Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations.

We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI).

Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045).

The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.

The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.Clinical practice guidelines (CPGs) are systematically developed statements backed by scientific evidence to assist practitioners in management in clinical practice. An international cross-sectional survey was conducted by the IPNA to examine the perceptions of pediatric nephrologists on guidelines and their usage and to identify important diseases for future clinical practice guidelines (CPGs). The survey found that the majority of pediatric nephrologists find CPGs useful in clinical practice and admitted to using them most of the time. Developing CPGs is challenging and there are standards available to develop trustworthy guidelines. While evidence-based global guidelines are ideal, pediatric nephrologists expressed the desire that they address regional differences. Most respondents (89.2%) to the survey agreed that adult guidelines did not cover the pediatric perspective adequately and 71.4% opined that consensus-based pediatric guidelines can be developed when evidence for the pediatric population is lacking. The development of high-quality practice guidelines requires substantial resources and may not be feasible in resource-poor countries. Adaptation of an existing guideline has been suggested as an alternative and the ADAPTE collaboration provides a systematic approach to adapting guidelines. Several diseases where pediatric guidelines are needed as a priority including IgA and C3 glomerulopathy were identified in the survey. Implementation of guideline-based care is challenging and the survey found that lack of availability of guidelines (43%) and resources (22.8%) are important reasons for poor implementation in lower-middle and low-income countries. Perceived complexity of guidelines, physician attitudes, and lack of training also contribute to non-adherence to guidelines.

Based on the available data, it can be assumed that microbiota is an integral part of the human body. The most heavily colonized area of the human body is the gut, with bacterial accumulation ranging from 10

-10

cells/g in the upper intestine to 10

-10

cells/g in the colon. However, colonization of the gut is not the same throughout, as it was shown that there are differences between the composition of the microbiota in the intestine lumen and in the proximity of the mucus layer.

Gut microbiota gradient can be differentially regulated by factors such as obesity and chronic stress. In particular, a high fat diet influences the gut microbial composition. It was also found that chronic stress may cause the development of obesity and thus change the organization of the intestinal barrier. Recent research has shown the significant effect of intestinal microflora on cardiovascular function. Enhanced absorption of bacterial fragments, such as lipopolysaccharide (LPS), promotes the onset of “metabolic endotas lipopolysaccharide (LPS), promotes the onset of “metabolic endotoxemia,” which could activate toll-like receptors, which mediates an inflammatory response and in severe cases could cause cardiovascular diseases. It is presumed that the intestinal microbiota, and especially its metabolites (LPS and trimethylamine N-oxide (TMAO)), may play an important role in the pathogenesis of arterial hypertension, atherosclerosis, and heart failure. WH-4-023 This review focuses on how gut microbiota can change the morphological and functional activity of the cardiovascular system in the course of obesity and in conditions of chronic stress.To explore the effect of olfactory dysfunction on treatment of motor manifestations in Parkinson’s disease (PD). The current longitudinal retrospective cohort study consecutively recruited 108 de novo PD patients. Of whom 29 were normosmia and 79 were hyposmia, respectively, which was determined by the Korean Version of Sniffin’ Sticks Test II at the time of diagnosis. All the participants underwent serial clinical examinations including Unified Parkinson’s Disease Rating Scale (UPDRS), Mini-Mental State Examination, and Montreal Cognitive Assessment. The normosmic group demonstrated a significantly greater reduction of the UPDRS III score (30.3 ± 5.9 to 21.9 ± 5.1) than that of the hyposmic group (34.5 ± 9.3 to 28.5 ± 8.1) from baseline to 1-year later (p, 0.003; Bonferroni correction for p  less then  0.0045). Of subdomains in UPDRS III, the axial domain revealed a remarkable decrease in the normosmic group. Further, the hyposmic group exhibited a higher development rate of freezing of gait (FOG) compared to the normosmic group (29/79 (36.