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Cureus Jan 2024There are no guidelines for the most effective medication to reduce hepatic encephalopathy (HE) or the associated mortality. The purpose of this study is to determine... (Review)
Review
There are no guidelines for the most effective medication to reduce hepatic encephalopathy (HE) or the associated mortality. The purpose of this study is to determine the most effective possible treatment among the single treatment options or the combined treatment options for decreasing the morbidity and mortality of HE. We evaluated the outcomes by various parameters such as the quality of life, reduction in ammonia, all causes of mortality, adverse events, reversal of minimal HE, and development of overt HE. We systematically searched PubMed, Cochrane, Web of Science, and Scopus till the 19th of January 2023 for studies that assess various treatment options for HE. Data were extracted from eligible studies and pooled in a frequentist network meta-analysis as standardized mean difference (SMD) and their 95% confidence interval (CI) using the MetaInsight web-based tool. The Cochrane Tool was used to assess the randomized controlled trials' quality (RCT), while the NIH tool was used to assess the quality of the included cohort studies. Utilizing the R software, the network meta-analysis was conducted. In addition to a significant variation in cases of (Lactulose and Rifaximin) compared with Rifaximin (RR= 0.39, 95% CI [0.17; 0.89]), the results demonstrated a significantly lower incidence of overt HE in (Lactulose and Rifaximin) compared with placebo (RR=0.19, 95% CI [0.09; 0.40]). Most arms demonstrated a statistically significant reduction in the incidence of overt HE compared to albumin and placebo. The results also demonstrated a significant reduction in ammonia between L-ornithine-L-aspartate (LOLA) and probiotics (MD= -19.17, 95% CI [-38.01; -0.32]), as well as a significant difference in the incidence of LOLA compared to placebo (MD= -22.62, 95% CI [-39.16; -6.07]). This network meta-analysis has significant data for managing subclinical HE in people without a history of overt HE. Our analysis showed that (Lactulose and Rifaximin), followed by (Rifaximin and L-carnitine), followed by (Lactulose and Rifaximin with zinc) were the best combinations regarding overt HE. LOLA reduced ammonia best, followed by Nitazoxanide and finally Lactulose. (Lactulose and Nitazoxanide) have the least adverse effects, followed by (Rifaximin and L-carnitine), then Probiotics. Yet, all mortality outcomes and quality of life changes yielded no useful findings. Future studies like RCTs must be done to compare our therapies directly.
PubMed: 38435950
DOI: 10.7759/cureus.53341 -
Environmental Research Jan 2023Foraminifera are considered good bioindicators of environmental stress based on morphological abnormalities, but physiological responses occur far earlier and have not... (Review)
Review
Foraminifera are considered good bioindicators of environmental stress based on morphological abnormalities, but physiological responses occur far earlier and have not been evaluated as pollution markers. The aim of this review was to collate all published articles reporting physiological changes in foraminifera after environmental and anthropogenic stressors, to evaluate their reliability as early markers of environmental stress. We reviewed 70 studies, meeting the inclusion criteria, reporting 13 physiological effects classes after exposure to 17 different stressors. Immune functions, bleaching and lifecycle disruptions, were the most reported. Amphistegina and Ammonia showed high proportion of effects with lead and mercury, with a significant relationship between these heavy metals and the number of physiological effects classes in Ammonia, and between bleaching in Amphistegina gibbosa and Amphistegina lobifera with solar light and temperature. This suggests physiological responses are potentially reliable early indicators of environmental stress. It is necessary to increase quantitative physiological measures and standard exposure protocols in order to properly evaluate these organisms as pollution bioindicators.
Topics: Foraminifera; Environmental Biomarkers; Ammonia; Reproducibility of Results; Metals, Heavy; Environmental Monitoring; Geologic Sediments; Water Pollutants, Chemical
PubMed: 36270533
DOI: 10.1016/j.envres.2022.114515 -
Journal of Gastroenterology and... May 2024Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the global population, with a significant risk of advancing to liver cirrhosis and... (Review)
Review
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the global population, with a significant risk of advancing to liver cirrhosis and hepatocellular carcinoma. The roles of ammonia and glutamine in MASLD's pathogenesis are increasingly recognized, prompting this systematic review. This systematic review was conducted through a meticulous search of literature on December 21, 2023, across five major databases, focusing on studies that addressed the relationship between ammonia or glutamine and MASLD. The quality of the included studies was evaluated using CASP checklists. This study is officially registered in the PROSPERO database (CRD42023495619) and was conducted without external funding or sponsorship. Following PRISMA guidelines, 13 studies were included in this review. The studies were conducted globally, with varying sample sizes and study designs. The appraisal indicated a mainly low bias, confirming the reliability of the evidence. Glutamine's involvement in MASLD emerged as multifaceted, with its metabolic role being critical for liver function and disease progression. Variable expressions of glutamine synthetase and glutaminase enzymes highlight metabolic complexity whereas ammonia's impact through urea cycle dysfunction suggests avenues for therapeutic intervention. However, human clinical trials are lacking. This review emphasizes the necessity of glutamine and ammonia in understanding MASLD and identifies potential therapeutic targets. The current evidence, while robust, points to the need for human studies to corroborate preclinical findings. A personalized approach to treatment, informed by metabolic differences in MASLD patients, is advocated, alongside future large-scale clinical trials for a deeper exploration into these metabolic pathways.
PubMed: 38763916
DOI: 10.1111/jgh.16603 -
Animals : An Open Access Journal From... Oct 2020Probiotics are live microorganisms which, when administered in adequate amounts, confer health benefits to the host. The use of probiotics in poultry has increased... (Review)
Review
Probiotics are live microorganisms which, when administered in adequate amounts, confer health benefits to the host. The use of probiotics in poultry has increased steadily over the years due to higher demand for antibiotic-free poultry. The objective of this systematic review is to present and evaluate the effects of probiotics on the nutrient utilization, growth and laying performance, gut histomorphology, immunity, and gut microbiota of poultry. An electronic search was conducted using relevant keywords to include papers pertinent to the topic. Seventeen commonly used probiotic species were critically assessed for their roles in the performance and gut health of poultry under existing commercial production conditions. The results showed that probiotic supplementation could have the following effects: (1) modification of the intestinal microbiota, (2) stimulation of the immune system, (3) reduction in inflammatory reactions, (4) prevention of pathogen colonization, (5) enhancement of growth performance, (6) alteration of the ileal digestibility and total tract apparent digestibility coefficient, and (7) decrease in ammonia and urea excretion. Thus, probiotics can serve as a potential alternative to antibiotic growth promoters in poultry production. However, factors such as the intestinal health condition of birds, the probiotic inclusion level; and the incubation conditions, feedstuff, and water quality offered to birds may affect the outcome. This systematic review provides a summary of the use of probiotics in poultry production, as well as the potential role of probiotics in the nutrient utilization, growth and laying performance, and gut health of poultry.
PubMed: 33066185
DOI: 10.3390/ani10101863 -
Poultry Science Apr 2023Particulate matter (PM) is one of the essential environmental stressors for the poultry industry in the world. Given its large specific surface area, PM can adsorb and... (Review)
Review
Particulate matter (PM) is one of the essential environmental stressors for the poultry industry in the world. Given its large specific surface area, PM can adsorb and carry a variety of pollutants, including heavy metal ions, ammonia, and persistent organic pollutants such as pathogenic microorganisms. High concentrations of PM induce poultry respiratory inflammation and trigger various diseases. However, the pathogenic mechanism of PM in poultry houses on respiratory diseases has not been clarified due to its complexity and lack of accurate assays. In terms of pathogenesis, there are 3 ways to explain this phenomenon: Inhaled PM irritates the respiratory tract, decreases immune resistance, and causes a respiratory disease; respiratory tract irritation by compounds presents in PM; infections with pathogenic and non-pathogenic microorganisms attached to PM. The latter 2 modes of influence are more harmful. Specifically, PM can induce the respiratory disease through several toxic mechanisms, including ammonia ingestion and bioaccumulation, lung flora dysbiosis, oxidative stress, and metabolic disorders. Therefore, this review summarizes the characteristics of PM in the poultry house and the impact of poultry PM on respiratory disease and proposes potential pathogenic mechanisms.
Topics: Animals; Particulate Matter; Poultry; Air Pollutants; Ammonia; Chickens; Respiratory Tract Diseases; Inflammation
PubMed: 36848758
DOI: 10.1016/j.psj.2023.102556 -
Journal of Critical Care Jun 2024Acute liver failure (ALF) is a rare syndrome leading to significant morbidity and mortality. An important cause of mortality is cerebral edema due to hyperammonemia.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Acute liver failure (ALF) is a rare syndrome leading to significant morbidity and mortality. An important cause of mortality is cerebral edema due to hyperammonemia. Different therapies for hyperammonemia have been assessed including continuous renal replacement therapy (CRRT). We conducted a systematic review and meta-analysis to determine the efficacy of CRRT in ALF patients.
MATERIALS AND METHODS
We searched MEDLINE, EMBASE, Cochrane Library, and Web of Science. Inclusion criteria included adult patients admitted to an ICU with ALF. Intervention was the use of CRRT for one or more indications with the comparator being standard care without the use of CRRT. Outcomes of interest were overall survival, transplant-free survival (TFS), mortality and changes in serum ammonia levels.
RESULTS
In total, 305 patients underwent CRRT while 1137 patients did not receive CRRT. CRRT was associated with improved overall survival [risk ratio (RR) 0.83, 95% confidence interval (CI) 0.70-0.99, p-value 0.04, I = 50%] and improved TFS (RR 0.65, 95% CI 0.49-0.85, p-value 0.002, I = 25%). There was a trend towards higher mortality with no CRRT (RR 1.24, 95% CI 0.84-1.81, p-value 0.28, I = 37%). Ammonia clearance data was unable to be pooled and was not analyzable.
CONCLUSION
Use of CRRT in ALF patients is associated with improved overall and transplant-free survival compared to no CRRT.
Topics: Adult; Humans; Continuous Renal Replacement Therapy; Renal Replacement Therapy; Ammonia; Hyperammonemia; Liver Failure, Acute; Acute Kidney Injury
PubMed: 38194760
DOI: 10.1016/j.jcrc.2023.154513 -
Obesity Research & Clinical Practice 2023Nonhepatic Hyperammonemic encephalopathy (NHAE) following Bariatric Surgery (BS), mainly Roux-en-Y Gastric Bypass (RYGB) and Biliopancreatic Diversion (BPD) is a... (Review)
Review
BACKGROUND
Nonhepatic Hyperammonemic encephalopathy (NHAE) following Bariatric Surgery (BS), mainly Roux-en-Y Gastric Bypass (RYGB) and Biliopancreatic Diversion (BPD) is a potentially devastating condition if not diagnosed and managed promptly.
METHODS
A literature review was performed using PRISMA guidelines. Eighteen studies and 3 conference abstracts with a total of 33 patients were included in this review.
RESULTS
Majority (28 patients, 84.8 %) had RYGB. Seven patients (21.2 %) had associated metabolic disorders. 60 % of patients presented with neurological symptoms or signs such as confusion, cognitive and/or psychomotor changes, and decreased reflexes. Two patients presented with status epilepticus. In 30 of the 33 patients an elevated serum ammonia levels was reported (90.9 %). The overall mortality was 39.3 %.
CONCLUSION
NHAE is a rare condition following bariatric surgery (in particular bypass procedures), carrying a high mortality rate. The signs and symptoms are predominantly neurological and may be mistaken for Wernicke's encephalopathy or other more common neurological conditions. Serum ammonia levels should be checked in those who present with these symptoms and signs. Prompt treatment might be life saving in patients with NHAE.
Topics: Humans; Obesity, Morbid; Ammonia; Bariatric Surgery; Gastric Bypass; Brain Diseases; Retrospective Studies
PubMed: 38007358
DOI: 10.1016/j.orcp.2023.11.001 -
Science Bulletin Oct 2022Ammonia, primarily made with Haber-Bosch process developed in 1909 and winning two Nobel prizes, is a promising noncarbon fuel for preventing global warming of 1.5 °C... (Review)
Review
Ammonia, primarily made with Haber-Bosch process developed in 1909 and winning two Nobel prizes, is a promising noncarbon fuel for preventing global warming of 1.5 °C above pre-industrial levels. However, the undesired characteristics of the process, including high carbon footprint, necessitate alternative ammonia synthesis methods, and among them is chemical looping ammonia production (CLAP) that uses nitrogen carrier materials and operates at atmospheric pressure with high product selectivity and energy efficiency. To date, neither a systematic review nor a perspective in nitrogen carriers and CLAP has been reported in the critical area. Thus, this work not only assesses the previous results of CLAP but also provides perspectives towards the future of CLAP. It classifies, characterizes, and holistically analyzes the fundamentally different CLAP pathways and discusses the ways of further improving the CLAP performance with the assistance of plasma technology and artificial intelligence (AI).
Topics: Ammonia; Artificial Intelligence; Nitrogen
PubMed: 36546112
DOI: 10.1016/j.scib.2022.09.013 -
International Journal of Environmental... Feb 2023Constructed wetlands (CWs) are an eco-technology for wastewater treatment and are applied worldwide. Due to the regular influx of pollutants, CWs can release... (Meta-Analysis)
Meta-Analysis Review
Constructed wetlands (CWs) are an eco-technology for wastewater treatment and are applied worldwide. Due to the regular influx of pollutants, CWs can release considerable quantities of greenhouse gases (GHGs), ammonia (NH), and other atmospheric pollutants, such as volatile organic compounds (VOCs) and hydrogen sulfide (HS), etc., which will aggravate global warming, degrade air quality and even threaten human health. However, there is a lack of systematic understanding of factors affecting the emission of these gases in CWs. In this study, we applied meta-analysis to quantitatively review the main influencing factors of GHG emission from CWs; meanwhile, the emissions of NH, VOCs, and HS were qualitatively assessed. Meta-analysis indicates that horizontal subsurface flow (HSSF) CWs emit less CH and NO than free water surface flow (FWS) CWs. The addition of biochar can mitigate NO emission compared to gravel-based CWs but has the risk of increasing CH emission. Polyculture CWs stimulate CH emission but pose no influence on NO emission compared to monoculture CWs. The influent wastewater characteristics (e.g., C/N ratio, salinity) and environmental conditions (e.g., temperature) can also impact GHG emission. The NH volatilization from CWs is positively related to the influent nitrogen concentration and pH value. High plant species richness tends to reduce NH volatilization and plant composition showed greater effects than species richness. Though VOCs and HS emissions from CWs do not always occur, it should be a concern when using CWs to treat wastewater containing hydrocarbon and acid. This study provides solid references for simultaneously achieving pollutant removal and reducing gaseous emission from CWs, which avoids the transformation of water pollution into air contamination.
Topics: Humans; Gases; Greenhouse Gases; Methane; Nitrous Oxide; Wastewater; Wetlands
PubMed: 36900888
DOI: 10.3390/ijerph20053876 -
Medicine Dec 2022Alterations in the gut microbiome usually occur in liver cirrhosis. Gut microbiome dysregulation damages the liver and accelerates the development of liver fibrosis.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alterations in the gut microbiome usually occur in liver cirrhosis. Gut microbiome dysregulation damages the liver and accelerates the development of liver fibrosis. Probiotic treatment has gradually become a major method for improving the prognosis of liver cirrhosis and reducing its complications. However, alterations in the gut microbiome have revealed different results, and the therapeutic effects of various probiotics are inconsistent.
METHODS
We searched the PubMed, Medline, EMBASE, ScienceDirect, and Cochrane databases up to August 2022 and conducted a systematic review and meta-analysis of 17 relevant studies.
RESULTS
The counts of Enterobacter (standardized mean difference [SMD] -1.79, 95% confidence interval [CI]: -3.08 to -0.49) and Enterococcus (SMD -1.41, 95% CI: -2.26 to -0.55) increased significantly in patients with cirrhosis, while the counts of Lactobacillus (SMD 0.63, 95% CI: 0.12-1.15) and Bifidobacterium (SMD 0.44, 95% CI: 0.12-0.77) decreased significantly. Blood ammonia (weighted mean difference [WMD] 14.61, 95% CI: 7.84-21.37) and the incidence of hepatic encephalopathy (WMD 0.40, 95% CI: 0.27-0.61) were significantly decreased in the probiotic group. As for mortality (MD 0.75, 95% CI: 0.48-1.16) and the incidence of spontaneous bacterial peritonitis (WMD -0.02, 95% CI: -0.07 to 0.03), no significant differences were found between the probiotic and placebo groups.
CONCLUSION
In summary, the gut microbiome in cirrhosis manifests as decreased counts of Lactobacillus and Bifidobacterium and increased counts of Enterobacter and Enterococcus. Targeted supplementation of probiotics in cirrhosis, including Lactobacillus combined with Bifidobacterium or Bifidobacterium alone, can reduce blood ammonia and the incidence of hepatic encephalopathy. The effect is similar to that of lactulose, but it has no obvious effect on mortality and spontaneous bacterial peritonitis.
Topics: Humans; Hepatic Encephalopathy; Gastrointestinal Microbiome; Ammonia; Liver Cirrhosis; Probiotics; Lactobacillus; Peritonitis; Bifidobacterium
PubMed: 36595801
DOI: 10.1097/MD.0000000000032335