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: Anxiety and depression, two of the most common affective disorders in cancer patients can affect one’s compliance to treatment leading to poorer outcomes. Therefore, means of determining the psychological wellness of cancer patients through screening tools for anxiety and depression are an integral part of their management. Objectives: 1) To measure the prevalence of anxiety and depression among cancer patients seen in an outpatient clinic of a tertiary hospital using the HADS-P. 2) To assess the impact of the following variables on symptoms of anxiety and depression: demographic, socio-economic, biological and health/clinical parameters. Methodology: This is a cross-sectional analytic study involving 381 cancer patients seen in the outpatient clinic. Symptoms of anxiety and depression were measured using the HADS-P with an 11+ cut-off to identify possible cases of anxiety and depression. Univariate analysis, using STATA Version 13, was performed to identify correlates of anxiety and depression. Results: The prevalence of anxiety, depression and mixed diagnosis (anxiety and depression) amongst this study population were 9.45%,4.72% & 2.89%, respectively. The multivariate analysis described non-college graduates (OR=1.82, CI 0.80-4.14), poor performance status (ECOG 2-3) (OR=5.34, CI 2.44-11.71) and the newly diagnosed and with ongoing treatment patients (OR= 12.02, CI 2.67-54.04 and OR=4.04, CI 0.88-18.58, respectively) as possible correlates of anxiety. Patients with poor performance status and have moderate-severe pain were likely to experience depression (OR= 6.14, CI 2.14-17.62; OR= 2.78, CI 0.92-8.46, respectively). Conclusions There are several factors that can affect one’s predisposition to having affective disorders. Clearly, there is a necessity to allocate resources for screening and treating affective disorders among cancer patients to improve their compliance, to achieve a more holistic approach in their management and ultimately, to improve their quality of life.
Anxiety ; Depression

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