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Thi Hong Nhi N, Dang Hai P. Septic arthritis and subsequent fatal septic shock caused by Pasteurella multocida in Vietnam. New Microbes New Infect 2023; 51:101080. [PMID: 36691647 PMCID: PMC9860375 DOI: 10.1016/j.nmni.2022.101080] [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: 09/22/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Pasteurella multocida is a facultative anaerobic and gram-negative bacteria. It lives in the upper airway of animals, especially dogs and cats. P. multocida infection commonly results in regional cellulitis, although septic shock complication is uncommon. Here, we report on a fatal case of septic shock developing from a natural knee joint infection.
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Affiliation(s)
| | - Pham Dang Hai
- Medical Intensive Care Unit, 108 Military Central Hospital, Viet Nam,Corresponding author. 108 Military Central Hospital, Vietnam, No. 1 Tran Hung Dao street, Ha Noi, Viet Nam.
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2
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Kumar P, Mhaskar R, Kim R, Anaya D, Frakes J, Hoffe S, Choi J, Kis B. Unresectable Intrahepatic Cholangiocarcinoma Treated with Radiation Segmentectomy/Lobectomy Using Yttrium 90-labeled Glass Microspheres. J Clin Exp Hepatol 2022; 12:1259-1263. [PMID: 36157145 PMCID: PMC9499841 DOI: 10.1016/j.jceh.2022.03.008] [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: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background There is no curative treatment option for patients with unresectable intrahepatic, cholangiocarcinoma (IHC). The aim of this study was to evaluate the efficacy of; radiation segmentectomy/lobectomy using Y90-labeled glass microspheres in patients with; unresectable IHC. Methods This IRB-approved, single-center study included, 16 patients (age: 67 ± 7.7 years) with IHC who received radiation segmentectomy or lobectomy, treatment using Y90-labeled glass microspheres between May 2009 and October 2019. Radiation, segmentectomy/lobectomy was defined as at least 190 Gy dose delivered into treated liver; volume. Results The median OS from IHC diagnosis was 22.7 months (95% CI: 13.9-66.1) and from, radioembolization it was 7 months (95% CI: 4.33-54.17). Patients who did not receive, chemotherapy before the radioembolization had significantly longer median OS (26.8 vs. 5.9, months, P = 0.03). Four patients had >20 months survival after radioembolization, including 2, patients with survival of 42 and 54 months. There was no 30-day mortality and no severe, complications. Conclusion Radiation segmentectomy/lobectomy is safe with minimal side effects. The median, OS of the study group is modest; however, 4 patients (25%) showed excellent survival. These results suggest a need for a larger study to define the IHC patient group who could, most benefit from this procedure.
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Affiliation(s)
- Premsai Kumar
- Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Richard Kim
- Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Daniel Anaya
- Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jessica Frakes
- Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sarah Hoffe
- Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Junsung Choi
- Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Bela Kis
- Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
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Balkrishna A, Lochab S, Varshney A. Livogrit, a herbal formulation of Boerhavia diffusa, Phyllanthus niruri and Solanum nigrum reverses the thioacetamide induced hepatocellular toxicity in zebrafish model. Toxicol Rep 2022; 9:1056-1064. [PMID: 35571233 PMCID: PMC9097504 DOI: 10.1016/j.toxrep.2022.03.053] [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] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
Research studies in the past years have shown encouraging therapeutic potential of herbal medicines in liver ailments. Livogrit is a well characterized formulation prepared by mixing extracts of plants, Boerhavia diffusa, Phyllanthus niruri and Solanum nigrum in precise ratios. Our study demonstrates the curative role of Livogrit in thioacetamide (TAA) induced zebrafish model of hepatotoxicity. This is a systematic study, wherein we first screened Livogrit for an effective dose and treatment time-course. Once established, we conducted subsequent experiments to compare the hepatoprotective effects of Livogrit with a reference drug, prednisone. We evaluated a wide range of liver function variables including, albumin, AST, bilirubin, creatinine, platelet clotting factor, INR and sodium blood serum to assess the degree of liver dysfunctionality. Results from screening experiments suggested that Livogrit treatment for 14 days at an effective dose (ED3-142 μg/kg) significantly revamped the deviated serum biochemistry. The experiments comparing prednisone and Livogrit demonstrated that the treatment with the herbal formation was more effective against TAA-induced hepatotoxicity. Liver function parameters indicating hepatic dysfunctionality showed better recovery with Livogrit as compared to prednisone. Furthermore, we enumerated a scoring method for assessing degree of liver dysfunctionality based on the values of bilirubin, creatinine and INR. The herbal formulation in comparison to prednisone successfully restored the liver dysfunction index to low risk. The liver cytology showed a decline in the hepatocyte cell death that further corroborated the promising curative potential of Livogrit.
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Affiliation(s)
- Acharya Balkrishna
- Drug Discovery and Development Division, Patanjali Research Institute, NH-58, Haridwar 249405, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Patanjali Yog Peeth, Roorkee-Haridwar Road, Haridwar 249405, Uttarakhand, India
- Patanjali Yog Peeth (UK) Trust, 40 Lambhill Street, Kinning Park, Glasgow G41 1AU, UK
| | - Savita Lochab
- Drug Discovery and Development Division, Patanjali Research Institute, NH-58, Haridwar 249405, Uttarakhand, India
| | - Anurag Varshney
- Drug Discovery and Development Division, Patanjali Research Institute, NH-58, Haridwar 249405, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Patanjali Yog Peeth, Roorkee-Haridwar Road, Haridwar 249405, Uttarakhand, India
- Special Centre for Systems Medicine, Jawaharlal Nehru University, New Delhi, India
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Gupta A, Bansal A, Patel RAG. Endovascular management of Chronic mesenteric ischemia in a patient with Left ventricular assist device. Curr Probl Cardiol 2022; 47:101164. [PMID: 35245598 DOI: 10.1016/j.cpcardiol.2022.101164] [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: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
Classical symptoms of chronic mesenteric ischemia include postprandial pain referred to as "intestinal angina", food fear and weight loss. Here we present a case of chronic mesenteric ischemia treated by endovascular stenting in a patient with chronic heart failure and left ventricular assist device.
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Key Words
- ATM, Atmosphere
- CMI: Chronic Mesenteric Ischemia CMI
- INR, International Normalized Ratio
- IVUS, Intravascular Ultrasound
- Left Ventricular assist device, chronic mesenteric ischemia, postprandial pain, weight loss, endovascular, Abbreviations, LVAD, Left Ventricular Assist Device
- SMA, Superior Mesenteric Artery
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Affiliation(s)
- Aashish Gupta
- Ochsner Medical Center, Ochsner Heart and Vascular Institute, New Orleans, LA.
| | - Aditya Bansal
- Ochsner Medical Center, Ochsner Heart and Vascular Institute, New Orleans, LA; University of Queensland, Ochsner Clinical School, New Orleans, LA
| | - Rajan A G Patel
- Ochsner Medical Center, Ochsner Heart and Vascular Institute, New Orleans, LA; University of Queensland, Ochsner Clinical School, New Orleans, LA
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Honerkamp I, Sandmann L, Richter N, Manns MP, Voigtländer T, Vondran FW, von Hahn T. Surgical Procedures in Patients Awaiting Liver Transplantation: Complications and Impact on the Liver Function. J Clin Exp Hepatol 2022; 12:68-79. [PMID: 35068787 PMCID: PMC8766540 DOI: 10.1016/j.jceh.2021.03.011] [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: 08/18/2020] [Accepted: 03/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Potential indications for surgery frequently arise in patients awaiting liver transplantation. There is a risk of hepatic decompensation and death triggered by surgical trauma, but this has not been studied in detail in this unique population. We aimed to quantify the impact of surgical interventions in patients awaiting liver transplantation on hepatic function and identify risk factors for decompensation. METHODS All surgeries between 2000 and 2018 in patients awaiting liver transplantation in a highvolume German liver transplant center were analyzed retrospectively. Change in liver function measured as indicated by MELD score was assessed and complication rates recorded. The primary endpoint was a composite of an increase in MELD score by > 5 points or death. A logistic regression model was used for multivariate analysis to identify risk factors. RESULTS In total, 177 surgical procedures in 148 patients were analyzed. The primary endpoint was reached in 42 cases (23.7%). The overall in-hospital complication rate (including death) was 44.1%. Multivariate analysis identified elevated leukocyte count, perioperative blood transfusion, preoperative presence of ascites, and preoperative circulatory support as independent risk factors for a decline in liver function or death. CONCLUSION Surgery in patients awaiting liver transplantation carries a relevant risk of hepatic decompensation and death that needs to be considered when deciding whether to perform elective surgery prior to or defer until after liver transplantation.
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Key Words
- ACLF, Acute-on-Chronic Liver Failure
- ALT, Alanine transaminase
- ASA, American Society of Anesthesiologists physical status classification system
- AST, Aspartate transaminase
- CHE, Cholinesterase
- CRP, C-reactive Protein
- HCC, Hepatocellular carcinoma
- Hb, Hemoglobin
- INR, International Normalized Ratio
- MELD
- MELD, Model for End-stage Liver Disease
- OR, Odds Ratio
- SBP, Spontaneous Bacterial Peritonitis
- Tsd, Thousand
- aPTT, Activated partial thromboplastin time
- cirrhosis
- dl, Deciliter
- g, Gram
- i.e., id est
- l, Liter
- liver transplantation
- log, Logarithm
- mg, Milligram
- min, Minutes
- mmol, Millimole
- surgery
- vs, Versus
- waiting list
- μl, Microliter
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Affiliation(s)
- Imke Honerkamp
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Lisa Sandmann
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Nicolas Richter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Florian W.R. Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany,Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University Budapest, Campus Hamburg, Rübenkamp 220, Germany,Address for correspondence: Prof. Dr. Med. Thomas von Hahn, Department of Gastroenterology, Hepatology and Interventional Endoscopy, Rübenkamp 220, Hamburg, 22307, Germany. Tel.: +49 40 18 18 82 3810; Fax: +49 40 18 18 82 3809.
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Adamidi ES, Mitsis K, Nikita KS. Artificial intelligence in clinical care amidst COVID-19 pandemic: A systematic review. Comput Struct Biotechnol J 2021; 19:2833-2850. [PMID: 34025952 PMCID: PMC8123783 DOI: 10.1016/j.csbj.2021.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 02/17/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 12/23/2022] Open
Abstract
The worldwide health crisis caused by the SARS-Cov-2 virus has resulted in>3 million deaths so far. Improving early screening, diagnosis and prognosis of the disease are critical steps in assisting healthcare professionals to save lives during this pandemic. Since WHO declared the COVID-19 outbreak as a pandemic, several studies have been conducted using Artificial Intelligence techniques to optimize these steps on clinical settings in terms of quality, accuracy and most importantly time. The objective of this study is to conduct a systematic literature review on published and preprint reports of Artificial Intelligence models developed and validated for screening, diagnosis and prognosis of the coronavirus disease 2019. We included 101 studies, published from January 1st, 2020 to December 30th, 2020, that developed AI prediction models which can be applied in the clinical setting. We identified in total 14 models for screening, 38 diagnostic models for detecting COVID-19 and 50 prognostic models for predicting ICU need, ventilator need, mortality risk, severity assessment or hospital length stay. Moreover, 43 studies were based on medical imaging and 58 studies on the use of clinical parameters, laboratory results or demographic features. Several heterogeneous predictors derived from multimodal data were identified. Analysis of these multimodal data, captured from various sources, in terms of prominence for each category of the included studies, was performed. Finally, Risk of Bias (RoB) analysis was also conducted to examine the applicability of the included studies in the clinical setting and assist healthcare providers, guideline developers, and policymakers.
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Key Words
- ABG, Arterial Blood Gas
- ADA, Adenosine Deaminase
- AI, Artificial Intelligence
- ANN, Artificial Neural Networks
- APTT, Activated Partial Thromboplastin Time
- ARMED, Attribute Reduction with Multi-objective Decomposition Ensemble optimizer
- AUC, Area Under the Curve
- Acc, Accuracy
- Adaboost, Adaptive Boosting
- Apol AI, Apolipoprotein AI
- Apol B, Apolipoprotein B
- Artificial intelligence
- BNB, Bernoulli Naïve Bayes
- BUN, Blood Urea Nitrogen
- CI, Confidence Interval
- CK-MB, Creatine Kinase isoenzyme
- CNN, Convolutional Neural Networks
- COVID-19
- CPP, COVID-19 Positive Patients
- CRP, C-Reactive Protein
- CRT, Classification and Regression Decision Tree
- CoxPH, Cox Proportional Hazards
- DCNN, Deep Convolutional Neural Networks
- DL, Deep Learning
- DLC, Density Lipoprotein Cholesterol
- DNN, Deep Neural Networks
- DT, Decision Tree
- Diagnosis
- ED, Emergency Department
- ESR, Erythrocyte Sedimentation Rate
- ET, Extra Trees
- FCV, Fold Cross Validation
- FL, Federated Learning
- FiO2, Fraction of Inspiration O2
- GBDT, Gradient Boost Decision Tree
- GBM light, Gradient Boosting Machine light
- GDCNN, Genetic Deep Learning Convolutional Neural Network
- GFR, Glomerular Filtration Rate
- GFS, Gradient boosted feature selection
- GGT, Glutamyl Transpeptidase
- GNB, Gaussian Naïve Bayes
- HDLC, High Density Lipoprotein Cholesterol
- INR, International Normalized Ratio
- Inception Resnet, Inception Residual Neural Network
- L1LR, L1 Regularized Logistic Regression
- LASSO, Least Absolute Shrinkage and Selection Operator
- LDA, Linear Discriminant Analysis
- LDH, Lactate Dehydrogenase
- LDLC, Low Density Lipoprotein Cholesterol
- LR, Logistic Regression
- LSTM, Long-Short Term Memory
- MCHC, Mean Corpuscular Hemoglobin Concentration
- MCV, Mean corpuscular volume
- ML, Machine Learning
- MLP, MultiLayer Perceptron
- MPV, Mean Platelet Volume
- MRMR, Maximum Relevance Minimum Redundancy
- Multimodal data
- NB, Naïve Bayes
- NLP, Natural Language Processing
- NPV, Negative Predictive Values
- Nadam optimizer, Nesterov Accelerated Adaptive Moment optimizer
- OB, Occult Blood test
- PCT, Thrombocytocrit
- PPV, Positive Predictive Values
- PWD, Platelet Distribution Width
- PaO2, Arterial Oxygen Tension
- Paco2, Arterial Carbondioxide Tension
- Prognosis
- RBC, Red Blood Cell
- RBF, Radial Basis Function
- RBP, Retinol Binding Protein
- RDW, Red blood cell Distribution Width
- RF, Random Forest
- RFE, Recursive Feature Elimination
- RSV, Respiratory Syncytial Virus
- SEN, Sensitivity
- SG, Specific Gravity
- SMOTE, Synthetic Minority Oversampling Technique
- SPE, Specificity
- SRLSR, Sparse Rescaled Linear Square Regression
- SVM, Support Vector Machine
- SaO2, Arterial Oxygen saturation
- Screening
- TBA, Total Bile Acid
- TTS, Training Test Split
- WBC, White Blood Cell count
- XGB, eXtreme Gradient Boost
- k-NN, K-Nearest Neighbor
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Affiliation(s)
- Eleni S. Adamidi
- Biomedical Simulations and Imaging Lab, School of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Konstantinos Mitsis
- Biomedical Simulations and Imaging Lab, School of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Konstantina S. Nikita
- Biomedical Simulations and Imaging Lab, School of Electrical and Computer Engineering, National Technical University of Athens, Greece
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Abstract
AIM The objective of this study was to determine the outcome of children with tyrosinemia type 1 from India. METHODS A retrospective observational study was conducted on 11 patients diagnosed with type I tyrosinemia under our care. Age at symptoms, age at diagnosis, age at starting 2-nitro-4-trifluoromethylbenzoyl-1,3-cyclohexanedione (NTBC), duration between diagnosis and initiation of NTBC, dose given, total duration of NTBC, and outcomes were noted. RESULTS Eleven children with a median age of 1.1 years (0.51-1.52) at onset of symptoms were included in the study. The median age at diagnosis was 1.76 years (0.95-2.43). Their current median age is 5.44 (2.36-8.80) years. Common clinical features at presentation were chronic liver disease in 8 (72.72%), rickets in 2 (18.18%), and fulminant liver disease in 1 (9.09%) patient. Hepatomegaly was observed in all children, growth retardation in 9 (81.81%), coagulopathy in 8 (72.72%), and abdominal distention in 6 (54.54%) patients. The median duration of NTBC therapy was 13.5 (7-21.25) months. The median dose of NTBC was 1 (0.77-1) mg/kg/day. One (9.09%) patient died due to liver cell failure. However, she had received NTBC only for a month. Another patient developed hepatocellular carcinoma (HCC) and underwent liver transplantation. He could receive NTBC only for 2 months, although he was diagnosed to have tyrosinemia for over a 1 year. Eight patients are on treatment with NTBC and are doing well, and 1 patient is not on NTBC and continues to have renal tubular acidosis. CONCLUSION NTBC therapy is effective and improves the prognosis of tyrosinemia. A long-term follow-up is required to determine progression to HCC and need for liver transplantation.
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Key Words
- AFP, Alpha-feto Protein
- ALP, Alkaline Phosphatase
- CLD, Chronic Liver Disease
- GGPT, γ-glutamine Transaminase
- HCC, Hepatocellular Carcinoma
- INR, International Normalized Ratio
- LFT, Liver Function Test
- NTBC
- NTBC, 2-nitro-4-trifluoromethylbenzoyl-1,3-cyclohexanedione
- RTA, Renal Tubular Acidosis
- SA, Succinylacetone
- SGOT, Aspartate Transaminase
- SGPT, Alanine Transaminase
- Tyrosinemia type 1
- hepatocellular carcinoma
- liver transplant
- succinylacetone
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Affiliation(s)
- Sonal Mirani
- Department of Pediatric Gastroenterology and Hepatology, B J Wadia Hospital for Children, Mumbai, India
| | - Vishrutha Poojari
- Department of Pediatric Gastroenterology and Hepatology, B J Wadia Hospital for Children, Mumbai, India
| | - Naman S. Shetty
- Department of Pediatric Gastroenterology and Hepatology, B J Wadia Hospital for Children, Mumbai, India
| | - Ira Shah
- Department of Pediatric Gastroenterology and Hepatology, B J Wadia Hospital for Children, Mumbai, India,Consultant in Pediatric Gastroenterology and Hepatology, Nanavati Hospital, Mumbai, India,Address for correspondence. Ira Shah, Head, Department of Pediatric Gastroenterology and Hepatology, B J Wadia Hospital for Children, Mumbai, India.
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Patidar Y, Chalamarla LK, Mukund A, Rastogi A, Sharma MK. Comparative Study of Ultrasound-guided Percutaneous Omental Biopsy in Cirrhotics and Noncirrhotics. J Clin Exp Hepatol 2020; 10:194-200. [PMID: 32405175 PMCID: PMC7212299 DOI: 10.1016/j.jceh.2019.10.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of ultrasound-guided (US-guided) omental biopsy in patients with liver cirrhosis and compare these with the noncirrhotic patients. METHODS We retrospectively studied the US-guided omental biopsies (73 males, 14 females with mean age 52.71 ± 15.90 y) between January 2012 and December 2018. Patients with biopsy-proven liver cirrhosis (n = 31) who underwent omental biopsy were included in Group 1, and patients without any features of the chronic liver disease (n = 56) were included in Group 2. The technical success, diagnostic parameters, complications, imaging appearance, and histopathology spectrum were compared between the two groups. Also, univariate analysis was done to evaluate the association of a parameter with histopathology. RESULTS The technical success, sample adequacy, diagnostic accuracy of Group 1 were 100%, 96.77%, and 96.77%, respectively, and for Group 2, these were 100%, 98.21%, and 98.21%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value of Group 1 were 95%, 100%, 100%, 91.67%, respectively, and for Group 2, these were 97.92%, 100%, 100%, 88.89%, respectively. There was one complication of abdominal wall hematoma in Group 1 (3.2%), which was managed conservatively. Smudged imaging appearance and nonspecific inflammation on histopathology were more common in Group 1, and there was a significant association of increased omental thickening with specific pathology in Group 1. CONCLUSION US-guided omental biopsy in patients with liver cirrhosis is safe and effective with comparable results to noncirrhotic patients.
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India,Address for correspondence. Yashwant Patidar, Department of Interventional Radiology, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India.
| | - Lakshmi K. Chalamarla
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manoj K. Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Kumar R, Lal BB, Sood V, Khanna R, Kumar S, Bharathy KG, Alam S. Predictors of Successful Kasai Portoenterostomy and Survival with Native Liver at 2 Years in Infants with Biliary Atresia. J Clin Exp Hepatol 2019; 9:453-459. [PMID: 31516261 PMCID: PMC6728523 DOI: 10.1016/j.jceh.2018.09.008] [Citation(s) in RCA: 5] [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: 07/05/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA) with subsequent liver transplantation in failed cases. The aim of this work was to study the outcome of KPE in children with BA and identify the factors predicting a successful KPE. METHODS Children diagnosed with BA and undergoing KPE between January 2010 and January 2018 were included in the study. A successful KPE was defined as decrease in bilirubin to less than 2 mg/dL at 6 months after KPE. Factors affecting the outcome (successful KPE and survival with native liver [SNL] at 2 years) were evaluated by logistic regression. RESULTS A total of 79 children with post-KPE BA were included. Successful KPE was achieved in 29 (36.7%) of 79 children undergoing KPE. The data for survival with native liver at 2 years were available for 61 children as 9 were lost to follow up before 2 years and another 9 were aged less than 2 years at the time of analysis. Twenty-seven (44.3%) of these 61 survived with their native liver at 2 years. On logistic regression analysis, lower age at KPE, use of postoperative steroids and absence of cholangitis were significant predictors of a successful KPE. A successful KPE at 6 months was the lone independent predictor of SNL at 2 years in these children. CONCLUSION Early age at KPE, use of postoperative steroid and prevention of cholangitis can result in successful KPE. Those with successful KPE are likely to survive with their native liver at 2 years.
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Affiliation(s)
- Ruchika Kumar
- Department of Pediatric Hepatology, New Delhi, India
| | | | - Vikrant Sood
- Department of Pediatric Hepatology, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, New Delhi, India
| | - Senthil Kumar
- Department of HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kishore G.S. Bharathy
- Department of HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology, New Delhi, India,Address for correspondence: Seema Alam, Professor and Head, Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070 India.
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Jain A, Dhore P, Meshram M, Bhatia S, Shukla A. Patients With Budd-Chiari Syndrome Have Variable Coagulation Status on Thromboelastography at Diagnosis. J Clin Exp Hepatol 2019; 9:460-7. [PMID: 31516262 DOI: 10.1016/j.jceh.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/08/2017] [Accepted: 10/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Budd-Chiari Syndrome (BCS) is considered a thrombophilic state, and most patients with BCS have thrombophilic disorder. Liver dysfunction-related coagulopathy makes coagulation function unpredictable in BCS. Thromboelastography (TEG) assesses the dynamics, strength, and stability of clot formation. We conducted a pilot study using TEG to evaluate coagulation status in patients with BCS. METHODS Fifty-one patients with newly diagnosed BCS (age 32.3 [10.7] years; 23 men) underwent TEG (TEG®5000 Hemostasis Analyzer®, USA), and its components were analyzed and correlated with clinical profile and thrombophilic disorders. Patients who had received anticoagulation, antiplatelet drugs, or radiological intervention were excluded. RESULTS Twenty-nine patients had normal TEG, 11 had procoagulant TEG, and 11 had hypocoagulant TEG. Among patients with hypocoagulant TEG, Coagulation Index (CI) was < -3 in 11 patients, R was >8 min in 6 patients, K was >3 min in 9 patients, alpha <55 in 9 patients, and MA <51 in 7 patients; among those with hypercoagulant TEG, CI was >3 in 3 patients, R < 2 min in 2 patients, K <1 min in 2 patients, alpha >78 in none, and MA >69 mm in 7 patients. TEG findings were similar in patients with and without thrombophilic disorder. The mean platelet count (1.75, 2.22, and 1.79 × 105/mm3; P = 0.13) and international normalized ratio (1.27, 1.34, and 1.28, P = 0.69) were similar in those with procoagulant, normal, and hypocoagulant TEG. Two patients in Rotterdam class-III had abnormal LY30. Other clinical parameters did not correlate with TEG findings. CONCLUSION Patients with BCS are heterogeneous with respect to coagulation status, with one-fifth of patients are hypocoagulant on TEG. Patients with advanced disease may have accelerated fibrinolysis.
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Key Words
- BCS, Budd-Chiari Syndrome
- CT, Computed Tomography
- CTP, Child-Turcotte-Pugh
- INR, International Normalized Ratio
- IVC, Inferior Vena Cava
- JAK-2, Janus Kinase-2
- MELD, Model for End-Stage Liver Disease
- MRI, Magnetic Resonance Imaging
- MTHFR, Methylene tetrahydrofolatereductase
- PNH, Paroxysmal Nocturnal Hemoglobinuria
- PT, Prothrombin Time
- TEG, Thromboelastography
- aPTT, Partial Thromboplastin Time
- cirrhosis
- gastrointestinal hemorrhage
- hepatic venous outflow tract obstruction
- portal hypertension
- varices
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Nagral A, Sarma MS, Matthai J, Kukkle PL, Devarbhavi H, Sinha S, Alam S, Bavdekar A, Dhiman RK, Eapen CE, Goyal V, Mohan N, Kandadai RM, Sathiyasekaran M, Poddar U, Sibal A, Sankaranarayanan S, Srivastava A, Thapa BR, Wadia PM, Yachha SK, Dhawan A. Wilson's Disease: Clinical Practice Guidelines of the Indian National Association for Study of the Liver, the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition, and the Movement Disorders Society of India. J Clin Exp Hepatol 2019; 9:74-98. [PMID: 30765941 PMCID: PMC6363961 DOI: 10.1016/j.jceh.2018.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 06/09/2018] [Accepted: 08/25/2018] [Indexed: 12/12/2022] Open
Abstract
Clinical practice guidelines for Wilson's disease (WD) have been published by the American Association for the Study of Liver Diseases and European Association for the Study of the Liver in 2008 and 2012, respectively. Their focus was on the hepatic aspects of the disease. Recently, a position paper on pediatric WD was published by the European Society of Pediatric Gastroenterology Hepatology and Nutrition. A need was felt to harmonize guidelines for the hepatic, pediatric, and neurological aspects of the disease and contextualize them to the resource-constrained settings. Therefore, experts from national societies from India representing 3 disciplines, hepatology (Indian National Association for Study of the Liver), pediatric hepatology (Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition), and neurology (Movement Disorders Society of India) got together to evolve fresh guidelines. A literature search on retrospective and prospective studies of WD using MEDLINE (PubMed) was performed. Members voted on each recommendation, using the nominal voting technique. The Grades of Recommendation, Assessment, Development and Evaluation system was used to determine the quality of evidence. Questions related to diagnostic tests, scoring system, and its modification to a version suitable for resource-constrained settings were posed. While ceruloplasmin and 24-h urine copper continue to be important, there is little role of serum copper and penicillamine challenge test in the diagnostic algorithm. A new scoring system - Modified Leipzig score has been suggested with extra points being added for family history and serum ceruloplasmin lower than 5 mg/dl. Liver dry copper estimation and penicillamine challenge test have been removed from the scoring system. Differences in pharmacological approach to neurological and hepatic disease and global monitoring scales have been included. Rising bilirubin and worsening encephalopathy are suggested as indicators predicting need for liver transplant but need to be validated. The clinical practice guidelines provide recommendations for a comprehensive management of WD which will be of value to all specialties.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACLF, Acute on Chronic Liver Failure
- ALF, Acute Liver Failure
- ALT, Alanine Transaminase
- AST, Aspartate Transaminase
- Cu, Copper
- DP, D-Penicillamine
- EASL, European Association for the Study of the Liver
- GAS for WD, Global Assessment Scale for Wilson's Disease
- HCC, Hepatocellular Carcinoma
- INR, International Normalized Ratio
- KF, Kayser-Fleischer
- LT, Liver Transplantation
- MARS, Molecular Absorption Recirculating System
- MELD, Model for End-Stage Liver Disease
- MRI, Magnetic Resonance Imaging
- NGS, Next-Generation Sequencing
- NWI, New Wilson's Index
- PELD, Pediatric end stage liver disease
- TPE, Total Plasma Exchange
- TTM, Tetrathiomolybdate
- WD, Wilson's Disease
- Wilson's disease scoring
- genetic disorder
- modified Leipzig scoring
- rare disease
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Affiliation(s)
- Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India,Department of Gastroenterology, Apollo Hospitals, Navi Mumbai, India,Address for correspondence: Aabha Nagral, 7, Snehasagar, Prabhanagar, Prabhadevi, Mumbai 400025, India.
| | - Moinak S. Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - John Matthai
- Department of Paediatric Gastroenterology, Masonic Medical Centre for Children, Coimbatore, India
| | | | - Harshad Devarbhavi
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon, India
| | - Rukmini M. Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Malathi Sathiyasekaran
- Department of Pediatric Gastroenterology, Kanchi Kamakoti Childs Trust Hospital Chennai, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anupam Sibal
- Department of Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Baburam R. Thapa
- Department of Gastroenterology & Pediatric Gastroenterology, MM Medical Institute of Medical Sciences and Research, Mullana, Ambala, India
| | - Pettarusp M. Wadia
- Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Surendra K. Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anil Dhawan
- Department of Pediatrics and Pediatric Liver GI and Nutrition Center and Mowat Labs, King's College Hospital, London, UK
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12
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Sonavane AD, Amarapurkar DN, Rathod KR, Punamiya SJ. Long Term Survival of Patients Undergoing TIPS in Budd-Chiari Syndrome. J Clin Exp Hepatol 2019; 9:56-61. [PMID: 30765940 PMCID: PMC6363956 DOI: 10.1016/j.jceh.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/08/2017] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has been significant improvement in understanding the etiology and management of Budd-Chiari Syndrome (BCS). Patients with chronic or acute-on-chronic BCS need radiological interventions in the form of angioplasty, hepatic vein/inferior vena cava stenting or Transjugular Intrahepatic Portosystemic Shunt (TIPS). Data regarding the long term follow up of patients undergoing TIPS is limited. We thus prospectively followed-up BCS patients who underwent TIPS at our center. METHODS This study included 42 patients with BCS who underwent TIPS with a covered stent between 2004 and 2014. We analyzed the etiology, symptoms, severity, laboratory parameters and imaging pre and post TIPS. All patients underwent surveillance for hepatocellular carcinoma. RESULTS Patients demographics included 26 males and 16 females with a mean age of 40.5 years (19-68 years). The mean Model for End-Stage Liver Disease score of the entire cohort was 15.38 (range: 9-25). Thirty-four patients were grouped into Rotterdam Class 2 and remaining into Class 3. There was significant improvement in ascites, gastrointestinal bleed, renal function and transaminase levels post TIPS. There were 11 deaths over the follow-up period - 4 within one month, 2 within six months and the rest after 3 years following TIPS. Median duration from clinical presentation to TIPS was 2.1 weeks and median survival till follow-up was 45.5 months (0-130 months). 33/42 patients underwent TIPS prior to 2013, and their median survival till follow-up was 55 months. Six out of eleven deaths that occurred within six months post-TIPS were before 2006; when the technique of TIPS creation was evolving. The cumulative 1 year, 5 years and 10 years OLT-free survival was 86%, 81% and 76%, respectively. Two patients underwent a liver transplant at 4 and 7 years after TIPS. CONCLUSION Our results validate the role of TIPS in the management of patients with BCS. With the accessibility of TIPS, the requirement for liver transplantation has become rare.
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Key Words
- AT III, Antithrombin III
- BCS, Budd-Chiari Syndrome
- Budd Chiari syndrome
- CT, Computerized Tomography
- CTP, Child-Turcotte-Pugh
- HV, Hepatic Vein
- INR, International Normalized Ratio
- IVC, Inferior Vena Cava
- JAK-2, Janus Kinase 2
- MELD, Model for End-Stage Liver Disease
- MRI, Magnetic Resonance Imaging
- MTHFR, Methylene Tetrahydrofolate Reductase
- OLT, Orthotopic Liver Transplantation
- SD, Standard Deviation
- TIPS, Transjugular Intrahepatic Portosystemic Shunt
- TIPS-BCS PI score, BCS-TIPS Prognostic Index score
- long term survival
- orthotopic liver transplantation free survival
- transjugular intrahepatic portosystemic shunt
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Affiliation(s)
- Amey D. Sonavane
- Post-graduate Resident, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India,Address for correspondence: Amey D. Sonavane, C-1804, Azziano, Rustomjee Urbania, Majiwada, Thane (West), Maharashtra 400601, India.
| | - Deepak N. Amarapurkar
- Consultant Gastroenterologist, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India
| | - Krantikumar R. Rathod
- Consultant, Department of Vascular and Interventional Radiology, Bombay Hospital and Institute of Medical Sciences, Mumbai, India
| | - Sundeep J. Punamiya
- Consultant, Department of Vascular and Interventional Radiology, Tan Tock Seng Hospital, Singapore
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13
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Premkumar M, Devurgowda D, Dudha S, Maiwall R, Bihari C, Grover S, Gupta E, Kumar S, Sarin SK. A/H1N1/09 Influenza is Associated With High Mortality in Liver Cirrhosis. J Clin Exp Hepatol 2019; 9:162-170. [PMID: 31024197 PMCID: PMC6477137 DOI: 10.1016/j.jceh.2018.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS A/H1N1/09 influenza is associated with a high risk of complications in patients with chronic diseases. In view of patients with cirrhosis being recognized as another high-risk group for influenza morbidity and mortality, we report a cluster of suspected A/H1N1/09 infection in 110 patients admitted to a hepatology intensive care unit. METHODS The pattern of spread, clinical outcome, and respiratory parameters of A/H1N1/09 of 22 positive cirrhotic patients were compared with those from a control group of 88 patients with chronic liver disease (CLD) with influenza-like pneumonia who tested negative for A/H1N1/09. RESULTS A/H1N1/09 infection was confirmed in 22 (20%) patients. Eighteen of 22 (81.8%) CLD patients with A/H1N1/09 died of pneumonia and acute respiratory distress syndrome despite timely antiviral treatment. In contrast, only 35 (40%)of the control group of cirrhotic patients without A/H1N1/09 died. On univariate analysis, age > 45 years [OR 1.3; 95% CI 1.1-5.7, (P = 0.054)], encephalopathy > grade 2 [OR 5.4; 95% CI 2.8-12.3, (P = 0.042)], serum bilirubin >8 mg/dl [OR 2.1; 95% CI 1.8-12.3, (P = 0.052)], serum creatinine >1.8 mg/dl [OR 2.8; 95% CI 1.9-9.2, (P = 0.042)], PaO2/FiO2 ratio <200 [OR 4.5; 95% CI 3.1-18.5, (P = 0.026)] and INR > 2.5 [OR 2.2; 95% CI 1.8-6.7, (P = 0.032)] were risk factors for mortality at presentation. However, on multivariate analysis only PaO2/FiO2 ratio <200 and serum creatinine >1.8 mg/dl remained predictors of mortality. Secondary infections, whether fungal or bacterial, were noted to be independent risk factors for disease severity in patients with cirrhosis. CONCLUSION Early detection and referral, and early antiviral treatment with a strict control of nosocomial spread is essential in patients with cirrhosis during epidemic influenza.
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Key Words
- AKI, Acute Kidney Injury
- APACHE II, Acute Physiologic Assessment and Chronic Health Evaluation II
- ARDS, Acute Respiratory Distress Syndrome
- CLD, Chronic Liver Disease
- CTP, Child Turcotte Pugh Score
- CXR, Chest Radiograph
- H1N1 influenza
- ICU, Intensive Care Unit
- ILI, Influenza Like Illness
- INR, International Normalized Ratio
- MELD, Model for End-Stage Liver Disease
- NASH, Non Alcoholic Steatohepatitis
- PCR, Polymerase Chain Reaction
- SOFA, Sequential Organ Failure Score
- critical care in liver disease
- pneumonia
- ventilatory support
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India,Address for correspondence: Madhumita Premkumar, Senior Resident, Department of Hepatology, ILBS, D-1, Vasant Kunj, New Delhi 110070, India. Tel.: +91 11 46300000.
| | - Devaraja Devurgowda
- Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Shivani Dudha
- Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Shrruti Grover
- Department of Pathology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Sachin Kumar
- Department of Pulmonology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, India
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14
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du Plessis K, Peters R, King I, Robertson K, Mackley J, Maree R, Stanley T, Pickford L, Rose B, Orchard M, Stewart H, d'Udekem Y. "Will she live a long happy life?" Parents' concerns for their children with Fontan circulation. Int J Cardiol Heart Vasc 2018; 18:65-70. [PMID: 29876506 PMCID: PMC5988481 DOI: 10.1016/j.ijcha.2018.02.008] [Citation(s) in RCA: 2] [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: 11/24/2017] [Accepted: 02/28/2018] [Indexed: 11/29/2022]
Abstract
Background Families of children at the worst end of the congenital heart disease endure a significant burden which is often not clearly delineated in the clinical literature. We examined the greatest concerns of parents whose children have a Fontan circulation. Methods Parents (N = 107) of children in the Australian and New Zealand Fontan Registry completed online surveys with open-ended and closed questions. A qualitative method approach incorporating thematic analyses was used. Results The greatest concerns for parents of a child with a Fontan circulation were centered on fear of death for their child and psychosocial well-being, followed by lesser themes around anti-coagulation use, pregnancy and financial burdens. Conclusions Fear of death and the psychological well-being of their children were the main parental concerns. It highlights the need to clearly communicate information on outcomes to families, and the need for family-focused psychological interventions to improve the psychosocial functioning of both parents and young people. Fontan parents' greatest concern for their child is fear of death and well-being. Clear communication around outcomes could help alleviate these fears. It highlights the need for psychological support for parents and young people.
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Affiliation(s)
- Karin du Plessis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rebecca Peters
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee
| | - Ingrid King
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee
| | | | | | - Rachel Maree
- Australian and New Zealand Fontan Advisory Committee
| | - Tracy Stanley
- Australian and New Zealand Fontan Advisory Committee
| | | | - Brian Rose
- Australian and New Zealand Fontan Advisory Committee
| | | | - Helen Stewart
- Australian and New Zealand Fontan Advisory Committee
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Fontan Advisory Committee.,Cardiac Surgery Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Adewole AA, Ugiagbe OA, Onile TG, Joseph GA, Kassim OD, Medupin PF, Adeniran AS. Snake bite in third trimester of pregnancy with systemic envenomation and delivery of a live baby in a low resource setting: A case report. Case Rep Womens Health 2018; 16:14-17. [PMID: 29594003 PMCID: PMC5842965 DOI: 10.1016/j.crwh.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/23/2015] [Revised: 10/09/2017] [Accepted: 10/13/2017] [Indexed: 12/05/2022] Open
Abstract
Background Snake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting. Case We present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby. Conclusion In resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment. Snakebite in pregnancy with systemic envenomation in a low resource setting. Live baby delivered possibly because placenta abruption that occurred was not severe. Multidisciplinary management was helpful for the survival of both the mother and baby.
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Key Words
- AGA, Appropriate for Gestational Age
- APGAR, Appearance Pulse Grimace Activity Respiration
- ARV, Anti-retrovirals
- Carpet viper
- Disseminated intravascular coagulopathy
- Envenomation
- Fetal morbidity
- HIV, Human Immunodeficiency Virus
- INR, International Normalized Ratio
- IU, International Units
- Maternal morbidity
- NHIS, National Health Insurance Scheme
- PCV, Packed Cell Volume
- PT, Prothrombin Time
- SPO2, Oxygen Saturation Pressure
- Snakebite
- TSB, Total Serum Bilirubin
- WBC, White Blood Count
- WBCT, Whole Blood Clotting Time
- aPTT, activated Partial Thromboplastin Time
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Affiliation(s)
- Adebayo A. Adewole
- Department of Obstetrics and Gynaecology, Federal Medical Center, Lokoja, Nigeria
- Corresponding author at: Department of Obstetrics and Gynaecology, Federal Medical Centre, Lokoja, Nigeria.Department of Obstetrics and GynaecologyFederal Medical CentreLokojaNigeria
| | - Osadolor A. Ugiagbe
- Department of Obstetrics and Gynaecology, Federal Medical Center, Lokoja, Nigeria
| | - Temitope G. Onile
- Department of Obstetrics and Gynaecology, Federal Medical Center, Lokoja, Nigeria
| | - Gabriel A. Joseph
- Department of Internal Medicine, Federal Medical Center, Lokoja, Nigeria
| | | | | | - Abiodun S. Adeniran
- Department of Obstetrics and Gynaecology, University of Ilorin, Ilorin, Nigeria
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16
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Taneja S, Kumar P, Mitra S, Duseja A, Minz R, Das A, Dhiman RK, Chawla Y. Acute Exacerbation to Autoimmune Hepatitis Mimicking Acute Viral Hepatitis-A Case Series and Review of Literature. J Clin Exp Hepatol 2018; 8:98-103. [PMID: 29743801 PMCID: PMC5938335 DOI: 10.1016/j.jceh.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/21/2017] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute exacerbation of Autoimmune Hepatitis (AIH) poses a significant challenge for diagnosis as it can mimic acute viral hepatitis especially in absence of autoantibodies and hypergammaglobulinemia. AIM To determine the clinical, laboratory, histopathological characteristics and response to treatment in AIH patients with acute exacerbation. METHODS A retrospective analysis of 16 patients with acute exacerbation of AIH diagnosed over a period of eight years (2008-2016). RESULTS Out of the 111 patients diagnosed with AIH, acute exacerbation of AIH was diagnosed in 16 (14.4%) patients. All patients were females with median age of 35 years. Nine patients (56%) had Type 1 AIH and seven (44%) patients were diagnosed with seronegative AIH. All 16 (100%) patients had acute viral hepatitis like illness at presentation. The median bilirubin was 4.2 mg/dl (range, 2.2-20), aspartate transaminase was 568 IU/L (range, 390-908), alanine transaminase was 430 IU/L (range, 257-1026) and serum alkaline phosphatase was 395 IU/L (range, 112-890) during symptomatic period. The histopathological examination showed underlying chronic hepatitis in 10 (71.4%) patients, only fibrosis in 2 (14.2) patients and cirrhosis with activity in 2 (14.2%). All 16 (100%) patients were treated with a combination of steroids and azathioprine. Thirteen (81%) patients achieved complete biochemical remission and three (19%) patients achieved partial remission out of which one (6%) patient succumbed to illness because of the complications of cirrhosis. CONCLUSION A suspicion of acute exacerbation of AIH should be considered in patients with unexplained acute hepatitis mimicking acute viral hepatitis in the absence of positive viral markers. Through evaluation with immunoserological markers and liver biopsy can clinch the diagnosis of acute exacerbation of AIH in such cases.
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Key Words
- AASLD, American Association of Study of Liver
- AIH, Autoimmune Hepatitis
- ALKM-1, Liver/Kidney Microsomes
- ALT, Alanine Transaminase
- AMA, Antimitochondrial Antibody
- ANA, Antinuclear Antibodies
- ANCA, Anti-neutrophil Cytoplasmic Antibody
- ASMA, Anti-smooth Muscle Antibodies
- AST, Aspartate Transaminase
- CBR, Complete Biochemical Response
- CT, Computed Tomography
- ELISA, Enzyme-linked Immunosorbent Assay
- IAIHG, International Autoimmune Hepatitis Group
- IIF, Indirect Immunofluorescence
- INR, International Normalized Ratio
- MRCP, Magnetic Response Cholangiopancreatography
- PBC, Primary Biliary Cirrhosis
- PBR, Partial Biochemical Response
- PSC, Primary Sclerosing Cholangitis
- SAP, Serum Alkaline Phosphatase
- acute exacerbation
- autoimmune hepatitis
- primary biliary cirrhosis
- primary sclerosing cholangitis
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Affiliation(s)
- Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India,Address for correspondence: Sunil Taneja, Assistant Professor, Department of Hepatology, PGIMER, Chandigarh, India. Tel.: +91 9592160444/172 2756344; fax: +91 1722756344.
| | - Pramod Kumar
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ranjana Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Yogesh Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Bolia R, Srivastava A, Marak R, Yachha SK, Poddar U. Prevalence and Impact of Bacterial Infections in Children With Liver Disease-A Prospective Study. J Clin Exp Hepatol 2018; 8:35-41. [PMID: 29743795 DOI: 10.1016/j.jceh.2017.08.007] [Citation(s) in RCA: 6] [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: 12/08/2016] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Risk of infections is increased in patients with Acute Liver Failure (ALF) and Decompensated Chronic Liver Disease (DCLD). We evaluated the frequency, site, type and risk-factors for bacterial infections in children with ALF and DCLD and its effect on outcome. METHODS ALF or DCLD children were enrolled prospectively. Clinical and laboratory details were recorded. Cultures (blood, urine and ascites) and chest X-ray were done at admission followed by weekly surveillance cultures. RESULTS 173 patients, 68 ALF and 105 DCLD were enrolled. Infections were more common in DCLD than ALF (60/105 [57.1%] vs. 27/68 [39.7%]; P = 0.02). Ascitic fluid infection, pneumonia, urinary tract infection and bacteremia were seen in 19%, 17.9%, 13.2% and 12.1% patients respectively. Healthcare-Associated (HCA) infections were most frequent (39/87, 44.8%), followed by Nosocomial (NC, 32%) and Community-Acquired (CA, 23%). Nearly 3/4th of bacterial isolates were resistant to cephalosporins and quinolones, 23% being Multiresistant Bacteria (MRB). DCLD patients with infection had higher Child-Pugh Score (10 [6-14] vs. 7 [6-14]; OR 3.2 [1.77-5.10]: P = 0.007), need for ICU care (26/60 vs. 3/45; OR 10.70 [2.98-38.42]: P = 0.01), in-hospital mortality (24/60 vs. 8/45;OR 3.08 [1.22-7.75]: P = 0.04) and mortality at 3 month follow-up (32/60 vs. 9/45; OR 4.57 [1.87-11.12]: P = 0.00). Infection did not affect the outcome in ALF. CONCLUSION Infections develop in 40% ALF and 57% DCLD children. HCA and NC infections account for 77% of infections. Most culture isolates are resistant to cephalosporins and fluoroquinolones and 23% have MRB. Risk of infections is higher in DCLD patients with advanced liver disease.
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Key Words
- ALF, Acute Liver Failure
- CA, Community Acquired
- DCLD, Decompensated Chronic Liver Diseases
- GIB, Gastrointestinal Bleeding
- GNB, Gram Negative Bacilli
- GPC, Gram Positive Cocci
- HCA, Healthcare Associated
- HE, Hepatic Encephalopathy
- ICU, Intensive Care Unit
- INR, International Normalized Ratio
- MRB, Multiresistant Bacteria
- NC, Nosocomial
- SBP, Spontaneous Bacterial Peritonitis
- UTI, Urinary Tract Infection
- chronic liver disease
- infections
- liver failure
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Kanetkar AV, Balakrishnan D, Sudhindran S, Dhar P, Gopalakrishnan U, Menon R, Sudheer OV. Is Portal Venous Pressure or Porto-systemic Gradient Really A Harbinger of Poor Outcomes After Living Donor Liver Transplantation? J Clin Exp Hepatol 2017; 7:235-246. [PMID: 28970711 PMCID: PMC5620358 DOI: 10.1016/j.jceh.2017.01.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/20/2016] [Accepted: 01/29/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Portal hyperperfusion as a cause of small for size syndrome (SFSS) after living donor liver transplantation (LDLT) remains controversial. Portal venous pressure (PVP) is often measured indirectly and may be confounded by central venous pressure (CVP). METHODS In 42 adult cirrhotics undergoing elective LDLT, PVP was measured by direct canulation of portal vein and porto systemic gradient (PSG) was obtained after subtracting CVP from PVP. None underwent portal inflow modulation. SFSS was looked in 27 patients after excluding 15 with technical complications. RESULTS Clinical features of SFSS found in 6 patients, 5 with graft recipient weight ratio (GRWR) > 0.8% and PVP < 20 mm of Hg. One with GRWR < 0.8% could truly be labeled as SFSS. Incidence of SFSS was not higher in patients with elevated PVP > 20 mm of Hg (14.3% vs 0%, P = 0.259) or PSG > 13 mm of Hg (33.3% vs 0%, P = 0.111). Intensive care unit (ICU) stay was longer in patients with elevated PVP (14.55 vs 9.13 days, P = 0.007) and PSG (16.8 vs 9.72 days, P = 0.009). There was no difference in graft functions, post-operative complications and mortality in first month post-LDLT. CONCLUSION Elevated PVP or PSG increased morbidity but neither predicted SFSS nor affected survival.
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Key Words
- BAL, bronchoalveolar lavage
- CTP, Child Turcot Pugh
- CVP, central venous pressure
- GRWR, graft to recipient weight ratio
- HAT, hepatic artery thrombosis
- INR, International Normalized Ratio
- LDLT, living donor liver transplant
- MELD, Model for End Stage Liver Disease
- MHV, middle hepatic vein
- N, total number
- P, probability value
- PNF, primary non-function
- PSG, porto systemic gradient
- PVP, portal venous pressure
- PVT, portal vein thrombosis
- ROC, receiver operating characteristics
- SD, standard deviation
- SFSS, small for size syndrome
- SGOT, serum glutamate oxaloacetate transaminase
- SGPT, serum glutamate pyruvate transaminase
- cirrhosis
- graft recipient weight ratio
- small for size syndrome
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Affiliation(s)
- Amol Vijay Kanetkar
- Address for correspondence: Amol Vijay Kanetkar, Resident, Department of Gastro Intestinal Surgery and Solid Organ Transplantation, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Ponekkara P.O., Kochi, Kerala 682041, India. Tel.: +91 9497641457.Resident, Department of Gastro Intestinal Surgery and Solid Organ Transplantation, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham UniversityPonekkara P.O.KochiKerala682041India
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Shariff MI, Kim JU, Ladep NG, Crossey MM, Koomson LK, Zabron A, Reeves H, Cramp M, Ryder S, Greer S, Cox IJ, Williams R, Holmes E, Nash K, Taylor-Robinson SD. Urinary Metabotyping of Hepatocellular Carcinoma in a UK Cohort Using Proton Nuclear Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2016; 6:186-194. [PMID: 27746614 PMCID: PMC5052404 DOI: 10.1016/j.jceh.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/25/2016] [Accepted: 03/20/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Discriminatory metabolic profiles have been described in urinary 1H nuclear magnetic resonance (NMR) spectroscopy studies of African patients with hepatocellular carcinoma (HCC). This study aimed to assess similarities in a UK cohort, where there is a greater etiological diversity. METHODS Urine from cirrhosis and HCC patients was analyzed using a 600 MHz 1H NMR system. Multivariate analysis and median group MR spectra comparison identified metabolite alterations between groups. Metabolite identification was achieved through literature reference and statistical total correlation spectroscopy. Diagnostic accuracy was compared to serum alpha-fetoprotein (AFP). RESULTS Of the 52 patients recruited, 13 samples from HCC and 25 from cirrhosis patients were selected. At 200 IU mL-1, diagnostic sensitivity of AFP was 27%. Multivariate analysis of urinary spectra generated diagnostic models with a sensitivity/specificity of 53.6%/96%. p-Cresol sulfate (P = 0.04), creatinine (P = 0.03), citrate (P = 0.21) and hippurate (P = 0.52) were reduced in the HCC patients. Carnitine (P = 0.31) and formate (P = 0.44) were elevated. CONCLUSION Diagnostic sensitivity was lower than previous African studies, but still outperformed serum AFP. Reduced creatinine, citrate and hippurate and elevated carnitine are comparable with the African studies. p-Cresol sulfate alteration is a novel finding and may indicate an altered sulfonation capacity of the liver in patients with HCC.
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Key Words
- 1H NMR
- 1H NMR, proton nuclear magnetic resonance
- AFP, alpha-fetoprotein
- ALT, alanine transaminase
- BCLC, Barcelona Clinic Liver Cancer
- BMI, body mass index
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- INR, International Normalized Ratio
- NASH, non-alcoholic steatohepatitis
- PCA, principal component analysis
- PLS-DA, partial least squares discriminant analysis
- SEER, surveillance Epidemiology and End Results
- STOCSY, statistical total correlation spectroscopy
- TSP, trimethyl-silyl phosphate
- US, ultrasonography
- biomarkers
- hepatocellular carcinoma
- metabonomics
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Affiliation(s)
- Mohamed I.F. Shariff
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Jin U. Kim
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom,Address for correspondence: Jin Un Kim, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom.Division of Digestive Health, Department of Surgery and Cancer, Imperial College LondonSt Mary's Campus, South Wharf RoadLondonW2 1NYUnited Kingdom
| | - Nimzing G. Ladep
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Mary M.E. Crossey
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Larry K. Koomson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Abigail Zabron
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
| | - Helen Reeves
- Northern Institute for Cancer Research, Paul O’Gorman Building, Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Matthew Cramp
- Liver Unit, Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
| | - Stephen Ryder
- Nottingham Digestive Diseases Centre, University of Nottingham and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Shaun Greer
- Department of Gastroenterology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
| | - I. Jane Cox
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London WC1E 6HX, United Kingdom
| | - Roger Williams
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London WC1E 6HX, United Kingdom
| | - Elaine Holmes
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Kathryn Nash
- Liver Unit, Southampton General Hospital, Tremona Rd, Southampton, Hampshire SO16 6YD, United Kingdom
| | - Simon D. Taylor-Robinson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London W2 1NY, United Kingdom
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Zhang J, Chen Z, Chen C. Impact of CYP2C9, VKORC1 and CYP4F2 genetic polymorphisms on maintenance warfarin dosage in Han-Chinese patients: A systematic review and meta-analysis. Meta Gene 2016; 9:197-209. [PMID: 27617219 PMCID: PMC5006145 DOI: 10.1016/j.mgene.2016.07.002] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Warfarin is the most commonly used antithrombotic drug. Single nucleotide polymorphisms (SNPs) of CYP2C9, CYP4F2, VKORC1 1173 and VKORC1-1639 influence warfarin maintenance dosage. We aimed to determine the impact of SNPs of these genes on mean daily warfarin dosage (MDWD) in Han-Chinese patients. Methods Strict literature inclusion criteria were established, and literature searching was performed on PubMed, Embase and Cochrane Library for English articles and CNKI, CBM and Wanfang database for Chinese articles before September 2, 2014. Revman 5.3 was used to analyze the relationship between gene SNPs and MDWD in Han-Chinese subjects. Results We included 33 studies researching the impact of gene SNPs on MDWD in Han-Chinese subjects. CYP2C9 *3/*3, *1/*3 and *3 carriers needed a 72% (95% confidence interval [CI]: 62.0%–81.0%), 28% (22.0%–33.0%) and 26% (21.0%–32.0%) lower MDWD, respectively, than CYP2C9 *1/*1 carriers. CYP4F2 TT, CT and T carriers required a 18% (7.0%–30.0%), 7% (7.0%–7.0%) and 11% (7.0%–14.0%) higher MDWD, respectively, than CYP4F2 CC carriers. VKORC1 1173 CC, CT and C carriers required a 98% (78.0%–118.0%), 49% (37.0%–62.0%) and 56% (44.0%–67.0%) higher MDWD, respectively, than VKORC1 1173 TT carriers. VKORC1-1639 GG, GA and G carriers needed a 101% (53.0%–149.0%), 40% (36.0%–45.0%) and 38% (35.0%–42.0%) higher MDWD, respectively, than VKORC1-1639 AA carriers. Conclusions This meta-analysis is the first to report the relationship between genotypes and MDWD among Han-Chinese patients. The results showed that SNPs of CYP2C9, CYP4F2, VKORC1 1173 and VKORC1-1639 significantly influenced the MDWD in Han-Chinese patients. This meta-analysis examined the effects of genotype on mean daily warfarin dosage. CYP2C9, CYP4F2 and VKORC1 genotypes were studied in Han-Chinese patients. CYP2C9, CYP4F2, VKORC1-1173 and VKORC1-1639 polymorphisms affected warfarin dosage. VKORC1-1173 C and VKORC1-1639 G mutations had similar frequencies and effects. Either genotype can be tested for to guide drug usage and lower medical costs.
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Key Words
- AF, Atrial Fibrillation
- AVR, Atrial Valve Replacement
- CI, Confidence Interval
- CYP2C9
- CYP2C9, Cytochrome P450 Complex Subunit 2C9
- CYP4F2, Cytochrome P450 Complex Subunit 4F2
- DVT, Deep Vein Thrombosis
- HVR, Heart Valve Replacement
- Han-Chinese
- INR, International Normalized Ratio
- MD, Mean Difference
- MDWD, Mean Daily Warfarin Dose
- MHVR, Mechanical Heart Valve Replacement
- MVR, Mitral Valve Replacement
- Meta-analysis
- NVAF, Non Valvular Atrial Fibrillation
- PE, Pulmonary Embolism
- RHD, Rheumatic Heart Disease
- SD, Standard Deviation
- SNPs, Single Nucleotide Polymorphisms
- VKORC1
- VKORC1, Vitamin K Epoxide Reductase Complex Subunit 1
- VTE, Venous Thromboembolism
- Warfarin
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Affiliation(s)
- Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
| | - Zhijie Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, PR China
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Pati GK, Singh A, Misra B, Misra D, Das HS, Panda C, Singh SP. Acute-on-Chronic Liver Failure (ACLF) in Coastal Eastern India: "A Single-Center Experience". J Clin Exp Hepatol 2016; 6:26-32. [PMID: 27194893 DOI: 10.1016/j.jceh.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 09/05/2014] [Accepted: 08/10/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute-On-Chronic liver failure (ACLF) is an emerging entity. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients. PATIENTS AND METHODS ACLF was defined as per Asia Pacific Association for the Study of Liver consensus criteria 2009. Patients fulfilling these criteria with some deviations were included and prospectively evaluated for clinical profile, etiologies of acute decompensation (AD) and underlying chronic liver disease, and short-term natural course [3 months]. RESULTS Out of 123 patients with ACLF (mean age: 45.83 ± 12.05 years; male:female 109:14), 45.53% cases had prior history of AD, and 54.47% presented for the first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic, and chronic hepatitis B virus infection in 65.04%, 23.57%, and 11.38% cases, respectively. Recent history of alcohol intake (within 4 weeks) [42.27%] followed by bacterial infections [36.58%] were the common etiologic precipitants for AD. Only 87 (70.73%) out of 123 cases could be followed up for a duration of 3 months; 62 (71.26%) cases died by 3 months. Most deaths occurred in the alcoholics compared to nonalcoholics [(43/53) 81.13% vs. (19/34) 55.88%; P = 0.01]. No significant difference in mortality rate was observed between ACLF cases with history of prior AD compared to newly diagnosed ACLF cases [30/40 (75%) vs. 32/47 (68.09%); P = 0.477]. The prognostic markers [MELD, MELD-Na, CTP] were not significantly different between survivors and nonsurvivors. CONCLUSION ACLF patients in our population had high short-term mortality rates with majority of deaths in alcoholics. Alcohol intake and bacterial infections were mainly responsible for AD in our study.
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Key Words
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- ALD, alcoholic liver disease
- ALT, alanine transaminase
- APASL, Asian Pacific Association for the Study of the Liver
- CLD, chronic liver disease
- CTP, Child-Turcotte-Pugh
- EASL-AASLD, European Association for the Study of the Liver-American Association for the Study of Liver Diseases
- HBV, hepatitis B virus
- HE, hepatic encephalopathy
- HEV, hepatitis E virus
- HRS, hepatorenal syndrome
- INR, International Normalized Ratio
- MELD, Model for End-Stage Liver Disease
- MELD-Na, Model for End-Stage Liver Disease Sodium
- PT, prothrombin time
- SD, standard deviation
- SIRS, systemic inflammatory response syndrome
- ascites
- encephalopathy
- hepatic decompensation
- renal failure
- sepsis
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Devarbhavi H, Murali AR. Safety of Ascitic Paracentesis in Patients with Budd-Chiari Syndrome on Oral Anticoagulation and Elevated International Normalized Ratio. J Clin Exp Hepatol 2015; 5:310-3. [PMID: 26900272 PMCID: PMC4723655 DOI: 10.1016/j.jceh.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/22/2015] [Accepted: 08/24/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Anticoagulation is the standard of care in patients with Budd-Chiari Syndrome (BCS). Ascites is a common symptom in patients with BCS. Often such patients require paracentesis while taking oral anticoagulation concurrently. It is unclear whether paracentesis leads to increased bleeding in such patients or whether anticoagulation has to be temporarily suspended. We describe our experience with paracentesis in patients with BCS taking oral anticoagulation. METHODS Our study subjects included consecutive patients with BCS with ascites on oral anticoagulation admitted between 2007 and 2011. The dose of oral anticoagulation was titrated to achieve international normalized ratio (INR) between 2 and 3. Routine hematological tests included Factor VIII (FVIII) levels. Paracentesis was undertaken without the prior administration of fresh frozen plasma and without the aid of ultrasonography. We looked for occurrences of bleeding at the puncture site or hemoperitoneum during and after the procedure. RESULTS Thirty-two of the 60 patients with BCS patients taking oral anticoagulation concurrently developed ascites. Thirty among 32 patients required paracentesis on one or more occasions. A total of 51 paracentesis procedures were performed (Median 1.6, Range 1-7). The mean INR was 3.1 (Range 1.4-7.9). No patient developed bleeding or hemoperitoneum. The mean FVIII measured was 138.8% of laboratory control and mean platelet level was 2.2 × 10(5)/ml. CONCLUSIONS Ascitic paracentesis in patients with BCS on anticoagulation is safe without an increased risk of abdominal wall bleeding or hemoperitoneum. Normal or high FVIII and platelet levels likely mitigate against bleeding risks.
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Affiliation(s)
- Harshad Devarbhavi
- Address for correspondence: Harshad Devarbhavi, Head, Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India. Tel.: +918022065134; fax: +91 8025520499.Head, Department of Gastroenterology, St. John's Medical College HospitalBangaloreIndia
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Abstract
Acute liver failure (ALF) is a rare, potentially fatal complication of severe hepatic illness resulting from various causes. In a clinical setting, severe hepatic injury is usually recognised by the appearance of jaundice, encephalopathy and coagulopathy. The central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a central role in the pathogenesis. The role of newer ammonia lowering agents is still evolving. Liver transplant is the only effective therapy that has been identified to be of promise in those with poor prognostic factors, whereas in the others, aggressive intensive medical management has been documented to salvage a substantial proportion of patients. A small fraction of patients undergo liver transplant and the remaining are usually treated with medical therapy. Therefore, identification of the complications and causes of death in such patients, and use of appropriate prognostic models to identify those who need liver transplant and those who can be managed with medical treatment is a vital component of therapeutic strategy. In this review, we discuss the various pathogenetic mechanisms and treatment options available.
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Key Words
- AASLD, American Association For the Study of Liver
- ALF, Acute Liver Failure
- ALFED, Acute Liver Failure Early Dynamic Model
- BBB, Blood Brain Barrier
- BCAA, Branched Chain Amino acid
- CBF, Cerebral Blood Flow
- CPP, Cerebral Perfusion Pressure
- CVVHD, Continuous Veno-Venous Hemodialysis
- FFP, Fresh Frozen Plasma
- GM-CSF, Granulocyte Macrophage Colony Stimulating Factor
- HE, Hepatic Encephalopathy
- ICU, Intensive Care Unit
- IEI, Icterus Encephalopathy Interval
- IL-1β, Interleukin-1 beta
- IL6, Interlekin 6
- INR, International Normalized Ratio
- LOLA, l-Ornithine L Aspartate
- LOPA
- LOPA, l-Ornithine Phenyl Acetate
- MAP, Mean Arterial Pressure
- NAC, N-Acetyl Cysteine
- NO, Nitric Oxide
- OLT, Orthotopic Liver Transplantation
- PCWP, Pulmonary Capillary Wedge Pressure
- PEEP, Positive End Expiratory Pressure
- PT, Prothrombin Time
- SIMV, Synchronous Intermittent mandatory Ventilation
- SIRS, Systemic Inflammatory Response Syndrome
- SPEAR, Selective Parenteral and Enteral Antibiotic Regimen
- TNF-α, Tumor Necrosis Factor alfa
- UCD, Urea Cycle Disorder
- USALF, United States Acute liver Failure Study Group
- ammonia
- cerebral edema
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Affiliation(s)
| | - Subrat K. Acharya
- Address for correspondence: Subrat K. Acharya, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
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