INTRODUCTION: Hepatorenal syndrome (HRS) is a functional renal impairment associated with advanced cirrhosis. The best treatment is liver transplantation; however, many patients die before this can be done. Terlipressin improves renal function in HRS, but recent studies have shown similar effects with the cheaper and more readily available norepinephrine. This review included randomized trials comparing noradrenaline to terlipressin for patients with type 1 HRS, as defined by the International Ascites Club.

OBJECTIVE: To determine the safety and effectiveness of noradrenaline in the management of HRS in terms of 1) reducing mortality, 2) reversal and 3) occurrence of adverse events

METHODOLOGY: For this meta-analysis paper, the researchers utilized an electronic search of databases and manual scanning of reference lists were performed. Standardized eligibility assessment was performed independently by three reviewers. Review Manager 5.0.23 was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) as well as I2 values for inter-trial heterogeneity. Standardized eligibility assessment was performed independently by three reviewers.

RESULTS: Thirty-six articles were found after electronic and manual searching. Three were assessed for validity and included in the final analysis. The total number of patients across all trials was 95. Noradrenaline was found not to differ from terlipressin in terms of 15-day survival rate (OR 01.17; 95% CI: 0.51-2.66), reversal of HRS (OR1.07; 95% CI: 0.47-2.44), and a post-hoc analysis on disease-free survival (OR 0.78; 95% CI: 0.34-1.79). Results of sensitivity analysis were consistent with the previous findings (15-day survival: OR=1.21 95% CI = 0.52-2.83; HRS reversal: OR= 1.33, 95% CI = 0.56-3.13; disease-free survival: 1.35, CI =0.56-3.25). Only transient adverse effects were noted with either drugs.

CONCLUSION: There is inconclusive evidence that noradrenaline and terlipressin are significantly different in the reversal of HRS and reduction of mortality. Larger trials on noradrenaline or a non-inferiority trial may be needed to establish the equivalence of noradrenaline with terlipressin.

Hepatorenal Syndrome ; Terlipressin ; Norepinephrine ; Survival Rate ; Liver Transplantation ; Ascites ; Disease-free Survival ; Lypressin ; Liver Cirrhosis ; Renal Insufficiency

BACKGROUND: HIV patients suffer from anxiety and depression but a formal assessment infrequently happens.

ObJECTIVES: The study aimed to measure the prevalence of anxiety and depression among HIV patients in UPPhilippine General Hospital.

METHODS: This study involving 417 HIV-positive patients used the Hospital Anxiety and Depression Scale - Pilipino version to identify cases, with stepwise regression analysis for correlation.

RESULTS: The prevalence of anxiety, depression, and mixed diagnosis was 10.1% (0.072-0.130), 3.1% (0.014-0.048), and 10.8% (0.078-0.138), respectively. Anxiety was correlated with female sex (OR = 7.82, CI 1.03-59.49), unemployment (OR = 1.76, CI 0.90-3.42), smoking (OR = 1.84, CI 0.89-3.79), homosexuality (OR = 7.64, CI 1.36-42.74), and non-use of protective methods during intercourse (OR = 1.81, CI 0.84-3.93). Depression was correlated with unemployment (OR = 2.79, CI 0.91-8.54) and non-disclosure of status (OR = 3.04, CI 0.79-11.67). Mixed diagnosis was correlated to unemployment (OR = 2.09, CI 1.10-3.96), smoking (OR = 2.14, CI 1.08-4.25), homosexuality (OR = 3.14, CI 0.92- 10.65), and non-use of protective methods during intercourse (OR = 1.65, CI 0.77-3.53).

CONCLUSIONS: Lower prevalence of anxiety and depression among HIV patients was found in this study compared with other countries. There is, however, a need to allocate resources for screening mental health problems in HIV patients.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Anxiety ; Depression ; Mental Health ; Human Immunodeficiency Virus