Mean platelet volume in acute pancreatitis: a systematic review and meta-analysis.

BACKGROUND: Several studies have suggested there may be statistically significant differences in mean platelet volume (MPV) between the onset and remission of acute pancreatitis (AP). This systematic review and meta-analysis aimed to better characterize the correlation between MPV and AP by identifying all relevant studies and summarizing their results. METHODS: A comprehensive literature review was conducted using EMBASE, PubMed/MEDLINE, Cochrane Library, ClinicalTrials.gov, and Google Scholar from January 2000 to December 2019 to identify all studies that reported MPV at the onset or remission of AP, or both. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. The Newcastle-Ottawa quality assessment scale was used to appraise the quality of the included studies. RESULTS: Ten observational studies, including 1019 patients and 363 controls, were included in the meta-analysis. MPV was smaller at the onset of AP than on remission (standardized mean difference= -0.33 fL, 95% confidence interval -0.54 to -0.12 fL; P=0.002); however, a moderate degree of heterogeneity (I 2=72%, P≤0.001) was observed. Subgroup analysis indicated comparable MPV in relation to the severity of AP. Similarly, no statistically significant difference was detected between AP patients and controls at either onset (P=0.760) or remission (P=0.700) of the disease. No statistically significant publication bias was detected (Eggers' regression P=0.938). Subgroup analysis suggested age (P<0.001) and sex (P=0.01) adjustment as potential sources of heterogeneity. CONCLUSION: MPV is smaller at the onset of AP. Further clinical evaluation is needed to assess its potential prognostic value.

Peginterferon alfa-2b as monotherapy or in combination with lamivudine in patients with HBeAg-negative chronic hepatitis B: a randomised study.

BACKGROUND: The efficacy of pegylated interferon alfa-2b alone or in combination with lamivudine for the treatment of patients with hepatitis B e antigen (HBeAg) negative (-) chronic hepatitis B (CHB) is understudied. MATERIAL/METHODS: One hundred twenty-six patients with HBeAg(-)chronic hepatitis B received pegylated interferon alfa-2b > or =1.5 micro g/kg/wk for 48 weeks. Ninety of those subjects were randomly selected to receive concomitant treatment with lamivudine 100 mg/d. The coprimary end points were the subjects' virologic (hepatitis B virus deoxyribonucleic acid [HBV DNA] <60 IU/mL) and biochemical (normalization of alanine aminotransferase levels) responses 24 weeks after treatment cessation. RESULTS: The scores for necroinflammatory activity and fibrosis in patients randomly assigned to receive monotherapy were statistically significantly lower than those in patients receiving combination therapy. HBV DNA levels were statistically significantly higher and alanine aminotransferase levels were statistically significantly lower in patients receiving monotherapy than in those receiving combination therapy. Virologic responses in the monotherapy and combination therapy groups were similar at weeks 48 and 72 (59.1 vs 42.9%). The biochemical response at week 72 was also similar in the treatment groups. The results of multiple regression analysis showed that the virologic response at week 72 was independently correlated with the pegylated interferon alfa-2b dose and that the biochemical response was independently correlated with necroinflammatory activity, the pegylated interferon alfa-2b dose, and lamivudine therapy. CONCLUSIONS: These data support the use of pegylated interferon alfa-2b in patients with HBeAg(-) chronic hepatitis B; however, the concomitant use of lamivudine produced no additional clinical benefit.

Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome.

AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy. The purpose of this study was to describe the causes and clinical outcome of these patients. METHODS: From January 1999 to October 2003, 111 patients with acute upper gastrointestinal bleeding (AUGIB) were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001 with AUGIB who were not taking warfarin. RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P < 0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604 (5.1%) patients not receiving anticoagulants (P = 0.0001). The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%) patients not taking a great dose of NSAIDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported. Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy. CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants. Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.