Diagnostic accuracy of circulating miRNAs to discriminate hepatocellular carcinoma from liver cirrhosis: a systematic review and meta-analysis.

Introduction: Hepatocellular carcinoma (HCC) and liver cirrhosis (LC) stand as the primary causes of global mortality. Given their profound impact, the development of highly sensitive and specific circulating diagnostic markers becomes imperative to effectively identify and differentiate between cirrhosis and HCC. Accurate diagnosis is paramount in guiding appropriate therapeutic interventions. Hence, this study aimed to evaluate the potential of microRNAs (miRNAs) in discerning between HCC and LC. Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, with the protocol officially registered on PROSPERO under the reference number CRD42023417494. A thorough search across multiple databases like PubMed, Embase, Scopus, Wiley Online Library, and Science Direct was conducted to identify relevant studies published from January 1, 2018, to August 10, 2023. The included studies underwent methodological quality assessment using the Quality Assessment of Diagnostic Accuracy Studies 2 (QADAS-2) tool. The synthesis of pooled sensitivity, specificity, and other relevant diagnostic parameters employed a random-effects model and was conducted using Stata 14.0. Heterogeneity was assessed using I2 and Cochrane Q, with subsequent subgroup analysis and meta-regression performed to identify potential sources of observed heterogeneity. A sensitivity analysis was performed to assess the resilience of the findings. Furthermore, Deeks' funnel plot was employed to evaluate publication bias. Results: In this meta-analysis, we included fifteen publications, encompassing 787 HCC patients and 784 LC patients. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) values of miRNAs in differentiating HCC from LC were 0.84 (95% CI: 0.78-0.88), 0.79 (95% CI: 0.73-0.84), 3.9 (95% CI: 3.0-5.2), 0.21 (95% CI: 0.14-0.29), 19.44 (95% CI: 11-34), and 0.88 (95% CI: 0.85-0.91), respectively. The results of the subgroup analysis revealed that upregulated miRNA levels and miRNA assessments specifically for individuals of European descent exhibited superior diagnostic performance. Conclusion: The results of this study suggested that circulating miRNAs, especially those that are upregulated, have the potential to function as robust and promising biomarkers in the differentiation of HCC from LC. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023475954.

Anemia among malaria patients with and without soil-transmitted helminths in Arba Minch town health facilities: A comparative cross-sectional study.

Anemia is one of the severe clinical outcomes associated with concomitant infection of malaria and soil-transmitted helminths (STH). Since STH infections mostly share similar geographical areas with malaria, the influence of co-infections on the epidemiology and course of Anemia deserves greater consideration to assess the impact of interventions, the adequacy of strategies implemented, and the progress made in the fight against Anemia. So, this study was done to investigate Anemia among STH-negative malaria patients and malaria patients co-infected with single or multiple STHs, in 3 health facilities of Arba Minch, 2020 to 2021. An institutional-based comparative cross-sectional study was conducted at 3 Governmental Health Institutions, Arba Minch, and southern Ethiopia from November 2020 to February 2021 on a total of 321 malaria-positive study participants. Thick and thin blood films were prepared for microscopic examination of malaria parasites and identification of species. A malaria parasite count was done to determine the intensity of the infection. A stool wet mount was done to identify STHs. Kato-Katz was done for microscopic quantitative examination of STHs. A complete blood cell count was done to determine hemoglobin level. Socio-demographic data were collected using a questionnaire. Data were analyzed using SPSS version 25. Independent samples t test and one-way analysis of variance were done. Anemia magnitude in this study was 38.3% and it was higher in malaria with multiple STH co-infection groups (55.1%). Malaria parasite density was significantly higher in malaria with multiple STHs co-infected study participants F (2, 318) = 20.075. It increased with the increasing intensity of hookworm, Trichuris trichiura, and several co-infecting helminth species. But it decreased with increasing intensity of Ascaris lumbricoides. The mean hemoglobin concentration of malaria with multiple STHs co-infection study participants was significantly lower than mono malaria-infected and malaria with single STHs co-infection study participants. The management of malaria should take account of STH infections and optimal modalities of treatment should be devised. Anti-helminthic treatments of malaria patients through regular, inexpensive, single-dose, and highly effective drugs must be seriously considered to protect the population from exacerbation of Anemia by intestinal helminth infections.

Thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: A cross-sectional study.

Thrombocytopenia (TCP) is the second most common hematological change during pregnancy and is considered as a major source of maternal and neonatal morbidity and mortality. Despite its effects to morbidity and mortality, it is frequently ignored or disregarded, particularly in resource-limited nations. Thus, the purpose of this study was to determine the prevalence of thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia from June 20 to August 30, 2022. A hospital-based cross-sectional study was conducted among 199 pregnant women selected through a systematic sampling technique. Ethical approval was obtained from the Ethics Review Committee of Haramaya University. Data related to sociodemographic and reproductive variables were collected using structured questionnaires. Four milliliters of venous blood were collected from each study participant and a complete blood cell count was determined using UniCel DxH 800 hematology analyzer. Logistic regression analysis was done to assess the association between TCP and independent variables and P < .05 was considered statistically significant. In this study, the prevalence of TCP was 14.1% (95% CI: 9.6-19.7). Of them, 10 (35.7%), 12 (42.9%), and 4 (21.4%) had mild, moderate, and severe TCP, respectively. Having more than 3 children (adjusted odds ratio, AOR = 7.90, 95% CI: 2.60, 24.3), no antenatal care follow-up (AOR = 7.90, 95% CI: 2.40-26.2), being in the second and third trimester (AOR = 6.90, 95% CI: 1.70, 28.9 and AOR = 5.04, 95% CI: 1.12, 22.7, respectively), and history of heavy menstrual bleeding (AOR = 4.03, 95% CI: 1.25, 13.1) were significantly associated with TCP. TCP is a public health problem among pregnant women in the study area. Having more than 3 children, lack of antenatal care follow-up, being in the second and third trimesters, and having history of heavy menstrual bleeding was significantly associated with TCP. As a result, regular platelet count monitoring and appropriate intervention approaches based on identified predictors should be explored to mitigate adverse outcomes in pregnant women.

The diagnostic accuracy of mean platelet volume in differentiating immune thrombocytopenic purpura from hypo-productive thrombocytopenia: A systematic review and meta-analysis.

BACKGROUND: Thrombocytopenia is defined as a decreased number of platelets in the circulating blood as a result of hypo-proliferation in marrow or peripheral destruction of platelets. Several diagnostic methods have been proposed to discriminate the underline cause of thrombocytopenia. Recent studies showed that mean platelet volume (MPV) could be used for differential diagnosis of immune thrombocytopenic purpura (ITP). Thus, we aimed to investigate the diagnostic accuracy of MPV for differential diagnosis of ITP from hypo-productive thrombocytopenia. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). The study protocol was registered on PROSPERO with the reference number CRD42023447789. Relevant published studies that were published up to April 10, 2023, in peer-reviewed journals were searched on electronic different databases. The methodological quality of the included studies was appraised using the quality assessment of diagnostic accuracy studies 2 (QADAS-2) tool. The pooled weight mean difference (WMD) of MPV between the ITP group and hypo-productive group was analyzed using a random-effects model meta-analysis. Relevant data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA 11.0 and Meta-disc 1.4 software. Publication bias was evaluated using Deek's funnel plot asymmetry test. RESULTS: A total of 14 articles were included in this systematic review and meta-analysis. The comparison of MPV between groups revealed that the pooled mean value of MPV increased significantly in ITP patients compared to patients with hypo-productive thrombocytopenia (WMD = 2.03; 95% CI, 1.38-2.69). The pooled sensitivity and specificity of MPV in differentiating ITP from hypo-productive thrombocytopenia were 76.0% (95% CI: 71.0%, 80.0%) and 79.0% (95% CI: 75.0%, 83.0%), respectively. The summary positive likelihood ratio (PLR) and negative likelihood ratio (NLR)using the random effects model were 3.89 (95% CI: 2.49, 6.10) and 0.29 (95% CI: 0.18, 0.46), respectively. CONCLUSION: MPV can be used to discriminate ITP from hypo-productive thrombocytopenia. It can possess large advantages as it is noninvasive, simple, quick, inexpensive, easy to perform, reliable, and routinely generated by automated cell counters.

The association of ABO and Rhesus blood groups with the occurrence of type 2 diabetes mellitus: A comparative cross-sectional study.

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated levels of glucose in circulation which result from insufficient insulin or insulin resistance. The blood group of an individual is thought to be genetically predetermined and plays a vital role in increasing susceptibility to DM for particular blood groups. Therefore, this study aimed to determine the association between ABO and Rhesus blood groups with type 2 DM. A comparative cross-sectional study was conducted on 326 participants (163 type 2 DM patients and 163 age and sex-matched healthy individuals). Socio-demographic data were collected using a semi-structured questionnaire while Clinical data were extracted from the patient chart. A blood sample was collected from each study participant for ABO and Rhesus blood grouping. Chi-square test, bivariable, and multivariable logistic regression analysis were employed to indicate the association between different blood group types and type 2 DM. The current result showed that blood group O had the highest frequency among all study participants followed by blood groups B, A, and AB. Blood groups B and A were more common in the type 2 DM group compared with the control group while blood groups O and AB were more frequent in the control group. A chi-square test indicated that the ABO blood group had a significant association with type 2 DM while the Rhesus blood group was not associated with type 2 DM. Moreover, logistic regression analysis showed that B and O blood groups had a significant association with type 2 DM while A and AB blood groups had no association. The findings of this study indicated that type 2 DM has an association with the ABO blood group and has no association with the Rhesus blood group. Individuals with blood group B have a higher risk of developing T2DM (type II DM) as compared to other ABO blood groups.

The prevalence of anemia among human immunodeficiency virus-infected individuals in East Africa: A systematic review and meta-analysis.

BACKGROUND: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients face several hematological abnormalities. Of these abnormalities, anemia is the most common one. Africa has a high prevalence of HIV/AIDS, especially in the East and South African region, which is heavily affected by the virus. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of anemia among patients with HIV/AIDS in East Africa. METHODS: This systematic review and meta-analysis was conducted based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Google Scholar, Science Direct, Dove Press, Cochrane Online, and African journals online were searched systematically. The quality of the included studies was assessed by 2 independent reviewers using the Joanna Briggs Institute critical appraisal tools. Data were extracted into an Excel sheet and then exported to STATA version 11 for analysis. A random-effect model was fitted to estimate the pooled prevalence and Higgins I2 test statistics were done to test the heterogeneity of studies. Funnel plots analysis and Egger-weighted regression tests were done to detect publication bias. RESULTS: The pooled prevalence of anemia among HIV/AIDS patients in East Africa was 25.35% (95% CI: 20.69-30.03%). A subgroup analysis by highly active antiretroviral therapy (HAART) status showed that the prevalence of anemia among HAART naive HIV/AIDS patients was 39.11% (95% CI: 29.28-48.93%) whereas the prevalence among HAART experienced was 36.72% (95% CI: 31.22-42.22%). A subgroup analysis by the study population showed that the prevalence of anemia among adult HIV/AIDS patients was 34.48% (95% CI: 29.52-39.44%) whereas the pooled prevalence among children was 36.17% (95% CI: 26.68-45.65%). CONCLUSION: This systematic review and meta-analysis revealed that anemia is among the most common hematological abnormalities in HIV/AIDS patients in East Africa. It also underscored the importance of taking diagnostic, preventive, and therapeutic measures for the management of this abnormality.

Platelet Parameters and Their Correlation with Parasitemia Levels Among Malaria Infected Adult Patients at Jinella Health Center, Harar, Eastern Ethiopia: Comparative Cross-Sectional Study.

Background: Malaria is a major public health problem with the highest morbidity and mortality in developing countries. Hematological changes play a great role in malaria pathogenesis through platelets and platelet parameters. However, the changes in platelet parameters are not clearly described in Ethiopia. Therefore, this study aimed to compare platelet parameters and their correlation with parasitemia among malaria-infected adult patients and healthy adults. Methods: An institutional-based comparative cross-sectional study was conducted involving 186 (93 malaria-infected patients and 93 healthy adults) study participants using a convenient sampling technique at Jinella health center, Harar, Eastern Ethiopia, from July 10-August 10, 2022. Five milliliters of venous blood were collected from each study participant, and platelet parameters were analyzed using a Unicel (DxH 800) automated hematologic analyzer. A drop of blood was taken from malaria-suspected patients for blood film preparation. Results between two groups were compared using the Mann-Whitney U-test. Spearman's rank correlation coefficient was used to evaluate the relationships between two continuous variables. A P-value of < 0.05 was considered statistically significant. Results: Platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults (103 x103cells/µL vs 268 x103cells/µL, 0.13 fl vs 0.23 fl, and 9.6 fl vs 15.3 fl), respectively). Conversely, platelet distribution width and platelet large cell ratio were higher in malaria-infected patients than healthy adults (19.2% vs 15.3% and 0.35% vs 0.29%), respectively). Parasitemia levels had a moderately inverse correlation with platelet count (r= -0.419) and a weakly positive correlation with mean platelet volume (r=0.278). Conclusion: The platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults. Malaria parasitemia had a moderate inverse correlation with platelet count and a weak positive correlation with mean platelet volume. Thrombocytopenia and alteration of platelet parameters should be considered in malaria patients.

The Diagnostic Value of Hepatic and Renal Biochemical Tests for the Detection of Preeclampsia Among Pregnant Women Attending the Antenatal Care Clinic at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia.

Background: Preeclampsia has a deleterious effect on renal and liver function, which results in alterations of various biochemical tests. Therefore, the main aim of this study was to evaluate the role of some hepatic and renal biochemical tests in the diagnosis of preeclampsia. Methods: A comparative cross-sectional study was carried out on a total of 126 pregnant women after 20th week of gestation who attended at the University of Gondar Comprehensive Specialized Hospital. The participants were divided into two groups as cases and controls. The case group consisted of 63 preeclamptic women, whereas the control group had 63 age and gestational week matched normotensive pregnant women. From each participant, three milliliters of blood was collected, the serum part was separated, and selected biochemical tests were measured using Humastar 800 chemistry analyzer. An independent t-test and receiver operating characteristics were done using SPSS 20 for comparison and diagnostic value determination of different biochemical tests between the study groups. Results: The maternal serum aminotransferases, total bilirubin, Creatinine, and Urea levels were all significantly elevated in preeclamptic women compared to normotensive pregnant women. The receiver operating characteristics plots revealed that serum aspartate aminotransferase level had area under the curve of 0.89 (95% CI: 0.84-0.95) and can distinguish preeclampsia patients from normotensive pregnant women at cut-off value of ≥58.5 U/l with 74.6% sensitivity, 87.3% specificity, and 80.9% diagnostic accuracy. Serum Creatinine level had area under the curve of 0.91 (95% CI: 0.86-0.96), which enabled to indicate preeclampsia at a cut-off value ≥0.90 mg/dl with 77.8% sensitivity and 85.7% specificity. Conclusion: An increased serum aminotransferases, total bilirubin, creatinine, and Urea levels in pregnant women could indicate the development of preeclampsia, and needs to be investigated. Among biochemical tests, serum Creatinine level was the best diagnostic marker of preeclampsia, followed by serum aspartate aminotransferase level.

Preeclampsia has an association with both platelet count and mean platelet volume: A systematic review and meta-analysis.

BACKGROUND: Preeclampsia (PE) is a pregnancy-specific disorder characterized by endothelial dysfunction, and activation of the coagulation system. Alteration of PLT parameters is the common hematological abnormality observed in women with PE. The main aim of this study was to systematically review previous studies from around the world to generate evidence about the relationship between platelet count (PC) and PE, as well as mean platelet volume (MPV) and PE, by calculating the pooled weighted mean difference (WMD) of PC and MPV between PE and normotensive (NT) groups. METHODS: Relevant articles which were published in the English language from January 10, 2011, to January 10, 2021, were systematically searched through PubMed, Web of Science, and African journals online. In addition, reference probing of published articles searching was employed through Google Scholar and Google for searching grey literature. The methodological qualities of articles were assessed using Joana Brigg's institute critical appraisal checklist. A random-effects model was used to estimate pooled WMD of PLT parameters between the two groups with the respective 95% confidence intervals (CI) using Stata version 11.0. The I2 statistics and Egger's regression test were used to assess heterogeneity and publication bias among included studies, respectively. RESULTS: A total of 25 articles were included in this systematic review and meta-analysis. Of which, 23 studies were used in each PC and MPV analysis. The overall pooled WMD of PC and MPV between PE and NT groups were -41.45 × 109/L [95% CI; -51.8, -31.0] and 0.98 fl [95% CI; 0.8, 1.1], respectively. The pooled WMD revealed that PC decreased significantly in the PE group compared to the NT group while MPV increased significantly in the PE group. CONCLUSIONS: This systematic review and meta-analysis indicated that there is a significant decrease in PC and a significant increase in MPV during PE development among pregnant women. As a result, a change in these parameters among pregnant women may indicate the development of PE.

The value of eosinophil count in the diagnosis of preeclampsia among pregnant women attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021.

BACKGROUND: Currently, studies showed that eosinophil count had clinical significance in the diagnosis and prognosis of diseases. But, the clinical significance of eosinophil count in pregnancy specifically in preeclampsia (PE) is not well studied. The main objective of the present study was to assess the diagnosis value of eosinophils counts among pregnant women with PE. METHODS: A comparative cross-sectional study was conducted on a total of 126 pregnant women at the University of Gondar Comprehensive Specialized Hospital, using a convenient sampling technique. Socio-demographic and clinical data were collected by questionnaire and datasheet from patient's charts, respectively. A total of six ml of blood was collected from each study participant; three ml for complete cell count analysis using Sysmex XS-500i hematology analyzer and three ml for liver function tests using Humastar 200 chemistry analyzer. The data were entered into Epi-data and exported to SPSS 20 for analysis. The independent t-test was used for normally distributed data and, the Mann-Whitney U test was used for non-normally distributed data. Binary logistic regression and receiver operative curve analyses were also done to assess the diagnosis value of eosinophils count. P-value < 0.05 was considered statistically significant. RESULTS: The eosinophils count of PE pregnant women were significantly lower than the normotensive (NT) pregnant women (median (IQR): 50 (10-200) vs. 120 (60 - 270); (p = 0.002). The eosinophil count ≤ 55 cells/µL had an AUC of 0.66 (95% CI; 0.56-0.75) for diagnosis of PE with a sensitivity of 50.8%, specificity of 77.8%, and positive and negative predictive value of 69.6% and 61.3%, respectively. The abnormal AST and ALT results were significantly higher among PE pregnant women compared to NT pregnant women (AOR: 14.86; 95% CI: 4.97-44.4 and Fischer exact test p-value = 0.001, respectively). CONCLUSION: The eosinophil count ≤ 55cells/µl had a reasonable/acceptable AUC which may use in the diagnosis of PE. AST and ALT were also significantly higher in PE pregnant women compared to NT pregnant women. Multicenter longitudinal studies with a large sample size are recommended to verify the role of eosinophil count in the diagnosis of PE.

The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit, Gondar, Ethiopia.

BACKGROUND: Preeclampsia (PE) is a pregnancy-related illness characterized by high blood pressure (BP) and proteinuria after the 20th gestational week (GW). Platelet (PLT) parameter changes are the common hematological abnormalities observed in PE patients. The main aim of this study was to assess the role of PLT parameters for PE diagnosis among pregnant women. METHODS: A comparative cross-sectional study was conducted at the University of Gondar Specialized Hospital. A total of 126 pregnant women (63 normotensive [NT] and 63 PE) were recruited using a convenient sampling method. Three milliliter blood was collected from each participant, and PLT parameters were determined using Sysmex XS-500i analyzer. An independent t-test supplemented with receiver-operating characteristics (ROC) were used for comparisons and diagnostic value of PLT parameters between the study groups. RESULTS: Platelet count (PC) was significantly lower in the PE group compared to that in the NT group, whereas mean platelet volume (MPV), platelet large cell ratio (P-LCR), and platelet distribution width (PDW) were significantly higher in PE. MPV had the largest area under the curve (AUC) [0.91: 95% CI; 0.85-0.96] followed by PC [0.79: 95% CI; 0.72-0.87]. MPV can differentiate PE patients from NT pregnant women at cut-off value ≥12.10 fl (84.1% sensitivity and 87.3% specificity) while PC can indicate PE at a cut-off value ≤176.5 × 109 /L (65.1% sensitivity and 87.3% specificity). CONCLUSION: A decreased PC and an increased MPV, P-LCR, and PDW can be used as a simple, cost-effective, quick, and reliable method of PE screening. Of them, MPV is the best indicator of PE.