INTRODUCTION: Split-dose bowel preparation leads to superior colon cleansing for colonoscopy. However, the magnitude of benefit in detecting colonic polyps is uncertain. We performed a systematic review to synthesize the data on whether using a split-dose bowel preparation regimen improves the detection of polyps when compared with other dosing methods or regimen products. METHODS: We searched MEDLINE, EMBASE, and CENTRAL databases (from the inception to June 2017) for randomized controlled trials that assessed the following: split-dose vs day-before, split-dose vs same-day (as colonoscopy), or different types of split-dose regimens for patients undergoing colonoscopy. We excluded studies limited to inpatients, children, or individuals with inflammatory bowel disease. We compared the number of patients undergoing colonoscopy with recorded detection of polyps, adenomas, advanced adenomas, sessile serrated polyps (SSPs), right colonic adenomas, right colonic polyps, or right colonic SSPs. RESULTS: Twenty-eight trials fulfilled the inclusion criteria (8,842 participants). Of the seven trials comparing split-dose vs day-before bowel preparation regimens, there was an increased detection rate of adenomas (risk ratio (RR) 1.26, 95% confidence intervals (CIs): 1.10–1.44; 4 trials; 1,258 participants), advanced adenomas (RR 1.53, 95% CI: 1.22–1.92; 3 trials; 1,155 participants), and SSPs (RR 2.48, 95% CI: 1.21–5.09; 2 trials; 1,045 participants). Pooled estimates from 8 trials (1,587 participants) evaluating split-dose vs same-day bowel preparations yielded no evidence of statistical difference. For various split-dose vs split-dose trials, 14 fulfilled the criteria (5,496 participants) and no superior split-regimen was identified. CONCLUSIONS: Compared with day-before bowel preparation regimens, split-dose bowel preparations regimens increase the detection of adenomas, advanced adenomas, and have the greatest benefit in SSP detection.
Discordance between patient perception and electrodiagnostic results regarding which hand is affected more severely in patients with CTS should alert the clinician to possible coexisting nonneurologic pathology and prompt regional musculoskeletal examination as indicated.
BACKGROUND: Binge drinking and non-alcoholic fatty liver disease (NAFLD) are common health problems throughout the world. However, the impact of binge drinking on NAFLD has yet to be described. The objective of this study was to document the extent of liver disease in community-based NAFLD patients who self-reported monthly binge drinking and compare the findings to NAFLD patients who denied binge drinking (controls). METHODS: The study was undertaken in four Manitoba First Nations communities where the sale and consumption of alcoholic beverages are prohibited. Binge drinkers were retrospectively matched 1:2 by age, sex, and body mass index (BMI) with controls. NAFLD was diagnosed by ultrasonographic features of excess fat in the liver and in individuals with no alternative, non-metabolic explanation for fatty infiltration of the liver. Hepatic inflammation and function were determined by standard liver biochemistry testing and fibrosis by FIB-4 levels and hepatic elastography. RESULTS: Of 546, 88 (16%) NAFLD patients attested to binge drinking. The mean ± SD age of binge drinkers was 40 ± 13 yrs, 51% were male, and the mean BMI was 34±7. Compared with controls, binge drinkers had similar liver biochemistry results (alanine and aspartate AMINOTRANSFERASES: 41 ± 39 and 36 ± 30 versus 36 ± 36 and 31 ± 27 U/L, p = 0.35 and 0.37, respectively), FIB-4 values (0.75 ± 0.55 versus 0.72 ± 0.44, p = 0.41, respectively), and hepatic elastrography (6.6 ± 3.9 versus 6.2 ± 2.9 kPa, p = 0.37, respectively) findings. CONCLUSIONS: In this study population, monthly binge drinking did not appear to impact the severity of NAFLD.
Background Non-alcoholic fatty liver disease (NAFLD) is a common liver disease in which 10–20% of patients are at risk of progressing to cirrhosis. Several risk factors and genetic variants have been proposed to explain such progression but these fail to explain all cases. SEN-V is a hepatotropic ssDNA virus transmitted by both parenteral and non-parenteral routes. In a previous study we documented serologic evidence of SEN-V infection in 21% of 108 patients with chronic Hepatitis B (HBV), C (HCV) or PBC disease. In a recent Japanese study, HCV patients who were SEN-V positive had higher rates of disease progression than those who were SEN-V negative. Conversely, in an Iranian study, liver enzyme levels were lower in HBV patients co-infected with SEN-V. No study has yet documented the prevalence or impact of SEN-V infection in NAFLD. Aims To determine the prevalence and impact of SEN-V infection in NAFLD. Methods Thirty-three consecutive patients with NAFLD confirmed on liver biopsy had serologic testing for SEN-V DNA using short and long primer target sequences; sequencing was confirmed by BLAST and phylogenetic analysis. Patients with other causes of chronic liver disease were excluded. ALT levels, NAFLD activity scores (NAS), and fibrosis scores on biopsy were compared between the SEN-V positive and negative groups using Mann-Whitney, t-test, and chi squared as appropriate. Results SEN-V serologic testing was positive in 15/33 (45%) NAFLD patients, significantly higher than the 24/108 (21%) reported in non-NAFLD historical controls (p < 0.01). Mean serum ALT levels were similar in the two cohorts (SEN-V positive: 109 +/- 163 versus SEN-V negative: 62 +/- 54 IU/L, p= 0.27). The median NAS scores were identical in both groups (5/8) 95% CI [3,6]. Although the median fibrosis stage in SEN-V positive patients was lower (1.0 95% CI [0,3] vs. 2.5 95% CI [1,4] respectively), the difference did not reach statistical significance (p= 0.27). Conclusions Within the limits of this small interim analysis, serologic evidence of SEN-V infection was more common amongst NAFLD patients than historical controls with non-NAFLD chronic liver diseases. However, there were no significant differences in ALT levels, NAS scores or fibrosis stages between SEN-V positive versus negative NAFLD patients. These results suggest that if SEN-V infection has any impact on NAFLD, it may contribute to the development but not severity of the disease. Funding Agencies None
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