Hepatic hydrothorax is a term that describes a pleural effusion induced by cirrhosis; these effusions are often resistant to standard medical therapy. The usefulness of pleuroperitoneal shunts for intractable pleural effusions has been reported, but there are few reports describing the use of this shunt for hepatic hydrothorax. We report our successful experience with a pleuroperitoneal shunt for palliative treatment of hepatic hydrothorax in a patient with cirrhosis. Our patient had class B liver cirrhosis per the Child-Pugh classification system. Two months prior to the procedure, she had undergone percutaneous coronary intervention for unstable angina. We selected a pleuroperitoneal shunt for noninvasive, palliative treatment of an intractable pleural effusion in this high-risk patient. After surgery, the pleural effusion was well controlled and our patient was able to live her daily life at home for 6 months before she died of complications related to shunt occlusion. The pleuroperitoneal shunt should be considered a useful treatment option for hepatic hydrothorax, especially in high-risk patients.
Aim: This study aimed to determine the prevalence and risk factors of HIV, HBV and HCV among refugees of the Mbile camp in the East Region of Cameroon. Materials and Methods: This was a cross-sectional study conducted in 2019 in the Mbile refugee camp. All recruited subjects were interviewed and provided blood samples for the screening of Hepatitis B Surface Antigen (HBsAg), anti-HIV and anti-HCV antibodies. Results: A total of 970 were included in this study, 57% being females and the median age was 27.0 years old (standard deviation: 19.2). Among this study population, 75 (7.7%) reacted to HBs antigen, 24 (2.5%) to HCV antibodies, and 17 (1.8%) to HIV antibodies. The identified risk factors for HBV infection were age group 20-39 years (p=0.005), being self-employed (p=0.003), Past medical history of surgery (p=0.014), multiple sex partners (p 40 years (p=0.010), injectable drug use (p=0.042) and history of multiple sex partners (p=0.010) were identified as risk factors. Conclusion: This study revealed an intermediate prevalence of HIV, HBV and HCV infections among refugees residing in the Mbile refugee camp. However, many risk factors for HIV, HBV and HCV infections have been identified in this specific population and could favor the spreading of these viruses. There is an urgent need to improve health policies in order to better control the current situation.
Introduction: the ampullary region is the region of the small intestine that presents the highest frequency of neoplastic transformation and malignancy. Endoscopic ultrasound is nowadays the best tool to examine the papilla and to perform the assessment of locoregional extension of ampullary and peri-ampullary tumors. It also makes it possible to establish the TNM classification with greater sensitivity than other imaging techniques. The aim of this work is to describe the interest of echo endoscopy in ampullary tumors. Methods Data: A 15-month restrospective study (August 2019-November 2020) during which 10 patients were enrolled. We evaluated papilla appearance, tumor parietal staging, associated lesions and the histological results. Results: From August 2019 to November 2020, 10 patients with ampullary tumors were defined. 60% of an enlarged tumor papilla (n = 6), 20% an hypoechoic and homogenous thickening of the papilla, without invasion of the duodenal wall (n = 2), papilla was normal in 20% (n = 2). 3 patients (30%) had a dilated CBD (common bile duct) with a choledocolithiasis, 5 (50%) patients had a gallblader stones. However, EUS revealed an isolated gallstone impaction at the ampulla of Vater in 2 patient (20%) without tumor. 8 patients (80%) underwent a 19G or 22G fine needle aspiration (FNA): Histopathological examination revealed 3 (37%) adenoma with low grade dysplasia, 3 (37%) invasive carcinoma and 2 papillitis (25%). By EUS, 3 (50% ) ampullary lesions were staged as uT2, 2 (33 %) as T1sm, and 1 (16 %) as T3 Conclusion: EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST(endoscopic sphincterotomy). Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important
The stem cells from human exfoliated deciduous teeth (SHED) are multipotent adult mesenchymal stem cells playing essential roles in tissue regeneration and tissue repair. This type of stem cells are able to differentiate into various cell types. Their regenerative ability can be applied in dentistry as well as in various fields of regenerative medicine. The results obtained from experimental trials are generally promising. However clinical trials are still missing because of various challanges. Herein, I focus on the data obtained from fundamental and clinical trials assessing the benefits of SHED on regeneration of tooth decays, wound healing, craniofascial abnormalities, and treatment of various neurological, cardiovascular, digestive and muscular diseases.
Background: The signal transducer and activator of the transcription 4 (STAT4) gene plays an important role in macrophages, dendritic cells, activated peripheral blood monocytes, and Th1-dependent liver injury. AIM: To assess the association of signal transducer and activator of transcription (STAT4) single gene polymorphisms (SNPs) (rs7574865, rs7582694) with type-1 autoimmune hepatitis (AIH) in Egyptian children. MATERIALS AND METHODS: 125 children diagnosed as AIH type-1and 125 control healthy children were included for genotyping of STAT4 SNPs (rs7574865 and rs7582694). Results: STAT4 (rs7574865) GT and TT genotypes increased the risk of AIH type-1 development by 2 and 4 folds regarding the GG genotype (p < 0.019, 0.001 respectively). T allele individuals had about 2.5 folds increased risk of the disease compared to those with G allele (p < 0.001). STAT4 (rs7582694) GC and CC genotypes increased the risk of AIH type-1 by 1.76 and 3.8 folds regarding the GG genotype (p < 0.037, 0.015 respectively). The C allele had about 1.88 folds increased risk of AIH type-1 development than those with the G allele (p = 0.002). Dominant model of either SNPs and the recessive model of rs7574865 only are significant predictors of AIH type-1. Conclusion: Minor alleles of both STAT4 SNPs (rs7574865 T allele, rs7582694 C allele) are associated with an increased risk of type-1 AIH. The disease could be predicted by the dominant model of either SNPs and by the recessive model of rs7574865.
Splanchnic venous thrombosis is one of the known vascular complications of acute pancreatitis. However, acute liver ischemia is rare, and we hereby present a unique case of acute necrotizing pancreatitis leading to acute liver ischemia and decompensated hepatic failure. This case demonstrates vascular complications with serial computed tomography and explores the potential benefit of extracorporeal blood purification in severe pancreatitis.
Recent discoveries have focused on the linking of gut-microbiome and the brain, which are achieved though several pathways, such as vagus nerve, immune system and endocrine system (hypothalamic-pituitary-adrenal axes). In present review we discussed the microbial metabolites, short chain fatty acids, in gastrointestinal functional, neuro-immune regulation and their role in stress-induced behavioral and physiological alterations. Furthermore we discussed the impact on the corticoid action of micRNAs. In case reports we showed that Kampo medicine, Yokukansan with aloe vera juice (AVJ) as an adjuvant exhibited possible efficacy for modulation in brain homeostasis and the drug privation with AVJ provided health maintenance in patient with Hashimoto’s clinical history and well-being QOL.
Overlap syndrome involving autoimmune hepatitis (AIH) and systemic lupus erythematosus (SLE) is a rare condition. The difference between the hepatic involvement of SLE and autoimmune hepatitis has not been clearly defined due to the presence of clinical and laboratory common features. We report a 42-year-old male patient with autoimmune hepatitis who presented with intermittent fever, jaundice, and dyspnea. CT scan showed pleural and pericardial effusion, high titer of antinuclear antibodies and positive anti-DNA antibody were found. Our patient fulfilled both the international criteria of SLE and AIH. Clinical symptoms and laboratory findings improved with treatment by corticosteroids.
Aim : Hepatitis C virus (HCV) infection is one of the most prevalent etiologies for liver cirrhosis and hepatocellular carcinoma. As a result of being highly heterogeneous, HCV has seven confirmed major genotypes and 67 confirmed subtypes. The importance of correctly determining each genotype and its subtype is dependent on choosing the relevant combination and duration of anti-viral treatment. The recombinant HCV genotype 2k/1b was first detailed in St. Petersburg in 2002 among intravenous drug users. Treatment of HCV 2k/1b patients with sofosbuvir and ribavirin resulted in a lowered sustained virologicresponse rate (SVR). The high efficacy of the 3D regimen (ombitasvir/paritaprevir/ritonavir and dasabuvir) has been proven for genotype1b population; however it has not been evaluated for patients with 2k/1b HCV genotype. The aim of this study was to evaluate the efficacy and safety of a twelve week treatment for patients infected with HCV 2k/1b utilizing the 3D regimin - ombitasvir/paritaprevir/ritonavir and dasabuvir (3D). Materials and Methods: This is an open-label, single arm study. Seven patients received ombitasvir/paritaprevir/ritonavir 25/150/100 mg once daily as well as dasabuvir 250 mg twice daily for twelve weeks. Results: Six patients achieved a SVR without significant adverse events. One patient discontinued the treatment at week four due to headaches and vomiting. Conclusions: This study demonstrates the high efficacy and safety of a twelve week treatment of ombitasvir/ paritaprevir/ritonavir and dasabuvir (3D) for adult patients with HCV 2k/1b. ClincialTrials.gov, number NCT03050905
BACKGROUND: In the pediatric population, recurrent abdominal pain (RAP) is one of the most frequent indications of upper gastrointestinal endoscopy. AIM: To evaluate the diagnostic role of upper gastrointestinal endoscopy (UGIE) in children with recurrent abdominal pain. MATERIALS AND METHODS: A three year prospective study was conducted on 100 consecutive children with recurrent abdominal pain who had UGIE. Baseline sociodemographic data, dyspepsia and any alarm symptoms were recorded. Other investigations such as stool analysis for ova, parasites, occult blood and fecal antigen for Helicobacter pylori as well as an abdominal ultrasound were also registered RESULTS: Our children were 47 (47%) males and 53 (53%) females with mean ±SD age of 10.9 ±4.2. Red flag symptoms were seen in 39(39%) of the subjects, and dyspepsia was seen in 52(52%). Endoscopy was diagnostic in 75 patients with the following endoscopic findings were: Esophagitis & hiatus hernia in 7%, gastritis in 39% of cases, nodularity in 25% of cases, 6% had gastric erosion, gastric ulcer was present in 5 %, 14% had hyperemia& erythemic membrane in the duodenum, and duodenal ulcer was seen in 2%. Significantly greater diagnostic yield of UGIE was determined in patients with alarm symptoms (66.6%) compared to those without (OR = 6.7, 95% CI: 2.5-23.3, p = 0.03). CONCLUSION: Upper gastrointestinal endoscopy is a helpful tool for determining the reason of recurrent abdominal pain in children because it provides an accurate assessment of gastrointestinal etiology.
The roles of acemannan and hyaluronan for inflammatory wound healing and recovery of bone were discussed. In case reports bone mineral regeneration, regression of mesenteric lymphadenopathy and microscopic polyangiitis were described. Kampo medicine with aloe vera juice as an adjuvant to connective tissue repair was exhibited.
Gastric cancer is the fifth most commonly diagnosed cancer in the world, with a peak incidence rate at 60 years of age and men affected more than women. Obstructive jaundice is a rare symptom associated with gastric cancer, with a prevalence rate of 2.3%. Management of obstructive jaundice through endoscopic retrograde cholangiopancreatography (ERCP) may be challenging in patients with an altered anatomy, such as a previous history of having undergone a Billroth II. As such, rendezvous techniques of ERCP and percutaneous transhepatic biliary drainage (PTBD) that enter one location through two access points can be used to alleviate the complexities of altered anatomy due to previous abdominal surgery of which ERCP alone was technically difficult and often unsuccessful in problematic conditions. In this case report we present a case of a male with a previous history of a rendezvous technique with ERCP and PTBD, following a Billroth II gastrectomy, and successful stent implantation without any complication.
AIMS: Expression of glutamine synthetase (GS) and cytochrome P-4502E1 (CYP2E1) are notable physiological processes characterizing hepatic metabolic zonation. It is unknown whether liver fibrogenesis modulates GS zonation. CYP2E1 is upregulated in liver fibrogenesis. The present study evaluated metabolic zonation of GS and CYP2E1 in progressive stages of liver fibrosis and whether their expressions were correlated. Methods: 32 cadaveric livers (mean age, 84.8 ± 1.9) with minimal fibrosis, septal fibrosis, bridging fibrosis, incomplete cirrhosis and cirrhosis were studied. Consecutive paraffin sections were immunostained for GS or CYP2E1. GS-positive hepatocytes in perivenous and non-perivenous areas were presented as numbers per central vein and staining scores. Zonal distribution of CYP2E1 was scored. RESULTS: GS-positive hepatocytes increased as fibrosis progressed cumulating in a significantly higher count at the bridging fibrosis stage. The increase was primarily attributed to a greater perivenous hepatocyte GS expression with minor contribution from non-perivenous cells. There was a significantly higher incidence of GS immunoreactivity in the non-perivenous area at the bridging fibrosis stage. GS expression was variable in incomplete cirrhosis and negligible in cirrhosis. GS-positive cell numbers correlated with their staining scores. CYP2E1 zonation was centrilobular and midlobular and occasionally periportal. CYP2E1 immunoreactivity was diffuse in nodular hepatocytes of cirrhosis. Staining scores of GS and CYP2E1 were not correlated. CONCLUSIONS: Increased GS metabolic zonation may reflect a regenerative cellular response to liver injury caused by fibrosis and/or aging-related pathologies. While CYP2E1 expression shows little changes in fibrosis progression, it may have a role in effectuating aging-related hepatic pathologies.
Aim : Helicobacter pylori has revolutionized our thinking on gastric carcinogenesis. However, given the low percentage of infected patients who develop gastric cancer, one may hypothized the presence of factors involving in the carcinogenesis. The aim of our study was to evaluate the prevalence of premalignant lesions: gastric atrophy and intestinal metaplasia in a population infected with Helicobacter pylori ; and to investigate about the factors predicting their development. Methods: This is a prospective study, including 481 patients with H.pylori infection confirmed by histological study of gastric biopsies performed per endoscopy. Results: Among our patients we had 216 (44, 9 %) women and 265 (55,1%) men. Chronic antral gastritis was found in 478 of patients (99,4%) and chronic fundic gastritis in 405 of patients (84,4%). The prevalence of gastric dysplasia was 0.4% . In our patients 12,6 % had gastric atrophy and 7,7 % had intestinal metaplasia. Multivariate analysis showed that only the activity of gastritis is an independent risk factor for the premalignant lesions : Gastric Atrophy : Antrum (OR = 2,66 ; p <0,001 ;) , Fundus : (OR = 2,09 ; p = 0.01 ).Intestinal metaplasia : Antrum : (OR=1,82; p =0,011 ) Fundus (OR=1,8 ; p =0,02 ). Conclusion: The prevalence of gastric atrophy and intestinal metaplasia in patients infected with Helicobacter pylori remains low compared with other countries. The activity of gastritis is significantly associated with these premalignant lesions. Keywords : Helicobacter pylori . Gastritic Atrophy. Intestinal metaplasia.
Historically, the presence of portal venous gas (PVG) on plain abdominal films was an indication for exploratory laparotomy and seen as an ominous finding with a mortality of almost 100%. Over the last decades, the introduction of CT scan has facilitated the diagnosis of PVG with a subsequent decrease in the mortality. PVG has been associated with ischemic bowel but also with other more benign conditions. We describe a case of a young patient with PVG of uncertain etiology with delayed portal vein thrombosis, with a discussion on the different conditions associated with PVG and the approach to the patient with PVG.
Introduction: Cirrhotic people often have impaired nutritional and functional status. Objective: To evaluate the effect of multidisciplinary rehabilitation on cirrhotic patients. Method: Controlled clinical trial conducted at the Gastroenterology Ambulatory in southern Brazil, involving 33 patients with liver cirrhosis, through a multidisciplinary rehabilitation program, distributed into the groups: nutritional intervention (n=22) and functional and nutritional rehabilitation (n=11). Nutritional orientation according to European Society for Clinical Nutrition and Metabolism (ESPEN) Guideline. Functional intervention, during a period of 3 months, three weekly sessions of up to fifty minutes of exercise. Clinical and etiological characteristics, Child Pugh, nutritional, anthropometric and functional aspects were collected. Significant associations values were considered when p<0,05. Results: Mostly male patients (60,6%), average age 58 years (± 11,9 years), prevalence of cryptogenic etiology, Child-Pugh A, well-nourished subjective global assessment (SGA). Significant changes in the parameters abdominal circumference (ABC) (p<0,049), muscular arm circumference (MAC) (p <0,001),six-minute walk test (6mWT) (p<0,001) between the groups, with significant improvement in multidisciplinary rehabilitation. Significant improvement in the indirect parameters of sarcopenia, handshake strength (HS) (p<0,008) and 6mWT (p<0,001), especially in the group with functional and nutritional rehabilitation. Body composition revealed a significant change in multidisciplinary rehabilitation, in Weight (p<0,001), BMI (p<0,001), Phase Angle (PA) (p<0,036), ABC (p<0,002), MAC (p<0,001) and thumb adductor muscle (TAM) (p<0,030), which was not observed in the nutritional intervention group. Conclusion: The multidisciplinary intervention shows positive results, as observed, where the group with the functional and nutritional rehabilitation activity was superior to the group with the isolated nutritional intervention.
Enteric or diarrheal viruses are primarily transmitted through contaminated water, and cause self-limiting gastroenteritis, diarrhea or jaundice. The human coronaviruses (CoV), including the severe acute respiratory syndrome CoV (SARS-CoV-1) and Middle-East respiratory syndrome CoV (MERS-CoV) which are inherently respiratory viruses, also manifest in gastrointestinal tract. Similarly, the novel SARS-CoV-2 also causes diarrhea and liver disorder as well as shed in stool in a proportion of SARS-CoV-2 diseases (COVID-19) patients. This is well supported by detections of SARS-CoV-2 RNA in gut specimen, rectal swabs and stool samples. Recent data on its occurrence in wastewater provides a warning on further spread of COVID-19 in resource-poor countries. Therefore, laboratory test of COVID-19 patients stool along with nasopharyngeal specimen as well as implementation of water surveillances could be very useful in protecting community health.
The impact of hepatitis C virus (HCV) elimination on liver fibrosis has been a hot topic since the introduction of direct-acting antivirals (DAAs). Liver stiffness (LS) can be evaluated non-invasively by transient elastography (TE). We aimed at evaluation of liver stiffness changes by FIB-4 and TE after HCV clearance. Patients and methods : prospectively, 137 patients were included (per-protocol analysis). Baseline liver test profile, LS by TE, and FIB-4 were done. Sustained virologic response was evaluated at 12 weeks after DAAs treatment (SVR12). LS and liver test profiles were re-evaluated after 12 months of follow-up. Results: An SVR12 was achieved among 97.3% of patients. In all patients, the FIB-4 and TE values after HCV elimination was significantly lower than its mean values at baseline (2.20±1.30 vs 3.76±2.23, and 8.32±3.16 v 11.75±5.47 kPa, P < 0.001 respectively). For patients with ≥ F2, 69.6% have fibrosis regression while cirrhosis regressed among 56.1% of patients with F4 at baseline. LS of 17.6 kPa could identify patients with a higher possibility of fibrosis regression (sensitivity= 94.4%, specificity= 82.6%, area under the curve = 0.88, p < 0.001). Fibrosis regression was associated with improvement in aminotransferases, serum albumin, bilirubin, and INR. Gender, age, platelet count, serum bilirubin, Child-Turcotte-Pugh score, and baseline fibrosis stage were the independent predictors for fibrosis regression. Conclusion : Achieving an SVR after DAAs therapy is associated with regression of fibrosis. Baseline clinicolaboratory parameters could predict the likelihood of fibrosis regression with an LS of 17.6 kPa is a suggested cut-off value
Hepatitis E virus (HEV) is inherently a hepatotropic virus that causes acute hepatitis E in general, and chronic liver diseases in some individuals. Notably, pregnancy related complications remain a serious issue in a proportion of HEV infected females. In addition, ample of clinical studies have also reported neuronal, intestinal, renal, cardiac, hematological, and pancreatic disorders in hepatitis E patients. The existing literature on extrahepatic manifestations in hepatitis E patients is, however, mainly based on case reports, small case series or observational studies. The extrahepatic infections or pathogenesis of HEV are suggested to be either directly by viral factors or indirectly by modulation of host-immune systems.
Background: Asplenic patients are at increased risk of serious and life-threatening infections, especially by encapsulated pathogens. These infections are easily prevented with appropriate vaccinations post-splenectomy. The Splenectomy Post-Op Clinical Vaccinations Order Set is one of the first initiatives to harmonized practice between sites at our organization. Objectives: This is a pre and post-intervention study aimed to assess the impact of the Splenectomy Order Set to improve practice adherence to recommended vaccination protocols outlined by the Canadian Immunization Guidelines among patients undergoing emergency splenectomy. Methods: A 5-year retrospective chart review was conducted in 2013 for the pre-intervention vaccination rates. Another 5-year retrospective chart review was conducted in 2018 to determine post-intervention rates. The quantitative results were then tallied and analyzed. Results: Overall, 46 patients were included in the pre-intervention group and 40 patients in the post-intervention group. Prior to the implementation of the Splenectomy Post-Op Clinical Vaccinations Order Set, 61% of patients at the organization received the required vaccinations. Post-intervention, vaccination rates increased to 93%. There is a statistically significant difference between the two groups with a p value less than 0.01. Similarly, in terms of appropriate timing, pre-intervention, 48% of patients received the vaccines in the right timeframe and post-intervention, this rate increased to 80%. This difference did not reach statistical significantly due to a smaller sample size. Conclusion: This quality improvement study showed that a multidisciplinary and evidence-based order set can significantly improve appropriate drug prescribing and patient care while sustaining improved outcomes.
