Win Khaing

Background: Dengue is a dynamic illness with an initial febrile phase followed by critical and recovery phases. Predicting disease progression during the febrile phase is essential for management. We evaluated whether a dengue-adapted modified pan-immune-inflammation value (mPIV) improves risk stratification compared with prior PIV model and neutrophil-to-lymphocyte ratio (NLR).Methods: We conducted a retrospective analysis of adults with dengue using data from previously published ARDENT cohort (2005–2008), excluding patients with dengue hemorrhagic fever or shock (DHF/DSS) at enrolment. PIV, mPIV, and NLR were calculated from complete blood counts (CBCs) longitudinally up to illness day 10 before DHF/DSS onset. Predictive performance was evaluated using generalized estimating equations, mixed-effects logistic regression, and time-dependent Cox models, adjusted for illness day, age, gender, ethnicity, Charlson score, and day-specific AUC-ROC.Results: Overall, 1,621 (22%) patients progressed to DHF/DSS. PIV and mPIV showed opposing associations: higher PIV was associated with lower risk, whereas higher mPIV was associated with increased risk. In phase-specific analyses, PIV performed best during the early febrile phase, with peak performance on day 2 (AUC 0.819, 95%CI: 0.709–0.929), surpassing mPIV and NLR. mPIV showed better discrimination during later illness (day 5 AUC 0.684, 95%CI: 0.652–0.717), while NLR consistently underperformed.Conclusions: Utilizing routine daily CBCs, PIV serves as a valuable predictor during the early febrile phase. As illness progresses and platelet counts decline, mPIV offers a slight advantage for risk stratification. Although NLR performance is slightly lagging, these indices provide objective clinical monitoring and could optimize resource allocation in adult dengue management.

Introduction: Metabolic syndrome (MetS) may be associated with obesity‐related cancer (ORC) owing to shared risk factors like physical inactivity, insulin resistance, gut microbiome dysfunction, and inflammation. We conducted an umbrella review of systematic reviews with meta‐analysis to synthesize the evidence on the association between MetS and ORC risk and survival. Methods: Searches in five databases (Medline, Embase, CINAHL, Cochrane Library, and Scopus) retrieved 2524 systematic reviews with meta‐analyses (SRMAs), which underwent title and abstract screening (2524), full‐text review (41), and data extraction for included SRMAs (21). Summary effects and 95% confidence intervals were re‐estimated using random‐effects models. Methodological quality, certainty of evidence, and publication bias were assessed using the AMSTAR 2, modified Ioannidis criteria, and Egger's test, respectively. Results: A total of 25 associations between MetS and ORC risk and five between MetS and survival were evaluated. Overall, 10 associations evaluating MetS and ORC risk were highly suggestive (four) or suggestive (six), while the rest were classified as weak (seven) or nonsignificant (eight). One association was suggestive for MetS and ORC survival, while the rest were classified as weak (three) or nonsignificant (one). The Egger's and excess significance tests were significant for 8(32%) associations between MetS and ORC risk and 3(60%) associations between MetS and ORC survival. Conclusion: This umbrella review suggests metabolic syndrome increases the risk of several obesity‐related cancers and worsens colorectal cancer survival. Despite study variability, consistent associations across diverse populations highlight the urgency of prevention and management strategies targeting metabolic dysfunction to reduce cancer burden. Summary: In this umbrella review, highly suggestive and suggestive evidence supports associations between MetS and the risk and survival of several obesity‐related cancers. However, a better understanding of the relationship between metabolic syndrome and obesity‐related cancers is still needed to provide appropriate clinical care, design optimal interventions, and prevent subsequent increases in the risks of cancer, morbidity, and mortality.

Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings.

Previous studies have reported discrepancy effects of education and income on cardiovascular diseases. This systematic review and meta-analysis was therefore conducted which aimed to summarize effects of education and income on cardiovascular diseases. Studies were identified from Medline and Scopus until July 2016. Cohorts were eligible if they assessed associations between education/income and cardiovascular diseases, had at least one outcome including coronary artery diseases, cardiovascular events, strokes and cardiovascular deaths. A multivariate meta-analysis was applied to pool risk effects of these social determinants. Among 72 included cohorts, 39, 19, and 14 were studied in Europe, USA, and Asia. Pooled risk ratios of low and medium versus high education were 1.36 (95% confidence interval: 1.11–1.66) and 1.21 (1.06–1.40) for coronary artery diseases, 1.50 (1.17–1.92) and 1.27 (1.09–1.48) for cardiovascular events, 1.23 (1.06–1.43) and 1.17 (1.01–1.35) for strokes, and 1.39 (1.26–1.54) and 1.21 (1.12–1.30) for cardiovascular deaths. The effects of education on all cardiovascular diseases were still present in US and Europe settings, except in Asia this was present only for cardiovascular deaths. Effects of low and medium income versus high on these corresponding cardiovascular diseases were 1.49 (1.16–1.91) and 1.27 (1.10–1.47) for coronary artery diseases, 1.17 (0.96–1.44) and 1.05 (0.98–1.13) for cardiovascular events, 1.30 (0.99–1.72) and 1.24 (1.00–1.53) for strokes, and 1.76 (1.45–2.14) and 1.34 (1.17–1.54) for cardiovascular deaths. Social determinants are risk factors of cardiovascular diseases in developed countries, although high heterogeneity in pooling. Data in Asia countries are still needed to update pooling.

Objectives To explore the intake of fruits and vegetables in the Yangon region, Myanmar, and to describe associations between intake of fruits and vegetables (FV) and established risk factors for non-communicable diseases. Design 2 cross-sectional studies, using the STEPs methodology. Setting Urban and rural areas of the Yangon region of Myanmar. Participants 1486, men and women, 25–74 years, were recruited through a multistage cluster sampling method. Institutionalised people, military personnel, Buddhist monks and nuns were not invited. Physically and mentally ill people were excluded. Results Mean intake of fruit was 0.8 (SE 0.1) and 0.6 (0.0) servings/day and of vegetables 2.2 (0.1) and 1.2 (0.1) servings/day, in urban and rural areas, respectively. Adjusted for included confounders (age, sex, location, income, education, smoking and low physical activity), men and women eating ≥2 servings of fruits and vegetables/day had lower odds than others of hypertriglyceridaemia (OR 0.72 (95% CI 0.56 to 0.94)). On average, women eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.28 mmol/L lower than the levels of other women. When only adjusted for sex and age, men eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.27 mmol/L higher than other men. Conclusions A high intake of FV was associated with lower odds of hypertriglyceridaemia among men and women. It was also associated with cholesterol levels, negatively among women and positively among men.