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Journal of Clinical Gastroenterology Jan 2022Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with liver failure and/or portal systemic shunting. Polyethylene glycol (PEG) electrolyte... (Meta-Analysis)
Meta-Analysis
Comparative Effectiveness and Safety of Polyethylene Glycol Electrolyte Solution Versus Lactulose for Treatment of Hepatic Encephalopathy: A Systematic Review and Meta-analysis.
BACKGROUND
Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with liver failure and/or portal systemic shunting. Polyethylene glycol (PEG) electrolyte solution is a commonly used for catharsis of gut, which has been demonstrated to relieve HE in a number of randomized controlled trials. The aim of this paper was to evaluate the comparative efficacy and safety of PEG with lactulose for current HE treatment.
METHODS
PEG electrolyte solution versus lactulose of HE was deeply studied by conducting a systematic search in electronic databases and other sources until December 31, 2020. The PRISMA statement recommended the use of meta-analysis with 95% confidence interval (CI), relative risk (RR), and weighted mean deviation (WMD) as the estimated effect size. A sensitivity analysis was performed comprehensively to present the risk of bias and the source of heterogeneity.
RESULTS
A total of 434 patients were involved in 7 randomized studies. It is found that there was a significant advantage of PEG therapy in the increase of clinical efficacy (RR=1.46; 95% CI: 1.26-1.68; P=0.000; I2=0.0%) and the decrease of hospital stay (WMD=-1.78; 95% CI: -2.72 to 0.85; P=0.000; I2=90.1%). There was no significant difference in the incidence of adverse events (RR=0.75; 95% CI: 0.48-1.19; P=0.222>0.05; I2=7.2%) and the level of serum ammonia (WMD=9.02; 95% CI: -14.39 to 32.43; P=0.45>0.05; I2=84.9%) after 24 hours between the 2 groups.
CONCLUSIONS
The results prove that PEG has a beneficial effect on the treatment of HE. Compared with lactulose, PEG can lead to more rapid HE resolution during the first 24 hours and shorten the length of stay without increasing the rate of adverse effects.
Topics: Electrolytes; Hepatic Encephalopathy; Humans; Lactulose; Polyethylene Glycols; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 34739404
DOI: 10.1097/MCG.0000000000001621 -
Animals : An Open Access Journal From... Jul 2021Since the approval by the European Medicines Agency in 2013 of a monensin controlled-release capsule (CRC) for the prevention of ketosis in dairy cows, there has been... (Review)
Review
Since the approval by the European Medicines Agency in 2013 of a monensin controlled-release capsule (CRC) for the prevention of ketosis in dairy cows, there has been widespread use across Europe. In recent decades, several papers have investigated the effects of monensin used as a CRC or as a feed additive to improve cattle energy metabolism and improve feed efficiency. Since the CRC is the only form of monensin permitted in Europe in dairy cows, the objective of this review was to report and summarize observations from the literature on the effects of this treatment in transition cows. The peer-reviewed literature published from 1997 was scanned, and papers written in English were evaluated for eligibility. Only papers evaluating the use of monensin in dairy cows for the prevention of ketosis during the transition period were reviewed. In total, 42 papers met the required criteria and were included in this review. The major findings focused on cow metabolism and health, rumen fermentation and milk production and quality. Overall, the review of the existing literature confirmed that monensin delivered as a CRC during the transition period has effects of different magnitude compared to other forms, doses or durations of administration. Studies agree on the antiketotic effects of this treatment, showing evidence of an increased propionate production in the rumen, reduced blood β-hydroxybutyrate, and improved liver function in treated cows, mainly resulting in reduced incidence of peripartum disease. On the contrary, the effects of CRC on ammonia production and rumen microflora are less robust than those reported for other forms. Of importance for the European market is the well-documented absence of any negative impact on milk and cheese production and composition using the CRC treatment.
PubMed: 34359115
DOI: 10.3390/ani11071988 -
Frontiers in Neuroscience 2021Hepatic encephalopathy (HE) is one of the most disabling metabolic diseases. It consists of a complication of liver disease through the action of neurotoxins, such as...
Hepatic encephalopathy (HE) is one of the most disabling metabolic diseases. It consists of a complication of liver disease through the action of neurotoxins, such as excessive production of ammonia from liver, resulting in impaired brain function. Its prevalence and incidence are not well known, although it has been established that up to 40% of cirrhotic patients may develop HE. Patients with HE episodes display a wide range of neurological disturbances, from subclinical alterations to coma. Recent evidence suggests that the resolution of hepatic encephalopathy does not fully restore cognitive functioning in cirrhotic patients. Therefore, the aim of this review was to evaluate the evidence supporting the presence of lingering cognitive deficits in patients with a history of HE compared to patients without HE history and how liver transplant affects such outcome in these patients. We performed two distinct meta-analysis of continuous outcomes. In both cases the results were pooled using random-effects models. Our results indicate that cirrhotic patients with a history of HE show clear cognitive deficits compared control cirrhotic patients (Std. Mean Difference (in SDs) = -0.72 [CI 95%: -0.94, -0.50]) and that these differences are not fully restored after liver transplant (Std. Mean Difference (in SDs) = -0.72 [CI 95%: -0.94, -0.50]).
PubMed: 33790729
DOI: 10.3389/fnins.2021.579263 -
Integrative Cancer Therapies 2021Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
METHODS
MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate.
RESULTS
20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87; = .006; number of RCTs, = 6; total sample size, N = 389; = 0%). BCAAs were also found to be beneficial for ascites (RR = 0.55; 95% CI = 0.35 to 0.86; = .008; = 4; N = 296; = 0%), body weight (MD = 3.24 kg; 95% CI = 0.44 to 6.04; = .02; = 3; N = 196; = 24%), and hospitalization length (MD = -2.07 days; 95% CI = -3.97 to -0.17; = .03; = 5; N = 362; = 59%). No differences were found between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level, and prothrombin time. No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified.
CONCLUSIONS
Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs.
PROSPERO REGISTRATION
CRD42018086168.
Topics: Amino Acids, Branched-Chain; Dietary Supplements; Humans; Neoplasm Recurrence, Local; Postoperative Complications; Quality of Life
PubMed: 33648360
DOI: 10.1177/1534735421997551 -
Minerva Anestesiologica Jun 2021The aim of this study was to summarize the incidence and risk factors of postoperative delirium (POD) after liver transplantation (LT) and associations of POD after LT... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The aim of this study was to summarize the incidence and risk factors of postoperative delirium (POD) after liver transplantation (LT) and associations of POD after LT with outcomes.
EVIDENCE ACQUISITION
A literature search of Pubmed, EMBASE, and the Cochrane Databases was performed to identify studies reporting POD after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect estimates were extracted and combined using random-effect model. Pooled mean differences and odds ratios for individual risk factors were calculated using inverse-variance method and Mantel-Haenszel method, as appropriate.
EVIDENCE SYNTHESIS
Eight articles with 1434 patients were included in the meta-analysis. Overall, the pooled estimated incidence rates of POD after LT were 30% (95% confidence interval: 20-39%). Fourteen statistically significant risk factors were identified in the pooled analysis: alcohol excess, preoperative renal replacement therapy (RRT), preoperative hospital length of stay (LOS), depression, hepatic encephalopathy, alcohol etiology of liver failure, Child-Turcotte-Pugh Score, APACHE II Score, MELD Score, preoperative INR, preoperative bilirubin, intraoperative use of fentanyl, intraoperative RBC transfusion, postoperative ammonia. Patients with POD had a significantly increased mechanical ventilation, postoperative RRT, LOS and mortality rate compared with those without POD.
CONCLUSIONS
POD after LT was common and multifactorial in etiology. There are significant associations of POD after LT with some clinical outcomes. Effective interventions during perioperative period may be promising to reduce the risk of POD after LT.
Topics: Delirium; Humans; Incidence; Liver Transplantation; Postoperative Complications; Risk Factors
PubMed: 33594873
DOI: 10.23736/S0375-9393.21.15163-6 -
Journal of Environmental Management Apr 2021The pathogen concentration in human excreta needs to be managed appropriately, but a predictive approach has yet to be implemented due to a lack of kinetics models for... (Meta-Analysis)
Meta-Analysis Review
The pathogen concentration in human excreta needs to be managed appropriately, but a predictive approach has yet to be implemented due to a lack of kinetics models for pathogen inactivation that are available under varied environmental conditions. Our goals were to develop inactivation kinetics models of microorganisms applicable under varied environmental conditions of excreta matrices and to identify the appropriate indicators that can be monitored during disinfection processes. We conducted a systematic review targeting previous studies that presented time-course decay of a microorganism and environmental conditions of matrices. Defined as a function of measurable factors including treatment time, pH, temperature, ammonia concentration and moisture content, the kinetic model parameters were statistically estimated using hierarchical Bayesian modeling. The inactivation kinetics models were constructed for Escherichia coli, Salmonella, Enterococcus, Ascaris eggs, bacteriophage MS2, enterobacteria phage phiX174 and adenovirus. The inactivation rates of a microorganism were predicted using the established model. Ascaris eggs were identified as the most tolerant microorganisms, followed by bacteriophage MS2 and Enterococcus. Ammonia concentration, temperature and moisture content were the critical factors for the Ascaris inactivation. Our model predictions coincided with the current WHO guidelines. The developed inactivation kinetics models enable us to predict microbial concentration in excreta matrices under varied environmental conditions, which is essential for microbiological risk management in emerging resource recovery practices from human excreta.
Topics: Ammonia; Bayes Theorem; Environmental Microbiology; Humans; Levivirus; Temperature
PubMed: 33582482
DOI: 10.1016/j.jenvman.2021.112088 -
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 -
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 -
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 -
PloS One 2020The choice of the most suitable litter treatment should be based on scientific evidence. This systematic review assessed the effectiveness of litter treatments on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The choice of the most suitable litter treatment should be based on scientific evidence. This systematic review assessed the effectiveness of litter treatments on ammonia concentration, pH, moisture and pathogenic microbiota of the litter and their effects on body weight, feed intake, feed conversion and mortality of broilers.
METHODS
The systematic literature search was conducted using PubMed (Medline), Google Scholar, ScienceDirect and Scielo databases to retrieve articles published from January 1998 to august 2019. Means, standard deviations and sample sizes were extracted from each study. The response variables were analyzed using the mean difference (MD) or standardized mean difference (SMD), (litter treatment minus control group). All variables were analyzed using random effects meta-analyses.
RESULTS
Subgroup meta-analysis revealed that acidifiers reduce pH (P<0.001), moisture (P = 0.002) ammonia (P = 0.011) and pathogenic microbiota (P <0.001) of the litter and improves the weight gain (P = 0.019) and decreases the mortality rate of broilers (P<0.001) when compared with controls. Gypsum had a positive effect on ammonia reduction (P = 0.012) and improved feed conversion (P = 0.023). Alkalizing agents raise the pH (P = 0.035), worsen feed conversion (P<0.001), increase the mortality rate (P <0.001), decrease the moisture content (P<0.001) and reduce the pathogenic microbiota of the litter (P<0.001) once compared to controls. Superphosphate and adsorbents reduce, respectively, pH (P<0.001) and moisture (P = 0.007) of the litter compared to control groups.
CONCLUSION
None of the litter treatments influenced the feed intake of broilers. Meta-analyses of the selected studies showed positive and significant effects of the litter treatments on broiler performance and litter quality when compared with controls. Alkalizing was associated with worse feed conversion and high mortality of broilers.
Topics: Acids; Alkalies; Ammonia; Animal Feed; Animal Husbandry; Animals; Bird Diseases; Body Weight; Chickens; Feeding Behavior; Housing, Animal; Humidity; Hydrogen-Ion Concentration; Microbiota; Waste Management; Weight Gain
PubMed: 32374780
DOI: 10.1371/journal.pone.0232853