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https://www.readbyqxmd.com/read/28207512/incidence-and-risk-factors-of-acute-kidney-injury-associated-with-continuous-intravenous-high-dose-vancomycin-in-critically-ill-patients-a-retrospective-cohort-study
#1
Guillaume Lacave, Vincent Caille, Fabrice Bruneel, Catherine Palette, Stéphane Legriel, David Grimaldi, Mathilde Eurin, Jean-Pierre Bedos
For vancomycin therapy of severe infections, the Infectious Diseases Society of America recommends high vancomycin trough levels, whose potential for inducing nephrotoxicity is controversial. We evaluated the incidence and risk factors of acute kidney injury (AKI) in critically ill patients given continuous intravenous vancomycin with target serum vancomycin levels of 20 to 30 mg/L.We retrospectively studied 107 continuous intravenous vancomycin treatments of ≥48 hours' duration with at least 2 serum vancomycin levels ≥20 mg/L in critically ill patients...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28203136/massive-hemorrhage-from-ectopic-duodenal-varices-importance-of-a-multidisciplinary-approach
#2
Tyler House, Patrick Webb, Chad Baarson
Duodenal variceal bleeding is an uncommon complication of portal hypertension that can easily go unrecognized and reach mortality rates as high as 40%. Cirrhosis is the most common cause of duodenal varices. In most cases, duodenal varices occur concomitantly with esophageal varices, further complicating identification with initial endoscopy. Although many modalities have been explored with respect to management and treatment approaches, guidelines have yet to be established owing to the infrequency in which bleeding occurs from ectopic duodenal varices...
January 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28197805/economic-analysis-and-budget-impact-of-tenofovir-and-entecavir-in-the-first-line-treatment-of-hepatitis-b-virus-in-italy
#3
M Ruggeri, M Basile, S Coretti, C Drago, A Cicchetti
BACKGROUND: Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications. The treatments of chronic hepatitis B cannot totally cure the disease but can prevent its progression to hepatocellular carcinoma, decreasing the levels of both morbidity and mortality. To date, there are several therapies indicated by the international guidelines as first-line treatments for the management of hepatitis B; two of the most effective are those based on either tenofovir or entecavir...
February 14, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28176349/early-detection-and-curative-treatment-of-hepatocellular-carcinoma-a-cost-effectiveness-analysis-in-france-and-in-the-united-states
#4
Benjamin Cadier, Julie Bulsei, Pierre Nahon, Olivier Seror, Alexis Laurent, Isabelle Rosa, Richard Layese, Charlotte Costentin, Carole Cagnot, Isabelle Durand-Zaleski, Karine Chevreul
: Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation...
February 8, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28160373/validating-deconstructing-and-refining-baveno-criteria-for-ruling-out-high-risk-varices-in-patients-with-compensated-cirrhosis
#5
Parastoo Jangouk, Laura Turco, Ana De Oliveira, Filippo Schepis, Erica Villa, Guadalupe Garcia-Tsao
Guidelines recommend variceal screening in patients with cirrhosis to identify varices at high-risk of bleeding requiring primary prophylaxis. Non-invasive criteria to rule out high-risk varices (HRV) will avoid unnecessary endoscopies. Recent Baveno VI criteria define patients with compensated cirrhosis in whom endoscopy can be avoided as those with a liver stiffness (LS) by transient elastography <20 kPa and a platelet count >150,000/mm(3) AIMS: To validate Baveno criteria in two cohorts with a different prevalence of HRV and 2) to determine whether alternate parameters not including LS would be equal/more accurate in ruling out HRV METHODS: Retrospective study evaluating patients with LS >10 kPa who had LS and endoscopy within one year of each other RESULTS: The study included 161 patients from a U...
February 3, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28147426/-spontaneous-bacterial-peritonitis
#6
Ľubomír Skladaný, Silvia Kasová, Anna Purgelová, Natália Bystrianska, Svetlana Adamcová-Selčanová
AIM OF STUDY: Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication of liver cirrhosis with serious consequences. Initially, SBP is always treated with empirical, not targeted, antibiotic therapy. Since a retrospective study performed in our department showed suboptimal effectiveness (only 40 %) of empirical antibiotic therapy in accordance with the EASL guidelines, a decision was made to change the protocol. The aims of this prospective study were to determine: (1) the incidence and characteristics of SBP in real clinical practice - in a liver unit of a tertiary hospital, (2) the effectiveness of new antibiotic therapy selected based on analysis of the spectrum of pathogens and their resistance to antibiotics as identified in a retrospective cohort study on SBP carried out in our department, (3) mortality, and to compare these findings with the literature data...
December 2016: Klinická Mikrobiologie a Infekc̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28099882/the-35-year-odyssey-of-beta-blockers-in-cirrhosis-any-gender-difference-in-sight
#7
REVIEW
Maria Antonella Burza, Hanns-Ulrich Marschall, Laura Napoleone, Antonio Molinaro
Cirrhosis is the end-stage of chronic liver disease and leads to the development of portal hypertension and its complications such as esophagogastric varices. Non-selective beta blockers (NSBB) are the keystone for the treatment of portal hypertension since the 1980s and, over the decades, several studies have confirmed their beneficial effect on the prevention of variceal (re)bleeding. Pharmacological studies showed effects of gender, sex hormones, oral contraceptives, and pregnancy on cytochrome P450 (CYPs) enzymes that metabolise NSBB, suggesting that gender differences might exist in the effect of NSBB...
January 15, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28078723/real-world-use-effectiveness-and-safety-of-anti-viral-treatment-in-chronic-hepatitis-c-genotype-3-infection
#8
M Cornberg, J Petersen, A Schober, S Mauss, K H W Böker, R Link, R Günther, Y Serfert, H Pfeiffer-Vornkahl, M P Manns, C Sarrazin, D Hüppe, T Berg, C Niederau
BACKGROUND: Treatment of chronic hepatitis C genotype 3 (GT3) is more challenging compared with other genotypes. Since 2014, several new treatment regimens have been approved but sometimes based on limited data. AIM: To validate the use, effectiveness and safety of anti-viral treatment in chronic hepatitis C genotype 3 infection under real-word conditions. METHODS: The German Hepatitis C-Registry is a large national non-interventional real-world study for patients with chronic hepatitis C...
January 12, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28046099/cost-effectiveness-of-treating-hepatitis-c-with-sofosbuvir-ledipasvir-in-germany
#9
Jona T Stahmeyer, Siegbert Rossol, Sebastian Liersch, Ines Guerra, Christian Krauth
BACKGROUND: Infections with the hepatitis C virus (HCV) are a global public health problem. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. Newly introduced direct acting antivirals, especially interferon-free regimens, have improved rates of sustained viral response above 90% in most patient groups and allow treating patients who were ineligible for treatment in the past. These new regimens have replaced former treatment and are recommended by current guidelines...
2017: PloS One
https://www.readbyqxmd.com/read/27981308/primary-biliary-cirrhosis-and-primary-sclerosing-cholangitis-an-update-on-mr-imaging-findings-with-recent-developments
#10
REVIEW
Jelena Djokić Kovač, Marc-André Weber
Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) are the most common immune-mediated chronic cholestatic liver diseases leading to cirrhosis and liver failure. Although magnetic resonance imaging (MRI) is not a necessary procedure for the diagnosis of PBC, MRI is recommended for monitoring disease progression and early detection of complications. Even though liver cirrhosis subtypes have similar MR imaging features, there are some findings which could indicate PBC, such as the periportal halo sign...
December 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
https://www.readbyqxmd.com/read/27976461/safety-and-efficacy-of-direct-acting-antivirals-for-the-treatment-of-chronic-hepatitis-c-in-a-real-world-population-aged-65-years-and-older
#11
Fabio Conti, Stefano Brillanti, Federica Buonfiglioli, Ranka Vukotic, Maria Cristina Morelli, Claudine Lalanne, Marco Massari, Francesco Giuseppe Foschi, Veronica Bernabucci, Ilaria Serio, Gian Maria Prati, Elisa Negri, Lorenzo Badia, Paolo Caraceni, Paolo Muratori, Giovanni Vitale, Alberto Porro, Marta Morotti, Giuseppe Mazzella, Pietro Andreone
The availability of direct acting antiviral agents (DAA) regimens has expanded the pool of patients eligible for treatment. However, data on the virological response and tolerability of DAAs in elderly patients are lacking. We evaluated the efficacy and safety of DAAs in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years. Between January and December 2015, all consecutive patients with HCV-related advanced fibrosis/cirrhosis treated with DAA at eleven tertiary referral centers in Emilia Romagna (Italy) were enrolled...
December 15, 2016: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/27931567/landscape-of-kidney-transplantation-in-patients-with-compensated-liver-disease-results-of-a-survey-of-transplant-surgeons-in-the-united-states
#12
L Sibulesky, R N Hansen, N Leca, C Blosser, A A Rahnemai-Azar, M I Montenovo, A A Dick, R Bakthavatsalam, S Rayhill, R Bhattacharya, J D Reyes
BACKGROUND: The therapeutic options that provide the best long-term outcome for patients who have a combination of end-stage renal disease and compensated cirrhosis are unknown. METHODS: Given the paucity of data and the lack of clinical guidance in this area, a national survey was conducted in the form of an e-mail-based questionnaire addressed to the transplantation surgeons registered with the American Society of Transplant Surgeons. RESULTS: Of the 818 surgeons invited to participate in the survey, 167 (20%) responded...
December 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27880998/recurrent-acute-portal-vein-thrombosis-in-liver-cirrhosis-treated-by-rivaroxaban
#13
Hyeyoung Yang, Seo Ree Kim, Myeong Jun Song
Cirrhosis can occur with the development of portal vein thrombosis (PVT). PVT may aggravate portal hypertension, and it can lead to hepatic decompensation. The international guideline recommends for anticoagulation treatment to be maintained for at least 3 months in all patients with acute PVT. Low-molecular-weight-heparin and changing to warfarin is the usual anticoagulation treatment. However, warfarin therapy is problematic due to a narrow therapeutic window and the requirement for frequent dose adjustment, which has prompted the development of novel oral anticoagulants for overcoming these problems...
December 2016: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/27871159/-acute-kidney-injury-in-cirrhotic-patients-with-portal-hypertension
#14
REVIEW
So Mi Kim, Il Han Song
Acute kidney injury (AKI) is one of the most common manifestations encountered in clinical practice. It is associated with high morbidity and mortality in cirrhotic pre- and post-transplantation patients. Hepatorenal syndrome (HRS), a special form of AKI in cirrhotic patients, was recognized as a consequence of renal vasoconstriction from systemic/renal hemodynamic alterations developed in advanced cirrhosis with portal hypertension. Recently, multiple factors-such as infection/inflammation, underlying glomerulonephritis, bile cast, or increased abdominal pressure-have been considered to contribute to renal dysfunction in cirrhotic patients, which were presumed to induce HRS...
November 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/27870642/hepatocellular-carcinoma-surveillance-among-patients-with-cirrhosis-in-a-population-based-integrated-health-care-delivery-system
#15
Amit G Singal, Jasmin Tiro, Xilong Li, Beverley Adams-Huet, Jessica Chubak
PURPOSE: Fewer than 1 in 5 patients with cirrhosis receive hepatocellular carcinoma (HCC) surveillance; however, most studies were performed in select patient populations, which may not be informative of practice patterns in population-based community practices. Further, few reported guideline-concordant consistent surveillance rates. GOALS: Characterize guideline-concordant HCC surveillance rates and patient-level factors associated with surveillance among a population-based cohort of patients with cirrhosis...
November 18, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27862856/liver-stiffness-and-platelet-count-for-identifying-patients-with-compensated-liver-disease-at-low-risk-of-variceal-bleeding
#16
Astrid Marot, Eric Trépo, Christopher Doerig, Alain Schoepfer, Christophe Moreno, Pierre Deltenre
BACKGROUND & AIMS: The 2015 Baveno VI guidelines recommend against performing upper gastrointestinal endoscopy in patients with compensated cirrhosis who have a liver stiffness <20 kPa and a platelet count >150 000/mm³ because of a low prevalence of varices at risk of bleeding in this population. The aim was to synthesize the available evidence on the usefulness of the combined use of liver stiffness and platelet count to identify patients without oesophageal varices. METHODS: Meta-analysis of trials evaluating the usefulness of a given cut-off for liver stiffness and platelet count to rule out the presence of oesophageal varices...
November 18, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27861767/antibiotic-resistance-in-healthcare-related-and-nosocomial-spontaneous-bacterial-peritonitis
#17
Philipp Lutz, Hans Dieter Nischalke, Benjamin Krämer, Felix Goeser, Dominik J Kaczmarek, Stefan Schlabe, Marijo Parcina, Jacob Nattermann, Achim Hoerauf, Christian P Strassburg, Ulrich Spengler
BACKGROUND: Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP. MATERIALS AND METHODS: We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria...
January 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/27806410/to-treat-or-not-to-treat-successful-hepatitis-c-virus-eradication-in-a-patient-with-advanced-hepatocellular-carcinoma-and-complete-response-to-sorafenib
#18
O Waidmann, J Peveling-Oberhag, K Eichler, F Schulze, J Vermehren
Background and aims: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Infection with the hepatitis C virus (HCV) is one of the most frequent underlying diseases leading to HCC development. Sorafenib is the standard of care for HCC patients not amenable to local treatment, resection, or liver transplantation. Although overall survival can be increased, objective response rates in patients treated with sorafenib are low. In HCC patients who underwent resection or ablation, HCV eradication with interferon-based regimens reduces the risk of recurrence...
November 2, 2016: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/27804005/palliative-care-quality-indicators-for-patients-with-end-stage-liver-disease-due-to-cirrhosis
#19
A M Walling, S C Ahluwalia, N S Wenger, M Booth, C P Roth, K Lorenz, F Kanwal, S Dy, S M Asch
BACKGROUND AND AIMS: There are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed. METHODS: We convened a 9-member, multidisciplinary expert panel and used RAND/UCLA modified Delphi methods to develop palliative care quality indicators for patients with cirrhosis. Experts were provided with a report based on a systematic review of the literature that contained evidence concerning the proposed candidate QIs...
November 1, 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/27743987/are-targeted-treatment-recommendations-in-chronic-hepatitis-c-tailored-to-diagnostic-methods-of-fibrosis
#20
Sylvie Deuffic-Burban, Jérôme Boursier, Vincent Leroy, Yazdan Yazdanpanah, Laurent Castera, Philippe Mathurin
BACKGROUND & AIMS: The progression of chronic HCV infection varies significantly depending on patient characteristics. The goal of the present study was to evaluate the consequences of targeted and universal therapy for HCV-related morbidity-mortality based on the use of non-invasive diagnostic tests in France, Italy and the UK. METHODS: A country-specific Markov model was used to predict clinical outcomes in patients with chronic HCV mono-infection over 5years...
October 13, 2016: Journal of Hepatology
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