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Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Buchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.

AIMTo assess "predictors" of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.METHODSOne hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King's Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of "predictors" for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure.RESULTSFIB-4 was the only strong and significant "predictor" of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the follow-up (median: 31.5 mo; interquartile range: 11-59 mo), 34 patients (24%) experienced a first EVB. FIB-4 was a poor predictor of EVB (the AUC was only 51%) for a cut-off value of 5.02. Furthermore, the AUC of AST/ALT, APRI, PC/SD, FI, MELD and King's Score ranged from 45% to 55%. None of the non-invasive markers turned out to be a useful predictor of EVB.CONCLUSIONDespite the low diagnostic accuracy, FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.

The aim was to determine the sociodemographic and etiologic factors, endoscopic accuracy, treatment efficiency and clinical outcome of patients with nonvariceal upper gastrointestinal system bleeding in Kosova.We retrospectively evaluated patients who had applied to our Gastroenterology Department between January 2006 and December 2010.There were 460 eligible cases with mean age 56.85+16.18 years, while male /female ratio was 2.71/1. The greatest occurrence was at age group of 60-69 years (27.1 %). The most common clinical symptom was melena (62.6%). Comorbid diseases were present in 57, 6% of the patients. The percentage of patients using acetylsalicylic acid and /or other non-steroidal anti-inflammatory drugs was 43.7%. Five point two percent were using anticoagulants. Peptic ulcer was the main cause of bleeding (82.2%) and most of them were Forrest III (41.6%). Endoscopic treatment was performed in 90 patients, primary hemostasis was achieved in 96.7% while rebleeding developed in 10% of these patients. The average length of hospital stay was 9.29+5.58 (1-35) days. Rebleeding was reported in 4.1% of all patients while the overall mortality rate was 5.7%.Age over 60 years, previous history of gastrointestinal bleeding, treatment with anticoagulants, low hemoglobin values at presentation (7 g/dL), hematemesis, Forrest class, localization of lesion of bleeding, comorbidities, tachycardia, transfusion requirement2 unit, type of treatment and time of endoscopy were predictors of poor outcome in study present.

Introduction: Because of the increasing resistance to clarithromycin and metronidazole, new therapeutic alternatives are needed. The purpose of this study was to compare the efficacy of 7- and 10-day triple therapy including omeprazole, levofloxacin and amoxicilline for Helicobacter pylori eradication as a first-line therapy. Methods: One hundred and five patients with peptic ulcer disease and with non-ulcer dyspepsia infected with Helicobacter pylori were included in this study. Patients were randomized to receive either 7-day or 10-day therapy with omeprazole (20 mg b.i.d.), plus levofloxacin (500 mg o.i.d.) and amoxicilline (1000 mg b.i.d.). Eradication was assessed by negative histological analyses, negative H. pylori stool antigen or rapid urease test. Results: In Group 1, the eradication rate was 86, 2%, while in group 2, eradication rate was 93, 6%. There was no difference between groups (p=0.218). Adverse effects were reported in 5, 25% of the patients, including nausea and diarrhea. Conclusions: The levofloxacin-based regimen can be one effective therapy for the first-line anti-H. pylori treatment. However, a levofloxacin-based triple therapy is not generally recommended as first-line therapy at the moment due to concerns about the rising prevalence of quinolone-resistant strains in the first-line and second-line anti-H. pylori therapies.

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome.Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm3in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator.Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02–1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; allP<0.001).Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome.

To evaluate and compare the clinical efficacy of intravenous omeprazole versus intravenous ranitidine therapy for the treatment of non-variceal upper gastrointestinal (UGI) bleeding after endoscopic therapy.108 patients (72 males and 36 females) admitted with non-variceal UGI bleeding in the Intensive Care Unit of the University Hospital of Durres, Albania, from 2004 to 2008, were included in the study. Patients with gastro-duodenal malignancy and those who were previously receiving anti-secretory drugs were excluded. All patients were treated endoscopically by injecting epinephrine (diluted 1:10.000) followed by ethanol and subsequently were randomized to receive either intravenous omeprazole (with an initial dose of 80 mg, followed by 8 mg/h infusion [n = 54]), or intravenous ranitidine (100 mg bolus, followed by 100 mg boluses every 6 hours for the next 72 hours [n = 54]).There-bleeding rate 72 hours after endoscopic treatment was lower in the omeprazole group than in the ranitidine group (6 vs. 14 patients, respectively; OR = 3.4; 95% CI = 1.1 -7.2; P0.01). Less volume of blood transfusion was needed for the omeprazole group than for the ranitidine one (1.1 +/- 1.8 units vs. 2.3 +/- 2.9 units, P = 0.03). The hospitalization period was shorter among patients treated with omeprazole than among those treated with ranitidine (5.4 +/- 2.6 days vs. 6.8 +/- 3.3 days, respectively; P = 0.04). The need for surgery and the mortality rate were not statistically different between the two groups.After endoscopic treatment of non-variceal UGI bleeding, intravenous omeprazole reduced the risk of recurrent bleeding, decreased the need for blood transfusion and shortened the period of hospitalization. Intravenous omeprazole should be used in patients with non-variceal UGI bleeding after effective endoscopic treatment.

To assess the association of Gastro-Esophageal Reflux Disease (GERD) with anthropometric indices [body mass index (BMI) and waist-to-hip ratio (W/H)] in the adult population of Tirana, the Albanian capital.A case-control study was conducted in Tirana in 2005-2007 including 126 consecutive patients diagnosed with GERD at the Endoscopy Unit of the University Hospital Center (77 men aged 54.95 +/- 14.58 years; 49 women aged 50.33 +/- 15.42 years), and 252 GERD-free hospital based controls (150 men aged 54.55 +/- 6.78 years; 102 women aged 50.30 +/- 11.00 years; 84% response). A structured questionnaire included information about socioeconomic characteristics and behavioral factors. Physical examination included measurement of height and weight, and waist and hip circumferences. Multivariable-adjusted binary logistic regression was used to assess the independent associations of anthropometric indices with GERD.GERD was positively associated with BMI (age-adjusted OR = 2.49, 95% CI = 1.40-4.43 for BMIor = 30 vs.30), but less so with W/H (OR = 1.33, 95% CI = 0.85-2.09 for values above cutoff vs. values below cutoff). Upon adjustment for socioeconomic characteristics and behavioral factors, the association with BMI persisted strongly (OR = 2.12, 95% CI = 1.13-3.98), whereas the relationship with W/H was slightly attenuated (OR = 1.22, 95% CI = 0.73-2.02).Our findings indicate that BMI is a strong predictor of symptomatic GERD, independent of animal fat intake, smoking, alcohol consumption and physical exercise.The positive relationship of BMI with symptomatic GERD is also confirmed in the adult population of transitional Albania.

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AIM: To assess the prevalence and socio-demographic distribution of hepatitis B virus (HBV) infection in Albania. METHODS: Blood samples from 410 unselected schoolboys, 666 students, 500 military personnel, 1286 casual blood donors, 378 voluntary blood donors and 640 pregnant women (total 3880 non-vaccinated residents of rural and metropolitan areas from all over Albania; 2354 (60.7%) male and 1526 (39.3%) female; mean age of 26.3 years) were tested during 2004-2006 for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B virus (anti-HBs) by ELISA. RESULTS: The HBsAg and anti-HBs prevalence were 9.5% and 28.7%, respectively. The highest HBsAg prevalence was evident in the younger age group, such as in schoolchildren (11.8%) and the military (10.6%). Consequently, the anti-HBs prevalence increased with age, from 21.2% in schoolchildren (mean age: 15.7 years), to 36.3% in pregnant women (mean age: 26.3 years) and 29.7% in voluntary blood donors (mean age: 40.1 years). There were no significant differences between males and females. CONCLUSION: Despite the estimated two-fold reduction of HBsAg prevalence in the general population from about 18%-19% to 9.5%, Albania remains a highly endemic country (i.e. over 8% of HBsAg prevalence rate).