Comparative effectiveness of metabolic and bariatric surgeries: a network meta-analysis.

Bariatric surgery is recommended for patients with unhealthy weight. Our study aim to compare and rank different bariatric surgical approaches in reducing weight parameters. We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science databases from inception to September 2023. We extracted all outcomes as mean change from the baseline. The mean difference and 95% confidence interval were used as a summary measure. All analysis was conducted with R version 4.2.2 (2022-10-31) and R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.). Included surgeries were: Biliopancreatic diversion (BPD-RYGB), Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Gastric Plication (LGP), Duodenal-Jejunal Bypass Sleeve (DJBS), Single-anastomosis gastric bypass (SAGB), Laparoscopic vertical banded gastroplasty (LVBG), Sleeve Gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Gastric plication, Biliopancreatic diversion (BPD), and Intra-gastric balloon (IGB). Only clinical trials were included, with outcomes focused on weight parameters such as reductions in BMI (kg/m²), weight (kg), waist circumference (cm), fat mass (kg), and excess weight loss (EWL) (%). Our analysis of 67 studies showed that SADI-S was the best surgical technique in decreasing BMI (kg/m2) (MD = -18.06; 95% CI [-25.31; -10.81]) and DS follows in efficacy with a P-score (MD = -18.88; 95% CI [-31.15; -6.62]) however the pooled analysis was heterogeneous (I2 = 98.5%). For weight (kg), waist circumference (cm), and fat mass (kg), BPD-RYGB was the best surgical technique to reduce these parameters (MD = -41.48; 95% CI [-47.80, -35.51], MD = -29.08; 95% CI [-37.16, -21.00], and MD = -31.11; 95% CI [-38.77, -23.46]; respectively). The pooled analysis was heterogeneous except in fat mass (I2 = 0%, p-value = 0.8). Our network meta-analysis showed that the best surgical technique in increasing EWL (%) was RY-DS (MD = -61.27; % CI [-91.72; -30.82]) the next one in efficacy according to P-score was LVBG (MD = -59.03; % CI [-84.47; -33.59]). SADI-S is most effective in reducing BMI followed by RYGB. DS was associated with most estimated weight loss %.

Relationship between sarcopenia and metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) formerly known as Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease. Identifying MASLD risk factors could help early intervention and reduce the burden of the disease. Previous studies investigated the association between sarcopenia and NAFLD. Several trials were published after the last meta-analysis with indecisive results. This is an updated meta-analysis which aims to assess the association between sarcopenia, MASLD, and MASLD-related fibrosis. MATERIALS AND METHODS: Relevant trials published on PubMed, Web of Science, Scopus, and Cochrane Library databases until October 2022 were included. We included studies in which skeletal mass index (SMI) or sarcopenia was compared between patients with and without NAFLD now MASLD. Also, studies comparing fibrosis between MASLD patients with and without sarcopenia were included. Data were pooled as odds ratios (ORs) and 95 % confidence intervals (CIs) using Review Manager Software. RESULTS: A total of 25 studies were included. The incidence of sarcopenia was significantly higher in MASLD than controls (OR, 1.25; 95 % CI, 1.08-1.44; P = 0.003). SMI odds showed no significant difference between MASLD patients and controls (OR, 1.02; 95 % CI, 0.91-1.15; P = 0.7). MASLD patients with sarcopenia had higher odds of fibrosis than MASLD patients without sarcopenia (OR, 1.49; 95 % CI, 1.03-2.14; P = 0.03). CONCLUSIONS: Sarcopenia increased MASLD's probability and was associated with a higher probability of liver fibrosis in MASLD patients. However, SMI had no predictive value of MASLD occurrence.

Histopathological features of idiopathic portal hypertension: A systematic review and meta-analysis.

BACKGROUND: Portal hypertension (PH) is a clinically significant entity that could present with life-threatening gastrointestinal bleeding. Cirrhosis is the most common cause of PH, with well-documented histopathology and etiology. However, in idiopathic portal hypertension (IPH), no single histopathologic finding is associated with PH. Our systematic review aims to identify and summarize the prevalence of the common histological findings of IPH. METHODS: We systematically searched PubMed, Cochrane CENTRAL, Web of Science, and Scopus till 1ST March 2022 for studies describing the histopathological features of IPH. Data were extracted from eligible studies and pooled as events rate and 95% confidence interval (CI) using binary random-effects model by open meta-analyst software. RESULTS: We included 23 retrospective studies with a total sample size of 813 patients. The overall incidence of nodular regenerative hyperplasia was 38.6%, 59.8% for portal fibrosis, 51.3% for periportal fibrosis, 39.3% for perisinusoidal fibrosis, 89.8% for portal vein sclerosis, 42.2% for portal inflammation, 53.3% for mega-sinusoids, 39.5% for thickening of portal vein branches, 93.8% for narrowing of portal veins, 53.3% for hepatic veins/venous outflow obstruction, 51.4% for aberrant portal/periportal vessels, 42.4% for shunt vessel, 50.9% for ductular proliferation, and 16.3% for steatosis. CONCLUSION: Due to the relatively non-pathognomonic and non-specific nature of IPH, a combination of different histological features such as the portal and periportal fibrosis, portal vein sclerosis, mega-sinusoids, narrowing of portal veins, hepatic venous outflow obstruction, aberrant portal or periportal vessels, and ductular proliferation may be of value in diagnosing IPH as the incidence rate of these features was at approximately 50%.

Budesonide Versus Mesalamine in Microscopic Colitis: A Comparative Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Microscopic colitis (MC) is an inflammatory bowel disease of autoimmune origin that causes chronic watery diarrhea. Medications, including budesonide, mesalamine, loperamide, cholestyramine, and bismuth subsalicylate, are first-line therapies. Meanwhile, azathioprine, 6-mercaptopurine, and methotrexate are indicated for refractory MC. OBJECTIVE: We aim to assess the efficacy and safety of budesonide compared with mesalamine for induction of remission in MC patients. METHODS: We searched the Cochrane Library, Scopus, Web of Science, and PubMed for relevant clinical trials comparing either mesalamine or budesonide with a control group. We included the following outcomes: clinical remission (3 or fewer stools/day), daily stool weight, daily stool frequency, number of patients with clinical response <50% in the disease activity, and daily stool consistency. Safety end points included: any adverse event, serious adverse events, any adverse event-related discontinuation, abdominal discomfort, constipation, flatulence, nausea, dizziness, headache, bronchitis, nasopharyngitis, and depression. We conducted a meta-analysis model using the generic inverse variance method and performed a subgroup analysis based on the intervention administered. RESULTS: Nineteen randomized clinical trials were included. We found that after 6 weeks of follow-up, budesonide is associated with increased clinical remission rates compared with mesalamine [RR=2.46 (2.27, 2.67), and RR=2.24 (1.95, 2.57), respectively]. However, the test of subgroup difference revealed that the difference is not significant (P=0.25). After 8 weeks of follow-up, budesonide showed significantly higher clinical remission rates than mesalamine RR=2.29 (2.14, 2.45), and RR=1.7 (1.41, 2.05), respectively (P=0.003). Regarding the daily stool weight, patients in the budesonide group showed nonsignificant less stool weight [MD=-351.62 (-534.25, -168.99)] compared with mesalamine [MD=-104.3 (-372.34, 163.74)], P=0.14. However, daily stool frequency was significantly less in the budesonide group compared with mesalamine (P<0.001). Budesonide is associated with a significantly lower incidence of adverse events compared with mesalamine (P=0.002). Analysis of other safety endpoints was not significant between both groups. CONCLUSIONS: Budesonide was found to be better than mesalamine in MC patients in terms of clinical remission rate, especially after 8 weeks of follow-up. Budesonide also showed less incidence of adverse events. There is an urgent need for randomized, double-blinded clinical trials to provide direct and reliable evidence.

Effects of Age and Biological Age-Determining Factors on Telomere Length in Type 2 Diabetes Mellitus Patients.

Background and Objectives: Telomere length (TL) undergoes attrition over time, indicating the process of aging, and is linked to a higher risk of diabetes mellitus type 2 (DM-2). This molecular epidemiological study investigated the correlation between leukocyte TL variations and determinants of molecular aging in 121 Pakistani DM-2 patients. Materials and Methods: The ratio of telomere repeats to the SCG copy number was calculated to estimate the TL in each sample through qPCR assays. Results: In this study, smaller mean TLs were observed in 48.8% of males (6.35 ± 0.82 kb), 3.3% of underweight patients (5.77 ± 1.14 kb), 61.2% of patients on regular medication (6.50 ± 0.79 kb), 9.1% with very high stress levels (5.94 ± 0.99 kb), 31.4% of smokers (5.83 ± 0.73 kb), 40.5% of patients with low physical activity (6.47 ± 0.69 kb), 47.9% of hypertensive patients (5.93 ± 0.64 kb), 10.7% of patients with DM-2 for more than 15 years, and 3.3% of patients with a delayed onset of DM-2 (6.00 ± 0.93 kb). Conclusion: This research indicated a significant negative correlation (R2 = 0.143) between TL and the age of DM-2 patients. This study demonstrated that the correlation of telomere length with age in DM-2 patients was also influenced by various age-determining factors, including hypertension and smoking habits, with significant strong (R2 = 0.526) and moderate (R2 = 0.299) correlations, respectively; sex, obesity, the stress level and age at the onset of diabetes with significant weak correlations (R2 = 0.043, 0.041, 0.037, and 0.065, respectively), and no significant correlations of medication routine, rate of physical activity, and the durations of DM-2 with age-adjusted telomere length. These results challenge TL as the sole marker of aging, thus highlighting the need for further research to understand underlying factors and mitigate the effect of aging or premature aging on diabetic patients.

Efficacy of endoscopic trans-papillary gallbladder stenting and drainage in acute calculous cholecystitis in high-risk patients: a systematic review and meta-analysis.

Background and aims: Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results: We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion: We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.

Effects of Aramchol in patients with nonalcoholic fatty liver disease (NAFLD). A systematic review and meta-analysis.

Introduction: Nonalcoholic fatty liver disease (NAFLD) comprises a wide range of related liver disorders affecting mainly people who drink no or very little alcohol. Aramchol is a new synthetic molecule that has been shown to reduce liver fat content. There is little evidence supporting its efficacy in humans. Aim: To evaluate the efficacy of Aramchol in patients with NAFLD according to different randomized clinical trials. Material and methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant clinical trials assessing the use of Aramchol in patients with NAFLD. Risk of bias assessment was performed using Cochrane's risk of bias tool. We included the following outcomes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), glycated haemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), HOMA-IR, and insulin level. Results: We included 3 clinical trials. We found that the Aramchol group did not show any significant difference from the control group regarding ALT (MD = 3.92 (-21.20, 29.04), p = 0.76), AP (MD = -0.59 (-8.85, 7.67), p = 0.89), HbA1c (MD = -0.11 (-0.32, 0.10), p = 0.29), TC (MD = 14.25 (-626, 34.77), p = 0.17), TG (MD = 2.29 (-39.30, 43.87), p = 0.91), HOMA-IR (MD = -0.11 (-1.58, 1.37), p = 0.89), and insulin levels (MD = -0.88 (-5.82, 4.06), p = 0.73). AST levels were significantly higher in the Aramchol group (MD =11.04 (4.91, 17.16), p = 0.04). Conclusions: Aramchol was a safe and tolerable drug to be used in patients with NAFLD. However, it was not superior to placebo in reducing the biochemical liver markers.

Estimating the optimum number of colon biopsies for diagnosing microscopic colitis: a systematic review.

Microscopic colitis (MC) is an inflammatory disease of the colon characterized by persistent watery, nonbloody diarrhea. Subtypes of MC include collagenous and lymphocytic MC. Microscopic examination of colon tissue is crucial to confirming the diagnosis because the colonic mucosa often appears normal during flexible sigmoidoscopy or colonoscopy. We aim to determine the optimal sites and minimum number of colon biopsies required to diagnose MC from published studies. We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases from inception until October 2020 using the following keywords: microscopic, lymphocytic, collagenous, colitis, biopsy, and biopsies. We screened the search results for eligibility and extracted data from the included studies. We pooled the numbers of biopsies provided by each study to calculate the mean number of biopsies, SD, and SEM. We included three retrospective cohort studies with 356 patients (148 collagenous, 192 lymphocytic, and 16 mixed), and the total number of biopsies were 1854. The mean number of biopsies that were recommended by the included studies are 4, 4, and 9, respectively. The pooled mean ± SD is 5.67 ± 2.89. The included studies reported that biopsies from the ascending colon (AC) and descending colon (DC) had the highest diagnostic rates. To ensure a high level of certainty in diagnosing MC, a total of six biopsies should be taken from the AC and DC (3 AC and 3 DC). However, special care should be directed toward differentiating MC from other forms of colitis. In addition, detailed and comparative studies are needed to provide stronger recommendations to diagnose MC.

Plasma somatostatin and insulin like growth factor-1 levels in women with polycystic ovary syndrome.

OBJECTIVE: To estimate plasma somatostatin and insulin like growth factor-1levels in women with polycystic ovary syndrome, and to compare it with healthy controls. METHODS: The cross-sectional comparative study was conducted at the University of Health Sciences (UHS), Lahore, Pakistan, from December 2016 to January 2018, and comprised patients of polycystic ovary syndrome selected from tertiary care hospitals of the city. A group of apparently healthy women was also raised from the local community to work as controls. Anthropometric measurements, general physical examination and fasting blood glucose levels were determined for each subject. Plasma insulin, somatostatin and insulin like growth factor-1levels were estimated using enzyme-linked immunosorbent assay. Data was collected using a predesigned questionnaire and was analysed using SPSS 20. RESULTS: Of the 80 subjects, 40(50%) were cases with a mean age of 22.63±4.47 years, and 40(50%) were controls with a mean age of 22.78±4.85 years (p>0.05). The cases had higher fasting blood glucose, insulin and insulin like growth factor-1levels (p<0.05) compared to the controls. CONCLUSIONS: Insulin resistance and lower somatostatin levels along with higher insulin like growth factor-1 levels were found in women with polycystic ovary syndrome compared to healthy women.