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https://www.readbyqxmd.com/read/28520728/cost-effectiveness-of-hepatitis-c-treatment-using-generic-direct-acting-antivirals-available-in-india
#1
Rakesh Aggarwal, Qiushi Chen, Amit Goel, Nicole Seguy, Razia Pendse, Turgay Ayer, Jagpreet Chhatwal
BACKGROUND & AIMS: Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. METHODS: A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs...
2017: PloS One
https://www.readbyqxmd.com/read/28501971/electrolyte-and-acid-base-disturbances-in-end-stage-liver-disease-a-physiopathological-approach
#2
REVIEW
José Víctor Jiménez, Diego Luis Carrillo-Pérez, Rodrigo Rosado-Canto, Ignacio García-Juárez, Aldo Torre, David Kershenobich, Eduardo Carrillo-Maravilla
Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination...
May 13, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28497759/long-term-challenges-and-perspectives-of-pre-adolescent-liver-disease
#3
REVIEW
Nedim Hadžić, Ulrich Baumann, Pat McKiernan, Valerie McLin, Valerio Nobili
Chronic liver disease is a growing problem that has substantial effects on public health. Many paediatric liver conditions are precursors of adult chronic liver disease, cirrhosis, and hepatocellular carcinoma. Clinical management of Wilson's disease, autoimmune liver disease, and chronic biliary disorders, such as biliary atresia, which remains the most common paediatric chronic liver disease and indication for liver transplantation, is similar in children and adults. In the past 10 or so years, paediatric hepatology has expanded into neighbouring clinical areas, such as metabolic liver diseases and systemic conditions with liver involvement...
June 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28495451/comparison-of-image-quality-and-diagnostic-performance-of-cone-beam-ct-during-drug-eluting-embolic-transarterial-chemoembolization-and-multidetector-ct-in-the-detection-of-hepatocellular-carcinoma
#4
Pierleone Lucatelli, Renato Argirò, Stefano Ginanni Corradini, Luca Saba, Carlo Cirelli, Fabrizio Fanelli, Carmelo Ricci, Giovanni Battista Levi Sandri, Carlo Catalano, Mario Bezzi
PURPOSE: To compare image quality and diagnostic performance of cone-beam computed tomography (CT) and multidetector CT in the detection of hypervascular hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing transarterial chemoembolization with drug-eluting embolic agents. MATERIALS AND METHODS: Fifty-five consecutive patients referred for chemoembolization of hypervascular HCC were prospectively enrolled. Imaging included preprocedural multidetector CT within 1 month before planned treatment, intraprocedural cone-beam CT, and 1-month follow-up multidetector CT...
May 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28490990/management-of-liver-cancer-the-surgeon-s-point-of-view
#5
REVIEW
Pierre Rabinel, Damien Dousse, Fabrice Muscari, Bertrand Suc
During the last twenty years, a huge progress has been achieved in the treatment of liver cancer and recent strategies include interventional radiology, chemotherapy regimens and surgery. Meanwhile, Stereotactic Body Radiation Therapy (SRBT) has developed in the treatment of all organs with millimetre accuracy, very few side effects and a high control rate. So, SRBT has become a therapeutic weapon in his own right in liver tumour treatment. Many publications have reported encouraging results in colorectal liver metastasis, hepatocellular carcinoma on cirrhosis and peripheric cholangiocarcinoma...
March 2017: Reports of Practical Oncology and Radiotherapy
https://www.readbyqxmd.com/read/28489645/portal-vein-thrombosis-in-cirrhosis
#6
Michael Loudin, Joseph Ahn
Portal vein thrombosis (PVT) in the cirrhotic population is a challenging clinical phenomenon requiring a nuanced management approach. Uncertainty exists regarding the clinical significance of PVT in the cirrhotic population because the data for PVT are based mainly on retrospective, small cohort studies. Therefore, strong recommendations regarding the optimal timing, modality, and duration of therapy for PVT in the cirrhotic population cannot be made. However, this review aims to summarize the current literature and provide stepwise guidance in diagnosing and managing PVT in patients with cirrhosis...
May 9, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28484826/-extracorporeal-therapies-in-hepatic-diseases
#7
REVIEW
D Jarczak, G Braun, V Fuhrmann
Acute and acute-on-chronic liver failure have different underlying causes and are associated with hepatic or extrahepatic organ failure. Depending on etiology, up to 20% of critically ill patients suffer from hepatic dysfunction, which contributes to increased morbidity and mortality. A variety of extracorporeal procedures including renal replacement therapies, artificial and bioartificial liver support, and plasma exchange are used in the management of patients with liver diseases. Several randomized controlled studies of artificial liver support and plasma exchange proved the safety of these procedures and demonstrated improvement of hepatic encephalopathy and hemodynamics...
May 8, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28481460/high-efficacy-of-sofosbuvir-plus-simeprevir-in-a-large-cohort-of-spanish-cirrhotic-patients-infected-with-genotypes-1-and-4
#8
Zoe Mariño, Juan Manuel Pascasio-Acevedo, Adolfo Gallego, Moisés Diago, Carme Baliellas, Rosa Morillas, Martín Prieto, José María Moreno, Gloria Sánchez-Antolín, Mercedes Vergara, Montserrat Forné, Inmaculada Fernández, Maria Ángeles Castro, Sonia Pascual, Alexandra Gómez, Lluis Castells, Jose Luis Montero, Javier Crespo, Jose Luis Calleja, Javier García-Samaniego, Jose Antonio Carrión, Ana Del Carmen Arencibia, Alejandro Blasco, Carmen López-Núñez, Juan José Sánchez-Ruano, Francisco Gea-Rodríguez, Álvaro Giráldez, Joaquín Cabezas, Vanessa Hontangas, Xavier Torras, Jose Castellote, Manuel Romero-Gómez, Juan Turnes, Tomás de Artaza, Isidoro Narváez, Valentín Cuervas-Mons, Xavier Forns
BACKGROUND AND AIMS: Hepatitis C (HCV) therapy with Sofosbuvir(SOF)/ Simeprevir(SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype(GT)-1 and 4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin(RBV) in a large cohort of cirrhotic patients. METHODS: This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV-GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January-2014 and December-2015...
May 8, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28469809/hepatocellular-carcinoma-in-non-alcoholic-steatohepatitis-current-knowledge-and-implications-for-management
#9
REVIEW
George Cholankeril, Ronak Patel, Sandeep Khurana, Sanjaya K Satapathy
With the prevalence of hepatitis C virus expected to decline, the proportion of hepatocellular carcinoma (HCC) related to non-alcoholic steatohepatitis (NASH) is anticipated to increase exponentially due to the growing epidemic of obesity and diabetes. The annual incidence rate of developing HCC in patients with NASH-related cirrhosis is not clearly understood with rates ranging from 2.6%-12.8%. While multiple new mechanisms have been implicated in the development of HCC in NASH; further prospective long-term studies are needed to validate these findings...
April 18, 2017: World Journal of Hepatology
https://www.readbyqxmd.com/read/28469455/perioperative-care-of-patients-with-liver-cirrhosis-a-review
#10
REVIEW
Naeem Abbas, Jasbir Makker, Hafsa Abbas, Bhavna Balar
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28468015/the-role-of-a-dedicated-non-alcoholic-fatty-liver-disease-clinic-in-2016
#11
Sarah A Townsend, Philip N Newsome
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of liver disease in the United Kingdom, and is predicted to become the leading indication for liver transplantation (LT) within the next 10 years. Key Messages: With rising demands on liver services, identifying those at risk of developing significant liver disease is important, so that risk factors for disease progression can be addressed. Emerging diagnostic techniques make it possible to diagnose significant fibrosis without the need for liver biopsy, and while there are currently no approved therapies for NAFLD, a specialist clinic can also provide access to clinical trials...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28468013/translating-our-current-understanding-of-ascites-management-into-new-therapies-for-patients-with-cirrhosis-and-fluid-retention
#12
Elisa Pose, Andres Cardenas
Ascites is the most common complication associated with cirrhosis resulting in poor quality of life, high risk of development of other complications of cirrhosis, increased morbidity and mortality associated with surgical interventions, and poor long-term outcome. Patients with cirrhosis and a first onset of ascites, have a probability of survival of 85% during the first year and 56% at 5 years without liver transplantation. Ascites is caused due to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28468002/pre-and-post-transplant-treatment-of-viral-hepatitis-c
#13
David Mutimer
BACKGROUND: Hepatitis C (HCV) is a common cause of liver failure and liver cancer, and is a frequent indication for liver transplantation (LT). Until recently, a majority of transplanted patients were viraemic at the time of transplantation and they inevitably underwent recurrent infection of the graft. Prior to the availability of specific direct-acting antiviral (DAA) drugs, HCV infection was seldom successfully treated before or after transplantation. Key Messages: During the past 2 years, the use of interferon-free DAA therapy has transformed the management of patients post-LT and of patients on the transplant waiting list...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28464346/review-article-maximising-quality-of-life-while-aspiring-for-quantity-of-life-in-end-stage-liver-disease
#14
REVIEW
R A Bhanji, E J Carey, K D Watt
BACKGROUND: With recent advances in the management of chronic liver disease and its complications, the long-term survival in cirrhosis has improved. Therefore, the number of individuals who will spend a significant proportion of their life with end-stage liver disease (ESLD) may continue to rise. Thus, more attention to quality of life (QOL) and its integration with traditional clinical endpoints is needed. AIMS: Recently, there have been many studies looking at treatment outcomes and their impact on the QOL in patients with ESLD...
May 2, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28462238/peritumoral-hyperplasia-in-hepatic-sclerosed-hemangioma
#15
Seitarou Shimada, Kazuto Tajiri, Hayato Baba, Masami Minemura, Koichi Tsuneyama, Masayuki Nakano, Toshiro Sugiyama
Peritumoral hyperplasia (PTH) is a hyperplastic lesion located around hypervascular tumors. Hepatic sclerosed hemangioma is a very rare form of hemangioma with sclerotic changes and is distinct from sclerosing hemangioma. We present a patient with non-alcoholic steatohepatitis-induced cirrhosis who presented with a hypervascular tumor. The tumor showed atypical findings of hemangioma and was treated with surgical resection because hepatic malignancy could not be ruled out. Histopathologic examination revealed the tumor was a sclerosed hemangioma with PTH...
2017: ACG Case Reports Journal
https://www.readbyqxmd.com/read/28459036/consensus-statement-on-dose-modifications-of-antidiabetic-agents-in-patients-with-hepatic-impairment
#16
REVIEW
Kalyan Kumar Gangopadhyay, Parminder Singh
Liver disease is an important cause of mortality in type 2 diabetes mellitus (T2DM). It is estimated that diabetes is the most common cause of liver disease in the United States. Virtually, entire spectrum of liver disease is seen in T2DM including abnormal liver enzymes, nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, and acute liver failure. The treatment of diabetes mellitus (DM) in cirrhotic patients has particular challenges as follows: (1) about half the patients have malnutrition; (2) patients already have advanced liver disease when clinical DM is diagnosed; (3) most of the oral antidiabetic agents (ADAs) are metabolized in the liver; (4) patients often have episodes of hypoglycemia...
March 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28457316/emergent-laparotomy-and-temporary-abdominal-closure-for-the-cirrhotic-patient
#17
Tyler J Loftus, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: Temporary abdominal closure (TAC) may be performed for cirrhotic patients undergoing emergent laparotomy. The effects of cirrhosis on physiologic parameters, resuscitation requirements, and outcomes following TAC are unknown. We hypothesized that cirrhotic TAC patients would have different resuscitation requirements and worse outcomes than noncirrhotic patients. METHODS: We performed a 3-year retrospective cohort analysis of 231 patients managed with TAC following emergent laparotomy for sepsis, trauma, or abdominal compartment syndrome...
April 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28452094/imaging-characteristics-of-liver-langerhans-cell-histiocytosis-in-children
#18
Hui Liu, Xueying Long, Xiaoyi Wang, Wenzheng Li, Yigang Pei
BACKGROUND: Hepatic involvement of Langerhans cell histiocytosis (LCH) in children is important not only for prognostic purposes, but also as a guide for therapeutic strategies. The purpose of this study was to evaluate the imaging characteristics of hepatic LCH by computed tomography (CT) and magnetic resonance imaging (MRI) in children. METHODS: Imaging features of 17 children with hepatic LCH diagnosed by physical examination, laboratory and histopathological tests were analyzed retrospectively...
April 28, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28442120/american-gastroenterological-association-institute-technical-review-on-the-role-of-elastography-in-chronic-liver-diseases
#19
Siddharth Singh, Andrew J Muir, Douglas T Dieterich, Yngve T Falck-Ytter
Chronic liver diseases (CLDs), due to chronic hepatitis C; hepatitis B; nonalcoholic fatty liver diseases (NAFLD); and alcoholic liver disease, are a leading cause of morbidity and mortality globally. Early identification of patients with cirrhosis at high risk of progression to liver-related complications may facilitate timely care and improve outcomes. With risks and misclassification associated with invasive tests, such as liver biopsy, noninvasive imaging modalities for liver fibrosis assessment have gained popularity...
May 2017: Gastroenterology
https://www.readbyqxmd.com/read/28439747/management-of-cirrhotic-patients-after-successful-hcv-eradication
#20
REVIEW
Ryan M Kwok, Tram T Tran
Chronic hepatitis C (HCV) is a hepatotropic virus which, when untreated, can lead to progressive inflammation and fibrosis resulting in cirrhosis, hepatocellular carcinoma (HCC), and decompensations related to end-stage liver disease. The relatively recent introduction of all oral, interferon-free, direct-acting antiviral medications against HCV has transformed the management of these patients. Previous treatment regimens were prolonged, poorly tolerated, and frequently did not result in cure. Current therapies achieve sustained viral response (SVR) in the vast majority of patients including those with decompensated liver disease; a previously challenging population to treat...
April 24, 2017: Current Treatment Options in Gastroenterology
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