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https://www.readbyqxmd.com/read/29330279/rare-cause-of-isolated-severe-coagulation-failure-in-cirrhosis-traditional-healing-with-fenugreek
#1
Cyriac A Philips, Philip Augustine
Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases...
January 12, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29327522/clinical-profile-and-outcome-of-pregnant-patients-with-acute-hev-hepatitis-during-water-borne-epidemic-in-himachal-pradesh-a-hospital-based-study
#2
Asha Ranjan, Surinder Thakur, Jatinder Mokta, Rajesh Bhawani, Varsha Ranjan
Background: Recent outbreak of HEV hepatitis epidemic in Himachal Pradesh in Shimla caused significant morbidity and mortality especially among pregnant patients. Overall mortality is 0.5- 4% in patients developing acute hepatic failure (ALF) and is significantly higher in pregnant patients (20%). Present study conducted to observe clinical profile and outcome in pregnant patients. Methodology: this is a retrospective observational study done on admitted pregnant and post partum patients with acute HEV hepatitis during 3 months periods...
December 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29318932/decreased-taurine-and-creatine-in-the-thalamus-may-relate-to-behavioral-impairments-in-ethanol-fed-mice-a-pilot-study-of-proton-magnetic-resonance-spectroscopy
#3
Su Xu, Wenjun Zhu, Yamin Wan, JiaBei Wang, Xi Chen, Liya Pi, Mary Kay Lobo, Bin Ren, Zhekang Ying, Michael Morris, Qi Cao
Minimal hepatic encephalopathy (MHE) is highly prevalent, observed in up to 80% of patients with liver dysfunction. Minimal hepatic encephalopathy is defined as hepatic encephalopathy with cognitive deficits and no grossly evident neurologic abnormalities. Clinical management may be delayed due to the lack of in vivo quantitative methods needed to reveal changes in brain neurobiochemical biomarkers. To gain insight into the development of alcoholic liver disease-induced neurological dysfunction (NDF), a mouse model of late-stage alcoholic liver fibrosis (LALF) was used to investigate changes in neurochemical levels in the thalamus and hippocampus that relate to behavioral changes...
January 2018: Molecular Imaging
https://www.readbyqxmd.com/read/29316579/-management-of-compensated-liver-cirrhosis-2018-evidence-based-prophylactic-measures
#4
Kathrin Karkmann, Felix Piecha, Anna Caterina Rünzi, Lisa Schulz, Moritz von Wulffen, Daniel Benten, Johannes Kluwe, Henning Wege
In 2015, more than 13 000 people died due to the consequences of liver cirrhosis in Germany. Frequently, relevant liver fibrosis is diagnosed by non-invasive methods (e. g., ultrasound-based measurement of liver stiffness) already in the compensated stage. Following diagnosis of liver fibrosis, a thorough investigation of the underlying chronic liver disease and effective treatment are important to prevent progression to decompensated cirrhosis. Since morbidity and mortality dramatically increase in the decompensated stage (patients may present with jaundice, ascites, hepatic encephalopathy, gastrointestinal bleeding) with an upsurge in 1-year-mortality from 1 - 3...
January 2018: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/29316555/intestinal-dysbiosis-secondary-to-proton-pump-inhibitor-use
#5
Yuji Naito, Kaori Kashiwagi, Tomohisa Takagi, Akira Andoh, Ryo Inoue
BACKGROUND: Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use. SUMMARY: We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease...
January 6, 2018: Digestion
https://www.readbyqxmd.com/read/29315693/nacseld-acute-on-chronic-liver-failure-nacseld-aclf-score-predicts-30-day-survival-in-hospitalized-patients-with-cirrhosis
#6
Jacqueline G O'Leary, K Rajender Reddy, Guadalupe Garcia-Tsao, Scott W Biggins, Florence Wong, Michael B Fallon, Ram M Subramanian, Patrick S Kamath, Paul Thuluvath, Hugo E Vargas, Benedict Maliakkal, Puneeta Tandon, Jennifer Lai, Leroy R Thacker, Jasmohan S Bajaj
NACSELD (North American Consortium for the Study of End-Stage Liver Disease) definition of acute-on-chronic liver failure (NACSELD-ACLF) as ≥2 extra-hepatic organ failures has been proposed as a simple bedside tool to assess risk of mortality in hospitalized patients with cirrhosis. We validated NACSELD-ACLF's ability to predict 30-day survival (defined as in-hospital death or hospice discharge) in a separate multicenter prospectively enrolled cohort of both infected and uninfected hospitalized patients with cirrhosis...
January 8, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29315304/transjugular-intrahepatic-portosystemic-shunts-tips-for-the-prevention-of-variceal-re-bleeding-a-two-decades-experience
#7
Theresa Bucsics, Maria Schoder, Magdalena Diermayr, Maria Feldner-Busztin, Nicolas Goeschl, David Bauer, Philipp Schwabl, Mattias Mandorfer, Bernhard Angermayr, Manfred Cejna, Arnulf Ferlitsch, Wolfgang Sieghart, Michael Trauner, Markus Peck-Radosavljevic, Josef Karner, Franz Karnel, Thomas Reiberger
BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunts (TIPS) are used in patients with cirrhosis for the prevention of variceal rebleeding. METHODS: We retrospectively evaluated re-bleeding rate, patency, mortality, and transplant-free survival (TFS) in cirrhotic patients receiving TIPS implantation for variceal bleeding between 1994-2014. RESULTS: 286 patients received TIPS (n = 119 bare metal stents, n = 167 polytetrafluorethylene (PTFE)-covered stents) for prevention of variceal re-bleeding...
2018: PloS One
https://www.readbyqxmd.com/read/29314146/sofosbuvir-plus-daclatasvir-with-or-without-ribavirin-in-551-patients-with-hepatitis-c-related-cirrhosis-genotype-4
#8
H El-Khayat, Y Fouad, H I Mohamed, H El-Amin, E M Kamal, M Maher, A Risk
BACKGROUND: The Daclatasvir and Sofosbuvir combination therapy (SOF/DCV) has shown efficacy in patients with chronic hepatitis C in clinical trials. AIM: To investigate the efficacy and safety of SOF/DCV for treatment of patients with hepatitis C-related liver cirrhosis genotype 4. METHODS: Multicentre study involving 551 patients with liver cirrhosis genotype 4; 432 naïve patients and 119 treatment-experienced patients. All patients received SOF (400 mg) and DCV (60 mg) daily in addition to weight-based ribavirin (RBV) for 12 weeks and when RBV is contraindicated the treatment duration was extended to 24 weeks...
January 3, 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29313695/prognostic-factors-of-liver-cirrhosis-mortality-after-a-first-episode-of-spontaneous-bacterial-peritonitis-a-multicenter-study
#9
Luigi Melcarne, Julia Sopeña, Francisco José Martínez-Cerezo, Mercedes Vergara, Mireia Miquel, Jordi Sánchez-Delgado, Blai Dalmau, Salvador Machlab, Dustin Portilla, Yonaisy Gonzàlez-Padrón, Mónica Real Álvarez, Chantal Carpintero, Meritxell Casas
INTRODUCTION: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. OBJECTIVE: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. PATIENTS AND METHODS: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression...
January 9, 2018: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29313245/effect-of-post-traumatic-stress-disorder-on-cognitive-function-and-covert-hepatic-encephalopathy-diagnosis-in-cirrhotic-veterans
#10
Thomas K Burroughs, James B Wade, Michael S Ellwood, Andrew Fagan, Douglas M Heuman, Michael Fuchs, Jasmohan S Bajaj
BACKGROUND: In veterans, post-traumatic stress disorder (PTSD) is often associated with substance abuse, which in turn can lead to cirrhosis. Cirrhotic patients are prone to cognitive impairment, which is typically due to covert hepatic encephalopathy (CHE), but can also be affected by PTSD. The aim was to define the impact of PTSD on cognitive performance and the diagnosis of CHE in cirrhotic patients. METHODS: Outpatient veterans with cirrhosis underwent two separate modalities for CHE cognitive testing [Psychometric Hepatic Encephalopathy Scale (PHES) and Inhibitory Control Test (ICT)]...
January 8, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29301550/role-of-the-indoleamine-2-3-dioxygenase-kynurenine-pathway-of-tryptophan-metabolism-in-behavioral-alterations-in-a-hepatic-encephalopathy-rat-model
#11
Xi Jiang, Lexing Xu, Lin Tang, Fuhe Liu, Ziwei Chen, Jiajia Zhang, Lei Chen, Cong Pang, Xuefeng Yu
BACKGROUND: This study aims to explore the role of indoleamine-2,3-dioxygenase (IDO)/kynurenine (KYN) pathway of tryptophan (TRY) metabolism in behavioral alterations observed in hepatic encephalopathy (HE) rats. METHODS: Expression levels of proinflammatory cytokines were tested by QT-PCR and ELISA, levels of IDOs were tested by QT-PCR and Western blot, and levels of 5-hydroxytryptamine (5-HT), KYN, TRY, 3-hydroxykynurenine (3-HK), and kynurenic acid (KA) in different brain regions were estimated using HPLC...
January 4, 2018: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/29297141/lactulose-a-simple-sugar-in-a-complex-encephalopathy
#12
Eelco F M Wijdicks
Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization's Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver-brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care...
January 2, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29290508/the-emergency-medicine-evaluation-and-management-of-the-patient-with-cirrhosis
#13
REVIEW
Brit Long, Alex Koyfman
BACKGROUND: Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider. OBJECTIVE OF THE REVIEW: Provide an evidence-based update for the resuscitation of decompensating cirrhotic patients and an overview of cirrhosis complications...
December 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29289486/posterior-reversible-encephalopathy-syndrome-following-blood-transfusion-in-a-patient-with-factor-x-deficiency-is-it-an-unusual-systemic-manifestation-of-an-adverse-transfusion-reaction
#14
Anupam Verma, Hemlata, Priti Elhence, Shubha R Phadke, Zafar Neyaz
Adverse neurological transfusion reactions including posterior reversible encephalopathy syndrome (PRES) following blood transfusion are rare. Our case an 18-year-female with known Factor X deficiency with menorrhagia developed severe hypertension, followed by generalised tonic clonic convulsions apparently after blood component transfusion. She had earlier received 4 units of red blood cells (RBC) for anaemia and 10 units of fresh frozen plasma (FFP) for menorrhagia (with prolonged PT and APTT) within short span of time at another hospital...
December 6, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29288802/increasing-extracellular-cgmp-in-cerebellum-in-vivo-reduces-neuroinflammation-gabaergic-tone-and-motor-in-coordination-in-hyperammonemic-rats
#15
Andrea Cabrera-Pastor, Tiziano Balzano, Vicente Hernández-Rabaza, Michele Malaguarnera, Marta Llansola, Vicente Felipo
Hyperammonemia is a main contributor to cognitive impairment and motor in-coordination in patients with hepatic encephalopathy. Hyperammonemia-induced neuroinflammation mediates the neurological alterations in hepatic encephalopathy. Intracerebral administration of extracellular cGMP restores some but not all types of cognitive impairment. Motor in-coordination, is mainly due to increased GABAergic tone in cerebellum. We hypothesized that extracellular cGMP would restore motor coordination in hyperammonemic rats by normalizing GABAergic tone in cerebellum and that this would be mediated by reduction of neuroinflammation...
December 27, 2017: Brain, Behavior, and Immunity
https://www.readbyqxmd.com/read/29286356/is-flumazenil-an-alternative-for-the-treatment-of-hepatic-encephalopathy
#16
Diego Reyes, Francisco Barrera
INTRODUCTION: Flumazenil is an antagonist of the GABA/benzodiazepines receptor complex that might play a role in the treatment of hepatic encephalopathy. However, its efficacy and safety are a matter of debate. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach...
December 26, 2017: Medwave
https://www.readbyqxmd.com/read/29279371/enhancement-of-hepatic-autophagy-increases-ureagenesis-and-protects-against-hyperammonemia
#17
Leandro R Soria, Gabriella Allegri, Dominique Melck, Nunzia Pastore, Patrizia Annunziata, Debora Paris, Elena Polishchuk, Edoardo Nusco, Beat Thöny, Andrea Motta, Johannes Häberle, Andrea Ballabio, Nicola Brunetti-Pierri
Ammonia is a potent neurotoxin that is detoxified mainly by the urea cycle in the liver. Hyperammonemia is a common complication of a wide variety of both inherited and acquired liver diseases. If not treated early and thoroughly, it results in encephalopathy and death. Here, we found that hepatic autophagy is critically involved in systemic ammonia homeostasis by providing key urea-cycle intermediates and ATP. Hepatic autophagy is triggered in vivo by hyperammonemia through an α-ketoglutarate-dependent inhibition of the mammalian target of rapamycin complex 1, and deficiency of autophagy impairs ammonia detoxification...
December 26, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/29275444/brain-mri-findings-in-acute-hepatic-encephalopathy-in-liver-transplant-recipients
#18
Ruo-Mi Guo, Qing-Ling Li, Li-Ru Zhong, Yu Guo, Ju Jiao, Shao-Qiong Chen, Jin Wang, Yong Zhang
Acute hepatic encephalopathy has significant morbidity and mortality in liver transplant recipients unless it is promptly treated. We evaluated the brain magnetic resonance (MR) imaging findings associated with acute hepatic encephalopathy in transplant recipients. We retrospectively reviewed the clinical and imaging data and outcomes of twenty-five liver transplant patients (16 male; mean age, 49.3 years) with clinically diagnosed acute hepatic encephalopathy and forty liver transplant patients (20 males; mean age, 45...
December 23, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29261352/incrementally-expandable-transjugular-intrahepatic-portosystemic-shunts-single-center-experience
#19
Jie Cui, Sara E Smolinski, Fengyong Liu, Dihua Xu, Kal Dulaimy, Zubin Irani
OBJECTIVE: The purpose of this study is to investigate the long-term safety and efficacy of a small-diameter expandable transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. MATERIALS AND METHODS: This single-center retrospective study included 28 patients (12 women and 16 men; mean age, 56.9 years) who underwent small-diameter expandable TIPS creation between 2008 and 2010 for refractory ascites (n = 15; mean [± SD] model for end-stage liver disease [MELD] score, 15...
December 20, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29259793/effect-of-physical-exercise-on-sarcopaenia-in-patients-with-overt-hepatic-encephalopathy-a-study-protocol-for-a-randomised-controlled-trial
#20
Kazunori Yoh, Hiroki Nishikawa, Hirayuki Enomoto, Yoshinori Iwata, Akio Ishii, Yukihisa Yuri, Noriko Ishii, Yuho Miyamoto, Kunihiro Hasegawa, Chikage Nakano, Ryo Takata, Takashi Nishimura, Nobuhiro Aizawa, Yoshiyuki Sakai, Naoto Ikeda, Tomoyuki Takashima, Hiroko Iijima, Shuhei Nishiguchi
Introduction: Limited data are currently available for patients with overt hepatic encephalopathy (OHE)) receiving physical exercise (PE). The aim of the current study is to prospectively examine the effect of PE on sarcopaenia in patients with OHE. Methods and analysis: At the time of patient recruitment, a precise assessment for nutritional status and daily physical activities will be performed in each subject. Study participants will be randomly assigned into two groups: (1) the PE group and (2) the control group...
2017: BMJ Open Gastroenterology
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