Medicine and Health Sciences Commons^™

Trends, Predictors, And Outcomes Of Hepatic Encephalopathy Treatment At A Quaternary Transplant Center From 2012-2022, Patrick Twohig, Thoetchai Peeraphatdit, Kaeli Samson, Makayla Schissel, Lynette M. Smith, Kyaw Min Tun, Ellen Tan, Kyle Scholten, Jason Barbaretta, Kevin Brittan, Timothy Mccashland

Graduate Medical Education Research Journal

Background: Hepatic encephalopathy (HE) is a devastating complication of cirrhosis that increases mortality. Many patients do not receive guideline recommended HE treatment.

Our aim is to evaluate trends in HE treatment over time, variables associated with receiving treatment, and outcomes based on the type of treatment received.

Methods: Retrospective single-center cohort study of hospitalized patients with HE from July 2012 – June 2022. HE treatment was defined as receiving lactulose, rifaximin, or combination therapy.

Results: A total of 1,683 unique patients were included, 72% of patients received HE treatment. Fewer HE patients received any treatment in 2022 (65.9%) compared to …

The Right Ventricle Outflow Tract Systolic Function Could Predict The Severity Of The Cirrhosis, İbrahim Dönmez, Güray Can, Emrah Acar

Turkish Journal of Medical Sciences

The distinctive liver framework is converted into structurally abnormal nodules as a consequence of tissue fibrosis in cirrhosis. Cardiac dysfunction in cirrhosis was described, and the term “cirrhotic cardiomyopathy (CCM)” was coined to describe this syndrome. Recent research has shown that the contractile characteristics of the right ventricular outflow tract (RVOT) have a significant impact on right ventricular functions. The right ventricular outflow tract-systolic excursion is an important systolic function marker of RVOT (RVOT-SE). There has yet to be published research on RVOT function in cirrhotic patients. We looked at the relationship between cirrhosis severity and the RVOT-SE.Materials and methods: …

Assessment Of Portal System Hemodynamics For The Prediction Of Portal-Vein Thrombosis In Cirrhosis - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankita Singh, Kailash Kolhe, Akash Roy, Kateryna Strubchevska

Conference Presentation Abstracts

Background: The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. Methods: Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CI). Results: A total of 31 studies (patients with …

Rare Presentation Of Metastatic Hepatocellular Carcinoma In The Finger: Case Report And Review Of Literature, F. Rhana Mousavi, Bassem Bekheit, Emon Alavi, Nick A. Hirad, Abanoub Gabra

Research Day

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that primarily develops in the setting of chronic liver disease. HCC is difficult to diagnose due to it requiring the use of multiple imaging modalities with the goal to detect tumors when they are less than or equal to 2 cm in size to allow all possible treatment options to be used. Herein, we discuss a 69-year-old male with stage IV liver cancer residing in hospice presenting with left middle finger osteomyelitis and extreme pain. Radiology revealed a destructive lesion but pathology provided the diagnosis of metastatic hepatocellular carcinoma in …

Serum Level Of Tnfα And Its Gene Polymorphism Association With Hepatocellular Carcinoma, Ahmed Ahmed Elshaarawy, Eman Ahmed Gawish, Noha Rabee Bayoumi, Asmaa Zaky Turky, Karema Abd Elhady Diab

Menoufia Medical Journal

Objectives: To evaluate serum level of TNFα and its gene polymorphism association with hepatocellular carcinoma

Background: HCC is one of the commonest fatal tumors worldwide, so it is a major international public health and considered the third leading cause of cancer death in the world.HCC is the second and sixth most prevalent cancer in men and women, respectively in Egypt. TNFα is a pleiotropic cytokine mainly produced by monocytes and macrophages. It has been linked to a number of physiological and pathological disorders. TNFα serum levels and its gene polymorphism have been shown to be significantly elevated in patients with …

Pharmacy Newsletter : April 2023, Pharmacy Department

Pharmacy Newsletter

• Changes in Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report
• TOX-TOK: Sulfonylurea Overdose
• Difference Between Parenteral Iron Products
• Drug-Drug Interactions Impacting the Treatment of HIV-TB Co-Infection
• Conversion Between Different Corticosteroid Preparations
• Use of Analgesics in Adult Patients with Cirrhosis

Failure To Treat Hcv In Patients Seen In A Predominately African American Socioeconomically Challenged Population, Crisshy Auguste, Paul H. Naylor Phd, Murray N. Ehrinpreis Md, Milton G. Mutchnik Md

Medical Student Research Symposium

The research objective of this proposal is to investigate the impediment with respect to moving a patient from initial antibody/PCR positive to successful completion of treatment. Secondary objectives include determining the most effective way for patients to progress from initial antibody/PCR positive to treatment and identifying the roadblocks for HCV antibody/PCR positive patients to be treated effectively.

Data was collected from 2019 HCV patient EMR charts, including demographics, laboratory studies, and treatment history. Concerning treatment, we evaluated linkage to the care; we defined success as treatment within six months of the initial visit. Thus, data on treatment initiation was collected …

Serum Beta-2 Microglobulin In Patients With Chronic Hepatitis C Virus With Or Without Hepatocellular Carcinoma, Amera F. Shehata, Ayman M. El-Lehleh, Moamena S. El-Hamoly, Randa M. Seddik, Walid A. Ghonim

Menoufia Medical Journal

Objectives To investigate serum beta-2 microglobulin (B2M) as a noninvasive marker for disease progression in chronic hepatitis C virus (HCV)-infected patients and to study its role as a tumor marker in diagnosis of hepatocellular carcinoma (HCC). Background HCV is a hepatotropic RNA virus that causes progressive liver damage, which might result in liver cirrhosis and HCC. Patients and methods From January 2020 to January 2022, this prospective study was carried on 136 participants who were classified into four groups: group I, 22 patients with noncirrhotic chronic hepatitis C; group II, 70 HCV-related cirrhotic patients; group III, 25 patients with HCC …

Study Of Arterial Blood Gases In Different Stages Of Chronic Liver Diseases, Moheb W. Elfaizy, Therese S. Ghatas

Journal of Medicine in Scientific Research

Background Early detection of arterial gas abnormalities and acid–base disturbances in patients with chronic liver disease is essential to improve prognosis on the basis of pulmonary and liver diseases. The aim of the current study was to detect arterial blood gas changes, acid–base disturbances, and prevalence of hepatopulmonary syndrome (HPS) in different classes of severity of chronic hepatic disease for achieving a higher survival rate. Results Patients with hypoxemia represented 38 (33.6%) cases: three (15.7%) of 19 patients in group A, 16 (33.3%) of 48 patients in group B, 12 (34.2%) of 35 patients in group C, and seven (63.6%) …

Study Of Autophagy-Related Gene 5 Polymorphism In Hepatocellular Carcinoma Complicating Chronic Hepatitis C, Mary A. Naguib, Mohamed S. Moustafa, Mona M. Hassouna, Yasmen A. Elhagali

Menoufia Medical Journal

Objective To evaluate autophagy-related gene 5 (ATG5) rs510432 T/C polymorphism in hepatocellular carcinoma (HCC) complicating chronic hepatitis C. Background HCC represents a universal health problem. Among Egyptians, it ranks the fourth common cancer. Autophagy is an evolutionarily conserved intracellular recycling system that obtains a fundamental role in maintaining metabolism and homeostasis. It was widely stated that dysregulated autophagy has been implicated in cancer development. ATG5 is a key regulator involved in autophagosome formation. Patients and methods A total of 100 participants (40 patients with HCC, 40 patients with liver cirrhosis, and 20 healthy controls) were selected, …

Hemosuccus Pancreaticus As An Initial Presentation Of Decompensated Alcoholic Cirrhosis., Aamir Shahzad, Anish Paudel, Zohaib Yousaf

Tower Health Research Day

No abstract provided.

Surgical And Oncological Outcomes Of Hepatic Resection For Hepatocellular Carcinoma: Report From A Low Volume Centre In A Developing Country, Muhammad Rizwan Khan, Saleema Begum, Muhammad Tayyab Ul Hasan Siddiqui

Section of General Surgery

Objective: To review the surgical and oncological outcomes of patients who underwent hepatic resection for hepatocellular carcinoma (HCC).
Study design: Cohort study.
Place and duration of study: Department of Surgery of the Aga Khan University Hospital Karachi, from 2008 to 2019.
Methodology: Consecutive patients who underwent hepatic resection for HCC at the Hospital were included. The data were collected and analysed on aspects including demographics, liver function status, tumour characteristics, perioperative management, and surgical and oncological outcomes. Survival analyses were performed using the Kaplan-Meier method, and log-rank test was applied to determine the influence of variables on overall and disease-free …

Transcatheter Aortic Valve Replacement Restoring Candidacy For Liver Transplant In Cirrhotic Patients, Mirna Kaafarani, Omar Shamma, Syed-Mohammed Jafri

Medical Student Research Symposium

Purpose: Current guidelines for preoperative workup for an orthotopic liver transplant (OLT) recommend an echocardiogram that often rule-out patients with superimposed severe aortic stenosis as transplant candidates. The purpose of this study was to shed light on the potential of transcatheter aortic valve replacement (TAVR) as a bridging therapy for liver transplants in cirrhotic patients with severe AS.

Methods: A retrospective chart review was performed on 500 patient records that underwent liver transplantation at a single large tertiary care center between 2017 and mid-2021. Two cases of alcohol cirrhosis were further investigated due to the simultaneous diagnosis of severe AS. …

A Systematic Review Of The Efficacy And Safety Of Fecal Microbiota Transplantation In The Treatment Of Hepatic Encephalopathy And Clostridioides Difficile Infection In Patients With Cirrhosis, Kyaw Min Tun, Annie S. Hong, Kavita Batra, Yassin Naga, Gordon Ohning

Internal Medicine Faculty Publications

The microbiome of the human gut and liver coexists by influencing the health and disease state of each system. Fecal microbiota transplantation (FMT) has recently emerged as a potential treatment for conditions associated with cirrhosis, such as hepatic encephalopathy and recurrent/refractory Clostridioides difficile infection (rCDI). We have conducted a systematic review of the safety and efficacy of FMT in treating hepatic encephalopathy and rCDI. A literature search was performed using variations of the keywords “fecal microbiota transplant” and “cirrhosis” on PubMed/MEDLINE from inception to October 3, 2021. The resulting 116 articles were independently reviewed by two authors. Eight qualifying studies …

Prevalence And Associated Factors Of Anxiety And Depression In Liver Cirrhosis At Outpatient Clinic, Naphat Sirinimnualkul, Piyawat Komolmit, Teerayuth Rungnirundorn

Chulalongkorn Medical Journal

Background: Liver cirrhosis is one of the chronic medical conditions which frequently leads to psychiatric comorbidities including depression and anxiety disorder. Objective: The aim of this study was to evaluate the prevalence and associated factors of anxiety and depression in patients with liver cirrhosis in outpatient clinic. Methods: Patients with liver cirrhosis aged from 18 years and above, excluded active liver malignancy, were recruited from liver clinic at outpatient of department of medicine. Anxiety and depression were identified using Thai Hospital Anxiety and Depression Scale (THAI-HADS). Descriptive statistic was applied to estimate prevalence of anxiety and depression and factors associated …

Impact Of Compensated Cirrhosis On Survival In Patients With Acute-On-Chronic Liver Failure, Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K. Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Saeed Hamid, Amna Subhan Butt

Section of Gastroenterology

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were …

Relationship Between Proton-Pump Inhibitor Use And Spontaneous Bacterial Peritonitis In Cirrhotic Patients With Ascites, Abdullah A. Bahnacy, Ashraf Gharieb Dela, Belal A. E. Montaser, Mohamed H. Badr, Mostafa M. Farrag

Menoufia Medical Journal

Objective The aim of this study was to assess the occurrence of spontaneous bacterial peritonitis in cirrhotic patients with ascites and is relationship to proton-pump inhibitor (PPI) use. Background Gastric acid plays an important role in resisting intestinal pathogens. Changes in gastric pH induced by antacids may damage the gastric protective barrier. Patients and methods This prospective cohort study was conducted on 100 patients of 18 years old or more, both sexes with liver cirrhosis and ascites. Patients were divided into two groups (50 patients in each); group (PPI use positive) with a history of PPIs use in the last …

Interventional Treatment With The Transjugular Intrahepatic Portosystemic Shunt (Tips) Procedure May Offer A Preferable Alternative To Systemic Anticoagulation In Patients With Cirrhosis And Portal Vein Thrombosis, Molly N. Pantelic

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Wang Z, Jiang MS, Zhang HL, et al. Is post-tips anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology. 2016;279(3):943-951. https://doi.org/10.1148/radiol.2015150369

for a patient with cryptogenic cirrhosis, gastroesophageal varices, pancreatic cancer, and portal vein thrombosis.

Diagnostic Accuracy Of The Forns Score For Liver Cirrhosis In Patients With Chronic Viral Hepatitis, Tayyaba Bukhari, Lena Jafri, Hafsa Majid, Sibtain Ahmed, Aysha Habib Khan, Shahab Abid, Aniqa Raza, Imran Siddiqui

Department of Pathology and Laboratory Medicine

Introduction: Liver cirrhosis is an irreversible and end-stage disease. It results from chronic liver damage characterized by the replacement of normal liver tissue by fibrosis, leading to the progressive loss of liver function. Making an early diagnosis of cirrhosis is important for patients with chronic hepatitis because early antiviral therapy can prevent the progression of cirrhosis and even induce regression. There have been efforts to develop surrogate markers for liver cirrhosis as the biopsy is invasive, costly, and difficult to standardize.
Methods: This was a cross-sectional study conducted at the Section of Chemical Pathology, the Department of Pathology and Laboratory …

Streptococcus Cristatus – An Oral Bacterium Causing A Case Of Mild Bacteremia And “Possible Endocarditis”, Camilo Guzman, Adi Zaclli, John Molinari

Medical Student Research Symposium

Streptococcus cristatus is a member of the Mitis streptococcus group. Like other members of this group, it resides in mucosal surfaces of the oral cavity but rarely causes disease. We present a case of S. cristatus bacteremia and “possible endocarditis” (per the modified Duke criteria) in a 59-year-old male suffering from end- stage cryptogenic cirrhosis. To date, it is the fifth reported case of disease caused by the microbe, and the first adult case in which S. cristatus was the sole microbe identified. Our patient had a history of dental caries and poor dentition, which were likely the source of …

Critical Importance Of Using Fibroscan To Identify Patients With Cirrhosis In A Predominantly African American Patient Population, Sarah Nasser, Katherine Wong, Paul Naylor, Murray Ehrinpreis, Milton Mutchnick

Medical Student Research Symposium

Introduction: Identifying patients with cirrhosis is complicated, but the availability of Transient Elastography by FibroScan for non-invasive assessment of fibrosis appears to have resolved this issue. The objective of our study was to use a Fibroscan database to identify patients with cirrhosis in our primarily African American Hepatitis C patients and to track outcome especially of patients with Hepatitis C (HCV).

Methods: The electronic medical records of 79 out of the 332 individuals (24%) with a Fibroscan between 2014 and 2016 and a score of >12.5 kPa laboratory values recorded, and etiology and outcomes evaluated. AST to Platelet …

Improving The Care Of Patients With Cirrhosis At Mmc, Lesley B. Gordon, Elizabeth Herrle, Matt Buttarazzi, Monica Thim, Jenna S. Ptaschinski, Victoria Molina, Natalie Channell

Costas T. Lambrew Research Retreat 2021

Purpose: Improve the rate and timeliness of paracenteses for patients with decompensated cirrhosis.

A Comparison Of The Prevalence Of Cirrhosis In A Hispanic And Non-Hispanic Population Based On Body Mass Index, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Jose Campo Maldonado, Angel Rendon

MEDI 9331 Scholarly Activities Clinical Years

Background and Significance

The obesity epidemic is a growing public health concern. In addition to the already known complications and comorbidities associated with obesity, data suggest that obesity is an independent risk factor for the development of liver disease. ^1,2 However, there is a paucity of data regarding the clinical correlation of obesity and cirrhosis in a predominantly Hispanic population. Therefore, the aim of this study is to investigate the prevalence of cirrhosis stratified by BMI in a predominately Hispanic population.

Materials and Methods

This retrospective single-centered study was approved by the University of Texas Rio Grande Valley institutional ethics …

Study Of Glycated Albumin To Glycated Hemoglobin Ratio As A Predictor Of Esophageal Varices Bleeding Risk, Belal A. E Mohsen Montaser, Ehab A. Elatty, Elsayed I. Elshayeb, Mohammed H. Badr, Mokhtar S. Hewezy

Menoufia Medical Journal

Objectives To evaluate glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio as a predictor of variceal bleeding in patients with liver cirrhosis. Background Variceal hemorrhage is a severe complication of liver cirrhosis and can be a direct cause of bleeding-related death. Therefore, upper endoscopy is considered necessary for all cirrhotic patients to evaluate the risk of variceal bleeding. Patients and methods A prospective clinical study was conducted on 100 patients with chronic hepatitis C-related cirrhosis who attended the Gastrointestinal Endoscopy Unit of the Department of Internal Medicine, Menoufia University hospitals, during the period between January 2017 and March 2018. Liver …

Changing Population Of Liver Transplant Recipients In The Era Of Direct-Acting Antiviral Therapy, Chencheng Xie, Yong-Fang Kuo, Ashwani K Singal

Division of Gastroenterology and Hepatology Faculty Papers

Background and Aims: With the availability of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection and changing liver disease etiology for liver transplantation (LT), data on the changes in LT recipient population in the DAA era are scanty. Methods: The United Network for Organ Sharing (UNOS) registry (01/2007 to 06/2018) was used to develop a retrospective cohort of LT recipients for HCV, alco-hol-associated liver disease (ALD), and non-alcoholic steato-hepatitis (NASH). LT recipients in the DAA era (2013-2018) were compared with those in the pre-DAA era (2007-2012) era for recipient characteristics. Chi-square and analysis of variance were the statistical …

Outcomes Of Patients Hospitalized With Community-Acquired Pneumonia With Liver Disease Or Cirrhosis., Bibodh Jung Karki, Sravan K. Ponnekanti, Vidyulata Salunkhe, Nishita Tripathi, Mahder A. Tella, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease.

Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three …

Cirrhosis For The Pcp, Krys Foster, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Understand the morbidity and mortality associated with Cirrhosis in the United States
• Recognize etiologies and clinical presentation of cirrhosis
• Identify decompensated cirrhosis and approaches to treatment and monitoring

Agenda

• Definition and Epidemiology
• Etiologies
• Clinical Presentation
• Diagnosis and Evaluation/Classification
• Management of Compensated Cirrhosis
• Decompensated Cirrhosis & Complications
• ○ Portal Hypertension ○ Varices ○ Ascites ○ SBP ○ Hepatorenal Syndrome ○ Hepatic Encephalopathy
• Secondary Prevention and Long Term Management
• Conclusions

Insulin Resistance As A Noninvasive Predictor Of Esophageal Varices In Hepatitis C Virus Cirrhotic Patients, Ahmed R. El-Gazzarah, Atef A. Ali, Belal A. Montaser, Heba G. Abdel-Fattah

Menoufia Medical Journal

Objectives The aim was to evaluate sensitivity and specificity of insulin resistance (IR) as a noninvasive predictor of esophageal varices (EV) in hepatitis C virus (HCV) cirrhotic patients. Background Variceal bleeding due to portal hypertension is associated with a high probability of circulatory dysfunction and even death. However, routine endoscopy is an invasive maneuver which consumes effort, time, and money. IR was studied as an early noninvasive predictor of EV. Patients and methods Eighty cirrhotic patients were included in this prospective case–control study and 20 nondiabetic nonhepatic patients served as the control group. Patients were recruited from the Gastrointestinal Endoscopy …

The Sonographic Progression Of Non-Alcoholic Fatty Liver Disease Into Non-Alcoholic Cirrhosis Of The Liver, Giana Tondora

Student Research Poster Presentations 2020

Cirrhosis is quickly becoming a prevalent disease in the United States alone and affects 1 in every 400 Americans. Cirrhosis occurs when the liver's fibrous bands are no longer fibrous in response to the liver being scarred and no longer being able to filter toxins from the blood. Ultrasound is a key tool along with blood tests that allows cirrhosis to definitively be detected and diagnosed in patients. Cirrhosis can be either non-alcoholic or alcoholic depending on the patient’s history and there are distinct differences in appearance of the liver sonographically as well as symptoms and treatment of this disease …

Prevalence Of Chronic Liver Disease In Patients With Covid-19 And Their Clinical Outcomes: A Systematic Review And Meta-Analysis, A. J. Kovalic, S. K. Satapathy, P. J. Thuluvath

Journal Articles

No abstract provided.