Aim of the study:To evaluate the efficacy of sodium/glucose cotransporter-2 inhibitors (SGLT2i) in improving hepatic fibrosis and steatosis of non-alcoholic fatty liver disease (NAFLD) patients with type 2 diabetes mellitus (T2DM). Material and methods: We searched CENTRAL, MEDLINE, and EMBASE and included any clinical trials involving patients with NAFLD and T2DM aged ≥ 18 years comparing efficacy of SGLT2i and other antidiabetic drugs in improving fibrosis and steatosis, irrespective of publication status, year of publication, and language. Results: Five clinical trials were included. One study reported significant improvements in the controlled attenuation parameter 314.6 ±61.0 dB/m to 290.3 ±72.7 dB/m (p = 0.04) in the SGLT2i group measured by transient elastography. In patients with significant fibrosis, dapagliflozin treatment significantly decreased the liver stiffness measurement from 14.7 ±5.7 kPa at baseline to 11.0 ±7.3 kPa after 24 weeks (p = 0.02). One study reported a significant decrease in liver fat content 16.2% to 11.3% (p < 0.001) in the SGLT2i group compared to the control (p < 0.001). Three studies reported significant improvement in the liver-to-spleen ratio in the SGLT2i group after treatment 0.96 (0.86-1.07) to 1.07 (0.98-1.14), p < 0.01, 0.80 ±0.24 to 1.00 ±0.18, p < 0.001, and 0.91 (0.64-1.04) to 1.03 (0.80-1.20), p < 0.001 respectively. All studies reported a significant decrease in alanine aminotransferase with SGLT2i. Conclusions: SGLT2i is associated with positive effects on hepatic steatosis measured by non-invasive modalities. Further studies are needed to confirm the impact of SGLT2i on hepatic fibrosis and steatosis.

BACKGROUND Variceal hemorrhage is associated with high mortality and is the cause of death for 20–30% of patients with cirrhosis. Nonselective β blockers (NSBBs) or endoscopic variceal ligation (EVL) are recommended for primary prevention of variceal bleeding in patients with medium to large esophageal varices. Meanwhile, combination of EVL and NSBBs is the recommended approach for the secondary prevention. Carvedilol has greater efficacy than other NSBBs as it decreases intrahepatic resistance. We hypothesized that there was no difference between carvedilol and EVL intervention for primary and secondary prevention of variceal bleeding in cirrhosis patients. AIM To evaluate the efficacy of carvedilol compared to EVL for primary and secondary prevention of variceal bleeding in cirrhotic patients METHODS We searched relevant literatures in major journal databases (CENTRAL, MEDLINE, and EMBASE) from March to August 2018. Patients with cirrhosis and portal hypertension, regardless of aetiology and severity, with or without a history of variceal bleeding, and aged ≥ 18 years old were included in this review. Only randomized controlled trials (RCTs) that compared the efficacy of carvedilol and that of EVL for primary and secondary prevention of variceal bleeding and mortality in patients with cirrhosis and portal hypertension were considered, irrespective of publication status, year of publication, and language. RESULTS Seven RCTs were included. In four trials assessing the primary prevention, no significant difference was found on the events of variceal bleeding (RR: 0.74, 95%CI: 0.37-1.49), all-cause mortality (RR: 1.10, 95%CI: 0.76-1.58), and bleeding-related mortality (RR: 1.02, 95%CI: 0.34-3.10) in patients who were treated with carvedilol compared to EVL. In three trials assessing secondary prevention, there was no difference between two interventions for the incidence of rebleeding (RR: 1.10, 95%CI: 0.75-1.61). The fixed-effect model showed that, compared to EVL, carvedilol decreased all-cause mortality by 49% (RR: 0.51, 95%CI: 0.33-0.79), with little or no evidence of heterogeneity. CONCLUSION Carvedilol had similar efficacy to EVL in preventing the first variceal bleeding in cirrhosis patients with esophageal varices. It was superior to EVL alone for secondary prevention of variceal bleeding in regard to all-cause mortality reduction.

Background: Globally, 219 million cases of malaria were recorded in 2017 with Ghana contributing 10.2 million cases, deaths was 599 and 327 were among children under 5 years. Despite the multiple interventions implemented to control malaria in the Volta Region, prevalence still remains high. We evaluated the system in Adaklu District, Volta Region to determine if the system is meeting its objectives of monitoring trends, and detecting epidemics, and assessed its usefulness and attributes.Methods & Materials: We extracted and reviewed malaria data from District Health Management Information System II covering the period of January 2014 and December 2018. We interviewed stakeholders using semi-structured questionnaire on their awareness and involvement in the system, case detection and reporting. System attributes were assessed using the CDC updated guidelines for evaluating public health surveillance. We performed summary descriptive statistics on quantitative data and directed content analysis on qualitative data.Results: Of a total 76,384 suspected malaria cases recorded in Adaklu District over the five-year period, 27,498 (57.4%) cases were recorded between March and October. Health care workers demonstrated good knowledge about the disease but had no idea about the IDSR case definition. All fifteen facilities reported malaria data each month. Stakeholders demonstrated no difficulty diagnosing and reporting cases. The average estimated predictive value positive was 62.9%, data quality was 95% and 100% timely for report submission. The system was used to monitor morbidity trends and evaluate control and preventive measures. There were no alert or epidemic thresholds to detect epidemics. The system missed an epidemic in August 2016. Conclusion:The system in Adaklu District was useful, simple, acceptable, representative with good data quality. Seasonal pattern was observed between March and October each year. The district needs to implement Seasonal Malaria Chemoprevention especially among children to help reduce the incidence among children under five years. We assisted them to set alert and epidemic thresholds based on past data.

Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease associated with venous and/or arterial thrombosis with the presence and persistence of antiphospholipid antibodies (aPL). One of the currently discussed markers related to a high risk of thromboembolism is increased Mean Platelet Volume (MPV). This study aimed to know whether an association exists between MPV and thrombosis event in APS patients. We systematically searched and reviewed studies from MEDLINE, Science Direct and the Cochrane Controlled Trials registry (CENTRAL) from October until November 2018. We use appraisal tools from Critical Appraisal Skills Programme (CASP-UK) for cohort studies. We found two relevant studies to be included in our review.In total, 389 patients consisting 92 APS patient and 297 APS-negative and healthy controls were included. In two studies, the mean of MPV in APS group with thrombosis ranged from 7.85 to 9.22 fl. MPV in APS group with thrombosis was higher than in the APS group without thrombosis and in healthy controls. The platelet size, measured as MPV, reflects platelet reactivity, including aggregation, glycoprotein IIb-IIIa expression and production of more thrombogenic factors. In summary, MPV has a positive correlation with thrombosis event in APS patient. MPV may also be a potential clinical predictor for recurrence of thrombosis in APS patient. We urge that more future prospective studies with larger sample size to be done in order to validate this potential marker.Keywords : Mean platelet volume, thrombosis, antiphospholipid syndrome