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Ma N, Yip R, Lewis S, Dinani A, Wyatt C, Crane M, Jirapatnakul A, Li L, Aloman C, Bansal MB, Dieterich D, Wyatt B, Yankelevitz D, Henschke C, Branch AD. Environmental exposures are important risk factors for advanced liver fibrosis in African American adults. JHEP Rep 2023; 5:100696. [PMID: 36937989 PMCID: PMC10017423 DOI: 10.1016/j.jhepr.2023.100696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/21/2023] Open
Abstract
Background & Aims The prevalence and aetiology of liver fibrosis vary over time and impact racial/ethnic groups unevenly. This study measured time trends and identified factors associated with advanced liver fibrosis in the United States. Methods Standardised methods were used to analyse data on 47,422 participants (≥20 years old) in the National Health and Nutrition Examination Survey (1999-2018). Advanced liver fibrosis was defined as Fibrosis-4 ≥2.67 and/or Forns index ≥6.9 and elevated alanine aminotransferase. Results The estimated number of people with advanced liver fibrosis increased from 1.3 million (95% CI 0.8-1.9) to 3.5 million (95% CI 2.8-4.2), a nearly threefold increase. Prevalence was higher in non-Hispanic Black and Mexican American persons than in non-Hispanic White persons. In multivariable logistic regression analysis, cadmium was an independent risk factor in all racial/ethnic groups. Smoking and current excessive alcohol use were risk factors in most. Importantly, compared with non-Hispanic White persons, non-Hispanic Black persons had a distinctive set of risk factors that included poverty (odds ratio [OR] 2.09; 95% CI 1.44-3.03) and susceptibility to lead exposure (OR 3.25; 95% CI 1.95-5.43) but did not include diabetes (OR 0.88; 95% CI 0.61-1.27; p =0.52). Non-Hispanic Black persons were more likely to have high exposure to lead, cadmium, polychlorinated biphenyls, and poverty than non-Hispanic White persons. Conclusions The number of people with advanced liver fibrosis has increased, creating a need to expand the liver care workforce. The risk factors for advanced fibrosis vary by race/ethnicity. These differences provide useful information for designing screening programmes. Poverty and toxic exposures were associated with the high prevalence of advanced liver fibrosis in non-Hispanic Black persons and need to be addressed. Impact and Implications Because liver disease often produces few warning signs, simple and inexpensive screening tests that can be performed by non-specialists are needed to allow timely diagnosis and linkage to care. This study shows that non-Hispanic Black persons have a distinctive set of risk factors that need to be taken into account when designing liver disease screening programs. Exposure to exogenous toxins may be especially important risk factors for advanced liver fibrosis in non-Hispanic Black persons.
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Key Words
- ALD, alcohol-associated liver disease
- ALT, alanine aminotransferase
- APC, annual percent change
- Aetiology
- BMI, body mass index
- CI, confidence interval
- Environmental toxins
- FIB-4, Fibrosis-4
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HR, hazard ratio
- KI, kidney insufficiency
- LF, liver fibrosis
- MA, Mexican American
- NAFLD, non-alcoholic fatty liver disease
- NEI, no exposure identified
- NHANES, National Health and Nutrition Evaluation Survey
- NHB, non-Hispanic Black
- NHW, non-Hispanic White
- Non-invasive scores
- O, other race
- PCB, polychlorinated biphenyl
- Q1–Q4, quartiles 1–4
- Racial disparities
- Screening
- ULN, upper limit of normal
- USFLI, US Fatty Liver Index
- VH, viral hepatitis
- WC, waist circumference
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Affiliation(s)
- Ning Ma
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Artit Jirapatnakul
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Li
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Costica Aloman
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Meena B. Bansal
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Brooke Wyatt
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - David Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
- Corresponding author. Address: Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1123, New York, NY 10029, USA. Tel.: +1-212-659-8371; Fax: +1-212-849-2574.
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2
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Park H, Brown C, Wilson DL, Huang PL, Hernández-Con P, Horne P, Goodin A, Joseph A, Segal R, Cabrera R, Cook RL. Clinician barriers, perceptions, and practices in treating patients with hepatitis C virus and substance use disorder in the United States. Prev Med Rep 2023; 32:102138. [PMID: 36865395 PMCID: PMC9971512 DOI: 10.1016/j.pmedr.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The likelihood of clinicians prescribing direct-acting antiviral (DAA) therapy for patients with chronic hepatitis C virus (HCV) and substance use disorder (SUD) was assessed via a survey emailed throughout the United States to clinicians (physicians and advanced practice providers) in gastroenterology, hepatology, and infectious disease specialties. Clinicians' perceived barriers and preparedness and actions associated with current and future DAA prescribing practices of HCV-infected patients with SUD were assessed. Of 846 clinicians presumably receiving the survey, 96 completed and returned it. Exploratory factor analyses of perceived barriers indicated a highly reliable (Cronbach alpha = 0.89) model with five factors: HCV stigma and knowledge, prior authorization requirements, and patient- clinician-, and system-related barriers. In multivariable analyses, after controlling for covariates, patient-related barriers (P < 0.01) and prior authorization requirements (P < 0.01) were negatively associated with the likelihood of prescribing DAAs. Exploratory factor analyses of clinician preparedness and actions indicated a highly reliable (Cronbach alpha = 0.75) model with three factors: beliefs and comfort level; action; and perceived limitations. Clinician beliefs and comfort levels were negatively associated with the likelihood of prescribing DAAs (P = 0.01). Composite scores of barriers (P < 0.01) and clinician preparedness and actions (P < 0.05) were also negatively associated with the intent to prescribe DAAs. Conclusion These findings underscore the importance of addressing patient-related barriers and prior authorization requirements-significant problematic barriers-and improving clinicians' beliefs (e.g., medication-assisted therapy should be prescribed before DAAs) and comfort levels for treating patients with HCV and SUD to enhance treatment access for patients with both HCV and SUD.
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Affiliation(s)
- Haesuk Park
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Carolyn Brown
- Health Outcomes, College of Pharmacy, University of Texas, Austin, TX, United States
| | - Debbie L Wilson
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Pei-Lin Huang
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Pilar Hernández-Con
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Patrick Horne
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Amanda Joseph
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Rich Segal
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Roniel Cabrera
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
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Kherghehpoush S, McKeirnan KC. The role of community pharmacies in the HIV and HCV care continuum. Explor Res Clin Soc Pharm 2023; 9:100215. [PMID: 36938123 PMCID: PMC10017415 DOI: 10.1016/j.rcsop.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction In 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. Methods This study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. Results Fifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. Conclusion Individuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.
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Ezzahi M, Zaid E, Farid A, Allali S, Bouardi NE, Haloua M, Hakima A, Alami B, Boubbou M, Maaroufi M, Lamrani MYA. Budd-Chiari syndrome secondary to retro-hepatic vena cava web: An unusual cause of epigastric pain. Radiol Case Rep 2023; 18:1088-1092. [PMID: 36684614 PMCID: PMC9849858 DOI: 10.1016/j.radcr.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Epigastric abdominal pain is a common indication for consultation. In the majority of cases, medical history, clinical examination and routine biological exams allow for an easy diagnosis. Sometimes the symptomatology is unusual, in which case it is essential to perform a complete clinical examination and to use various imaging techniques to search for eventual atypical causes. Membranous obstruction of inferior vena cava is a rare cause of such a phenomenon. We describe a Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava in a 66-year-old woman with no medical history as a rare cause of epigastric abdominal pain. We will describe this clinical experience in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- APS, antiphospholipid syndrome
- AST, aspartate aminotransferase
- Anti-LKM, anti-liver and kidney microsome
- Anti-SLA, anti-soluble liver antigen
- BCS, Budd-Chiari syndrome
- Budd-Chiari
- CT
- CT, computed tomography
- GGT, gamma-glutamyl transferase
- HBc, hepatitis B core
- HBs Ag, hepatitis B surface antigen
- HCV, hepatitis C virus
- IVC, inferior vena cava
- MOIVC
- MOIVC, membranous obstruction of inferior vena cava
- MPS, myeloproliferative syndromes
- MRI, magnetic resonance imaging
- PT, prothrombin time
- Supra-hepatic veins
- TIPS, trans-jugular intra-hepatic portosystemic shunt
- Ultrasound
- Vena cava
- WCC, white count cell
- Web
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Affiliation(s)
- Manar Ezzahi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco,Corresponding author.
| | - Ennasery Zaid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Aassouani Farid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Soukayna Allali
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Nizar El Bouardi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Haloua
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Abid Hakima
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Boubbou
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Mustapha Maaroufi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
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Ntandja Wandji LC, Ningarhari M, Lassailly G, Dharancy S, Boleslawski E, Mathurin P, Louvet A. Liver Transplantation in Alcohol-related Liver Disease and Alcohol-related Hepatitis. J Clin Exp Hepatol 2023; 13:127-138. [PMID: 36647412 PMCID: PMC9840078 DOI: 10.1016/j.jceh.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
Alcohol-related liver disease (ARLD) remains one of the leading causes of chronic liver disease and the prevalence of alcohol-related cirrhosis is still increasing worldwide. Thus, ARLD is one of the leading indications for liver transplantation (LT) worldwide especially after the arrival of direct-acting antivirals for chronic hepatitis C infection. Despite the risk of alcohol relapse, the outcomes of LT for ARLD are as good as for other indications such as hepatocellular carcinoma (HCC), with 1-, 5-, and 10- year survival rates of 85%, 74%, and 59%, respectively. Despite these good results, certain questions concerning LT for ARLD remain unanswered, in particular because of persistent organ shortages. As a result, too many transplantation centers continue to require 6 months of abstinence from alcohol for patients with ARLD before LT to reduce the risk of alcohol relapse even though compelling data show the poor prognostic value of this criterion. A recent pilot study even observed a lower alcohol relapse rate in patients receiving LT after less than 6 months of abstinence as long as addictological follow-up is reinforced. Thus, the question should not be whether LT should be offered to patients with ARLD but how to select patients who will benefit from this treatment.
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Key Words
- AH, alcohol-related hepatitis
- ARLD, Alcohol-related liver disease
- AUDIT, Alcohol Use Disorders Identification Test
- CLD, chronic liver disease
- ELTR, European Liver Transplant Registry
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- LT, liver transplantation
- NASH, non-alcoholic steatohepatitis
- NIAAA, National Institute on Alcohol Abuse and Alcoholism
- UNOS, United Network for Organ Sharing
- alcohol
- alcohol-related hepatitis
- alcohol-related liver disease
- liver transplantation
- survival
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Affiliation(s)
- Line Carolle Ntandja Wandji
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
| | - Massih Ningarhari
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
| | - Guillaume Lassailly
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
| | - Sébastien Dharancy
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
| | - Emmanuel Boleslawski
- University of Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Lille, F-59000 France
| | - Philippe Mathurin
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
| | - Alexandre Louvet
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, F-59000 France
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Maasoumy B, Ingiliz P, Spinner CD, Cordes C, Stellbrink HJ, Schulze zur Wiesch J, Schneeweiß SM, Deterding K, Müller T, Kahlhöfer J, Dörge P, von Karpowitz M, Manns MP, Wedemeyer H, Cornberg M. Sofosbuvir plus velpatasvir for 8 weeks in patients with acute hepatitis C: The HepNet acute HCV-V study. JHEP Rep 2022; 5:100650. [PMID: 36852107 PMCID: PMC9957891 DOI: 10.1016/j.jhepr.2022.100650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background & Aims EASL guidelines recommend 8 weeks of treatment with sofosbuvir plus velpatasvir (SOF/VEL) for the treatment of acute or recently acquired HCV infection, but only 6- and 12-week data are available. Therefore, the aim of this study was to evaluate the safety and efficacy of a shortened 8-week SOF/VEL treatment for acute HCV monoinfection. Methods In this investigator-initiated, prospective, multicentre, single-arm study, we recruited 20 adult patients with acute HCV monoinfection from nine centers in Germany. Patients received SOF/VEL (400/100 mg) as a fixed-dose combination tablet once daily for 8 weeks. The primary efficacy endpoint was the proportion of patients with sustained virological response 12 weeks after the end of treatment (SVR12). Results The median HCV RNA viral load at baseline was 104,307 IU/ml; the distribution of HCV genotypes was as follows: GT1a/1b/2/3/4: n = 12/1/1/3/3. Thirteen (65%) of the 20 patients were taking medication for HIV pre-exposure prophylaxis. SVR12 was achieved in all patients who complied with the study protocol (n = 18/18 [100%], per protocol analysis), but the primary endpoint was not met in the intention-to-treat analysis (n = 18/20 [90%]) because two patients were lost to follow-up. One serious adverse event (unrelated to study drug) occurred during 12 weeks of post-treatment follow-up. Conclusions The 8-week treatment with SOF/VEL was well tolerated and highly effective in all adherent patients with acute HCV monoinfection. Early treatment of hepatitis C might effectively prevent the spread of HCV in high-risk groups. Clinical Trial Number NCT03818308. Impact and implications The HepNet acute HCV-V study (NCT03818308), an investigator-initiated, single-arm, multicenter pilot study, demonstrates the efficacy and safety of 8 weeks of daily treatment with the fixed-dose combination sofosbuvir/velpatasvir (400/100 mg) in patients with acute hepatitis C virus (HCV) infection. All patients who completed therapy and were followed-up achieved sustained virologic response. Thus, early treatment with SOF/VEL which might effectively prevent the spread of HCV in high-risk groups can be recommended for patients with acute HCV monoinfection.
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Affiliation(s)
- Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany,German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany
| | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany,University Hospital Henri-Mondor, INSERM U955, Créteil, France
| | - Christoph D. Spinner
- Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | | | | | - Julian Schulze zur Wiesch
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,Department of Gastroenterology and Hepatology, University Hospital Essen, 45147 Essen, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Julia Kahlhöfer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Petra Dörge
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany
| | | | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany,German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany,Center for Individualized Infection Medicine (CiiM), Hannover, Germany,Corresponding author. Address: Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Tel.: +49 511 5326821
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7
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Ruck JM, Zhou AL, Zeiser LB, Alejo D, Durand CM, Massie AB, Segev DL, Bush EL, Kilic A. Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients. JTCVS Open 2022; 12:269-279. [PMID: 36590744 PMCID: PMC9801334 DOI: 10.1016/j.xjon.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Objective Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established. Methods Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS. Results From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all P > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT. Conclusions HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.
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Key Words
- D+, HCV-viremic donor
- DAAs, direct-acting antivirals
- DCD, donation after circulatory death
- D–, HCV-seronegative donor
- ECMO, extracorporeal membranous oxygenation
- HCV, hepatitis C virus
- HT, heart transplant
- IABP, intra-aortic balloon pump
- IQR, interquartile range
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- R–, HCV-seronegative recipient
- SRTR, Scientific Registry of Transplant Recipients
- aHR, adjusted hazard ratio
- aOR, adjusted odds ratio
- donor pool
- heart transplant
- hepatitis C
- outcomes
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Affiliation(s)
- Jessica M. Ruck
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alice L. Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Laura B. Zeiser
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Diane Alejo
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christine M. Durand
- Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Allan B. Massie
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Dorry L. Segev
- Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY,Scientific Registry of Transplant Recipients, Minneapolis, Minn
| | - Errol L. Bush
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md,Address for reprints: Ahmet Kilic, MD, Department of Surgery, Johns Hopkins Medical Institutions, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
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Lee DH, Chou EY, Moore K, Melly S, Zhao Y, Chen H, Buehler JW. Patient characteristics and neighborhood attributes associated with hepatitis C screening and positivity in Philadelphia. Prev Med Rep 2022; 30:102011. [PMID: 36245804 DOI: 10.1016/j.pmedr.2022.102011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/20/2022] Open
Abstract
Among patients of an urban primary care network in Philadelphia with a universal hepatitis C virus (HCV) screening policy for patients born during 1945-1965, we examined whether being unscreened and HCV positivity were associated with attributes of the census tracts where patients resided, which we considered as proxies for social health determinants. For patients with at least one clinic visit between 2014 and mid-2017, we linked demographic and HCV screening information from electronic health records with metrics that described the census tracts where patients resided. We used generalized estimating equations to estimate adjusted relative risk ratios (aRRs) for being unscreened and HCV positive. Overall, 28% of 6,906 patients were unscreened. Black race, male gender, and residence in census tracts with relatively high levels of violent crime, low levels of educational attainment and household incomes, and evidence of residential segregation by Hispanic ethnicity were associated with lower aRRs for being unscreened. Among screened patients, 9% were HCV positive. Factors associated with lower risks of being unscreened were, in general, associated with higher HCV positivity. Attributes of census tracts where patients reside are probably less apparent to clinicians than patients' gender or race but might reflect unmeasured patient characteristics that affected screening practices, along with preconceptions regarding the likelihood of HCV infection based on prior screening observations or implicit biases. Approaching complete detection of HCV-infected people would be hastened by focusing on residents of census tracts with attributes associated with higher infection levels or, if known, higher infection levels directly.
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Shadaker S, Sood A, Averhoff F, Suryaprasad A, Kanchi S, Midha V, Kamili S, Nasrullah M, Trickey A, Garg R, Mittal P, Sharma SK, Vickerman P, Armstrong PA. Hepatitis B Prevalence and Risk Factors in Punjab, India: A Population-Based Serosurvey. J Clin Exp Hepatol 2022; 12:1310-1319. [PMID: 36157147 PMCID: PMC9499839 DOI: 10.1016/j.jceh.2022.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of hepatitis B virus (HBV) infection in Punjab, India, is unknown. Understanding the statewide prevalence and epidemiology can help guide public health campaigns to reduce the burden of disease and promote elimination efforts. Methods A cross-sectional, population-based survey was conducted from October 2013 to April 2014 using a multistage stratified cluster sampling design. All members of selected households aged ≥5 years were eligible. Participants were surveyed for demographics and risk behaviors; serum samples were tested for total antibody to hepatitis B core (total anti-HBc), hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody (anti-HCV), and HCV RNA. HBsAg-positive specimens were tested for HBV genotype. Results A total of 5543 individuals participated in the survey and provided serum samples. The prevalence of total anti-HBc was 15.2% (95% confidence interval [95% CI]: 14.1-16.5) and HBsAg was 1.4% (95% CI: 1.0-1.9). Total anti-HBc positivity was associated with male sex (adjusted odds ratio [aOR] 1.46; 95% CI: 1.21-1.75), older age (aOR 3.31; 95% CI: 2.28-4.79 for ≥60 vs. 19-29 years), and living in a rural area (aOR 2.02; 95% CI: 1.62-2.51). Receipt of therapeutic injections in the past 6 months also increased risk (4-8 injections vs. none; aOR 1.39; 95% CI: 1.05-1.84). Among those positive for total anti-HBc, 10.4% (95% CI: 8.1-13.2) were also anti-HCV positive. Conclusion Punjab has a substantial burden of HBV infection. Hepatitis B vaccination programs and interventions to minimize the use of therapeutic injections, particularly in rural areas, should be considered.
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Key Words
- CI, confidence interval
- HBV, hepatitis B virus
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- India
- OR, odds ratio
- Punjab
- STI, sexually transmitted infection
- WHO, World Health Organization
- aOR, adjusted odds ratio
- anti-HBc, antibody to hepatitis B core
- anti-HCV, antibody to hepatitis C
- hepatitis B
- prevalence
- risk factors
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Affiliation(s)
- Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, NCHHSTP, Atlanta, GA, 30333, USA
| | - Ajit Sood
- Dayanand Medical College, Department of Gastroenterology, Civil Lines, Tagore Nagar, Ludhiana, Punjab, 141001, India
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, NCHHSTP, Atlanta, GA, 30333, USA
| | | | | | - Vandana Midha
- Dayanand Medical College, Department of Gastroenterology, Civil Lines, Tagore Nagar, Ludhiana, Punjab, 141001, India
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, NCHHSTP, Atlanta, GA, 30333, USA
| | - Muazzam Nasrullah
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, NCHHSTP, Atlanta, GA, 30333, USA
| | - Adam Trickey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ravinder Garg
- Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, 151203, India
| | - Pramod Mittal
- Mittal Liver and Gastroenterology Centre, Patiala, Punjab, India
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, NCHHSTP, Atlanta, GA, 30333, USA
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Wang XJ, Borah B, Rojas R, Kamath MJ, Moriarty J, Allen AM, Kamath PS. Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act. Mayo Clin Proc Innov Qual Outcomes 2022; 6:291-301. [PMID: 35722655 PMCID: PMC9198455 DOI: 10.1016/j.mayocpiqo.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and Methods We compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. Results There were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P<.001) than the NE states. The length of stay was lower by 0.21 days (P=.00028), with a $587.40 lower cost per hospitalization (P=.00091), in the E states than in the NE states. The readmission rates within 30, 60, and 90 days decreased in the E states after ACA implementation but increased in the NE states after ACA implementation. Conclusion Among patients hospitalized for cirrhosis, quality indicators, such as the rate of admission increase, complications, costs, and readmissions, were more favorable in the states that expanded Medicaid. Medicaid expansion under ACA may have benefited patients with cirrhosis.
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Affiliation(s)
- Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bijan Borah
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ricardo Rojas
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - James Moriarty
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Okumura K, Nishida S, Sogawa H, Veillette G, Bodin R, Wolf DC, Dhand A. Inferior Liver Transplant Outcomes during early COVID-19 pandemic in United States. J Liver Transpl 2022; 7:100099. [PMID: 38013989 PMCID: PMC9110062 DOI: 10.1016/j.liver.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background : Since its declaration as a global pandemic on March11th 2020, COVID-19 has had a significant effect on solid-organ transplantation. The aim of this study was to analyze the impact of COVID-19 on Liver transplantation (LT) in United States. Methods : We retrospectively analyzed the United Network for Organ Sharing database regarding characteristics of donors, adult-LT recipients, and transplant outcomes during early-COVID period (March 11- September 11, 2020) and compared them to pre-COVID period (March 11 - September 11, 2019). Results : Overall, 4% fewer LTs were performed during early-COVID period (4107 vs 4277). Compared to pre-COVID period, transplants performed in early-COVID period were associated with: increase in alcoholic liver disease as most common primary diagnosis (1315 vs 1187, P< 0.01), higher MELD score in the recipients (25 vs 23, P<0.01), lower time on wait-list (52 vs 84 days, P<0.01), higher need for hemodialysis at transplant (9.4 vs 11.1%, P=0.012), longer distance from recipient hospital (131 vs 64 miles, P<0.01) and higher donor risk index (1.65 vs 1.55, P<0.01). Early-COVID period saw increase in rejection episodes before discharge (4.6 vs 3.4%, P=0.023) and lower 90-day graft/patient survival (90.2 vs 95.1 %, P<0.01; 92.2 vs 96.5 %, P<0.01). In multivariable cox-regression analysis, early-COVID period was the independent risk factor for graft failure at 90-days post-transplant (Hazard Ratio 1.77, P<0.01). Conclusions : During early-COVID period in United States, overall LT decreased, alcoholic liver disease was primary diagnosis for LT, rate of rejection episodes before discharge was higher and 90-days post-transplant graft survival was lower.
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Key Words
- ALD, alcoholic related liver disease
- ALF, acute liver failure
- BMI, body mass index
- CI, confidence interval
- COD, causes of death
- COVID-19
- COVID-19 mortality
- COVID-19, Coronavirus disease 2019
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazard ratio
- ICU, intensive care units
- IQR, interquartile range
- LT, liver transplant
- MELD, model for end-stage liver disease
- MV, mechanical ventilation
- SARS-CoV-2, severe acute respiratory syndrome coronavirus-2
- SE, standard error
- UNOS, United Network for Organ Sharing
- United Network for Organ Sharing
- United Network for Organ Sharing database
- alcohol related liver disease
- graft failure
- liver transplant
- liver transplant recipients
- outcomes
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - Hiroshi Sogawa
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - Gregory Veillette
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - Roxana Bodin
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - David C Wolf
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center / New York Medical College, Valhalla, NY, USA
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12
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Liu X, Chen Z, Tang Q, Hu P. Phylogenetic signature and prevalence of natural resistance-associated substitutions for hepatitis C virus genotypes 3a and 3b in southwestern China. J Virus Erad 2022; 8:100071. [PMID: 35757658 PMCID: PMC9218835 DOI: 10.1016/j.jve.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/01/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Patients infected with hepatitis C (HCV) genotype (GT) 3, especially GT3b, are still difficult to cure. GT3b is more common than GT3a in southwestern China. Here we aimed to investigate the prevalence of naturally occurring RASs in HCV GT3 in southwestern China and performed phylogenetic analysis. Methods Serum samples were collected from patients with HCV GT3 infection. Sanger sequencing was used to validate resistance-associated substitutions (RASs). Phylogenetic analysis was performed using MEGA X and the observed-minus-expected-squared algorithm was used to analyze amino acid covariance. Results A total of 136 patients were enrolled, including 41 HCV GT3a and 95 GT3b infected patients. In the NS5A region, the proportion of RASs found in GT3b (99%) was notably higher than in GT3a (9%). In the NS3 region, RASs prevalence in GT3b (5%) was lower than in GT3a (24%). NS5B-specific RASs were rare. Both the NS5A30k and L31 M substitutions occurred in 96% of GT3b sequences. The A30K + L31M combination was found in 94% of GT3b isolates, however, there were no A30K or L31M mutations observed in the GT3a sequence. Conclusions Significant differences were observed between HCV GT3a and GT3b in terms of RAS prevalence. The origin of GT3a appears to be more diverse compared with GT3b in southern China. Studies specifically aimed at HCV GT3b infection should be initiated to gain more insight into this subtype.
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Affiliation(s)
| | | | | | - Peng Hu
- Corresponding author. Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.,
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Al jandale O, Jumah H, Jamil H. Hepatitis A virus infection is complicated by both pancytopenia and autoimmune hemolytic anemia (AIHA). Ann Med Surg (Lond) 2022; 78:103765. [PMID: 35600174 PMCID: PMC9118502 DOI: 10.1016/j.amsu.2022.103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Hepatitis A infection affects liver tissue primarily and might have some extrahepatic manifestations. Hematologically, the extrahepatic manifestations include aplastic anemia, red cell aplasia, and thrombocytopenia. There were reports about pancytopenia among patients with Hepatitis A infections, however, its association with autoimmune hemolytic anemia is rare as in our case. Case presentation A 30-year-old male visited the emergency room with tiredness, unmeasured fever, and jaundice. He also mentioned that recently he had anorexia and weight loss without night sweating. Initial laboratory findings showed pancytopenia and marked elevation of AST and ALT. Direct Coombs and IgM anti-Hepatitis A virus were positive. Consequently, he was diagnosed with HAV complicated by both pancytopenia and AIHA and treated with prednisone (1 mg/kg) leading to significant improvement in his anemia. Discussion This report describes a case of acute viral hepatitis A complicated with severe autoimmune hemolytic anemia and pancytopenia, which was successfully treated by high dose (1 mg/kg/day) prednisolone therapy. Conclusion This case represents a rare case in the literature review that can increase the awareness of the wide range of complications of HAV and its association with pancytopenia and AIHA.
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Affiliation(s)
- Omar Al jandale
- Department of Internal Medicine, Damascus University Hospital, Damascus, Syria
| | - Heba Jumah
- Department of Internal Medicine, Damascus University Hospital, Damascus, Syria
- Department of Hematological Diseases, Damascus University Hospital, Damascus, Syria
| | - Hasan Jamil
- Graduate School of Public Health, St. Luke International University, Tokyo, 104-0044, Japan
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Kalita D, Deka S, Chamuah K, Ahmed G. Laboratory Evaluation of Hepatitis C Virus Infection in Patients Undergoing Hemodialysis from North East India. J Clin Exp Hepatol 2022; 12:475-482. [PMID: 35535106 PMCID: PMC9077174 DOI: 10.1016/j.jceh.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/30/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Subjects undergoing hemodialysis have enhanced vulnerability to hepatitis C virus (HCV) infection due to invasive procedures and poor infection control practices. Early detection and treatment are essential to prevent cross-infection and mortality/morbidity. However, common use anti-HCV antibody tests lack the necessary accuracy, and alternative tests (e.g. core antigen detection kits) which are available need to be examined as a viable alternative. METHOD A total of 270 continuous serum samples were collected from patients undergoing dialysis within 15 months of study period. Sequentially, multiple tests were performed - immunochromatography-based rapid test, third-generation ELISA i.e. (anti-HCV antibody detection), fourth-generation ELISA (HCV antigen-antibody combined detection assay), and HCV RNA quantitative real time polymerase chain reaction (qPCR) assay. Diagnostic parameters of serological kits were compared in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and so on. Statistical Package for the Social Sciences was used. RESULTS HCV-combined core antigen-antibody assays performed better than other serological assays in reference to the gold standard HCV RNA. This fourth-generation assay yielded a Kappa value of 0.947 compared with the value of 0.747 and 0.619 for anti-HCV ELISA and rapid detection test. Other parameters such as sensitivity, specificity, PPV, NPV, and so on were also better for fourth-generation ELISA compared with third-generation ELISA and other serological assays. HCV RNA was negative in 7.3% of anti-HCV-positive patients and was detected in 11.4% of anti-HCV ELISA-negative patients. In about 1.6% of HCV RNA-positive cases, fourth-generation ELISA was negative and had low HCV viral load (650 IU/ml and below). Fourth generation ELISA detected additional 7.4% HCV positive cases (compared to third generation kits) and upon cost effective analyis, additional cost to be bear for the better detection (by fourth generation kit) was found to be only INR 27 per 1% increased case detection. CONCLUSION In resource scant setup, screening and follow-up of patients undergoing hemodialysis can be performed by fourth-generation HCV ELISA (antigen-antibody combined assay) instead of the current practice of anti-HCV antibody ELISA. Better yield in detection rate will compensate for slight addition to costs.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- CI, confidence interval
- GGT, gamma-glutamyl transferase
- HBV, hepatitis B virus
- HBsAg, hepatitis B virus surface antigen
- HCV RNA
- HCV core antigen
- HCV, hepatitis C virus
- HIV, human immunodeficieny virus
- ICT, immunochromatography
- LQ, lower quartile
- NAT, nucleic acid amplification test
- NPV, negative predictive value
- OCI, occult hepatitis infection
- PCR, polymerase chain reaction
- PPV, positive predictive value
- PWID, persons who inject drug
- RDT, rapid detection test
- SD, standard deviation
- UQ, upper quartile
- anti-HCV antibodies
- dialysis patient
- viral load
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Affiliation(s)
- Deepjyoti Kalita
- Dept. of Microbiology, All India Institute of Medical Sciences, Rishikesh, Virbhadra Road, Rishikesh 249203, Uttarakhand, India
- Address for correspondence: Dr. Deepjyoti Kalita, Associate Professor, Dept. of Microbiology, All India Institute of Medical Sciences, Rishikesh, Virbhadra Road, Rishikesh 249203, Uttarakhand, India.
| | - Sangeeta Deka
- Dept. of Microbiology, All India Institute of Medical Sciences, Rishikesh, Virbhadra Road, Rishikesh 249203, Uttarakhand, India
| | - Kailash Chamuah
- State Level Viral Research and Diagnostic Laboratory (VRDL), Gauhati Medical College & Hospital, Guwahati, PO: Indrapur, 781005, Guwahati, India
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Padole P, Arora A, Sharma P, Chand P, Verma N, Kumar A. Saroglitazar for Nonalcoholic Fatty Liver Disease: A Single Centre Experience in 91 Patients. J Clin Exp Hepatol 2022; 12:435-439. [PMID: 35535066 PMCID: PMC9077151 DOI: 10.1016/j.jceh.2021.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Saroglitazar is a novel, dual peroxisome proliferator-activated receptors-α/γ agonist and is being investigated for the treatment of nonalcoholic fatty liver disease (NAFLD). Patients and methods Consecutive overweight (body mass index [BMI] >23 kg/m2) patients of NAFLD, diagnosed based on controlled attenuation parameter (CAP) >248 dB/m, and attending the outpatient department of a tertiary care centre in New Delhi, were enrolled. Patients with cirrhosis (liver stiffness measurement [LSM] >13.5 kPa) and those with concomitant liver disease due to other aetiologies (alcohol, viral, etc.) were excluded. All patients received saroglitazar 4 mg/day; in addition, they were advised to reduce weight and were counselled regarding diet and exercise. At 3-month follow-up, patients were categorized into those who were able to reduce ≥5% body weight and those who could n'ot, and both these groups were compared. Results A total of 91 patients (median age 45 years [range 18-66 years]; 81% men) were included in the study. The median BMI was 29.3 kg/m2 (range 23.6-42.2 kg/m2). The baseline median (range) aspartate transaminase, alanine transaminase, gamma glutamyl transferase, LSM and CAP values were 40 IU/dL (range 22-144 IU/dL), 48 IU/dL (range 13-164 IU/dL), 42 IU/dL (range 4-171 IU/dL), 6.7 kPa (range 3.6-13.1 kPa), and 308 dB/m (range 249-400 dB/m). All patients tolerated saroglitazar well. At 3-month, 57 patients (63%) were able to reduce ≥5% weight, whereas in the remaining 34 patients (37%), the weight reduction was <5% from baseline. Transaminases values improved in both the groups; however, LSM and CAP values improved only in patients who reduced weight. Conclusion In overweight patients with NAFLD, a 3-month therapy with saroglitazar is able to improve transaminases but not LSM and CAP values unless accompanied by weight reduction of at least 5%. Larger randomized controlled trials are needed to document the independent effect of saroglitazar in these patients.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- BMI, body mass index
- CAP, controlled attenuation parameter
- DCGI, Drug Controller General of India
- FDA, Food and Drug Administration
- GGT, gamma glutamyl transferase
- HCV, hepatitis C virus
- IQR, interquartile range
- IU, international units
- LSM, liver stiffness measurement
- MAFLD, metabolic (dysfunction) associated fatty liver disease
- NAFLD
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- PPAR, peroxisome proliferator-activated receptor
- controlled attenuation parameter
- dB, decibels
- kPa, kilopascal
- obesity
- pPAR agonist
- saroglitazar
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Affiliation(s)
- Prateek Padole
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Prakash Chand
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Nishant Verma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Vaishnav M, Elhence A, Biswas S, Pathak P, Anand A, Sheikh S, Singh V, Maitra S, Goel A. The Outcome in Cirrhosis after Hospital Discharge is Not Worsened with COVID-19 Infection: A Propensity Score-matched Analysis. J Clin Exp Hepatol 2022; 12:830-840. [PMID: 34840484 PMCID: PMC8610830 DOI: 10.1016/j.jceh.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with cirrhosis and coronavirus disease-2019 (COVID-19) have high in-hospital mortality. The information on the outcome of cirrhosis patients in the posthospitalization period is limited. AIMS We aimed to study the outcome of cirrhosis patients with COVID-19 after hospital discharge. METHODS The records of the cirrhosis patients discharged after COVID-19 were reviewed. Their data were compared with a similar number of cirrhosis patients without COVID-19 after propensity score matching for age, sex, etiology of cirrhosis, and model for end-stage liver disease (MELD) score. RESULTS Cirrhosis patients with (n = 92) or without (n = 92) COVID-19 were included in 1:1 ratio. The mortality among COVID-19 (22; 23.9%) and non-COVID-19 (19; 20.7%) were comparable (HR 1.224; 95% CI 0.663-2.263, P = 0.520), over a similar duration of follow-up [186 (86-271) vs. 183 (103-274)]. Among COVID-19 patients, 45; 48.9% developed a new acute decompensation-increased ascites (40; 43.5%), hepatic encephalopathy (20; 21.7%), or variceal bleeding (8; 8.7%) whereas 25 (27.2%) patients needed rehospitalization. A proportion of participants continued to have either fatigue/weakness (24/80; 30.0%), sleep disturbances (11/80; 13.7%), or joint pains (16/80; 20.0%). The most common causes of death in patients of both groups were end-stage liver disease: 16 (72.7%) vs. 9 (47.4%), followed by multiorgan dysfunction: 4 (18.2%) vs. 6 (31.6%), GI bleeding: 2 (9.1%) vs. 4 (21.0%), P = 0.484. A lower albumin level, higher international normalized ratio, bilirubin, Child-Turcotte-Pugh, and MELD scores at discharge predicted mortality in the COVID-19 group. CONCLUSION Short-term outcomes of patients with cirrhosis who survive the initial insult of COVID-19 are not different from patients without COVID-19, and survival is determined by the severity of liver disease at discharge.
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Key Words
- ACE2, Angiotensin-converting enzyme 2
- AD, acute decompensation
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Alk P, alkaline phosphatase
- COVID-19, coronavirus disease-2019
- CTP, Child-Turcotte-Pugh
- GI, Gastrointestinal
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- INR, international normalized ratio
- IQR, interquartile range
- MELD, model for end-stage liver disease
- NAFLD, nonalcoholic fatty liver disease
- TLC, Total leukocyte count
- chronic liver disease
- coronavirus
- mortality
- pandemic
- virus
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Affiliation(s)
- Manas Vaishnav
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Piysuh Pathak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Anand
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sabreena Sheikh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kulkarni AV, Kumar K, Candia R, Arab JP, Tevethia HV, Premkumar M, Sharma M, Menon B, Rao GV, Reddy ND, Rao NP. Prophylactic Perioperative Terlipressin Therapy for Preventing Acute Kidney Injury in Living Donor Liver Transplant Recipients: A Systematic Review and Meta-Analysis. J Clin Exp Hepatol 2022; 12:417-427. [PMID: 35535072 PMCID: PMC9077193 DOI: 10.1016/j.jceh.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) is common in the perioperative transplant period and is associated with poor outcomes. Few studies reported a reduction in AKI incidence with terlipressin therapy by counteracting the hemodynamic alterations occurring during liver transplantation. However, the effect of terlipressin on posttransplant outcomes has not been systematically reviewed. Methods A comprehensive search of electronic databases was performed. Studies reporting the use of terlipressin in the perioperative period of living donor liver transplantation were included. We expressed the dichotomous outcomes as risk ratio (RR, 95% confidence interval [CI]) using the random effects model. The primary aim was to assess the posttransplant risk of AKI. The secondary aims were to assess the need for renal replacement therapy (RRT), vasopressors, effect on hemodynamics, blood loss during surgery, hospital and intensive care unit (ICU) stay, and in-hospital mortality. Results A total of nine studies reporting 711 patients (309 patients in the terlipressin group and 402 in the control group) were included for analysis. Terlipressin was administered for a mean duration of 53.44 ± 28.61 h postsurgery. The risk of AKI was lower with terlipressin (0.6 [95% CI, 0.44-0.8]; P = 0.001). However, on sensitivity analysis including only four randomized controlled trials (I2 = 0; P = 0.54), the risk of AKI was similar in both the groups (0.7 [0.43-1.09]; P = 0.11). The need for RRT was similar in both the groups (0.75 [0.35-1.56]; P = 0.44). Terlipressin therapy reduced the need for another vasopressor (0.34 [0.25-0.47]; P < 0.001) with a concomitant rise in mean arterial pressure and systemic vascular resistance by 3.2 mm Hg (1.64-4.7; P < 0.001) and 77.64 dyne cm-1.sec-5 (21.27-134; P = 0.007), respectively. Blood loss, duration of hospital/ICU stay, and mortality were similar in both groups. Conclusions Perioperative terlipressin therapy has no clinically relevant benefit.
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Key Words
- AKI, acute kidney injury
- BMI, body mass index
- BUN, blood urea nitrogen
- C, control
- CI, confidence interval
- CNI, calcineurin inhibitors
- CTP, Child-Turcotte-Pugh score
- DDLT, deceased donor liver transplantation
- GRWR, graft-torecipient weight ratio
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HRS, hepatorenal syndrome
- ICU, intensive care unit
- LDLT, living donor liver transplantation
- MAP, mean arterial pressure
- MELD, model for end-stage liver disease
- NR, not reported
- PRBC, packed red blood cells
- RCT, randomized controlled trial
- RRT, renal replacement therapy
- SD, standard deviation
- SVR, systemic vascular resistance
- Tp, Terlipressin
- acute kidney injury
- hemodynamics
- mTORi, mammalian target of rapamycin inhibitors
- portal hypertension
- renal replacement therapy
- sCr, serum creatinine
- vasoconstrictors
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Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India,Address for correspondence. Dr. Anand V.Kulkarni, Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India.
| | - Karan Kumar
- Department of Hepatology, Pacific Institute of Medical Sciences, Udaipur, India
| | - Roberto Candia
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Juan P. Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Harsh V. Tevethia
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Balachandandran Menon
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru V. Rao
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nagaraja P. Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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18
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Fuentes-Valenzuela E, Tejedor-Tejada J, García-Pajares F, Rubiales BM, Nájera-Muñoz R, Maroto-Martín C, Sánchez-Delgado L, Alonso-Martín C, Álvarez CA, Sánchez-Antolín G. Postreperfusion Liver Biopsy as Predictor of Early Graft Dysfunction and Survival After Orthotopic Liver Transplantation. J Clin Exp Hepatol 2022; 12:1133-1141. [PMID: 35814514 PMCID: PMC9257905 DOI: 10.1016/j.jceh.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postreperfusion liver biopsy (PRB) can assess the degree of ischemia/reperfusion injury (IRI) after orthotopic liver transplantation (OLT). The influence of IRI on graft outcomes and overall survival is controversial. AIM To determine the correlation between the severity of IRI in PRB and overall graft and patient survival and, secondarily, to identify factors on PRB that predict poor graft outcomes. METHODS This is a retrospective analysis of all patients who underwent OLT using donation after brain death (DBD) with PRB. The severity of IRI in PRB was graded. Predictors of IRI were assessed using univariate and multivariate analysis and the Kaplan-Meier with log rank test for the graft and overall survival, respectively. RESULTS We included 280 OLTs (64.7%). The histopathological assessment of IRI severity was as follows: no IRI (N = 96, 34.3%), mild IRI (N = 65; 23.2%), moderate IRI (N = 101; 36.1%), and severe IRI (N = 18; 6.4%). The incidence rates of initial good graft function (IGGF), primary nonfunction and early allograft dysfunction (EAD) were 32.5%, 3.9%, and 18.6%, respectively. Severe IRI was associated with a lower incidence of IGGF (OR: 0.34, 95% CI 0.12-0.92; P = 0.03). Patients with severe IRI tended to have a higher incidence of EAD (33.2% vs. 18.6, P = 0.23). The cold ischemia time was an independent predictor of severe IRI on the multivariate analysis. Severe IRI was associated with poor 1- and 5-year overall survival rates (67% and 44%, respectively, compared with 84 and 68% in nonsevere IRI). Patients with severe IRI exhibited worse graft and overall survival. CONCLUSIONS Cold ischemia time predicts the development of severe IRI. Patients with severe IRI show worse graft and overall survival and a lower incidence of IGGF, suggesting that histopathological findings could be useful for identifying patients at high risk of worse outcomes after OLT.
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Key Words
- ALD, alcohol-related liver disease
- ALF, acute liver failure
- ALT, alanine aminotransferase
- CIHD, chronic ischaemic heart disease
- CNI, calcineurin inhibitors
- COPD, chronic obstructive pulmonary disease
- DBD, donation after brain death
- EAD, early allograft dysfunction
- H&E, hematoxylin and eosin
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- IGGF, initial good graft function
- IQR, interquartile range
- IRI, ischaemia/reperfusion injury
- MELD, Model for End-stage Liver Disease
- OLT, orthotopic liver transplantation
- ONT, Organización Nacional de Transplantes
- PBC, primary biliary cholangitis
- PNF, primary nonfunction
- PRB, postreperfusion liver biopsy
- SD, standard deviation
- STROBE, Strengthening the Reporting of Observational studies in Epidemiology
- cold ischemia time
- early allograft dysfunction
- ischemia reperfusion injury
- liver transplantation
- postreperfusion biopsy
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Affiliation(s)
- Esteban Fuentes-Valenzuela
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain,Address for correspondence: Esteban Fuentes-Valenzuela, Department of Gastroenterology and Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, st Dulzaina,2. 47012. Valladolid, Spain.
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Félix García-Pajares
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Beatriz M. Rubiales
- Department of Pathology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Rodrigo Nájera-Muñoz
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carlos Maroto-Martín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Laura Sánchez-Delgado
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carmen Alonso-Martín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carolina A. Álvarez
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Gloria Sánchez-Antolín
- Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
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19
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Bhatti S, Lizaola-Mayo B, Al-Shoha M, Garcia-Saenz-de-Sicilia M, Habash F, Ayoub K, Karr M, Ahmed Z, Borja-Cacho D, Duarte-Rojo A. Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation. J Clin Exp Hepatol 2022; 12:319-328. [PMID: 35535104 PMCID: PMC9077224 DOI: 10.1016/j.jceh.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background End-stage liver disease (ESLD) is not considered a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lifestyle characteristics commonly associated with increased ASCVD risk are highly prevalent in ESLD. Emerging literature shows a high burden of asymptomatic coronary artery disease (CAD) in patients with ESLD and a high ASCVD risk in liver transplantation (LT) recipients. Coronary artery calcium score (CAC) is a noninvasive test providing reliable CAD risk stratification. We implemented an LT evaluation protocol with CAC playing a central role in triaging and determining the need for further CAD assessment. Here, we inform our results from this early experience. Methods Patients with ESLD referred for LT evaluation were prospectively studied. We compared accuracy of CAC against that of CAD risk factors/scores, troponin I, dobutamine stress echocardiogram (DSE), and single-photon emission computed tomography (SPECT) to detect coronary stenosis ≥70 (CAD ≥ 70) per left heart catheterization (LHC). Thirty-day post-LT cardiac outcomes were also analyzed. Results One hundred twenty-four of 148 (84%) patients underwent CAC, 106 (72%) DSE/SPECT, and 50 (34%) LHC. CAC ≥ 400 was found in 35 (28%), 100 to 399 in 17 (14%), and <100 in 72 (58%). LHC identified CAD ≥ 70% in 8 of 29 (28%), 2 of 9 (22%), and 0 of 4, respectively. Two acute coronary syndromes occurred after LT in a patient with CAC 811 (CAD < 70%), and one with CAC 347 (CAD ≥ 70%). No patients with CAC < 100 presented with acute coronary syndrome after LT. When using CAD ≥ 70% as primary endpoint of LT evaluation, CAC ≥ 346 was the only test showing predictive usefulness (negative predictive value 100%). Conclusions CAC is a promising tool to guide CAD risk stratification and need for LHC during LT evaluation. Patients with a CAC < 100 can safely undergo LT without the need for LHC or cardiac stress testing, whereas a CAC < 346 accurately rules out significant CAD stenosis (≥70%) on LHC, outperforming other CAD risk-stratification strategies.
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Key Words
- ACS, Acute coronary syndromes
- ALD, alcoholic liver disease
- ASCVD, Atherosclerotic cardiovascular disease
- ASCVD, atherosclerosis cardiovascular disease risk
- BMI, Body mass index
- CABG, Coronary angioplasty bypass surgery
- CAC, Coronary calcium score
- CAD, Coronary artery disease
- CKD, chronic kidney disease
- DSE/SPECT, Dobutamine stress echocardiogram or single-photon emission computed tomography
- ESLD, End-stage liver disease
- HCV, hepatitis C virus
- IQR, Interquartile range
- LCx, left circumflex
- LHC, Left heart catheterization
- LT, liver transplantation
- MELD, model for end stage liver disease
- MESA, Multi-Ethnic Study of Atherosclerosis
- METs, Metabolic equivalents
- NPV, negative predictive value
- OM, obtuse marginal
- OPTN, Organ Procurement and Transplantation Network
- PCI, Percutaneous coronary intervention
- PDA, posterior descending artery
- POBA, plain old balloon angioplasty
- PPV, positive predictive value
- RCA, right coronary artery
- RI, ramus intermedius
- ROC, Receiver operating characteristic
- RPL, right posterolateral
- SD, Standard deviation
- VT, Ventricular tachycardia
- agatston score
- angiogram
- cardiac stress test
- cirrhosis
- end-stage liver disease
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Affiliation(s)
- Sabha Bhatti
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Blanca Lizaola-Mayo
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, United States
| | - Mohammad Al-Shoha
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | | | - Fuad Habash
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Karam Ayoub
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Michael Karr
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Zubair Ahmed
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Daniel Borja-Cacho
- Division of Transplant Surgery, Northwestern University, 676 N Saint Clair, Chicago, IL, 60611, United States
| | - Andres Duarte-Rojo
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
- Thomas E. Starzl Transplantation Institute and Division of Gastroenterology, Hepatology and Nutrition; University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States
- Address for correspondence: Andres Duarte-Rojo, MD, MS, DSc, Starzl Transplantation Institute and Center for Liver Diseases, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States. Tel.: +1 412 647-1170; fax: +1 412 647 9268
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20
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Jadaun SS, Sharma S, Madhusudhan KS, Sharma R, Nayak B, Kedia S, Singh V, Gunjan D, Acharya SK, Saraya A, Shalimar. Spectrum of Neuroimaging Abnormalities in Brain in Patients of Acute-on-Chronic Liver Failure. J Clin Exp Hepatol 2022; 12:343-52. [PMID: 35535112 DOI: 10.1016/j.jceh.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aims Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality. There is a paucity of data about the spectrum of neuroimaging abnormalities in the brain in ACLF patients. The present study was aimed to study the prevalence of cerebral edema and other parenchymal changes in MR imaging of the brain in patients with ACLF. Methods In this prospective observational study, MR imaging was done in patients with ACLF (n = 41), and findings were compared with age and sex-matched patients with acute decompensation (AD) (n = 13) and those with cirrhosis but without any decompensation at recruitment (n = 21). Results Forty-one patients with ACLF (24.4% Grade 1 and Grade 2, 51.2% Grade 3) with 14 (34.1%) having cerebral failure were included in the study. T2-weighted (T2W) diffuse white matter hyperintensities (WMHs) and focal WMHs were seen in 17 (41.4%) and 7 (17%) patients, respectively. T1W basal ganglia hyperintensities in 20 (48.7%), cerebral microbleeds (CMBs) in 6 (14.6%), and 2 (4.8%) patients had cerebral edema. In patients with AD, T2W diffuse WMHs were seen in 3 (23%), T2W focal WMHs in 3 (23%) patients. None of the patients with AD had cerebral edema or CMBs. In compensated cirrhosis patients, T2W diffuse WMHs were present in 7 (33.3%), T2W focal WMHs in 5 (23.8%), while 3 (14.2%) patients had CMBs. T1 weighted hyperintensities in basal ganglia were more common in AD [9 (69.2%)] and compensated cirrhosis [15 (71.4%)] as compared to ACLF patients [20 (48.7%)], P = 0.174. The survival time of 30 and 90 days for patients with diffuse T2W WMHs was significantly lesser than patients without T2W WMHs (P = 0.007). Conclusion Cerebral edema is uncommon in ACLF patients, and T2-weighted diffuse white matter hyperintensities may be associated with worse outcomes. However, due to the limited scope of the present study, the same needs to be explored further in larger cohorts.
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Key Words
- ACLF
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- ADC, Apparent diffusion coefficient
- CMBs, cerebral microbleeds
- CT, computed tomography
- CTP score, Child Turcotte Pugh score
- Cho/Cr ratio, Choline/creatine ratio
- DWI, Diffusion weighted Imaging
- Glu/Cr ratio, glutamine/creatine ratio
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HE, hepatic encephalopathy
- INR, international normalization ratio
- MELD-Na, model for end-stage liver disease-sodium
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- Myo/Cr ratio, Myoinositol/creatine ratio
- NASH, nonalcoholic steatohepatitis
- PT, prothrombin time
- SOFA, sequential organ failure assessment
- T2W, T2 weighted
- TE, echo time
- WMHs, white matter hyperintensities
- brain imaging
- white matter hyperintensities
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21
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Elhence A, Vaishnav M, Biswas S, Anand A, Gunjan D, Kedia S, Mahapatra SJ, Nayak B, Sheikh S, Soni KD, Trikha A, Goel A, Shalimar. Predictors of in-hospital Outcomes in Patients With Cirrhosis and Coronavirus Disease-2019. J Clin Exp Hepatol 2022; 12:876-86. [PMID: 34728983 DOI: 10.1016/j.jceh.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) cases continue to increase globally. Poor outcomes in patients with COVID-19 and cirrhosis have been reported; predictors of outcome are unclear. The existing data is from the early part of the pandemic when variants of concern (VOC) were not reported. AIMS We aimed to assess the outcomes and predictors in patients with cirrhosis and COVID-19. We also compared the differences in outcomes between the first wave of pandemic and the second wave. METHODS In this retrospective analysis of a prospectively maintained database, data on consecutive cirrhosis patients (n = 221) admitted to the COVID-19 care facility of a tertiary care center in India were evaluated for presentation, the severity of liver disease, the severity of COVID-19, and outcomes. RESULTS The clinical presentation included: 18 (8.1%) patients had compensated cirrhosis, 139 (62.9%) acute decompensation (AD), and 64 (29.0%) had an acute-on-chronic liver failure (ACLF). Patients with ACLF had more severe COVID-19 infection than those with compensated cirrhosis and AD (54.7% vs. 16.5% and 33.3%, P < 0.001). The overall mortality was 90 (40.7%), the highest among ACLF (72.0%). On multivariate analysis, independent predictors of mortality were high leukocyte count, alkaline phosphatase, creatinine, child class, model for end-stage liver disease (MELD) score, and COVID-19 severity. The second wave had more cases of severe COVID-19 as compared to the first wave, with a similar MELD score and Child score. The overall mortality was similar between the two waves. CONCLUSION Patients with COVID-19 and cirrhosis have high mortality (40%), particularly those with ACLF (72%). A higher leukocyte count, creatinine, alkaline phosphatase, Child class, and MELD score are predictors of mortality.
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Key Words
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Alk P, alkaline phosphatase
- COVID-19, Coronavirus disease-2019
- CTP, Child-Turcotte-Pugh
- EHPVO, extrahepatic portal vein obstruction
- HBV
- HBV, hepatitis B virus
- HCV
- HCV, hepatitis C virus
- INR, international normalized ratio
- MELD, model for end-stage liver disease
- MODS, multiorgan dysfunction syndrome
- NAAT, Nucleic Acid Amplification Test
- NAFLD
- NAFLD, nonalcoholic fatty liver disease
- NCPF, noncirrhotic portal fibrosis
- TLC, Total leukocyte count
- VOC, variants of concern
- VOI, variants of interest
- alcohol
- portal hypertension
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Abstract
BACKGROUND Chronic hepatitis B (CHB) remains a public health burden, with more than 257 million persons living with hepatitis B virus globally. Despite the availability of a safe and efficacious vaccine, access to immunization remains poor. As per current estimates, if Asian countries rely only on immunization to reduce the burden of disease, the timelines for HBV elimination will be extended to 2060-2090, a far cry from the World Health Organization's clarion call for viral hepatitis elimination by 2030. METHODS Currently, all practice guidelines lay stress on immunization, prevention of mother-to-child transmission and treatment of immune active disease or cirrhosis. In this review, we critically examine the data from the Asian cohorts, clinical and public health rationale of early treatment, risk of HCC, and assess the need for revision of guidelines. DISCUSSION Patients in the immune tolerant phase (IT) remain untreated till they meet variable age, transaminase, or fibrosis criteria, are often lost to follow up and continue transmitting the infection. With global migration patterns, immunization programmes alone cannot prevent the complications of HBV like cirrhosis, end-stage liver disease, and hepatocellular carcinoma (HCC). In addition, data from Asian cohorts from Taiwan and Korea suggest that HBV DNA levels are directly associated with increased risk of HCC. Histological evidence of advanced fibrosis or immune reactive T cell subsets in the IT phase also raises doubts about the viability of current guidelines that focus on age, alanine transaminase levels, and liver stiffness as markers of risk of inflammation and fibrosis. Current practice does not take into account the histological subsets with minimal inflammation, HBV genome integration or risk of HCC with high viral loads. CONCLUSION New data from Asian cohorts argue the case of expanding access to care to IT-CHB from public health and clinical perspective.
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Key Words
- ALT, alanine transaminase
- CHB, chronic hepatitis B
- HBV Elimination in India
- HBV RNA
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- IA, immune active
- IT, immune tolerant
- MTCT, mother-to-child transmission
- NA, nucleos(t)ide analogs
- PWID, persons who inject drugs
- WHO, World Health Organization
- cccDNA
- chronic hepatitis B
- hepatocellular carcinoma
- immune tolerant phase
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Yogesh K. Chawla
- Emeritus Kalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, India
- Address for correspondence: Prof. Yogesh K Chawla, Ex-Director (PGIMER), Former Prof, & Head, Department of Hepatology, PGIMER, Chandigarh, 160012, India.
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Abstract
Patients with chronic liver disease (CLD) with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis, and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines, and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus has shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers, and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine-preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated, and barriers faced by healthcare professionals in immunizing those with liver disease.
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Key Words
- ACIP, Advisory Committee on Immunization Practices
- ACLF, acute on chronic liver failure
- ALD, alcohol-related liver disease
- CLD, Chronic liver disease
- CLIF-C, Chronic Liver Failure Consortium
- DAA, direct-acting antiviral drugs
- HAV, hepatitis A virus
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- LT, liver transplant
- NAFLD, nonalcoholic fatty liver disease
- SARS-CoV-2
- SOFA, sequential organ failure assessment
- chronic liver disease
- immunization
- vaccines
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Affiliation(s)
- Joseph J. Alukal
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA
| | | | - Paul J. Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore MD, USA
- Address for correspondence: Paul J. Thuluvath, MD., FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA.
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Das GC, Chaluvashetty SB, Gupta S, De A. Hepatic Angiosarcoma-Uncommon Presentation of a Rare Tumor and its Management by Interventional Radiology. J Clin Exp Hepatol 2022; 12:204-207. [PMID: 35068800 PMCID: PMC8766558 DOI: 10.1016/j.jceh.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/30/2021] [Indexed: 01/03/2023] Open
Abstract
Hepatic angiosarcoma is an uncommon primary malignancy of the liver. It carries a poor prognosis because of very aggressive nature of the tumor. Clinical presentation of hepatic angiosarcoma is variable, most common being hepatomegaly or abdominal mass. Here we report a case of primary hepatic angiosarcoma presented with spontaneous rupture and hemoperitoneum, which was managed successfully by transarterial embolization.
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Affiliation(s)
- Gaurav C. Das
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | | | - Shruti Gupta
- Department of Cytology and Gynecological Pathology, PGIMER, Chandigarh, India
| | - Arka De
- Department of Hepatology, PGIMER, Chandigarh, India
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Abstract
BACKGROUND Cirrhosis is the outcome of chronic liver disease of any etiology due to progressive liver injury and fibrosis. Consequently, cirrhosis leads to portal hypertension and liver dysfunction, progressing to complications like ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, cirrhotic cardiomyopathy, sarcopenia, hepatocellular carcinoma, and coagulation disorders. End-stage liver disease leads to an impaired quality of life, loss of social and economic productivity, and reduced survival. METHODS This narrative review explains the pathophysiology of complications of cirrhosis, the diagnostic approach and innovative management, with focus on data from India. A comprehensive literature search of the published data was performed in regard with the spectrum, diagnosis, and management of cirrhosis and its complications. RESULTS There is a change in the epidemiology of metabolic syndrome, lifestyle diseases, alcohol consumption and the spectrum of etiological diagnosis in patients with cirrhosis. With the advent of universal vaccination and efficacious long-term viral suppression agents for chronic hepatitis B, availability of direct-acting antiviral agents for chronic hepatitis C, and a booming liver transplantation programme across the country, the management of complications is essential. There are several updates in the standard of care in the management of complications of cirrhosis, such as hepatorenal syndrome, hepatocellular carcinoma, and hepatic encephalopathy, and new therapies that address supportive and palliative care in advanced cirrhosis. CONCLUSION Prevention, early diagnosis, appropriate management of complications, timely transplantation are cornerstones in the management protocol of cirrhosis and portal hypertension. India needs improved access to care, outreach of public health programmes for viral hepatitis care, health infrastructure, and disease registries for improved healthcare outcomes. Low-cost initiatives like immunization, alcohol cessation, awareness about liver diseases, viral hepatitis elimination, and patient focused decision-making algorithms are essential to manage liver disease in India.
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Key Words
- AIH, autoimmune hepatitis
- ALP, alkaline phosphatase
- AVB, acute variceal bleeding
- BMI, body mass index
- CLD, chronic liver disease
- CSPH, clinically significant portal hypertension
- CTP, Child Turcotte Pugh Score
- DAAs, direct-acting antiviral agents
- GGT, gamma glutamyl transpeptidase
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HE, hepatic encephalopathy
- HR, hazard ratio
- HRQoL, health-related quality of life
- HVPG, hepatic vein pressure gradient
- MELD, Model for End Stage Liver disease
- MetS, metabolic syndrome
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NSBB, Non-selective beta blockers
- NVHCP, National Viral Hepatitis Control programme
- SAAG, Serum-ascites albumin gradient
- SBP, spontaneous bacterial peritonitis
- WHO, World Health Organization
- cirrhosis, ascites
- hepatic encephalopathy
- hepatocellular carcinoma
- portal hypertension
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Gu W, Hortlik H, Erasmus HP, Schaaf L, Zeleke Y, Uschner FE, Ferstl P, Schulz M, Peiffer KH, Queck A, Sauerbruch T, Brol MJ, Rohde G, Sanchez C, Moreau R, Arroyo V, Zeuzem S, Welsch C, Trebicka J. Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018). Lancet Reg Health Eur 2021; 12:100240. [PMID: 34901909 PMCID: PMC8640738 DOI: 10.1016/j.lanepe.2021.100240] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Cirrhosis is known to have a high prevalence and mortality worldwide. However, in Europe, the epidemiology of cirrhosis is possibly undergoing demographic changes, and etiologies may have changed due to improvements in standard of care. The aim of this population-based study was to analyze the trends and the course of liver cirrhosis and its complications in recent years in Germany. Methods We analyzed the data of all hospital admissions in Germany within diagnosis-related groups from 2005 to 2018. The diagnostic records of cirrhosis and other categories of diseases were based on ICD-10-GM codes. The primary outcome measurement was in-hospital mortality. Trends were analyzed through Poisson regression of annual number of admissions. The impact of cirrhosis on overall in-hospital mortality were assessed through the multivariate multilevel logistic regression model adjusted for age, sex, and comorbidities. Findings Of the 248,085,936 admissions recorded between 2005 and 2018, a total of 2,302,171(0•94%) were admitted with the diagnosis of cirrhosis, mainly as a comorbidity. Compared with other chronic diseases, patients admitted with cirrhosis were younger, mainly male and had the highest in-hospital mortality rate. Diagnosis of cirrhosis was an independent risk factor of in-hospital mortality with the highest odds ratio (OR:6•2[95%CI:6.1-6•3]) among all diagnoses. The prevalence of non-alcoholic fatty liver disease has increased four times from 2005 to 2018, while alcoholic cirrhosis is 20 times than other etiologies. Bleeding was found to be decreasing over time, but ascites remained the most common complication and was increasing. Interpretation This nationwide study demonstrates that cirrhosis represents a considerable healthcare burden, as shown by the increasing in-hospital mortality, also in combination with other chronic diseases. Alcohol-related cirrhosis and complications are on the rise. More resources and better management strategies are warranted. Funding The funders had no influence on this study.
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Key Words
- ALD, alcoholic liver diseases
- DAA, direct-acting antiviral
- DALYs, disability-adjusted life years
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- ICD, International Classification of Diseases
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- OPS, operation and procedure key system
- YLDs, years lived with disability
- YLLs, years of life lost
- cirrhosis
- hospital admission
- male
- mortality
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Affiliation(s)
- Wenyi Gu
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Hannah Hortlik
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Hans-Peter Erasmus
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Louisa Schaaf
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Yasmin Zeleke
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frank E Uschner
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Philip Ferstl
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Martin Schulz
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kai-Henrik Peiffer
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alexander Queck
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tilman Sauerbruch
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Maximilian Joseph Brol
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- University Hospital Frankfurt, Department of Respiratory Medicine and Allergology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Cristina Sanchez
- European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Richard Moreau
- European Foundation for Study of Chronic Liver Failure, Barcelona, Spain.,APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | - Vicente Arroyo
- European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christoph Welsch
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.,European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
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Stainbrook T, Elliott K, Powell A, Simpson MA, Bash M. Hepatitis C identification and treatment in rural Pennsylvania, USA. Prev Med Rep 2021; 24:101526. [PMID: 34976603 PMCID: PMC8683873 DOI: 10.1016/j.pmedr.2021.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/30/2021] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
The opioid epidemic in the United States has led to increases in hepatitis C virus (HCV) infection especially in rural communities. It is recommended that persons who inject drugs undergo screening and treatment. We initiated HCV screening and treatment within a mostly rural area of Pennsylvania by targeting medicated-assisted treatment (MAT) facilities and community events. Screening was conducted in 43 rural and 13 urban counties by a clinical team. At MAT facilities, the clinical team performed HCV screening between 4:30am and 1:00pm using the OraQuick HCV test free of charge. Participants with a positive screen were linked to treatment. In all, 3,051 screening tests were conducted among 2,995 unique participants, who were mostly white (2821, 94%) and from rural counties (2597, 87%). Participants were most frequently 25-to-34 years old (798, 27%). A total of 730 patients were HCV screen positive, 371 patients received an HCV RNA PCR test, and 272 were HCV RNA positive. Of them, 249 met with a healthcare provider, 102 initiated treatment, and 50 completed SVR testing, with 49 achieving SVR. Anti-HCV positivity was more frequent among MAT facility versus non-MAT patients (41% versus 5%) (p < .001). Non-MAT participants were more likely to begin treatment for HCV (91% [21/23] versus 30% [81/272]) and achieve SVR (71% versus 43%). In HCV screening and treatment among high-risk patients, substantial numbers of participants were lost at every point of care between screening and follow-up testing. Specific screening, treatment, and follow-up strategies for persons in rural communities may be needed.
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Affiliation(s)
| | - Kelsey Elliott
- TruCare Internal Medicine & Infectious Diseases, DuBois, PA, USA
| | - Amy Powell
- TruCare Internal Medicine & Infectious Diseases, DuBois, PA, USA
| | - Mary A. Simpson
- TruCare Internal Medicine & Infectious Diseases, DuBois, PA, USA
| | - Maddy Bash
- TruCare Internal Medicine & Infectious Diseases, DuBois, PA, USA
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28
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Dhiman RK, Grover GS, Premkumar M, Roy A, Taneja S, Duseja A, Arora S. Outcomes of Real-World Integrated HCV Microelimination for People Who Inject Drugs: An expansion of the Punjab Model. EClinicalMedicine 2021; 41:101148. [PMID: 34712928 PMCID: PMC8529203 DOI: 10.1016/j.eclinm.2021.101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of chronic hepatitis C (CHC) in People Who Inject Drugs (PWID) is 8-10% as compared to 3·6% in the general population in Punjab, India. We assessed the real-world efficacy and safety of free-of-charge generic direct-acting antivirals (DAAs), sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir)±ribavirin in the microelimination of CHC in PWID in a public health setting. METHODS An integrated care team at 25 sites provided algorithm based DAAs treatment to PWID supervised by telemedicine clinics between 18th June 2016 and 31st July 2019. The primary endpoint was sustained virological response at 12 weeks (SVR-12); the secondary endpoints were treatment completion, adherence, safety, and adverse events. ClinicalTrials.gov number: NCT01110447. FINDINGS We enrolled 3477 PWID (87·2% men; mean age 33·6±12·5 years; 83·8% rural; 6·8% compensated cirrhosis). While 2280 (65·5%) patients completed treatment, 1978 patients completed 12 weeks of follow up for SVR-12. SVR-12 was achieved in 91·1% of patients per protocol, 49.5% as per intention to treat (ITT) and 90·1% in a modified ITT analysis. Of 546 (15·7%) patients with treatment interruptions, 99 (19·7%) could be traced to test for SVR-12 with a cure rate of 77·8%. There were no major adverse events or consequent treatment discontinuation. INTERPRETATION Integrated care of PWID with CHC with DAAs is safe and effective. Measures for reducing treatment interruptions will further improve outcomes. FUNDING The Government of the state of Punjab, India under the Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF) project, funds the project.
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Key Words
- ALT, alanine aminotransferase
- CHC, chronic hepatitis C
- CI, confidence interval
- DAAs, direct-acting antiviral agents
- DCV, Daclatasvir
- DH, District Hospital
- ECHO, Extension for Community healthcare Outcome
- G, Genotype
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV
- HCV, hepatitis C virus
- IDU, injection drug use
- INASL, Indian National Association for study of the Liver
- India
- LDV, ledipasvir
- MMPHCRF, Mukh Mantri Punjab Hepatitis C Relief Fund
- NVHCP, National Viral Hepatitis Control Programme
- OST, opioid substitution therapy peg-interferon
- PWID, People Who Inject Drugs
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained virologic response
- VEL, Velpatasvir
- hepatitis C virus
- injection drug use
- microelimination
- people who inject drugs
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Affiliation(s)
- Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
- Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India
- Technical Resource Group - National Viral Hepatitis Control Program (NVHCP), Government of India, India
- Injection Safety Project, Punjab Government, Punjab, India
| | | | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Roy
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjeev Arora
- ECHO Institute University of New Mexico, USA, New Mexico, United States
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Song S, Gao P, Sun L, Kang D, Kongsted J, Poongavanam V, Zhan P, Liu X. Recent developments in the medicinal chemistry of single boron atom-containing compounds. Acta Pharm Sin B 2021; 11:3035-3059. [PMID: 34729302 PMCID: PMC8546671 DOI: 10.1016/j.apsb.2021.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/25/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Various boron-containing drugs have been approved for clinical use over the past two decades, and more are currently in clinical trials. The increasing interest in boron-containing compounds is due to their unique binding properties to biological targets; for example, boron substitution can be used to modulate biological activity, pharmacokinetic properties, and drug resistance. In this perspective, we aim to comprehensively review the current status of boron compounds in drug discovery, focusing especially on progress from 2015 to December 2020. We classify these compounds into groups showing anticancer, antibacterial, antiviral, antiparasitic and other activities, and discuss the biological targets associated with each activity, as well as potential future developments.
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Key Words
- ACTs, artemisinin combination therapies
- ADCs, Acinetobacter-derived cephalosporinases
- AML, acute myeloid leukemia
- AMT, aminopterin
- BLs, β-lactamases
- BNCT, boron neutron capture therapy
- BNNPs, boron nitride nanoparticles
- BNNTs, boron nitride nanotubes
- Boron-containing compounds
- CEs, carboxylesterases
- CIA, collagen-induced arthritis
- COVID-19, coronavirus disease 2019
- ClpP, casein protease P
- Covalent inhibitors
- GSH, glutathione
- HADC1, class I histone deacetylase
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- LeuRS, leucyl-tRNA synthetase
- Linker components
- MBLs, metal β-lactamases
- MDR-TB, multidrug-resistant tuberculosis
- MERS, Middle East respiratory syndrome
- MIDA, N-methyliminodiacetic acid
- MM, multiple myeloma
- MTX, methotrexate
- Mcl-1, myeloid cell leukemia 1
- Mtb, Mycobacterium tuberculosis
- NA, neuraminidase
- NS5B, non-nucleoside polymerase
- OBORT, oxaborole tRNA capture
- OPs, organophosphate
- PBA, phenylboronic acid
- PDB, Protein Data Bank
- PPI, protein–protein interaction
- Prodrug
- QM, quinone methide
- RA, rheumatoid arthritis
- ROS, reactive oxygen species
- SARS-CoV-2, syndrome coronavirus 2
- SBLs, serine β-lactamases
- SERD, selective estrogen receptor downregulator
- SHA, salicyl hydroxamic acid
- SaClpP, Staphylococcus aureus caseinolytic protease P
- TB, tuberculosis
- TTR, transthyretin
- U4CR, Ugi 4-component reaction
- cUTI, complex urinary tract infection
- dCTPase, dCTPase pyrophosphatase
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Affiliation(s)
- Shu Song
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Ping Gao
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Lin Sun
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Dongwei Kang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Jacob Kongsted
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M. DK-5230, Denmark
| | - Vasanthanathan Poongavanam
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M. DK-5230, Denmark
- Corresponding authors. Tel./fax: +86 531 88380270.
| | - Peng Zhan
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
- Corresponding authors. Tel./fax: +86 531 88380270.
| | - Xinyong Liu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
- Corresponding authors. Tel./fax: +86 531 88380270.
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Abstract
The association between alcohol and liver disease, including alcoholic hepatitis, cirrhosis, acute-on-chronic liver failure, and hepatocellular carcinoma, has been well described, but the same cannot be said for the association between smoking, water pipe or tobacco chewing. A review of cumulative evidence suggests that smoking is independently a risk factor for liver fibrosis and contributes to carcinogenesis in HCC. Smoking-related fibrosis has been reported in patients with nonalcoholic fatty liver disease, primary biliary cholangitis, alcoholic liver disease and chronic viral hepatitis. Heavy smoking leads to systemic inflammation, oxidative stress, insulin resistance, and results in tissue hypoxia, as well as free radical damage. Other than damaging the liver, patients also suffer from the systemic effects of the 4000 chemicals associated with tobacco, which include nitrosamines, aromatic hydrocarbons, nicotine, nornicotine, and other alkaloids. These include respiratory ailments, cancer of the lungs, oral cavity, esophagus, pancreas and colon, atherosclerotic vascular disease, and stroke.
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Key Words
- ALP, alkaline phosphatase
- BMI, body mass index
- CLD, chronic liver disease
- GGT, gamma-glutamyl transpeptidase
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazard ratio
- MetS, metabolic syndrome
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- RR, relative risk
- ST, smokeless tobacco
- WHO, World Health Organization
- cirrhosis
- hepatocellular carcinoma
- inflammation
- smoking
- tobacco
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anil C Anand
- Department of Hepatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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31
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Gomaa AA, Abdel-Wadood YA. The potential of glycyrrhizin and licorice extract in combating COVID-19 and associated conditions. Phytomed Plus 2021; 1:100043. [PMID: 35399823 PMCID: PMC7886629 DOI: 10.1016/j.phyplu.2021.100043] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 04/28/2023]
Abstract
BACKGROUND Several recent studies have stated that glycyrrhizin and licorice extract are present in most traditional Chinese medicine formulas used against SARS-CoV-2 in China. Significant data are showing that glycyrrhizin and licorice extract have multiple beneficial activities in combating most features of SARS-CoV-2. PURPOSE The aim of current review was to highlight recent progresses in research that showed the evidence of the potential use of glycyrrhizin and licorice extract against COVID-19. METHODOLOGY We have reviewed the information published from 1979 to October 2020. These studies demonstrated the effects , use and safety of glycyrrhizin and icorice extract against viral infections,bacterial infections, inflammatory disorders of lung ( in vitro and in vivo). These studies were collated through online electronic databases research (Academic libraries as PubMed, Scopus, Web of Science and Egyptian Knowledge Bank). RESULTS Pooled effect size of articles provides information about the rationale for using glycyrrhizin and licorice extract to treat COVID-19. Fifty studies demonstrate antiviral activity of glycyrrhizin and licorice extract. The most frequent mechanism of the antiviral activity is due to disrupting viral uptake into the host cells and disrupting the interaction between receptor- binding domain (RBD) of SARS-COV2 and ACE2 in recent articles. Fifty studies indicate that glycyrrhizin and licorice extract have significant antioxidant, anti-inflammatory and immunomodulatory effects. Twenty five studies provide evidence for the protective effect of glycyrrhizin and licorice extract against inflammation-induced acute lung injury and cardiovascular disorders. CONCLUSION The current study showed several evidence regarding the beneficial effects of glycyrrhizin and licorice extract in combating COVID-19. More randomized clinical trials are needed to obtain a precise conclusion.
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Key Words
- 18β-GA, 18β-glycyrrhetinic acid
- : ACE2, angiotensin-converting enzyme 2
- ALI, acute lung injury
- ARDS, acute Respiratory Distress Syndrome
- Acute lung injury protector
- COVID-19
- COVID-19, Coronavirus disease 2019
- COX-2, cyclooxygenase-2
- DCs, dendritic cells
- Gl, glycyrrhizin
- Glycyrrhizin and licorice extract;Antiviral and antimicrobial, Anti-inflammatory and antioxidant
- HBsAg, hepatitis B surface antigen
- HCV, hepatitis C virus
- HMGB1, high-mobility group box 1
- IL, interleukin
- Immunododulator
- MAPKs, mitogen-activated protein kinases
- MERS, Middle East respiratory syndrome
- MR, mineralocorticoid receptor
- MRSA, Methicillin-resistant Staphylococcus aureus
- NO, nitric oxide
- RBD, receptor-binding domain
- ROS, reactive oxygen species
- S, Spike
- SARS, severe acute respiratory syndrome
- TCM, traditional Chinese medicine
- TLR, toll-like receptor
- TMPRSS2, type 2 transmembrane serine protease
- TNF-α, tumor necrosis factor alpha
- h, hour
- iNOS, inducible nitric oxide synthase
- licorice extract, LE
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Affiliation(s)
- Adel A Gomaa
- Department of Medical Pharmacology, Faculty of Medicine, Assiut Universitya, Beni-Suif, Egypt
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Shirai D, Shinkawa H, Takemura S, Tanaka S, Amano R, Kimura K, Kinoshita M, Kawada N, Kubo S. Impact of alcohol abstinence on survival after hepatic resection for hepatocellular carcinoma in patients with alcohol-related liver disease. Ann Med Surg (Lond) 2021; 68:102644. [PMID: 34386231 PMCID: PMC8346358 DOI: 10.1016/j.amsu.2021.102644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate the prognostic impact of alcohol abstinence on survival after hepatic resection for hepatocellular carcinoma (HCC) in patients with alcohol-related liver disease (ALD). Patients and methods In total, 92 patients with ALD-HCC who underwent initial and curative hepatic resection were identified, including 56 and 36 patients with and without alcohol abstinence, respectively. Results The 3-, 5-, and 7-year recurrence-free survival (RFS) were 46%, 43%, and 37% in the abstinence group, and 61%, 36%, and 36% in the non-abstinence group, respectively (p = 0.71). The 3-, 5-, and 7-year overall survival (OS) were 91%, 76%, and 66% in the abstinence group, and 87%, 57%, and 44% in the non-abstinence group, respectively (p = 0.023). Multivariate analysis revealed that non-abstinence was an independent prognostic factor for OS (P = 0.026). The incidence rate of liver-related death including HCC-specific death, liver failure, and renal failure in cirrhosis (hepatorenal syndrome) between the non-abstinence and abstinence groups were 41.7% vs. 19.6% (p = 0.032). Worsening of the Child–Pugh grade at intrahepatic recurrence was more frequently observed in the non-abstinence (33.3%) than that in the abstinence group (6.5%) (p = 0.039). Conclusions Alcohol abstinence might improve the long-term survival of patients with ALD-HCC undergoing hepatic resection. Non-abstinence after surgery was an independent prognostic factor for overall survival with a 2.2-fold increased risk. Worsening of Child–Pugh grade at intrahepatic recurrence was less frequently observed in the abstinent patients. Hepatic resection tended to be more frequently performed for the treatment of HCC recurrence in the abstinent patients. The incidence rate of liver-related death was significantly lower in the abstinent patients.
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Key Words
- ALD, alcohol-related liver disease
- ALT, alanine aminotransferase
- APRI, aspartate aminotransferase-to-platelet ratio index
- AST, aspartate aminotransferase
- Alcohol abstinence
- Alcohol-related liver disease
- BMI, body mass index
- FIB-4, fibrosis index based on four factors
- GGT, gamma-glutamyl transpeptidase
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- Hepatocellular carcinoma
- OS, overall survival
- RFS, recurrence-free survival
- TACE, transcatheter arterial chemoembolization
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Affiliation(s)
- Daisuke Shirai
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Norifumi Kawada
- Department of Hepatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Kuwano A, Tanaka M, Suzuki H, Kurokawa M, Imoto K, Tashiro S, Goya T, Kohjima M, Kato M, Ogawa Y. Upregulated expression of hypoxia reactive genes in peripheral blood mononuclear cells from chronic liver disease patients. Biochem Biophys Rep 2021; 27:101068. [PMID: 34307908 PMCID: PMC8283323 DOI: 10.1016/j.bbrep.2021.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022] Open
Abstract
Liver fibrosis induces intrahepatic microcirculation disorder and hypoxic stress. Hypoxic stress has the potential for an increase in the possibility of more liver fibrosis and carcinogenesis. Liver biopsy is a standard method that evaluates of intrahepatic hypoxia, however, is invasive and has a risk of bleeding as a complication. Here, we investigated the hypoxia reactive gene expressions in peripheral blood mononuclear cells (PBMC) from chronic liver disease patients to evaluate intrahepatic hypoxia in a non-invasive manner. The subjects enrolled for this study were composed of 20 healthy volunteers (HV) and 48 patients with chronic liver disease (CLD). CLD patients contained 24 patients with chronic hepatitis(CH)and 24 patients with liver cirrhosis (LC). PBMC were isolated from heparinized peripheral blood samples. We measured the transcriptional expression of hypoxia reactive genes and inflammatory cytokines by quantitative RT-PCR. mRNA expression of adrenomedullin (AM), vascular endothelial growth factor A (VEGFA) superoxide dismutase (SOD), glutathione peroxidase (GPx) (p < 0.05), Interleukin-6 (IL-6), transforming growth factor-beta (TGF-β) and heme oxygenase-1 (HO-1) in CLD group were significantly higher than HV. AM mRNA expression is correlated with serum lactate dehydrogenase (LDH), serum albumin (Alb), IL6, and SOD mRNA expression. The hypoxia reactive gene expression in PBMCs from CLD patients was more upregulated than HV. Especially, angiogenic genes were notably upregulated and correlated with liver fibrosis. Here, we suggest that mRNA expression of AM in PBMCs could be the biomarker of intrahepatic hypoxia. The hypoxia reactive genes in PBMC were elevated in patients with chronic liver disease. •Angiogenic genes were upregulated and correlated with liver fibrosis in patients with chronic liver disease. •Adrenomedullin mRNA expression in PBMC was correlated with liver function. •mRNA expression of adrenomedullin in PBMC could be the biomarker of intrahepatic hypoxia.
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Key Words
- AM, Adrenomedullin
- ANGPTL4, Angiopoietin-like 4
- Adrenomedullin
- CH, chronic hepatitis
- CLD, chronic liver disease
- Chronic liver disease
- GPx, glutathione peroxidase
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIF, hypoxia inducible factor
- HO-1, heme oxygenase -1
- HV, healthy volunteers
- IL-6, Interleukin-6
- Intrahepatic hypoxia
- LC, liver cirrhosis
- LDH, lactate dehydrogenase
- MCP-1, Monocyte chemoattractant protein-1
- PBMC, Peripheral blood mononuclear cells
- PT, prothrombin time
- Peripheral blood mononuclear cells
- ROS, reactive oxygen species
- SOD, Superoxide dismutase
- TGF-β, transforming growth factor-beta
- TNF-α, Tumor Necrosis Factor-α
- VEGF, vascular endothelial growth factor
- VEGFA, vascular endothelial growth factor A
- VEGFR2, vascular endothelial growth factor receptor 2
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Affiliation(s)
- Akifumi Kuwano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Hepatology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Masatake Tanaka
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideo Suzuki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Miho Kurokawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Imoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shigeki Tashiro
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Goya
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Motoyuki Kohjima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,CREST, Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
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Das A, Ahmed R, Akhtar S, Begum K, Banu S. An overview of basic molecular biology of SARS-CoV-2 and current COVID-19 prevention strategies. Gene Rep 2021; 23:101122. [PMID: 33821222 PMCID: PMC8012276 DOI: 10.1016/j.genrep.2021.101122] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) manifests as extreme acute respiratory conditions caused by a novel beta coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which is reported to be the seventh coronavirus to infect humans. Like other SARS-CoVs it has a large positive-stranded RNA genome. But, specific furin site in the spike protein, mutation prone and phylogenetically mess open reading frame1ab (Orf1ab) separates SARS-CoV-2 from other RNA viruses. Since the outbreak (February-March 2020), researchers, scientists, and medical professionals are inspecting all possible facts and aspects including its replication, detection, and prevention strategies. This led to the prompt identification of its basic biology, genome characterization, structural and expression based functional information of proteins, and utilization of this information in optimizing strategies to prevent its spread. This review summarizes the recent updates on the basic molecular biology of SARS-CoV-2 and prevention strategies undertaken worldwide to tackle COVID-19. This recent information can be implemented for the development and designing of therapeutics against SARS-CoV-2.
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Key Words
- AEC2, angiotensin-converting enzyme 2
- CD4 and CD8, cluster of differentiation
- CDC, Centers for Disease Control and Prevention
- COVID-19, Coronavirus Diseases 2019
- GM-CSF, macrophage colony-stimulating factor
- Genome organization and expression
- HCV, hepatitis C virus
- HIV, human immune deficiency virus
- LAMP, loop mediated isothermal amplification
- MARS-CoV, Middle East Respiratory Syndrome Coronavirus
- Prevention strategies
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- WHO, World Health Organization
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Affiliation(s)
- Ankur Das
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam 781014, India
| | - Raja Ahmed
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam 781014, India
| | - Suraiya Akhtar
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam 781014, India
| | - Khaleda Begum
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam 781014, India
| | - Sofia Banu
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam 781014, India
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Dajti E, Marasco G, Ravaioli F, Colecchia L, Ferrarese A, Festi D, Colecchia A. Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness. JHEP Rep 2021; 3:100289. [PMID: 34095798 PMCID: PMC8165428 DOI: 10.1016/j.jhepr.2021.100289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/06/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs. METHODS This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development. RESULTS During a median follow-up of 41.5 (IQR 32-49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001-1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 ≤10 kPa were at the lowest risk of HCC. In patients with LSM-SVR24 >10 kPa, HCC incidence was not further influenced by LSM values (10-20 kPa vs. >20 kPa), but only by SSM-SVR24 values (≤42 vs. >42 kPa). CONCLUSIONS Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement. LAY SUMMARY Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals.
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Key Words
- ACLD, advanced chronic liver disease
- ALT, alanine aminotransferase
- DAA
- DAA, direct-acting antiviral
- Direct-acting antiviral
- HCC
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- INR, international normalised ratio
- LSM, liver stiffness measurement
- Liver stiffness
- MELD, model for end-stage liver disease
- SSM, spleen stiffness measurement
- SVR, sustained virologic response
- Spleen stiffness
- TE, transient elastography
- Transient elastography
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Affiliation(s)
- Elton Dajti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federico Ravaioli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luigi Colecchia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alberto Ferrarese
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
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Ji D, Chen GF, Niu XX, Zhang M, Wang C, Shao Q, Wu V, Wang Y, Cheng G, Hurwitz SJ, Schinazi RF, Lau G. Non-alcoholic fatty liver disease is a risk factor for occurrence of hepatocellular carcinoma after sustained virologic response in chronic hepatitis C patients: A prospective four-years follow-up study. Metabol Open 2021; 10:100090. [PMID: 33889834 PMCID: PMC8050772 DOI: 10.1016/j.metop.2021.100090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background and aim The incidence of hepatocellular carcinoma (HCC) decreases significantly in chronic hepatitis C (CHC) patients with sustained virologic response (SVR) after pegylated-interferon plus ribavirin (PR) or direct-acting antiviral (DAAs) therapy. We follow-up a single cohort of CHC patients to identify risk factors associated with HCC development post-SVR. Method CHC patients with SVR in Beijing/Hong Kong were followed up at 12–24 weekly intervals with surveillance for HCC by ultrasonography and alpha-fetoprotein (AFP). Multivariate Cox proportional hazards regression analysis was used to explore factors associated with HCC occurrence. Results Between October 2015 and May 2017, SVR was observed in 519 and 817 CHC patients after DAAs and PR therapy respectively. After a median post -SVR follow-up of 48 months, HCC developed in 54 (4.4%) SVR subjects. By adjusted Cox analysis, older age (≥55 years) [HR 2.4, 95% CI (1.3–4.3)], non-alcoholic fatty liver diseases [HR 2.4, 95%CI (1.3–4.2), higher AFP level (≥20 ng/ml) [HR 3.4, 95%CI (2.0–5.8)], higher liver stiffness measurement (≥14.6 kPa) [HR 4.2, 95%CI (2.3–7.6)], diabetes mellitus [HR 4.2, 95%CI (2.4–7.4)] at pre-treatment were associated with HCC occurrence. HCC patients in the DAAs induced SVR group had a higher prevalence of NAFLD as compared with those in the PR induced SVR group, 62% (18/29) vs 28% (7/25), p = 0.026. A nomogram formulated with the above six independent variables had a Concordance-Index of 0.835 (95% CI 0.783–0.866). Conclusion Underlying NAFLD is associated with increased incidence of HCC in chronic HCV patients post-SVR, particularly in those treated with DAA. Patients with chronic hepatitis C infection are still at risk of HCC after achieving sustained virus clearance (SVR). Non-alcoholic liver disease (NAFLD) is emerging as an important risk factor for hepatocellular carcinoma. Underlying NAFLD is associated with increased incidence of HCC in patients with chronic HCV infection after sustained virologic response SVR.
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Key Words
- AFP, alpha-fetoprotein
- ALT, alanine aminotransferase
- ANGPTL, angiopoietin-like proteins
- AST, aspartate aminotransferase
- ASV, asunaprevir
- BCLC, Barcelona-Clinic Liver Cancer Group
- BMI, body mass index
- CHC, chronic hepatitis C
- CI, confidence intervals (CI)
- Chronic hepatitis C
- DAAs, direct-acting antiviral agents
- DCV, daclatasvir
- FGF, fibroblast growth factor
- HCC
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, Hazard Ratio
- IFN, interferon
- LDV, ledipasvir
- LSM, liver stiffness measurement
- NAFLD
- PLT, platelet count
- PR, Peg-IFN-α with RBV
- Peg-IFN, Pegylated interferon
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virologic response
- Sustained virologic response
- TBIL, total bilirubin
- TNF, tumor necrosis factor
- ULN, upper limit of normal
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Affiliation(s)
- Dong Ji
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Guo-Feng Chen
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Xiao-Xia Niu
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Mingjie Zhang
- Faculty of Health Science, Macau University, Taipa, Macau
| | - Cheng Wang
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Qing Shao
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China
| | - Vanessa Wu
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Yudong Wang
- Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Gregory Cheng
- Faculty of Health Science, Macau University, Taipa, Macau.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
| | - Selwyn J Hurwitz
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Raymond F Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - George Lau
- Department of Liver Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.,Fifth Medical Center of Chinese PLA General Hospital-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Centre, Beijing, 100039, China.,Humanity and Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong, China
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Siddiqe R, Ghosh A. Genome-wide in silico identification and characterization of Simple Sequence Repeats in diverse completed SARS-CoV-2 genomes. Gene Rep 2021; 23:101020. [PMID: 33521382 DOI: 10.1016/j.genrep.2021.101020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/06/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022]
Abstract
Simple sequence repeats (SSRs) or, Microsatellites are short repeat sequences that have been extensively studied in eukaryotic (plants) and prokaryotic (bacteria) organisms. Compared to other organisms, the presence and incidence of SSR on viral genomes are less studied. With the emergence of novel infectious viruses over the past few decades, it is imperative to study the genetic diversity in such viruses to predict their evolutionary and functional changes over time. Following the emergence of SARS-CoV-2, we have assembled 121 complete genomes reported from 31 countries across the six continents for the identification and characterization of SSR repeats. Using two independent SSR identification tools, we have found remarkable consistency in the diversity of microsatellites pattern (38–42 per genome) found in the 121 analyzed SARS-CoV-2 genomes indication their important role for genome stability. Among the identified motifs, trinucleotide and hexanucleotide repeats were found to be the most abundant form followed by mono- and di-nucleotide. There were no tetra- or penta-nucleotide repeats in the analyzed SARS-CoV-2 genomes. The discovery of microsatellites in SARS-CoV-2 genomes may become useful for the population genetics, evolutionary analysis, strain identification and genetic variation.
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Robinson A, Hirode G, Wong RJ. Ethnicity and Insurance-Specific Disparities in the Model for End-Stage Liver Disease Score at Time of Liver Transplant Waitlist Registration and its Impact on Mortality. J Clin Exp Hepatol 2021; 11:188-194. [PMID: 33746443 PMCID: PMC7953015 DOI: 10.1016/j.jceh.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Disparities in timely referral to liver transplantation (LT) evaluation persist. We aim to examine race/ethnicity and insurance-specific differences in the Model for End-Stage Liver Disease (MELD) score at time of waitlist (WL) registration and its impact on WL survival. METHODS We retrospectively evaluated U.S. adults listed for LT using 2005-2018 United Network for Organ Sharing LT registry. Multiple linear regression methods examined factors associated with MELD at listing, and Fine-Gray competing risks regression were used to analyze WL mortality. RESULTS Among 144,163 WL registrants (median age = 56 years, 65.3% male, 56.4% private insurance, 23.3% Medicare, 15.7% Medicaid), mean WL MELD at listing was higher in African Americans versus non-Hispanic whites (2.57 points higher, 95%CI: 2.40-2.74, P < 0.001). Compared with patients with private insurance, adjusted mean WL MELD was higher among those with no insurance, Medicare, or Medicaid (P < 0.001 for all). After correcting for differences in MELD at listing, Asians had lower risk of WL death versus non-Hispanic whites (subhazard ratio (SHR): 0.92, 95% CI: 0.86-1.00, P = 0.04), but no difference was observed in African Americans or Hispanics. Compared with patients with private insurance, higher risk of WL death was observed in patients with no insurance (SHR: 1.33, 95%CI: 1.14-1.56, P < 0.001), Medicare (SHR: 1.20, 95%CI: 1.16-1.25, P < 0.001), or Medicaid (SHR: 1.22, 95%CI: 1.17-1.27, P < 0.001). CONCLUSION Higher MELD scores at listing among African Americans did not translate into increased WL mortality. Patients with Medicare, Medicaid, or uninsured had significantly higher WL mortality than privately insured patients, even after correcting for disparities in MELD scores at listing.
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Key Words
- BMI, body mass index
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazards ratio
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NASH, nonalcoholic steatohepatitis
- OPTN, Organ Procurement and Transplantation Network
- UNOS, United Network for Organ Sharing
- UNOS/OPTN
- WL, waitlist
- insurance
- liver transplantation
- survival
- waitlist mortality
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Affiliation(s)
- Ann Robinson
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Canada
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA,Address for correspondence: Robert J. Wong. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
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Choudhary NS, Saraf N, Saigal S, Soin AS. Long-term Management of the Adult Liver Transplantation Recipients. J Clin Exp Hepatol 2021; 11:239-253. [PMID: 33746450 PMCID: PMC7953009 DOI: 10.1016/j.jceh.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
The survival of liver transplantation (LT) recipients has been improved remarkably in short-term. The major causes of mortality in long-term include nonimmunological causes such as cardiovascular, de novo malignancy, chronic kidney disease, and recurrence of primary disease. Rejection-related mortality is rare in the long-term after LT. We discuss nonrejection causes of long-term morbidity/mortality, risk factors, and management strategies in LT recipients. In addition, we discuss osteoporosis, contraception, and pregnancy in LT recipients.
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Key Words
- AIH, autoimmune hepatitis
- BMI, body mass index
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- CVD, cardiovascular disease
- DDLT, deceased donor liver transplantation
- DM, diabetes mellitus
- DNM, de novo malignancy
- HCV, hepatitis C virus
- HR, hazard ratio
- IUCD, Intrauterine contraceptive devices
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MDRD, Modification of Diet in Renal Disease
- MMF, mycophenolate
- MS, metabolic syndrome
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- PSC, primary sclerosing cholangitis
- PTDM, posttransplantation diabetes mellitus
- PTMS, posttransplantation metabolic syndrome
- SVR, sustained virological response
- cardiovascular disease
- de novo malignancy
- eGFR, estimated glomerular filtration rate
- mTORi, Mammalian target of rapamycin inhibitors
- osteoporosis
- pregnancy
- recurrence
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Affiliation(s)
| | - Neeraj Saraf
- Address for correspondence: Dr Neeraj Saraf, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity Hospital, Sector 38, Gurgaon, Delhi (NCR), India.
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Falleti E, Cmet S, Cussigh AR, Salvador E, Bitetto D, Fornasiere E, Fumolo E, Fabris C, Toniutto P. Recurrent and Treatment-Unresponsive Spontaneous Bacterial Peritonitis Worsens survival in Decompensated Liver Cirrhosis. J Clin Exp Hepatol 2021; 11:334-42. [PMID: 33994716 DOI: 10.1016/j.jceh.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. METHODS Two hundred two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP was included in the study. RESULTS SBP was detected in 28 of 202 (13.9%) patients; in 26 of 28 patients, the neutrophil count in the ascitic fluid was ≥250 cells/μl, and in 15 of 28 patients, the cultures were positive. Variables independently associated with SBP were as follows: a higher model of end-stage liver disease (MELD) score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall, the median (range) transplant-free survival was 289 (54-1253) days. One hundred (49.5%) patients died, whereas 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were a higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. CONCLUSION The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rate.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BMI, body mass index
- CLIF-SOFA, chronic liver failure-sequential organ failure assessment
- CP, Child-Pugh
- CRP, C-reactive protein
- EPS, hepatic encephalopathy
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- INR, international normalized ratio
- LT, liver transplantation
- MELD, model of end-stage liver disease
- OR, odds ratio
- PLT, platelet
- SBP, Spontaneous bacterial peritonitis
- SIRS, systemic inflammatory response syndrome
- WBC, white blood cell
- antibiotic-resistant infections
- ascites
- gGT, gamma-glutamyl transpeptidase
- liver transplantation
- survival
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Behera MK, Pati GK, Narayan J, Mishra D, Meher LK, Singh A, Uthansingh K, Sahu MK. Tenofovir is Superior to Entecavir in Patients with Treatment-naïve Hepatitis B e-Antigen-Positive Chronic Hepatitis B. J Clin Exp Hepatol 2021; 11:37-44. [PMID: 33679047 DOI: 10.1016/j.jceh.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Chronic Hepatitis B (CHB) is a global health problem affecting around 400 million of people worldwide. Two available first-line antiviral drugs are tenofovir disoproxil fumarate (TDF) and Entecavir (ETV). Till date,there are few published reports from India comparing efficacy of TDF and ETV in CHB cases. Therefore, this present study was carried out with an aim to compare the efficacy of ETV and TDF in patients with nucleos(t)ide naïve CHB. MATERIALS AND METHODS This retrospective cohort study was carried out in 192 treatment naïve CHB cases, who completed 24 months of treatment with either TDF or ETV between March 2015 and August 2017. The primary end point of the study was undetectable hepatitis B virus DNA after 24 months of therapy. RESULTS Of total 192 patients with CHB, 38 hepatitis B e-antigen (HBeAg)-positive and 53 HBeAg-negative patients were treated with tenofovir, whereas 40 HBeAg-positive and 61 HBeAg-negative patients were treated with ETV. Pretreatment characteristics at baseline were not statistically different between the TDF and ETV groups. Patients treated with TDF achieved significantly higher complete viral suppression as compared with ETV-treated patients (Log rank: 7.04, P = 0.008) in HBeAg-positive CHB during the 24 months follow-up time; whereas no significant difference in viral suppression rate could be noticed in HBeAg-negative patients (Log rank: 0.98, P = 0.38). Both univariate and multivariate analysis by cox proportional hazard model confirmed that tenofovir had significant rate of complete viral suppression in comparison with ETV in HBeAg-positive patients (P < 0.05); whereas complete viral suppression rates were similar in HBeAg-negative patients. CONCLUSION In our study, tenofovir had more effective antiviral suppressive effect compared with ETV in HBeAg-positive, nucleos(t)ide-naïve CHB cases.
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Key Words
- ALT, alanine aminotransferase
- APRI, AST-to-platelet Ratio Index
- BMI, body mass index
- CHB, chronic hepatitis B
- CI, confidence interval
- ETV, entecavir
- HBV, hepatitis B virus
- HBVDNA, hepatitis B DNA
- HBeAg, hepatitis B e antigen
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- Hb, hemoglobin
- TDF, tenofovir disoproxil fumarate
- antiviral therapy
- chronic hepatitis B
- entecavir
- tenofovir
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Abstract
OBJECTIVE The Budd-Chiari Syndrome (BCS) is a rare disorder characterized by hepatic venous outflow obstruction. The primary objectives of our study were to assess temporal trends in the prevalence of BCS among hospitalized patients in the United States using the National Inpatient Sample (NIS) database and to evaluate demographics, risk factors, and common presentation of BCS. METHODS Data were extracted from the NIS to identify patients >18 years of age using all listed diagnosis of BCS from 1998 to 2017 and analyzed. RESULTS Between 1998 and 2017, we identified a total of 8435 hospitalizations related to BCS. Over the 19-year period, the hospitalization rate for BCS increased consistently from 4.96 per 1,000,000 US population in 1998 to 10.44 per 1,000,000 in 2017, with an annual percentage change increase of 4.41% (95% confidence interval [CI]: 4.23%-4.59%, P < 0.0001). The most common risk factor (7.75%) was myeloproliferative disorder (essential thrombocythemia, polycythemia vera, myelofibrosis, chronic myeloid leukemia) followed (7.32%) by a hypercoagulable state (primary thrombophilia, protein C deficiency, factor V Leiden mutation, antiphospholipid antibody syndrome or prothrombin gene mutation) and paroxysmal nocturnal hemoglobinuria (1.63%). Cirrhosis was present in 18.7%, Portal vein thrombosis in 7.9%, and inferior vena cava thrombosis in 6.4%. The most common manifestations of BCS were ascites (29.9%) or acute kidney injury (18.8%) followed by hepatic encephalopathy (9.6%) and acute liver failure (5.6%). CONCLUSION This large population-based study from the United States showed increasing hospitalizations related to BCS. Common presentation was ascites and acute kidney injury.
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Key Words
- APC, annual percentage change
- APLA, antiphospholipid antibody
- BCS, Budd–Chiari syndrome
- Budd Chiari syndrome
- CI, confidence interval
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazard ratio
- ICD, International Classification of Diseases
- IVC, inferior vena cava
- NIS
- NIS, National Inpatient Sample
- PNH, paroxysmal nocturnal hemoglobinuria
- complications
- epidemiology
- risk factors
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Affiliation(s)
- Joseph J. Alukal
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Talan Zhang
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J. Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Address for correspondence: Paul J. Thuluvath, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.
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El-Komy MHM, Mashaly H, Sayed KS, Hafez V, El-Mesidy MS, Said ER, Amer MA, AlOrbani AM, Saadi DG, El-Kalioby M, Eid RO, Azzazi Y, El Sayed H, Samir N, Salem MR, El Desouky ED, Zaher HAEM, Rasheed H. Clinical and epidemiologic features of psoriasis patients in an Egyptian medical center. JAAD Int 2020; 1:81-90. [PMID: 34409325 PMCID: PMC8362248 DOI: 10.1016/j.jdin.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
Background Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. Objective To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. Methods This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. Results The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. Limitations Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. Conclusions This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.
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Affiliation(s)
- Mohamed Hussein Medhat El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Mashaly
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khadiga S Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa S El-Mesidy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman R Said
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa A Amer
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya M AlOrbani
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona El-Kalioby
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem O Eid
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yousra Azzazi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hagar El Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nesrin Samir
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa R Salem
- Department of Public Health and Community, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman D El Desouky
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hesham Abd El-Moaty Zaher
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rasheed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ekpanyapong S, Philips N, Loza BL, Abt P, Furth EE, Tondon R, Khungar V, Olthoff K, Shaked A, Hoteit MA, Reddy KR. Predictors, Presentation, and Treatment Outcomes of Recurrent Hepatocellular Carcinoma After Liver Transplantation: A Large Single Center Experience. J Clin Exp Hepatol 2020; 10:304-315. [PMID: 32655233 PMCID: PMC7335705 DOI: 10.1016/j.jceh.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is an accepted therapeutic option for hepatocellular carcinoma (HCC) in patients with cirrhosis. Despite careful candidate selection, HCC recurrence occurs. We aimed to describe the predictors of recurrence, clinical presentation, and predictors of survival after HCC recurrence post-LT. METHODS Patients with recurrent HCC after LT between January 1996 and December 2017 were retrospectively reviewed. RESULTS Of 711 patients, 96 (13.5%) patients had post-LT HCC recurrence. The median time to recurrence was 17.1 months, and the median survival was 10.1 months. Initial recurrence was more often in the graft (34.4%), and most (60.4%) had multiple recurrent lesions, and 26% were in multiple sites. In multivariate analysis, factors associated with shorter survival were poorly differentiated histology in explant (Hazard ratio [HR] = 1.96; p = 0.027), bilirubin ≥1.2 mg/dL (HR = 2.47; p = 0.025), and albumin <3.5 mg/dL (HR = 2.13; p = 0.014) at recurrence, alpha-fetoprotein at recurrence ≥ 1000 ng/mL (HR = 2.96; p = 0.005), and peritoneal disease (HR = 3.20; p = 0.022). There was an increased survival in patients exposed to sirolimus (HR = 0.32; p < 0.0001). CONCLUSIONS Recurrent HCC after LT is often in extrahepatic sites with a decreased survival in those with poorly differentiated explant pathology, high bilirubin, low albumin, marked elevation of alpha-fetoprotein at recurrence, and peritoneal recurrence. Sirolimus-based immunosuppression may provide benefit.
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Key Words
- AFP, alpha-fetoprotein
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- CNI, calcineurin inhibitor
- CT, computed tomography
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- INR, international normalized ratio
- LT, Liver transplantation
- MRI, magnetic resonance imaging
- NASH, nonalcoholic steatohepatitis
- RETREAT, Risk Estimation of Tumor Recurrence After Transplant
- RFA, radiofrequency ablation
- TACE, transarterial chemoembolization
- UCSF, University of California San Francisco
- UNOS, United Network for Organ Sharing
- hepatocellular carcinoma
- immunosuppression
- liver transplantation
- mTOR, mammalian target of rapamycin
- recurrence
- survival
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Affiliation(s)
- Sirina Ekpanyapong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Philips
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Bao-Li Loza
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Abt
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma E. Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vandana Khungar
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kim Olthoff
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Abraham Shaked
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maarouf A. Hoteit
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - K. Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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Rao H, Liu H, Wu E, Yang M, Feng B, Lin A, Fei R, Fontana RJ, Wei L, Lok AS. Comparison of clinical outcomes and impact of SVR in American and Chinese patients with chronic hepatitis C. JHEP Rep 2020; 2:100136. [PMID: 32715286 PMCID: PMC7369613 DOI: 10.1016/j.jhepr.2020.100136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/30/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background & Aims Chronic HCV infection is an important cause of hepatocellular carcinoma (HCC) and liver failure in the US but limited data are available in China. We compared the incidence of clinical outcomes among adults with chronic HCV infection in the US and China and examined factors associated with outcomes. Methods A parallel prospective study of 2 cohorts of patients with HCV RNA+ recruited in 1 site in the US (UMHS) and 3 sites (PUHSC) in China between September 2011 and July 2015 was carried out. Composite liver outcomes (liver-related deaths, HCC, liver transplantation or liver decompensation), were analysed using competing-risk Cox proportional hazards model to determine incidence and associated factors. Results A total of 795 UMHS and 854 PUHSC patients were followed for a median of 3.06 and 3.99 years, respectively. At enrolment, a significantly higher percentage of UMHS patients had cirrhosis (45.4% vs. 16.2%). The 5-year cumulative incidence of composite liver outcomes was significantly higher in UMHS than in PUHSC patients (25.3% vs. 6.6%, p <0.0001). Stratification by stage of liver disease at enrolment showed this difference persisted only in the subgroup without cirrhosis due to higher aspartate aminotransferase to platelet ratio index (APRI) in the UMHS cohort. A total of 493 UMHS and 502 PUHSC patients received HCV treatment, and sustained virologic response (SVR) was achieved in 88.0% UMHS and 86.8% PUHSC treated-patients. SVR as time-dependent variable was associated with 80% lower risk of composite liver outcomes among patients with decompensated cirrhosis but not the overall cohorts. Conclusions When accounting for disease severity at entry, the incidence of composite liver outcomes was similar in patients with HCV in the US and China. Achievement of SVR had the greatest short-term impact on patients with decompensated cirrhosis. Lay summary Patients with chronic hepatitis C virus infection were recruited from centres in the United States and China. During follow-up, a higher percentage of the American patients had clinical outcomes: liver failure, liver cancer, liver transplant or liver-related deaths than the Chinese patients, mainly because more American patients had cirrhosis at enrolment. Older age and more advanced liver disease were associated with higher incidence of outcomes overall and viral clearance after hepatitis C treatment was associated with a lower incidence of outcomes in patients with advanced cirrhosis. Our findings highlight the importance of improving diagnosis and treatment of hepatitis C before advanced liver disease develops. The incidence of clinical outcomes in US and Chinese patients with chronic HCV infection was compared. Outcome rates were higher in the US cohort, in which cirrhosis was more common. SVR rates were similar in the 2 cohorts. SVR decreased the incidence of clinical outcomes in patients with decompensated cirrhosis over a median 3-year follow-up.
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Key Words
- AFP, alpha fetoprotein
- AIC, Akaike Information Criterion
- ALB, albumin
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- APRI, aspartate aminotransferase to platelet ratio index
- AST, aspartate aminotransferase
- BMI, body mass index
- Cirrhosis
- DAA, direct-acting antiviral
- Decompensation
- Direct-acting antiviral therapy
- FIB-4, fibrosis-4
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- Hepatocellular carcinoma
- INR, international normalized ratio
- LT, liver transplantation
- LrD, liver-related deaths
- MELD, model for end-stage liver disease
- PUHSC, Peking University Health Science Center
- SVR, sustained virologic response
- TBIL, total bilirubin
- UMHS, University of Michigan Health System
- anti-HBc, antibody to HBcAg
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Affiliation(s)
- Huiying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Huixin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
| | - Elizabeth Wu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Ming Yang
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Bo Feng
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Andy Lin
- The Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - Ran Fei
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Robert J Fontana
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Peking University Health Science Center, Beijing, China
| | - Anna S Lok
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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Chan CK, Yeung AM, Lee YK, Chau LH, Man CW, Chu PS. Urethroscrotal fistula complicating large spermatocele in a male ketamine abuser: A case report. Urol Case Rep 2020; 33:101284. [PMID: 32514403 PMCID: PMC7267707 DOI: 10.1016/j.eucr.2020.101284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Ketamine related urinary tract complications were first reported in Hong Kong since 2007. The current case report describes a 37 years old male with long history of ketamine abuse, renal impairment, hypertension and HCV hepatitis, presented to us with insidious onset of painful scrotal swelling post bilateral nephrectomy, prostate and seminal vesicle preserving cystectomy. Radiological imaging and intraoperative finding revealed that it was a large spermatocele with urethroscrotal fistula, which was likely due to urethra stricture. The review of literature showed no guidelines for treatment, a symptoms based and multidisciplinary team approach is recommended.
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Affiliation(s)
- Calvin Ky Chan
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | | | - Y K Lee
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | | | - C W Man
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Peggy Sk Chu
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
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47
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Jadhav PV, Kothakota SR, Sasidharan M, Kareem H, Nair AK. Effect of Donor Hepatic Steatosis on Ischemia Reperfusion Injury in Liver Transplant Recipient. J Clin Exp Hepatol 2020; 10:236-244. [PMID: 32405180 PMCID: PMC7212288 DOI: 10.1016/j.jceh.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Ischemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI. AIM The aim of this study was to determine the effect of type and grade of donor liver steatosis on the occurrence and severity of IRI in LT recipients. METHODS This was an observational study conducted at a single center over a period of 37 months from July 2013 to August 2016. Liver biopsy was performed twice, initially at the time of procurement before graft perfusion for steatosis assessment. Steatosis was classified as microsteatosis (MiS) or macrosteatosis (MaS) with mild, moderate, or severe grade. Second biopsy for IRI assessment was taken before skin closure in death donor LT (DDLT) and at the time of transaminitis in postoperative period (<72 hrs) in living donor LT (LDLT). IRI was graded as per neutrophil infiltrate, apoptosis, and hepatocyte cell dropout. Prevalence of IRI and association steatosis was studied along with other factors. RESULTS Among 53 subjects, 35 were DDLTs and 18 were LDLTs. All live donor grafts were restricted to <15% MaS and the deceased liver grafts had different type and degree of steatosis. In DDLTs, the association between occurrence of IRI and MaS was not statistically significant (P = 0.201). In DDLTs, the mild steatosis was not significantly associated with IRI. Death donor and ischemic time were significantly associated with IRI. Child's stage and MELD scores, gender, and age were not associated with risk of IRI. Severity of IRI is significantly associated with 3-month mortality (P = 0.001). CONCLUSION In patients with mild steatosis, IRI does not correlate with steatosis. However, more patients with moderate and severe steatosis are needed to define the relationship of the two in this group of patients.
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Key Words
- ALT, alanine transferase
- AST, aspartate transferase
- CIT, cold ischemia time
- DDLT, death donor liver transplant
- DRI, donor risk index
- ECD, extended criteria donor
- EHBA, extrahepatic biliary atresia
- H&E, haematoxilin & eosin
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HPE, histopathological examination
- IRI, ischemia reperfusion injury
- LAI, liver attenuation index
- LDLT, living donor liver transplant
- LT, liver transplant
- MELD, model for end-stage liver disease
- MaS, macrosteatosis
- MiS, microsteatosis
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- PNF, primary nonfunction (graft)
- WIT, warm ischemia time
- cold ischemic time
- ischemia reperfusion injury
- macrosteatosis
- microsteatosis
- warm ischemic time
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Affiliation(s)
- Prafulla V. Jadhav
- Department of Gastroenterology, KIMS Hospital, Trivandrum, Kerala, India
| | | | - Madhu Sasidharan
- Department of Gastroenterology, KIMS Hospital, Trivandrum, Kerala, India
| | - Harish Kareem
- Department of Gastroenterology, KIMS Hospital, Trivandrum, Kerala, India
| | - Ajith K. Nair
- Department of Gastroenterology, KIMS Hospital, Trivandrum, Kerala, India
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Affiliation(s)
- Mary Alice Sallman
- John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Janet Y Li
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | - Michael Swaby
- Department of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan Y Chon
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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Affiliation(s)
- Mussarat N. Rahim
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Catherine Williamson
- Division of Women's Health, King's College London, London SE1 1UL, United Kingdom
| | - Nikos A. Kametas
- Fetal Medicine Research Unit, King's College Hospital, London SE5 8BB, United Kingdom
| | - Michael A. Heneghan
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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Bischin AM, Vishnu P, Chen R, Knopf KB, Aboulafia DM. Quality Initiative in Clinical Practice: A Single-Institution Appraisal of Quality Metrics in the Management of Newly Diagnosed Diffuse Large B-Cell Lymphoma. Mayo Clin Proc Innov Qual Outcomes 2019; 3:485-94. [PMID: 31993568 DOI: 10.1016/j.mayocpiqo.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/30/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To assess our adherence to treatment guidelines for diffuse large B-cell lymphoma (DLBCL) established by the American Society of Hematology in 2014 through implementation of a quality improvement initiative (QII) at our institution in 2015. Patients and Methods Patients with newly diagnosed DLBCL treated from January 1, 2006, through December 31, 2017, were identified. Electronic medical records were reviewed for documentation of American Society of Hematology Practice Improvement Module quality measures (eg, key pathologic features of DLBCL, lymphoma staging, and screening for hepatitis B virus [HBV] infection in patients receiving rituximab-based chemotherapy). We also reviewed assessment of prognosis by revised International Prognostic Index score, testing for hepatitis C virus, HBV, and HIV, chemotherapy education, and the addition of rituximab in the treatment regimen of CD20+ DLBCL. Results Following QII implementation, we saw improvements in most metrics, including reporting of key molecular features (fluorescence in situ hybridization for c-MYC, BCL2, and BCL6, from 45.5% [75 of 165 patients] before QII to 91.7% [22 of 24 patients] after QII; P<.001), screening for HBV (41.8% [69 of 165 patients] to 91.7% [22 of 24 patients]; P<.001) and HIV infections (33.9% [56 of 165 patients] to 87.5% [21 of 24 patients]; P<.0001), providing chemotherapy education (92.7% [153 of 165 patients] to 100%), and use of rituximab for CD20+ DLBCL (83.6% [138 of 165 patients] to 100%; P=.05). All patients had positron emission tomography–computed tomography for DLBCL staging, and there was significantly lower use of bone marrow biopsy (P=.011). Conclusion Implementating a QII and employing standardized metrics can aid in improving quality of care for patients with newly diagnosed DLBCL and allow opportunities to build and ensure better adherence to evolving patient care guidelines.
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Key Words
- ASH-PIM, American Society of Hematology Practice Improvement Module
- BMB, bone marrow biopsy
- CT, computed tomography
- DLBCL, diffuse large B-cell lymphoma
- EMR, electronic medical record
- G-CSF, granulocyte colony-stimulating factor
- HAART, highly active antiretroviral therapy
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- NHL, non-Hodgkin lymphoma
- PET, positron emission tomography
- QII, quality improvement initiative
- R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
- VMMC, Virginia Mason Medical Center
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