Cases Of Cirrhosis Research Articles

Projected Long-Term Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hepatitis C Outcomes in the United States: A Modeling Study.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic disrupted access to and uptake of hepatitis C virus (HCV) care services in the United States. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes.MethodsWe used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12 and 24 months.ResultsCompared to the “no pandemic” scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100 000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to “no pandemic,” the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR.ConclusionsA recommitment to the HCV epidemic in the United States that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.

1204Modelling impact of targeted hepatitis B treatment for culturally and linguistically diverse populations in Australia

Abstract Background Antiviral treatment gap in culturally and linguistically diverse (CALD) populations may be a barrier progress in national elimination. Using modelling, we estimated and predicted the impact of antiviral treatment and migration on HBV burden, and HBV-related mortality in CALD populations in Australia. Methods We developed a dynamic, deterministic mathematical model using three antiviral treatment scale-up scenarios - the baseline treatment, intermediate treatment scale-up (80% of eligible by 2030), and optimistic scale-up (20% of all HBV by 2022) to predict the incidence of HBV infection, liver cirrhosis, hepatocellular carcinoma, and HBV-related mortality in four groups of people according to their country of birth. Results The number of chronic HBV cases will remain similar, and HBV-related morbidity and mortality will increase if the baseline approach is followed to 2030. Implementing an optimistic treatment scale-up could reduce the number of new cases of liver cirrhosis (30% in European-born, and 40% in Asia-Pacific-born) by 2030. Following the optimistic scale-up approach, the incidence of HCC decreased by 30% and a 15%-25% reduction in HCC-related mortality could be achieved in the four population subgroups by 2030. Conclusions Following the current antiviral treatment coverage, HBV elimination targets in migrants may not be achieved. A rapid treatment scale-up approach reduces HBV incidence, liver cirrhosis and HCC. Key messages Targeted antiviral treatment for migrants with HBV using rapid scale-up reduces HBV-related disease and mortality and contributes to achievement of national elimination targets.

P-70 SEROPREVALENCE OF HEPATITIS C VIRUS IN DONORS OF THE BLOOD BANK OF THE GENERAL HOSPITAL OF MEXICO "DR. EDUARDO LICEAGA " A FOUR-YEAR EVALUATION

Since the molecular identification of the hepatitis C virus (HCV) in 1989 and the development of antibodies as an initial part of the diagnosis of this infection, blood banks have taken an important step to exclude potential donors with this infection, the World Health Organization established as a mandatory measure, the screening of all blood donated for transfusion for communicable infections such as HCV, HBV, HIV and HTLV as a mandatory measure. HCV affects between 130 and 150 million people worldwide, with a global prevalence of around 2.2%, and is the cause of 27% of cirrhosis cases and 25% of primary hepatocellular carcinoma cases in the world. In developed countries. To evaluate the seroprevalence of HCV and risk factors in potential blood donors in a tertiary hospital for 4 years. Retrospective, observational, cross-sectional, descriptive study carried out in blood donors at the Hospital General de México "Dr. Eduardo Liceaga." From January 1, 2016, to December 31, 2019. Donor files were reviewed, and those with HCV positivity were analyzed. The SPSS v 22 program was used for statistical analysis. 92,214 donors were included. Of these, 1,265 patients (1.37%), 449 women (35%) and 816 men (64.5%) were positive. Risk factors found in the positive group: alcoholism 153 (12.09%), dental surgery 128 (10.11%). tattoos (6.87%), piercings (7.19%), acupuncture (3.08%) and risky sexual partners (0.23%). The prevalence of 1.37% is similar to that reported in the literature; the predominance is slightly in the group of men, which contrasts with the past years that due to obstetric events, women were the most prevalent, perhaps it is related to tattoos, piercings, and use of intravenous or intranasal drugs. Although all the donors were approved in the official questionnaire, the positivity may be related to factors not declared by the patients themselves.

From the Editor’s Desk…

From the Editor’s Desk…

NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040.

Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040. This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with incident cirrhosis (2000-2017) were identified, and etiology was defined as HCV, HBV, NAFLD, alcohol-associated liver disease (ALD), or autoimmune liver disease/other using validated case definitions. Annual age/sex-adjusted cirrhosis incidence rate per 100,000 person-years was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. In total, 159,549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI, 1.6-2.4; P<0.001). The largest increases were for HCV (AAPC, 4.1%/year; 95% CI, 2.6-5.7; P<0.001) and NAFLD (AAPC, 3.3%/year; 95% CI, 2.6-4.1%; P<0.001). ALD and HCV cirrhosis in those born >1980 increased by 11.6%/year (95% CI, 9.3-13.9; P<0.001) and 9.5%/year (95% CI, 6.2-13.0; P<0.001), respectively. However, by 2040, cirrhosis incidence is projected to continue to increase, driven mostly by NAFLD, especially in postmenopausal women, and ALD in individuals born >1980. Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.

A Donor With Green Kidneys—To Transplant or Not to Transplant: A Case Report

A Donor With Green Kidneys—To Transplant or Not to Transplant: A Case Report

Evaluation of tumor mutational burden in small early hepatocellular carcinoma and progressed hepatocellular carcinoma.

While researchers know that tumor mutational burden (TMB) is low in hepatocellular carcinoma (HCC), prior studies have not investigated TMB in cirrhosis, small early HCC and progressed HCC. HCC (n = 18) and cirrhosis (n = 6) cases were identified. TMB was determined by a 1.7 megabase, 409-gene next-generation sequencing panel. TMB values were defined as the number of nonsynonymous variants per megabase of sequence. There was no significant difference between cirrhosis versus small early HCC or between cohorts when stratified by size, early versus progressed, differentiation or morphology. There was a significant difference between cirrhosis and small early HCC versus progressed HCC (p = 0.045), suggesting TMB may be related to HCC progression. TMB similarities in small early HCC and background cirrhosis suggest TMB is not a useful tool for diagnosing small early HCC. Additional study is needed to address TMB in histological and molecular subsets of HCC.

TO STUDY THE SEROPREVALENCE OF HEPATITIS C IN CASES OF ACUTE VIRAL HEPATITIS AND CIRRHOSIS OF LIVER

Background: Viral hepatitis is a global public health problem affecting millions of people worldwide. The main objective was to study the seroprevalence of hepatitis C in patients with acute viral hepatitis and cirrhosis of liver. Method: The study was carried out in the department of Medicine, Pt. J.N.M medical college and associated Dr B.R Ambedkar Memorial Hospital Raipur, Chhattisgarh from April 2002 to February 2003. Result: Maximum number of acute viral hepatitis cases were observed in the age group &gt;24-34 years. Maximum numbers of cirrhosis of liver cases were observed in the age group &gt; 44-54 years. There were 2 cases of acute viral hepatitis that tested positive for anti- HCV and both were males. There were 5 cases of cirrhosis of liver who were HBsAg Positive. Conclusion: HCV infection is quite prevalent in Raipur, Chhattisgarh and therefore, stresses the need for early detection so that further transmission could be prevented.

HEPATOCELLULAR CARCINOMA INCIDENCE IN HEPATITIS C PATIENTS TREATED WITH DIRECT-ACTING ANTIVIRALS AND ITS RELATIONSHIP TO HEPATIC FIBROSIS STAGE

The Hepatitis C virus (HCV) has a major impact on public health and is thought to be responsiblefor 25% of hepatocellular carcinoma (HCC) and 27% of cirrhosis cases worldwide.Recent direct-acting antivirals (DAAs) for hepatitis C have the potential to reduce this diseaseburden, but there are increased worries about HCC incidence in HCV patients receivingDAAs. This work assessed the HCC incidence in HCV patients treated with DAAs and its relationship to Hepatic Fibrosis Stage.The study included 400 chronic HCV patients equally divided into two groups: chronicHCV patients who did not receive anti HCV medication (control group) and chronic HCV patientswho received different DAAs treatment regimens. There was a highly significant differencebetween both groups as regards hepatic fibrosis stages before DAAs therapy. The DAAreceiving group had highly statistically advanced hepatic fibrosis when compared to the controlgroup. After eighteen months of follow up, the DAA receiving group had a significantlylower incidence of HCC when compared to the control group (5.5% versus 11% respectively,p-value 0.04).

Dynapenia Rather Than Sarcopenia Is Associated with Metabolic Syndrome in Patients with Chronic Liver Diseases.

We aimed to examine the association between sarcopenia-related factors and metabolic syndrome (Met-S) in patients with chronic liver diseases (CLDs, n = 582, average age = 59.5 years, 290 males, 168 liver cirrhosis cases). Met-S was determined based on the Japanese criteria. Sarcopenia was determined based on grip strength (GS) and skeletal muscle index (SMI) by bioelectrical impedance analysis. Our cohort was divided into the four groups: (A) sarcopenia (n = 44), (B) dynapenia (n = 45), (C) presarcopenia (n = 112), and (D) the control (n = 381). Impacts of GS and SMI on Met-S were investigated. In males, waist circumference (WC) ≥ 85 cm was observed in 199 patients (68.6%), while in females, WC ≥ 90 cm was observed in 94 patients (32.2%). Met-S was identified in 109 patients (18.7%). The proportion of Met-S in the group A, B, C and D were 18.2%, 48.9%, 8.0%, and 18.4% (A vs. B, p = 0.0033; B vs. C, p < 0.0001; C vs. D, p = 0.0081; A vs. C, p = 0.0867; A vs. D, p = 1.000, B vs. D, p < 0.0001; overall p value < 0.0001). Multivariate analysis revealed that age, gender, and group B (dynapenia) were significant factors linked to the presence of Met-S. In conclusion, dynapenia rather than sarcopenia is associated with Met-S in CLD patients.

Clinical profile of patients with AKI and liver cirrhosis attending tertiary care hospital

Despite improved understanding of precipitants and physiology of underlying AKI in cirrhosis, considerable confusion still continues to surround its diagnosis due to arbitrary use of creatinine which is effected by several factors like diet, volume status, protein intake, muscle mass, interference with assays of creatinine by elevated bilirubin level making traditional criteria of AKI with serum creatinine greater than 1.5 gm/dl not suitable as diagnostic criteria as it can delay the detection of AKI, further delaying treatment & prognosis. All participating patients of either gender admitted in department of GASTROENTEROLOGY with age >18 years with either diagnosed or newly diagnosed case of cirrhosis of liver (Including both compensated & decompensated cases) admitted with acute kidney injury diagnosed according to International Club of Ascites Classification were enrolled in this study. 64.9% of patients with AKI in the study had MELD score between 16-30 followed by 23.4% & 11.7% in MELD > 30 & MELD

Prediction of hepatocellular carcinoma using fibro markers in Egyptian patients with chronic liver disease

Objective The aim was to evaluate inflammatory and fibrosis markers as predictors for hepatocellular carcinoma (HCC) development among patients with chronic liver disease (CLD). Background Progression of liver fibrosis in chronic hepatitis C is closely associated with the high risk of HCC development. Patients and methods This study was conducted on 100 patients suffering from liver cirrhosis as group A and 100 patients suffering from liver cirrhosis with HCC as group B from January 2018 to April 2019. Diagnosis of CLD was based on clinical, laboratory, and imaging evidence of CLD with and without hepatic decompensation or portal hypertension. Results Child–Pugh C patients was significantly more prevalent in HCC (37 vs 10% in liver cirrhosis cases). Serum hemoglobin, albumin, and leukocytic count were significantly lower in HCC cases. Also, α-fetoprotein, bilirubin international normalized ratio, and blood urea were highly significantly higher in the HCC group than the non-HCC group. King's score, fibro-quotient (Fibro Q), and FIB-4 scores were significantly higher in HCC than in cirrhotic cases, while blood red cells and Fibro-α scores were highly significantly higher in group B than in group A. Conclusion Our findings have shown the possibility to predict HCC development in Egyptian patients suffering from chronic hepatitis C by using noninvasive scores, (Fibro markers) as they performed well, cheap, and easy to perform.

Cell-based clinical and experimental methods for assisting the function of impaired livers – Present and future of liver support systems

Currently, one of the most serious public health issues is the increasing number of cases of chronic liver disease and cirrhosis both of which can lead to liver failure. The only effective method of treatment for this life-threatening condition remains liver transplantation. Unfortunately, the chronic shortage of transplantable organs seriously limits its accessibility to patients. Thus, tremendous research has been done to develop methods capable of replacing liver transplantation by artificial means or to create techniques to partially or fully replace liver function in patients with impaired livers, until liver regeneration or transplantation. This review article is focused on research results that utilize living cells in order to establish bridging therapies in cases of liver failure. This includes both experimental and clinically tested techniques, such as hepatocyte transplantation and usage of the hybrid bioartificial liver devices. The article also discusses research which presents the long-term culture of hepatocytes in conditions that preserve their differentiated state, which is important for such applications as drug development and toxicity testing. Last but not least, the article describes the groundbreaking efforts toward building sophisticated scaffolds for hepatocyte culture that mimic their natural environment, which are based on decellularized tissues and on three-dimensional bioprinting.

Energy metabolism characteristic with risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease

Objective: To investigate and analyze the energy metabolism characteristics and the correlation between energy metabolism and the risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease (HBV-CLD). Methods: Data of 183 cases admitted to the Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2020 were retrospectively analyzed. 79 cases of chronic hepatitis B, 51 cases of hepatitis B-related liver cirrhosis, and 53 cases of hepatitis B-related liver failure were collected. Among them patients with liver failure and decompensated liver cirrhosis were defined as severe liver disease group. The Quark RMR indirect calorimetry (COSMED Corporation, Italy) was used to exam the patients' energy metabolism condition, and the incidences of secondary bacterial infection of the patients during hospitalization were recorded. Shapiro-Wilk test and normal QQ plot were used to analyze the normal distribution of continuous variable data, which was consistent with the normal distribution and was described by mean ± standard deviation. In addition, if it did not conform to the normal distribution, the median and interquartile distance were used to describe it. Levene's test was used to test the homogeneity of variance of the data, which was consistent with the normal distribution. The t-test was used to compare the means of the two groups of samples. One-way analysis of variance was used to compare the mean values of the three groups of samples, and then the Tukey's test was used to compare the two groups. If the variance was uneven or did not conform to the normal distribution, the Wilcoxon rank sum test was used to compare the differences between the two groups. Kruskal-Wallis test (H test) was used to compare the differences between the three groups of samples, and then the Dunnett's test (Z test) was used for comparison between the two groups. Categorical variable data were analyzed using chi-square test. Logistic regression analysis was used to screen independent risk factors, and the criteria for variable inclusion (P < 0.05). Results: The respiratory entropy (RQ) and non-protein respiratory entropy (npRQ) of the three groups had statistically significant difference (P < 0.05). Among them, the RQ and npRQ of the chronic hepatitis B group were higher than hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group. There were statistically significant differences in fat oxidation rate (FAT%) and carbohydrate oxidation rate (CHO%) between the three groups (P < 0.05). Compared with hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group, chronic hepatitis B group (P < 0.05) had lower FAT% and higher CHO%. There were no statistically significant differences in the measured and predicted resting energy expenditure and protein oxidation rate (PRO%) between the three groups. The incidence of secondary bacterial infection in patients with severe liver disease was 48.39% (45/93). Compared with the non-infected group, the RQ and npRQ values ​​of the infected group were significantly decreased (P < 0.05), while FAT% was significantly increased (P < 0.05). Logistic regression analysis showed that glutamyltransferase, cholesterol, and npRQ were independent risk factors for secondary bacterial infections in patients with severe liver disease. Glutamyltransferase elevation, and cholesterol and npRQ depletion had suggested an increased risk of secondary bacterial infection. Subgroup analysis of patients with hepatitis B-related liver failure also showed that compared with non-infected group, RQ value and npRQ value of secondary bacterial infection group were significantly decreased (P < 0.05), while FAT% was significantly increased (P < 0.05). Conclusion: Patients with hepatitis B virus-related chronic liver disease generally have abnormal energy metabolism. Low RQ, npRQ, CHO% and high FAT% are related to the severity of the disease; while npRQ reduction is related to the risk of secondary bacterial infection in patients with severe liver disease, and thus can be used as a clinical prognostic indicator.

Estimating the attributable fraction of cirrhosis and hepatocellular carcinoma due to hepatitis B and C.

A goal of the WHO strategy on the elimination of hepatitis as a public threat is a 65% reduction in the attributable mortality. Deaths related to hepatitis B and C infections are mostly due to decompensated cirrhosis and hepatocellular carcinoma (HCC) but accurately measuring mortality is challenging as death certificates often do not capture the underlying disease. The aim of this collaborative study between European Centre for Disease Prevention and Control (ECDC) and the European Association for the Study of the Liver (EASL) was to assess a WHO‐developed protocol to support countries in implementing studies to collect data on the fraction of cirrhosis and hepatocellular carcinoma attributable to hepatitis B and C. Three sentinel sites (in Bulgaria, Norway and Portugal) collected data for patients first admitted or seen in their centres during 2016. Patients with cirrhosis or HCC were identified through patient files or healthcare databases using ICD‐10 codes. The proportion of patients with cirrhosis and HCC who tested positive for HBV and HCV were calculated to estimate the aetiological fractions. After the pilot study was completed, each site was asked about the feasibility and acceptability of the protocol. A total of 1249 patients presenting with cirrhosis and/or HCC were evaluated across the three sites. The prevalence of HBV and HCV among cases of cirrhosis showed that in Norway and Portugal, HCV was responsible for about one‐quarter of the cases, whereas in Bulgaria, HBV was more common. For HCC, HCV was responsible for more than one‐third of cases in Norway and Portugal, while in Bulgaria HBV was more frequent as the underlying cause. Results obtained during the pilot study were comparable to published estimates obtained through statistical modelling or meta‐analyses. Several challenges were reported from the sites involved in the pilot including the considerable time needed for reviewing the hospital records and extracting patient data. The pilot demonstrated the feasibility of collecting data on the prevalence of HBV and HCV infection among patients with cirrhosis and HCC in sentinel sites. This method can be used to estimate mortality attributable to HBV and HCV for elimination monitoring. Where easily implementable, sentinel studies are the best way to empower countries, get up‐to date data and closely monitor the changes in the attributable fraction at a country level.

Relation Of Serum Uric Acid Concentrations With Etiology And Severity In Patients With Cirrhosis Of Liver

Background: Hyperuricemia is now an established factor to cause oxidative stress, insulin resistance and systemic inflammation. So it is likely that hyperuricemia might be involved in hepatic necro-inflammation and destruction which are the common underlying pathophysiology of cirrhosis. On the other hand, as uric acid is the end product of cellular degradation, increased hepatocyte destruction due to any etiology increases the level of serum uric acid which might further aggravate hepatic necro-inflammation, cirrhosis &amp; complications. Objectives: To assess serum uric acid concentrations in patients of cirrhosis of liver and its relation with cirrhosis of different etiology, disease severity and liver enzymes. Materials and Methods: This cross sectional observational study was carried out in the Department of Gastroenterology, BSMMU, Bangladesh during the period of September 2015 to October 2016. A total of 220 diagnosed cases of cirrhosis of liver due to any cause from inpatient &amp; outpatient Department of Gastroenterology of Banghabandhu Sheikh Mujib Medical University were enrolled as the study population. Serum uric acid level was measured in each patient and its relationship with different etiology of cirrhosis, severity of cirrhosis and liver enzymes were assessed. Results: The mean age was found to be 47.8 ± 14.6 years and male: female ratio was 1.9:1. Majority patients (52.3%) belonged to CTP Class C. The mean (±SD) value of serum uric acid was 6.19 (±3.25mg/dl) and hyperuricemia (&gt;7 mg/dl) was detected in 27.73% patients. Among all etiologies of CLD, the higher mean (±SD) level of serum uric acid was found in NAFLD (19.54 ±2.20 mg/dl). There was positive correlation of serum uric acid with liver enzymes. Conclusion: Mean serum uric acid level increased gradually as the cirrhotic patients progressed to higher CTP classes &amp; there was positive correlation of serum uric acid with liver enzymes. It requires further large scale multicenter studies with increased sample size &amp; prolong follow-up to establish serum uric acid as a risk factor of CLD.

Clinical Analysis of Liver Cirrhosis in Abdomen Ultrasound Examination at Dr, H Hospital, Marzoeki Mahdi Bogor

INTRODUCTION. Cirrhosis is a form of liver damage. Cirrhosis of the liver is the final stage of the process of liver fibrosis, which is the consistent from chronic liver disease that the liver cells lose their function. Cirrhosis is most often caused by alcoholism, hepatitis b, hepatitis c and fatty liver but many other charges (Digestive N, Information D. cirrhosis, 2014). OBJECTIVE . To know the effort to depict the cases of cirrhosis of the liver and its signs precisely and accurately by using ultrasound examination METHOD . This research was conducted by qualitative descriptive method. The population is patients who perform abdominal ultrasound examination in Marzuki Mahdi hospital. The sample used was a patient who examined his liver with a diagnosed liver cirrhosis. The number of samples used is 2 patients. RESULTS . After being analyzed and observed, ultrasonography is an appropriate and accurate examination in describing cases of liver cirrhosis. The use of Doppler or laboratory testing is sometimes needed to further confirm the diagnosis of visible signs. CONCLUSION . Based on this research, it can be expected that ultrasound modalities can be used as the first consideration in enforcing liver cirrhosis cases with accurate, fast, cheap and safe results.

P374 Safety and drug survival of methotrexate versus tioguanine after failure of conventional thiopurines in patients with Crohn’s disease

Abstract Background Both methotrexate (MTX) and tioguanine (TG) can be considered as viable treatment options before initiating biological therapy following failure of conventional thiopurines for Crohn’s disease. It is unclear how safety and effectiveness compare for both therapies. This study aimed to compare tolerability and drug survival of MTX and TG therapy after failure of conventional thiopurines in patients with Crohn′s disease. Methods We conducted a retrospective, multi-centre study in five Dutch hospitals, including patients initiating MTX or TG for Crohn’s disease after failure (all causes) of conventional thiopurines. Patients with prior MTX or TG use, MTX or TG not primarily prescribed for Crohn’s disease, or patients receiving concomitant biological treatment at baseline were excluded. Follow-up duration from starting treatment was 104 weeks or until treatment discontinuation. Primary outcome was therapy discontinuation rate due to adverse events (AE). Secondary outcome was ongoing treatment without initiation of biological treatment. Results In total, 221 patients with failure of conventional thiopurines and subsequent therapy with either MTX (n=106) or TG (n=115) were included. Median follow-up was 89 weeks (IQR 28-104). Previous biological failure was present in 28 (26%) MTX and 17 (15%) TG treated patients (p=0.044). Sixty-four (29%) patients (MTX 41.5%, TG 17.4%, p&amp;lt;0.001) discontinued their treatment due to AE during follow-up (Figure 1). Median time until discontinuation due to AE was 16.5 weeks (IQR 8.0–39.0) for MTX and 17.5 weeks (IQR 1.3–69.8) for TG (p=0.925). MTX use was associated with a significantly higher risk of treatment failure due to AE (OR 3.37 [95% CI 1.82–6.25] p&amp;lt;0.001). Previous biological failure was not predictive for MTX or TG failure due to AE (OR 1.086, p=0.828). The most frequent discontinuation reasons were nausea for MTX (n=11) and abdominal pain for TG (n=4). In both groups, 8 (MTX 8%, TG 7%) serious adverse events (SAE) occurred. Infections comprised the majority of all SAE, 4 (50%) for MTX and 7 (88%) for TG. Discontinuation because of elevated liver enzymes occurred in 5 (11%) MTX and 4 (20%) TG treated patients. There were no cases of histological nodular regenerative hyperplasia, liver fibrosis, or cirrhosis. Initiation of concomitant biological therapy was not significantly different (MTX: n=26, TG: n=30, p=0.877). Total monotherapy drug survival after 104 weeks was 46% for TG and 25% for MTX (p&amp;lt;0.001). Conclusion Forty-two percent of MTX, compared to 17% of TG treated patients, discontinued therapy due to AE in patients with Crohn’s disease with prior failure of conventional thiopurines. These data may aid in the selection of subsequent therapy after failure of conventional thiopurine therapy.

Association of the Low-density Lipoprotein Cholesterol/High-density Lipoprotein Cholesterol Ratio with Glecaprevir-pibrentasvir Treatment.

Objective The change in serum lipid levels by direct-acting antiviral (DAA) treatment for chronic hepatitis C varies depending on the type of DAA. How the lipid level changes induced by glecaprevir-pibrentasvir (G/P) treatment contribute to the clinical outcome remains unclear. We conducted a prospective observational study to evaluate the effectiveness of G/P treatment and the lipid level changes. Methods The primary endpoint was a sustained virologic response at 12 weeks (SVR12). The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels and LDL-C/HDL-C (L/H) ratio were measured every two weeks. Patients This study included 101 patients. Seventeen cases of liver cirrhosis and nine cases of DAA retreatment were registered. The G/P treatment period was 8 weeks in 74 cases and 12 weeks in 27 cases. Results SVR12 was evaluated in 96 patients. The rate of achievement of SVR12 in the evaluable cases was 100%. We found significantly elevated TC and LDL-C levels over the observation period compared to baseline. The serum levels of HDL-C did not change during treatment but were significantly increased after treatment compared to baseline. The L/H ratio was significantly increased two weeks after the start of treatment but returned to the baseline after treatment. Conclusion The primary endpoint of the SVR12 achievement rate was 100%. G/P treatment changed the serum lipid levels. Specifically, the TC and LDL-C levels increased during and after treatment, and the HDL-C levels increased after treatment. G/P treatment may be associated with a reduced thrombotic risk. Therefore, validation in large trials is recommended.

Clinical and morphological case of developing liver cirrhosis associated with viral hepatitis in a young patient

The significance of chronic hepatitis is determined not only by the disease per se, but also by the increased risk of the formation of long-term adverse effects such as liver cirrhosis. Viral cirrhosis of the liver (as the outcome of chronic hepatitis B, C, B + D) comprise from 10% to 24.5% of all liver cirrhosis cases. Cirrhosis of the liver is considered as an irreversible stage of chronic hepatitis, more often observed in men above 40 years, but recently more and more its cases are found in young, working ones leading to disability. Due to the high liver regenerative potential, a prognosis for liver lesions of different etiologies may be rather favorable. As a result, early diagnostics, dynamic monitoring and the use of promising methods for treating liver pathology to stimulate its regeneration that compensates for lost liver functions are necessary. In the clinical and morphological case, pathomorphological changes in organs with liver cirrhosis, which developed as a result of viral hepatitis are described. The aim of the study was to describe pathomorphological changes in organs during liver cirrhosis, which developed due to viral hepatitis, which led to multiple organ failure in a young patient. Materials and methods. The analysis of the obtained accompanying medical documentation (outpatient card, medical history) was performed. The standard methodology of autopsy was used. To process histological sections of autopsy material, hematoxylin-eosin staining was used. Results. Histological examination in the liver shows development of portal tract fibrosis with lymphohistio cytic infiltration, formation of monolobular regenerated nodes, signs of edema, areas of demyelination, dystrophic changes in neurocytes, signs of acute renal failure, a combined profound change in the kidneys detected in the lungs and brain, which resulted in multiple organ failure and subsequent lethal outcome in a young patient. The early formation of portal hypertension with liver cirrhosis, esophageal and gastric varicose veins dilatation lead to fatal bleeding in half of patients. Therefore, timely diagnosed cirrhosis and hepatitis as their predecessors is one of the most relevant issues in medicine.