Middle East Liver Disease Center

Abstract Background A comprehensive analysis of the trends in mortality of digestive cancers over the past decades in the U.S. is lacking. This study investigates U.S. mortality trends for digestive cancers during the pandemic and assesses the impact of COVID-19. Methods Using data from the National Vital Statistics System and CDC WONDER (2006–2023), age-standardized all-cause mortality (ASACM) rates for digestive cancers were analyzed by joinpoint analysis with annual percentage changes (APC). The percentage of COVID-19-related deaths and the proportion of COVID-19-related deaths among the predicted excess mortality were calculated. Results Between 2018 and 2023, there were 1,089,603 digestive cancer deaths in U.S. adults. The ASACM for digestive cancer decreased significantly from 2006 to 2018 (APC, -0.81%, 95%CI: -1.37, -0.64%), then plateaued from 2018 to 2023 (APC, 0.25%, 95%CI: -0.40\(\:,1\).84). The ASACM was stable at approximately 71 per 100,000 persons between 2018 and 2020, increased to 72.5 per 100,000 persons in 2021, and then declined back to baseline in 2022. The percentage of COVID-19-related deaths among decedents with digestive cancer rose between 2020 and 2022 (1.6%->2.0%->2.2%) and then declined in 2023 (0.8%). The proportion of COVID-19-related deaths was higher in men, older individuals, and American Indian/Alaska Native populations. Conclusions The COVID-19 pandemic temporarily reversed the decreasing trend of digestive cancer mortality. The impact of COVID-19 on cancer-related mortality is underestimated by the proportion of COVID-related deaths, likely related to indirect effects from delays in screening and treatment.

Background:Steatotic liver diseases (SLDs) and their subcategories—metabolic dysfunction–associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD)—significantly contribute to liver-related and extrahepatic morbidity and mortality. This project aimed to assess the landscape of SLDs and clinically significant fibrosis (CSF) before (2017–2020) and during (2021–2023) the COVID-19 pandemic.Methods:Using National Health and Nutrition Examination Survey (NHANES) data, we analyzed 8965 prepandemic and 6337 pandemic participants aged ≥18 years. The main evaluated outcomes were changes in age-adjusted mean CSF, mean controlled attenuation parameter score, and age-adjusted prevalence of MASLD, MetALD, and ALD before and during the pandemic.Results:The age-adjusted prevalence of SLDs changed significantly (p=0.003) between the prepandemic and pandemic periods. ALD prevalence rose from 0.94% to 2.27%, MetALD from 2.60% to 4.42%, while MASLD declined from 30.13% to 25.46%. Vigorous and moderate physical activity decreased significantly (p<0.001), whereas moderate/excessive alcohol intake increased (p<0.001). The prevalence of CSF increased from 8.3% to 10.5% (p=0.028). Multivariable analyses showed the COVID-19 pandemic (adjusted OR: 1.47, 95% CI: 1.00–2.17) and moderate/excessive alcohol intake (adjusted OR: 2.13, 95% CI: 1.15–3.95) were associated with CSF. In addition, older age, higher body mass index, larger waist circumference, prediabetes/diabetes, and lower income were each independently associated with CSF.Conclusions:Our study highlights a shift in SLDs in the United States during the COVID-19 pandemic, showing a decrease in MASLD and increases in MetALD and ALD, with an alarming increase in the prevalence of CSF, likely reflecting lifestyle changes, including physical inactivity and alcohol consumption.

Immune checkpoint inhibitors (ICIs) have become the first-line treatment of unresectable hepatocellular carcinoma (HCC). The prognostic value of immune-related adverse events (irAEs) in these patients remains controversial. We aimed to investigate the association between irAEs and clinical outcomes in patients with HCC treated with ICIs. We searched the PubMed, Scopus, Web of Science, and Central Register of Controlled Trials databases for articles published from inception to June 2024, using keywords including ICI, HCC, and irAEs. Statistical analysis was performed with a random effects model. Of 3,028 studies, 24 (4,127 patients) met the criteria for inclusion. Atezolizumab plus bevacizumab was the most common treatment regimen (n = 10 studies). IrAEs were associated with an increased objective response rate (pooled relative ratio: 1.73; 95% confidence interval [CI]: 1.36-2.21, I 2 = 41%), a higher disease control rate (pooled relative ratio: 1.45; 95% CI: 1.21-1.74, I 2 = 74%), and longer progression-free survival (pooled hazard ratio [HR]: 0.66; 95% CI: 0.52-0.84, I 2 = 71%). There was a trend toward longer overall survival for patients with irAEs compared with those without (pooled HR: 0.84; 95% CI: 0.63-1.12, I 2 = 73%). Subgroup analysis indicated a survival benefit for patients with grade 1-2 irAEs (pooled HR: 0.50; 95% CI: 0.36-0.67, I 2 = 0%) and for those with endocrine irAEs (pooled HR: 0.63; 95% CI: 0.48-0.83, I 2 = 12%). The development of irAEs is associated with favorable clinical outcomes in HCC, including improved progression-free survival and higher objective response rate. Overall survival benefit was noted in patients with mild irAEs but not those with severe irAEs.

Untreated dental caries in permanent teeth is a widespread public health concern. These disparities arise from complex interactions between socioeconomic, healthcare, and dietary factors, despite advancements in dental care and prevention strategies. This study aims to analyze global geographical disparities in untreated dental caries of permanent teeth and identify key systemic factors influencing its prevalence, such as dental workforce density, affordability of fluoride toothpaste, sugar consumption, and healthcare expenditure. An ecological study design was utilized, incorporating country-level data from the World Health Organization and related databases. Descriptive analyses, chi-square tests, and multiple linear regression models were employed to explore associations between untreated caries prevalence and independent variables. Sensitivity analyses addressed data outliers and regional variability. The prevalence of untreated caries ranged from 22.8% to 49.5%, with a mean of 32.4% ± 4.8%. Dental workforce density was a statistically significant predictor (P = 0.014), with higher density associated with increased caries prevalence, suggesting underlying systemic inefficiencies. Other factors, such as sugar consumption and affordability of fluoride toothpaste, showed weak or nonsignificant associations. Sensitivity analyses confirmed the robustness of these findings, highlighting notable regional disparities and indirect influences on caries outcomes. Geographical disparities in untreated caries prevalence are driven by systemic factors, with evidence pointing to inefficiencies in the distribution and accessibility of oral healthcare resources. These findings emphasize the need for targeted public health policies that address regional inequities, improve preventive care access, and account for broader socioeconomic determinants.

Abstract In 2022, highly pathogenic avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b became enzootic and caused mass mortality in Sandwich terns and other seabird species across northwestern Europe. We present data on characteristics of the spread of the virus between breeding colonies and the number of dead adult Sandwich terns recorded at breeding sites throughout northwestern Europe. Within two months after the first mortalities were reported, in total 20,531 adult Sandwich terns were found dead, which is &gt;17% of the total northwestern European breeding population. Losses are likely higher, as we expect that many victims were not found (mortality rate might be up to 74% of the breeding population). Inside the colonies almost all chicks died. After the peak of the outbreak, in a colony established by late breeders, 25.7% of adults showed immunity against HPAI subtype H5. Removal of carcasses helped in reducing the spread of the disease and consequently total mortality. More research on the sources and modes of transmission, incubation times, effective containment and immunity is urgently needed to combat this major threat for colonial seabirds.