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Big news in the field of Hepatology

In 1980, Jurgen Ludwig and his colleagues at Mayo Clinic, identified a severe type of fatty liver disease in people who did not drink signficant amounts of alcohol. The disease was more common in women, most patients were obese and suffered… pic.twitter.com/aAq2vneIov

— TheLiverDoc (@theliverdr) June 25, 2023

Consensus Statement 2023 Update | Timing of elective surgery and risk assessment after SARS-CoV-2 infection

30 Jun, 2023 | 15:00h | UTC

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update – Anaesthesia

Commentary on Twitter

?"In most circumstances, surgery should proceed unless risk assessment indicates that the risk of proceeding exceeds the risk of delay."@Assoc_Anaes @RCoANews @UkFssa @RCSnews @elboghdadly @doctimcook @justin_kua @NigelMercer @rmoonesinghe

?https://t.co/gfjymze0oi pic.twitter.com/D8bEfAHBD7

— ??????????? (@Anaes_Journal) June 20, 2023

Phase 2 RCT | FGF21 analogue Pegozafermin treatment leads to improvement in NASH fibrosis

30 Jun, 2023 | 14:58h | UTC

Summary: In a phase 2b, multicenter, double-blind, randomized, placebo-controlled trial, the fibroblast growth factor 21 (FGF21) analogue pegozafermin was examined for its efficacy and safety in treating patients with biopsy-confirmed noncirrhotic nonalcoholic steatohepatitis (NASH). A total of 222 patients with moderate or severe fibrosis (stage F2 or F3) were assigned to receive either subcutaneous pegozafermin at varying doses or a placebo. The primary endpoints were an improvement in fibrosis and resolution of NASH without worsening of fibrosis at 24 weeks.

The results showed that a larger percentage of patients receiving pegozafermin met the criteria for fibrosis improvement and NASH resolution compared to those receiving placebo. The most significant improvements were observed in the 44-mg pegozafermin group, with 27% showing fibrosis improvement and 26% meeting NASH resolution criteria, compared to 7% and 2% in the placebo group, respectively. Adverse events were mainly gastrointestinal and included nausea and diarrhea. These findings support the progression of pegozafermin into phase 3 development.

Article: Randomized, Controlled Trial of the FGF21 Analogue Pegozafermin in NASH – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary on Twitter

Late breaking at #EASLCongress: In this phase 2b, placebo-controlled trial involving patients with nonalcoholic steatohepatitis, pegozafermin, a long-acting glycopegylated FGF21 analogue, reduced fibrosis at 24 weeks. Full results by @drloomba et al.: https://t.co/mfRRrV2yX2

— NEJM (@NEJM) June 24, 2023

RCT | Substituting saline with balanced crystalloid solution reduces delayed graft function in kidney transplantation

30 Jun, 2023 | 14:56h | UTC

Summary: The BEST-Fluids study was a pragmatic, multicentre, double-blind, randomized controlled trial carried out across 16 hospitals in Australia and New Zealand, aimed at comparing the use of balanced crystalloid solution (Plasma-Lyte 148) and saline in deceased donor kidney transplantation. The sample size comprised of 808 participants, who were either adults or children of any age, with the primary outcome defined as delayed graft function (DGF) occurring within 7 days post-transplantation.

Findings from the trial revealed that the balanced crystalloid group experienced less DGF than the saline group, with 121 out of 404 participants (30%) and 160 out of 403 participants (40%), respectively. This result yields an adjusted relative risk of 0.74 and an adjusted risk difference of 10.1%.

The study suggests that balanced crystalloid solution significantly reduces the incidence of DGF compared to saline. As no significant safety concerns were raised during the trial, the researchers recommend the use of balanced crystalloid solution as the standard-of-care intravenous fluid in deceased donor kidney transplantation. However, the study doesn’t indicate any significant differences in graft failure or mortality rates, which calls for further research.

Article: Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trial – The Lancet (free registration required)

SR | Little to no impact of low glycemic index/glycemic load diets on weight loss in overweight or obese individuals

30 Jun, 2023 | 14:54h | UTC

Summary: This systematic review examined the impact of low glycaemic index or load (GI/GL) diets on weight loss in overweight or obese individuals, analyzing data from 10 randomized controlled trials (RCTs), with 1,210 participants. The main outcomes included changes in body weight, body mass index (BMI), adverse events, health-related quality of life, and mortality. The study showed that low GI/GL diets probably result in little to no difference in body weight and BMI changes compared to higher GI/GL diets or other diets. The evidence suggests a lack of effect on all main outcomes and the possible positive influence on mood remains uncertain.

The studies included in this review had a small sample size with a moderate to very low certainty of evidence. This suggests more well-structured studies with larger sample sizes are needed for firmer conclusions. Limitations of this review included the risk of bias, as many of the studies did not adopt objective outcome measurements and some had a high degree of loss to follow-up. Furthermore, the researchers recommend that future studies focus on diverse demographic groups and include participants from low- and middle-income countries.

Article: Low glycaemic index or low glycaemic load diets for people with overweight or obesity – Cochrane Library

Summary: Do low glycaemic index or low glycaemic load diets help people with overweight or obesity to lose weight? – Cochrane Library

Consensus Statement | Evaluation and management of deficiency of adenosine deaminase 2

30 Jun, 2023 | 14:53h | UTC

Evaluation and Management of Deficiency of Adenosine Deaminase 2: An International Consensus Statement – JAMA Network Open

Invited Commentary: Finding a Quorum in Deficiency of Adenosine Deaminase 2 Management – JAMA Network Open

M-A | Interventions using wearable activity trackers to improve patient physical activity in adults who are hospitalized

30 Jun, 2023 | 14:46h | UTC

Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized: A Systematic Review and Meta-analysis – JAMA Network Open

Author Interview: Wearable Activity Trackers to Improve Physical Activity and Outcomes – JAMA

News Release: Wearable activity trackers accelerate hospital patient recovery – University of South Australia

Efficacy and safety of luspatercept versus epoetin alfa in erythropoiesis-stimulating agent-naive, transfusion-dependent, lower-risk myelodysplastic syndromes (COMMANDS): interim analysis of a phase 3, open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

M-A | Comparing the efficacy of different types of exercise for the treatment and prevention of depression in youths

30 Jun, 2023 | 14:40h | UTC

Comparing the efficacy of different types of exercise for the treatment and prevention of depression in youths: a systematic review and network meta-analysis – Frontiers in Psychiatry

RCT | Noninferior results with quick resumption of activity after pelvic organ prolapse surgery

30 Jun, 2023 | 14:38h | UTC

Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery: A Randomized Clinical Trial – JAMA Surgery (link to abstract – $ for full-text)

See also: Visual Abstract

Commentary: No Need to Avoid Exercise After Prolapse Surgery, Study Finds – HealthDay

Open-label RCT | Weekly insulin Icodec proves noninferior to daily Glargine in type 2 diabetes

Scoping Review | High correlation of positive outcomes in oncology meta-analyses with industry funding

M-A | Clinical tests for confirming tracheal intubation or excluding esophageal intubation

M-A | Higher versus lower blood pressure targets after cardiac arrest

Review | Respiratory challenges and ventilatory management in different types of acute brain-injured patients

SR | Polyclonal anti‐thymocyte globulins for the prophylaxis of GVHD after allogeneic stem cell or bone marrow transplantation

SR | Gonadotropin‐releasing hormone analogues for endometriosis

SR | Oral contraceptives containing drospirenone for premenstrual syndrome

USPSTF Recommendations | Screen for anxiety disorders in adults, including pregnant and postpartum women

From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization

Consensus Statement 2023 Update | Timing of elective surgery and risk assessment after SARS-CoV-2 infection

Phase 2 RCT | FGF21 analogue Pegozafermin treatment leads to improvement in NASH fibrosis

RCT | Substituting saline with balanced crystalloid solution reduces delayed graft function in kidney transplantation

SR | Little to no impact of low glycemic index/glycemic load diets on weight loss in overweight or obese individuals

Consensus Statement | Evaluation and management of deficiency of adenosine deaminase 2

M-A | Metoclopramide effective in acute migraine relief, comparable to most active drugs, superior to placebo

M-A | Tracheostomy timing not a key determinant of clinical outcomes in critically ill stroke patients

SR | Medical equipment that improve safety and outcomes of inter-facility transportation of critically ill patients

M-A | Effects of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus

M-A | Interventions using wearable activity trackers to improve patient physical activity in adults who are hospitalized

Consensus Paper | Colorectal neuroendocrine tumors

Development and validation of an international preoperative risk assessment model for postoperative delirium

RCT | Luspatercept outperforms epoetin alfa in interim analysis, shows promise for lower-risk myelodysplastic syndromes

M-A | Comparing the efficacy of different types of exercise for the treatment and prevention of depression in youths

RCT | Noninferior results with quick resumption of activity after pelvic organ prolapse surgery

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