Adiponectin as a biomarker in liver cirrhosis-A systematic review and meta-analysis.

INTRODUCTION: Adiponectin, a key adipokine, shows promise as a non-invasive biomarker for liver cirrhosis by reflecting inflammation and metabolic changes, but conflicting findings highlight the need for a systematic review and meta-analysis to clarify its role. Our study aimed to evaluate adiponectin levels across various stages of liver cirrhosis, compare them with other chronic liver diseases (CLD) and hepatocellular carcinoma (HCC), and assess its potential as a diagnostic and prognostic biomarker. METHODS: Our systematic search was conducted on September 2023 using PubMed, EMBASE and Scopus, searching for observational studies evaluating serum and plasma adiponectin levels in liver cirrhosis. Inclusion and exclusion criteria were applied, and study quality was assessed using the Newcastle-Ottawa Scale. To evaluate the overall effect size, we utilized a random-effects model along with a mean difference (MD) analysis. The principal summary outcome was the MD in adiponectin levels. RESULTS: We included 16 articles involving 2617 subjects in our qualitative and quantitative synthesis. We found significantly higher adiponectin levels in liver cirrhosis patients (8.181 [95% CI 3.676, 12.686]), especially in Child-Pugh B individuals (13.294 [95% CI 4.955, 21.634]), compared to controls. Child-Pugh A patients did not show significant differences compared to controls. In addition, adiponectin levels were significantly elevated in primary biliary cholangitis (PBC) patients compared to controls (8.669 [95% CI .291, 17.047]), as well as in liver cirrhosis compared to other CLD patients (4.805 [95% CI 1.247, 8.363]), including non-alcoholic fatty liver disease (NAFLD) (8.532 [95% CI 3.422, 13.641]), but not viral hepatitis. No significant MD was observed between liver cirrhosis and HCC patients. CONCLUSION: Adiponectin levels are significantly elevated in liver cirrhosis, especially in advanced stages, potentially serving as a biomarker for advanced cirrhosis. Adiponectin also differentiates cirrhosis from other CLD, including NAFLD. However, its role in distinguishing cirrhosis from viral hepatitis and HCC is limited.

Exploring the Role of Hemogram-Derived Ratios and Liver Fibrosis Scores in Pulmonary Fibrosis.

Background and Objectives: Pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF) and secondary pulmonary fibrosis (SPF), is a progressive lung disease that significantly impairs respiratory function. Accurate differentiation between IPF and SPF is crucial for effective management. This study explores the association between pulmonary fibrosis and hepatic conditions, evaluating the utility of various hemogram-derived ratios and hepatic fibrosis scores in distinguishing between IPF and SPF. Materials and Methods: We conducted a retrospective study involving patients diagnosed with IPF or SPF at the "Leon Daniello" Clinical Hospital of Pneumology in Cluj-Napoca, Romania. Pulmonary fibrosis was confirmed via imaging techniques, and hepatic steatosis and fibrosis were assessed using non-invasive scores. We analyzed clinical, laboratory, and pulmonary function data, focusing on hemogram-derived ratios and hepatic scores. Statistical analyses, including ROC curves, were used to evaluate the effectiveness of these biomarkers in differentiating IPF from SPF. Results: We included a total of 38 patients with IPF and 28 patients with SPF. Our findings revealed that IPF patients had a significantly higher FIB-4 score compared to SPF patients, suggesting increased hepatic fibrosis risk in IPF, as well as an increased RDW/PLT ratio. Conversely, SPF patients exhibited elevated PLR, PNR, and SII, reflecting a more pronounced inflammatory profile. PLR and PNR demonstrated the highest discriminatory ability between IPF and SPF, while traditional hepatic fibrosis scores showed limited differentiation capabilities. No significant differences in pulmonary function tests were observed across hepatic fibrosis risk categories. Conclusions: The study highlights the value of biomarkers like PLR and PNR in differentiating between IPF and SPF, offering additional diagnostic insights beyond traditional imaging. Integrating hepatic assessments into the management of pulmonary fibrosis could improve diagnostic accuracy and patient care.

Silent Struggles Within: Alexithymia Unveiled in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

Background/Aims: In recent years, the presence of alexithymia in patients with irritable bowel syndrome (IBS) has gained more attention, and several studies have evaluated this relationship. However, no clear conclusion has been reported yet. Therefore, we conducted a systematic review and meta-analysis to better understand the association between IBS and alexithymia. Methods: We performed a systematic search on the medical databases PubMed, EMBASE, and Scopus using predefined keywords to identify observational studies assessing the association between IBS and alexithymia. The included studies diagnosed IBS using the Rome criteria, and alexithymia was evaluated using the 20-item Toronto Alexithymia Scale (TAS-20) score. We used The Newcastle-Ottawa Scale to evaluate the quality of included studies. The primary summary outcome was the mean difference in TAS-20 scores. Results: We included 7 studies involving 1,513 individuals in our qualitative analysis, with 6 of them included in our quantitative analysis. All studies were considered to be of satisfactory quality according to the Newcastle-Ottawa Scale criteria. We found significantly higher TAS-20 scores in IBS patients compared to controls (8.063 [95% CI, 2.554-13.572]). However, no significant mean difference in TAS-20 scores was observed in IBS vs inflammatory bowel disease patients (0.884 [95% CI -2.536-4.304]). Conclusions: We demonstrated that IBS is associated with an increased risk of developing alexithymia. However, our study did not show a significant difference in TAS-20 scores between patients with IBS compared to inflammatory bowel disease.

Unlocking the potential of biomarkers: The promise of adrenomedullin and its precursors in diagnosing and assessing heart failure.

BACKGROUND: Several studies have examined the potential of adrenomedullin (ADM), pro-adrenomedullin (Pro-ADM), and mid-regional-pro-ADM (MR-Pro-ADM) as biomarkers for diagnosing and assessing the severity of heart failure (HF), with conflicting results. We aimed to investigate their diagnostic utility and their correlation with HF severity based on the New York Heart Association (NYHA) classification. METHODS: We searched PubMed, EMBASE, and Scopus using a predefined search string. The quality assessment of included studies was conducted using the Newcastle Ottawa Scale (NOS), and the primary outcome was the mean difference (MD) in serum levels of ADM, Pro-ADM, and MR-Pro-ADM, in addition to the area under the curve (AUC). RESULTS: A total of 28 articles fulfilled our inclusion criteria and were included in our qualitative and quantitative synthesis, with a total of 15,405 subjects. Significant MD in ADM levels in HF patients vs. controls (6.024 [95 % CI 1.691, 10.356]), NYHA I vs. controls (-1.202 [95 % CI -2.111, -0.292]), NYHA IV vs. controls (-7.536 [95 % CI -12.680, -2.393]), NYHA III vs. NYHA IV (-4.438 [95 % CI -7.612, -1.263]), and NYHA I-II vs NYHA III-IV (-2.351 [95 % CI -4.361, -0.341]) were observed. Moreover, a significant MD was observed in pro-ADM levels in NYHA I-II patients vs. controls (-0.960 [95 % CI -1.479, -0.440]), NYHA III-IV vs. controls (-1.979 [95 % CI -2.958, -1.000]), and NYHA I-II vs. NYHA III-IV (-0.966 [95 % CI -1.407, -0.526]). Furthermore, MR-Pro-ADM levels were significantly different in NYHA I-II vs. NYHA III-IV (-0.428 [95 % CI -0.492, -0.365]). MR-Pro-ADM predicted HF with an AUC of 0.781 (95 % CI 0.755, 0.806). CONCLUSIONS: Among HF patients, there was a significant increase in ADM levels compared to control subjects, and these levels increased with the progression of NYHA classes. Similarly, both Pro-ADM and MR-Pro-ADM displayed higher concentrations in NYHA class III-IV HF patients compared to those in NYHA class I-II. However, MR-Pro-ADM exhibited lower accuracy in predicting HF compared to established biomarkers.

Self-Perceived Lactose Intolerance Versus Confirmed Lactose Intolerance in Irritable Bowel Syndrome: A Systematic Review.

BACKGROUND AND AIMS: Disorders of gut-brain interaction (DGBI) are prevalent, affecting 20-40% of the population, with irritable bowel syndrome (IBS) being the most common and impactful. While congenital lactose intolerance is rare, lactase deficiency in adults is widespread, causing gastrointestinal symptoms like bloating and diarrhea. Self-perceived lactose intolerance often overestimates symptoms, impacting dietary choices and quality of life, necessitating better understanding and management for improved patient outcomes. This article evaluates the diagnostic accuracy of self-reported lactose intolerance in patients with lactose intolerance and IBS through a systematic review. METHODS: A systematic literature search was conducted using PubMed, EMBASE, and SCOPUS, including terms related to IBS, lactose intolerance, and self-reported symptoms, without applying filters to ensure comprehensive coverage. Inclusion criteria focused on observational studies with adult participants diagnosed with lactose intolerance, addressing symptoms and lactose malabsorption, while excluding non-English articles, reviews, editorials, and studies involving pediatric subjects. RESULTS: The systematic review analyzed six studies with 845 participants, revealing significant variability and moderate accuracy in self-reported lactose intolerance for diagnosing actual lactose intolerance in IBS patients. Hydrogen breath tests (HBTs) showed that self-reported symptoms often led to false positives, underscoring the need for objective diagnostic tools and standardized criteria. The findings highlight the complexity of diagnosing lactose intolerance in IBS patients and suggest that lactose-free diets and routine HBT should not be recommended without clear indications. CONCLUSIONS: The rigorous selection process ensured the inclusion of high-quality, relevant studies, thereby enhancing the reliability and validity of the review's findings. These studies revealed that a lactose-free diet should not be routinely recommended for IBS patients, nor should the routine use of HBT to identify lactose malabsorption in this group. Future research should focus on better understanding the factors influencing lactose perception and tolerance, which is crucial for more effective management of lactose intolerance in IBS patients.

The Use of Proton Pump Inhibitors in Patients with Liver Cirrhosis: Real Life Experience.

(1) Background: Proton pump inhibitors (PPIs) are commonly prescribed for gastric disorders. In patients with liver cirrhosis, PPI use is associated with an increased risk of spontaneous bacterial peritonitis and increased mortality rates; therefore, they should be used with caution. This study aims to evaluate the appropriateness of PPI prescriptions in hospitalized cirrhotic patients against current clinical guidelines to identify patterns of misuse and guide better prescribing practices. (2) Methods: A retrospective study was conducted on liver cirrhosis inpatients in an internal medicine department from January 2022 to May 2023. The primary measure was the proportion of PPI prescriptions aligned with clinical guidelines. Medical files were entirely reviewed by researchers to assess the appropriateness of PPI prescriptions using the current guidelines. Outcomes included the identification of common reasons for PPI prescription and the rate of inappropriate PPI use among the study population. (3) Results: The study included 189 cirrhotic patients, with PPIs prescribed to 95 (50.2%) patients during hospitalization and 75 (39.7%) patients at discharge. Among those, 47.4% of the inpatients and 34.7% at discharge had no valid indication for PPI administration. The most common reason for PPI prescription during hospital stays was gastritis, followed by antiplatelet use in high-risk patients, ulcers, and upper gastrointestinal bleeding. The most common inappropriate indication was portal hypertensive gastropathy (PHG), followed by treatment with corticosteroids and anticoagulants alone. We did not find an association between PPI administration during hospital stays and infections. Only in 4% of cases patients should have received PPIs and did not. (4) Conclusions: There is a concerning overprescription of PPIs in cirrhotic patients, often deviating from established guidelines. It subjects patients to unnecessary risks. There is an urgent need for increased awareness and adherence to clinical guidelines regarding PPI prescriptions in cirrhotic patients.

The Role of Adipokines in Chronic Pancreatitis. A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Adipokines are among the biomarkers that have been studied in chronic pancreatitis (CP), as well as in pancreatic cancer (PC). So far, the existing findings are contradictory and inconclusive. Therefore, we assessed the levels of three major adipokines in CP in comparison to controls and PC, adiponectin, leptin, and resistin. METHODS: A systematic electronic search was carried out in November 2022 using PubMed, Embase, and Scopus, reviewing observational studies. By using the Newcastle-Ottawa Scale, the included studies' quality was evaluated (NOS). In the examination of the estimated overall effect size, we employed the random-effects model in conjunction with the mean difference (MD) analysis. The MD with 95% confidence interval (CI) served as the primary summary outcome. RESULTS: Our systematic review included a total of 14 studies, out of which nine were considered in our meta-analysis. A significant MD related to leptin levels in CP patients vs. controls (-1.299, 95%CI: -2.493 - -0.105), resistin levels in CP patients vs. controls (8.356, 95%CI: 3.700-13.012), and adiponectin levels in PC patients vs. controls (11.240, 95%CI: 5.872-16.60) was reported. However, no significant MD was reported in leptin levels between CP vs. PC patients (-0.936, 95%CI: -3.325-1.454), as well as adiponectin levels in CP patients vs. controls (0.422. 95%CI -5.651-6.535]) and in CP vs. PC patients (-6.252, 95%CI -13.269-0.766). CONCLUSIONS: CP was significantly associated with decreased leptin levels and increased resistin levels. Furthermore, increased levels of adiponectin are associated with PC. Yet, no significant MD was seen for leptin and adiponectin levels between CP and PC patients, and likewise for adiponectin levels between CP patients and controls. Results should be interpreted with caution due to the high heterogeneity between the included studies.

Prevalence of Celiac Disease in Romania.

BACKGROUND AND AIMS: Celiac disease (CD) is an autoimmune disorder that targets the small intestine, triggered by the ingestion of gluten in genetically predisposed individuals, causing damage to the villi and impairing nutrient absorption. Despite increased awareness and improved diagnostic techniques, CD remains significantly underdiagnosed, with many individuals suffering from unexplained symptoms or misdiagnosed conditions. This study aims to investigate the prevalence and demographic characteristics of CD in a Romanian population using rapid diagnostic tests followed by histological confirmation. METHODS: This cross-sectional study aimed to determine the prevalence of CD in Romania using the BIOHIT Celiac Quick Test among adult participants recruited from tertiary healthcare centers and medical institutions. The prevalence of CD was calculated by dividing the number of confirmed positive cases by the total number of participants, with further evaluation including endoscopy and histological examination for those with positive quick test results. To our knowledge, this is the first prospective study in Romania to assess the prevalence of CD using a serological test. RESULTS: Out of 713 participants from Romania, 9 tested positive for CD using a rapid diagnostic test, confirmed by histological examination, resulting in a prevalence rate of 1.26%. The mean age of the CD-positive group was significantly younger (30.3 years) compared to the general population (49.2 years), and they had a lower mean BMI (22.2 vs. 28.1). Most CD-positive patients were female (66.7%) and resided in urban areas (55.6%). CONCLUSIONS: Our study found the prevalence of CD in a Romanian population to be slightly higher than the global average, highlighting the effectiveness of rapid diagnostic tests followed by histological confirmation. The significant regional variability in CD prevalence suggests the need for further research into environmental, dietary, and genetic factors, along with enhanced awareness and improved diagnostic protocols to better manage and prevent long-term complications of CD.

Extra-digestive manifestations of celiac disease.

Introduction: Celiac disease (CD) is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals, presenting with a diverse range of symptoms that extend beyond the gastrointestinal tract. The condition's systemic nature is evidenced by its extra-digestive manifestations, which can affect various organs including the skin, joints, liver, and nervous system. Methods: This descriptive, retrospective study was conducted at a tertiary care center, focusing on adult patients diagnosed with CD who exhibited extra-digestive symptoms. Data were extracted from medical records of patients admitted between January 1, 2010 and June 30, 2024. Variables included demographic information, primary diagnosis, and associated extra-digestive manifestations. Descriptive statistical methods were employed for data analysis. Results: The sample included 108 patients with CD, the mean age was 43.21 years, with a predominance of females (76.85%). Iron deficiency anemia was the most common extra-digestive manifestation, affecting 20.37% of patients, followed by hypoproteinemia (18.52%) and Hashimoto's thyroiditis (14.81%). Co-occurrence analysis revealed frequent combinations of conditions, such as anemia with cardiovascular diseases and depressive disorders. Notable associations with neurological conditions like gluten ataxia and peripheral neuropathy were also observed. Conclusion: This study highlights the extensive extra-digestive manifestations of celiac disease, underscoring its systemic impact. The high prevalence of autoimmune conditions such as Hashimoto's thyroiditis and rheumatoid polyarthritis among CD patients reflects the need for holistic management strategies. Discrepancies between our findings and existing literature, particularly regarding skin and neurological conditions, emphasize the need for further research to better understand these associations and the long-term effects of a gluten-free diet.

Comparative Prevalence of Ineffective Esophageal Motility: Impact of Chicago v4.0 vs. v3.0 Criteria.

Background and Objectives: The threshold for ineffective esophageal motility (IEM) diagnosis was changed in Chicago v4.0. Our aim was to determine IEM prevalence using the new criteria and the differences between patients with definite IEM versus "inconclusive diagnosis". Materials and Methods: We retrospectively selected IEM and fragmented peristalsis (FP) patients from the high-resolution esophageal manometries (HREMs) database. Clinical, demographic data and manometric parameters were recorded. Results: Of 348 HREMs analyzed using Chicago v3.0, 12.3% of patients had IEM and 0.86% had FP. Using Chicago v4.0, 8.9% of patients had IEM (IEM-4 group). We compared them with the remaining 16 with an inconclusive diagnosis of IEM (borderline group). Dysphagia (77% vs. 44%, Z-test = 2.3, p = 0.02) and weight loss were more commonly observed in IEM-4 compared to the borderline group. The reflux symptoms were more prevalent in the borderline group (87.5% vs. 70.9%, p = 0.2). Type 2 or 3 esophagogastric junction morphology was more prevalent in the borderline group (81.2%) vs. 64.5% in IEM-4 (p = 0.23). Distal contractile integral (DCI) was lower in IEM-4 vs. the borderline group, and resting lower esophageal sphincter (LES) pressure and mean integrated relaxation pressure (IRP) were similar. The number of ineffective swallows and failed swallows was higher in IEM-4 compared to the borderline group. Conclusions: Using Chicago v4.0, less than 10% of patients had a definite diagnosis of IEM. The dominant symptom was dysphagia. Only DCI and the number of failed and inefficient swallows were different between definite IEM patients and borderline cases.

Gemini-Assisted Deep Learning Classification Model for Automated Diagnosis of High-Resolution Esophageal Manometry Images.

Background/Objectives: To develop a deep learning model for esophageal motility disorder diagnosis using high-resolution manometry images with the aid of Gemini. Methods: Gemini assisted in developing this model by aiding in code writing, preprocessing, model optimization, and troubleshooting. Results: The model demonstrated an overall precision of 0.89 on the testing set, with an accuracy of 0.88, a recall of 0.88, and an F1-score of 0.885. It presented better results for multiple categories, particularly in the panesophageal pressurization category, with precision = 0.99 and recall = 0.99, yielding a balanced F1-score of 0.99. Conclusions: This study demonstrates the potential of artificial intelligence, particularly Gemini, in aiding the creation of robust deep learning models for medical image analysis, solving not just simple binary classification problems but more complex, multi-class image classification tasks.

Meditation-Based Therapies for Chronic Neuropathy: A Systematic Review and Meta-Analysis.

Mind-body therapies have been found to be effective in a variety of pathologies. The purpose of this study was to evaluate the efficacy of meditation-based therapies in relieving the symptoms severity, quality of life, stress and other associated mood conditions, in individuals with chronic neuropathy of various etiologies. A systematic review of randomized controlled trials, involving adult patients with persistent peripheral neuropathy, was performed. Seven article databases were searched. A meta-analysis was conducted to assess the benefits of meditation-based therapy on symptomatology, quality of life, anxiety, depression, perceived stress, sleep quality and mindfulness score. Ten of the 1133 reviewed papers were selected for quantitative review. The meditation group had a lower standardized mean difference (SMD) score (-0.47 (95% CI: -0.97 to 0.02), p=0.062) for neuropathic pain severity score; lower anxiety scores (-2.5 (95% CI: -3.68 to -1.32), p=<0.001); lower depression scores (-1.53 (95% CI: -2.12 to -0.93), p=<0.001); lower perceived stress (-1.06 (95% CI: -3.15 to 1.04), p=0.323); higher quality of life scores (2.19 (95% CI: -0.65 to 5.03), p=0.13); lower sleep quality scores (-1.27 (95% CI: -4.22 to 1.67), p=0.397); higher mindfulness scores (6.71 (95% CI: 4.09 to 9.33), p=<0.001); and lower pain severity at 1 to 1.5 follow up (-1.75 (95% CI: -2.98 to -0.51), p=0.006). Some of the results were characterized by a substantial, statistically significant heterogeneity. Nevertheless, a major part of the results pointed in the same direction, improving symptomatology with meditation-based therapy. The studies had a risk of bias mostly regarding the measurement of the outcome, randomization process and selection of the reported result. The current study discovered that the meditation group had significantly lower pain (at 1 to 1.5 months follow-up) anxiety, and depression scores and higher mindfulness scores at the end of the interventions.

Mental Disorders, Social Media Addiction, and Academic Performance in Romanian Undergraduate Nursing Students.

Introduction: We aimed to evaluate social media addiction in Romanian undergraduate nursing students and its association with academic performance, depression, and anxiety. Methods: We used a cross-sectional online survey to collect data among nursing undergraduate students enrolled at the University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. The Social Media Addiction Scale-Student Form (SMAS-SF), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) were used to assess social media addiction, depression, and anxiety, respectively. Results: A total of 90 nursing students participated in the study, of which 82 (91.1%) were females and 81 (90%) were of Romanian ethnicity. The median age of participants was 21 years (18-40). Males showed higher BDI total scores, SMAS-SF total scores, and STAI scale A state anxiety compared to females, and females showed higher STAI scale A trait anxiety compared to males, although these results were not statistically significant. Also, we found no significant difference in these variables between participants from different study years. Participants with no or mild depression had a significantly higher academic performance (p-value = 0.001), lower SMAS-SF (p-value = 0.004), and lower STAI scores (p-value < 0.001) compared to participants with borderline, moderate, or severe depression after performing multivariate regression analysis. Conclusions: Our study demonstrated that depression was significantly associated with social media addiction, anxiety, and lower academic performance in Romanian undergraduate nursing students.

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international st.

Background/Aims: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC). Methods: An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up. Results: Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04-1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03-1.26; P=0.014, respectively). Conclusions: In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

Clostridioides difficile Infection: Use of Inflammatory Biomarkers and Hemogram-Derived Ratios to Predict Mortality Risk in Hospitalized Patients.

BACKGROUND: Clostridioides difficile infection (CDI) is a significant cause of mortality, especially in healthcare environments. Reliable biomarkers that can accurately predict mortality in CDI patients are yet to be evaluated. Our study aims to evaluate the accuracy of several inflammatory biomarkers and hemogram-derived ratios in predicting mortality in CDI patients, such as the neutrophil-to-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), the platelet-to-neutrophil ratio (PNR), the derived neutrophil-to-lymphocyte ratio (dNLR), C-reactive protein (CRP), the platelet-to-lymphocyte ratio (PLR), and procalcitonin (PCT). RESULTS: NLR showed a sensitivity of 72.5% and a specificity of 58.42% with an area under curve (AUC) = 0.652. SII had a sensitivity of 77.5%, a specificity of 54.74%, and an AUC = 0.64. PNR, neutrophils, dNLR, and lymphocytes had lower AUCs which ranged from 0.595 to 0.616, with varied sensitivity and specificity. CRP, leukocytes, and platelets showed modest predictive values with AUCs below 0.6. PCT had a sensitivity of 100%, a low specificity of 7.41%, and an AUC = 0.528. METHODS: We conducted a retrospective analysis of CDI patients from two different hospital settings in Italy and Romania during the COVID-19 pandemic, from 1 January 2020 to 5 May 2023. Statistical analyses included t-tests, Wilcoxon rank-sum tests, χ2 tests, and multivariate logistic regression to identify predictors of mortality. ROC analysis assessed the accuracy of biomarkers and hemogram-derived ratios. A p value < 0.05 was considered significant. CONCLUSIONS: Neutrophils, dNLR, NLR, SII, and PNR are valuable biomarkers for predicting mortality in CDI patients. Understanding these predictors can improve risk stratification and clinical outcomes for CDI patients.

Breaking Barriers in Functional Dyspepsia: A Systematic Review and Meta-analysis on Duodenal Tight Junction Protein Expression.

Background/Aims: Disruptions in tight junction (TJ) protein expression leading to duodenal epithelial barrier impairment may contribute to increased intestinal permeability, potentially playing a role in functional dyspepsia (FD) pathophysiology. Currently published studies evaluated the role of several TJ proteins in FD patients with inconsistent results. Therefore, we conducted this systematic review and metaanalysis to evaluate the duodenal mucosal expression of several TJ proteins in FD. Methods: We performed a systematic electronic search on PubMed, EMBASE, and Scopus using predefined keywords. Diagnosis of FD by Rome III or Rome IV criteria was considered acceptable. Full articles satisfying our inclusion and exclusion criteria were included. The principal summary outcome was the mean difference of several TJ proteins in FD patients and control subjects. Results: A total of 8 and 5 studies were included in our qualitative and quantitative synthesis, respectively, with a total population of 666 participants, out of which 420 were FD patients. No significant differences were observed between FD patients and controls in the expression of claudin-1 (-0.102 [95% CI, -0.303, 0.099]), claudin-2 (0.161 [95% CI, -0.134, 0.456)], claudin-3 (0.278 [95% CI, -0.280, 0.837]), claudin-4 (0.045 [95% CI, -0.264, 0.354]), ZO-1 (-0.221 [95% CI, -0.683, 0.241]), ZO-2 (-0.070 [95% CI, -0.147, 0.007]), ZO-3 (-0.129 [95% CI, -0.376, 0.118]), ß-catenin (-0.135 [95% CI, -0.484, 0.214]), E-cadherin (-0.083 [95% CI, -0.229, 0.063]), and occludin (-0.158 [95% CI, -0.409, 0.093]). Conclusions: The expressions of all evaluated proteins including claudin-1, claudin-2, claudin-3, claudin-4, ZO-1, ZO-2, ZO-3, ß-catenin, E-cadherin, and occludin did not significantly differ between FD patients and controls. However, due to the limited number of included studies, results should be interpreted with caution.

Meditation and Compassion Therapy in Psychiatric Disorders: A Pilot Study.

Introduction Our study aimed to compare meditation and compassion-based group therapy with the standard of care in patients with eating disorders, drug addiction, alcohol addiction, and depression, concerning acceptance, mindfulness awareness, self-compassion, and psychological distress. Methods A controlled designed study was performed, comparing meditation and compassion-focused group therapy added to the standard of care with the standard of care alone, on patients with eating disorders, drug addiction, alcohol addiction, and mood disorders. Four validated questionnaires were administered: the Acceptance and Action Questionnaire-II (AAQ-II), which assesses the ability to be fully in touch with the present moment; the Mindful Attention Awareness Scale (MAAS), which assesses the ability to experience consciously what is happening in the present moment; the Self-Compassion Scale (SCS), which assesses self-compassion characteristics, including loving-kindness; and the Symptom Checklist-90 (SCL-90), which measures psychological distress (anxiety, depression, psychotic behavior, etc.). Results There was a total of 75 subjects, out of which 48 represented the experimental group, and 27 represented the control group. The overall mean age of the subjects was 44.8 ± 13.2 years. There were statistically significant increases in the experimental group (baseline vs. end of study) for the AAQ-II, MAAS, and SCS scores, and a statistically significant decrease in the SCL-90 score. In the control group, there was a statistically significant decrease in the SCL-90 score, but no significant differences for other measurements. The comparisons between the two groups at the end of the study were as follows: AAQ-II: 0.7 (-5.74 to 7.15), p = 0.827; MAAS: 4.78 (-3.19 to 12.75), p = 0.233; SCS: 5.89 (-3.18 to 14.96), p = 0.199; SCL-90: -0.26 (-0.62 to 0.1), p = 0.157. Conclusion Within the experimental group, all scales improved statistically significantly. There were no statistically significant differences at the end of the study concerning the four scales between the groups. The comparison between groups was limited by data availability.

Evaluation of Google Search Trends for Liver Diseases in Europe.

BACKGROUND AND AIMS: Chronic liver diseases belong to the most common diseases worldwide and are associated with increased morbidity and mortality. Although more than one in three adults are estimated to have metabolic dysfunction-associated steatotic liver disease (MASLD), awareness of this condition is low amongst the general public, health care professionals and policy makers. However, meaningful knowledge transfer is essential for raising awareness and improving prevention and treatment. This study set out to investigate the use of the major internet search engine to understand how knowledge transfer has evolved by analyzing liver-related searches trends. METHODS: We investigated Google search trends by measuring the number of hits relating to liver diseases between 2004 and 2021 in seven languages and European countries but also worldwide. All analyses were performed in R using the R Google trends package gtrendsR. RESULTS: We found that interest in MASLD [formerly non-alcoholic fatty liver disease (NAFLD)] has generally increased over time, but that interest in metabolic associated steatohepatitis (MASH) - the most severe form of MASLD - has decreased. Interest in viral hepatitis C has decreased, whereas the number of queries regarding viral hepatitis B have been stable but dominated by interest in vaccination for it. Recent medical developments (in viral hepatitis) did not lead to a noticeable change in overall search behavior. Users preferred searching using their native language and less complex medical terms and acronyms (e.g., fatty liver instead of NAFLD). CONCLUSIONS: In the last two decades, Google search trends have followed the general development in the field of hepatology. Searches were dominated by non-experts and are not being rapidly influenced by novel scientific developments. Also, users preferred search terms in their native languages rather than English and tended to avoid complex medical search terms. Awareness and communication strategies around MASLD should consider these preferences when addressing the general public.

A Hidden Cause of Hypertransaminasemia: Liver Toxicity Caused by Chelidonium Majus L. : Report of Two Cases of Herb-Induced Liver Injury and Literature Review.

BACKGROUND: In instances where individuals manifest elevated transaminase levels without a clearly discernible cause, a comprehensive patient history proves invaluable in unveiling latent triggers. In this report, we present 2 cases of herb-induced liver injury (HILI) characterized by severe hypertransaminasemia attributed to the consumption of Chelidonium majus L . (also known as greater celandine [GC]), an agent considered an alternative therapeutic remedy. AREAS OF UNCERTAINTY: Exploring the occurrence and range of clinical manifestations in HILI linked to Chelidonium majus L ., while also investigating the potential triggers and predisposing factors for hepatotoxic reactions post Chelidonium majus L. usage, remains challenging due to the absence of definitive laboratory tests to identify the causative agent. DATA SOURCES: Two case reports were detailed, and a systematic literature review using PubMed was conducted including published literature till March 2023. Moreover, a manual search of reference lists of pertinent articles was performed to identify any additional relevant missed publications. RESULTS: In the first case, a 64-year-old woman presented with jaundice, revealing a 1-month history of using GC capsules to manage gallstones. Diagnostic assessment identified HILI, gallstones, and choledocolithiasis, with transaminase levels exceeding 1000 IU/L. After discontinuing GC and receiving intravenous therapy with amino acids and phospholipids, the patient's condition significantly improved. Subsequently, she underwent endoscopic common bile duct stone removal and cholecystectomy. In the second case, a 66-year-old woman presented with elevated liver function test results discovered incidentally during musculoskeletal pain evaluation. Upon further questioning, the patient disclosed regular consumption of GC tea for "health promotion." Following intravenous therapy using amino acids and phospholipids, her transaminase levels returned to normal. The literature review identified 38 cases of HILI associated with GC preparations, primarily in adult women aged 27-77 years, with a predominant reporting location in Germany. Various forms of GC were used, with treatment durations ranging from 1 week to a year. Discontinuation of GC generally led to recovery in these cases. CONCLUSION: Chelidonium majus L ., a potent herb often used in alternative medicine, has significant hepatotoxic potential, requiring physicians to be vigilant in cases of unexplained liver injury.

Are adipokines related to COVID-19 and its severity? A systematic review and meta-analysis.

Introduction: The relationship between several adipokines and COVID-19 severity has lately been evaluated, results being inconclusive. Therefore, we aimed to assess the association between adipokines in COVID-19 and its severity. Methods: A search was performed in PubMed, Scopus, and Embase using predefined keywords. The Newcastle of Ottawa Scale (NOS) was used for the quality assessment of included studies. The main summary outcome was the mean difference (MD) in adipokine levels. Results: A total of 8 studies involving 473 individuals were included. A significant MD in serum adiponectin levels was demonstrated in mild vs. severe COVID-19 patients (-5.734 [95% CI -11.215 - -0.252]), with no significant MD in mild vs. moderate (-7.117 [95% CI -19.546 - 5.313]), or moderate vs. severe COVID-19 (-1.846 [95% CI -4.516 - 0.824]). Moreover, no significant MD was found in adiponectin and leptin levels when comparing COVID-19 patients vs. controls (-12.675 [95% CI -36.159 - 10.808]) and (8.034 [95% CI -10.403 - 26.471]), respectively. Conclusion: Adiponectin levels were significantly increased in patients with severe compared to mild COVID-19. However, no significant MD was found in adiponectin levels in mild vs. moderate and moderate vs. severe COVID-19 patients, nor in adiponectin and leptin levels in COVID-19 patients vs. controls.