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Background: The relationship between viral infections and host factors holds high hopes for identifying the role of Interferon Lambda 3 (IFNL3) and Interleukin 6 (IL-6) polymorphisms in the development of Chronic Liver Disease (CLD) in patients infected with hepatitis Delta virus (HDV) in the Western Brazilian Amazon. Methods: Cross-sectional study conducted with a cohort of 40 chronic HDV patients, 27 with CLD and 13 without evident liver damage. Biological samples from the participants were analyzed using the polymerase chain reaction (PCR) technique, followed by sequencing by the automated Sanger method. Results: The rs8099917 T allele, from the IFNL3 gene, showed a higher frequency in both groups; however, it was not possible to establish an association with HDV infection [OR = 1.42 (0.42 - 4.75; p = 0.556 (95% CI). For IL-6, the rs1800795 G allele was superior to rs1800795 C. Analyzing both distributions in the studied groups, any association with HDV was absent (p > 0.05). Conclusion: The results suggest that the rs8099917 T/G (IFNL3) and rs1800795 G/C (IL-6) polymorphisms are not associated with the evolution of HDV in the studied population.
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Humans , Hepatitis Delta Virus , Hepatitis D, Chronic , Polymorphism, Single Nucleotide , Brazil/epidemiologyABSTRACT
ABSTRACT BACKGROUND: Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) in the liver of individuals with undetectable hepatitis B virus surface antigen (HBsAg) in the serum. The actual prevalence of OBI and its clinical relevance are not yet fully understood. OBJECTIVE: To evaluate the prevalence of HBV DNA in liver biopsies of HBsAg-negative patients with chronic liver disease of different etiologies in a referral center in Brazil and compare two different HBV DNA amplification protocols to detect HBV. DESIGN AND SETTING: This cross-sectional observational study was conducted at the Liver Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil, between January 2016 and December 2019. METHODS: HBV DNA was investigated in 104 liver biopsy samples from individuals with chronic liver disease of different etiologies, in whom HBsAg was undetectable in serum by nested-polymerase chain reaction (nested-PCR), using two different protocols. RESULTS: OBI, diagnosed by detecting HBV DNA using both protocols, was detected in 6.7% of the 104 individuals investigated. Both protocols showed a good reliability. CONCLUSION: In addition to the differences in the prevalence of HBV infection in different regions, variations in the polymerase chain reaction technique used for HBV DNA amplification may be responsible for the large variations in the prevalence of OBI identified in different studies. There is a need for better standardization of the diagnostic methods used to diagnose this entity.
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Patients with advanced chronic liver disease （ACLD） are hospitalized due to hepatitis， acute decompensation or liver failure and its complications， and they often require stratified management due to different severities. The patients with acute－on－chronic liver failure （ACLF） have the highest short－term mortality rate among ACLD patients and should be treated in tertiary hospitals. Although non－ACLF patients tend to have a relatively low mortality rate， they still have the risk of progression to ACLF， and there is a significant increase in mortality rate after progression to ACLF， which requires stratified management. The patients with extremely low progression rates often have favorable clinical outcomes and can be administrated in primary hospitals， while the high－risk population should be closely monitored and timely transferred in case of disease progression. However， currently there is still a lack of accurate predictive models for evaluating the risk of progression to ACLF， and further studies are needed to find new biomarkers or algorithms.
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ABSTRACT Background Variceal hemorrhage (VH) is a medical emergency. Prompt endoscopic variceal ligation (EVL) is therapeutic. Terlipressin is used in VH and continued for 2—5 days even after EVL. As hemostasis is primarily achieved by EVL, the benefit of continuing trelipressin after EVL is unknown. Objective To evaluate the efficacy of continuing terlipressin after EVL to prevent re-bleed and mortality. Methods In this pilot study, after EVL 74 patients of VH were randomized into two treatment groups TG2 & TG5, received terlipressin (1 mg IV bolus q 4 hourly) for 2 days and 5 days respectively and one control group (TG0), received 0.9% normal saline (10 mL IV bolus q 4 hourly) and followed up for 8 weeks. Results A total of 9 (12.6%) patients had re-bleed with maximum 4 (5.6%) patients in TG5 group followed by 3 (4.2%) in TG2 and 2 (2.8%) in TG0 groups (P=0.670). The overall mortality was 15 (21.1%) patients, 6 (8.5%) patients in TG0 group, followed by 5 (7.0%) in TG5 and 4 (5.6%) in TG2 group (P=0.691). Adverse drug reactions were significantly higher in treatment groups with maximum 18 (24.32%) patients in TG5, followed by 8 (10.8%) in TG2 and 2 (2.7%) in TG0 groups (P=0.00). Duration of hospital stay was also significantly higher in treatment group, 6.63 (±0.65) days in TG5 followed by 3.64 (±0.57) in TG2 and 2.40 (±0.50) days in TG0 groups (P=0.00). Conclusion The rational for continuing terlipressin after EVL is doubtful as it didn't have any benefit for the prevention of re-bleed or mortality; rather it increased the risk of adverse drug reactions and duration of hospital stay. Further randomized clinical trials are encouraged to generate more evidence in support or against continuing terlipressin after EVL.
RESUMO Contexto A hemorragia varicosa (HV) é emergência médica. A ligadura endoscópica imediata das varizes (LEV) é terapêutica. A terlipressina é usada em HV e contínua por 2—5 dias mesmo após a LEV. Como a hemostasia é alcançada principalmente pela LEV, o benefício do uso contínuo da terlipressina após o evento é desconhecido. Objetivo Avaliar a eficácia da terlipressina contínua após a LEV para evitar o ressangramento e a mortalidade. Métodos Neste estudo piloto, após a LEV, 74 pacientes com HV foram randomizados em dois grupos de tratamento TG2 & TG5, que receberam terlipressina (1 mg EV em bolus a cada 4 horas) durante 2—5 dias, respectivamente, e um grupo controle (TG0), que receberam soro fisiológico normal de 0,9% (10 mL EV em bolus a cada 4 horas) e foram seguidos por 8 semanas. Resultados Um total de 9 (12,6%) pacientes tiveram ressangramento, 4 (5,6%) no grupo TG5, seguidos por 3 (4,2%) no TG2 e 2 (2,8%) no grupo TG0 (P=0,670). A mortalidade geral de pacientes foi de 15 (21,1%), 6 (8,5%) no grupo TG0, seguidos por 5 (7,0%) no TG5 e 4 (5,6%) no TG2 (P=0,691). As reações adversas de medicamentos foram significativamente maiores em grupos de tratamento em 18 (24,32%) pacientes no TG5, seguidos por 8 (10,8%) no TG2 e 2 (2,7%) em grupo TG0 (P=0,00). A duração da internação hospitalar também foi significativamente maior no grupo de tratamento, 6,63 (±0,65) dias no TG5, seguido por 3,64 (±0,57) em TG2 e 2,40 (±0,50) dias em grupos TG0 (P=0,00). Conclusão O uso racional para a continuação da terlipressina após a LEV é duvidoso, pois não teve qualquer benefício para a prevenção de ressangramento ou mortalidade; pelo contrário, aumentou o risco de efeitos adversos e duração da internação hospitalar. Outros ensaios clínicos randomizados são necessários para gerar mais evidências em apoio ou contra a terlipressina contínua após a LEV.
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Background: Amoebic liver abscesses (ALA) in the presence of Alcoholic liver disease (ALD) constitutes a high-risk group of patients who are prone to complications and may need more aggressive treatment. This study was aimed at evaluating disease course and outcomes in patients of ALA with ALD, in comparison to those without ALD. Material & Methods: This prospective observational study was conducted on 60 consecutive patients of ALA without ALD (Group-I) and 60 consecutive patients of ALA with ALD (Group II). Result: The patients ALA with ALD were older (47.2 ±13.3 years) than those without ALD (34.1±14 years). Mean size of the abscess cavity was significantly larger in patients with ALD (391.2± 208.7 cc in Group I and 594.3 ± 297.9 cc in Group II). In Group I, conservative management was most common (43.3%); while in Group II pigtail catheter insertion was the most frequently used modality of treatment (45%). Complications like empyema (6.6%), acute on chronic liver failure (8.3%) and impending liver failure (23.3%) manifesting as ascites and oedema were seen only in patients in Group II and they also had longer hospital stay. (4.87 days in Group I vs 8.37 in Group II). Conclusion: Patients of ALA with ALD have a more aggressive course of disease and should be managed with a lower threshold for abscess drainage.
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La historia natural de la enfermedad hepática crónica (EHC) se caracteriza por una fase de cirrosis compensada asintomática seguida de una fase descompensada, que se acompaña de signos clínicos evidentes, de los cuales los más frecuentes son la ascitis, las hemorragias, la encefalopatía y la ictericia. Esta guía actualizada sobre el manejo de pacientes con EHC en la edad pediátrica fue confeccionada con el propósito de mejorar la práctica clínica de estos pacientes complejos y darle herramientas al pediatra de cabecera para un seguimiento adecuado. Para ello, un grupo de expertos subrayó la importancia del inicio temprano del tratamiento etiológico en cualquier grado de enfermedad hepática y ampliaron su labor jerarquizando las complicaciones de la cirrosis: ascitis, hemorragia digestiva, infecciones, malnutrición; aspectos endocrinológicos, neurológicos, oftalmológicos y gastrointestinales; y complicaciones vasculares pulmonares y renales. Se incluyeron, además, aspectos psicosociales, así como el cuidado del adolescente en su transición a la vida adulta.
The natural history of chronic liver disease (CLD) is characterized by a phase of asymptomatic compensated cirrhosis followed by a decompensated phase, accompanied by the development of evident clinical signs, the most frequent being ascites, hemorrhages, encephalopathy and jaundice. This updated guideline on the management of pediatric patients with CLD was developed with the purpose of improving the clinical practice of these complex patients and to provide the pediatrician with tools for an adequate follow-up. To this end, a group of experts, after stressing the importance of early initiation of etiologic treatment in any degree of liver disease, expanded their work to include a hierarchy of complications of cirrhosis: ascites, gastrointestinal bleeding, infections, malnutrition, endocrinological, neurological, ophthalmological, gastrointestinal, pulmonary vascular and renal complications. Psychosocial aspects including the care of the adolescent in their transition to adult life were also included.
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Humans , Child , Adolescent , Adult , Ascites/etiology , Jaundice , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/therapyABSTRACT
Despite recent advances in pediatric chronic cholestatic diseases, the causes and effective therapies remain elusive, and many patients progress to liver failure and need liver transplantation.Malnutrition is a common complication in these patients and is a well-recognized, tremendous challenge for the clinician.The malnutrition and failure to thrive are associated with increased risks of morbidity and mortality, and they also affect the outcomes of liver transplantation, including long-term survival.Malnutrition in children with chronic cholestatic disease is multifactorial and with multiple potential nutritional deficiencies.Supplemental feeding, including medium-chain triglycerides, essential fatty acids, branched-chain amino acids.In order to improve the life expectancy and quality of life of children with chronic liver disease, this paper reviews ways to address the nutritional needs for specific cause of malnutrition in children.
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The Baveno VII workshop held in October 2021 was featured by the subject of personalized care in portal hypertension. The workshop focused on the following 9 topics including: the relevance and indications for measuring the hepatic venous pressure gradient as a gold standard; the use of non-invasive tools for the diagnosis of compensated advanced chronic liver disease and clinically significant portal hypertension; the impact of etiological and of non-etiological therapies in the course of cirrhosis; the prevention of the first episode of decompensation; the management of the acute bleeding episode; the prevention of further decompensation; as well as the diagnosis and management of splanchnic vein thrombosis and other vascular disorders of the liver. This essay provides a compilation and summary of recommendations regarding the abovementioned topics, and presents the most recent research proceedings and the corresponding consensus to our readers.
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Humans , Consensus , Esophageal and Gastric Varices , Hypertension, Portal/therapy , Liver Cirrhosis/therapy , Portal PressureABSTRACT
Background. Chronic liver disease (CLD) is linked to immune system failure, which increases the risk of infections and consequences brought on by COVID-19. Therefore, we aimed to compare hospitalized COVID -19 patients with and without CLD to assess the effect of CLD on the severity of COVID-19 infection. Methods. The study was conducted between April and October 2022 at Zagazig university hospitals. It enrolled 108 subjects admitted at the isolation hospital for COVID-19 illness. The cases were allocated equally into three groups, group (I): Patients without evidence of liver disease. Group (II): patients with chronic hepatitis, and group (III): patients with cirrhotic liver. Result. There were significant correlations between the severity of COVID -19 and the CTP classification of Group III (r=0.5 p=0.05 in child A, r=0.08 p=0.05 in child B, r=0.4 p=0.001in child C). In addition, there were significant correlations between laboratory parameters such as INR (r=0.6, p=0.05), bilirubin (r=0.4, p=0.001), ALT (r= 0.5, p=0.05), and AST (r=0.08, p=0.05) and severity of COVID -19 in studies groups. Conclusion: Those with CLD and cirrhosis had a higher death rate. COVID-19 severity related to the Child-Turcotte-Pugh score (CTP) score.
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Humans , Male , Female , COVID-19 , Liver DiseasesABSTRACT
Introdução: A doença hepática gordurosa não alcoólica (DHGNA) é uma das causas mais comuns de hepatopatia. Devido ao grande risco de progressão para cronicidade, seu rastreamento se faz necessário. A Elastografia por Ressônancia Magnética (MRE) foi estabelecida em diversos estudos como uma técnica acurada para o diagnóstico de fibrose. Objetivos: Descrever a prevalência de esteatose e de fibrose hepática em pacientes com DHGNA submetidos à MRE; estimar o grau de fibrose, correlacionando com a escala METAVIR, e avaliar a fração de gordura por densidade de prótons (PDFF) e os fatores clínicos associados à esteatose e fibrose. Métodos: Estudo transversal, realizado mediante revisão de imagens de MRE, entre janeiro de 2017 e março de 2019, em um hospital da região sul do Brasil. Resultados: Dos 298 pacientes incluídos, a maioria dos pacientes apresentava esteatose leve (41,6%, n=124) ou ausente (30,9%, n=92), enquanto 15,1% (n=45) apresentava esteatose moderada e 12,4% (n=37), acentuada. A maioria dos pacientes (65,8%, n=181) apresentava rigidez hepática dentro da normalidade, 11,6% (n=32) inflamação crônica, 7,6% (n=21) fibrose estágio 1-2, 3,6% (n=10) fibrose estágio 2-3, 4,7% (n=13) fibrose estágio 3-4 e 6,5% (n=18) fibrose estágio 4 ou cirrose. Discussão: Os resultados encontrados nesta amostra reforçam os fatores de risco para o desenvolvimento de DHGNA previamente avaliados. Uma combinação de estratégias não invasivas, incluindo a MRE, poderá selecionar os pacientes com maior probabilidade de agravos. Conclusão: Nesse estudo, a maioria dos pacientes apresentou a forma leve ou ausência de esteatose e rigidez hepática dentro da normalidade. A MRE tem se mostrado uma técnica altamente acurada, não invasiva para estadiamento de fibrose hepática em pacientes com DHGNA, sem influência significativa da idade, sexo, adiposidade e grau de inflamação hepática.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of liver disease. Due to the high risk of progression to chronicity, its tracking is necessary. Magnetic Resonance Elastography (MRE) has been established in several studies as an accurate technique for diagnosing fibrosis. Objectives: To describe the prevalence of steatosis and liver fibrosis in NAFLD patients undergoing MRE; estimate the degree of fibrosis, correlating with the METAVIR scale, and assess the proton density fat-fraction (PDFF). Methods: A cross-sectional study, performed by reviewing MRE images, between January 2017 and March 2019, in a hospital in southern Brazil. Results: Of the 298 patients included, most patients had mild (41.6%, n=124) or absent (30.9%, n=92) steatosis, while 15.1% (n=45) had moderate and 12.4% (n=37) marked steatosis. Most patients (65.8%, n=181) had liver stiffness within the normal range, 11.6% (n=32) chronic inflammation, 7.6% (n=21) stage 1-2 fibrosis, 3.6% (n=10) stage 2-3 fibrosis, 4.7% (n=13) stage 3-4 fibrosis, and 6.5% (n=18) stage 4 fibrosis or cirrhosis. Discussion: The results found in this sample reinforce the risk factors for the development of NAFLD previously evaluated. A combination of non-invasive strategies, including MRE, may select the patients with the greatest likelihood of harm. Conclusions: MRE has been shown to be a highly accurate, non-invasive technique for staging liver fibrosis in NAFLD patients, with no significant influence of age, sex, adiposity, and degree of liver inflammation.
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Background: The molecular epidemiology of HCV and its association with liver diseases in North India is not well understood. Aim: To assess the incidence of HCV infection in blood donors and liver disease patients and the influence of HCV genotype on the severity of the liver disease. Methods: We screened 487 patients with acute viral hepatitis (AVH), 141 patients of fulminant hepatic failure(FHF), 1058 patients of chronic liver disease (CLD) (chronic hepatitis-468, cirrhosis-527, HCC-63), and 3504 voluntary blood donors for anti-HCV. Anti HCV positive patients were further subjected to HCV RNA testing followed by genotyping. Results: HCV infection was observed in 1.6%, 12.94%, 10.64%, 27.13%, 21.25% and 49.2% of blood donors, AVH,FHF, chronic hepatitis, cirrhosis and HCC patients respectively. Conclusion: Genotype 3 was found to be the major genotype. HCV genotype one infection was associated with advanced liver disease.
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@#Cirrhosis is the result of chronic liver disease due to a variety of causes. It is deemed to be cryptogenic when the leading cause cannot be identified despite extensive laboratory, radiological and pathological investigations. The prevalence of cryptogenic cirrhosis diagnosis has been dramatically reduced in recent years due to the advanced achievement in diagnostic medicine, whereby it is attributed to only about less than 5% of cirrhosis cases. Here, we present a case of a 16-year-old boy with nonsignificant family history, was not taking any regular medication, and presented with progressive intermittent jaundice for a few years due to liver cirrhosis. Although an extensive investigation has been done, the etiology of the cirrhotic liver was still unknown. He had no features to support nonalcoholic steatohepatitis. He was in Child’s Grade B and prophylactically treated with a regular dose of propranolol to prevent portal hypertension complication while waiting for a liver transplant. This case report served the objective of showing that despite the advances in medical diagnostic techniques, cryptogenic cirrhosis is still used as a diagnosis in cases of chronic liver disease of unknown etiology.
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Non-alcoholic Fatty Liver DiseaseABSTRACT
Objective:To assess the transient elastography (TE) in assessing hepatic fibrosis in pediatric chronic liver disease.Methods:Children with chronic liver disease who were both examined with TE and percutaneous transhepatic puncture for grading Scheuer scores in the Children′s Hospital of Fudan University from January 2017 to September 2017 were recruited.Ordinal Logistic regression analysis was used to analyze the interfering factors for hepatic fibrosis.Receiver operating characteristic (ROC) curves were plotted to acquire the optimal cut-off value and to calculate the area under the curve (AUC). Results:Thirty-eight children were enrolled finally, including 28 boys and 10 girls with the mean age of 7.4 years old (1.1-16.0 years). The success rate of detecting hepatic fibrosis was 85%.Ordinal Logistic regression analysis discovered that only the value of liver stiffness measured by TE was correlated with the grade of hepatic fibrosis ( β=0.055, P<0.001). TE was effective to differentiate hepatic fibrosis[<S2 vs.≥S2 (6.6±4.0) kPa vs.(21.2±18.6) kPa, P=0.001], significant hepatic fibrosis[<S3 vs.≥S3 (7.4±4.0) kPa vs.(34.8±19.0) kPa, P=0.000 1, and cirrhosis[<S4 vs.S4 (10.6±12.3) kPa vs.(35.8±15.1) kPa, P=0.002]. At the cut-off values of liver stiffness measurement with 6.89 kPa and 14.39 kPa, AUC of it to predict the grade of hepatic fibrosis ≥S2 and ≥S3 were 0.81 ( P=0.001) and 0.94( P<0.001), respectively. Conclusions:TE is a useful and reliable noninvasive tool to assess hepatic fibrosis in pediatric chronic liver disease.
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Diabetes mellitus is one of the most common complications after liver transplantation. The survival rate of recipients after liver transplantation with diabetes mellitus and the long-term survival rate of grafts are significantly lower than those of their counterparts without diabetes mellitus. In recent years, diabetes mellitus after liver transplantation has attracted widespread attention along with the rapid development of liver transplantation in China. Although post-transplantation diabetes mellitus (PTDM) has been extensively investigated in the past two decades, multiple problems remain to be further resolved. The study was designed to review the latest research progress upon diabetes mellitus after liver transplantation, covering the definition and diagnostic criteria of PTDM, risk factors, prevention and treatment of diabetes mellitus after liver transplantation, aiming to deepen the understanding of diabetes mellitus following liver transplantation, deliver effective prevention and management, improve the long-term survival rate and enhance the quality of life of the recipients.
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Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients. Keywords: Chronic liver disease, Diastolic dysfunction, Systolic dysfunction
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Humans , Blood Pressure , Acute-On-Chronic Liver Failure , Acrodynia , Olfaction DisordersABSTRACT
Resumen: El brote del virus SARS-CoV-2 que comenzó a fines del año 2019 en China, se ha expandido a Chile y al mundo rápidamente. Hasta la fecha, en Chile, ha afectado a 18.435 personas con una letalidad en adultos de 1,4%. Los pacientes pediátricos con enfermedades hepáticas crónicas son también susceptibles a COVID-19 y podrían tener una peor evolución. El objetivo es entregar recomendaciones sobre el tratamiento médico de pacientes pediátricos con daño hepático crónico (DHC), hepatitis autoinmune (HAI), Enfermedad de hígado graso no alcohólico (EHGNA) y trasplantados hepáticos (TH) en relación a COVID-19. Lo primordial es evitar el contagio y para esto, lo más importante es el lavado de manos, uso de mascarilla en espacios públicos y cerrados, como el distanciamiento social y evitar contacto con personas sintomáticas. Los pacientes con DHC, HAI, EHGNA y TH deben evitar los controles presenciales y favorecer la telemedicina. No existe evidencia que recomiende la modifi cación del tratamiento basal en estos casos. En pacientes COVID-19 (+) se recomienda medidas de aislamiento, preferir uso de paracetamol como antipirético y analgésico y en el manejo de la inmunosupresión, debe considerarse cada caso de forma individual, según gravedad y con evaluación del especialista. Además, se revisan las actuales terapias específicas para COVID-19 y sus precauciones en pacientes con hepatopatías. Las medidas de prevención del contagio, aislamiento social y diagnóstico precoz son fundamentales en pacientes con enfermedad hepática y el riesgo de infección por SARS- CoV-2.
Abstract: The SARS-CoV-2 virus outbreak, which began in late 2019 in China, has spread very quickly to Chile and worldwide. In Chile, we currently have around 18,435 people infected with 1.4% of adult mor tality. Pediatric patients with chronic liver diseases (CLD) are susceptible as well to COVID-19 and could have a worse prognosis. The objective is to give recommendations about medical treatment to pediatric patients with chronic liver disease (CLD), autoimmune hepatitis (AIH), Non- Alcoholic fatty liver disease (NAFLD), and liver transplant in the context of COVID-19. The most important issue in the management of these patients is to avoid exposure to the virus, hand washing, the use of face masks in public and closed places, as well as social distancing, and avoiding contact with positive COVID-19 patients. In Children with CLD, AIH, NAFLD, and liver transplant, outpatient follow-up should be avoided when possible and replaced with videoconference consultation. No evidence re commends modifications to their baseline treatment. Positive COVID-19 patients should be isolated, the use of paracetamol as an antipyretic and analgesic and modifications to immunosuppressant drugs should be seen by the specialist in a case to case basis according to its severity. In addition, we reviewed current specific therapies for COVID-19 and their precautions in patients with liver disease. Protective measures, social distancing, and early diagnosis are very important in patients with liver disease to decrease the risk of SARS-CoV-2 infection.
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Cranial metastases from hepatocellular carcinoma (HCC) has been seldom reported. Reported herein is the case of a painless parietal bone mass as an initial presentation of HCC in a 63-year-old female patient who was subsequently diagnosed to have HCV related cirrhosis. The biopsy from cranial lesion was confirmatory of HCC on immunohistochemistry. The patient had no known history of chronic liver disease. The presented diagnosis was made through detailed history, laboratory parameters and cross sectional imaging.
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Anxiety and depression were interlinked with the severity of liver diseases. Patients should know the true severity ofthe disease and patient counseling helps them. This was a cross-sectional study carried out on 100 patients sufferingfrom chronic liver disease. Child Turcotte Pugh score was used to calculate the severity of the disease. HospitalAnxiety and Depression Scale was used to calculate the anxiety and depression of patients. Non-parametric tests areused to find out the association. The level of significance was p < 0.05. The mean age group of patients was 47.29± 13.17 years. The three most presenting clinical signs and symptoms according to their occurrence was abdominalpain (74%), edema (58%), and ascites (51%). The median Child Turcotte Pugh score was 9 corresponds to class B.We observed highly significant association (p < 0.01) between total bilirubin (p < 0.0001), albumin (p < 0.0001),and the severity and prognosis of the disease. We observed a higher percentage of patients with borderline abnormalanxiety (61%) and depression (51%) in our study. High-risk patients were made aware of the severity of the diseaseand consequences thereafter, provided with patient counseling along with a list of deaddiction centers. Integrating apsychologist can benefit patients struggling with deaddiction of alcohol.
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Background: Alcohol is one of the most common etiology for chronic liver disease. There are several enzymes which remain elevated in both excessive Alcohol consumption and Alcohol induced liver cirrhosis1. But none is sensitive or specific. The ratio of Aspartate transaminase (AST) with Alanine transaminase (ALT) is one of the best marker for alcohol liver disease. Current study mainly compares the ratio of AST/ALT with both Alcoholic liver disease and excessive Alcohol consumption patients.Methods: Observational, cross sectional study conducted on 50 patients diagnosed with alcoholic liver disease and 50 patients of alcohol withdrawal syndrome. Either admitted or seen on outpatient basis at Bangalore medical college and research institute and data was compared among the groups and appropriate statistical methods are applied.Results: The mean ratio of AST/ALT ratio in 50 patients of alcoholic liver disease group was 3.45, whereas the mean ratio in 50 patient of alcohol withdrawal was about 99. When compared statistically this ratio was significant in chronic liver disease group.Conclusions: Most of the patients with heavy alcohol drinking had high AST and alt levels. But ratio of AST/ALT levels was significant high and suggest chronic liver disease secondary to alcohol.
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ABSTRACT BACKGROUND: Sarcopenia is a common complication in patients with cirrhosis and may lead to increased morbidity and mortality. OBJECTIVE: To investigate the prevalence of sarcopenia and its association with disease severity scores, among patients with cirrhosis. DESIGN AND SETTING: Observational and retrospective cohort study carried out in a tertiary-care hospital in southern Brazil. METHODS: This study was conducted among patients with chronic liver disease who were followed up at the gastroenterology and hepatology outpatient clinic of a tertiary-care hospital in southern Brazil and who underwent computed tomography scans of the abdomen through any indication. RESULTS: We included 83 patients in the study. In the population evaluated, there was a predominance of males (57.80%) and the mean age was 56 years. Hepatitis B or C virus was present in the genesis of the disease in 34.9% of the cases, followed by an etiology of alcohol abuse (30.1%). Sarcopenia was diagnosed in 41 (49.4%) of the patients when the cutoff point for cirrhotic patients was used. There was no significant correlation between the Child-Pugh and MELD severity scores and the occurrence of sarcopenia. CONCLUSION: Sarcopenia presents high prevalence among patients with chronic liver disease, without any association with predictors of severity.