Hepatitis B induced fulminant liver failure: A call for prevention

Acute fulminant hepatic failure is a condition in which a healthy liver deteriorates rapidly following an insult, resulting in the impairment of its synthetic functions. This condition is rare and is associated with high fatality rates. We report the case of a 19-year-old male who was brought to the emergency room in an unconscious state with jaundice and persistent fever for 2–3 weeks after recently commencing intravenous use of morphine. He was found to be hepatitis B surface antigen reactive, and his laboratory tests indicated severe liver dysfunction with elevated levels of serum bilirubin, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and International normalized ratio. The patient was diagnosed with fulminant liver failure with coagulopathy and hepatic encephalopathy. The patient’s family was addressed and counseled regarding the urgent need for liver transplantation. However, due to a lack of funds and insurance, supportive treatment was the only option left. Despite all supportive measures, the patient expired within 48 h. This case highlights the importance of various socioeconomic issues involved with liver transplantation, as in a resource-limited setting, urgent transplantation seems nearly impossible. In addition, this case report raises certain ethical issues that need consideration, particularly in an injection drug use scenario. It also highlights the importance of addressing the rising issue of injection drug use among youth, particularly in the regions of Punjab.

Hyperacute Liver Failure with Multi-organ Dysfunction Syndrome (MODS) by Leptospirosis: A Case Report

Introduction: Leptospirosis may have multi-organ involvement in its severe form with potentially life-threatening consequences. However, acute fulminant hepatic failure is very uncommonly reported. A case study is presented here with fulminant hepatic failure and a diagnostic dilemma for etiology. Case history: A 40-year-old man with no significant medical history presented with fever, muscle pain, weakness, and pain in the upper abdomen. On clinical work, he has developed multi-organ hepatic, respiratory, and renal failure. A timely workup was done, but due to the rapid progression of the disease, the patient succumbed to the disease in the intensive care unit by the time his report for positive leptospirosis test arrived. Conclusion: Leptospirosis must be considered as an important differential diagnosis of acute liver failure patients. An early suspicion for leptospirosis in patients with fulminant hepatic failure and multi-organ failure in India particularly in the rainy season is warranted owing to its high mortality rate.

Clinical and immunological characteristics of PD-1 associated fulminant type 1 diabetes mellitus / 中南大学学报(医学版)

OBJECTIVES@#Programmed death 1 (PD-1) associated fulminant type 1 diabetes (PFD) is a rare acute and critical in internal medicine, and its clinical characteristics are still unclear. This study aims to analyze the clinical characteristics of PFD patients to improve clinical diagnosis and treatment.@*METHODS@#We retrospectively analyzed the clinical data of 10 patients with PFD admitted to the Second Xiangya Hospital of Central South University, combined with the data of 66 patients reported in the relevant literature, analyzed and summarized their clinical and immunological characteristics, and compared the patients with PFD with different islet autoantibody status.@*RESULTS@#Combined with our hospital and literature data, a total of 76 patients with PFD were reported, with the age of (60.9±12.1) years old, 60.0% male and body mass index of (22.1±5.2) kg/m2. In 76 patients, the most common tumors were lung cancer (43.4%) and melanoma (22.4%). Among PD-1 inhibitors, the most common drugs are nivolumab (37.5%) and pembrolizumab (38.9%). 82.2% of PFD patients developed diabetes ketoacidosis. The median onset time from PD-1 related inhibitor treatment to hyperglycemia was 95 (36.0, 164.5) d, and the median treatment cycle before the onset of diabetes was 6 (2.3, 8.0) cycles. 26% (19/73) of PFD patients had positive islet autoantibodies, and the proportion of ketoacidosis in the positive group was significantly higher than that in the negative group (100.0% vs 75.0%, P<0.05). The onset time and infusion times of diabetes after PD-1 inhibitor treatment in the autoantibody positive group were significantly lower than those in the autoantibody negative group (28.5 d vs 120.0 d; 2 cycles vs 7 cycles, both P<0.001).@*CONCLUSIONS@#After initiation of tumor immunotherapy, it is necessary to be alert to the occurrence of adverse reactions of PFD, and the onset of PFD with islet autoantibody positive is faster and more serious than that of patients with autoantibodies negative. Detection of islet autoantibodies and blood glucose before and after treatment with PD-1 inhibitors is of great value for early warning and prediction of PFD.

A Rare Case Of Peritonitis Due To Ulcerative Amoebic Colitis - Case Report

ULCERATIVE AMOEBIC COLITIS is a rare complication of amoebiasis that is associated with high mortality. Only 1 to 4 cases are seen per year in India & only few such cases have been reported. This requires early diagnosis and surgical intervention. We recently cared for a patient who presented with acute abdomen with history of Abdominal pain,Fever,Obstipation. Before presenting to our institution he was admitted at outside private hospital for 2 days in view of Left Diabetic FOOT with ACUTE KIDNEY INJURY with SEPSIS and was treated conservatively.On emergency exploration, MULTIPLE CAECAL PERFORATIONS with extensive necrosis of Ascending COLON were seen. SEGMENTAL RESECTION OF 5 CM TERMINAL ILEUM,CAECUM,ASCENDING COLON and 5 CM TRANSVERSE COLON was performed. Postoperative course was marked by septicaemia and multi-organ failure followed by death. This case report emphasizes the importance of early diagnosis and treatment of acute AMOEBIC COLITIS and associated high mortality.

Purpura fulminante por déficit de proteína S (enfermedad oclusiva no inflamatoria) / Fulminant purpura due to protein S deficiency (non-inflammatory occlusive disease)

Paciente sexo masculino de 53 años de edad sin patologías de base conocidas acude por un cuadro de 72 horas de evolución de petequias pruriginosas que inician en región interna de muslos, que progresan a ambas piernas y pies de forma simétrica, luego aumentan en número y tamaño y cambio de coloración (de rojo a purpura). Se realiza biopsia de piel (pie y brazo izquierdo). Se realizan los estudios para búsqueda de etiología, donde llama la atención dosaje de proteína S disminuida (88 %)

A 53-year-old male patient with no known underlying pathologies presented with a 72-hour history of pruritic petechiae that began in the inner thighs, progressed symmetrically to both legs and feet, then increased in number and size. and color change (from red to purple). Skin biopsy (left foot and arm) is performed. Studies are performed to search for etiology, where low protein S dosage (88%) is striking.

Clinical and Etiopathological Correlation of Acute Infective Hepatitis and Fulminant Hepatic Failure in Pediatric Patients.

Introduction: In India, infectious Hepatitis is one of the major health care burdens, with viral hepatitis being the most common culprit, followed by dengue, typhoid, and malarial hepatitis. Fulminant hepatitis manifests as a sudden abnormality in liver function enzymes in a child with no prior hepatic pathology. Aims and Objects: This study was aimed at identifying the various etiological factors and correlating clinical features of viral hepatitis, and fulminant liver failure. Materials and Methods: This observational study was conducted in the paediatrics in-patient department of S.P. Medical College & P.B.M. Associated Group of Hospitals, Bikaner (Rajasthan) over a period of one year. A total of 125 children with a clinical and lab-confirmed diagnosis of acute infective hepatitis were included. Data including clinical signs, symptoms, and laboratory parameters were obtained and analyzed. Results: Most commonly affected age group was between 5-10 years with the mean age being 7.1±4.6 years. The most common etiology was hepatitis A (n=39), followed by hepatitis E (n=24) and mixed hepatitis A virus (HAV)/hepatitis E virus (HAE) infection (n=20). Other causative organisms were dengue virus (n=16), typhoid (n=13), malaria (n=9), and hepatitis B. The most common clinical symptoms were fever, jaundice, loss of appetite, and vomiting/nausea. There were some clinical features seen more commonly in case of infection with certain organisms. High frequency of diarrhoea, arthralgia, and thrombocytopenia was seen with HAV. Neurological, renal complications and high mortality were associated with HEV or HAV/HEV co-infection. While retroorbital pain and purpuric rash were exclusive with dengue, malarial hepatitis was strongly associated with pallor and altered sensorium. Conclusion: Acute infective hepatitis is most commonly caused by HAV and HEV in Western Rajasthan. It is imperative to educate the masses regarding the prevention of common infections transmissible by infected drinking water, poor hand hygiene, improper waste disposal, and open defecation.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Fulminant myocarditis with multiple organ dysfunction treated by extracorporeal life support in ICU: report of 9 adult cases / 中华全科医师杂志

Objective:To summarize the clinical experience in the treatment of fulminant myocarditis with multiple organ dysfunction using extracorporeal life support in the ICU.Methods:Clinical data of 9 adult cases of fulminant myocarditis complicated with multiple organ dysfunction admitted in ICU from January 2019 to October 2020 were retrospectively analyzed.Results:All patients received immunoregulatory and antiviral therapy; mechanical ventilation and renal replacement treatment were performed. Extracorporeal life support was also applied, including 1 case receiving intra-aortic balloon pump (IABP) support, and 6 cases receiving IABP and venous-arterial extracorporeal membrane oxygenation (VA-ECMO). In 6 cases with ECMO, the SpO 2(100.0±0)%, ScvO 2(78.7±3.9)%, hsTnI [10.0(2.2,31.8)mg/ml], oxygenation index[437.0(326.5,450.8)], lactic acid [(1.5±0.5)mmol/L], BE(-1.1±1.9)and LVEF(53.5±12.6)% were significantly improved 5 days after treatment compared with before [(98.0±1.4)%,(61.9±4.3)%,27.1(16.6,50.0)mg/ml,159.7(70.3,190.9),(6.4±3.4)mmol/L,(-10.3±4.6),(29.0±11.1)%]( t=-3.46, -9.74; Z=-1.99, -4.89; t=3.63, -5.84, -3.33; P<0.05). Eight patients were discovered and discharged, and one patient died. Conclusion:Fulminant myocarditis develops rapidly, integrated treatment based on extracorporeal mechanical life support and immunomodulatory therapy can improve the outcome of patients in the ICU.

Influence of extracorporeal membrane oxygenation on in-hospital survival and prognosis of adult patients with fulminant myocarditis / 中华危重病急救医学

Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) on in-hospital survival and prognosis of adult patients with fulminant myocarditis.Methods:The registration materials of 21 patients with fulminant myocarditis supported by veno-arterial ECMO (VA-ECMO) from March 2019 to January 2022 in the Heart Center of the First Hospital of Lanzhou University were selected from the Chinese Society for Extracorporeal Life Support (CSECLS) Registry Database. The clinical baseline data, laboratory and echocardiographic data, VA-ECMO related parameters, complications and in-hospital outcome were recorded. The main end events of follow-up were death and readmission due to heart failure.Results:① The median age of 21 patients was (42.7±16.4) years, there were 12 males (57.1%) and 9 females (42.9%), and 16 patients (76.2%) survived in hospital and 5 patients (23.8%) died in hospital. ② Compared with the survival group, patients in the death group had a higher proportion of invasive ventilator support and continuous renal replacement therapy (CRRT) [3/16 (18.8%) vs. 4/5 (80.0%), 3/16 (18.8%) vs. 4/5 (80.0%)], and a lower survival after VA-ECMO score (SAVE) [score: -5.0 (-5.0, -3.0) vs. 1.0 (-6.0, 5.0)], the serum creatinine (SCr) level was higher during VA-ECMO support [μmol/L: 248.0 (144.0, 447.0) vs. 83.0 (71.7, 110.9)], the platelet count (PLT) level was lower [×10 9/L: 60.0 (31.5, 96.5) vs. 100.0 (71.0, 139.3)], and the ECMO initial support flow rate was higher (L/min: 3.2±0.7 vs. 2.6±0.4). All the differences were statistically significant (all P < 0.05). ③ The echocardiography indexes of the survival group were significantly improved at discharge compared with those at admission [left ventricular ejection fraction (LVEF, %): 54.0±6.7 vs. 30.0±7.2], left ventricular end-diastolic volume [(LVESV, mL): 55.7±27.5 vs. 85.9±28.7], cardiac index [(CI, L·min -1·m -2): 2.6±0.4 vs. 1.9±0.6], cardiac output [(CO, L/min): 4.5±0.7 vs. 3.2±0.9]. All the differences were statistically significant (all P < 0.05). ④ The median follow-up time of the 16 survivial patients was 9 (2, 14) months. During the follow-up period, 5 patients (31.3%) were readmitted to the hospital due to heart failure (1 case of cardiogenic death). The average ECMO support duration of the 5 patients who readmitted to the hospital due to heart failure was significantly shorter than that of the 11 patients without heart failure [hours: 82.0 (47.0, 99.0) vs. 116.0 (98.0, 156.0), Z = -2.381, P = 0.017]. Conclusions:On the basis of immunomodulatory and other treatments, early application of VA-ECMO in adult patients with fulminant myocarditis can significantly improve in-hospital survival rate and cardiac function. Heart failure after discharge may be related to short VA-ECMO support time during hospitalization.

Neonatal-onset protein C deficiency: case report and literature review / 中国新生儿科杂志

Objective:To study the clinical features, diagnosis, treatment and genetic characteristics of neonatal-onset protein C deficiency (PCD).Methods:The clinical data of a newborn patient with severe PCD admitted to our neonatal department was reviewed. Databases including CNKI, Wanfang Database, CMB, VIP database, PubMed, Embase and SCI database were searched using" infantile", " neonate ", "newborn", "protein C deficiency" and "purpura fulminans" as key words. Published cases of PCD were analyzed.Results:The patient was a full-term female infant who developed multiple symptoms within 2 days after birth. The symptoms included thrombocytopenia, intracranial hemorrhage, purpura fulminans (PF), disseminated intravascular coagulation (DIC), celiac hemorrhage, hypertension, portal and iliac vein thrombosis, purulent meningitis and retinal detachment. Protein C activity was less than 10%. Genetic tests showed compound heterozygous mutations c.314G>T (p.c105f) of paternal origin and c.1218G>A (p.m406i) of maternal origin in PROC gene. According to ACMG guidelines, the mutations were strongly suspected pathogenic variants and consistent with an autosomal recessive (AR) inheritance pattern. The patient was discharged after 6 weeks of treatment at parents' request of withdrawal. A total of 25 articles on 29 patients with relatively complete clinical data were retrieved, including 18 males and 11 females. 4 patients were preterm and 25 full-term. 28 patients showed symptoms within 7 days after birth. The common clinical features were cutaneous PF and splanchnic thrombi. 22 cases documented protein C activity and ranged from 0 to 25%. 16 patients had PROC gene abnormalities and compound heterozygous mutations were found in 10 patients. Among the 22 patients with prognostic data, 11 died (9 within 3 months after birth), the remaining survivors suffered from sequelae including severe intellectual motor development disorder, epilepsy and blindness.Conclusions:The main clinical manifestations of neonatal-onset PCD include PF, DIC, multi-organ hemorrhage and thrombus. The disease is acute and severe, with rapid progression, poor prognosis and high fatality rate. Protein C activity and PROC gene testing may help establish the diagnosis.

Expression and Significance of Circulating microRNA-29b in Adult Fulminant Myocarditis / 中国医学科学院学报

Objective To explore the expression profiles of circulating microRNA(miRNA)and potential markers for the diagnosis of adult fulminant myocarditis(FM). Methods The expression profiles of circulating miRNA were determined by microarray analysis and verified by real-time quantitative PCR.The key role of circulating miRNA in FM was determined via KEGG pathway enrichment.The correlations between miRNA and cardiac function parameters in patients with FM were analyzed.The receiver operating characteristic(ROC)curve was established to evaluate the sensitivity and specificity of circulating miRNA in the diagnosis of FM. Results Compared with healthy controls,the FM patients had up-regulated expression levels of miR-29b(t=18.925,P<0.001)and miR-125b(t=5.981,P=0.029)in the plasma.After treatment,the expression levels of miR-29b(t=12.943,P<0.001)and miR-125b(t=14.016,P<0.001)were significantly down-regulated.KEGG pathway enrichment showed that the targets of miR-29b were involved in inflammatory response and apoptosis pathways.The results of cell proliferation and apoptosis assay demonstrated the transfection of miR-29b mimic had a more significant inducing effect on cardiomyocyte apoptosis than that of miR-125b mimic(χ 2=6.168,P=0.047),whereas there was no significant difference in the inhibition of cell proliferation between the two groups(χ2=1.452,P=0.417).The expression levels of miR-29b and miR-125b were negatively correlated with left ventricular ejection fraction(r=-0.67,P=0.071;r=-0.49,P=0.003).They were positively correlated with cardiac troponin I level(r=0.61,P=0.019;r=0.52,P=0.016),interferon β level(r=0.42,P=0.014;r=0.36,P=0.021),and myocardial edema area(r=0.86,P=0.005;r=0.73,P=0.013).The ROC curve analysis demonstrated that miR-29b had higher sensitivity for the diagnosis of FM(93.6% vs.89.2%;t=0.896,P=0.795)and specificity(72.4% vs.59.6%;t=9.478,P=0.002)than miR-125b. Conclusion The circulating miR-29b may be a potential biomarker for the diagnosis of FM.

Nursing care of an elderly patient with fulminant myocarditis and acute myocardial infarction in emergency heart transplantation / 中国实用护理杂志

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.

Advance on the diagnosis and treatment of fulminant myocarditis in children / 中华实用儿科临床杂志

Fulminant myocarditis (FM) in children is an acute inflammatory myocardial disease, prominently manifesting as hemodynamic disorder.Because of acute onset and rapid progression, FM can cause myocardial cell edema, necrosis, cardiac shock and sudden death.Early symptoms of FM are usually atypical and laboratory tests are nonspecific, thus leading to misdiagnosis.If in time identification and diagnosis of FM is failed, its premature mortality rate can be significantly risen.Electrocardiogram, echocardiogram and cardiac magnetic resonance examinations are of great importance for early detection of FM and prognosis evaluation.Currently, mechanical circulation support is the effective therapeutic strategy for FM.A growing number of studies have focused on the clinical diagnosis and treatment of FM in children, especially the early diagnosis and active interventions, which is of great significance to improve the survival and quality of life in the future.In this paper, the advance on current diagnosis and treatment of FM in children were reviewed.

Fulminant type 1 diabetes mellitus in pregnancy

Fulminant type 1 diabetes mellitus (FT1DM) has received clinical attention for its low incidence and poor prognosis. Currently, few cases of FT1DM are associated with pregnancy in clinical practice, but it poses a great threat to the life of mothers and infants. Here, we present two cases of FT1DM in pregnancy. In Case 1, the patient was a 26-year-old woman who was admitted to the hospital with reduced fetal movement. She was diagnosed with FT1DM and delivered a dead female fetus. Lispro and lantus were administered to control blood glucose, and lipoic acid for antioxidant therapy. In Case 2, the patient was a 28-year-old woman who developed nausea, vomiting, diarrhea, and polydipsia, which later proved to be FT1DM. An abortion was induced and blood glucose levels were controlled using an insulin pump. All physicians should be aware of this disease in order to provide prompt diagnosis and emergency treatment, thus improving maternal prognosis. We suggest that plasma glucose/hemoglobin A1C ratio be adopted as a new clinical parameter in predicting FT1DM.

Temporal echocardiography findings in patients with fulminant myocarditis: beyond ejection fraction decline / 医学前沿

The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients. In this study, changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored. We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment. Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled. Conventional echocardiographic measurements were obtained, and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%). Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified, and their changes with time were monitored in 14 FM patients. All patients had severely impaired cardiac function. Steep improvement in LVEF and GLS were observed within 6 days. Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal. In conclusion, FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days. The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.

A Successful Case of Central ECMO with a Transapical Left Ventricular Vent for Fulminant Myocarditis / 日本心臓血管外科学会雑誌

We report a successful case of fulminant myocarditis treated with central ECMO with a transapical left ventricular vent (TLVV). A 33-year-old man was diagnosed with fulminant myocarditis with acute biventricular failure. Using a cardio-pulmonary bypass, we introduced central ECMO with ascending aortic perfusion, right atrial venous drainage and TLVV. After ancillary circulation, his cardiac function gradually improved. The endotracheal tube was removed 5 days after the surgery (POD 5), and he was weaned from ECMO on POD 7 and discharged on POD 38. Although there are many cases in which peripheral veno-arterial ECMO (VA-ECMO) is used for fulminant myocarditis, there is a drawback to VA-ECMO : left ventricle (LV) unloading may be incomplete. Insufficient LV unloading may cause pulmonary congestion or disadvantage in myocardial recovery. TLVV can be used as a solution to unload the left ventricle. Central ECMO with TLVV should be useful therapy for fulminant myocarditis.

ECMO application of patients with Critical Corona Virus Disease 2019 and fulminant myocarditis / 中华实验和临床病毒学杂志

Objective To evaluate the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment on two cases of infection with the critical Corona Virus Disease 2019 (COVID-19) complicated by fulminant myocarditis (FM) . Methods This study selects two COVID-19 cases comorbid with fulminant myocarditis and had been treated with ECMO in Shenzhen Third People's Hospital from January 2020 to February 2020. We compare the index of inflammation, immunization, D-dimer and lactic acid before and after ECMO treatment in 24 and 96 hours, cardiopulmonary function before and after ECMO treatment in 24, 48, 72, 96 hours,. We also analyze the complications and clinical outcomes of the two cases during the ECMO treatment. Results Both patients were elderly obese men with chronic cardiopulmonary disease. Comparing the laboratory test results and imaging data of the two patients, the acute lung injury score, oxygenation index, albumin level, hypersensitive C-reactive protein, lactate and lactate dehydrogenase levels in 2 patients after ECMO treatment were improved as compared with those before ECMO treatment. Finally, case 1 died of multiple organ failure and his cardiac function continued to deteriorate, while, case 2 successfully withdrew and his cardiac function gradually improved. Conclusions For critical COVID-19 patients with fulminant myocarditis, ECMO treatment can improve pulmonary function in the short term, provide valuable time for rescuing COVID-19 patients with fulminant myocarditis.

Clinical characteristics of fulminant Type 1 diabetes mellitus / 中南大学学报(医学版)

OBJECTIVES@#To compare the differences in clinical characteristics between Type 1 diabetes mellitus (T1DM) and fulminant Type 1 diabetes mellitus (FT1DM), and to reduce the missed diagnosis, misdiagnosis, and mistreatment of FT1DM by medical staff.@*METHODS@#A total of 101 hospitalized patients with T1DM (including 8 cases of FT1DM) were enrolled in this study from Changsha Central Hospital between June 2012 and December 2018. Clinical characteristics of the 8 FT1DM patients were collected and compared with all T1DM patients.@*RESULTS@#All FT1DM patients were adult with the average age of (30.25±5.28) years old, accompanied by severe diabetic ketoacidosis (DKA) occurred within 1 week after onset. Moreover, pancreatic beta cells in these patients were destroyed and the islet-related antibodies were negative, while the serum pancreatic enzyme levels were increased. Compared with classic T1DM patients, the plasma glucose levels in FT1DM patients were much higher [(41.89±12.54) mmol/L vs (22.57±9.74) mmol/L], but glycosylated hemoglobin (HbA1c) and fasting C peptide levels were significantly lower [(6.08±0.41)% vs (10.87±2.46%)%, @*CONCLUSIONS@#The onset time of FT1DM patients is very urgent via driving DKA. These patients have higher blood glucose concentration than classic T1DM patients, accompanied by electrolyte disturbances, impaired renal function, partially impaired liver function, as well as gastrointestinal symptoms and elevated trypsin. Most FTDM patients are adolescents and adults with no gender difference, especially pregnant women who are at high risk. Lifelong insulin dependence in FT1DM patients should be paid more attention in clinical treatment.

Falla hepática aguda / Acute liver failure

La falla hepática aguda es la pérdida súbita de la función hepática en un corto plazo en un paciente sin enfermedad hepática previa, que se acompaña de coagulopatía y encefalopatía. Es una entidad rara con una incidencia muy baja que afecta especialmente a personas jóvenes. La principal causa en países desarrollados es la toxicidad por acetaminofén, mientras que en los países subdesarrollados son las hepatitis virales. El curso natural de la enfermedad es la progresión rápida a muerte por falla orgánica multisistémica, sepsis o edema cerebral. Después del diagnóstico, los pacientes deben remitirse tempranamente a la unidad de cuidado intensivo y a centros que ofrezcan trasplante hepático. La supervivencia sin trasplante hepático hasta hace pocos años era menor al 15%; sin embargo, en la actualidad puede ser hasta del 50%, dependiendo de la causa, y está relacionada con tratamientos específicos, la disponibilidad de trasplante hepático y una atención óptima en las unidades de cuidados intensivos. El trasplante hepático se constituye en el tratamiento de elección para los pacientes con falla hepática aguda y criterios de mal pronóstico del King's College.

Acute liver failure is the severe short-term liver function impairment in a patient without previous liver disease, which is accompanied by coagulopathy and encephalopathy. It is a rare condition with a very low incidence that affects young people. The leading cause in developed countries is acetaminophen toxicity, while in developing countries is mainly caused by viral hepatitis. The natural course is characterized by a rapid progression to death due to multisystemic organ failure, sepsis, or cerebral edema. After diagnosis, patients must be transferred to the intensive care unit and liver transplantation centers. Survival without liver transplantation until a few years ago was less than 15%; however, currently it can be up to 50% depending on the cause, and it is related to specific treatments, availability of liver transplantation and optimal care in the intensive care units. Liver transplantation is the treatment of choice for patients with acute liver failure and King's College criteria for poor prognosis.

Insuficiencia hepática fulminante por paracetamol / Fulminant hepatic failure due to paracetamol

Resumen: La insuficiencia hepática aguda es una enfermedad poco común pero que amenaza la vida y afecta con mayor frecuencia a pacientes que no tienen enfermedades preexistentes del hígado. El paracetamol (acetaminofén) es uno de los medicamentos analgésicos-antipiréticos prescritos con más frecuencia por los médicos y automedicados por las personas, cuyos efectos adversos son desde molestias leves hasta efectos adversos letales, que no necesariamente requieren la dosis tóxica para causar tales efectos graves. No es sorprendente que el paracetamol sigue siendo causa importante de sobredosis: desde intoxicaciones intencionadas (suicida) y no intencionadas (consumo crónico), cuyos efectos graves van desde la insuficiencia hepática fulminante relacionada con sobredosis hasta la muerte; la mitad de estos episodios se atribuyen al paracetamol y estos casos parecen estar aumentando cada vez más debido a su fácil acceso y venta libre. El objetivo de este artículo es comunicar un caso y revisar la bibliografía al respecto.

Abstract: Acute liver failure is a rare disease but life-threatening, and occurs more frequently in patients without preexisting liver disease. Paracetamol (acetaminophen) is one of the analgesic-antipyretic drugs most frequently prescribed by physicians and self- medicated by people, whose adverse effects are mild discomfort and even lethal side effects that do not necessarily require the toxic dose to cause such serious effects. Not surprisingly, acetaminophen remains a major cause of overdose: from intentional poisoning (suicide) and unintentional (chronic use), whose major effects are ranging from fulminant hepatic failure related to overdose to death; half of these episodes are attributable to paracetamol, and these cases seem to be increasing more and more, because of its easy access and free sale. The aim of this paper is to present a case report and a literature review.