The association between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: A systematic review and meta-analysis.

BACKGROUND AND AIMS: The term metabolic dysfunction-associated fatty liver disease (MAFLD) has been established to better define patients with fatty liver disease who also present with metabolic dysfunction. However, the association between MAFLD and chronic-kidney disease (CKD) remains elusive. METHODS: . We conducted systematic literature searching across multiple databases-PubMed, EMBASE, Cochrane library, and Google Scholar up until June 9th, 2022. The main exposure was the diagnosis of MAFLD and nonalcoholic fatty liver disease (NAFLD) regardless of the diagnostic modalities being used. The outcome of interest was the prevalence or the incidence of CKD. RESULTS: There were 355,886 subjects from 11 included studies with the period of follow up of 4.6-6.5 years. Meta-analysis of cross-sectional studies showed that MAFLD was associated with a higher prevalent CKD (OR 1.50, 95%CI [1.02-2.23]; test for overall effect Z = 2.04, p = 0.04; I2 = 97.7%, p < 0.001) and incident CKD (adjusted HR 1.35, 95%CI [1.18-1.52]; test for overall effect Z = 15.47, p < 0.001; I2 = 84.6%, p < 0.001) and did not vary between age, sex, comorbidities, study region, and follow-up duration. No difference in CKD prevalence was found between MAFLD and NAFLD patients. Significant liver fibrosis, but not steatosis in was associated with greater odds of developing CKD. More severe MAFLD was also associated with higher odds of developing CKD. CONCLUSION: This present meta-analysis using a large population indicates a significant association between MAFLD and the prevalence and incidence of CKD.

Low Body Mass Index as a Risk Factor for Antiretroviral Drug-Related Liver Injury Among HIV Patients.

BACKGROUND: antiretroviral drug-related liver injury (ARLI) is a drug-induced hepatotoxicity due to antiretroviral medication (ARV). It commonly disrupts compliance to treatment and causes treatment discontinuation in HIV-infected patients. Several studies have been conducted on predisposing factors for ARLI including studies on body mass index (BMI) and cluster of differentiation 4 (CD4). The association of BMI and CD4 with ARLI remains controversial as previous studies have demonstrated different outcomes. Our study was conducted to identify the association of low baseline BMI and CD4 cell count as risk factors for ARLI in HIV-infected patients. METHODS: this is a cross-sectional study. Subjects were 75 patients with HIV-AIDS who received ARV therapy using fixed-dose combination  (tenofovir, lamivudine, efavirenz) at the Teratai HIV outpatient clinic of Hasan Sadikin Hospital in Bandung city. Alanine aminotransferase (ALT) test was performed prior to starting ARV treatment and the test was repeated on the sixth month of therapy. RESULTS: there was no significant difference on the proportion of low baseline CD4 count between ARLI and non-ARLI group (p=0.155). Bivariate analysis demonstrated that regarding the proportion of low baseline BMI, there was a significant difference between ARLI and non-ARLI group (p= 0.001). Multivariate analysis using logistic regression showed that BMI of < 18.5 kg/m2 increased the risk for developing ARLI by 5.53 fold; while CD4 cell count of < 200 cells/µL did not the risk. CONCLUSION: our study indicates that low baseline BMI may increase the risk for developing ARLI; while low baseline CD4 cell count does not; therefore, we suggest that ALT test should be performed on a routine basis among HIV-AIDS patients for early detection of ARLI, particularly in patients with low BMI.

Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity?

There are increased reports of pill-induced esophagitis in the past 2 decades, with almost 100 different substances identified as the cause for more than 700 cases, and the overall incidence is estimated to be 0.004% per year. Antibiotics are one of the major contributors for these cases, especially tetracycline and doxycycline; other major contributors are bisphosphonates, nonsteroidal anti-inflammatory drugs, and iron pills. Clindamycin is commonly prescribed by physicians, yet side effect in the form of esophagitis is uncommon and mostly documented in case report. It is possible that these cases are mostly unnoticed due to initial consideration of common and more serious problems. Thus, patients may be assumed to be having a severe episode of acid reflux, and it is not routinely reported or recognized. In this case series, we presented 8 patients with clindamycin-induced esophagitis. The initial presentation of all patients was odynophagia, which appeared within the first day of taking the antibiotic. All patients were subjected to endoscopic examination and ulcer was found in all cases, in the form of localized solitary or multiple ulcers with sharply defined borders. Patients were treated with proton pump inhibitor and sucralfate, and the symptoms subside within 1 week. Patient education regarding the proper way of ingesting drug seems to be the key factor in the prevention of pill-induced esophagitis. The prevention of esophagitis is even more important with antibiotics as adverse effect would decrease the patient compliance in completing the regimen and would ultimately increase antibiotic resistance.

A questionnaire-based survey on the prescription of non-steroidal anti-inflammatory drugs by physicians in East Asian countries in 2007.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are widely used clinically but increase the risk of gastrointestinal (GI) complications. AIM: To examine the current prescription of NSAIDs and comedication to prevent GI complications from NSAIDs within East Asia by means of a questionnaire survey. METHODS: Representative members of the Committee of the International Gastrointestinal Consensus Symposium provided a questionnaire to physicians in 6 East Asian countries. RESULTS: A total of 1,568 physicians participated in this survey. Most physicians prescribed nonselective NSAIDs, cyclooxygenase-2 inhibitors (COXIBs) or aspirin for more than 5 patients per week in all countries, with the exception of the prescription of COXIBs in Japan. Of the nonselective NSAIDs, the drug most frequently prescribed as a first choice was loxoprofen (34%), which was mainly prescribed in Japan, followed by diclofenac (30%). The frequency of prescription of comedication with nonselective NSAIDs was higher compared with that for selective COXIBs or aspirin. Physicians in the northern region (China, Japan and Korea) preferred mucoprotective drugs for comedication with NSAIDs or aspirin, while those in southern region (Indonesia, Philippines and Thailand) frequently used proton-pump inhibitors. CONCLUSION: Among East Asian countries, there are both similarities and differences in the prescription of NSAIDs and of comedication to prevent GI complications.