meta-analysis. How this risk should be managed in clinical practice requires further investigation.
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http://dx.doi.org/10.20524/aog.2020.0535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599342PMC
September 2020

Diabetes mellitus is associated with a lower risk of amyotrophic lateral sclerosis: A systematic review and meta-analysis.

Clin Neurol Neurosurg 2020 12 28;199:106248. Epub 2020 Sep 28.

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195 USA. Electronic address:

Background/aims: Previous studies have suggested that diabetes mellitus (DM) could be a protective factor against amyotrophic lateral sclerosis (ALS) although the results are inconsistent. This study aimed to comprehensively investigate this relationship by identifying all available studies and summarizing their results.

Methods: A systematic review was conducted in MEDLINE and EMBASE database from inception to January 1st, 2020 to identify cohort studies and case-control studies that investigated the risk of development of ALS among patients with DM versus individuals without DM. Point estimates and standard errors from eligible studies were pooled together using the generic inverse variance method, as described by DerSimonian and Laird. Visualization of the funnel plot was used to assess for the presence of publication bias.

Results: A total of 1683 articles were identified by the search strategy. After two rounds of review, three cohort studies and eight case-control studies fulfilled the inclusion criteria and were included in the meta-analysis. The risk of developing ALS was significantly lower among patients with DM than individuals without DM with the pooled relative risk of 0.68 (95 % CI, 0.55 - 0.84; I 81 %). The funnel plot was relatively symmetric and was not suggestive of the presence of publication bias.

Conclusion: A significantly decreased risk of ALS among patients with DM was observed in this meta-analysis.
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http://dx.doi.org/10.1016/j.clineuro.2020.106248DOI Listing
December 2020

Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis.

Sci Rep 2020 10 7;10(1):16727. Epub 2020 Oct 7.

Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.

Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients. We aim to assess the efficacy and safety of MMF in controlling relapse and disease severity. Eligible studies obtained from the EMBASE and Ovid MEDLINE databases were studies of NMOSD patients treated with MMF, which reported treatment outcomes as Annualized Relapse Rate (ARR) or Expanded Disability Status Scale (EDSS) before and after treatment. Fifteen studies included 1047 patients, of whom 915 (87.4%) were aquaporin-4 immunoglobulin seropositive. The total number of patients that received MMF was 799. A meta-analysis on ARR was conducted in 200 patients from 4 studies and on EDSS in 158 patients from 3 studies. The result showed a significant improvement with a mean reduction of 1.13 [95% confidence interval (CI) 0.60-1.65] in ARR, and a mean reduction of 0.85 (95% CI 0.36-1.34) in EDSS after MMF therapy. Adverse events occurred in 106 (17.8%) of 594 patients during MMF therapy. This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rates and improve disease severity with acceptable tolerability.
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http://dx.doi.org/10.1038/s41598-020-73882-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541495PMC
October 2020

Vibratory Angioedema Subgroups, Features, and Treatment: Results of a Systematic Review.

J Allergy Clin Immunol Pract 2021 02 19;9(2):971-984. Epub 2020 Sep 19.

Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address:

Background: Vibratory angioedema (VA) is a subtype of chronic inducible urticaria that manifests with erythematous wheals or angioedema after skin exposure to vibration. Because the condition is rare, the available information is limited.

Objective: To systematically review the clinical manifestations and treatment options of VA.

Methods: Relevant literature published until August 2020 was searched using the terms "vibratory urticaria," "vibratory angioedema," "vibratory-induced angioedema," and "vibratory-induced urticaria." Preferred Reporting Items for Systematic Reviews and Meta-analysis recommendations were applied to this systematic review.

Results: On the basis of review of 22 studies (16 case reports, 4 case series, and 2 cohort studies) that had a combined total of 83 patients, we propose that VA be classified as hereditary VA (33.7%) and acquired VA (66.3%). Vibration-induced itching was frequent in both subgroups. Patients with hereditary VA more commonly had wheals and systemic symptoms, whereas patients with acquired VA more frequently had angioedema, burning, pain, or tingling. Although many VA treatments are used, there is little information on their efficacy. Most patients do not achieve complete control.

Conclusions: The novel VA classification proposed could help clinicians with the diagnostic workup of patients with VA. Because of the paucity of reported cases, firm recommendations for the treatment of VA are currently not possible. For patients with acquired VA, we suggest second-generation H-antihistamines as the first-line treatment. Controlled therapeutic trials are needed and should be performed.
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http://dx.doi.org/10.1016/j.jaip.2020.09.009DOI Listing
February 2021

Effect of plasma exchange in neuromyelitis optica spectrum disorder: A systematic review and meta-analysis.

Ann Clin Transl Neurol 2020 11 21;7(11):2094-2102. Epub 2020 Sep 21.

Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To conduct systematic review and meta-analysis for the efficacy of therapeutic plasma exchange (TPE) for neuromyelitis optica spectrum disorder (NMOSD) with an acute attack.

Methods: Systematic review was performed using EMBASE and OVID/Medline database. The eligible studies must be the studies of NMOSD patients treated with TPE during the acute phase. They must report treatment outcomes using either Expanded Disability Status Scale (EDSS) or visual acuity (VA) before and after the therapy. Pooled mean difference (MD) was then calculated by combining MDs of each study using the random-effects model.

Results: Fifteen studies were identified; eleven with 241 NMOSD patients reported EDSS outcome and four studies with 103 NMOSD reported visual outcomes. The meta-analysis demonstrated a significantly decreased in EDSS after TPE treatment for NMOSD with an acute attack with the pooled MD of 0.83 (95% CI, 0.26-1.40; I 69%) comparing pretreatment to immediate posttreatment and 2.13 (95% CI, 1.55-2.70; I 31%) comparing pretreatment to posttreatment at 6 months to 1-year follow-up. Unfortunately, only one of the four studies evaluating visual outcomes reported standard deviation in association with mean LogMAR; therefore, the meta-analysis cannot be conducted. Nonetheless, all studies consistently demonstrated the benefit of TPE with improved VA and/or LogMAR after treatment.

Interpretation: This systematic review and meta-analysis showed the benefit of TPE during the NMOSD attack with a significantly improved disability status immediately after treatment and during follow-up.
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http://dx.doi.org/10.1002/acn3.51203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664276PMC
November 2020
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