This meta-analysis examined the effect of probiotics on outcomes associated with cardiovascular disease risk factors (high blood pressure, overweight BMI, high cholesterol and triglycerides, elevated HbA1c and serum glucose). All randomised controlled trials publish on PubMed, Scopus, Embase, Grey Literature and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to 2020 were systematically searched. The PEDro scale was used to assess the quality of studies. A total of 34 studies with 2177 adults were selected for inclusion in the analysis. The mean difference and effect size with a 95% confidence interval (CI) were analysed for the pooled results. Statistically significant pooled effects of probiotics were found in the reduction of systolic and diastolic blood pressure, total cholesterol, LDL-C, serum glucose, HbA1C and BMI; and elevation of HDL-C. No significant changes were observed in the outcome of triglycerides. Subgroup analysis revealed statistically significant effects of probiotics on the treatment of risk factors, with results favouring longer duration of treatment (> 1.5 months), use of alternate formulations (kefir and powder), higher dosage of probiotics (> 1.0 × 10 9 CFU), lower rate of study attrition (< 15%), double blinding of the study, diabetic patients and female populations. In summary, our meta-analysis showed a highly significant reduction in SBP, DBP associated with type 2 diabetes and in patients with diabetes mellitus, milk intake and more than 1.5 months duration intake. The effect on the reduction of total cholesterol LDL-C was associated with diabetes, hypertension, hypercholesterolemia, yoghurt intake and less than 1.5 months probiotic intake. The effect on the reduction of glucose and HbA1c was associated with diabetes, small dosage of probiotics, milk type and less than 1.5 months duration intake. Additionally, probiotic supplement had a beneficial effect in reducing BMI associated with obesity, higher dosage intake of probiotics and more than 1.5 months duration of intake.

BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology. It is a convenient and cost-effective method of intervention, which has shown to be successful in improving glyceamic control for type 2 diabetes patients. The utility of a successful diabetes intervention is vital to reduce disease complications, hospital admissions and associated economic costs. AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), post-prandial glucose (PPG), fasting plasma glucose (FPG), weight, cholesterol, mental and physical quality of life (QoL) in patients with type 2 diabetes. The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention; telemedicine characteristics, patient characteristics and self-care outcomes. METHODS PubMed Central, Cochrane Library, Embase and Scopus databases were searched from inception until 18 th of June 2020. The quality of the 43 included studies were assessed using the PEDro scale, and the random effects model was used to estimate outcomes and I 2 for heterogeneity testing. The mean difference and standard deviation data were extracted for analysis. RESULTS We found a significant reduction in HbA1c [-0.486%; 95% confidence interval (CI) -0.561 to -0.410, P < 0.001], DBP (-0.875 mmHg; 95%CI -1.429 to -0.321, P < 0.01), PPG (-1.458 mmol/L; 95%CI -2.648 to -0.268, P < 0.01), FPG (-0.577 mmol/L; 95%CI -0.710 to -0.443, P < 0.001), weight (-0.243 kg; 95%CI -0.442 to -0.045, P < 0.05), BMI (-0.304; 95%CI -0.563 to -0.045, P < 0.05), mental QoL (2.210; 95%CI 0.053 to 4.367, P < 0.05) and physical QoL (-1.312; 95%CI 0.545 to 2.080, P < 0.001) for patients following telemedicine interventions in comparison to control groups. The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups. The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention, as well as those involving telemonitoring, and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction. In addition, interventions delivered at a less than weekly frequency, as well as those given for a duration of 6 mo, and those lead by allied health resulted in better HbA1c outcomes. Furthermore, interventions with a focus on biomedical parameters, as well as those with an engagement level > 70% and t...

Purpose The purpose of the study is to assess the global risk of extracolonic secondary primary cancers (SPCs) in patients with colorectal cancer (CRC). Methods Studies of SPC in patients with CRC were included if they reported the standardised incidence ratio (SIR) for extracolonic SPCs in patients with CRC compared with the general population. Pooled summary estimates were calculated using a random-effects model. Results A total of 7,716,750 patients with CRC from 13 retrospective cohort studies that reported extracolonic SPC incidence were included. The overall risk of several SPCs was significantly higher in patients with CRC compared with the general population, including cancers of the urinary bladder (pooled SIR 1.19, 95% confidence interval (CI) 1.06–1.33; p = 0.003), female genital tract (1.88, 1.07–3.31; p = 0.03), kidney (1.50, 1.19–1.89; p = 0.0007), thorax (lung, bronchus and mediastinum) (1.16, 1.01–1.32; p = 0.03), small intestine (4.26, 2.58–7.01; p < 0.0001), stomach (1.22, 1.07–1.39; p = 0.003), and thyroid (1.40, 1.28–1.53; p < 0.0001), as well as melanoma (1.28, 1.01–1.62; p = 0.04). There was also a decreased risk of developing cancer of the gall bladder (0.75, 0.60–0.94; p = 0.01). Conclusion Patients with CRC had a significantly increased risk of extracolonic SPCs compared with the general population. These findings highlight the need to develop research strategies for the management of second primary cancer in patients with CRC.

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