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OBJECTIVEGlycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA 1c variability and micro-and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODSMedline and Embase were searched (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) for studies describing associations between HbA 1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA 1c variability, method of analysis, and diabetes type. RESULTS

Despite the substantial statistical and clinical heterogeneity, our findings indicate a probable association between PPI use and incident and recurrent CDI. This risk is further increased by concomitant use of antibiotics and PPI, whereas H2RAs may be less harmful.

P reeclampsia is a major cause of maternal mortality worldwide 1 and affects 2% to 8% of all pregnancies. 2,3 It is confined to pregnancy and defined as onset of hypertension after 20-week gestation with proteinuria, organ dysfunction, or uteroplacental dysfunction. 4 The pathogenesis of preeclampsia remains poorly understood and is thought to be because of the failure of spiral artery remodeling in the placenta causing placental hypoperfusion and hypoxia. The resultant oxidative stress triggers an excessive systemic inflammatory response, which causes endothelial dysfunction and vasoconstriction leading to systemic hypertension and end-organ hypoperfusion. 2,5 There is growing evidence that these effects on end organs persist after pregnancy.Cardiovascular disease is a leading cause of mortality globally and also of maternal death in the United Kingdom and United States. 6,7 Several studies have examined the relationship between preeclampsia and future incident cardiovascular disease, although the literature has been inconsistent. Some studies reported significantly higher risks of composite cardiovascular events or heart failure, 8,9 whereas others have not demonstrated such relationships. 10,11 It is unclear whether preeclampsia is an independent risk factor for future cardiovascular disease or an early marker of women with high-risk profiles for future cardiovascular disease. Factors that predispose women to preeclampsia are also found in the risk profile for cardiovascular diseases. These include obesity, 12 metabolic abnormalities, dyslipidemia, insulin resistance, 13 heightened inflammatory responses, hypercoagulable states, and endothelial dysfunction.14 Alternatively, the body may not fully recover from the damage to the Background-Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases. Methods and Results-We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure (risk ratio ). Conclusions-Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk f...

BackgroundRadial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature.Methods and ResultsWe searched MEDLINE and EMBASE for studies of RAO in transradial access. Relevant studies were identified and data were extracted. Data were synthesized by meta‐analysis, quantitative pooling, graphical representation, or by narrative synthesis. A total of 66 studies with 31 345 participants were included in the analysis. Incident RAO ranged between <1% and 33% and varied with timing of assessment of radial artery patency (incidence of RAO within 24 hours was 7.7%, which decreased to 5.5% at >1 week follow‐up). The most efficacious measure in reducing RAO was higher dose of heparin, because lower doses of heparin were associated with increased RAO (risk ratio 0.36, 95% CI 0.17–0.76), whereas shorter compression times also reduced RAO (risk ratio 0.28, 95% CI 0.05–1.50). Several factors were found to be associated with RAO including age, sex, sheath size, and diameter of radial artery, but these factors were not consistent across all studies.Conclusions RAO is a common complication of transradial access. Maintenance of radial patency should be an integral part of all procedures undertaken through the radial approach. High‐dose heparin along with shorter compression times and patent hemostasis is recommended in reducing RAO.

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function, but limited evidence exists for delirium or mortality outcomes.

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