Objective: In the TRANS-IBD clinical trial, the outcomes are measured with selected validated questionnaires. Cross-cultural and age adaptations of the Self-Efficacy Scale for adolescents and young adults (IBD-SES), the Transition Readiness Assessment Questionnaire (TRAQ), and the Self-Management and Transition Readiness Questionnaire (STARx) were performed. Methods: Linguistic and cultural adaptation was carried out with the usage of reliability coefficients (Cronbach's α coefficients, Spearman's rank correlation), and with confirmatory factor analysis (CFA; root Mean Square Error of Approximation [RMSEA], Comparative Fit Index [CFI], and Tucker-Lewis Index [TLI]). Results: 112 adolescents participated in the study (45.5% male, mean age 17 ± 1.98 years). CFA was acceptable in the IBD-SES and the TRAQ. Internal consistency was acceptable in IBD-SES and good in TRAQ (0.729; 0.865, respectively). Test-retest reliability was good in IBD-SES, but below the acceptable threshold in TRAQ (ρ = 0.819; ρ = 0.034). In STARx tools, RMSEA showed poor fit values, CFI and TLI were below acceptable fit values, and internal consistency was not satisfied (0.415; 0.693, respectively), while test-retest reliabilities were acceptable (ρ = 0.787; ρ = 0.788, respectively). Conclusions: Cross-cultural, age-specific adaptation was successfully completed with IBD-SES and TRAQ. Those are comparable to the original validated versions. The adaption of the STARx tools was not successful.
BACKGROUND: The TRANS-IBD study examines the superiority of joint transition visits, with drug adherence and patient satisfaction among the outcome measures. Our aim was a cross-cultural, age- and disease-specific adaptation of the 'Medication Adherence Rating Scale' (MARS) and 'Patient satisfaction with health care in inflammatory bowel disease questionnaire' (CACHE) questionnaires in patients with inflammatory bowel disease (IBD). METHODS: Linguistic and cultural adaptation using test and re-test procedures were performed. Internal consistency with Cronbach's α coefficients, confirmatory factor analyses with root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI) were determined. RESULTS: A total of 122 adolescents and 164 adults completed the questionnaires (47.5% male, mean age 17 ± 1; and 29.3% male, mean age 38 ± 11, respectively). In the MARS questionnaire, Cronbach's α scores were found good in adolescents (0.864) and acceptable in adults (0.790), while in the CACHE questionnaire, scores were rated as excellent in both populations (0.906 and 0.945, respectively). The test-retest reliabilities were satisfactory in both groups (MARS questionnaire: r = 0.814 and r = 0.780, CACHE questionnaire: r = 0.892 and r = 0.898, respectively). RMSEA showed poor fit values in the MARS questionnaire and reasonable fit values in the CAHCE questionnaire, CFI and TLI had statistically acceptable results. CONCLUSION: Age-and disease-specific Hungarian versions of the questionnaires were developed, which are appropriate tools for TRANS-IBD RCT and daily IBD care.
Összefoglaló. Az idült betegségek, köztük a gyulladásos bélbetegség kezelése összetett feladat, amely a megfelelo technikai feltételek mellett naprakész szaktudással és tapasztalattal rendelkezo egészségügyi személyzet együttmuködését igényli. Célunk a gyulladásos bélbetegség ellátásának célirányos összegzése volt. Kiemelten foglalkoztunk a korai diagnosztika és szakorvoshoz utalás kérdésével, a korszeru ellátáshoz szükséges, személyre szabott terápia és a célértékre történo kezelés, valamint a biológiai terápiás centrumba utalás szükségességével. Részleteztük továbbá a kompetens és felelosségteljes gondozás ellátószintjeit, és bemutattuk az ellátásban együttmuködo multidiszciplináris csoport felépítését is. Az összefoglaló közleményhez a nemzetközi irodalmat és a hazai terápiás protokollokat tekintettük át. A krónikus betegségek gondozásában elengedhetetlen a társszakmák együttmuködése. A betegség kezelésében fontos a folyamatosan változó ajánlások, protokollok ismerete és a kompetenciaszintek elfogadása a beteg megfelelo életminoségének elérése és a szövodmények csökkentése céljából. Orv Hetil. 2021; 162(33): 1311-1317. Summary. The treatment of chronic diseases, including inflammatory bowel disease, is a complex task that requires the collaboration of health professionals with up-to-date expertise and experience under the appropriate technical conditions. Our aim was to systematically review the management of inflammatory bowel disease. We focused on the issue of early diagnosis and referral to a specialist, the need for personalized therapy and "treat-to-target" concept, and the appropriate timing of referral to a biological therapy center. The levels of competent and responsible care and the structure of a multidisciplinary team were also discussed. For the article, international and Hungarian therapeutic protocols and literature were reviewed. The collaboration of disciplines is essential in the management of chronic diseases. For disease management, it is critical to be up-to-date with changing recommendations, protocols, and to adopt competency levels to achieve a patient's adequate quality of life and reduce disease complications. Orv Hetil. 2021; 162(33): 1311-1317.
Inflammatory Bowel Diseases , Quality of Life , Biological Therapy , Chronic Disease , Humans , Hungary
INTRODUCTION: Hemorheology is the study of the flow properties of the blood and its elements, which, together with natural anticoagulants, are important determinants of cardiovascular events. This study aimed to assess hemorheological and natural anticoagulant profiles of patients with celiac disease (CeD) comprehensively. METHODS: Our study is a case-control study (registered under ISRCTN49677481) comparing patients with CeD with age- and sex-matched control subjects (1:1). We measured erythrocyte deformability (ED) at high (3-30 Pa) and low shears (0.3-3 Pa), erythrocyte aggregation, whole blood viscosity, plasma viscosity, and natural anticoagulants (protein C, protein S, and antithrombin activity). Adherence to gluten-free diet was estimated through dietary interview and urine gluten immunogenic peptide (urine GIP) detection. RESULTS: After matching, we analyzed the data of 100 study participants. ED at high shears was impaired in CeD (P < 0.05 for all shears, confirmed by random forest analysis) independently of findings on CeD-specific serological assessment and urine GIP detection but slightly dependently on dietary adherence (P = 0.025 for 30 Pa shear). ED at low shears seemed to be impaired only in urine GIP+ CeD patients (P < 0.05 for all comparisons with urine GIP- CeD patients and control subjects). All parameters describing erythrocyte aggregation and whole blood viscosity were shifted toward a prothrombotic direction in patients with CeD with poor dietary adherence compared with those with good dietary adherence. Plasma viscosity and activity of natural anticoagulants did not differ across groups. DISCUSSION: We observed diet-dependent and diet-independent prothrombotic hemorheological alterations in CeD, which can contribute to the elevated cardiovascular risk. The untoward metabolic changes during gluten-free diet, which can further aggravate hemorheological status, may indicate the implementation of prevention strategies.(Equation is included in full-text article.).
Cardiovascular Diseases/epidemiology , Celiac Disease/blood , Diet, Gluten-Free , Hemorheology/immunology , Adolescent , Adult , Aged , Antithrombins/blood , Cardiovascular Diseases/blood , Cardiovascular Diseases/immunology , Case-Control Studies , Celiac Disease/complications , Celiac Disease/diet therapy , Celiac Disease/immunology , Female , Glutens/immunology , Heart Disease Risk Factors , Humans , Male , Middle Aged , Patient Compliance/statistics & numerical data , Protein C/analysis , Protein S/analysis , Young Adult
INTRODUCTION: The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the therapy of chronic myeloid leukemia (CML). Although the efficacy of TKIs is beyond dispute, conception-related safety issues are still waiting to be explored, particularly in males. This systematic review aimed to summarize all available evidence on pregnancy outcomes of female spouses of male CML patients who fathered children after TKI treatment for CML. METHODS: We performed a systematic search in seven electronic databases for studies that reported on male CML patients who did or did not discontinue TKI treatment before conceiving, and the pregnancy outcomes of their female spouse are available. The search centered on the TKI era (from 2001 onward) without any other language or study design restrictions. RESULTS: Out of a total of 38 potentially eligible papers, 27 non-overlapping study cohorts were analyzed. All were descriptive studies (case or case series studies). Altogether, 428 pregnancies from 374 fathers conceived without treatment discontinuation, 400 of which (93.5%) ended up in a live birth. A total of ten offspring with a malformation (2.5%) were reported: six with imatinib (of 313 live births, 1.9%), two with nilotinib (of 26 live births, 7.7%), one with dasatinib (of 43 live births, 2.3%), and none with bosutinib (of 12 live births). Data on CML status were scarcely reported. Only nine pregnancies (from nine males) and no malformation were reported in males who discontinued TKI treatment before conception. CONCLUSION: Malformations affected, on average 2.5% of live births from fathers who did not discontinue TKI treatment before conception, which is comparable with the rate of malformations in the general population. Large-scale studies with representative samples are awaited to confirm our results.
Antineoplastic Agents/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pregnancy Outcome , Protein Kinase Inhibitors/therapeutic use , Abnormalities, Multiple/etiology , Aniline Compounds/therapeutic use , Child , Dasatinib/therapeutic use , Fathers , Female , Humans , Imatinib Mesylate/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Male , Nitriles/therapeutic use , Paternal Exposure/adverse effects , Pregnancy , Pyrimidines/therapeutic use , Quinolines/therapeutic use
INTRODUCTION: Inflammatory bowel diseases (IBD) are among the most common chronic illnesses diagnosed in childhood. Transition from paediatric to adult care is a crucial phase. The implementation of joint visits during the transition period in IBD is widely recommended, however, strong evidence supporting their benefit is still missing. In this trial, we aim to prove the superiority of joint visits compared with usual care in improving transition outcomes of adolescents with IBD. METHODS AND ANALYSIS: This is a randomised controlled two-arm multicentre trial. A minimum of 160 adolescents with IBD aged between 16.75 and 17 years will be recruited from Hungarian tertiary IBD centres. After randomisation, eligible subjects in the intervention arm attend a total of four joint visits with adult and paediatric gastroenterologist between the ages of 17 and 18. In the control arm, adolescents meet only the paediatric gastroenterologist, but there is a balanced consultation between the two gastroenterologist regarding the patient's treatment plan. Patients in both groups receive the same training and education, the only determinative difference between the two arms is the presence of the adult gastroenterologist at the joint visits. Data will be collected at inclusion, at transfer and 12 months post-transfer. Primary outcome is the change in health-related quality of life measured with the IMPACT-III questionnaire at 1 year after transfer. Secondary outcomes include the number of patients not lost to follow-up, healthcare utilisation, disease activity, medication adherence, self-efficacy, transition readiness and patient's satisfaction. To compare the results of the two patient groups, two-sample T-test and Mann-Whitney test will be applied. ETHICS AND DISSEMINATION: The Scientific and Research Ethics Committee of the Hungarian Medical Research Council approved this study (50457-2/2019/EKU). Findings will be disseminated at conferences and in medical journals. TRIAL REGISTRATION NUMBER: NCT04290156.
Inflammatory Bowel Diseases , Quality of Life , Transition to Adult Care , Adolescent , Adult , Child , Humans , Hungary , Inflammatory Bowel Diseases/therapy , Multicenter Studies as Topic , Prospective Studies , Randomized Controlled Trials as Topic
The prevalence of fatty liver disease (FLD) and that of non-alcoholic fatty liver disease (NAFLD) share some risk factors known to exacerbate the course of acute pancreatitis (AP). This meta-analysis aimed to investigate whether FLD or NAFLD carry a higher risk of untoward outcomes in AP. In accordance with PRISMA guidelines, we performed a systematic search in seven medical databases for cohort studies that compared the outcomes of AP for the presence of FLD or NAFLD, and we calculated pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). We included 13 articles in our meta-analysis. AP patients with FLD were more likely to die (5.09% vs 1.89%, OR = 3.56, CI = 1.75-7.22), develop severe AP (16.33% vs 7.87%, OR = 2.67, CI = 2.01-3.56), necrotizing pancreatitis (34.83% vs 15.75%, OR = 3.08, CI = 2.44-3.90) and had longer in-hospital stay (10.8 vs 9.2 days, WMD = 1.46, OR = 0.54-2.39). Patients with NAFLD were more likely to have severe AP and longer hospital stay. Both FLD and NAFLD proved to be independent risk factors of a more severe disease course (OR = 3.68, CI = 2.16-6.29 and OR = 3.39, CI = 1.52-7.56 for moderate/ severe vs. mild AP, respectively). FLD and NAFLD worsen the outcomes of AP, which suggests that incorporating FLD or NAFLD into prognostic scoring systems of AP outcomes might improve the prediction of severity and contribute to a more individualized patient care.
PURPOSE: Since little is known about transitional care practices of adolescents with inflammatory bowel diseases (IBD) in Central-Eastern Europe, we aimed to investigate the currently applied transition practices in Hungary. DESIGN AND METHODS: A nationwide, multicentre survey was conducted with the invitation of 41 pediatric and adult IBD centres in February 2019.We developed a 34-item questionnaire, which included single- and multiple-choice questions related to the current clinical practice of IBD transition. RESULTS: The overall response rate was 31.7% (13/41); answers came predominantly from tertiary centres. Only 15.4% of the respondent centres followed international IBD guidelines. The majority of the IBD centres provided transition support; however, responses revealed a marked heterogeneity of these services. Joint visits were held only in 54% of the clinics. Gastroenterologists and next of kin are not provided education regarding transition across most centres (85 and 92%). Although adolescents received age-specific education, transition readiness was not measured. More IBD nurses and dietitians were employed in adult centres than in pediatric ones. CONCLUSIONS: The current survey revealed critical gaps in the Hungarian IBD transition practices. As the beneficial effects of structured IBD transition programmes are recognized in Hungary, there is a growing need for the introduction of new, more effective transition practices. PRACTICE IMPLICATIONS: Our results can serve as a basis for planning more effective transition strategies.
Inflammatory Bowel Diseases , Transitional Care , Adolescent , Adult , Child , Cross-Sectional Studies , Humans , Hungary , Inflammatory Bowel Diseases/therapy , Surveys and Questionnaires
AIM: To compare the efficacy and safety of stent insertion alone to stent insertion combined with any active oncological treatment in the palliative care of esophageal cancer. METHODS: A meta-analysis and systematic review were performed according to the PRISMA Statement. Comparative studies with patients receiving stent insertion alone (control group) were compared to patients receiving oncological therapy in addition to stent placement (intervention group). For mean dysphagia grade before stenting, weighted mean differences (WMD), for the complications of stenting, risk ratios (RR) were calculated, both were interpreted with 95% confidence intervals (CI). Whenever possible, subgroup analyses were performed for studies with irradiation stents as intervention. Survival, late dysphagia, esophageal perforation and medical costs were analyzed via systematic review. The protocol of the study was registered prior on PROSPERO. RESULTS: 17 studies with 1177 esophageal cancer patients were included in the final analysis, with 629 and 548 in the control and intervention groups, respectively. We found no significant difference in any complications of stenting between the two groups. 13 studies reported mean or median survival, and 8 found that combined therapy resulted in a significantly longer life expectancy. In the other 5 studies, there was no difference in survival between the two groups. Furthermore, additional treatment may be more effective in the long-term relief of dysphagia than stenting alone. CONCLUSIONS: Irradiation stents may prolong survival, and stenting combined with oncological treatment does not increase the risk of complications as compared to stenting alone. However, further studies are warranted. CORE TIP: Esophageal cancer is the eighth most common type of malignancy worldwide, and its prognosis is very poor. This suggests that palliative treatment modalities are paramount in its treatment. Self-expanding metal stents play an important role in the management of dysphagia caused by the tumor. However, it is unclear whether any additional oncological therapy should be administered to patients besides stenting. In this meta-analysis and systematic review, we evaluated the safety and efficacy of additional oncological therapies alongside stenting versus stenting alone in case of unresectable esophageal cancer.
Deglutition Disorders , Esophageal Neoplasms , Deglutition Disorders/etiology , Esophageal Neoplasms/therapy , Humans , Palliative Care , Prognosis , Stents , Treatment Outcome
BACKGROUND: Transition of adolescents from pediatric to adult care is of great importance in the management of inflammatory bowel disease (IBD). Our aim was to review and summarize the currently applied interventions and outcomes related to transition practices in IBD. METHODS: A systematic review was performed in accordance with the PRISMA Statement. We searched PubMed, EMBASE, CENTRAL, and Web of Science databases up to February 15, 2019. Controlled studies evaluating adolescents and young adults with IBD participating in structured transition interventions or patient educational programs and single-arm (before-after) studies were included. Several individual, health care, and social outcomes were assessed. The PROSPERO registration number is CRD42019118520. RESULTS: A total of 23 articles were eligible for qualitative synthesis. Eleven studies compared an intervention to a control group, whilst 12 studies were uncontrolled before-after studies. The age of the participants varied from 11 to 25 years. The most common structured transition interventions were joint visits and patient education programs. IBD nurses were operating as nominated transition coordinators in the transition process. Quality of life, patient satisfaction, self-efficacy, disease-specific knowledge, adherence rate, and nonattendance rate at outpatient clinic were identified as main health care transition outcomes besides disease-related outcomes. Despite the various study designs and methodological limitations, outcomes improved with the application of structured transition interventions in eleven of the studies. CONCLUSION: These results facilitate the design of randomized controlled trials along better standards in transitional care in IBD.
Adolescent Health Services , Inflammatory Bowel Diseases/therapy , Quality of Life , Transition to Adult Care/standards , Adolescent , Humans , Patient Education as Topic , Randomized Controlled Trials as Topic , Self Care/standards
Patients with inflammatory bowel disease (IBD) are at risk of sarcopenia, which is associated with poor clinical outcomes. We conducted this study to assess whether sarcopenia predicts the need for surgery and postoperative complications in patients with IBD. We performed a systematic search of four electronic databases, last updated in March, 2019. Data from studies comparing rates of surgery and postoperative complications in sarcopenic IBD patients versus non-sarcopenic IBD patients were pooled with the random-effects models. We calculated the odds ratios (OR) with a 95% confidence interval (CI). Ten studies with a collective total of 885 IBD patients were included in our meta-analysis. Although the analysis of raw data did not reveal significant differences between the two groups with respect to the rate of surgery and postoperative complications (OR = 1.826; 95% CI 0.913-3.654; p = 0.089 and OR = 3.265; 95% CI 0.575-18.557; p = 0.182, respectively), the analysis of adjusted data identified sarcopenia as an independent predictor for both of the undesirable outcomes (OR = 2.655; 95% CI 1.121-6.336; p = 0.027 and OR = 6.097; 95% CI 1.756-21.175; p = 0.004, respectively). Thus, early detection of sarcopenia in patients with IBD is important to prevent undesirable outcomes.
Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/surgery , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Sarcopenia/diagnosis , Sarcopenia/etiology , Body Composition , Early Diagnosis , Forecasting , Humans , Risk , Treatment Outcome
BACKGROUND: Despite the high rate of postoperative recurrence (POR) in Crohn's disease (CD), there is no widely accepted consensus on its prevention. AIM: To compare the efficacy of biological and conventional therapies in preventing POR of CD. METHODS: We searched four electronic databases up to April 2019 for articles that examined the efficacy of different preventive therapies against POR. Our PICO was: (P) adults with CD who underwent intestinal resection, (I) biological agents, (C) conventional therapies or a placebo, and (O) clinical, endoscopic, and histological POR. RESULTS: Anti-TNFα agents were significantly better in preventing clinical, endoscopic, severe endoscopic and histological POR compared to conventional therapies (OR: 0.508, 95% CI: 0.309-0.834, Pâ¯=â¯0.007; OR: 0.312, 95% CI: 0.199-0.380, Pâ¯<â¯0.001; OR: 0.195, 95% CI: 0.107-0.356, Pâ¯<â¯0.001; and OR: 0.255, 95% CI: 0.106-0.611, Pâ¯=â¯0.002, respectively), as well as in the subgroup of nonselected CD patients (OR: 0.324, 95% CI: 0.158-0.664, Pâ¯=â¯0.002; OR: 0.225, 95% CI: 0.124-0.409, Pâ¯<â¯0.001; and OR: 0.248, 95% CI: 0.070-0.877, Pâ¯=â¯0.031, respectively). Infliximab and adalimumab proved to be equally effective in preventing endoscopic POR. CONCLUSION: Anti-TNFα agents are more effective in preventing clinical, endoscopic and histological POR than conventional therapies, even in nonselected CD patients.
Crohn Disease/prevention & control , Crohn Disease/surgery , Gastrointestinal Agents/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Humans , Infliximab , Postoperative Period , Preoperative Period , Recurrence , Secondary Prevention
PURPOSE: To evaluate the effect of our current transition process on clinical outcomes in adolescent patients with inflammatory bowel diseases (IBD). DESIGN AND METHODS: Two groups of patients with IBD diagnosed in pediatric care were compared retrospectively: Group A patients did not attend the transition process, while Group B patients entered the planned transition service. Outcomes at 1-year after transfer to adult care were evaluated. RESULTS: Forty-five patients with IBD diagnosed under the age of 18â¯years were identified of whom 35 had Crohn's disease and 10 had ulcerative colitis. Twenty-four patients were in Group A (without transition), and 21 patients in Group B (with at least one planned transition visit). Mean age at diagnosis was 15.1⯱â¯2.2 and 13.7⯱â¯3.0â¯years (pâ¯=â¯0.086), respectively. There were no significant differences in disease duration before transfer, Montreal classification at diagnosis, body mass index, anti-TNF therapy usage, and disease status at transfer between the two groups. A significantly higher number of Group B patients were in remission at 12â¯months after transfer when compared to patients in Group A (11 vs. 18, respectively, pâ¯=â¯0.037). There was a significant difference between groups regarding the number of scheduled visits within the examined period (9 vs. 16, pâ¯=â¯0.011, respectively). CONCLUSIONS: Planned transition visits resulted in higher disease remission rate at 1-year follow-up after transfer from pediatric to adult health care system in adolescent patients with IBD. PRACTICE IMPLICATION: Well-established transition programs in IBD are needed.
Adolescent Health Services/standards , Colitis, Ulcerative/therapy , Crohn Disease/therapy , Transition to Adult Care/standards , Transitional Care/standards , Adaptation, Psychological , Adolescent , Adult , Colitis, Ulcerative/psychology , Crohn Disease/psychology , Female , Humans , Male , Medication Adherence , Young Adult
Background: In steroid-refractory acute severe ulcerative colitis (ASUC), cyclosporine (CYS) or infliximab (IFX) may be considered as a second-line alternative to avoid colectomy. There are short-term data reported, but until now, there is no meta-analysis regarding long-term outcomes of CYS and IFX in patients with ASUC. Aim: To compare long-term efficacy and safety of CYS and IFX in a meta-analysis. Methods: Three electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials) were searched for studies which compared CYS vs. IFX in adults with ASUC. Long-term colectomy-free rate from 1 to 10 years during CYS or IFX therapy was collected, last updated up to 22nd May 2019. Primary outcome was long-term colectomy-free rate, secondary outcomes were adverse events (AE), serious adverse events (SAE), and mortality. Long-term colectomy-free survival and safety measures were pooled with the random-effect model. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Data from 1,607 patients in 15 trials were extracted. In the first 3 years, pooled OR for colectomy-free survival was higher with IFX than with CYS (OR = 1.59, 95% CI: 1.11-2.29, p = 0.012; OR = 1.57, 95% CI: 1.14-2.18, p = 0.006; and OR = 1.75, 95% CI: 1.08-2.84, p = 0.024; at 1, 2, and 3 years, respectively). However, the significant difference remained undetected from the fourth year of follow-up and in subgroup of RCTs (OR = 1.35, 95% CI: 0.90-2.01, p = 0.143; OR = 1.41, 95% CI: 0.94-2.12, p = 0.096; and OR = 1.34, 95% CI: 0.89-2.00, p = 0.157; at 1, 2, and 3 years, respectively). No significant difference was detected regarding adverse events, serious adverse events and mortality between the groups. The neutral associations proved to be underpowered with trial sequential analysis. Conclusion: However observational studies show IFX as a better choice, according to the RCTs, choosing either CYS or IFX as rescue therapy for ASUC, the long-term outcomes are not different, although further large RCTs are warranted.
Elevated serum triglyceride concentration (seTG, >1.7 mM or >150 mg/dL) or in other words hypertriglyceridemia (HTG) is common in the populations of developed countries. This condition is accompanied by an increased risk for various diseases, such as acute pancreatitis (AP). It has been proposed that HTG could also worsen the course of AP. Therefore, in this meta-analysis, we aimed to compare the effects of various seTGs on the severity, mortality, local and systemic complications of AP, and on intensive care unit admission. 16 eligible studies, including 11,965 patients were retrieved from PubMed and Embase. The results showed that HTG significantly elevated the odds ratio (OR = 1.72) for severe AP when compared to patients with normal seTG (<1.7 mM). Furthermore, a significantly higher occurrence of pancreatic necrosis, persistent organ failure and renal failure was observed in groups with HTG. The rates of complications and mortality for AP were significantly increased in patients with seTG >5.6 mM or >11.3 mM versus <5.6 mM or <11.3 mM, respectively. We conclude that the presence of HTG worsens the course and outcome of AP, but we found no significant difference in AP severity based on the extent of HTG.
Hypertriglyceridemia/blood , Pancreatitis/diagnosis , Triglycerides/blood , Humans , Pancreatitis/blood , Prognosis
The aim of the current study was to review the available data regarding eosinophil density in healthy tissue specimen originating from lower gastrointestinal segments to support suggested diagnostic cutoffs widely used in clinical practice. A systematic search was performed in 3 different databases. Calculations were made with Comprehensive MetaAnalysis software using random-effects model. Cell number measurements were pooled using the random-effects model and displayed on forest plots. Summary point estimations, 95% confidence intervals (CIs), and 95% prediction intervals (PIs) were calculated. The cumulative mean cell numbers were 8.26 (95% CI 4.71-11.80) with PI of 0-25.32 for the duodenum, 11.52 (95% CI 7.21-15.83) with PI 0-60.64 for the terminal ileum, and 11.10/ high-power field (HPF) (95% CI 9.11-13.09) with PI of 0.96 to 21.23 in the large intestine and the rectum (HPF areaâ=â0.2âmm). Previous studies included control patients with irritable bowel syndrome and functional gastrointestinal disorders. As mucosal eosinophils have a role in their pathomechanism, those patients should have been excluded. A critical point of interpreting reported data is that HPF is relative to the technical parameters of the microscopes; therefore, it is important to report findings in cell/mm. The present meta-analysis does not support the higher (>20) or lower (<10) cutoff values for healthy tissue eosinophil number. In contrast to the esophagus, there is no normal cutoff eosinophil density in the small intestine and the colon. A prospective, multicenter study to establish normal mucosal eosinophil density is clearly needed.
Colon/cytology , Eosinophils , Intestine, Small/cytology , Gastrointestinal Diseases/diagnosis , Humans , Reference Standards
