1.Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis
Yu Jun WONG ; Vy H. NGUYEN ; Hwai-I YANG ; Jie LI ; Michael Huan LE ; Wan-Jung WU ; Nicole Xinrong HAN ; Khi Yung FONG ; Elizebeth CHEN ; Connie WONG ; Fajuan RUI ; Xiaoming XU ; Qi XUE ; Xin Yu HU ; Wei Qiang LEOW ; George Boon-Bee GOH ; Ramsey CHEUNG ; Grace WONG ; Vincent Wai-Sun WONG ; Ming-Whei YU ; Mindie H. NGUYEN
Clinical and Molecular Hepatology 2023;29(3):705-720
Background/Aims:
Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.
Methods:
We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.
Results:
We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001).
Conclusions
IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.
2.Timing of arrival to a tertiary hospital after acute ischaemic stroke - A follow-up survey 5 years later.
Deidre Anne De SILVA ; Norazieda YASSIN ; April J P TOH ; Dao Juan LIM ; Wan Xin WONG ; Fung Peng WOON ; Hui Meng CHANG
Annals of the Academy of Medicine, Singapore 2010;39(7):513-515
INTRODUCTIONIntravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset. We aimed to determine whether the problem of delayed hospital arrival persists in 2009 and to establish the impact of widening the time window for intravenous tPA to 4.5 hours.
MATERIALS AND METHODSWe prospectively surveyed consecutive ischaemic stroke patients admitted to the SGH from 9th March to 30th April 2009. Patients and/or relatives were interviewed with a standardised form similar to the 2004 survey.
RESULTSAmong the 146 ischaemic stroke patients surveyed (median age 67 years, 59% male, median NIHSS score 2), 6% presented to SGH within 2 hours and 15% within 3.5 hours of onset. Median time from stroke onset to hospital arrival was 1245 minutes (20.75 hours). Pre-hospital consultation was significantly associated with hospital arrival after 2 hours from onset. Main reasons cited for delay were not realising the gravity of symptoms (31%) and not recognising them as stroke (27%).
CONCLUSIONDelayed arrival to SGH following acute ischaemic stroke remains a problem in 2009. This confirms the lack of stroke awareness in Singapore and highlights the need for public stroke education. Furthermore, these data confirm that widening the time window for intravenous tPA treatment to 4.5 hours at SGH will increase its utilisation.
Acute Disease ; therapy ; Aged ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitalization ; trends ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care ; statistics & numerical data ; Prospective Studies ; Stroke ; therapy ; Time Factors