Alcoholic Etiology Research Articles

Impact of COVID-19 pandemic on acute pancreatitis presentations, management, and in-hospital outcomes: a single-center, retrospective observational study from the northeast of China.

Since initially detected in late December 2019, the novel coronavirus disease 2019 (COVID-19) outbreak rapidly swept the world, which has profoundly affected healthcare system and clinical practice in the management of gastrointestinal diseases. We aimed to evaluate the impact of COVID-19 pandemic on the pattern of hospital admissions and healthcare services for acute pancreatitis (AP). We conducted a retrospective observational cohort study using the anonymized electronic medical records. This single-center, retrospective observational study from a regional medical center in the northeast of China included all consecutively admitted patients with AP from 23 January to 10 June 2020 (during the COVID-19 outbreak in Harbin), compared with the equivalent period of the previous year, in terms of demographics, clinical characteristics, and in-hospital outcomes. In this article, we observed a reduction in AP admissions after the beginning of COVID-19 outbreak. With the prolonged time from symptom onset to hospitalization [32.0 (22.0-72.0) versus 18.0 (12.0-24.0) h; p < 0.001], a higher proportion of AP patients developed acute renal failure (14.0% versus 7.4%, p = 0.004) and acute necrotic collection (16.5% versus 11.2%; p = 0.038) in the COVID-19 era. The percentage of alcohol etiology significantly decreased after the implementation of social restriction measures (11.5% versus 20.4%; p = 0.002), whereas biliary etiology was numerically more common amidst the COVID-19 era (41.6% versus 32.6%; p = 0.014). No significant differences were found in the rates of intensive care unit admission and mortality between the two groups. This study preliminarily demonstrated the descending trend and delay in hospital presentations for AP during the outbreak of COVID-19. Given that the pandemic may persist for several years, adjustments of medical services according to the varying degrees of local breakouts are imperative to provide appropriate care for AP patients and diminish the risk of viral transmission. ClincialTrials.gov number ChiCTR2100043350.

Relationship Between Disorders of Lipid Profile and Features of Liver Cirrhosis- An Open Prospective and Comparative Analysis of Patients of Stavropol Territory in Russian Federation

Introduction: Liver plays an essential role in the metabolism, synthesis, transport and clearance of lipids and lipoproteins, therefore, changes in the lipid profile in liver pathology reflects the degree of its dysfunction. Leading role in the development of atherosclerosis belongs to lipid spectrum disorders in the form of hyperlipidaemia and dyslipidaemia, associated with an increased cardiovascular risk in liver cirrhosis. Aim: To study the relationship between violations of lipid profile of blood with the features and the clinical picture of Liver Cirrhosis (LC). Material and methods: The study was an open prospective and comparative analysis of patients with LC, conducted at Stavropol State Medical University (Stavropol State, Russia). Research was conducted from June 2020 till August 2020. In 108 patients with LC, blood concentration of total cholesterol, triglycerides, High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL) were studied in association with manifestations of the disease. Control group constituted of 45 healthy individuals, comparable in sex, age and ethnicity. Two sample Student’s t-test, Newman Keuls test, chi-square test with Yates’s correction and Pearson’s linear correlation coefficient (r) were calculated. Receiver Operating Characteristic (ROC) analysis was used, the Odds Ratio (OR) and its 95% Confidence Interval (CI), sensitivity, specificity, positive and negative predictive value, and accuracy were determined. Differences were considered statistically significant at p≤0.05. Results: Regardless of gender and age of patients, decrease of serum levels of total cholesterol (p&lt;0.05), triglycerides (p&lt;0.05), HDL (p&lt;0.05) and LDL (p&lt;0.05) were marked, associated with expression of portal hypertension and severity of liver cirrhosis. Parameters of LDL more than 2.16 mmol/L {OR 6.78-95% CI (2.74-16.78)} were connected with absence of oesophageal varices. Levels of triglycerides less than 0.83 mmol/L {OR 10.85-95% CI (2.86-41.19)} were associated with presence of oesophageal varices of grade III. Generally, hyperlipidaemia was observed in 17.6% of patients, and it was associated with alcoholic etiology of liver cirrhosis (c2 =3.7; p=0.053). Hypocholesterolaemia (81.5 % of cases) or hypotriglyceridemia (48.1 % of cases) was more commonly observed in patients with ascites (c2 =8.8; p=0.003), and classes B, C according ChildPugh score (c2 =4.0; p=0.045). Conclusion: In this study it was found that, in liver cirrhosis, there is a decrease in the serum content of total cholesterol, triglycerides, HDL and LDL, regardless of gender and age of patients. The LDL values of more than 2.16 mmol/L are associated with an increased chance of absence of oesophageal varices in patients with liver cirrhosis.

Smoking and fatty liver disease in rural therapeutic area residents

Aim: Evaluate the relationship of Smoking with fatty liver disease (FLD) of various etiologies.Materials and Methods: Out of1568 residents of the rural therapeutic area agreed to participate in the study of 1123 residents of the rural medical area with negative markers of hepatitis B and / or C. The survey included the collection of anamnesis for smoking and alcohol consumption. An objective, laboratory (complete blood count, biochemical liver function tests) and instrumental examination, including ultrasound examination of the abdominal organs, were carried out.Results: Non-alcoholic fatty liver disease (NAFLD) was detected in 247 (22.0%) people, alcoholic liver disease (ALD) — in 276 (24.6%) (p&gt;0.05). 542 people smoked of the surveyed. Among patients with NAFLD, Smoking was 20.2%, their Smoking experience was 35.1±11.5 years, and the Smoking index was 24.5±10.9. Among patients with ALP, Smoking is higher-93.1% (p&lt;0.05), Smoking experience is less — 29.5±9.8 years (p&lt;0.05), as is the Smoking index of 21.8±7.7 (p&lt;0.05). Among smokers, 56.8% had FLD, 83.8% of them were of alcoholic etiology, and 16.2% were non — alcoholic (p&lt;0.05). Among non-smokers, compared with smokers, FLD was detected less frequently — in 37.2% of people (p&lt;0.05), of which alcohol etiology — in 8.8% (p&lt;0.05), non — alcoholic-in 91.2% (p&lt;0.05).Conclusion: In the rural therapeutic area, 93.1% of ALD sufferers smoke, and 20.2% of NAFLD patients smoke (p&lt;0.05). In patients with NAFLD, the duration of smoking was longer (35.1 ± 11.5) than in patients with ALD — 29.5 ± 9.8 years (p &lt;0.05); the smoking index was 24.5 ± 10.9 and 21.8 ± 7.7 pack-years (p&lt;0.05), respectively. In smokers, FLD was more common (56.8%) than in non-smokers (37.2%) (p&lt;0.05). FLD in smokers was of alcoholic etiology more often (83.8%) than non-alcoholic (16.2%) (p&lt;0.05), in non-smokers non-alcoholic etiology prevailed (91.2%) (p&lt;0.05).

P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

Abstract Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with &amp;gt;50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and &amp;gt;50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

Efficacy and Safety of a Fixed Combination of Glycyrrhizic Acid and Essential Phospholipids in Non-Alcoholic Fatty and Alcoholic Liver Disease: Results from Randomized Placebo-Controlled Trials

Background. Drug treatment of non-alcoholic fatty and alcoholic liver disease remains an urgent, unsolved problem. Due to the commonality of many pathogenetic mechanisms and predictors of progression, a universal approach to the search for a therapeutic agent can be considered.&#x0D; Aims pooled analysis of the results of two multicenter, randomized, double-blind, placebo-controlled studies of a fixed combination of glycyrrhizic acid and essential phospholipids in two dosage forms to study its efficacy and safety in non-alcoholic fatty and alcoholic liver disease, in the presence and absence of predictors of disease progression.&#x0D; Methods. The pooled analysis included 180 patients with non-alcoholic fatty liver disease (Gepard study) and 120 patients with alcoholic liver disease (Jaguar study). Patients of the main group received a fixed combination of 5.0 g intravenous jet 3 times a week for the first 2 weeks; then 2 capsules 3 times a day for the next 10 weeks. Patients in the control group received placebo according to the same scheme. The total duration of treatment was 12 weeks in the Gepard study (1 course of stepwise therapy) and 24 weeks in the Jaguar study (2 courses of stepwise therapy). A comparative analysis of the efficacy and safety of a fixed combination and a placebo was carried out, in the presence and absence of predictors of progression, separately for each nosology and in a mixed sample.&#x0D; Results. In patients with non-alcoholic fatty and alcoholic liver disease who received the fixed combination, in contrast to the placebo group, there was a statistically more significant decrease in the level of biochemical markers of inflammation alanine aminotransferase, aspartate aminotransferase, adiponectin, and the value of the AktiTest index. There was no negative trend in the NAFLD fibrosis score; more significant positive dynamics of FibroTest is shown. Predictors of disease progression hyperglycemia, hyperlipidemia, age did not have a negative impact on the results in the study group. The efficacy of the study drug was noted in patients with non-alcoholic fatty liver disease and normal body weight; data were obtained indicating its possible effectiveness with a high activity of the inflammatory process associated with alcoholic liver damage. The frequency of adverse events in the study and control groups was comparable.&#x0D; Conclusions. Based on a generalized analysis of the results of two studies, promising directions for the study and use of a fixed combination of glycyrrhizic acid and essential phospholipids were identified: non-alcoholic fatty liver disease without obesity, alcoholic steatohepatitis of high activity (as an adjuvant); steatohepatitis of non-alcoholic and alcoholic etiology, combined with hyperglycemia and hyperlipidemia.

A STUDY OF ECHOCARDIOGRAPHIC CHANGES IN PATIENTS WITH CIRRHOSIS OF LIVER

Background/Aims: Cirrhosis is associated with a significant number of cardiac abnormalities but, the information available is scanty about the changes associated with it in India. Which include increased cardiac output, increased wall thickness of cardiac chambers, left ventricular diastolic dysfunction, and PAH. These cardiac abnormalities in patients with Cirrhosis have been termed as Cirrhotic Cardiomyopathy. Cirrhotic Cardiomyopathy may be a significant cause of morbidity and mortality in patients with Cirrhosis. With the advent of increased liver transplantation in India, this entity may have an impact on transplantation success. The present study aims to evaluate the cardiac abnormalities in patients with cirrhosis using 2D Echocardiography to detect the occurrence of LV dysfunction, pulmonary hypertension, pericardial effusion, and to assess the contribution of cardiac dysfunction on mortality, if any. Methodology: Thirty patients with Cirrhosis (alcoholic and non-alcoholic) were enrolled. Thirty age and sex-matched controls without cardiovascular disease were included for comparison. Data collection was done by clinical history taking, examination, and investigations. All subjects underwent Echo study was at 0, 6 and12 months and controls at the start of the study. Observations and Results: 1. The mean age of study group was 54.5 ± 15 yrs among them, males constituted 93 % of the study population, the majority of patients were in Child class B (43.3%), and Child A (40%). None of the study population died during follow up. 2. The salient Echocardiographic abnormalities noted in the study population were a) Interventricular septal thickness showed significant change compared to control (9.80 ± 1.06 vs. 8.00 ± 1.00mm mm). b) Doppler echocardiography detected elevated pulmonary arterial pressure (PAP) in the study population compared to control (20.73 ±2.43mm Hg vs.18.26 ± 2.1mm Hg). c) Diastolic dysfunction occurred in the form of increased Deceleration time (223.17 ± 13.93 ms vs. 190.83 ± 14.0ms) and increased E: A ratio (1.10±0.1 vs. 1.04±0.12) was noted in subjects with Cirrhosis. Two of the study subjects had pericardial effusion. (6.7%) 3. There is no evidence of systolic dysfunction noted in the study population. 4. There is no correlation between the severity of Cirrhosis and echocardiographic changes. 5. There were no differences in echo parameters among patients with alcoholic or non-alcoholic etiology of Cirrhosis. 6. There was no fatality recorded due to cardiac dysfunction Conclusion: 1. This study demonstrates that Indian patients with cirrhosis do have diastolic dysfunction. In the absence of other cardiac disease risk factors, this dysfunction can be attributed only to cirrhotic cardiomyopathy. 2. Echocardiography plays a significant role in detecting early cardiac changes in cirrhosis however, these changes do not seem to be a predictor of increased mortality in cirrhosis patients.

Optimized treatment of patients with alcoholic steatohepatitis taking into account comorbid anaemic conditions and H.pylori contamination

The prospective study of patients with alcoholic steatohepatitis (ASH) showed that 40 % of patients with ASH were diagnosed with anaemic conditions (AC), among which vitamin B12-deficiency anaemia was registered - in 17.5% of cases, anaemia of chronic disease (ACD) – in 10.0% of cases and hemolytic anemia (HA) - in 12.5% of cases. In patients with SH of mixed (including alcoholic) etiology AC was found in 32.0%: vitamin B12 - deficient - in 16.0%, ACD - in 8.0% and hemolytic - in 8.0 % of patients. In patients with ASH, H. pylori contamination was present in 32 (80.0%) individuals, including 100% of patients with B12-deficient anaemia. Among patients with SH of mixed (including alcoholic) etiology, H. pylori was detected in 100.0% of people with AS. The use of Hepadif in the complex therapy of ASH contributed to the elimination or reduction of the intensity of the main clinical syndromes (astheno-vegetative, dyspeptic, cholestatic, hepato-, splenomegaly, hepatic steatosis) and biochemical syndromes (mesenchymal-inflammatory cholestasis, hepatocellular insufficiency), in the range of 1.3-4.3 times (p &lt;0.05), as well as higher efficiency of treatment of patients with ASH with anaemic syndrome in 6.0 times (p &lt;0.05). The efficiency of eradication of H. pylori in the main and control groups accompanied by the use of the 3-component programme of the first line according to the stool test was the same (85.7% and 84.2% (p&gt; 0.05), respectively), but in 57.9 % of patients in the control group, the symptoms of dyspepsia increased or appeared on the background of antibacterial therapy, while no side effects of the drug were found during the study in the main group.

Prevalence of primary painless chronic pancreatitis: A systematic review and meta-analysis

Background/objectivesWhile pain is the predominant symptom of chronic pancreatitis (CP), a subset of patients may experience a painless course. This systematic review aimed to determine the prevalence of primary painless CP. MethodsMEDLINE (PubMed), EMBASE and Web of Science Core Collection databases were searched for published studies through September 15, 2020 that included at least 10 consecutive patients with CP and which reported the number with painless CP. The presence of a history of recurrent acute pancreatitis (RAP), exocrine pancreatic insufficiency (EPI), diabetes mellitus (DM) and pancreatic adenocarcinoma (PA) in the painless CP patients was also recorded. A random effects model was used to determine pooled prevalence estimates with 95% confidence intervals (95% CI). ResultsAmong the 5057 studies identified and screened, 42 full-text articles were included in the final analysis. There were a total of 14,277 patients with CP among whom 1569 had painless CP. The pooled prevalence of painless CP was 12% (95% CI 10–15%). Among a subset of studies that reported on calcifications (n = 11), DM (n = 12), EPI (n = 8) and history of RAP (n = 14), the pooled prevalence estimates were 96% (95% CI 73–100%), 51% (95% CI 32–70%), and 47% (95% CI 15–81%), respectively. Alcohol, idiopathic/genetic and other etiologies were attributed to be the cause of painless CP in 32.4%, 56.9% and 8.9% patients, respectively. ConclusionApproximately one in ten patients with CP have primary painless disease with the majority being attributable to an idiopathic/genetic etiology. Further research is needed to determine the optimal management of these patients.

Necrotizing pancreatitis due to Ascaris lumbricoides: Causes, diagnosis, and current treatment

Necrosis in acute pancreatitis presents a high mortality rate despite advances in critical care. After biliary and alcoholic etiology, the third most common cause of pancreatitis is idiopathic etiology, with 10% of cases related to parasites, being Ascaris the most common parasite involved in pancreas necrosis and inflammation. Considering the high rates of mortality related to necrotizing pancreatitis, a case of ascariasis is analyzed, including its growing epidemiology, its causes, its clinical and imaging diagnosis, and its antiparasitic treatment based on current evidence.

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis-A Real Life Cohort.

Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI and the risk factors in cirrhotic patients with a previous episode of SBP receiving norfloxacin as secondary prophylaxis. Materials and Methods: We performed a prospective, cohort study including patients with liver cirrhosis and SBP, successfully treated over a 2-year period in a tertiary university hospital. All the patients received secondary prophylaxis for SBP with norfloxacin 400 mg/day. Results: There were 122 patients with liver cirrhosis and SBP included (mean age 57.5 ± 10.8 years, 65.5% males). Alcoholic cirrhosis was the major etiology accounting for 63.1% of cases. The mean MELD score was 19.7 ± 6.1. Twenty-three (18.8%) of all patients developed CDI during follow-up, corresponding to an incidence of 24.8 cases per 10,000 person-years. The multivariate Cox regression analysis demonstrated that alcoholic LC etiology (HR 1.40, 95% CI 1.104–2.441, p = 0.029) and Child-Pugh C class (HR 2.50, 95% CI 1.257–3.850, p = 0.034) were independent risk factors for CDI development during norfloxacin secondary prophylaxis. The development of CDI did not influence the mortality rates in cirrhotic patients with SBP receiving norfloxacin. Conclusions: Cirrhotic patients with SBP and Child-Pugh C class and alcoholic liver cirrhosis had a higher risk of developing Clostridioides difficile infection during norfloxacin secondary prophylaxis. In patients with alcoholic Child-Pugh C class liver cirrhosis, alternative prophylaxis should be evaluated as SBP secondary prophylaxis.

P-54 STUDY OF BACTERIAL INFECTIONS IN 134 HOSPITALIZATIONS OF PATIENTS WITH LIVER CIRRHOSIS

In cirrhotic, bacterial infections are frequent and demands 25-40% of hospitalizations, can trigger decompensations, organ failure, even death. Spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), pulmonary and skin are recurrent foci. Thus, preventive measures, early diagnosis and proper management are crucial to reduce morbidity and mortality. Analyze the epidemiology of admitted cirrhoticsat tertiary hospital, their infection, prognosis and mortality. Retrospective observational study by analyzing 134 hospitalizations (103 patients) from 06/01/2018 to 05/31/2019. Inclusion: diagnosed cirrhotics (clinic/image). Exclusion: elective hospitalization. 71 men and 32 women. Mediumage 58.4 ± 12.3. Etiologies: alcoholic 46 patients; NAFLD 22; hepatitis C 12. Of all, 45 admissions (33.58%) had community infections - prevalent UTI followed by SBP. Among this 45 hospitalizations, 12 (26.66%) reinfected during the stay. Overall death rate was 31%. Deaths: 2 without infection (71 hospitalizations); 30 infected (63 hospitalizations). In-hospital infections: 18 hospitalizations (13.4%), UTI principally, of which 11 patients died, 8 (72.72%) due to infection. Admission's Child-Pugh (CP) and Meld scores, by site: pulmonary (CP 11 ± 2.05; Meld 27 ± 10.02); 2 focus (CP 10.1 ± 1.86; Meld 23.8 ± 2.92); indeterminate (CP 10.1 ± 2.63; Meld 23.3 ± 8.31); urinary (CP 10.2 ± 2.64; Meld 21.5 ± 10.50); PBE (CP 9.8 ± 1.39; Meld 20.8 ± 4.21); intestinal (CP 9.8 ± 2.31; Meld 21.8 ± 7.68); cutaneous (CP 9.4 ± 0.89; Meld 18.2 ± 2.38); bloodstream (C 7.5 ± 0.70; Meld 16 ± 9.89). Death rate by site: indeterminate 83.3%; 2 sites 71.4%; pulmonary 60%; bloodstream 50%; UTI 35.3%; Intestinal 33.3%; SBP 30%; cutaneous 20%. The most admitted cirrhotics are men and alcoholic etiology. Undetermined focus infections, 2 sites and lungs had higher mortality and CP/Meld scores on admission. Therefore, broad-spectrum empirical antibiotic therapy and semi-intensive care to this population are recommended.

The global, regional, and national burden of acute pancreatitis in 204 countries and territories, 1990\u20132019

BackgroundAcute pancreatitis is a common and potentially lethal gastrointestinal disease, but literatures for the disease burden are scarce for many countries. Understanding the current burden of acute pancreatitis and the different trends across various countries is essential for formulating effective preventive intervenes. We aimed to report the incidence, mortality, and disability-adjusted life-years (DALYs) caused by acute pancreatitis in 204 countries and territories between 1990 and 2019.MethodsEstimates from the Global Burden of Disease Study 2019 (GBD 2019) were used to analyze the epidemiology of acute pancreatitis at the global, regional, and national levels. We also reported the correlation between development status and acute pancreatitis’ age-standardized DALY rates, and calculated DALYs attributable to alcohol etiology that had evidence of causation with acute pancreatitis. All of the estimates were shown as counts and age-standardized rates per 100,000 person-years.ResultsThere were 2,814,972.3 (95% UI 2,414,361.3–3,293,591.8) incident cases of acute pancreatitis occurred in 2019 globally; 1,273,955.2 (1,098,304.6–1,478,594.1) in women and 1,541,017.1 (1,307,264.4–1,814,454.3) in men. The global age-standardized incidence rate declined from 37.9/100,000 to 34.8/100,000 during 1990–2019, an annual decrease of 8.4% (5.9–10.4%). In 2019, there were 115,053.2 (104,304.4–128,173.4) deaths and 3,641,105.7 (3,282,952.5–4,026,948.1) DALYs due to acute pancreatitis. The global age-standardized mortality rate decreased by 17.2% (6.6–27.1%) annually from 1.7/100,000 in 1990 to 1.4/100,000 in 2019; over the same period, the age-standardized DALY rate declined by 17.6% (7.8–27.0%) annually. There were substantial differences in the incidence, mortality and DALYs across regions. Alcohol etiology attributed to a sizable fraction of acute pancreatitis-related deaths, especially in the high and high-middle SDI regions.ConclusionSubstantial variation existed in the burden of acute pancreatitis worldwide, and the overall burden remains high with aging population. Geographically targeted considerations are needed to tailor future intervenes to relieve the burden of acute pancreatitis in specific countries, especially for Eastern Europe.

Vascular Complications in Patients with Chronic Pancreatitis.

Introduction: Chronic pancreatitis (CP) is a long-standing progressive inflammation of the pancreas, which can lead to a variety of vascular complications, such as splanchnic venous thrombosis (VT) and arterial pseudoaneurysm (PA). There is a lack of studies on vascular complications in Scandinavian countries. Methods: We performed a retrospective analysis of medical records of patients with CP identified from the Karolinska University Hospital database between 2003 and 2018. A total of 394 patients with definite CP were included in the study. Results: There were 33 patients with vascular complications, with a median age of 62 (IQR 55–72) years. The cumulative incidence of vascular events was 3.2% at 5 years. Thirty patients had isolated VT, whereas three patients had PA (7.6% and 0.8%, respectively). Isolated splenic vein thrombosis was most common (53.3%), followed by a combination with other splanchnic veins. PA was found in the splenic artery in two patients and in the left gastric artery in one patient. Varices were present in three (10%) patients; variceal bleeding was not recorded. All patients had asymptomatic splanchnic VT, most with chronic VT with developed collaterals (83.3% had abdominal collateral vessels). Nearly two-thirds of patients with VT (63.3%) received no treatment, whereas 11 (36.6%) were treated with anticoagulants. Pseudocysts and alcoholic etiology of CP are risk factors for vascular complications. Conclusions: The cumulative incidence of vascular complications was 3.2% at 5 years. Splanchnic VT is more common than PA. Patients were asymptomatic with no variceal bleeding, explained by well-developed collateral vessels and strong study inclusion criteria.

Forecasting Hepatocellular Carcinoma Mortality using a Weighted Regression Model to Estimate Cohort Effects in Taiwan.

To eliminate the influence of age and period in age cycle contingency table data, a multistage method was adopted to evaluate the cohort effect. The most general primary malignant tumor of the liver is hepatocellular carcinoma (HCC). HCC is associated with liver cirrhosis with alcohol and viral etiologies. In epidemiology, long-term trends in HCC mortality were delineated (or forecasted) by using an age-period-cohort (APC) model. The HCC deaths were determined for each cohort with its weighted influence. The confidence interval (CI) of the weighted mean is fairly narrow (compared to the equally weighted estimates). Due to the fairly narrow CI with less uncertainty, the weighted mean estimation was used as a means for forecasting. With the multistage method, it is recommended to use weighted mean estimation based on a regression model to evaluate the cohort effect in the age-period contingency table data.

AYURVEDIC INSIGHTS OF AVASCULAR NECROSIS OF FEMORAL HEAD

Avascular necrosis of the femur head (AVNFH) is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear (idiopathic) etiology, affecting mostly the middle aged population. Clinically AVNFH is associated with impaired blood supply to the femoral head resulting in bone necrosis and collapse.In Ayurveda, there is no direct reference of disease resembling to Avascular necrosis of femoral head, hence it can be understand on the basis of Vikaraprakriti of disease caused by vitiation of Dosa, Adhisthana (abodesite) and Hetu (causes of vitiation of Dosa). In the present study an effort has been made to understand AVN on the ground of Ayurveda.

Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil-to-lymphocyte ratio.

Spontaneous bacterial peritonitis (SBP) is a severe complication of liver cirrhosis whose diagnosis is based on a polymorphonuclear leukocyte (PMN) value >250 mm3, yet this PMN value cannot identify all existing types. The aim of our study was to determine the clinical and biological factors that were associated with SBP and predict its occurrence, focusing on the neutrophil-to-lymphocyte ratio (NLR) as one of them. Our retrospective study included 216 patients with liver cirrhosis who were hospitalized between December 2019 and January 2010 at the Emergency County Clinical Hospital of 'St. Apostle Andrew' in Constanta, Romania. Demographic, clinical, and laboratory data were collected from patient observation sheets. The patients were divided into two groups: One group of patients with SBP and the other without SBP. The diagnosis of SBP was made when patients presented with PMN >250 mm3 and other causes of secondary bacterial peritonitis were excluded. The mean age of the patients was 61.25±10.67 years, and the alcoholic etiology of liver cirrhosis was most common (44%). Univariate logistic regression analysis showed that there was an association between biological parameters, such as serum white blood cells, total platelet count, total bilirubin, serum albumin, international normalized ratio, creatinine, erythrocyte sedimentation rate (ESR), serum sodium, alkaline reserve, and NLR, and clinical parameters, such us upper gastrointestinal bleeding and cardiac comorbidities in the occurrence of SBP. Multivariate analysis identified ESR and NLR as predictive factors in the occurrence of SBP. The area under the curve (AUC) was 0.916 [P<0.001, 95% confidence interval (CI) 0.870-0.949] for ESR and AUC was 0.963 (P<0.001, 95% CI 0.928-0.984) for NLR, respectively. In conclusion, the combination of these 2 biological parameters is useful in identifying or excluding SBP.

Hypertriglyceridemia Induced Pancreatitis Treated with Medical Management without Plasmapheresis

Hypertriglyceridemia is third prevailing cause of acute pancreatitis after biliary and alcoholic etiology. It accounts for 1 to 4% cases of pancreatitis. Present case describes a thirty years old diabetic male, who presented in emergency with pain in the abdomen and yellow discoloration of the skin. He was admitted with suspicion of diabetic ketoacidosis (DKA), but no improvement was seen after DKA treatment. His laboratory investigations showed normal serum amylase levels and dyslipidemia with raised serum triglycerides levels. He was diagnosed as acute pancreatitis secondary to hypertriglyceridemia, which is considered as a rare cause of acute pancreatitis.

Intensity of liver parenchym fibrosis in patients with alcoholic and non-alcoholic steatohepatitis depending on the presence of dysmetabolic iron overload syndrome

Objective — to establish the features of iron homeostasis in patients with steatohepatitis of alcoholic and nonalcoholic etiology depending on the presence of dysmetobolic iron overload syndrome, to identify the probable link between ferrokinetics and markers of biochemical syndromes of steatohepatitis, the intensity of endotoxicosis and fibrosing reactions.&#x0D; Materials and methods. The study was based on the clinical follow‑up of 125 individuals, including 60 patients with nonalcoholic steatohepatitis and 65 patients with alcoholic steatohepatitis, 25 practically healthy individuals of appropriate age and gender. Depending on the indicators of iron homeostasis, the examined patients were divided into 4 groups: alcoholic steatohepatitis with dysmetabolic iron overload syndrome — 40 patients, 25 patients without dysmetabolic iron overload syndrome; 18 patients with non‑alcoholic steatohepatitis and dysmetabolic iron overload syndrome and 42 patients — without dysmetabolic iron overload syndrome.&#x0D; Results. In alcoholic steatohepatitis, activation of collagen anabolism processes was observed through the growth of protein‑bound oxyproline in blood — in the presence of iron overload syndrome 2.5 times (p &lt; 0.05), in the absence — 2.0 times (p &lt; 0.05), as well as a significant increase in the intensity of collagen catabolism — by increasing the content of free oxyproline in blood, respectively — by 1.5 and 1.3 times (p &lt; 0.05), which occurred due to a significant increase in collagenolytic activity of blood plasma (respectively in 1.6 and 1.4 times; p &lt; 0.05) with the presence of a probable intergroup difference (p &lt; 0.05) in all the cases. There was a significant increase in the content of hexosamines in blood: with iron overload syndrome 1.6 times (p &lt; 0.05), in its absence — 1.5 times (p &lt; 0.05), the content of sialic acids, respectively — 1.6 and 1.5 times (p &lt; 0.05), and the accelerated degradation of fucoglycoprotein components of the extracellular matrix. In non‑alcoholic steatohepatitis, activation of collagen synthesis processes with an increase in blood protein‑bound oxyproline was established — in the presence of iron overload syndrome 1.6 times (p &lt; 0.05), in the absence — 1.3 times (p &lt; 0.05), as well as a slight increase in the intensity of collagen breakdown — with an increase in the content of free oxyproline in blood in non‑alcoholic steatohepatitis with iron overload syndrome — 1.2 times (p &lt; 0.05). There was also a significant increase in the content of hexosamines in blood: in the presence of iron overload syndrome by 1.3 times (p &lt; 0.05), in its absence — by 1.2 times (p &lt; 0.05), the content of sialic acids, respectively — in 1.4 and 1.2 times (p &lt; 0.05), and the accelerated degradation of fucoglycoproteins.&#x0D; Conclusions. The regularities of liver fibrosis progression in patients with alcoholic steatohepatitis with iron overload syndrome are inextricably linked with the activation of collagen anabolism, the increase in the intensity of collagen catabolism, which occurred due to a significant increase in collagenolytic activity of blood plasma. An important consequence of the activation of cytolysis and inflammation is a significant increase in the content of hexosamines in blood. In patients with nonalcoholic steatohepatitis, there was an activation of collagen synthesis, a slight increase in the intensity of collagen breakdown in the presence of iron overload syndrome, as well as a characteristic increase in blood hexosamines, and the accelerated degradation of fucoglycoproteins.&#x0D;

The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study

BackgroundAlcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.MethodsObservational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.ResultsELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823–0.968) and 0.923 (95% CI 0.866–0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908–0.960); non-alcohol = 0.907 (95% CI 0.895–0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55–4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39–2.99, p < 0.001).ConclusionsELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.

Predictors for external and internal pancreatic fistulas after pancreatic necrosis

Aim . To analyze the outcomes of pancreatic necrosis depending on the depth and localization of damage to the pancreatic tissue, to determine the main risk factors for the development of external and internal pancreatic fistulas. Materials and methods. The analysis of long-term results of treatment of pancreatic necrosis in 81 patients was carried out: 53 patients were treated at the stage of acute pancreatitis in our clinic, 28 – in other medical institutions. The algorithm of the survey included a CT scan with contrast enhancement, fistulography, MRI-pancreatocholangiography and/or endoscopic retrograde cholangiopancreatography. The influence of various factors on the development of pseudocysts and pancreatic fistulas was estimated using the Spearman correlation coefficient. Results. Signs of damage to the pancreatic duct were detected in 19 (36%) of 53 patients: 9 were diagnosed with pseudocysts, 10 had external pancreatic fistulas. The daily flow rate of pancreatic juice ( α -amylase activity &gt;20950 u/l) was 300–350 ml. Interventions (minimally invasive, open surgery) required 10 patients (52.6%). The correlation coefficient of external pancreatic fistulas with the depth of pancreatic necrosis was 0.46 ( р = 0.00005), the CT severity index according to Balthazar – 0.05 ( р = 0.63), the localization of necrosis in the neck – 0.31 ( р = 0.006), the amount of drainage discharge – 0.55 ( р = 0.000001), the activity of α -amylase fluid – 0.53 ( р = 0.000002). There was a significant positive correlation of mediastinal pancreatogenic cysts with pseudocysts located on the posterior surface of the pancreas ( r = 0.7; p = 0.003), pleural effusion with high activity of α -amylase ( r = 0.87, р = 0.0005) and alcoholic etiology of acute pancreatitis ( r = 0.75, р = 0.002). Conclusion. Predictors of resistant to conservative treatment external pancreatic fistulas are deep necrosis, especially in the area of the neck of the pancreas, the discharge flow rate through the drainage is more than 150 ml with an α -amylase activity of more than 1000 u/l. A risk factor for the development of internal pancreatic fistulas with penetration into the mediastinum is the localization of pseudocysts on the posterior surface of the pancreas in the body and tail area.