ABSTRACT
BACKGROUND & AIMS: Chronic liver disease (CLD) and cirrhosis are associated with immune dysregulation, leading to concerns that affected patients may be at risk of adverse outcomes following SARS-CoV-2 infection. We aimed to determine the impact of COVID-19 on patients with pre-existing liver disease, which currently remains ill-defined. METHODS: Between 25th March and 8th July 2020, data on 745 patients with CLD and SARS-CoV-2 (including 386 with and 359 without cirrhosis) were collected by 2 international registries and compared to data on non-CLD patients with SARS-CoV-2 from a UK hospital network. RESULTS: Mortality was 32% in patients with cirrhosis compared to 8% in those without (p <0.001). Mortality in patients with cirrhosis increased according to Child-Pugh class (A [19%], B [35%], C [51%]) and the main cause of death was from respiratory failure (71%). After adjusting for baseline characteristics, factors associated with death in the total CLD cohort were age (odds ratio [OR] 1.02; 1.01-1.04), Child-Pugh A (OR 1.90; 1.03-3.52), B (OR 4.14; 2.4-7.65), or C (OR 9.32; 4.80-18.08) cirrhosis and alcohol-related liver disease (OR 1.79; 1.03-3.13). Compared to patients without CLD (n = 620), propensity-score-matched analysis revealed significant increases in mortality in those with Child-Pugh B (+20.0% [8.8%-31.3%]) and C (+38.1% [27.1%-49.2%]) cirrhosis. Acute hepatic decompensation occurred in 46% of patients with cirrhosis, of whom 21% had no respiratory symptoms. Half of those with hepatic decompensation had acute-on-chronic liver failure. CONCLUSIONS: In the largest such cohort to date, we demonstrate that baseline liver disease stage and alcohol-related liver disease are independent risk factors for death from COVID-19. These data have important implications for the risk stratification of patients with CLD across the globe during the COVID-19 pandemic. LAY SUMMARY: This international registry study demonstrates that patients with cirrhosis are at increased risk of death from COVID-19. Mortality from COVID-19 was particularly high among patients with more advanced cirrhosis and those with alcohol-related liver disease.
Subject(s)
Acute-On-Chronic Liver Failure , COVID-19 , Liver Cirrhosis , Acute-On-Chronic Liver Failure/diagnosis , Acute-On-Chronic Liver Failure/epidemiology , COVID-19/mortality , COVID-19/therapy , Disease Progression , Female , Global Health/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Liver Function Tests/methods , Male , Middle Aged , Mortality , Registries/statistics & numerical data , Risk Assessment/methods , Risk Factors , SARS-CoV-2/isolation & purification , United Kingdom/epidemiologyABSTRACT
Cystoscopy is most common diagnostic investigation. The examination technique and the findings, both normal and pathological, were well described described a hundred years ago. With technological advances, there has been over-emphasis on imaging modalities for diagnostic purposes. A basic maneuver of examining the ureteral orifices is sometimes rushed through when in fact careful examination can clinch the diagnosis. The importance is exemplified by two cases, one of which is a rare case of Xanthoma of the ureter.
Subject(s)
Conjunctiva/pathology , Conjunctival Diseases/diagnosis , Conjunctival Diseases/pathology , Sarcoidosis/diagnosis , Sarcoidosis/pathology , Adult , Biopsy , Conjunctival Diseases/drug therapy , Diagnosis, Differential , Female , Glucocorticoids/administration & dosage , Humans , Prednisolone/administration & dosage , Sarcoidosis/drug therapyABSTRACT
BACKGROUND: Systemic exposure to amphetamine (AMPH) leads to a number of long-lasting neuroadaptations including changes in dendritic morphology in rat forebrain. It remains unknown whether these changes relate to associative drug conditioning or to nonassociative drug sensitization, two forms of plasticity produced by systemic exposure to AMPH. METHODS: We compared the behavioral, neuronal, and morphologic consequences of exposing rats to intraperitoneal (IP) AMPH to those of exposure to AMPH applied to the ventral tegmental area (VTA), infusions that sensitize AMPH-induced locomotion and nucleus accumbens (NAcc) DA overflow but do not produce drug conditioning. RESULTS: Both IP and VTA AMPH exposure sensitized locomotion and NAcc DA overflow, but only IP AMPH exposure produced conditioned locomotion. Importantly, whereas IP AMPH exposure increased spine density and dendritic length and branching in the NAcc, exposure to VTA AMPH produced the opposite effects. A similar differentiation of effects was observed in cortical areas. CONCLUSIONS: Together these findings suggest that the morphological changes seen following IP AMPH exposure reflect associative drug conditioning rather than nonassociative drug sensitization. The decreases observed in the NAcc of VTA AMPH exposed rats may reflect the inability of these infusions to support conditioning.
