Tonatiuh Barrientos-Gutierrez

Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding

BACKGROUNDnBacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic prophylaxis seems to decrease the incidence of bacterial infections. Oral antibiotics, active against enteric bacteria, have been commonly used as antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002.nnnOBJECTIVESnTo assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with upper gastrointestinal bleeding.nnnSEARCH STRATEGYnWe searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies.nnnSELECTION CRITERIAnRandomised clinical trials comparing different types of antibiotic prophylaxis with no intervention, placebo, or another antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding.nnnDATA COLLECTION AND ANALYSISnThree authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes.nnnMAIN RESULTSnTwelve trials (1241 patients) evaluated antibiotic prophylaxis compared with placebo or no antibiotic prophylaxis. All trials were at risk of bias. Antibiotic prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different antibiotic regimens. Data could not be combined as each trial used different antibiotic regimen. None of the examined antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections.nnnAUTHORS CONCLUSIONSnProphylactic antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of antibiotic used; thus, no specific antibiotic can be preferred. Therefore, antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.

Bariatric surgery for non-alcoholic steatohepatitis in obese patients

BACKGROUNDnNonalcoholic fatty liver disease (NAFLD) is increasingly recognised as a condition associated with overweight or obesity that may progress to end-stage liver disease. NAFLD histology resembles alcohol-induced liver injury, but occurs in patients with no history of alcohol abuse. NAFLD has a broad spectrum of clinical and histological manifestations, ranging from simple fatty liver to hepatic steatosis with inflammation, advanced fibrosis, and cirrhosis. The inflammatory stage is known as non-alcoholic steatohepatitis (NASH). Recent reports indicate that weight loss induced by bariatric procedures could be beneficial for NASH treatment.nnnOBJECTIVESnTo assess the benefits and harms of bariatric surgery for NASH in obese patients.nnnSEARCH STRATEGYnWe searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded to October 2009.nnnSELECTION CRITERIAnAll randomised clinical trials evaluating any bariatric procedure versus no intervention, placebo (sham procedure), or other interventions in patients with NASH regardless of publication status, number of patients randomised, language, or blinding. Quasi-randomised clinical studies were to be considered for the review if no randomised clinical trials were identified. If included, their bias towards positive findings was to be considered.nnnDATA COLLECTION AND ANALYSISnWe extracted data in duplicate, and we planned to analyse the data by intention-to-treat.nnnMAIN RESULTSnWe could not find any randomised clinical trials or quasi-randomised clinical studies that fulfilled the inclusion criteria. Our search resulted in twenty-one prospective or retrospective cohort studies, in which improvement on steatosis or inflammation scores was reported. However, four studies also described some deterioration in the degree of fibrosis.nnnAUTHORS CONCLUSIONSnThe lack of randomised clinical trials and quasi-randomised clinical studies precludes us to assess the benefits and harms of bariatric surgery as a therapeutic approach for patients with NASH. Limitations of all other studies with inferior design did not allow us to draw any unbiased conclusion on bariatric surgery for treatment of NASH.

A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy

Background and aimBecause low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy.MethodsFor this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-valueu2009>u20090.10 (χ2) or I2u2009>u200925%.ResultsFour trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD –0.62; 95% CI –1.12 to –0.11) reported in three trials (nu2009=u2009189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (nu2009=u2009169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported.ConclusionOral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available.

Repeatability and comparability of anterior segment biometry obtained by the Sirius and the Pentacam analyzers

To assess the repeatability and comparability of six anterior segment biometry parameters obtained with a novel Scheimpflug camera with a Placido disc topographer (Sirius) and slit-scanning tomography with a Scheimpflug camera (Pentacam), in a sample of 16 unoperated eyes of healthy subjects. The anterior segment was analyzed by a single examiner using the Sirius and the Pentacam analyzers. Mean simulated keratometry (Sim K), flat and steep axis keratometry (Kf and Ks), central and thinnest corneal thicknesses (CCT and TCT), and anterior chamber depth (ACD) measurements were evaluated. Repeatability of three sets of measurements from each device was assessed using the coefficient of variation (CV), within-subject standard deviation, and intraclass correlation coefficient (ICC). Bonferroni-adjusted t-tests, and Bland and Altman plots were used to establish agreement between devices. For both devices the CV of repeated measurements was <0.79xa0%. The ICC was >0.95 in all measurements except for Sirius Ks (ICCxa0=xa00.869). For all parameters evaluated, the Pentacam systematically yielded higher values, although differences were statistically significant in only three parameters—0.31 diopters for Ks, 10.1xa0μm for CCT and 12.4xa0μm for TCT. In the assessment of normal corneas both devices showed overall high repeatability. Although good agreement was found in three parameters (Sim K, Kf and ACD) these devices do not seem to be interchangeable for pachymetric determination.

Built environment change and change in BMI and waist circumference: Multi-ethnic Study of Atherosclerosis

To examine longitudinal associations of the neighborhood built environment with objectively measured body mass index (BMI) and waist circumference (WC) in a geographically and racial/ethnically diverse group of adults.

Associations of Alcohol Availability and Neighborhood Socioeconomic Characteristics With Drinking: Cross-Sectional Results From the Multi-Ethnic Study of Atherosclerosis (MESA).

Background: Living in neighborhoods with a high density of alcohol outlets and socioeconomic disadvantage may increase residents’ alcohol use. Few researchers have studied these exposures in relation to multiple types of alcohol use, including beverage-specific consumption, and how individual demographic factors influence these relationships. Objective: To examine the relationships of alcohol outlet density and neighborhood disadvantage with alcohol consumption, and to investigate differences in these associations by race/ethnicity and income. Methods: Using cross-sectional data (N = 5,873) from the Multi-ethnic Study of Atherosclerosis in 2002, we examine associations of residential alcohol outlet density and neighborhood socioeconomic disadvantage with current, total weekly and heaviest daily alcohol use in gender-specific regression models, as well as moderation by race/ethnicity and income. Results: Drinking men living near high densities of alcohol outlets had 23%–29% more weekly alcohol use than men in low density areas. Among women who drank, those living near a moderate density of alcohol outlets consumed approximately 40% less liquor each week than those in low density areas, but higher outlet densities were associated with more wine consumption (35%–49%). Living in highly or moderately disadvantaged neighborhoods was associated with a lower probability of being a current drinker, but with higher rates of weekly beer consumption. Income moderated the relationship between neighborhood context and weekly alcohol use. Conclusions/Importance: Neighborhood disadvantage and alcohol outlet density may influence alcohol use with effects varying by gender and income. Results from this research may help target interventions and policy to groups most at risk for greater weekly consumption.

Are movies with tobacco, alcohol, drugs, sex, and violence rated for youth? A comparison of rating systems in Argentina, Brazil, Mexico, and the United States

BACKGROUNDnThis study aimed to determine between-country differences and changes over time in the portrayal of youth risk behaviors in films rated for youth in Argentina, Brazil, Mexico and the United States.nnnMETHODSnContent and ratings were analyzed for 362 films that were popular across all four countries from 2002 to 2009. Country-specific ratings were classified as either youth or adult, and Generalized Estimating Equations were used to determine between-country differences in the presence of tobacco, alcohol, drugs, sexual content, and violence in youth-rated films. Within-country differences in this content over time were also assessed, comparing films released from 2002 to 2005 with those released from 2006 to 2009.nnnRESULTSnIn the US, films rated for youth were less likely to contain all five risk behaviors than in youth-rated films in Argentina, Brazil, and, when the 15 and older rating was considered a youth rating, in Mexico. All three Latin American countries downrated films that received an adult rating in the US. Nevertheless, tobacco and drug use in youth-rated films declined over time in all countries, whereas moderate to extreme alcohol use and violence involving children or youth increased in all countries.nnnCONCLUSIONSnTobacco and drug use have declined in popular US films, but these behaviors are still prevalent in films rated for youth across the Americas. The apparent success of advocacy efforts to reduce tobacco and other drugs in films suggests that similar efforts be directed to reduce alcohol portrayals.

Dry Eye Disease in Chronic Graft-Versus-Host Disease: Results From a Spanish Retrospective Cohort Study

We describe the incidence, clinical features, and final outcome of dry eye disease (DED) associated with chronic graft-versus-host disease (GVHD) over a 5-year period. We reviewed 109 clinical charts from patients undergoing hematopoietic stem cell transplantation (HSCT) between January 2000 and December 2005, abstracting data from the 57 patients who developed chronic GVHD and survived at least 180 days after allogenic HSCT. DED occurred in 22 (40%) patients at an average of 16.5 months after HSCT. Photophobia, irritation, and foreign body sensation were the most frequent symptoms, while punctate keratitis was the most common sign. DED tended to improve over time, with fewer than 5% of patients requiring more than two topical medications at the end of follow-up. Our study represented a formal evaluation of DED incidence among Spanish chronic GVHD patients. It is of utmost importance to assure patients will undergo a comprehensive ophthalmologic evaluation throughout their follow-up.

Longitudinal associations of neighborhood socioeconomic characteristics and alcohol availability on drinking: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Neighborhood socioeconomic characteristics and alcohol availability may affect alcohol consumption, but adequate longitudinal research to support these hypotheses does not exist. We used data from the Multi-Ethnic Study of Atherosclerosis (MESA) (Nxa0=xa06163) to examine associations of changes in neighborhood socioeconomic status (SES) and alcohol outlet density, with current, weekly, and heavy daily alcohol consumption in hybrid effects models. We also examined whether these associations were moderated by gender, race/ethnicity, and income. Increases in neighborhood SES were associated with decreases in the probability of current alcohol use after adjustment for age, gender, race/ethnicity, individual SES, marital status and time since baseline [probability ratio (PR) per SD increase in neighborhood SESxa0=xa00.96, 95% confidence interval (CI) (0.96.0.99)]. Increases in liquor store densities were associated with increases in weekly alcohol consumption [ratio of weekly drinks per SD increase in outlet densityxa0=xa01.07, 95% CI (1.01.1.05) for men, PRxa0=xa01.11, 95% CI (1.01.1.21) for women]. Relationships between current alcohol use and neighborhood SES and between weekly beer consumption and neighborhood SES were generally stronger among those with higher incomes. Neighborhood socioeconomic context and the availability of alcohol may be important for understanding patterns of alcohol use over time, and for targeting interventions and policies to reduce harmful alcohol use.

Exposure to Neighborhood Foreclosures and Changes in Cardiometabolic Health: Results from MESA

Home foreclosures can precipitate declines in health among the individuals who lost their homes. Whether home foreclosures can “spillover” to affect the health of other neighborhood residents is largely unknown. Using longitudinal data from the Multi-Ethnic Study of Atherosclerosis that were linked to foreclosure data from 2005 to 2012, we assessed whether greater exposure to neighborhood foreclosures was associated with temporal changes in 3 objectively measured cardiometabolic risk factors: body mass index, systolic blood pressure, and fasting glucose level. We used fixed-effects models to estimate mean changes in cardiometabolic risk factors associated with changes in neighborhood foreclosures over time. In models in which we controlled for time-varying income, working status, medication use, neighborhood poverty, neighborhood unemployment, and interactions of age, sex, race, and state foreclosure laws with time, a standard-deviation increase in neighborhood foreclosures (1.9 foreclosures per quarter mile) was associated with increases in fasting glucose (mean = 0.22 mg/dL, 95% confidence interval: −0.05, 0.50) and decreases in blood pressure (mean = −0.27 mm Hg, 95% confidence interval: −0.49, −0.04). Changes in neighborhood foreclosure rates were not associated with changes in body mass index. Overall, greater exposure to neighborhood foreclosures had mixed associations with cardiometabolic risk factors over time. Given the millions of mortgages still in default, further research clarifying the potential health effects of neighborhood foreclosures is needed.