Low back pain-related meta-analysis:Caution is needed when interpreting published research results

The systematic reviews(SRs) including a meta-analysis are considered as the top level of evidence.Although the existence of more than a hundred of low back pain(LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic,adeep analysis indicates that several of these SRs included only very few studies.Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality,or some studies which differed significantly regarding the studied populations and/or the experimental procedure.The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles.To conclude,although meta-analysis is at the top of the evidence pyramid and have several strengths,the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses.This is true,whether it be for LBP-related SRs including a meta-analysis,or any other.Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice.Furthermore,clinical reasoning remains crucial,especially to consider the potential differences between one's patient and the patients included in the meta-analysis.

Red meat intake and the risk of endometrial cancer:Metaanalysis of observational studies

AIM:To evaluate whether red meat intake is related to the risk of endometrial cancer(EC) using meta-analysis.METHODS:We searched Pub Med,EMBASE,and the Cochrane Library up to June 2013,using common keywords related to red meat and EC.Case-control studies and cohort studies comparing the risk of endometrial cancer among categories by the amount of intake were included.Eleven case-control studies and five cohort studies met our criteria.We performed a conventional and a dose-response meta-analysis of case-control studies using the Der Simonian-Laird method for random-effects.For cohort studies we performed a conventional meta-analysis.Publication bias was evaluated using Egger's test.RESULTS:In the meta-analysis of 11 case-control studies including 5419 cases and 12654 controls,higher red meat consumption was associated with an increased risk of EC [summary relative risk(SRR) = 1.43,95%CI:1.15-1.79;I2 = 73.3% comparing extreme intake categories).In a dose-response analysis,for red meat intake of 100 g/d,SRR was 1.84(95%CI:1.64-2.05).In contrast,in the meta-analysis of five prospective studies including a total of 2549 cases among 247746 participants,no significant association between red meat intake and EC risk(SRR = 0.97,95%CI:0.85-1.11;I2 = 4.9% comparing extreme intake categories) was observed.CONCLUSION:Our meta-analysis found a significantlinear association between red meat intake and EC risk based on case-control studies but this was not confirmed in prospective studies.

Effect of auricular plaster for primary hypertension in older people:A meta-analysis

BACKGROUND Hypertension is a critical public health problem globally.Antihypertensive drugs can create an extra burden on hypertension patients'self-regulation leading to an imbalance of blood supply and demand.This study aimed to evaluate the effect of auricular plaster therapy combined with western medicine to treat primary hypertension in older people.AIM To carry out a systematic review and meta-analysis for the effect of auricular plaster in elderly hypertension patients.METHODS Multiple databases like PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature on Disc,China National Knowledge Infrastructure,Wan Fang and Chinese Science and Technology Periodical Database were used to search for the relevant studies and full-text articles involved in the evaluation of auricular plaster combined with western medicine and western medicine alone for primary hypertension in older people.All included articles were quality assessed and the data analysis was conducted with the Review Manager(5.4).Forest plots,sensitivity analysis and funnel plots were also performed on the included articles.RESULTS In this analysis,fourteen(14)relevant studies were included.The Meta-analysis showed a significant difference in the effective ratio(OR=3.62;95%CI,2.46 to 5.33;P<0.00001),diastolic blood pressure change(5.68 mmHg;95%CI,3.49 to 7.87;P<0.00001),systolic blood pressure change(MD=8.78 mmHg;95%CI,5.04 to 12.53;P<0.00001)and symptom score(MD=3.20;95%CI,1.23 to 5.18;P=0.001)between auricular plaster combined with western medicine group and western medicine alone group.One bias was detected as selection bias and another two in reporting bias.Sensitivity analysis fulfilled the stability of the results.CONCLUSION Our study suggested that auricular plaster combined with western medicine improved primary hypertension better than western medicine alone.Limited by the quality of included studies,further studies should be performed to confirm our findings.

Effect of dl-3-n-butylphthalide on infarction volume in animal models of ischemic stroke:A meta-analysis

BACKGROUND Ischemic stroke is a frequently-occurring disease in the elderly and characterized by high morbidity and mortality.Dl-3-n-butylphthalide(NBP),a synthetic compound based on natural celery seeds,has potential therapeutic effects on cerebral ischemia,brain trauma,memory impairment,and epilepsy.AIM To evaluated the effect of NBP on infarct volume in experimental ischemic stroke.METHODS Twenty one relevant literatures were included from the PubMed,EMBASE,Web of Science,Chinese National Knowledge Infrastructure,VIP information database,and Wanfang database,and data on the effect of dl-3-n-butylphthalide on infarction volume in the middle cerebral artery occlusion model were extracted.Statistical analysis was performed using standard mean difference with random effects model of Revman 5.3.RESULTS The data of meta-analysis of the 21 studies had suggested that NBP reduced the cerebral infarction volume of middle cerebral artery occlusion model animals compared to the control group significantly[SMD:-3.97,95%CI:-4.71 to-3.23,P<0.01;heterogeneity:χ2=59.09,df=20(P<0.01);I2=66%].CONCLUSION NBP was effective in experimental ischemic stroke.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUNDPeriod poverty is a global health and social issue that needs to be addressed.It has been reported that many females compromise their education,employment,and social commitments during their menstruation days due to a number of reasons,including lack of access to toilets or menstrual products.AIM To provide a comprehensive understanding on period poverty,including outcomes associated with menstruation.METHODS All observational and randomised clinical trials reporting menstruation challenges,menstrual poverty and menstrual products were included.Our search strategy included multiple electronic databases of PubMed,Web of Science,ScienceDirect,ProQuest and EMBASE.Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included.The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies.Pooled odds ratios(ORs)together with 95%confidence intervals(CIs)are reported overall and for sub-groups.RESULTS A total of 80 studies were systematically selected,where 38 were included in the meta-analysis.Of the 38 studies,28 focused on children and young girls(i.e.,10-24 years old)and 10 included participants with a wider age range of 15-49 years.The prevalence of using disposable sanitary pads was 45%(95%CI:0.35-0.58).The prevalence of menstrual education pre-menarche was 68%(95%CI:0.56-0.82).The prevalence of good menstrual hygiene management(MHM)was 39%(95%CI:0.25-0.61).Women in rural areas(OR=0.30,95%CI:0.13-0.69)were 0.70 times less likely to have good MHM practices than those living in urban areas.CONCLUSION There was a lack of evidence,especially from low-and middle-income countries.Further research to better understand the scope and prevalence of period poverty should be considered.This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Prevalence,awareness and control of hypertension in Malaysia from 1980-2018:A systematic review and meta-analysis

BACKGROUND Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases,contributing to high morbidity and mortality.However,there has been no systematic review and meta-analysis of a multiethnic population such as that of Malaysia.AIM To determine the trend in prevalence,awareness and control rate of hypertension in Malaysia.METHODS Systematic searches were conducted in six databases(PubMed,Scopus,Ovid,CINAHL,Malaysian Medical Repository and Malaysia Citation Index)for articles published between 1980 and 2018.Two authors reviewed the studies and performed quality assessment and data extraction independently.Pooled estimates of hypertension prevalence,awareness and control rate were calculated using the DerSimonian-Laird random-effects model.Subgroup and sensitivity analyses were performed.RESULTS We included 56 studies involving a total of 241796 participants.The overall pooled prevalence of hypertension aged≥18 years was 29.7%.The prevalence of hypertension was the lowest in the 1980s(16.2%,95%confidence interval(CI):13.4,19.0),increasing up to 36.8%(95%CI:6.1,67.5)in the 1990s,then decreasing to 28.7%(95%CI:21.7,35.8)in the 2000s and 26.8%(95%CI:21.3,32.3)in the 2010s.The prevalence of awareness was 51.4%(95%CI:46.6,56.3),while 33.3%(95%CI:28.4,38.2)of those on treatment had achieved control of their blood pressure.CONCLUSION In Malaysia,three in ten adults aged≥18 years have hypertension,while four in ten adults aged≥30 years have hypertension.Five out of ten people are aware of their hypertension status and only one-third of those under treatment achieved control of their hypertension.Concerted efforts by policymakers and healthcare professionals to improve awareness and control of hypertension should be of high priority.

Development of the first Arabic cognitive dental anxiety scale for children and young adults

AIM: To validate the Arabic version of abeer children dental anxiety scale.METHODS: Two ethical approvals for this study were obtained from United Arab Emirates, Ministry of Health and Dubai Health Authority; reference number: 2011/57. The Abeer children dental anxiety scale(ACDAS) was translated from English to Arabic by the native speaker chief investigator, and then back translated by another native speaker in Dubai(AS) to ensure comparability with the original one. Part C of ACDAS was excluded for the schoolchildren because those questions were only applicable for children at the dentist with their parents or legal guardian. A total of 355 children(6 years and over) were involved in this study; 184 in Dubai, 96 from the Religious International Institute for boys and 88 from Al Khansaa Middle School for girls. A sample of 171 children was assessed for external validity(generalizability) from two schools in different areas of London in the United Kingdom.RESULTS: Receiver operating characteristic curve showed that the cut-off ≥ 26 for ACDAS gave the optimal results for sensitivity = 90%(95%CI: 81.2%-95.6%), and specificity = 86.6%(95%CI: 78.2%-92.7%), with AUROC = 0.93(95%CI: 0.90-0.97). Cronbach's Alpha(α) was 0.90 which indicated good internal consistency. Results of the external validity assessing the agreement between ACDAS and dental subscale of the children's fear survey schedule was substantial for the East London school(κ = 0.68, 95%CI: 0.53-0.843); sensitivity = 92.9%(95%CI: 82.7%-98.0%); specificity = 73.5%(95%CI: 55.6%-87.1%) and almost perfect for the Central London school(κ = 0.79; 95%CI: 0.70-0.88); sensitivity = 96.4%(95%CI: 81.7%-99.9%); specificity = 65.9%,(95%CI: 57.4%-73.8%). CONCLUSION: The Arabic ACDAS is a valid cognitive scale to measure dental anxiety for children age 6 years or over.

Endoscopic vs radiologic gastrostomy for enteral feeding:A systematic review and meta-analysis

BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and percutaneous radiological gastrostomy(PRG)are minimally invasive techniques commonly used for prolonged enteral nutrition.Despite safe,both techniques may lead to complications,such as bleeding,infection,pain,peritonitis,and tube-related complications.The literature is unclear on which technique is the safest.AIM To establish which approach has the lowest complication rate.METHODS A database search was performed from inception through November 2022,and comparative studies of PEG and PRG were selected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.All included studies compared the two techniques directly and provided absolute values of the number of complications.Studies with pediatric populations were excluded.The primary outcome of this study was infection and bleeding.Pneumonia,peritonitis,pain,and mechanical complications were secondary outcomes.The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials(RoB2)and we used The Risk of Bias in Nonrandomized Studies(ROBINS-I)to analyze the retrospective studies.We also performed GRADE analysis to assess the quality of evidence.Data on risk differences and 95%confidence intervals were obtained using the Mantel-Haenszel test.RESULTS Seventeen studies were included,including two randomized controlled trials and fifteen retrospective cohort studies.The total population was 465218 individuals,with 273493 having undergone PEG and 191725 PRG.The only outcome that showed a significant difference was tube related complications in retrospective studies favoring PEG(95%CI:0.03 to 0.08;P<0.00001),although this outcome did not show significant difference in randomized studies(95%CI:-0.07 to 0.04;P=0.13).There was no difference in the analyses of the following outcomes:infection in retrospective(95%CI:-0.01 to 0.00;P<0.00001)or randomized(95%CI:-0.06 to 0.04;P=0.44)studies;bleeding in retrospective(95%CI:-0.00 to 0.00;P<0.00001)or randomized(95%CI:-0.06 to 0.02;P=0.43)studies;pneumonia in retrospective(95%CI:-0.04 to 0.00;P=0.28)or randomized(95%CI:-0.09 to 0.11;P=0.39)studies;pain in retrospective(95%CI:-0.05 to 0.02;P<0.00001)studies;peritonitis in retrospective(95%CI:-0.02 to 0.01;P<0.0001)studies.CONCLUSION PEG has lower levels of tube-related complications(such as dislocation,leak,obstruction,or breakdown)when compared to PRG.

Exclusive cigar smoking in the United States and smoking-related diseases: A systematic review

BACKGROUND Little information has been published on the risks of cigar smoking.Since 1990 cigar smoking has become more prevalent in the United States.AIM To summarise the evidence from the United States relating exclusive cigar smoking to risk of the major smoking-related diseases.METHODS Literature searches detected studies carried out in the United States which estimated the risk of lung cancer,chronic obstructive pulmonary disease(COPD),heart disease,stroke or overall circulatory disease in exclusive cigar smokers as compared to those who had never smoked any tobacco product.Papers were identified from reviews and detailed searches on MEDLINE.For each study,data were extracted onto a study database and a linked relative risk database.Relative risks and 95%CIs were extracted,or estimated,relating to current,former or ever exclusive cigar smokers,and meta-analysed using standard methods.Sensitivity analyses were conducted including or excluding results from studies that did not quite fit the full selection criteria(for example,a paper presenting combined results from five studies,where 86%of the population were in the United States).RESULTS The literature searches identified 17 relevant publications for lung cancer,four for COPD and 12 for heart disease,stroke and circulatory disease.These related to 11 studies for lung cancer,to four studies for COPD and to eight studies for heart disease,stroke or overall circulatory disease.As some studies provided results for more than one disease,the total number of studies considered was 13,with results from four of these used in sensitivity analyses.There was evidence of significant heterogeneity in some of the meta-analyses so the random-effects estimates are summarized below.As the results from the sensitivity analyses were generally very similar to those from the main analyses,and involved more data,only the sensitivity results are summarized below.For lung cancer,relative risks(95%CI)for current,former and ever smokers were respectively,2.98(2.08 to 4.26),1.61(1.23 to 2.09),and 2.22(1.79 to 2.74)based on 6,4 and 10 individual study estimates.For COPD,the corresponding estimates were 1.44(1.16 to 1.77),0.47(0.02 to 9.88),and 0.86(0.48 to 1.54)based on 4,2 and 2 estimates.For ischaemic heart disease(IHD)the estimates were 1.11(1.04 to 1.19),1.26(1.03 to 1.53)and 1.15(1.08 to 1.23)based on 6,3 and 4 estimates,while for stroke they were 1.02(0.92 to 1.13),1.08(0.85 to 1.38),and 1.11(0.95 to 1.31)based on 5,3 and 4 estimates.For overall circulatory disease they were 1.10(1.05 to 1.16),1.11(0.84 to 1.46),and 1.15(1.06 to 1.26)based on 3,3 and 4 estimates.CONCLUSION Exclusive cigar smoking is associated with an increased risk of lung cancer,and less so with COPD and IHD.The increases are lower than for cigarettes.

Statin use and risk of liver cancer: A meta-analysis of 7 studies involving more than 4.7 million patients

AIM： To pool data currently available to determine the association between statin use and the risk of liver cancer.METHODS： A computerized literature search was conducted to identify those relevant studies between Janu-ary 1966 and March 2013. Stata 11.0 （Stata Corp, College Station, Texas） was used for statistical analyses. Pooled relative risk （RR） estimates with 95%CI were calculated for overall analysis and subgroup analyses, using the random- and fxed-effects models. Heteroge-neities between studies were evaluated by Cochran’s Q test and I^2 statistic. The Begg’s funnel plot and Egger’s regression asymmetry test were used to detect the publication bias.RESULTS： Seven studies were included in our meta-analysis according to the selection criteria, including four cohort studies and three case-control studies. These studies involved 4725593 people and 9785 liver cancer cases. The overall analysis showed that statin use was statistically associated with a signifcantly reduced risk of liver cancer （random-effects model, RR=0.61, 95%CI： 0.49-0.76, P 〈 0.001; fxed-effects mod-el, RR=0.64, 95%CI： 0.57-0.71, P 〈 0.001）; however, significant heterogeneity was found between studies （Cochran’s Q statistic=19.13, P=0.004; I^2 = 68.6%）. All subgroup analyses provided supporting evidence for the results of overall analysis. Begg’s （Z=0.15, P=0.881） and Egger’s test （ t=-0.44, P=0.681） showed no signifcant risk of having a publication bias.CONCLUSION： Statin use was associated with the reduced risk of liver cancer. To clearly clarify this relationship, more high quality studies are required.

Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units:A systematic review and meta-analysis

BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.

Different methods of acupuncture for relief of pain due to liver cancer:A network meta-analysis

BACKGROUND Pain in the liver is a common symptom of liver cancer in late stages,and the pain incidence rate exceeds 50%[1].In serious cancer pain,morphine and other major analgesics have been commonly administrated for clinical treatments,and their effects are accurate,but with a high incidence of side effects,such as nausea,vomiting,constipation,and other conditions.Acupuncture is a traditional Chinese medicine therapy.There have been many randomized controlled trials addressing the safety and usefulness of different methods of acupuncture in alleviating liver cancer pain.However,which of these methods is the most effective method is still unclear.AIM To compare the effectiveness of different acupuncture methods for alleviating pain due to liver cancer.METHODS Eligible studies were retrieved from eight databases(the Cochrane Library,PubMed,EMBASE,Medline,CNKI,CBM,Chongqing VIP,and Wan Fang Database)up to March 31,2021 and screened based on the established inclusion and exclusion criteria.The quality of the include studies was evaluated.Stata software was applied for statistical analyses.Publication bias of the included studies was also determined.Finally,the network meta-analysis was carried out to evaluate the efficacy of acupuncture methods for relief of pain due to liver cancer.RESULTS A total of eight randomized controlled trials were included in the network metaanalysis.Eight trials(covering 5 treatments and 734 patients)provided data suitable for analysis.Most trials focused on short-term effects and many were classed as being of poor quality with a high risk of bias,commonly associated with lack of blinding(which was sometimes impossible to achieve).End of treatment results showed that four interventions,including wrist-ankle acupuncture,triple puncture and remaining needle acupuncture,Tian Yuan acupuncture,and block acupuncture,produced a statistically significant reduction in pain when compared with the three-step analgesic ladder therapy.The surface under the cumulative ranking sorting results showed that triple puncture and remaining needle acupuncture had a relatively high effective rate.CONCLUSION The network meta-analysis results indicate that the overall effectiveness of triple puncture and remaining needle acupuncture is better than the other therapies.

Endoscopic management of biliary strictures post-liver transplantation

Biliary complications play a significant role in morbidity of liver transplant recipients. Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased donors. Strictures can be classified as either anastomotic or non-anastomotic and may be related to ischemic events. Endoscopic management of biliary strictures in the posttransplant setting has become the preferred initial approach due to adequate rates of resolution of anastomotic and non-anastomotic strictures(NAS).However, several factors may increase complexity of the endoscopic approach including surgical anatomy, location, number, and severity of bile duct strictures.Many endoscopic tools are available, however, the approach to management of anastomotic and NAS has not been standardized. Multi-disciplinary techniques may be necessary to achieve optimal outcomes in select patients. We will review the risk factors associated with the development of bile duct strictures in the posttransplant setting along with the efficacy and complications of current endoscopic approaches available for the management of bile duct strictures.

Prognostic significance of post percutaneous coronary intervention thrombocytopenia

Several definitions of post percutaneous coronary intervention(PCI)thrombocytopenia(TC)were formulated.Recent studies demonstrated that a relative drop in platelet count≥25%is the most appropriate criterion.By this definition a population is detected that is exposed not only to increased risk of hemorrhagic complications but also to increased risk of ischemic events,which may appear a paradox.In patients with acute coronary syndromes undergoing PCI,several conditions might be associated with TC:cardiopulmonary bypass and the presence of extra corporeal membrane oxygenators,intra aortic balloon pump(IABP),cardiogenic shock,thrombolytic drugs and anticoagulant or antiplatelet drugs.Several studies demonstrated that TC and ischemic outcomes are related although it is unclear whether this is a direct relationship or TC is just a secondary effect of another cryptic protagonist.It is suggested that further investigations determine whether there is a real link between TC,a probably welldefined covariate,and ischemic outcomes or whether IABP is the joining link between these two variables and whose presence needs in any case be considered in multivariable statistics.Post-PCI TC could be only a secondary effect of IABP use.On turn,the prolonged use of heparin necessarily accompanying the use of IABP,and producing a paradoxical pro-thrombotic TC,might also be implicated.

Lipocalin-2 as a biomarker for diabetic nephropathy

Diabetes is a major global public health issue.The prevalence of type 1 diabetes is comparatively static,as hereditary and genetic causes are involved,while type 2 diabetes(T2D)prevalence is increasing day by day.T2D is associated with chronic complications,including diabetic neuropathy(DN),nephropathy,retinopathy,and other complications like diabetic foot.DN is the main complication of both types of diabetes.DN can be diagnosed by routine laboratory tests,microalbuminuria>300 mg/24 h,and a gradual decrease in glomerular filtration rate.As the appearance of microalbuminuria is a late manifestation,an early marker for renal damage is needed.Lipocalin-2,also known as neutrophil gelatinaseassociated lipocalin(NGAL),is a small protein purified from neutrophil granules and a good marker for kidney disease.NGAL is a transporter protein responsible for many physiological processes,such as inflammation,generation of the immune response,and metabolic homeostasis.NGAL has been reported to depict the early changes in renal damage when urine microalbumin is still undetecable.Therefore,elucidating the role of NGAL in detecting DN and understanding its mechanism can help establish it as a potential early marker for DN.

Is dose modification or discontinuation of nilotinib necessary in nilotinib-induced hyperbilirubinemia?

Nilotinib is a specific breakpoint cluster region-Abelson leukemia virus-tyrosine kinase inhibitor that is used as an effective first-or second-line treatment in imatinib-resistant chronic myelogenous leukemia(CML)patients.Hepatotoxicity due to nilotinib is a commonly reported side effect;however,abnormal liver function test(LFT)results have been reported in asymptomatic cases.When alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels are more than five-fold the upper limit of the normal(ULN)or when the serum total bilirubin level is more than three-fold the ULN,dose modification or discontinuation of nilotinib is recommended,resulting in decreased levels of hematological indicators in certain patients with CML.Nilotinib-induced hyperbilirubinemia typically manifests as indirect bilirubinemia without elevated ALT or AST levels.Such abnormal liver functioning is thus not attributed to the presence of a true histologic lesion of the liver.The underlying mechanism may be related to the inhibition of uridine diphosphate glucuronosyltransferase activity.Therefore,nilotinib dose adjustment is not recommended for this type of hyperbilirubinemia,and in the absence of elevated liver enzyme levels or presence of abnormal LFT findings,physicians should consider maintaining nilotinib dose intensity without modifications.

Gastrointestinal and hepatic manifestations of COVID-19 infection:Lessons for practitioners

Originating from Wuhan in China,coronavirus disease 2019(COVID-19)spread globally within months and was declared a pandemic by World Health Organization in March 2020,making it one of the biggest healthcare calamities of our time.As more data on COVID-19 infection became available,what was initially thought to be a simple respiratory illness was found to be more complex.Many extra-pulmonary manifestations are now frequently reported for COVID-19 in available literature,most commonly gastrointestinal and hepatopancreatobiliary manifestations.Due to early scarcity of data,extra pulmonary manifestations were initially overlooked and may have contributed to nosocomial spread of the infection.Practitioners,especially gastroenterologists,who frequently encounter patients with these symptoms,need to be aware of them.This can not only help minimize the nosocomial spread,ensure safety of provider but also help conserve already stretched-thin healthcare resources.A tremendous amount of COVID-19 related literature is getting added to the growing pool every day,making it difficult for providers to follow.The aim of our review is to summarize the available evidence for gastrointestinal and hepatopancreatobiliary manifestations of COVID-19.We here briefly discussed the possible pathophysiologic mechanism for these manifestations and summarized the recommendations put forward by multiple gastrointestinal societies regarding safe and effective clinical practice during the ongoing pandemic.

Artificial intelligence for endoscopy

In recent times,there has been progressive development in artificial intelligence(AI)following the introduction of deep learning in the medical field including gastroenterology and endoscopy.Most of the reported studies were based on retrospective data.Several prospective studies of real-time diagnosis of moving images using the AI system are expected to match the real clinical situation and to aid the endoscopists in the detection and diagnosis of neoplasms without missing any lesion.AI can read a large number of endoscopic images in a few minutes and make a diagnosis;therefore,it is expected to cover the lack of support for the screening esophagogastroduodenoscopy in the health check-up and a large number of capsule images,thereby freeing the endoscopists from this burden.AI can help make the diagnosis during the endoscopic procedure and thereby prevent an unnecessary biopsy for patients taking antithrombotic drugs.AI can also be useful for education and training in endoscopy.Trainees can learn to perform endoscopy and the detection and diagnosis of lesions by the support of AI.In the near future,real-time endoscopic diagnosis using AI is expected to lessen the burden of endoscopists,to enhance the quality level of endoscopists,to overcome the miss of lesions and to make optimal diagnosis.

Treatment of recurrent hepatocellular carcinoma following liver resection,ablation or liver transplantation

Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and causes one third of cancer related deaths world-wide.Approximately one third of patients with HCC are eligible for curative treatments that include hepatic resection,liver transplantation or imaging guided tumor ablation.Recurrence rates after primary therapy depends on tumor biology and pre-treatment tumor burden with early recurrence rates ranging from 30%-80%following surgical resection and ablation.HCC recurs in over ten percent following liver transplantation for HCC.Treatment modalities for tumor recurrence following resection and ablation include repeat liver resection,salvage liver transplantation,locoregional therapies,and systemic chemotherapy/immunotherapy.Locoregional and immune mediated therapies are limited for patients with tumor recurrence following liver transplantation given potential immune related allograft rejection.Given the high HCC recurrence rates after primary tumor treatment,it is imperative for the clinician to review the appropriate treatment strategy for this disease entity.This article will review the current literature regarding HCC recurrence after primary curative therapies and will discuss the relevant future trends in the HCC field.

Asymptomatic bacteriuria among hospitalized diabetic patients:Should they be treated?

Diabetes Mellitus is a significant health care challenge in the United States.The Center for Disease Control and Prevention estimates approximately 9.4%of patients in the United States are afflicted by diabetes.The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive cleancatch voided urine specimens with isolation of the same bacterial strain in counts≥105 cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics.Urinary tract infections(UTIs)tend to be the most common infection contracted by this population.UTIs are not only a significant cause of morbidity and mortality,they are also a significant financial burden.The data are conflicting,in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications.However,clinicians continue to prescribe antibiotics empirically.Further randomized controlled study looking into the specific population as immunocompromised diabetic patients,patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.