Karn Wijarnpreecha

Underweight and obesity increase the risk of mortality after lung transplantation: a systematic review and meta-analysis.

Many studies have found an association between abnormal body mass index (BMI) and poor outcomes among lung transplant recipients. We performed a systematic review and meta‐analysis to identify outcomes associated with an abnormal pretransplant BMI after lung transplantation (LTx). The MEDLINE and EMBASE databases were searched from inception to May 2015 with focus on original observational studies with post‐transplant survival data in candidates with abnormal BMI (underweight, overweight, or obese). We performed meta‐analyses examining survival and primary graft dysfunction after LTx. We identified 866 citations; 13 observational cohort studies involving 40 742 participants met our inclusion criteria for systematic review. Seven of the 13 were included in the meta‐analysis. There was a significant risk of mortality after LTx in candidates with underweight and obesity (underweight versus normal, relative risk [RR] 1.36, 95% confidence interval [CI] 1.11–1.66, I2 = 0%; obesity vs. normal, RR 1.90, 95% CI 1.45–2.56, I2 = 0%; overweight vs. normal, RR 1.36, 95% CI 1.11–1.66, I2 = 0). There was also a significant risk of primary graft dysfunction in obese (RR 1.92, 95% CI 1.39–2.65, I2 = 0%) and overweight (RR 1.72, 95% CI, 1.32–2.24, I2 = 0%) candidates. Lung transplant candidates who are underweight or obese have a higher risk of post‐transplant mortality than recipients with a normal BMI.

Bariatric surgery reduces urinary albumin excretion in diabetic nephropathy: a systematic review and meta-analysis.

BACKGROUNDnBariatric surgery is found to prevent type 2 diabetes, improve glycemic control, and decrease long-term incidence of microvascular and macrovascular complications in obese persons. However, its effect on urinary albumin excretion (UAE) in patients with diabetic nephropathy (DN) is still unknown. This is a systematic review and meta-analysis of observational studies on bariatric surgery and change in UAE in patients with diabetes.nnnOBJECTIVEnTo explore whether there is improvement in UAE after bariatric surgery.nnnMETHODSnWe comprehensively searched the databases of MEDLINE, Embase, and Cochrane. The inclusion criteria were published studies evaluating effects of bariatric surgery in patients with DN at baseline. The primary outcome was the pre- and postbariatric surgery UAE as characterized by urinary albumin-to-creatinine ratio and albuminuria. A meta-analysis comparing pre- and postsurgery UAE was performed.nnnRESULTSnFrom 65 full-text articles, 15 observational studies met our inclusion criteria, and 11 studies were included in the meta-analysis based on the random effects model. There was a significant reduction in urinary albumin-to-creatinine ratio after bariatric surgery with a mean difference of -6.60 mg/g of creatinine (95% CI -9.19 to -4.02; P<.001). There was also a reduction in albuminuria with a mean difference of -55.76 mg/24 hours (95% CI -92.11 to -19.41; P<.001) after bariatric surgery.nnnCONCLUSIONnBariatric surgery significantly decreases urinary albumin excretion in DN. However, studies comparing bariatric surgery and conventional or intensive care of diabetes on UAE outcome should be done.

Vitamin D and histologic severity of nonalcoholic fatty liver disease: A systematic review and meta-analysis

BACKGROUNDnNAFLD and vitamin D deficiency often coexist and epidemiologic evidence has shown that both of these conditions share several risk factors. Recent studies investigating the relationship between vitamin D levels and severity of NAFLD showed conflicting results. Thus we conducted a systematic review and meta-analysis to evaluate association between vitamin D and NAFLD histologic severity.nnnMETHODSnA comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through November 2016. Observational studies compared serum vitamin D levels among NAFLD patients with high and low histologic severity, which was determined by NAFLD activity score (NAS) and fibrosis score. We calculated pooled mean difference (MD) of 25-hydroxyvitamin D levels with 95% confidence intervals (CI) using random-effects model.nnnRESULTSnData were extracted from 6 studies involving 974 NAFLD patients. There was no difference in 25-hydroxyvitamin D levels among NAFLD patients with high NAS (score of ≥5) versus low NAS (pooled MD=-0.93, 95%CI -2.45 to 0.58, I2=0%) and also high fibrosis score (score of ≥3) versus low fibrosis score (pooled MD=0.88, 95%CI -2.65 to 4.42, I2=64%).nnnCONCLUSIONSnDespite evidence implicating vitamin D in NAFLD pathogenesis, serum 25-hydroxyvitamin D may not be associated with NAFLD histologic severity.

Nonalcoholic fatty liver disease and osteoporosis: a systematic review and meta-analysis.

Several major risk factors for osteoporosis have been identified. One of these risk factors is chronic inflammation. Several recent studies have supported the association between low bone mineral density (BMD) and nonalcoholic fatty liver disease (NAFLD), which comprises a spectrum of disorders involving liver inflammation. However, conflicting evidence regarding this association has been obtained thus far. We, therefore, conducted a meta-analysis of observational studies to show the association between NAFLD and BMD. The Cochrane Central Register of Controlled Trials, Cochrane Library, Medline, and Embase were searched from database inception to November 2014 for all observational studies evaluating the association between NAFLD or nonalcoholic steatohepatitis (NASH) and bone mass, BMD, or osteoporosis. All patients were ≥18xa0years of age and had no other cause of liver disease, osteoporosis, or pathological bone disease at baseline. Risk factors were NAFLD and NASH; control subjects were individuals without NAFLD. Eleven articles underwent full-length review. Data were extracted from five cross-sectional studies involving 1276 participants; 638 had NAFLD. The main meta-analysis showed no significant difference in BMD between patients with fatty liver disease and controls. Among all variables analyzed, body mass index had the strongest and most significant predictive effect on the difference in BMD. Controversy exists regarding the effect of BMD on NAFLD. Further studies are required to fully show this relationship.

Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonic diverticular disease: Systematic review and meta-analysis

Diverticular disease and colorectal neoplasia are common digestive disorders worldwide. Both diseases share epidemiological trends and certain risk factors including advancing age, physical inactivity, and Western diet and lifestyle. Studies assessing the association between these diseases reported inconsistent results. Thus, we conducted a systematic review and meta‐analysis to determine the association between diverticular disease and colorectal adenomas, advanced adenomas and cancer.

Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis

BACKGROUNDnReports of mortality due to magnesium dysregulation in the critical care setting are controversial. We performed a systematic review and meta-analysis to evaluate the association between hypomagnesemia and mortality in patients admitted to the intensive care unit.nnnMETHODSnEligible studies assessing the association between hypomagnesemia or hypermagnesemia and mortality in the critical care setting were comprehensively searched in MEDLINE and EMBASE from their inception to September 2015. Inclusion criteria were published observational studies in adults who were admitted to the intensive or critical care setting with initial serum magnesium measurement. We used the definition of abnormal magnesium level defined by each study. Primary outcome was all-cause mortality. We performed meta-analysis using random-effects model and calculated pooled effect estimate of outcome comparing between hypomagnesemia and normal magnesium category.nnnRESULTSnFrom 30 full-text articles, 6 studies involving 1550 participants were included in the meta-analysis. There was a statistically significant higher risk of mortality in critically ill patients who had hypomagnesemia with RR of 1.90 (95% CI: 1.48-2.44, Pu2009<u20090.001, I(2u2009)=(u2009)63.5%). Risk for needing mechanical ventilation was also higher in the hypomagnesemia group with RR of 1.65 (95% CI: 1.12-2.43, Pu2009=u20090.01, I(2u2009)=(u2009)84%). Length of ICU stay was also higher in the hypomagnesemia group with mean difference of 4.1 days (95% CI: 1.16-7.04, Pu2009=u20090.01).nnnCONCLUSIONnThe findings of this meta-analysis indicate hypomagnesemia is associated with higher mortality, the need of mechanical ventilation and also the length of ICU stay in patients admitted to ICU.

Heparin-bridging therapy and risk of post-polypectomy bleeding: Meta-analysis of data reported by Japanese colonoscopists

Peri‐procedural bridging (PPB) with heparin is recommended for patients with high thromboembolic risk who need to withhold antithrombotic therapy for colonoscopic polypectomy. However, little is known about the bleeding risk from heparin‐bridging therapy itself.

Fusobacterium Nucleatum: Atypical Organism of Pyogenic Liver Abscess Might be Related to Sigmoid Diverticulitis.

Context: Pyogenic liver abscesses (PLAs) are the most common form of liver abscesses in the United States. Most cases are caused by enteric bacteria and anaerobes. We report a case of PLA caused by a rare pathogen, Fusobacterium nucleatum, from an unusual primary site of infection. Case Report: A 60-year-old male presented with subacute fever. Initial work-up revealed leukocytosis and elevated alkaline phosphatase (ALP). Dental examination and Panorex x-ray were normal. Imaging of the liver with abdominal computed tomography demonstrated a 5.5 cm abscess in the right lobe of the liver. Culture of the aspirate grew Fusobacterium nucleatum. He improved with abscess drainage and antibiotic therapy with moxifloxacin and metronidazole. Colonoscopy performed a few weeks later, demonstrated sigmoid ulceration most likely from the previous diverticulitis. Conclusion: PLAs can be a complication of sigmoid diverticulitis and as a result of occult dental disease as well. The clinical presentation of Fusobacterium infection is diverse and can be fatal if diagnosis is delayed. Therefore, early diagnosis and treatment are the keys to preventing serious complications.

The utility of NAFLD fibrosis score for prediction of mortality among patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of cohort study

BACKGROUNDnNonalcoholic fatty liver disease (NAFLD) is a common liver disorder worldwide. Several noninvasive diagnostic scoring systems have been developed to determine the severity of liver fibrosis and to predict long-term outcome of patients with NAFLD in lieu of liver biopsy. We conducted this systematic review and meta-analysis to investigate the role of NAFLD fibrosis score (NFS) for prediction of mortality from NAFLD.nnnMETHODSnMEDLINE and EMBASE databases were searched through October 2016 for studies that investigated the association between high NFS and mortality. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effects model, generic inverse variance method. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2.nnnRESULTSnA total of five cohort studies with 5033 NAFLD patients were identified. High NFS (score of greater than 0.675) was significantly associated with increased mortality with the pooled RR of 4.54 (95%CI: 1.85-11.17). The statistical heterogeneity was high with I2 of 88% (Pheterogeneity<0.01).nnnCONCLUSIONSnHigh NFS is associated with increased risk of mortality among patients with NAFLD. This scoring system may be considered as an alternative to liver biopsy for prediction of mortality outcome.

Association between Helicobacter pylori infection and osteoporosis: a systematic review and meta-analysis.

were included in the meta-analysis. Four were crosssectional studies and one was a prospective cohort study. Studies were performed in Japan, South Korea, and Taiwan. All except Asaoka et al. [4] included only postmenopausal women. We performed a meta-analysis using a random-effects model. There is no significant association between H. pylori infection and osteoporosis with pooled OR = 1.49 (95 % CI 0.88–2.55, p = 0.14, I = 52 %, Pheterogeneity = 0.08). From this result, we demonstrated that H. pylori infection does not seem to be an important factor related to osteoporosis. This finding rejects the hypothesis that cytokines released from H. pylori infection lead to bone resorption and increase the risk of osteoporosis. Larger prospective studies that vary in ethnicity, age group and gender are required to determine the causal relationship between H. pylori and bone resorption. Further randomized controlled trials may be done to determine the role of H. pylori eradication in reducing the incidence of osteoporosis.