Publications by authors named "Javier Zamora"

Introduction: Global migration has increased in recent decades due to war, conflict, persecutions, and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs by reasons for migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances in TB care for migrants and new treatment strategies, decisions for the management of migrants at risk of TB often rely on expert opinions, rather than clinical evidence.

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Objective: To identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research.

Study Design: We used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers.

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Background: Fetal growth restriction is associated with perinatal morbidity and mortality. Early identification of women having at-risk fetuses can reduce perinatal adverse outcomes.

Objectives: To assess the predictive performance of existing models predicting fetal growth restriction and birthweight, and if needed, to develop and validate new multivariable models using individual participant data.

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Objective: To predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit.

Design: Individual participant data meta-analysis.

Data Sources: Individual participant data of four cohorts (237 228 pregnancies) from the International Prediction of Pregnancy Complications (IPPIC) network dataset.

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  • - The study explored how serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) levels could predict worsening disability in multiple sclerosis (MS), enrolling 725 patients across 13 European hospitals from 1994 to 2023.
  • - Higher levels of sNfL were significantly associated with increased risks of relapse-associated worsening (RAW), progression independent of relapse activity (PIRA), and reaching an Expanded Disability Status Scale (EDSS) score of 3, while elevated sGFAP levels were linked to a higher risk of reaching the EDSS score.
  • - Combining both sNfL and sGFAP levels indicated that low values represented low risk for worsening
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  • Intrauterine insemination (IUI) is a common fertility treatment, but the ways it's done can be very different at different clinics, and there are extra methods that might help it work better.
  • This study looked at many previous trials to see which add-on methods are actually helpful and safe for IUI treatments.
  • They found that using vaginal progesterone and endometrial scratch techniques might increase the chances of getting pregnant, but the proof isn't very strong for all methods.
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Objective: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes.

Design: Systematic review and meta-analysis.

Data Sources: Major databases between December 2019 and January 2023.

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Background & Aims: Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT).

Methods: This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020.

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  • The study investigates the risks of complications associated with twin pregnancies conceived through Assisted Reproductive Technology (ART) compared to those conceived naturally or through non-ART methods.
  • It systematically reviews maternal and perinatal outcomes using data from 111 studies, focusing solely on twin pregnancies to avoid discrepancies from including higher order multiples like triplets.
  • Findings show that ART-conceived twins are at a significantly higher risk for issues like preterm birth, hypertensive disorders, gestational diabetes, and requiring cesarean deliveries compared to non-ART twins, with notable statistical evidence supporting these risks.
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Background: Findings related to the association between persistent organic pollutants (POPs) and gestational diabetes mellitus (GDM) are inconclusive.

Objectives: To estimate the strength of the association between POP exposure and GDM in a systematic review with meta-analysis.

Search Strategy: MEDLINE, Scopus and Web of Science were searched until July 2023.

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  • Pregnant women infected with SARS-CoV-2 face increased risks, including preterm birth and higher rates of stillbirth or neonatal admissions, highlighting ongoing concerns even after the WHO declared an end to the COVID-19 pandemic in May 2023.
  • A systematic review was performed to analyze the prevalence of early pregnancy loss in women with SARS-CoV-2 and compare these results to those of non-infected pregnant women.
  • The review included various studies that reported pregnancy losses before 20 weeks, as well as data on ectopic pregnancies and pregnancy terminations, ensuring a comprehensive examination of the impact of SARS-CoV-2 on early pregnancy outcomes.
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Objective: To determine the feasibility of a definitive trial of metformin to prevent type 2 diabetes in the postnatal period in women with gestational diabetes.

Design: A multicentre, placebo-controlled, double-blind randomised feasibility trial with qualitative evaluation.

Setting: Three inner-city UK National Health Service hospitals in London.

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  • Delirium is a serious condition that can confuse patients in critical care, and it's often not diagnosed properly.
  • The CAM-ICU is a special tool that helps doctors figure out if ICU patients have delirium, even if they can't talk.
  • The goal of this study was to check how well the CAM-ICU works at diagnosing delirium in adult ICU patients.
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Context: There is limited knowledge about the disparities between the sexes in obesity prevalence and associated cardiovascular complications in low- and middle-income countries (LMICs).

Objective: We undertook a systematic review and meta-analysis to assess sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, the burden in women, and variations by region, country's income status, setting, and time.

Methods: We searched major databases from inception to March 2023.

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Background: Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body. There are different treatments including immunosuppressants, hair growth stimulants, and contact immunotherapy.

Objectives: To assess the benefits and harms of the treatments for alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in children and adults.

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  • - The study investigates the effectiveness of four biomarkers (procalcitonin, C-reactive protein, interleukin-6, and presepsin) in predicting mortality in critically ill adults with sepsis, addressing inconsistencies found in previous research.
  • - A systematic review and meta-analysis of 60 studies involving over 15,000 patients revealed a high risk of bias in more than 60% of assessments for these biomarkers as prognostic indicators.
  • - The findings indicate that baseline measurements of these biomarkers do not reliably predict mortality outcomes, suggesting that their role in sepsis prognosis may be limited.
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Evidence syntheses of randomized clinical trials (RCTs) offer the highest level of scientific evidence for informing clinical practice and policy. The value of evidence synthesis itself depends on the trustworthiness of the included RCTs. The rising number of retractions and expressions of concern about the authenticity of RCTs has raised awareness about the existence of problematic studies, sometimes called "zombie" trials.

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Background: Randomized clinical trials (RCTs) are experiencing a crisis of confidence in their trustworthiness. Although a comprehensive literature search yielded several reviews on RCT integrity, an overarching overview is lacking.

Objectives: The authors undertook a scoping umbrella review of the research integrity literature concerning RCTs.

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We assessed whether low CD4 count and high viral load (VL) affect the response to currently preferred ART. We performed a systematic review of randomized, controlled clinical trials that analyzed preferred first-line ART and a subgroup analysis by CD4 count (≤ or >200 CD4/μL) or VL (≤ or >100 000 copies/mL). We computed the odds ratio (OR) of treatment failure (TF) for each subgroup and individual treatment arm.

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  • Anticoagulation in patients with cirrhosis and portal vein thrombosis is shown to significantly reduce all-cause mortality and liver-related mortality, based on an individual patient data meta-analysis of 500 patients.
  • The study indicates that patients receiving anticoagulation had a higher rate of recanalization compared to those who did not.
  • However, there was an increased risk of non-portal-hypertension-related bleeding in the anticoagulation group, suggesting a trade-off between benefits and risks.
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Background: Systematic reviews of studies of clinical prediction models are becoming increasingly abundant in the literature. Data extraction and risk of bias assessment are critical steps in any systematic review. CHARMS and PROBAST are the standard tools used for these steps in these reviews of clinical prediction models.

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Background: Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention.

Methods: Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia.

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Background And Aims: In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options.

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