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Transplant International : Official... 2022Hyperammonemia after lung transplantation (HALT) is a rare but serious complication with high mortality. This systematic review delineates possible etiologies of HALT... (Review)
Review
Hyperammonemia after lung transplantation (HALT) is a rare but serious complication with high mortality. This systematic review delineates possible etiologies of HALT and highlights successful strategies used to manage this fatal complication. Seven biomedical databases and grey literature sources were searched using keywords relevant to hyperammonemia and lung transplantation for publications between 1995 and 2020. Additionally, we retrospectively analyzed HALT cases managed at our institution between January 2016 and August 2018. The systematic review resulted in 18 studies with 40 individual cases. The mean peak ammonia level was 769 μmol/L at a mean of 14.1 days post-transplant. The mortality due to HALT was 57.5%. In our cohort of 120 lung transplants performed, four cases of HALT were identified. The mean peak ammonia level was 180.5 μmol/L at a mean of 11 days after transplantation. HALT in all four patients was successfully treated using a multimodal approach with an overall mortality of 25%. The incidence of HALT (3.3%) in our institution is comparable to prior reports. Nonetheless, ammonia levels in our cohort were not as high as previously reported and peaked earlier. We attributed these significant differences to early recognition and prompt institution of multimodal treatment approach.
Topics: Ammonia; Cohort Studies; Humans; Hyperammonemia; Lung Transplantation; Retrospective Studies
PubMed: 35620675
DOI: 10.3389/ti.2022.10433 -
Journal of the International Society of... Dec 2023Citrulline is a popular dietary supplement, primarily thought to exert ergogenic effects on exercise performance through the enhancement of nitric oxide (NO) synthesis... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Citrulline is a popular dietary supplement, primarily thought to exert ergogenic effects on exercise performance through the enhancement of nitric oxide (NO) synthesis and ammonia buffering. However, recent findings surrounding citrulline's effect on endurance performance have been inconsistent. A systematic review and meta-analysis of the relevant literature have yet to be undertaken.
AIM
To determine if acute ingestion of citrulline has an ergogenic effect on endurance performance in young healthy adults.
METHODS
A systematic search of three databases was undertaken to find peer-reviewed randomized controlled trials (RCTs) published in English investigating the effects of citrulline supplementation on endurance performance in young healthy adults. Two independent investigators completed a three-phased screening procedure against pre-determined eligibility criteria. Included studies evaluated loading or bolus dosage regimes of citrulline in participants aged 18 or over that were at least recreationally active. Outcome measures focused on time-to-completion (TTC) or time-to-exhaustion (TTE) in continuous submaximal intensity exercise. Cochrane's Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in individual studies. Meta-analysis was conducted using a fixed-effects model to pool the weighted estimate of standardized mean differences (SMD) across studies. A chi-squared test assessed heterogeneity between studies. This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Nine studies ( = 158 participants) met the eligibility criteria; five reported TTE outcomes (I = 0%, χ = 0.37, df = 4, = 0.99) and four reported TTC outcomes (I = 0%, χ = 0.46, df = 3, = 0.93), both with a low between-study heterogeneity. The results of the meta-analyses showed no significant difference in the endurance performance measures, TTE (pooled SMD = 0.03 [-0.27, 0.33]) and TTC (pooled SMD = -0.07 [-0.50, 0.15]), after acute ingestion of citrulline supplementation or a control in young healthy adults.
DISCUSSION
The current evidence suggests no significant benefit of citrulline supplementation for endurance performance. However, the small evidence base requires further research to fully evaluate this topic. Recommendations include a focus on female populations; higher continuous doses of citrulline over seven days; and TTC outcome measures over longer distances to simulate competition.
Topics: Female; Humans; Adult; Citrulline; Exercise; Dietary Supplements; Nutritional Status
PubMed: 37155582
DOI: 10.1080/15502783.2023.2209056 -
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 -
Orphanet Journal of Rare Diseases Oct 2020N-Acetylglutamate synthase (NAGS) deficiency is an extremely rare autosomal recessive metabolic disorder affecting the urea cycle, leading to episodes of hyperammonemia... (Review)
Review
BACKGROUND
N-Acetylglutamate synthase (NAGS) deficiency is an extremely rare autosomal recessive metabolic disorder affecting the urea cycle, leading to episodes of hyperammonemia which can cause significant morbidity and mortality. Since its recognition in 1981, NAGS deficiency has been treated with carbamylglutamate with or without other measures (nutritional, ammonia scavengers, dialytic, etc.). We conducted a systematic literature review of NAGS deficiency to summarize current knowledge around presentation and management.
METHODS
Case reports and case series were identified using the Medline database, as well as references from other articles and a general internet search. Clinical data related to presentation and management were abstracted by two reviewers.
RESULTS
In total, 98 cases of NAGS deficiency from 79 families, in 48 articles or abstracts were identified. Of these, 1 was diagnosed prenatally, 57 were neonatal cases, 34 were post-neonatal, and 6 did not specify age at presentation or were asymptomatic at diagnosis. Twenty-one cases had relevant family history. We summarize triggers of hyperammonemic episodes, diagnosis, clinical signs and symptoms, and management strategies. DNA testing is the preferred method of diagnosis, although therapeutic trials to assess response of ammonia levels to carbamylglutamate may also be helpful. Management usually consists of treatment with carbamylglutamate, although the reported maintenance dose varied across case reports. Protein restriction was sometimes used in conjunction with carbamylglutamate. Supplementation with citrulline, arginine, and sodium benzoate also were reported.
CONCLUSIONS
Presentation of NAGS deficiency varies by age and symptoms. In addition, both diagnosis and management have evolved over time and vary across clinics. Prompt recognition and appropriate treatment of NAGS deficiency with carbamylglutamate may improve outcomes of affected individuals. Further research is needed to assess the roles of protein restriction and supplements in the treatment of NAGS deficiency, especially during times of illness or lack of access to carbamylglutamate.
Topics: Amino-Acid N-Acetyltransferase; Ammonia; Humans; Hyperammonemia; Infant, Newborn; Urea Cycle Disorders, Inborn
PubMed: 33036647
DOI: 10.1186/s13023-020-01560-z -
Clinical and Experimental Hepatology Jun 2023Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits...
AIM OF THE STUDY
Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has shown benefit in some clinical trials. This review aimed to systematically analyze the efficacy of probiotics in the treatment of MHE.
MATERIAL AND METHODS
A systematic search of the electronic databases PubMed, Science Direct, and Cochrane Library was conducted for randomized controlled trials (RCTs) in adult patients with MHE who had been given probiotics intervention. The primary outcomes were reversal of MHE and improvement of neuropsychometric tests, while the secondary outcome was the reduction of serum ammonia.
RESULTS
Nine RCTs involving 776 MHE patients were included, consisting of 311 patients receiving probiotics and 465 patients receiving comparator (placebo or no treatment, lactulose, L-ornithine L-aspartate [LOLA], or rifaximin). The meta-analysis showed that probiotics significantly reversed MHE (OR = 3.95, < 0.0001, 95% CI: 2.05 to 7.60) compared with placebo or no treatment. Probiotics also significantly reduced serum ammonia compared with placebo (pooled mean difference -25.94, = 0.04, 95% CI: -50.21 to -1.66). However when compared to lactulose and LOLA, probiotics did not show a significant difference in reversal of MHE or reduction of serum ammonia levels.
CONCLUSIONS
Probiotics were more effective in reversal of MHE and reduced serum ammonia levels in patients with MHE compared to placebo or no treatment, but not more effective than lactulose or LOLA.
PubMed: 37502435
DOI: 10.5114/ceh.2023.128768 -
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 -
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 -
BMJ Open Apr 2022To determine the accuracy of metabolomics in predicting hypertensive disorders in pregnancy.
OBJECTIVE
To determine the accuracy of metabolomics in predicting hypertensive disorders in pregnancy.
DESIGN
Systematic review of observational studies.
DATA SOURCES AND STUDY ELIGIBILITY CRITERIA
An electronic literature search was performed in June 2019 and February 2022. Two researchers independently selected studies published between 1998 and 2022 on metabolomic techniques applied to predict the condition; subsequently, they extracted data and performed quality assessment. Discrepancies were dealt with a third reviewer. The primary outcome was pre-eclampsia. Cohort or case-control studies were eligible when maternal samples were taken before diagnosis of the hypertensive disorder.
STUDY APPRAISAL AND SYNTHESIS METHODS
Data on study design, maternal characteristics, how hypertension was diagnosed, metabolomics details and metabolites, and accuracy were independently extracted by two authors.
RESULTS
Among 4613 initially identified studies on metabolomics, 68 were read in full text and 32 articles were included. Studies were excluded due to duplicated data, study design or lack of identification of metabolites. Metabolomics was applied mainly in the second trimester; the most common technique was liquid-chromatography coupled to mass spectrometry. Among the 122 different metabolites found, there were 23 amino acids and 21 fatty acids. Most of the metabolites were involved with ammonia recycling; amino acid metabolism; arachidonic acid metabolism; lipid transport, metabolism and peroxidation; fatty acid metabolism; cell signalling; galactose metabolism; nucleotide sugars metabolism; lactose degradation; and glycerolipid metabolism. Only citrate was a common metabolite for prediction of early-onset and late-onset pre-eclampsia. Vitamin D was the only metabolite in common for pre-eclampsia and gestational hypertension prediction. Meta-analysis was not performed due to lack of appropriate standardised data.
CONCLUSIONS AND IMPLICATIONS
Metabolite signatures may contribute to further insights into the pathogenesis of pre-eclampsia and support screening tests. Nevertheless, it is mandatory to validate such methods in larger studies with a heterogeneous population to ascertain the potential for their use in clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42018097409.
Topics: Case-Control Studies; Female; Humans; Hypertension, Pregnancy-Induced; Mass Spectrometry; Metabolomics; Pre-Eclampsia; Pregnancy
PubMed: 35470187
DOI: 10.1136/bmjopen-2021-054697 -
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 -
Blood Purification 2021Hyperammonemia is a life-threatening condition. However, clearance of ammonia via extracorporeal treatment has not been systematically evaluated.
INTRODUCTION
Hyperammonemia is a life-threatening condition. However, clearance of ammonia via extracorporeal treatment has not been systematically evaluated.
METHODS
We searched EMBASE and MEDLINE databases. We included all publications reporting ammonia clearance by extracorporeal treatment in adult and pediatric patients with clearance estimated by direct dialysate ammonia measurement or calculated by formula. Two reviewers screened and extracted data independently.
RESULTS
We found 1,770 articles with 312 appropriate for assessment and 28 studies meeting eligibility criteria. Most of the studies were case reports. Hyperammonemia was typically secondary to inborn errors of metabolisms in children and to liver failure in adult patients. Ammonia clearance was most commonly reported during continuous renal replacement therapy (CRRT) and appeared to vary markedly from <5 mL/min/m2 to >250 mL/min/m2. When measured during intermittent hemodialysis (IHD), clearance was highest and correlated with blood flow rate (R2 = 0.853; p < 0.001). When measured during CRRT, ammonia clearance could be substantial and correlated with effluent flow rate (EFR; R2 = 0.584; p < 0.001). Neither correlated with ammonia reduction. Peritoneal dialysis (PD) achieved minimal clearance, and other extracorporeal techniques were rarely studied.
CONCLUSIONS
Extracorporeal ammonia clearance varies widely with sometimes implausible values. Treatment modality, blood flow, and EFR, however, appear to affect such clearance with IHD achieving the highest values, PD achieving minimal values, and CRRT achieving substantial values especially at high EFRs. The role of other techniques remains unclear. These findings can help inform practice and future studies.
Topics: Ammonia; Continuous Renal Replacement Therapy; Critical Illness; Humans; Hyperammonemia; Peritoneal Dialysis; Renal Dialysis; Renal Replacement Therapy
PubMed: 33279903
DOI: 10.1159/000512100