Efficacy and Safety of Variable Treatment Options in the Prevention of Hepatic Encephalopathy: A Systematic Review and Network Meta-Analysis

There are no guidelines for the most effective medication to reduce hepatic encephalopathy (HE) or the associated mortality. The purpose of this study is to determine the most effective possible treatment among the single treatment options or the combined treatment options for decreasing the morbidity and mortality of HE. We evaluated the outcomes by various parameters such as the quality of life, reduction in ammonia, all causes of mortality, adverse events, reversal of minimal HE, and development of overt HE. We systematically searched PubMed, Cochrane, Web of Science, and Scopus till the 19th of January 2023 for studies that assess various treatment options for HE. Data were extracted from eligible studies and pooled in a frequentist network meta-analysis as standardized mean difference (SMD) and their 95% confidence interval (CI) using the MetaInsight web-based tool. The Cochrane Tool was used to assess the randomized controlled trials' quality (RCT), while the NIH tool was used to assess the quality of the included cohort studies. Utilizing the R software, the network meta-analysis was conducted. In addition to a significant variation in cases of (Lactulose and Rifaximin) compared with Rifaximin (RR= 0.39, 95% CI [0.17; 0.89]), the results demonstrated a significantly lower incidence of overt HE in (Lactulose and Rifaximin) compared with placebo (RR=0.19, 95% CI [0.09; 0.40]). Most arms demonstrated a statistically significant reduction in the incidence of overt HE compared to albumin and placebo. The results also demonstrated a significant reduction in ammonia between L-ornithine-L-aspartate (LOLA) and probiotics (MD= -19.17, 95% CI [-38.01; -0.32]), as well as a significant difference in the incidence of LOLA compared to placebo (MD= -22.62, 95% CI [-39.16; -6.07]). This network meta-analysis has significant data for managing subclinical HE in people without a history of overt HE. Our analysis showed that (Lactulose and Rifaximin), followed by (Rifaximin and L-carnitine), followed by (Lactulose and Rifaximin with zinc) were the best combinations regarding overt HE. LOLA reduced ammonia best, followed by Nitazoxanide and finally Lactulose. (Lactulose and Nitazoxanide) have the least adverse effects, followed by (Rifaximin and L-carnitine), then Probiotics. Yet, all mortality outcomes and quality of life changes yielded no useful findings. Future studies like RCTs must be done to compare our therapies directly.

Geo- and Environmental Hazard Studies in Kuwait

Low magnitude Earthquakes are the most natural hazard facing Kuwait, while other environmental challenges such as flooding, dust fallout, land degradation, and aeolian sand movement often arise from human impact as well as natural factors. Because of the rapid socio-economic development in the last five decades in Kuwait, these issues cause environmental and social problems as well as economic disturbance; they are also considered natural disasters for country. The scale and intensity of the geological environment hazards are considerably increasing especially land degradation, and impacting on the harsh structure of desert ecosystem. Due to fragility of the desert environment, human activities exceeding the carrying capability of the geo-environment system can easily lead to geological and environmental hazards; such as runoff, sand and dunes movements and dust fallout causing serial environmental and health impacts. Geographic Information System (GIS) has been used to evaluate the degrees of geological hazard and risk by producing maps for each hazard; seismic, sand potentiality, hydrologic risk, land degradation, and sand drift severity maps are produced.

Ceftriaxone versus clavulanate-potentiated amoxycillin for prophylaxis against post-operative sepsis in biliary surgery: a prospective randomized study in 200 patients

A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.