Aim and background: Sarcopenia, defined as reduced muscle mass and strength, is associated with poor outcomes in cirrhosis. Severe sarcopenia includes low performance status. While CT imaging is the standard for assessing muscle mass, anterior thigh ultrasound (TUS) may offer a low-cost, bedside alternative. This study aimed to validate TUS—measuring total muscle thickness (TMT) and superficial fat (SF)—against bioelectrical impedance analysis (BIA), and to explore its relationship with the Liver Frailty Index (LFI). Method: In this cross-sectional study, patients with cirrhosis were recruited from hepatology clinic and compared to healthy controls. TMT was measured at the midpoint between the patella and anterior superior iliac spine using B-mode ultrasound with minimal probe pressure. BIA (SECA mBCA 525) was the reference standard. Sarcopenia was diagnosed using the Sergi equation. Functional metrics (handgrip, sit-to-stand), LFI, and body fat percentage were also assessed. Results: A total of 124 participants were included (87 cirrhotic, 37 controls). TMT ≤ 3.47 cm in men and ≤ 2.94 cm in women predicted sarcopenia with AUCs of 0.90 and 0.83, respectively. SF correlated with fat mass index in both sexes (rho = 0.61 in males and rho = 0.57 in females, P < 0.001). LFI negatively correlated with TMT (rho = - 0.32, P = 0.002). No correlation was found between TMT or LFI and MELD or Child-Pugh scores. Conclusion: TUS is a valid, bedside tool to detect sarcopenia and frailty in cirrhosis. TMT correlates with reduced muscle function, supporting its clinical utility in identifying high-risk patients.

Background and aims:Acute pancreatitis (AP) frequently presents in emergency departments and poses challenges in predicting severity and mortality. Established scoring systems like Ranson criteria, Acute Physiology And Chronic Health Evaluation II (APACHE) II, and Bedside Index of Severity in Acute Pancreatitis (BISAP) have varying effectiveness. Lactate dehydrogenase (LDH), an enzyme released during tissue damage, shows promise as a marker for organ injury in AP. This study aimed to evaluate LDH's potential to predict mortality risk and hospital stay duration in AP patients. Methods:A retrospective cohort study analyzed AP cases at HCA Healthcare facilities from January 2011 to January 2021. Among 514 patients with LDH data at admission, groups were categorized based on LDH levels. Outcomes included hospital and ICU stay lengths, mortality rates, and factors such as age, gender, race, BMI, and medical history. Results:Patients were stratified into three groups: Group 1 (<300 IU/L), Group 2 (300-600 IU/L), and Group 3 (>600 IU/L) based onLDHlevels. Patients withLDH>600 IU/L experienced an average hospital stay extension of 4.5 days,were 3.2 times more likely to require ICU admission, and faced a 12.1 times higher mortality risk compared to those with LDH <300 IU/L. Conclusion:This study highlights LDH as a potentially valuable predictor of hospital stay duration, ICU requirements, and mortality rates in AP patients. Its cost-effectiveness and accessibility suggest LDH testing could aid clinical decision-making in AP management. Future prospective studies should further explore LDH's role in optimizing AP patient care.

Polymorphonuclear neutrophils (PMNs) are critical mediators in the innate immune response, and their levels in ascitic fluid are pivotal for diagnosing spontaneous bacterial peritonitis (SBP), particularly in patients with liver cirrhosis. This retrospective study investigates the association between varying PMN counts in ascitic fluid and hospital outcomes, including mortality, 30-day readmission rates, and length of stay (LOS). We analyzed de-identified data from HCA Healthcare hospitals (July 2013-December 2023), focusing on patients aged 18 and older with a diagnosis of liver cirrhosis who underwent paracentesis. Patients were categorized based on PMN counts into three groupings to assess their clinical outcomes. Our findings suggest that lower PMN counts correlate with increased mortality, particularly in groups with counts ≤100 and ≤200 cells/mm3. Conversely, higher PMN counts (201-249 cells/mm3) were associated with reduced odds of mortality. While 30-day readmissions demonstrated complex associations, higher counts also linked to increased readmission risk in the highest subgroup. Interestingly, LOS showed no significant differences across PMN levels. This study underscores the nuanced role of PMN counts in prognostication and treatment decisions for cirrhotic patients. Given emerging literature questioning the strict PMN diagnostic threshold for SBP, our results advocate for reconsideration of current guidelines to optimize patient management and outcomes. Further investigation is warranted to delineate the implications of PMN levels in the context of antimicrobial therapy and broader clinical strategies in liver disease management.

Background:Colonic varices (CV) remain an extremely rare condition, the usual cause of which is portal hypertension due to liver disease, chronic pancreatitis or malignancy. Here we present a case of familial idiopathic CV in a middle-aged female, complicated by a polyp removal during colonoscopy. Case presentation:A 57-year-old female with a past medical history of 5 months of melena, polyps and hemorrhoids diagnosed with idiopathic CV during diagnostic colonoscopy. She had no prior history of liver disease, pancreatic disease, non-steroidal anti-inflammatory drugs (NSAID) use, or blood thinner use. She was later found to have a family history of the condition. Conclusion:The rarity of this case is of particular concern for clinicians due to its life threatening complication of severe lower gastrointestinal bleed - a true medical emergency. This is particularly difficult in the absence of usual predisposing triggers. Differential diagnoses should be considered in patients that present with rectal bleeding of unknown cause.

In the landscape of pancreatic cancer, extra-pancreatic manifestations like pleural effusion are infrequent. Our case spotlights a 78-year-old female with a recent diagnosis of pancreatic adenocarcinoma with isolated metastasis to the pleura. The patient presented with exacerbated dyspnea and cough, shedding light on the uncommon link between pancreatic adenocarcinoma and pleural effusion. Pancreatic cancer typically exhibits nonspecific symptoms, and its association with pleural effusion significantly complicates diagnosis, often leading to delayed recognition and management challenges. This case underscores the diagnostic complexities and the need for heightened vigilance when faced with atypical presentations in pancreatic cancer, emphasizing the intricacies of managing such rare extra-pancreatic manifestations.

Background:As mental health awareness increases, healthcare professionals must understand the interplay between chronic gastrointestinal (GI) conditions and psychological well-being, particularly regarding healthcare utilization. This study uniquely aggregates various chronic GI disorders, such as inflammatory bowel disease, celiac disease, and eosinophilic esophagitis, to examine their impact on depression and anxiety. Methods:Utilizing a retrospective observational design, we analyzed data from 34,876 patients admitted to HCA national hospitals from January 2016 to December 2022. Results:We found that patients with GI conditions and comorbid psychiatric disorders had significantly higher readmission rates and longer hospital stays compared to those without mental health diagnoses. Results indicated that patients with GI disorders and depression or anxiety were 1.29 times more likely to be readmitted within 90 days and had 1.50 times longer hospital stay. Conclusion:These findings underscore the importance of integrated care approaches addressing physical and mental health in managing chronic GI conditions. Future research should focus on targeted interventions to enhance mental health management and improve outcomes in this vulnerable patient population.

Probiotics have emerged as an in-demand and highly marketed commodity in the healthcare space. In 2021, the global market valued the probiotic industry at USD 58.17 billion in 2021. It is expected to have a compound annual growth rate of 7.5% yearly from 2021 to 2030. The inclusion of probiotics in various products has become synonymous with health benefits despite limited understanding of mechanism of action or benefit. This chapter will survey the state of our understanding of the interactions between probiotics with the innate immunity, adaptive immunity, and the host gut microbiome. Additionally, we will also highlight the theorized beneficial and possible detrimental immunomodulatory effects of probiotics on human health.

The genus Lactobacillus is a heterogeneous group of lactic acid bacteria (LAB) with important implications in biotechnology. It is a predominant microorganism in the world of gastrointestinal health, but various other uses are being explored. They have long been considered in the generally recognized as safe (GRAS) category by the Food and Drug Authority (FDA). They have been extensively used in fermentation and there is growing interest regarding their use in gut health, vaccine production, and biomedical innovation. This chapter highlights the application of lactobacilli in healthcare.

Multiorgan transplantation is offered to a selected group of patients every year. The sequence in which organs are transplanted depends on ischemic time graft tolerance and the sickest organ first strategy. In the case of Lung-Liver transplantation, lung allografts are usually implanted before the liver. There are some theoretical advantages to a liver-first strategy and a few centers have reported a series of cases that spark a growing interest in the feasibility and potential benefits of this approach. In this contemporary study of the United Network for Organ Sharing (UNOS) database, we evaluate and report outcomes using either strategy.