International Journal Of Hepatology[JOURNAL]
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200 papers
The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival.
Ninh KV, Nguyen NQ, Trinh SH … +2 more , Pham AG, Doan TN
Int J Hepatol · 2021 · PMID 34007489 · Full text
BACKGROUND: Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable str...
BACKGROUND: Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). OBJECTIVES: In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. METHODS: We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in 52.6 ± 33 months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm) to body weight (kg) > 0.8% (for right hepatectomy). Perioperative parameters were collected and analyzed. RESULTS: The average operation time was 196.2 ± 62.2 minutes, and blood loss was 261.4 ± 202.9 ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was 11.4 ± 3.7 days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. CONCLUSION: SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.
Emerging Roles of Impaired Autophagy in Fatty Liver Disease and Hepatocellular Carcinoma.
Niture S, Lin M, Rios-Colon L … +3 more , Qi Q, Moore JT, Kumar D
Int J Hepatol · 2021 · PMID 33976943 · Full text
Autophagy is a conserved catabolic process that eliminates dysfunctional cytosolic biomolecules through vacuole-mediated sequestration and lysosomal degradation. Although the molecular mechanisms that regulate autophagy...
Autophagy is a conserved catabolic process that eliminates dysfunctional cytosolic biomolecules through vacuole-mediated sequestration and lysosomal degradation. Although the molecular mechanisms that regulate autophagy are not fully understood, recent work indicates that dysfunctional/impaired autophagic functions are associated with the development and progression of nonalcoholic fatty liver disease (NAFLD), alcoholic fatty liver disease (AFLD), and hepatocellular carcinoma (HCC). Autophagy prevents NAFLD and AFLD progression through enhanced lipid catabolism and decreasing hepatic steatosis, which is characterized by the accumulation of triglycerides and increased inflammation. However, as both diseases progress, autophagy can become impaired leading to exacerbation of both pathological conditions and progression into HCC. Due to the significance of impaired autophagy in these diseases, there is increased interest in studying pathways and targets involved in maintaining efficient autophagic functions as potential therapeutic targets. In this review, we summarize how impaired autophagy affects liver function and contributes to NAFLD, AFLD, and HCC progression. We will also explore how recent discoveries could provide novel therapeutic opportunities to effectively treat these diseases.
Low Serum 25-Hydroxy Vitamin D (25-OHD) and Hepatic Encephalopathy in HCV-Related Liver Cirrhosis.
Afifi MAE, Hussein AM, Rizk M
Int J Hepatol · 2021 · PMID 33628512 · Full text
BACKGROUND: Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patien...
BACKGROUND: Patients with liver cirrhosis experience a large variety of metabolic disorders associated with more hepatic decompensation. Hepatic encephalopathy (HE) is a significant complication in liver cirrhosis patients, presenting a wide spectrum of neuropsychological symptoms. A deficiency of 25-hydroxy vitamin D (25-OHD) in the general population is associated with a loss of cognitive function, dementia, and Alzheimer's disease. . Our study aims to check the relationship between low serum 25-OHD and HE in patients with HCV-related liver cirrhosis and assess its link with patient mortality. . This study was observationally carried out on 100 patients with HCV-related liver cirrhosis. The patients were divided into 2 groups: Group A-included 50 HCV-related cirrhotic patients with HE, and Group B-included 50 HCV-related cirrhotic patients without HE. Assessment of disease severity using the end-stage liver disease (MELD) model and Child Turcotte Pugh (CTP) scores were done, and 25-OHD levels were measured. Comparison of vitamin D levels in different etiologies and different CTP categories was made using one-way ANOVA. Pearson's correlation between the level of vitamin D and other biomarkers was applied. RESULTS: There was a statistically significant Vitamin D level difference between the two groups. A lower level of vitamin D was observed in the HE group where the severe deficiency was 16%, while it was 6% in the other group and the moderate deficiency was 24% in HE group as compared to 10% in the other group. The insufficient vitamin D level represented 46% of the non-HE group while none of the HE group falls in this category. Vitamin D level was statistically higher in Grade 1 HE than in Grade 2 which is higher than in Grades 3 to 4. Vitamin D level was also significantly higher in those who improved from HE as compared to those who died. CONCLUSION: The lower levels of 25-OHD were associated with the higher incidence of HE in cirrhotic HCV patients. The worsening vitamin D deficiency was associated with increased severity of the liver disease, so vitamin D may be considered a prognostic factor for the severity of liver cirrhosis and high mortality rate in HE patients.
Antioxidant Effects of Eugenol on Oxidative Stress Induced by Hydrogen Peroxide in Islets of Langerhans Isolated from Male Mouse.
Oroojan AA, Chenani N, An'aam M
Int J Hepatol · 2020 · PMID 33457017 · Full text
BACKGROUND: The antioxidant system in islets of Langerhans is weak, which can lead to diabetes. Meanwhile, the main component of cloves that produce antioxidant effects is eugenol. Accordingly, the present study was cond...
BACKGROUND: The antioxidant system in islets of Langerhans is weak, which can lead to diabetes. Meanwhile, the main component of cloves that produce antioxidant effects is eugenol. Accordingly, the present study was conducted to investigate the antioxidant effect of eugenol on oxidative stress induced by hydrogen peroxide (HO) in islets of Langerhans isolated from the male mice. MATERIALS AND METHODS: In this experimental study, adult Naval Medical Research Institute (NMRI) mice (20-25 g) were prepared. The collagenase digestion method was used for dissecting the islets of Langerhans. HO 50 M was administered for 30 min to induce oxidative stress, with 50, 100, and 200 M of eugenol employed for 2 hours before the administration of HO. The experimental groups were divided into five groups: (control, HO, and HO+eugenol 50, 100, and 200 M). Finally, the islet's lipid peroxidation and antioxidants levels were measured by the ELISA assay method. RESULTS: Malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), and catalase (CAT) increased in all groups when compared to the control ( < 0.05). MDA diminished in HO+eugenol 50, 100, and 200 M ( < 0.01) groups versus the HO. TAC was elevated when eugenol 50, 100, and 200 M was administered in oxidative stress-induced islets ( < 0.001). Also, CAT increased in the HO+eugenol 50 ( < 0.05) group in comparison with the HO group. CONCLUSIONS: In conclusion, HO induced oxidative stress and lipid peroxidation in the islets, and administration of eugenol recovered these alterations by raising the level of TAC and CAT, while reducing MDA as a lipid peroxidation biomarker.
Prognostic Factors of Radiofrequency Ablation plus Systemic Chemotherapy for Unresectable Colorectal Cancer with Liver Metastasis.
Thai Doan K, Nguyễn Việt L, Nguyen Tien T … +7 more , Nguyen Canh B, Ngo Thi H, Nguyen Thanh N, Bui Quang B, Le Van Q, Woong Lee H, Mai Hong B
Int J Hepatol · 2020 · PMID 33381321 · Full text
INTRODUCTION: Survival outcomes in patients with unresectable colorectal cancer (CRC) liver metastasis treated by radiofrequency ablation (RFA) combined with systemic chemotherapy and correlation with potential prognosti...
INTRODUCTION: Survival outcomes in patients with unresectable colorectal cancer (CRC) liver metastasis treated by radiofrequency ablation (RFA) combined with systemic chemotherapy and correlation with potential prognostic factors were investigated. . A retrospective cohort study was conducted on 61 CRC patients with unresectable liver metastasis who underwent liver tumor-directed percutaneous RFA combined with conventional systemic chemotherapy between October 2013 and September 2018. Survival analyses were conducted using the Kaplan-Meier method, and the log-rank test was used to characterize differences in the median survival time and the 1-year, 3-year, and 5-year overall survival rates of subgroups to identify prognostic factors. RESULTS: Median overall survival and progression-free survival of all patients were 32 and 14 months, respectively. The cumulative survival rates at 1-, 3-, and 5-years were 93.2%; 44.5%, and 38.2%, respectively. Univariate analysis revealed that pre-RFA serum CEA levels, Eastern Cooperative Oncology Group (ECOG) status, number of liver lesions, the size of the largest lesion, and the total lesion size were prognostic factors. However, multivariate analysis demonstrated that only the number of liver lesions and the size of the largest lesion were independent prognostic factors for survival. CONCLUSION: RFA plus systemic chemotherapy provides an encouraging survival outcome for patients with unresectable CRC liver metastasis. Multivariate analysis demonstrated that the number and size of liver metastatic lesions are independent prognostic factors for survival.
The High Prevalence of Negative Hepatitis B Surface Antibody (Anti-HBs) among Pregnant Women in Bandung, Indonesia: A Community-Based Study.
Girawan D, Judistiani RTD, Risan NA … +4 more , Bestari MB, Nugraha ES, Ermaya YS, Prasetyo D
Int J Hepatol · 2020 · PMID 33133698 · Full text
BACKGROUND: Hepatitis B virus (HBV) infection is a disease that creates a high global burden by affecting approximately 3.5% of the total world population. The main transmission of this disease is from mother to child (M...
BACKGROUND: Hepatitis B virus (HBV) infection is a disease that creates a high global burden by affecting approximately 3.5% of the total world population. The main transmission of this disease is from mother to child (MTCT). HBV vaccination program was already initiated in Indonesia in 1987. However, after three decades, the HBV infection prevalence stays stagnant. This study aimed to explore the seroprevalence of HBV markers and the attributable risk factors of pregnant women at risk of transmitting HBV to their offspring. METHOD: A cross-sectional study was conducted on pregnant women from primary midwifery and obstetric clinics across Bandung, Indonesia, to assess the HBsAg, anti-HBc, and anti-HBs serological markers. Questionnaire-based interviews were used to obtain the sociodemographic determinants. Logistic regression was applied to assess the association of each determinant factor to positive HBsAg or negative anti-HBs as a dependent variable, which was then reported as odds ratios (OR). RESULTS: A total of 196 subjects were recruited with 12/196 (6.1%) of them were positive HBsAg. After exclusions of those with positive HBsAg and anti-HBc, 24/175 (13.7%) women were isolated as positive anti-HBs, leaving 151/175 (86.3%) women with negative anti-HBs who were susceptible to HBV infection. Low body mass index (BMI) less than 18.5 kg/m was a risk factor for positive HBsAg with OR = 5.850 (95% CI 1.466-23.34), = 0.012. Nevertheless, no significant determinant factor was associated with negative anti-HBs. CONCLUSION: Most pregnant women in Bandung, Indonesia, are susceptible to HBV infection, as marked by the negative anti-HBs status.
Hepatocyte and Islet Cell Cotransplantation on Poly-L-Lactide Matrix for the Treatment of Liver Cirrhosis.
Hendrawan S, Lheman J, Nuraeni … +2 more , Weber U, Baer HU
Int J Hepatol · 2020 · PMID 33123384 · Full text
The human autologous hepatocyte matrix implant is a promising alternative procedure to counter liver damage. We assessed the outcome of human hepatocytes isolation from cirrhotic liver compared to the clinical and histol...
The human autologous hepatocyte matrix implant is a promising alternative procedure to counter liver damage. We assessed the outcome of human hepatocytes isolation from cirrhotic liver compared to the clinical and histological scores of disease severity. A total of 11 patients with various clinical scores (CTP and MELD) and histological score (Metavir, fibrosis) of liver cirrhosis were included in the hepatocyte matrix implant clinical phase I study. The liver segment and pancreatic tissue were harvested from each patient, and hepatocytes and cells of islets of Langerhans were isolated. The freshly isolated human hepatocytes were coseeded with the islet cells onto poly(l-lactic acid) (PLLA) scaffolds, cultured, and transplanted back into the patient. Human hepatocytes were isolated from 11 cirrhotic liver specimens with a resulting yield of 1.4 ± 0.5 × 10 cells per gram of the liver specimen and a viability rate of 52 ± 13%. It was found that the yield and viability of the liver cells were not correlated with the clinical and histological scores of the liver cirrhosis. A correlation was found between the hepatocyte yield obtained and the average number of hepatocytes counted in 10 microscopic fields of view. More viable cells were obtained from cirrhotic livers caused by chronic hepatitis B as compared to chronic hepatitis C in the same MELD score range. There was no correlation between the clinical and histological disease severity scores of liver cirrhosis and the outcome of hepatocytes isolation. It seems that the yield could depend on the type of hepatitis underlying the cirrhotic tissue. The study was registered at www.clinicaltrial.gov with the study identifier: NCT01335568.
Endothelial Dysfunction, a Marker of Atherosclerosis, Is Independent of Metabolic Syndrome in NAFLD Patients.
Narayan J, Das HS, Nath P … +4 more , Singh A, Mishra D, Padhi PK, Singh SP
Int J Hepatol · 2020 · PMID 32724678 · Full text
BACKGROUND: The study was designed to assess cardiovascular risk factors flow-mediated dilatation % (FMD%) and carotid intima-media thickness (CIMT) in NAFLD. METHODS: 126 NAFLD subjects and 31 chronic hepatitis B (CHB)...
BACKGROUND: The study was designed to assess cardiovascular risk factors flow-mediated dilatation % (FMD%) and carotid intima-media thickness (CIMT) in NAFLD. METHODS: 126 NAFLD subjects and 31 chronic hepatitis B (CHB) controls were studied. Measuring carotid intima-media thickness (CIMT) and the flow-mediated dilatation % (FMD%) by brachial artery Doppler ultrasound were used to assess atherosclerosis. The risk of cardiac events at 10 years (ROCE 10) was estimated by the Prospective Cardiovascular Munster Study (PROCAM) score. RESULTS: 58 of 126 NAFLD have coexistent metabolic syndrome. Mean CIMT was 0.73 ± 0.041 mm among NAFLD with MS, 0.66 ± 0.016 mm among NAFLD without MS, and 0.66 ± 0.037 in controls CHB patients. FMD% in NAFLD with MS was 10.43 ± 3.134%, but was 8.56 ± 3.581% in NAFLD without MS and 17.78 ± 6.051% in controls. PROCAM score of NAFLD with MS was 46.95 ± 6.509 while in NAFLD without MS was 38.2 ± 3.738. Controls had a PROCAM score of 38.13 ± 5.755. ROCE 10 in NAFLD with MS was 13.64 ± 8.568 while NAFLD without MS was 5.55 ± 1.949. Controls have a ROCE 10 of 5.95 ± 3.973. Post hoc analysis showed CIMT was dependent upon MS while FMD% was different between all subgroups hence independent of metabolic syndrome. CONCLUSION: The markers of endothelial dysfunction are significantly higher in patients with NAFLD than controls.
Hepatocellular Expression of SIRT1 and Its Effect on Hepatocellular Carcinoma Progression: A Future Therapeutic Perspective.
Molla MD, Dessie G, Akalu Y … +1 more , Ayelign B
Int J Hepatol · 2020 · PMID 32607257 · Full text
Hepatocellular carcinoma (HCC) is an aggressive primary hepatic malignancy with a significant morbidity and mortality rate. Although chemotherapy along with surgical incision is believed to be an effective therapeutic ap...
Hepatocellular carcinoma (HCC) is an aggressive primary hepatic malignancy with a significant morbidity and mortality rate. Although chemotherapy along with surgical incision is believed to be an effective therapeutic approach, to date recurrence is being lifted a major concern. Thus, identifying another best therapeutic approach is becoming the main aim of physicians and scholars. In support of this, recently, several studies reported a significant observation of Sirtuin1 (SIRT1) overexpression in the malignant tumor cells, including HCC. As a result, they believed that overexpression of SIRT1 may have an effect on the progression of HCC by targeting growth and/or apoptotic controlling transcriptional factors/signaling pathways. Similarly, other reports confirmed that SIRT1 inhibition had a direct or indirect role in the control of tumor cell growth and metastasis. Therefore, inhibiting the expression and activity of SIRT1 might have a therapeutic effect to handle HCC. However, there are a limited number of reviews regarding the issue, and here, we summarized hepatocellular expression of SIRT1 and its role on HCC progression.
Drug Treatment of Patients with Liver Cirrhosis in a Tertiary Hospital in Northern Ghana: Does It Comply with Recommended Guidelines?
Mohammed BS, Aidoo M
Int J Hepatol · 2020 · PMID 32550025 · Full text
The diverse influence of liver function on drug disposition can lead health-care practitioners to inappropriate drug selection, inappropriate drug dosing, or some level of therapeutic negativism. The aim of this study wa...
The diverse influence of liver function on drug disposition can lead health-care practitioners to inappropriate drug selection, inappropriate drug dosing, or some level of therapeutic negativism. The aim of this study was to assess how drug prescribing in patients with liver cirrhosis at the Tamale Teaching Hospital comply with recommendations of pharmacotherapy and safety guidelines. A prospective cross-sectional study was conducted from February to July, 2019, at the medical ward of the Tamale Teaching Hospital. A total of 152 liver cirrhotic patients were included in this study. Common etiologies for liver cirrhosis were chronic hepatitis B 80 (52.6%) and chronic hepatitis C 30 (19.7%); about 12.5% of etiologies were unknown. Of the 1842 prescription issued, 69% (1270/1842) were compliant. Of the 572 noncompliant prescriptions, about 32% (183/572) were due to pharmacotherapy and 68% (389/572) due to safety guideline recommendations. There was a substantial number (31%) of prescription noncompliance with recommendations for pharmacotherapy and safety guidelines in liver cirrhotic patients at the tertiary hospital in northern Ghana. Prescribers need to be conscious of the role of the liver in drug elimination and prescribe as recommended by guidelines.
Prevalence and Knowledge of Hepatitis B Virus Infection among Pregnant Women in the Ningo-Prampram District, Ghana.
Kwadzokpui PK, Akorsu EE, Abaka-Yawson A … +3 more , Quarshie SS, Amankwah SA, Tawiah PA
Int J Hepatol · 2020 · PMID 32411482 · Full text
BACKGROUND: Hepatitis B virus (HBV) infection has been suggested to play a role in various adverse birth outcomes. The study determined the prevalence as well as knowledge of hepatitis B virus infection among pregnant wo...
BACKGROUND: Hepatitis B virus (HBV) infection has been suggested to play a role in various adverse birth outcomes. The study determined the prevalence as well as knowledge of hepatitis B virus infection among pregnant women in the Ningo-Prampram District of the Greater Accra Region of Ghana. MATERIALS AND METHODS: A cross-sectional study using simple random sampling technique was used to recruit 213 pregnant women receiving antenatal care in three different health facilities (Prampram Polyclinic (PPC), Dangme Community Hospital (DCH), and Old Ningo Health Center (ONHC)) in the Ningo-Prampram District of Ghana from November 2018 to January 2019. A semi-structured questionnaire was used to collect data which included participants' HBsAg test results, sociodemographic and gynaecological characteristics, and their level of knowledge on HBV infection. Knowledge of the participants on HBV infection was classified as either excellent, good, or poor based on their cumulative percentage scores from the questionnaire according to Al Rubaish system of classification. RESULTS: Overall low-intermediate prevalence of HBV infection was 3.3%; however, PPC recorded the highest prevalence of 4.0% while DCH and ONHC recorded 2.82% and 2.50%, respectively. Statistically significant association was observed between HBV infection and the health facility. Majority (77.40%) of the study participants had poor knowledge on HBV infection while only 14 (6.57%) had excellent knowledge on HBV. Regarding excellent knowledge, 8 (11.0%) among the participants were demonstrated by the majority of those who received antenatal care from DCH. Generally, knowledge on HBV and the infection was poor among the study participants. Knowledge on HBV infection was found to be associated with residential status ( = 0.006), educational level ( < 0.001), occupation ( < 0.001), and gestational period ( < 0.001). Participant's knowledge was also significantly associated with the health facility ( = 0.027). CONCLUSION: HBV infection among pregnant women is prevalent in the Ningo-Prampram District even though the prevalence is not very high. The majority of pregnant women in the Ningo-Prampram District inadequate knowledge on HBV infection and it mode of transmission. Intensive public health education on the HBV infection is required in the district to help prevent and manage future transmissions as well as inform the population about the negative side effects of the virus and the need to prevent it by way of vaccination.
Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus.
Mada PK, Malus ME, Parvathaneni A … +8 more , Chen B, Castano G, Adley S, Moore M, Hieda M, Alam MJ, Feldman M, King JW
Int J Hepatol · 2020 · PMID 32395351 · Full text
AIM: To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). METHODS: We performed a r...
AIM: To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). METHODS: We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (hemoglobin A1C level ≥ 6.5%) who were eligible for treatment were included in the study. Of 118 such patients, 59 were treated with oral DAAs for 8-12 weeks with the goal of achieving a sustained virologic response (SVR). A control group of 59 patients did not receive treatment for their hepatitis C and was followed in the clinic. Patients in the control group did not receive treatment either due to insurance issues or refusal of hepatitis C treatment. RESULTS: Fifty-five of the 59 patients treated with DAAs (93%) achieved a SVR. Six months after treatment completion, their mean ± SEM HbA1C level had decreased by 1.1 ± 0.03% ( < 0.0001). Four of the 59 patients treated with DAAs did not achieve a SVR. Their mean HbA1C 6 months after treatment completion had increased by 0.8 ± 0.2%. Furthermore, there was no improvement in HbA1C levels over time in the untreated group (mean HbA1C increase, 0.2 ± 0.05%; < 0.0001 vs. the treatment group, which had a mean HbA1C decrease of 0.9 ± 0.2%). CONCLUSION: This controlled study demonstrated that treatment of chronic hepatitis C with DAAs results in statistically significant and meaningful reductions in hemoglobin A1C levels in patients with coexisting diabetic mellitus if a SVR is achieved.
Isoniazid and Rifampicin Produce Hepatic Fibrosis through an Oxidative Stress-Dependent Mechanism.
Biswas A, Santra S, Bishnu D … +3 more , Dhali GK, Chowdhury A, Santra A
Int J Hepatol · 2020 · PMID 32373368 · Full text
METHODS: A combined dose of INH (50 mg) and RMP (100 mg) per kg body weight per day was administered to mice by oral gavage, 6 days a week, for 4 to 24 weeks for the assessment of liver injury, oxidative stress, and deve...
METHODS: A combined dose of INH (50 mg) and RMP (100 mg) per kg body weight per day was administered to mice by oral gavage, 6 days a week, for 4 to 24 weeks for the assessment of liver injury, oxidative stress, and development of hepatic fibrosis, including demonstration of changes in key fibrogenesis linked pathways and mediators. RESULTS: Progressive increase in markers of hepatic stellate cell (HSC) activation associated with changes in matrix turnover was observed between 12 and 24 weeks of INH-RMP treatment along with the elevation of liver collagen content and significant periportal fibrosis. These were associated with concurrent apoptosis of the hepatocytes, increase in hepatic cytochrome P450 2E1 (CYP2E1), NADPH oxidase (NOX) activity, and development of hepatic oxidative stress. CONCLUSIONS: INH-RMP can activate HSC through generation of NOX-mediated oxidative stress, leading to the development of liver fibrosis.
The Many Difficulties and Subtleties in the Cognitive Assessment of Chronic Hepatitis C Infection.
Abrantes J, Torres DS, Brandão-Mello CE
Int J Hepatol · 2020 · PMID 32257447 · Full text
Since the discovery of HCV in 1989, several diseases have been related to chronic infection by this virus. Often, patients with hepatitis C virus (HCV) complain of cognitive impairment even before the development of hepa...
Since the discovery of HCV in 1989, several diseases have been related to chronic infection by this virus. Often, patients with hepatitis C virus (HCV) complain of cognitive impairment even before the development of hepatic cirrhosis, which they described as "brain fog." Several studies have proposed a link between chronic HCV infection and the development of cognitive alterations, but the inclusion of confounding factors in their samples significantly limits the analysis of the results. In this article, we will give an overview about cognitive dysfunction in patients with HCV.
Comparative Study of Protective Effect of Cimetidine and Verapamil on Paracetamol-Induced Hepatotoxicity in Mice.
Danish L, Siddiq R, Jahan S … +3 more , Taneez M, Khan M, Sandhu M
Int J Hepatol · 2020 · PMID 32099681 · Full text
Paracetamol, chemically known as acetaminophen, if taken in higher doses has hepatotoxic potential. Cimetidine by inhibiting the cytochromal enzymes and reducing the production of the toxic metabolite can reduce the hepa...
Paracetamol, chemically known as acetaminophen, if taken in higher doses has hepatotoxic potential. Cimetidine by inhibiting the cytochromal enzymes and reducing the production of the toxic metabolite can reduce the hepatotoxic potential while Verapamil can act as a hepatoprotective by maintaining calcium homeostasis. The present study was conducted to study the hepatoprotective activity of Cimetidine and Verapamil against the toxicity induced by paracetamol. In addition to the group receiving only distilled water or 300 mg/kg paracetamol additional groups were added treated with 150 mg/kg Cimetidine and Verapamil alone or both. The Liver function tests and histopathology revealed hepatotoxicity in the group receiving paracetamol (PCM) while normal parameters were observed in the groups receiving Cimetidine and Verapamil. Our results strongly suggested that Cimetidine and Verapamil possess hepatoprotective potential against paracetamol induced hepatotoxicity.
Avatrombopag, an Alternate Treatment Option to Reduce Platelet Transfusions in Patients with Thrombocytopenia and Chronic Liver Disease-Integrated Analyses of 2 Phase 3 Studies.
Poordad F, Terrault NA, Alkhouri N … +3 more , Tian W, Allen LF, Rabinovitz M
Int J Hepatol · 2020 · PMID 32047671 · Full text
AIMS: Thrombocytopenia complicates the management of patients with chronic liver disease (CLD) undergoing invasive procedures with a bleeding risk. Until recently, prophylactic platelet transfusion was the only treatment...
AIMS: Thrombocytopenia complicates the management of patients with chronic liver disease (CLD) undergoing invasive procedures with a bleeding risk. Until recently, prophylactic platelet transfusion was the only treatment option, but has significant safety and efficacy limitations. Phase 3 data demonstrated the superiority of avatrombopag to placebo in reducing platelet transfusions for bleeding, supporting its recent approval. METHODS: Integrated analyses of pooled data ( = 435) from two randomized, double-blind, placebo-controlled, phase 3 studies assessed the original efficacy endpoints. Additional analyses included subgroup analyses, alternate Baseline platelet count definitions, and another efficacy endpoint. RESULTS: Avatrombopag was superior to placebo in increasing patients not requiring a platelet transfusion or rescue procedure, those achieving a platelet count ≥50 × 10/L on Procedure Day, and the change in platelet counts from Baseline. The avatrombopag treatment effect was consistently positive across clinically important disease and Baseline clinical characteristic subgroups, and using alternate Baseline platelet count cohort definitions. Similarly, more avatrombopag-treated patients achieved ≥50 × 10/L platelets with an increase of ≥20 × 10/L from Baseline. The incidence and severity of adverse events were similar between avatrombopag and placebo. Further, safety data demonstrated a low risk for thromboembolic events and hepatotoxicity. CONCLUSION: These integrated analyses confirmed the superiority of avatrombopag to placebo in reducing platelet transfusions or rescue procedures for bleeding in patients with thrombocytopenia and CLD scheduled to undergo an invasive procedure, and its tolerable safety profile. Importantly, these data warrant reconsideration of clinical decision making regarding the need to treat thrombocytopenia in patients with CLD. This trial was registered with NCT01972529 and NCT01976104.
Fecal Microbiota Transplantation for Clostridioides Difficile Infection in Patients with Chronic Liver Disease.
Meighani A, Alimirah M, Ramesh M … +1 more , Salgia R
Int J Hepatol · 2020 · PMID 32047670 · Full text
BACKGROUND: Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant infection (CDI). However, the efficacy of FMT in patients with chronic liver disease rem...
BACKGROUND: Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant infection (CDI). However, the efficacy of FMT in patients with chronic liver disease remains elusive. AIMS: We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. METHODS: A cohort of all patients who received FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were monitored for a year after FMT. Descriptive analysis was conducted to compare the effect of FMT in patients with and without CLD. RESULTS: A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. CDI development in these patients was associated with recent exposure to antibiotics and was observed to be significantly different between both groups (17% of CLD patients vs. 58% in the general cohort, = 0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), = 0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%). CONCLUSION: FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis.
Knowledge, Attitude, and Practice towards Hepatitis B Virus among Pregnant Women Attending Antenatal Care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.
Gebrecherkos T, Girmay G, Lemma M … +1 more , Negash M
Int J Hepatol · 2020 · PMID 32015916 · Full text
BACKGROUND: Hepatitis B virus (HBV) infection remains a serious public health concern worldwide. Mother-to-child transmission (MTCT) is the major mode in endemic areas, including Ethiopia, where little is known about pre...
BACKGROUND: Hepatitis B virus (HBV) infection remains a serious public health concern worldwide. Mother-to-child transmission (MTCT) is the major mode in endemic areas, including Ethiopia, where little is known about pregnant women's knowledge, attitudes, and practice towards HBV infection and MTCT. Therefore, the study is aimed at determining the knowledge, attitude, and practice towards HBV among pregnant women attending antenatal care. METHOD: A cross-sectional study was conducted from February to April 2018, at the University of Gondar Comprehensive Specialized Hospital. A total of 354 pregnant women were selected by systematic random sampling and included in this study. KAP of participants on HBV MTCT was assessed using a structured questionnaire. Data was analyzed using SPSS version 22 software. RESULT: The total response rate was 100% (354/354). Out of the 354 participants, 73.4% were within the poor knowledge. Only 18.9% of the respondents know HBV can be transmitted from mother to child during pregnancy. Less than half (43.8) of the participants think that they will never be infected with HBV, and 47.7% of them go to traditional healers when they have symptoms of HBV. Majority of the respondents (85.87%) had never screened for HBV, and only 28.5% of the participants believed that hepatitis B can cause liver cancer. In multivariable analysis, residence, income, and educational level were associated with mean score knowledge and attitude. CONCLUSIONS: Knowledge about HBV among pregnant women was found to be poor, and their attitude and practice were also limited. Therefore, extensive health education program should be given to the pregnant women to increase their awareness towards HBV infection. All pregnant women should be screened for HBV as part of ANC follow-up.
Dilatation Therapy and Demographic Characteristics Significantly Influence the Amount of Propofol for Therapeutic Endoscopic Retrograde Cholangiography.
Schmidt CA, Keil C, Kirstein MM … +5 more , Lehner F, Manns MP, von Hahn T, Lankisch TO, Voigtländer T
Int J Hepatol · 2019 · PMID 31355004 · Full text
BACKGROUND AND STUDY AIMS: Patients undergoing therapeutic endoscopic retrograde cholangiography (ERC) may require different amounts of sedative agents depending on demographic characteristics, indication of ERC, and/or...
BACKGROUND AND STUDY AIMS: Patients undergoing therapeutic endoscopic retrograde cholangiography (ERC) may require different amounts of sedative agents depending on demographic characteristics, indication of ERC, and/or endoscopic intervention. PATIENTS AND METHODS: We retrospectively analyzed all patients undergoing therapeutic ERC from 2008 - 2014 who received deep sedation with propofol ± midazolam. RESULTS: A total of 2448 ERC procedures were performed in 781 patients. The cumulative per procedure propofol dose in the different groups was as follows: PSC 479 mg (±256), bile duct stones 356 mg (±187), benign stenosis/cholestasis 395 mg (±228), malignant stenosis 401 mg (±283), and postliver transplant complications 391 mg (±223) (p < 0.05). Multivariable analysis showed that dilatation therapy (p = 0.001), age (p = 0.001), duration of the intervention (p = 0.001), BMI (p = 0.001), gender (p = 0.001), platelet count (p = 0.003), and bilirubin (p = 0.043) influence independently the propofol consumption. CONCLUSIONS: Demographic characteristics and endoscopic interventions have a distinct influence on the amount of sedation required for therapeutic ERC. Although the sedation-associated complication rate is low optimization of sedative regimens is a prime goal to further reduce adverse events of therapeutic ERC.
Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites.
Prabhu M, Gangula RS, Stanley W
Int J Hepatol · 2019 · PMID 31275659 · Full text
CONTEXT: Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from tho...
CONTEXT: Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. AIMS: To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites. SETTINGS AND DESIGN: The present study is a prospective, descriptive, hospital-based, cross-sectional study. METHODS AND MATERIAL: The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis. STATISTICAL ANALYSIS USED: ANOVA, Kruskal-Wallis H test, and ROC curve analysis. RESULTS: Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. CONCLUSIONS: With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).
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