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Abstract
Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.
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Key Words
- AAPC, Average annual percentage change
- ABIC, Age, Serum bilirubin, INR and serum Creatinine
- ABV, Alcohol by volume
- ALD, Alcohol-associated liver disease
- AUD, Alcohol use disorder
- BAC, Blood alcohol concentration
- CDC, Centers for Disease Control and Prevention
- COVID-19, Coronavirus disease 2019
- GAHS, Glasgow alcoholic hepatitis score
- HE, Hepatic encephalopathy
- HRS, Hepatorenal syndrome
- ICD-10, International Classification of Diseases, 10th Edition
- MDF, Maddrey's Discriminant Function
- MELD, Model of end-stage liver disease
- MRI, Magnetic resonance imaging
- NHANES, National Health and Nutrition Examination Survey
- NIAAA, National Institute of Alcohol Abuse and Alcoholism
- NIS, National inpatient sample
- NSDUH, Annual National Survey on Drug Use and Health
- SAMHSA, Substance Abuse and Mental Health Services Administration
- US, United States
- USG, Ultrasonography
- WHO, World Health Organization
- YLD, Years of life lost to disability
- alcohol
- alcohol use disorder
- alcoholic cirrhosis
- alcoholic hepatitis
- alcoholic steatosis
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Affiliation(s)
- Aysha Aslam
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, USA
| | - Paul Y. Kwo
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, USA
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Semalti K, Kilambi R, Pal S, Srivastava DN, Sahni P, Madhusudhan KS. Benign Hepatic Nodules in Patients With Primary Extrahepatic Portal Vein Obstruction: Clinical and Magnetic Resonance Imaging Features. J Clin Exp Hepatol 2022; 12:1301-1309. [PMID: 36157149 PMCID: PMC9499837 DOI: 10.1016/j.jceh.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background/objective To retrospectively evaluate the magnetic resonance imaging (MRI) features of benign hepatic nodules in patients with extrahepatic portal vein obstruction (EHPVO) and assess predictable features for their development. Methods This retrospective observational study included 18 diagnosed patients of EHPVO who underwent contrast enhanced abdominal MRI at our Institute between June 2016 and May 2017, and who could be followed up for at least two years. The patients with liver nodules formed the study group (n = 8; 4 males, 4 females; mean age: 26.1 ± 10.9 years) and patients without liver nodules were controls (n = 10; 3 males, 7 females; mean age: 24.2 ± 15.1 years). Liver nodules were confirmed as benign by either biopsy or stability on follow up imaging. MRI features of liver nodules were assessed. Clinical details and imaging data of the study group were compared with controls to assess predictable features. Results There was no statistically significant difference in age, gender, clinical characteristics and upper gastrointestinal endoscopic findings between the study and control groups. The size of the lienorenal collateral, left renal vein and superior mesenteric vein were significantly larger in the study group (P < 0.05). In the study group, the majority had multiple hepatic nodules with most of them being isointense on T1 (18/35; 51.4%) and T2-weighted images (16/35; 45.7%) and showing restriction of diffusion (21/35; 60%). All (n = 35) lesions showed arterial phase hyperenhancement and none showed washout in the venous phase. The patients in the control group did not develop any liver nodules during the follow-up period. Conclusion Liver nodules in patients with EHPVO are likely to be benign and have characteristic MRI features. Significantly larger lienorenal collateral, left renal vein and superior mesenteric vein were associated with the development of these nodules.
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Affiliation(s)
- Kapil Semalti
- Department of Radiodiagnosis and Interventional Radiology. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ragini Kilambi
- Department of Gastrointestinal Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Deep N. Srivastava
- Department of Radiodiagnosis and Interventional Radiology. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kumble S. Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Patel RK, Chandel K, Tripathy T, Choudhury A, Mukund A. Bleeding Stomal Varices and Their Interventional Management- A Series of Three Cases. J Clin Exp Hepatol 2022; 12:649-653. [PMID: 35535115 PMCID: PMC9077216 DOI: 10.1016/j.jceh.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 12/12/2022] Open
Abstract
Although stomal and parastomal varices are uncommon causes of variceal bleeding, the mortality rate might be as high as 40%. Timely intervention is essential for the management of these ectopic bleeding varices. Due to the rarity of such varices, no standard treatment guideline is available. We present three cases of bleeding stomal varices managed with an endovascular approach, one through percutaneous transhepatic and the other two through transjugular intrahepatic portosystemic shunt approach.
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Key Words
- APR, Abdominoperineal resection
- BRTO, Balloon-occluded retrograde transvenous obliteration of stomal varices
- CECT, Contrast-enhanced computed tomography
- CTP score, Child-Turcotte-Pugh score
- GI, Gastrointestinal
- IMV, Inferior mesenteric vein
- MELD, Model for end-stage liver disease
- NASH, Nonalcoholic steatohepatitis
- Na, Sodium
- SMV, Superior mesenteric vein
- SVB, Stomal variceal bleeding
- TIPS, Transjugular intrahepatic portosystemic shunt
- UGIE, Upper gastrointestinal endoscopy
- USG, Ultrasonography
- glue
- stomal varices
- transjugular intrahepatic portosystemic shunt (TIPS)
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Affiliation(s)
- Ranjan Kumar Patel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Taraprasad Tripathy
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Ashok Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India,Address for correspondence: Amar Mukund, Additional Professor, Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India. Tel.: +011-46300000x11176.
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Mahajan VK, Chauhan NS, Rana BS, Mehta KS, Hooda S, Chauhan PS, Kukreja A. The Association Between Chronic Plaque Psoriasis and Nonalcoholic Fatty Liver Disease in Indian Patients: Results of a Pilot Study. J Clin Exp Hepatol 2022; 12:785-792. [PMID: 35677516 PMCID: PMC9168695 DOI: 10.1016/j.jceh.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic dermatosis with potential to cause systemic disease by triggering dysmetabolism, such as metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). We studied the relationship and associations between NAFLD and clinical features, including age, gender, disease duration, and severity of psoriasis in our patients. METHODS This cross-sectional study comprised 61 (m:f, 43:19) patients without pre-existing comorbidities and matched 24 (m:f, 16:8) healthy controls aged between 20 and 68 years. Disease severity was graded as mild, moderate, and severe by psoriasis area and severity index score and body surface area (BSA) involvement. The grades of fatty liver and liver fibrosis were assessed using liver ultrasonography (USG) and transitional vibration-controlled elastography (Fibroscan). RESULTS Overall, 67.2% of patients were aged >40 years, and the duration of disease was <5years in 60.7% of patients. Mild and moderate to severe psoriasis occurred in 78.7% and 21.3% of patients, respectively. BSA was >10% in 57.5% patients. The proportion of NAFLD was 27.9% and 32.8% by USG and Fibroscan compared with 20.8% in controls. Statistically, there was no significant difference or association between the prevalence of NAFLD among patients and controls, and gender, age (mean ± standard deviation, 47.5 ± 13.8 vs. 45.2 ± 15.7), duration, severity of psoriasis, and arthritis between psoriatic patients with and without NAFLD. CONCLUSION This was a pilot study because of the numerosity of sample and highlights trends for possible link between psoriasis and NAFLD, but the results need cautious interpretation and clinical application. Whether NAFLD can be attributed to overall systemic inflammatory process of psoriasis or it occurs as an epiphenomenon of concurrent metabolic syndrome needs elucidation with well-designed studies. Cross-sectional study design, small number of patients, and controls remain major limitations. The study did not compare its findings with liver biopsy.
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Affiliation(s)
- Vikram K. Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India,Address for correspondence: Vikram K Mahajan, Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India.
| | - Narvir S. Chauhan
- Department of Radio Diagnosis, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Baldev S. Rana
- Department of Gastroenterology & Hepatology, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Karaninder S. Mehta
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Sheenam Hooda
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Pushpinder S. Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Amisha Kukreja
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
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Gyawali S, Das SK. Gall bladder Ascariasis: A rare entity. IDCases 2021; 26:e01333. [PMID: 34815938 DOI: 10.1016/j.idcr.2021.e01333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Gall bladder ascariasis is a rare entity. The causative organism for gall bladder ascariasis is Ascaris lumbricoides It usually presents as acute acalculous cholecystitis. Conservative management with anti-helminthic drugs is preferred while sometimes the patient may need surgical intervention.
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Alshaar M, Alkhatib M, Sara S, Alsabek MB. Primary breast angiosarcoma resembling a common benign tumor: A case report. Ann Med Surg (Lond) 2021; 65:102281. [PMID: 33981422 PMCID: PMC8082197 DOI: 10.1016/j.amsu.2021.102281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance The breast angiosarcoma is a rare malignant vascular neoplasm; it represents nearly 0.05% of all breast cancers. Clinically, it could look like a haemangioma or pseudoangiomatous hyperplasia. Here, we report a case of a primary angiosarcoma of the breast (PAB) that mimics a giant fibroadenoma in physical examination and ultrasound features. Case presentation A 22 year-old woman came to our hospital complaining of a mobile non-tender mass in her right breast. It was monitored for a while until it became an 8 × 7 cm2. Past medical and family histories were unremarkable. Ultrasonography showed a well circumscribed hypoechoic lobular mass. The wide excision was performed and the pathological study showed angiosarcoma. The patient was re-operated for total mastectomy, screened for distant Metastases and followed-up closely for one year. Clinical discussion Fibroadenoma-like lesions are not uncommon and physicians should pay an attention for any breast mass even in the patient who is young and has no risk factors of the traditional breast cancer. PAB is used to be missed in the clinical practice over the world; it is extremely rare and is proved by Immunohistochemistry. The full management could be totally completed by a mastectomy with/out axillary node dissection. Conclusion The primary angisarcoma of the breast (PAB) could resemble a fibroadenoma in pre-operative investigations. In many reviews, PAB mimicked many diseases. Thus, the medical literature needs more case reports and series to identify an ideal protocol of diagnosis and management.
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Affiliation(s)
- Muhammad Alshaar
- Department of Surgery, Al-Mouwassat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Mahmoud Alkhatib
- Department of Surgery, Al-Mouwassat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria
| | - Samer Sara
- Department of Surgery, Al-Mouwassat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria
- Al-Jazzera Private University, Damascus, Syria
| | - Mhd Belal Alsabek
- Department of Surgery, Al-Mouwassat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria
- Department of Surgery, Syrian Private University, Faculty of Medicine, Damascus, Syria
- Corresponding author. Faculty of Medicine, Damascus University, Damascus, P.O. Box: 10989, Syria.
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Agarwal A, Joy D, Das P, Dash NR, Srivastava DN, Madhusudhan KS. Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report. J Clin Exp Hepatol 2021; 11:260-263. [PMID: 33746452 PMCID: PMC7953012 DOI: 10.1016/j.jceh.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
Liver rupture in pregnancy is an acute condition with significant risk to the mother and fetus. It is known to occur with tumors such as hepatic adenoma, infective causes such as abscess, granulomatous diseases, and parasitic infections, and rarely spontaneously. Most of these conditions have overlapping clinicoradiological findings, almost always requiring histopathological confirmation. We report a case of a ruptured hepatic lesion, with an unusual diagnosis of Bartonella henselae infection causing cat-scratch disease, in a 24-year-old pregnant lady.
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Key Words
- ALFP, Acute liver failure in pregnancy
- CSD, Cat-scratch disease
- CT, Computed tomography
- FNH, Focal nodular hyperplasia
- HCC, Hepatocellular carcinoma
- HELLP, Hemolysis, elevated liver enzymes, and low platelet
- IFA, Immunofluorescent assay
- Ig-G, Immunoglobulin-G
- MRI, Magnetic resonance imaging
- PCR, Polymerase chain reaction
- USG, Ultrasonography
- cat-scratch disease
- hemorrhagic liver lesion
- liver rupture in pregnancy
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Affiliation(s)
- Ayushi Agarwal
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Danny Joy
- Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prasenjit Das
- Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nihar R. Dash
- Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Deep N. Srivastava
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kumble S. Madhusudhan
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Address for correspondence: Kumble S. Madhusudhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Makhija N, Vikram NK, Srivastava DN, Madhusudhan KS. Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2021; 11:654-660. [PMID: 34866843 PMCID: PMC8617527 DOI: 10.1016/j.jceh.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. MATERIALS AND METHODS Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imaging with DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. RESULTS There was a weak correlation between ADC values and PDFF (r = -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r = -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). CONCLUSION DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.
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Affiliation(s)
- Nikhil Makhija
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Naval K. Vikram
- Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Deep N. Srivastava
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Kumble S. Madhusudhan
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India,Address for correspondence: Kumble S. Madhusudhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Nagral A, Adhyaru K, Rudra OS, Gharat A, Bhandare S. Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic - A Case Series. J Clin Exp Hepatol 2021; 11:732-738. [PMID: 34230786 PMCID: PMC8252698 DOI: 10.1016/j.jceh.2021.06.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has resulted in widespread use of complementary and alternative medicines. Tinospora cordifolia is a widely grown shrub which has been commonly used in India's traditional system of Ayurveda for its immune booster properties and has been extensively used as prophylaxis against COVID-19. Six patients (4 women, 2 men) with a median (IQR) age of 55 years (45-56) and with an history of Tinospora cordifolia consumption presented with symptoms of acute hepatitis during the study period of 4 months in the COVID-19 pandemic. The median (IQR) duration of Tinospora cordifolia consumption was 90 days (21-210). The median (IQR) peak bilirubin and AST were 17.5 mg/dl (12.2-24.9) and 1350 IU/ml (1099-1773), respectively. The patients had either a definite (n = 4) or probable (n = 2) revised autoimmune hepatitis score with an autoimmune pattern of drug-induced liver injury on biopsy. Four of these patients (all women) had underlying silent chronic liver disease of possible autoimmune etiology associated with other autoimmune diseases - hypothyroidism and type 2 diabetes mellitus. One of the three patients treated with steroids decompensated on steroid tapering. The other five patients had resolution of symptoms, liver profile, and autoimmune serological markers on drug withdrawal/continuing steroid treatment. The median (IQR) time to resolution from discontinuing the herb was 86.5 days (53-111). Tinospora cordifolia consumption seems to induce an autoimmune-like hepatitis or unmask an underlying autoimmune chronic liver disease, which may support its immune stimulant mechanism. However, the same mechanism can cause significant liver toxicity, and we recommend that caution be exercised in the use of this herb, especially in those predisposed to autoimmune disorders. Besides, in patients presenting with acute hepatitis, even in the presence of autoimmune markers, a detailed complementary and alternative medicine history needs to be elicited.
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Key Words
- AIH, Autoimmune hepatitis
- ALT, Alanine Transaminase
- ASMA, Anti-Smooth Muscle Antibody
- AST, Aspartate Transaminase
- CAM, Complementary and Alternative Medicines
- COVID-19, Coronavirus Disease of 2019
- DILI, Drug-Induced Liver Injury
- Giloy
- IQR, Inter Quartile Range
- IgG, Immunoglobulin G
- LFT, Liver Function Tests
- RUCAM, Roussel Uclaf Causality Assessment Method
- SMT, Standard medical treatment
- TC, Tinospora cordifolia
- ULN, Upper Limit of Normal
- USG, Ultrasonography
- drug induced liver injury
- drug-induced autoimmune hepatitis
- herb induced liver injury
- tinospora cordifolia
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Affiliation(s)
- Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India,Department of Gastroenterology, Apollo Hospital, Navi Mumbai, India,Address for correspondence. Aabha Nagral, 7, Snehasagar, Prabhanagar, Prabhadevi, Mumbai, 400025, India. Tel.: +919820156834.
| | - Kunal Adhyaru
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Omkar S. Rudra
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Amit Gharat
- Department of Gastroenterology, Apollo Hospital, Navi Mumbai, India
| | - Sonal Bhandare
- Department of Pathology, Jaslok Hospital and Research Centre, Mumbai, India
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Jain S, Thanage R, Panchal F, Rathi PM, Munshi R, Udgirkar SS, Contractor QQ, Chandnani SJ, Sujit NP, Debnath P, Singh A. Screening of Family Members of Nonalcoholic Fatty Liver Disease Patients can Detect Undiagnosed Nonalcoholic Fatty Liver Disease Among Them: Is There a Genetic Link? J Clin Exp Hepatol 2021; 11:466-474. [PMID: 34276153 PMCID: PMC8267349 DOI: 10.1016/j.jceh.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) has multifactorial origin. Genetic and environmental factors lead to the biology of this complex disorder. In this study, we screened parents of cases with NAFLD and compared them with parents of cases without NAFLD to see its familial aggregation and the role of patatin-like phospholipase domain containing 3 (PNPLA3). METHOD It was a cross-sectional study. Parents of probands with NAFLD and without NAFLD were screened with abdominal sonography, anthropometry, blood tests, transient elastography, and PNPLA3 polymorphism. RESULTS We had enrolled 303 individuals: 51 probands with NAFLD, 50 probands without NAFLD, and their 202 parents. Parents of the NAFLD group had significantly higher metabolic risk factors as compared with parents of the non-NAFLD group. They had a significantly higher rate of fatty liver (P = 0.0001), mean serum aspartate aminotransferase levels (P = 0.011), mean serum alanine aminotransferase levels (P = 0.001),raised fasting and postprandial blood sugar levels, lower mean platelets (P = 0.033) and serum albumin levels (P = 0.005), and higher mean liver stiffness (P = 0.001) on transient elastography.Frequency of PNPLA3 polymorphism within NAFLD group was higher compared to the non-NAFLD group (mutant GG-13.3 vs 3.3%). Similarly, parents of NAFLD group had mutant GG in 15 % versus 5% in parents of non-NAFLD group, (P = 0.105, odds ratio 6), though it was not statistically significant but may be relevant. In this study, offsprings of parents with nonalcoholic steatohepatitis were likely to have GG homozygous allele. A NAFLD16 score based on parent's parameters was calculated to predict the probability of NAFLD occurrence in an overweight obese individual. CONCLUSION Screening of parents of individuals with NAFLD will help in the identification of undiagnosed NAFLD cases and other metabolic risk factors among them as there is a familial aggregation of NAFLD. One can predict the occurrence of NAFLD in the next generation using the NAFLD16 score.
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Key Words
- ALT, Alanine Aminotransferase
- APRI, AST/Platelet Ratio Index
- AST, Aspartate Aminotransferase
- BMI, Body Mass Index
- FBS, Fasting Blood Sugar
- FIB-4, Fibrosis-4 Index
- HDL, High-Density Lipoprotein
- HOMA IR, Homeostatic Model Assessment of Insulin Resistance
- HWE, Hardy-Weinberg Equilibrium
- I148M, isoleucine to methionine
- IAAT, Intra-Adipose Tissue Thickness
- LSM, Liver Stiffness Measurement
- NAFLD
- NAFLD, Nonalcoholic Fatty Liver Disease
- NAFLD16 score
- NASH, Nonalcoholic Steatohepatitis
- PLBS, Postprandial Blood Sugar
- PNPLA3
- PNPLA3, Patatin-like Phospholipase Domain Containing 3
- SNP, single-nucleotide polymorphism
- TE, Transient Elastography
- USG, Ultrasonography
- WHR, Waist-Hip Ratio
- familial aggregation of NAFLD
- transient elastography
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Affiliation(s)
- Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India,Address for correspondence. Dr.Shubham Jain, Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India.
| | - Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Falguni Panchal
- Molecular Genetic Laboratory, Department of Clinical Pharmacology, Topiwala National Medical College and BYL Nair Ch.Hospital, Dr.AL Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Pravin M. Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Renuka Munshi
- Molecular Genetic Laboratory, Department of Clinical Pharmacology, Topiwala National Medical College and BYL Nair Ch.Hospital, Dr.AL Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Suhas S. Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Qais Q. Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Sanjay J. Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Nair P. Sujit
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Anupam Singh
- Department of Medicine, Santosh Medical College and University, Ghaziabad, (U.P), 201001, India
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11
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Mukund A, Vats P, Jindal A, Patidar Y, Sarin SK. Early Hepatocellular Carcinoma Treated by Radiofrequency Ablation-Mid- and Long-Term Outcomes. J Clin Exp Hepatol 2020; 10:563-573. [PMID: 33311893 PMCID: PMC7719976 DOI: 10.1016/j.jceh.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a standard treatment for small inoperable hepatocellular carcinoma (HCC). Studies on mid- and long-term outcome of RFA as first-line therapy for HCC from India are limited. METHODS We evaluated consecutive HCC patients who underwent RFA as primary treatment modality at our institute between July 2009 and April 2016. The median follow-up period was 26 months, range 1-84 months. We evaluated post-RFA tumor response, disease-free survival (DFS), overall survival (OS), and local tumor progression (LTP). Prognostic factors were also analyzed. RESULTS In 147 patients (male:female = 121:26; mean age, 59.2 years), 209 RFA sessions were done for 228 lesions (mean size of 21.5 ± 8.3 mm, range 10-50 mm). Primary success rate was 94.2%. The estimated cumulative proportion survival at 1, 3, and 5 years was 90.2%, 63.8%, and 60.2%, respectively. The cumulative incidence of LTP estimated at 1, 3, and 5 years was 13.1%, 19.7%, and 20.1%, respectively. The mean estimate of LTP-free survival was 53.6 months (95% confidence interval: 0.49-0.58) which is 58.2 months in <3 cm lesions and 20.4 months in >3 cm lesions (P < 0.01). There was no significant difference in LTP rates between lesions in perivascular versus nonperivascular location (P = 0.71) and surface versus parenchymal lesions (P = 0.66). The mean DFS was 30.3 months (95% CI: 25.6-35.0). For OS, age and Child-Turcotte-Pugh class B were significant factors while for LTP, tumor size >3 cm was significant. Higher baseline alpha-fetoprotein level and LTP were poor predictors for DFS. Complication rate per RFA session was 7/209 (3.3%). CONCLUSIONS RFA is a safe and effective curative modality for first-line treatment of HCC < 3 cm.
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Key Words
- AASLD, The American Association for the Study of Liver Diseases
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona Clinic Liver Cancer
- CTP, Child–Turcotte–Pugh score
- DFS, Disease-free survival
- FNAC, Fine needle aspiration cytology
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- INR, International normalized ratio
- LT, Liver transplantation
- LTP, Local tumor progression
- MELD, Model for end-stage liver disease
- MWA, Microwave ablation
- NASH, Nonalcoholic steatohepatitis
- OS, Overall survival
- PIVKA-II, Protein induced by vitamin K absence-II
- PS, Performance status
- RFA, Radio-frequency ablation
- SIR, Society of Interventional Radiology
- TACE, Transarterial chemoembolization
- TIPS, Transjugular intrahepatic portosystemic shunt
- USG, Ultrasonography
- alpha-fetoprotein
- cirrhosis
- hepatocellular carcinoma
- mRECIST, Modified response evaluation criteria in solid tumors
- radiofrequency ablation
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Prayas Vats
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India,Address for correspondence. Ankur Jindal, MD, DM, Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
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12
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Wani MA, Sodhi JS, Yatoo GN, Shah A, Geelani S, Zargar SA, Gulzar GM, Khan M, Aziz SA. Clinical Profile and Efficacy of Antivirals in Hepatitis B Virus Reactivation, in Patients With Cancer Receiving Chemotherapy. J Clin Exp Hepatol 2020; 10:590-598. [PMID: 33311896 PMCID: PMC7719970 DOI: 10.1016/j.jceh.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/PURPOSE Hepatitis B virus reactivation (HBVR) is common in patients withcancer. The aim of the present study was to find out clinical profile of patients with cancer receiving chemotherapy with HBVR and to study the efficacy of entecavir (ETV) and tenofovir in the treatment of HBVR. METHODS This is a prospective study in which all consecutive patients with cancer with evidence of HBVR were included. HBVR was defined as: New onset transaminitis with alanine aminotransferase (ALT) >3 times upper limit of normal and >10 fold increase in HBV DNA levels from baseline levels or detection of HBV DNA ≥100,000 IU/ml in patients with no baseline HBV DNA. Patients with HBVR were put on ETV or tenofovir and were closely monitored for efficacy and safety for minimum of 1 year. RESULTS Of 204 Hepatitis B surface antigen (HBsAg)-positive patients with different cancers, 92 met the inclusion criteria. Of 92, 46 received ETV 0.5 mg/day and 46 received tenofovir disoproxil fumarate (TDF) 300 mg/day. At 6 months, there was 4.7 log reduction in HBV DNA level in the ETV group and 5.2 log reduction in the TDF group (P = 0.029). Proportion of patients with undetectable HBV DNA (75.7% vs 87.5%), ALT normalization (89.2% Vs 87.5%), HBsAg negativity (25% vs 28.1%), and seroconversion (2.8% vs 3.1%) at 1 year were almost similar in both groups with P value > 0.05 for all efficacy end points. There was no HBVR-related mortality in any group. CONCLUSION Both ETV and tenofovir are very effective in the treatment of HBVR and reduce the liver-related mortality and morbidity in such patients.
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Key Words
- AASLD, American Association of Study of Liver Diseases
- ADR, Adverse Drug Reaction
- ALT, Alanine Aminotransferase
- ANOVA, Analysis of Variance
- CHB, Chronic Hepatitis B
- CT, Chemotherapy
- CXR, Chest X-ray
- EASL, European Association of Study of Liver
- ETV, Entecavir
- HBV, Hepatitis B Virus
- HBVR, Hepatitis B Virus reactivation
- HCC, Hepatocellular Carcinoma
- INASL, Indian National Association of Study of Liver
- PCR, Polymerase Chain Reaction
- TAF, Tenofovir Alafenamide
- TDF, Tenofovir Disoproxil Fumarate
- USG, Ultrasonography
- cancer
- chemotherapy
- reactivation
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Affiliation(s)
- Manzoor A. Wani
- Jawahar Lal Nehru Memorial Hospital(JLNMH), Srinagar, J&K, India
- Address for correspondence. Manzoor Ahmad Wani (MD, DM Gastroenterology and Hepatology), Consultant Gastroenterology and Hepatology, Jawahar Lal Nehru Memorial hospital(JLNMH) 584, lane 5, Umer Colony B,Lalbazar, Srinagar,J&K, India. 190023.
| | - Jaswinder S. Sodhi
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
| | - Ghulam N. Yatoo
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
| | - Altaf Shah
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
| | | | - Showkat A. Zargar
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
| | - Ghulam M. Gulzar
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
| | - Mushtaq Khan
- Department of Gastroenterology and Hepatology, Sheri Kashmir Institute of Medical Sciences (SKIMS), India
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13
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Makhija N, Vikram NK, Kaur G, Sharma R, Srivastava DN, Madhusudhan KS. Role of Magnetic Resonance Imaging in the Monitoring of Patients with Nonalcoholic Fatty Liver Disease: Comparison with Ultrasonography, Lipid Profile, and Body Mass Index. J Clin Exp Hepatol 2020; 10:139-149. [PMID: 32189929 PMCID: PMC7067995 DOI: 10.1016/j.jceh.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this study was to study the role of magnetic resonance imaging (MRI) in monitoring hepatic fat content in cases of nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS 41 adults (mean age: 39 years, 22 males; 19 females) with NAFLD were included after obtaining approval from the institutional ethics committee. The baseline clinical (weight, body mass index [BMI]) and biochemical parameters, fatty liver grade on ultrasonography (USG), and hepatic fat signal fraction (FSF) using dual-echo chemical shift imaging and proton density fat fraction on magnetic resonance spectroscopy (MRS-PDFF) were assessed, before and after intervention (dietary and lifestyle changes and oral vitamin E for six months). They were categorized into Group A (good compliance to intervention) and Group B (poor compliance), and the clinical and imaging parameters were compared between them. RESULTS After intervention, Group A (n = 30) showed significant reduction in BMI (28.35 ± 3.25 to 27.14 ± 3.24 kg/m2; P < 0.001), hepatic FSF (19.30 ± 9.09% to 11.18 ± 7.61%; P < 0.05), and MRS-PDFF (18.79 ± 8.53% to 10.64 ± 6.66%). In Group B (n = 11), there was significant increase in BMI (28.85 ± 2.41 to 29.31 ± 2.57 kg/m2; P < 0.001), hepatic FSF (18.96 ± 9.79% to 21.48 ± 11.80%; P < 0.05), and reduction in high-density lipoproteins (P < 0.05). Although there was good correlation between USG and MRS in quantifying liver fat (r = 0.84-0.87; P < 0.001), USG was unable to detect <5.3% change in hepatic fat. There was poor correlation between lipid profile and MRS-PDFF. Change in body weight significantly correlated with change in hepatic fat content (r = 0.76; P < 0.001). CONCLUSION MRI is useful in accurately quantifying and in monitoring hepatic fat content and is better than clinical and biochemical parameters and USG.
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Key Words
- BMI, Body Mass Index
- CSI, Chemical Shift Imaging
- FSF, Fat Signal Fraction
- HCC, Hepatocellular Carcinoma
- HDL, High Density Lipoproteins
- LDL, Low Density Lipoproteins
- MRI, Magnetic Resonance Imaging
- MRS, Magnetic Resonance Spectroscopy
- NAFLD, Non-Alcoholic Fatty Liver Disease
- NASH, Non-Alcoholic SteatoHepatitis
- PDFF, Proton Density Fat Fraction
- USG, Ultrasonography
- fatty liver
- magnetic resonance imaging
- nonalcoholic fatty liver disease
- ultrasonography
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Affiliation(s)
- Nikhil Makhija
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Gurdeep Kaur
- Department of Dietetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Deep N. Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India
| | - Kumble S. Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 10029, India,Address for correspondence: Dr K S Madhusudhan, Associate Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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14
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Shah D, Mandot A, Cerejo C, Amarapurkar D, Pal A. The Outcome of Primary Hepatic Neuroendocrine Tumors: A Single-Center Experience. J Clin Exp Hepatol 2019; 9:710-5. [PMID: 31889752 DOI: 10.1016/j.jceh.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary hepatic neuroendocrine tumor is an extremely rare entity. Only case reports are available in the literature. The aim of the study was to analyze the symptoms, diagnosis, management, and the outcome of patients with primary liver neuroendocrine tumors. METHODS In the study, a total of eight patients were diagnosed with primary liver neuroendocrine tumors between 2001 and 2017 in our center. Data were analyzed from the records available including the presentation, diagnosis, treatment received, and follow-up. RESULTS Of eight patients, five were males and three were females. The age of presentation was between 35 and 70 years. Two patients had pain in the right side of the abdomen, while it was accidentally detected in two patients in routine checkup. One patient presented with carcinoid syndrome, while two had ascites and one patient presented only with loose motions. Of eight patients, two patients with poorly differentiated neuroendocrine tumor died within 1 month of follow-up. Four patients are still being followed up, while 10-12 years of follow-up data are available for the remaining two patients. Four patients underwent surgery, and three patients received Sandostatin LAR for tumor recurrence after procedure. Transarterial chemoembolization (TACE) of the tumor was performed in two patients for whom resection was not possible. CONCLUSIONS Our data suggest that the prognosis of the tumor seems favorable. Surgical resection is the curative treatment. TACE is a favorable option in unresectable tumors.
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Key Words
- CK 7, Cytokeratin 7
- CT, Computed tomography
- CgA, Chromogranin A
- HIAA, Hydroxyindoleacetic acid
- MRI, Magnetic resonance imaging
- NET, Neuroendocrine tumor
- NSE, Neuron-specific enolase
- PHNET, Primary hepatic neuroendocrine tumor
- TACE, Transarterial chemoembolization
- USG, Ultrasonography
- primary hepatic neuroendocrine tumor
- surgical resection
- transarterial chemoembolization (TACE)
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15
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Tmu N, Kumar A, Sharma P, Singla V, Bansal N, Arora A. Results of Sofosbuvir Plus Ribavirin in Patients With Hepatitis C Related Decompensated Cirrhosis. J Clin Exp Hepatol 2019; 9:4-12. [PMID: 30765933 PMCID: PMC6363947 DOI: 10.1016/j.jceh.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sofosbuvir (SOF), a direct acting antiviral, has revolutionized the treatment of chronic Hepatitis C Virus (HCV) infection. However, data is scarce about efficacy of SOF plus Ribavarin (RBV) in Indian patients with decompensated cirrhosis. We evaluated the efficacy of SOF plus RBV in decompensated cirrhosis, and compared the outcome with compensated cirrhosis and non-cirrhotics. PATIENTS AND METHODS Consecutive decompensated cirrhotic patients of chronic HCV with detectable HCV RNA were treated with 24-week course of SOF (400 mg) plus weight based RBV. Sustained Virological Response (SVR), Child Turcotte Pugh (CTP) and Model for Endstage Liver Disease (MELD) scores were assessed at 36 weeks (i.e. 12 weeks after completion of therapy). Non-cirrhotic chronic hepatitis C patients and patients with compensated cirrhosis treated with SOF plus RBV during the same period were used as controls. During the period of this study ledipasvir and daclatasvir were not available in India. RESULTS A total of 47 patients [median age 50 (29-82) years, 64% males] with decompensated cirrhosis were included as 'cases' in the study; while, 27 patients with compensated cirrhosis and 29 patients with chronic hepatitis were included as 'controls'. Age, gender, HCV RNA levels, and genotype distribution were similar in cases and controls. The median CTP and MELD scores of cases were 8 (7-12) and 13 (6-25), respectively. Among cases 39 (83%) could complete the therapy, while 1 (2%) was intolerant and 7 (15%) died before completion of therapy. End of Treatment Response (ETR) was achieved in 37/39 (95%) cases. Of these, another 3 died before SVR, and 7 failed to achieve SVR, thus 27/34 (79%) could achieve SVR. Thus according to intention-to-treat analysis, only 27/47 (57%) cases could achieve SVR. In comparison, 24/28 (86%) compensated cirrhotics and 27/28 (96%) of chronic hepatitis achieved SVR. There was a significant improvement in mean CTP score in cases who achieved SVR (P < 0.01) compared to those who did not achieve SVR/ETR. On multivariate analysis the only independent factor influencing successful outcome patients was a serum albumin >3.5 g/dL. CONCLUSIONS A 24-week course of SOF plus ribavirin in decompensated HCV cirrhosis could lead to SVR in only 57% of patients. The failure of therapy in 43% patients was either due to non-response, intolerance, or death. A serum albumin of more than 3.5 is associated with success of antiviral therapy. Thus an early initiation of antiviral therapy is recommended before decompensation sets in as it precludes successful outcome.
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Key Words
- CBC, Complete Blood Count
- CHC, Chronic Hepatitis C
- CTP, Child Turcotte Pugh
- DAA, Direct-Acting Antivirals
- ETR, End of Treatment Response
- GFR, Glomerular Filtration Rate
- HBV, Hepatitis B Virus
- HBsAg, Hepatitis B Surface Antigen
- HCC, Hepatocellular Carcinoma
- HCV
- HCV, Hepatitis C Virus
- HIV, Human Immunodeficiency Virus
- LFT, Liver Function Test
- MELD, Model for Endstage Liver Disease
- PegIFN, Pegylated Interferon
- RFT, Renal Function Test
- RNA, Ribo-nucleic Acid
- RVR, Rapid Virological Response
- SOF, Sofosbuvir
- SVR, Sustained Virological Response
- UGI, Upper Gastro-intestinal
- USG, Ultrasonography
- ascites
- decompensated cirrhosis
- direct acting antivirals
- sofosbuvir
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Affiliation(s)
| | | | | | | | | | - Anil Arora
- Address for correspondence: Anil Arora, Chairman, Institute of Liver, Gastroenterology, & Panceatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India. Fax: +91 11 25861002.
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16
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Mitra S, Rathi S, Debi U, Dhiman RK, Das A. Primary Hepatic Leiomyosarcoma: Histopathologist's Perspective of a Rare Case. J Clin Exp Hepatol 2018; 8:321-326. [PMID: 30302051 PMCID: PMC6175749 DOI: 10.1016/j.jceh.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
Primary hepatic leiomyosarcoma is a rare primary mesenchymal tumor of the liver requiring exclusion of any other primary site of origin and histological and immunohistochemical exclusion of other hepatic/extrahepatic tumors with spindle cell morphology. Only about 70 cases are reported in the English literature and many of these tumors have predisposing conditions in the form of immunosuppression or associated malignancies. The occurrence of this tumor in the immunocompetent individual is also known. Histomorphology of this tumor shows a spindle cell lesion which needs to be distinguished from other spindle cell lesions of this region. The main diagnostic challenge of this tumor lies in its rarity, lack of awareness and morphological mimickers in the given site. A complete range of immunohistochemical markers is required to distinguish the lesion from its close morphological mimickers. Here, we discuss a case of primary hepatic leiomyosarcoma in an adult female patient with detailed histomorphological differentials and respective immunoprofiles.
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Key Words
- AFP, Alpha Fetoprotein
- CEA, Carcinoembryonic Antigen
- CEMRI, Contrast Enhanced Magnetic Resonance Imaging
- EBER-ISH
- EBER-ISH, Epstein Barr Encoded RNA-In Situ Hybridization
- EBV, Epstein-Barr Virus
- FDG, Fluorodeoxyglucose
- FNAC, Fine Needle Aspiration Cytology
- GIST, Gastrointestinal Stromal Tumor
- PET-CT, Positron Emission Tomography – Computed Tomography
- SMA
- SMA, Smooth Muscle Antigen
- TPCT, Triple Phasic Computed Tomography
- UGIE, Upper Gastrointestinal Endoscopy
- USG, Ultrasonography
- gastrointestinal stromal tumor
- immunocompetent
- primary hepatic leiomyosarcoma
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Affiliation(s)
- Suvradeep Mitra
- Senior Resident, Department of Histopathology, PGIMER, Chandigarh, India
| | - Sahaj Rathi
- Senior Resident, Department of Hepatology, PGIMER, Chandigarh, India
| | - Uma Debi
- Assistant Professor, Department of Radiology, PGIMER, Chandigarh, India
| | - Radha K. Dhiman
- Professor and Head, Department of Hepatology, PGIMER, Chandigarh, India
| | - Ashim Das
- Professor, Department of Histopathology, PGIMER, Chandigarh, India,Address for correspondence: Ashim Das, Professor, PGIMER, Department of Histopathology, Research Block A, 5th Floor, Chandigarh 160012, India. Tel.: +91 9872223744.
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17
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Agrawal S, Rana BS, Mitra S, Duseja A, Das A, Dhiman RK, Chawla Y. A Case of Acute-on-Chronic Liver Failure (ACLF) Due to An Uncommon Acute And Chronic Event. J Clin Exp Hepatol 2018; 8:95-97. [PMID: 29743800 PMCID: PMC5938333 DOI: 10.1016/j.jceh.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
Acute on Chronic Liver Failure (ACLF) is an acute worsening of patients with chronic liver disease resulting in liver failure. Usually these patients have cirrhosis as the underlying liver disease with alcohol being the most common etiology. Common hepatitic illnesses causing acute worsening in Indian patients of ACLF include alcoholic hepatitis, acute viral hepatitis related to hepatitis E virus and acute flare in chronic hepatitis B. We report an adult case of ACLF due acute viral hepatitis related to hepatitis A virus infection superimposed on nonalcoholic steatohepatitis without cirrhosis.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACLF
- ACLF, Acute on Chronic Liver Failure
- ALT, Alanine Aminotransferase
- APASL, Asia-Pacific Association for the Study of Liver
- AST, Aspartate Aminotransferase
- EASL, European Association for the Study of the Liver
- HAV, Hepatitis A Virus
- HCV, Hepatitis C Virus
- NAFLD
- NAFLD, Nonalcoholic Fatty Liver Disease
- NASH
- NASH, Nonalcoholic Steatohepatitis
- ULN, Upper Limit of Normal
- USG, Ultrasonography
- cryptogenic cirrhosis
- hepatitis A virus
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Affiliation(s)
- Swastik Agrawal
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Baldev S. Rana
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Ajay Duseja, Professor, Department of Hepatology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India. Tel.: +91 172 2756336; fax: +91 172 2744401.
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Raj V, Redkar R, Krishna S, Tewari S. Rare case of transverse testicular ectopia - Case report and review of literature. Int J Surg Case Rep 2017; 41:407-410. [PMID: 29546003 PMCID: PMC5723351 DOI: 10.1016/j.ijscr.2017.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/09/2017] [Accepted: 09/10/2017] [Indexed: 11/16/2022] Open
Abstract
This case report has been reported in line with the SCARE criteria; Consensus-based surgical case report guidelines of International Journal of Surgery 2016. Introduction Transverse Testicular Ectopia (TTE) is a rare condition which manifests with unilateral undescended testis and contralateral hernia. Till now around 100 cases have been described in the literature. The management depends on the anatomy of the vas, vessels and testis found on surgical exploration. An algorithm exists for its management and we propose a modified algorithm for management of TTE. Case presentation Five year male presented with complaints of unilateral undescended testis on the right and hernia on the left. Clinically the right testis was impalpable and left testis palpable in the left hemiscrotum and fluid hernia on the same side. Discussion Transverse testicular ectopia is a rare condition presenting with UDT and contralateral inguinal hernia. Although more than 100 cases have been described in the literature so far, those managed with a transeptal contralateral orchidopexy are two cases to the best of our knowledge. TTE was first described by Von Lenhossek in 1886. The mean age of presentation is around 4 years and most of the cases are diagnosed on surgical exploration. The management of TTE remains controversial even though an algorithm has been described for its management due to its varied presenting scenarios. Conclusion TTE is a rare condition which requires high index of suspicion for diagnosis preoperatively. Whenever suspected we recommend an USG and/or MRI prior to diagnostic laparoscopy and proceed with orchidopexy. Diagnostic laparoscopy is both helpful in diagnosis and management. Transeptal contralateral orchidopexy gives good tension free fixation of testes in the scrotum.
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Affiliation(s)
- Vinod Raj
- Lilavati Hospital & Research Centre, India.
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Mammen S, Keshava SN, Kattiparambil S. Acute Portal Vein Thrombosis, No Longer a Contraindication for Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) Insertion. J Clin Exp Hepatol 2015; 5:259-61. [PMID: 26628844 PMCID: PMC4632077 DOI: 10.1016/j.jceh.2014.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022] Open
Abstract
Portal vein thrombosis, once considered as a contraindication to transjugular intrahepatic porto-systemic shunt (TIPS) is now considered as an indication. We report a case with clinical and technical success in a patient with Budd Chiari syndrome and acute portal venous thrombosis. Though it is a well-established option, with the best of our knowledge, we could not find a report from India.
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Key Words
- BCS, Budd Chiari syndrome
- CT, Computed tomography
- DSA, Digital subtraction angiography
- HCC, Hepatocellular carcinoma
- HV, Hepatic vein
- PV thrombosis
- PV, Portal vein
- PVT, Portal vein thrombosis
- RUPS, Rosch-Uchida liver access set
- TIPS
- TIPS, Transjugular intrahepatic porto-systemic shunts
- USG, Ultrasonography
- thrombolysis
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Affiliation(s)
- Suraj Mammen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004, India,Address for correspondence: Suraj Mammen, Assistant Professor, Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
| | - Shyamkumar N. Keshava
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Sajith Kattiparambil
- Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu 632004, India
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