Concomitant Liver Research Articles

Рrospects for the use of "dry" carbon dioxide baths in patients with chronic viral hepatitis c with concomitant non-alcoholic fatty liver disease (literature review and own research)

Рrospects for the use of "dry" carbon dioxide baths in patients with chronic viral hepatitis c with concomitant non-alcoholic fatty liver disease (literature review and own research)

Cryptococcosis in Liver Transplant Candidates and Recipients

Evaluate the epidemiology, risk factors, pathophysiology, and clinical outcomes of cryptococcal infections in patients with advanced liver disease or liver transplantation. Cryptococcal infections in patients with advanced liver disease (ALD) are uncommon but associated with high mortality. Less than 10% of patients in a prospective study of non-HIV-infected cryptococcal meningitis patients had ALD. Significantly, fever was uncommon, resulting in delays in diagnosis. Modalities for diagnosing cryptococcal infections include the rapid lateral flow cryptococcal antigen (CrAg) assay from serum and cerebrospinal fluid (CSF) specimens and multiplex polymerase chain reactions from CSF. Screening all ALD patients with CrAg has not been beneficial. Cryptococcal infections in patients with ALD and liver transplantation result in poor outcomes due to diagnostic delays and concomitant impaired liver function with hepatotoxic therapies. A high index of suspicion is necessary as routine screening has very low yield for early detection.

Liver Involvement in COVID-19 infected patients

Coronavirus outbreak in December 2019 was reported in the city of Wuhan, China firstly named 2019 novel coronavirus (2019-nCoV). Later on, the World Health Organization (WHO) declared another name for this disease which is Corona Virus Disease (COVID-19). On the eleventh of March, 2020, WHO considered the disease as a pandemic. Person-to-person transmission has been reported either through droplet transmission or direct contact. The affected individuals complain from mild symptoms to severe acute respiratory syndrome (ARDS). With the increasing number of COVID-19 infected patients, several studies reported that the liver is the most frequently affected organ after lung damage. Elevation of transaminases was frequently reported in patients with severe disease and patients admitted to ICU. The mechanism of hepatic injury in COVID-19 not completely understood. Multiple factors have been accused including direct invasion of the hepatocyte by SARS-CoV-2, high level of inflammatory mediators, drug-induced hepatic injury, and or concomitant chronic liver diseases. So, evaluation of the mechanism of hepatic injuries in COVID-19 infection is needed.

Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B

Concomitant non-alcoholic fatty liver disease is common in patients with chronic hepatitis B (CHB) infection, although its impact on liver-related outcomes remains controversial. We aimed to study the effect of hepatic steatosis on the risk of fibrosis progression and the likelihood of HBsAg seroclearance. Treatment-naïve patients with CHB, normal alanine aminotransferase and low viraemia (serum HBV DNA <2,000 IU/ml) were prospectively recruited for baseline and 3-year transient elastography assessment. Fibrosis staging was defined according to the EASL-ALEH guidelines, with fibrosis progression defined as ≥1 stage increment of fibrosis. Hepatic steatosis and severe hepatic steatosis were defined as controlled attenuation parameter (CAP) ≥248 dB/m and ≥280 dB/m, respectively. A total of 330 patients (median age 50.5 years, 41.2% male, median HBV DNA 189 IU/ml) were recruited. Twenty-two patients (6.7%) achieved HBsAg seroclearance during follow-up, and the presence of hepatic steatosis was associated with a significantly higher chance of HBsAg seroclearance (hazard ratio 3.246; 95% CI 1.278-8.243; p= 0.013). At baseline, 48.8% and 28.8% of patients had steatosis and severe steatosis, respectively, while 4.2% had F3/F4 fibrosis at baseline, increasing to 8.7% at 3 years. The rate of liver fibrosis progression in patients with persistent severe steatosis was higher than in those without steatosis (41.3% vs. 23%; p= 0.05). Persistent severe hepatic steatosis was independently associated with fibrosis progression (odds ratio 2.379; 95% CI 1.231-4.597; p= 0.01). CAP measurements have predictive value in patients with virologically quiescent CHB. The presence of hepatic steatosis was associated with a higher risk of fibrosis progression but, paradoxically, a 3-fold increase in HBsAg seroclearance rate. Co-existing fatty liver disease in patients with chronic viral hepatitis B infection leads to worsening liver fibrosis, but also increases the chance of cure from hepatitis B virus. Routine bedside assessment of liver fat content is important for risk assessment in treatment-naïve patients with chronic hepatitis B.

Surgical management of pancreatic neuroendocrine liver metastases.

Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of neoplasms that vary in their clinical presentation, behavior and prognosis. The most common site of metastasis is the liver. Surgical resection of neuroendocrine liver metastases (NELM) is thought to afford the best long-term outcomes when feasible. Initial preoperative workup should include surveillance for carcinoid syndrome, screening for evidence of liver insufficiency, and performance of imaging specific to neuroendocrine tumors such as a somatostatin receptor positron emission tomography scan. Standard surgical principles apply to hepatic surgery for NELM, namely prioritizing low central venous pressure anesthesia, minimizing blood loss, knowledge of liver anatomy, generous use of intraoperative ultrasound, as well as safe parenchymal transection techniques and practices to avoid bile leakage. Knowledge of established prognostic factors may assist with patient selection, which is important for optimizing short- and long-term outcomes of hepatic resection. Adjunct therapies such as concomitant liver ablation are used frequently and are generally safe when used appropriately. For patients with synchronous resectable NELM, resection of the primary either in a staged or combined fashion is recommended. Primary tumor resection in the setting of unresectable metastatic disease is more controversial, however generally recommended if morbidity is acceptable. For patients who are not surgical candidates, due to either patient performance status or burden of liver disease, several liver-directed therapies such as transarterial embolization, chemoembolization, and radioembolization are available to assist with locoregional control, extend progression-free survival (PFS), and improve symptoms of carcinoid syndrome. Multiple systemic therapy options exist for patients with metastatic PNET which are often prioritized for those patients with advanced or progressive disease. A systematic approach in a multi-disciplinary setting is likely to result in the best long-term outcomes for patients with pancreatic NELM. Ongoing research is needed to determine the optimal patient selection for hepatic surgery as well as the ideal treatment sequencing for those patients with NELM.

Subclinical liver fibrosis in patients with idiopathic pulmonary fibrosis.

Data on the presence of subclinical fibrosis across multiple organs in patients with idiopathic lung fibrosis (IPF) are lacking. Our study aimed at investigating through hepatic transient elastography (HTE) the prevalence and clinical impact of subclinical liver fibrosis in a cohort of patients with IPF. Patients referred to the Centre for Rare Lung Disease of the University Hospital of Modena (Italy) from March 2012 to February 2013 with established diagnosis of IPF and without a documented history of liver diseases were consecutively enrolled and underwent HTE. Based on hepatic stiffness status as assessed through METAVIR score patients were categorized as "with liver fibrosis" (corresponding to a METAVIR score of F1-F4) and "without liver fibrosis" (METAVIR F0). Potential predictors of liver fibrosis were investigated through logistic regression model among clinical and serological variables. The overall survival (OS) was assessed according to liver fibrosis and multivariate Cox regression analysis was used to identify independent predictors. In 13 out of 37 patients (35%) with IPF, a certain degree of liver fibrosis was documented. No correlation was found between liver stiffness and clinical-functional parameters. OS was lower in patients 'with liver fibrosis' than in patients 'without liver fibrosis' (median months 33 [23-55] vs. 63 [26-94], p = 0.038). Patients 'with liver fibrosis' presented a higher risk of death at seven years as compared to patients 'without liver fibrosis' (HR = 2.6, 95% CI [1.003-6.7], p = 0.049). Higher level of AST to platelet ratio index (APRI) was an independent predictor of survival (HR = 4.52 95% CI [1.3-15.6], p = 0.02). In our cohort, more than one-third of IPF patients had concomitant subclinical liver fibrosis that negatively affected OS. These preliminary claims further investigation aimed at clarifying the mechanisms beyond multiorgan fibrosis and its clinical implication in patients with IPF.

Liver Transplantation in Patients With Pretransplant Renal Dysfunction: A "Safety Net" Is in Place, but Who Should Walk the Tightrope?

Liver Transplantation in Patients With Pretransplant Renal Dysfunction: A "Safety Net" Is in Place, but Who Should Walk the Tightrope?

COVID-19, MERS and SARS with Concomitant Liver Injury-Systematic Review of the Existing Literature.

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

Сlinical experience of using mineral water and vitafonotherapy in the complex treatment of patients with chronic viral hepatitis C with concomitant non-alcoholic fatty liver disease

Сlinical experience of using mineral water and vitafonotherapy in the complex treatment of patients with chronic viral hepatitis C with concomitant non-alcoholic fatty liver disease

SUN-495 Rapid Resolution of Hyperthyroidism Induced Hepatic Dysfunction with Methimazole

Background:Hepatic dysfunction in the setting of hyperthyroidism is difficult to diagnose and poses a challenge in therapy, since the classic medications used are potentially hepatotoxic.Clinical case:A 51-year-old female patient presented with fatigue, palpitations and tremors. BP 146/65 mmHg, HR 111 bpm and Temp 97.8 F. She was severely thyrotoxic with 3 + DTRs, tremors, enlarged thyroid gland with bruit on auscultation, clear lungs and no lower extremities edema. Blood tests showed TSH <0.003 IU/ml (0.450-5.330 IU/ml), Free T4 5.33 ng/dL (0.45-1.80 ng/dL), Free T3 > 30.0 pg/mL (2.3-4.2 pg/mL). Liver enzymes showed elevation in transaminases with ALT 319 IU/L (7-40 IU/L), AST 330 IU/L (7-40 IU/L) normal total Bilirubin 0.7 mg/dL (0.1-1.5 mg/dL) and Alkaline phosphatase 65 IU/L (40-200 IU/L). Transaminases were also elevated 3 weeks prior to presentation and this was extensively worked up with no identifiable etiology to explain the liver dysfunction. She was started on beta blocker therapy and admitted to the ICU. She had no clinical or echocardiographic evidence of cardiac dysfunction and remained hemodynamically stable. She was started on Methimazole 45 mg daily. The patient improved clinically and a pronounced decline in transaminase levels was documented in the first 72 hours. She was discharged home on day 3 of admission. On follow up visit her transaminases were found to have completely normalized within 14 days.Discussion:The diagnosis of elevated transaminases in hyperthyroidism is a challenge. This is due to the possibility of multiple etiologies including decreased cardiac output and/or liver congestion, concomitant primary liver disease or more specifically autoimmune hepatic disease such as primary biliary cirrhosis. (1-2). Incidentally Methimazole has been associated with transient asymptomatic transaminitis typically during the first three months of therapy (3). Our case indicates, that methimazole can be used in patients with a presumed diagnosis of hyperthyroidism induced hepatotoxicity after all possible etiologies are ruled out. Hyperthyroidism as the cause of liver dysfunction can only be entertained after all those etiologies are ruled out and upon resolution of transaminase elevation in conjunction with improvement in the hyperthyroid state itself, as was demonstrated in this case.Conclusion:Methimazole can be safely used in patients with severe hyperthyroidism and elevated liver enzymes when all other etiologies of liver dysfunction have been ruled out.

Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Advanced Liver Disease: An Exploratory Meta-Analysis.

Direct oral anticoagulants (DOACs) have had a positive impact in preventing cardioembolic stroke in patients with atrial fibrillation (AF) who were associated with lower bleeding complications; however, data on subjects with concomitant advanced liver diseases (ALDs) are poor. This meta‐analysis evaluates bleeding and thromboembolic complications in patients with coexisting AF and ALD who were treated with DOACs or vitamin K antagonists (VKAs). We performed a meta‐analysis of randomized controlled trials and observational studies identified by the PubMed and Embase databases using a combination of the following keywords: “direct oral anticoagulants,” “advanced liver disease,” “cirrhosis,” “bleeds,” “stroke.” No time restriction was applied to the research. Two physicians reviewed data on outcome measures and assessed the quality rating. The main outcome was major bleeding, and the secondary outcomes were bleedings (all, intracranial, and gastrointestinal) and ischemic strokes. A total of four studies (one prospective, three retrospective) were identified involving 3,483 subjects with AF and ALD; of these, 1,547 were on VKAs and 1,936 on DOACs. Advanced liver disease was defined as liver cirrhosis or fibrosis‐4 score >3.25. Compared to VKA use, DOAC use was associated with reduced risk for major bleedings (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.44‐0.77; P < 0.001), total bleedings (HR, 0.45; 95% CI, 0.36‐0.55; P < 0.05), intracranial hemorrhage (HR, 0.51; 95% CI, 0.32‐0.80; P < 0.004), and gastrointestinal bleedings (HR, 0.61; 95% CI, 0.42‐0.88; P < 0.008). Efficacy analysis showed no significant difference between VKA‐ and DOAC‐treated patients (HR, 0.83; 95% CI, 0.58‐1.15; P = 0.31). Conclusion: In patients with AF and ALD, the safety and efficacy profile of DOACs did not appear to differ from those with AF without ALD.

Beyond 10years, with or without an intestinal graft: Present and future?

Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n=26) and without (group 2, n=9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87mL/min/1.73m2 . Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.

Acute-on-chronic liver failure alters meropenem pharmacokinetics in critically ill patients with continuous hemodialysis: an observational study

BackgroundInfection and sepsis are a main cause of acute-on-chronic liver failure (ACLF). Adequate dosing of antimicrobial therapy is of central importance to improve outcome. Liver failure may alter antibiotic drug concentrations via changes of drug distribution and elimination. We studied the pharmacokinetics of meropenem in critically ill patients with ACLF during continuous veno-venous hemodialysis (CVVHD) and compared it to critically ill patients without concomitant liver failure (NLF).MethodsIn this prospective cohort study, patients received meropenem 1 g tid short-term infusion (SI). Meropenem serum samples were analyzed by high-performance liquid chromatography. A population pharmacokinetic analysis was performed followed by Monte Carlo simulations of (A) meropenem 1 g tid SI, (B) 2 g loading plus 1 g prolonged infusion tid (C) 2 g tid SI, and (D) 2 g loading and continuous infusion of 3 g/day on days 1 and 7. Probability of target attainment (PTA) was assessed for 4× the epidemiological cut-off values for Enterobacterales (4 × 0.25 mg/L) and Pseudomonas spp. (4 × 2 mg/L).ResultsNineteen patients were included in this study. Of these, 8 patients suffered from ACLF. A two-compartment model with linear clearance from the central compartment described meropenem pharmacokinetics. The peripheral volume of distribution (V2) was significantly higher in ACLF compared to NLF (38.6L versus 19.7L, p = .05). PTA for Enterobacterales was achieved in 100% for all dosing regimens. PTA for Pseudomonas spp. in ACLF on day 1/7 was: A: 18%/80%, B: 94%/88%, C: 85%/98% D: 100%/100% and NLF: A: 48%/65%, B: 91%/83%, C: 91%/93%, D: 100%/100%.ConclusionALCF patients receiving CVVHD had a higher V2 and may require a higher loading dose of meropenem. For Pseudomonas, high doses or continuous infusion are required to reach PTA in ACLF patients.

Hyperthyroidism and hepatic dysfunction: Report of 17 cases.

AimsHyperthyroidism has been known to be associated with abnormalities of serum liver chemistry. The objective of our study is to describe clinical, biochemical and therapeutic features of hepatic dysfunction in hyperthyroidism.Methods and ResultsThis retrospective study was conducted on patients hospitalized in our endocrinology department over 20 years. We included patients with untreated and noniatrogenic hyperthyroidism among whom biochemical findings noted hepatic dysfunction and excluded those with concomitant liver disease. Our population is composed of 10 men and 7 women. The average age was 41.4 years. The mean serum level of free thyroxine was 83.8 pmol/L. The serum thyrotropin level was below the detection limit in 10/17 cases. Graves' disease was the most frequently found etiology of hyperthyroidism. Fourteen patients had hyperthyroidism's complications. Eleven patients manifested congestive heart failure. Hepatic dysfunction was moderate and severe in eight and two cases, respectively. Fifteen patients had cholestasis, associated with jaundice in five cases. Hepatocellular injury and synthetic liver dysfunction were noted in seven and five cases, respectively. Thyroid peroxidase antibodies were positively correlated with the serum level of bilirubin (ρ = 0.695; P = 0.038). A negative correlation was noted between alanine aminotransferase and left ventricular ejection fraction (ρ = −0.812; P = 0.05). Radioactive iodine was indicated in 15/17 cases. Follow‐up liver tests were performed in 11 cases. They all had normalized hepatic function once euthyroidism restored.ConclusionLiver injury in hyperthyroidism is relatively common, ranging from mild to severe. Therefore, patients presenting unexplained hepatic abnormalities require close examination and an evaluation of the thyroid function should be sought.

FEATURES OF MICROCIRCULATORY DYSFUNCTION ACCORDING TO WAVLET ANALYSIS LASER DOPPLER FLOWMETRY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE AND CONCOMITANT DIFFUSE LIVER DISEASES

Aim. To determine the features of microcirculatory dysfunction and in patients with chronic ischemic heart disease, depending on the presence of concomitant diffuse liver disease. Materials and methods. We performed a prospective study on the basis of MC «Doctor Vera», as well as in the diagnostic department of Medbud Clinic between 2009 and 2019. A total of 187 patients were examined. Patients' blood flow was assessed by transthoracic echocardiography, wavelet analysis laser Doppler flowmetry (LDF). Results. In the analysis of indicators of microcirculatory dysfunction in patients with ischemic heart disease, statistically significant deterioration of wavelet analysis laser Doppler flowmetry was determined. In patients with ischemic heart disease and left ventricular ejection fraction &lt; 40 %, indicators of wavelet analysis LDF were significantly lower. We also found that the severity of diffuse liver disease significantly disrupts peripheral blood flow (Р &lt; 0.05). Conclusions. The results of intracardiac hemodynamics, microcirculatory dysfunction were first presented. In patients with isolated ischemic heart disease as the left ventricular EF decreased, a significant decrease in capillary blood flow was observed as a result of deterioration of central hemodynamics, development of atherosclerotic vascular changes, as well as an increase in their vascular tone. We have proved that in the presence of DLD in patients with ischemic heart disease and EF &lt; 40 %, the degree of increase in peripheral resistance and impaired venous outflow were more pronounced due to the depletion of vasoactive substances production, impaired their excretion by hepatocytes due to irreversible morpho-functional changes in liver at the stage of decompensation of HF, severe fibrosis, the formation of regeneration nodes. In patients with LC, the most severe disorders of peripheral blood flow were determined according to the data of the digital capillaroscopy, which testifies to the influence of the degree of liver damage on the state of microcirculation.

Gallbladder perforation with concomitant liver abscess: a case report with a review of treatment options

Gallbladder perforation (GBP) management is still controversial in regards to time (early vs. interval), first procedure (surgical vs. drainage) and technique (laparoscopic vs. open). This is the case report of an adult patient with GBP Niemeier type II, complicated with a concomitant hepatic abscess. The patient was treated medically and with laparoscopic drainage of abscess and pyocholecistolithiasis. She was scheduled shortly after for endoscopic retrograde cholangiopancreatography, and posteriorly for definitive treatment with laparoscopic cholecystectomy 1 month later. Satisfactory postsurgical outcome, with uneventful 1-month follow-up.

Individualized concept for the treatment of autosomal recessive polycystic kidney disease with end-stage renal disease.

Management of children with autosomal recessive polycystic kidney disease (ARPKD) who develop end-stage renal disease (ESRD) remains challenging because of concomitant liver disease. Patients with recurrent cholangitis are candidates for liver-kidney transplantation, while the treatment for patients with splenomegaly and pancytopenia due to portal hypertension is controversial. Herein, we report 7 children who were treated using an individualized treatment strategy stratified by liver disease. Two patients with recurrent cholangitis underwent sequential liver-kidney transplantation, while 4 patients with splenomegaly and pancytopenia but without recurrent cholangitis underwent splenectomy followed by isolated kidney transplantation. The remaining patient, who did not have cholangitis and pancytopenia, underwent isolated kidney transplantation. Blood cell counts were normalized after splenectomy was performed at the median age of 8.7 (range, 7.4-11.7) years. Kidney transplantation was performed at the median age of 8.8 (range, 1.9-14.7) years in all patients. Overwhelming post-splenectomy infections and cholangitis did not occur during the median follow-up period of 6.3 (range, 1.0-13.2) years. The estimated glomerular filtration rate at the last follow-up was 53 (range, 35-107) mL/min/1.73m2 . No graft loss occurred. Our individualized treatment strategy stratified by recurrent cholangitis and pancytopenia can be a feasible strategy for children with ARPKD who develop ESRD and warrants further evaluation.

GOUT AND NONALCOHOLIC FATTY LIVER DISEASE: EFFECT OF ENTEROSORPTION’S ADDITION TO COMMON TREATMENT

Background. Gout is still one of the major health problems despite significant advances in treatment in recent years. It has been proved that pathogenetic mechanisms of development and progression of gout are associated with nonalcoholic fatty liver disease. Complex pathogenic treatment of patients aimed at different parts of the pathological process has recently been supplemented with the enterosorbents.&#x0D; Objective. The aim of the research is to study the clinical features of gout with concomitant nonalcoholic fatty liver disease (NAFLD) and to evaluate the effect of carbon enterosorbent on its course.&#x0D; Methods. 123 patients were involved in the study. They were divided into 2 groups: group 1 included patients with gout without liver damage, and group 2 included patients with concomitant NAFLD. Each of these groups was divided into subgroups, in which the patients received carbon enterosorbent carboline plus basic treatment. The control group consisted of 30 healthy persons. Anamnesis, physical examination, uric acid (UA), C-reactive protein (CRP) content, erythrocyte sedimentation rate (ESR) in serum were determined. Gout activity was evaluated using the Gout Activity Score (GAS).&#x0D; Results. Basic treatment in combination with carbon enterosorbent contributed to faster cure of intoxication, pain and joint syndromes, as well as decrease of the inflammatory process activity.&#x0D; Conclusions. The course of gout in the patients with concomitant NAFLD is more severe. Adding of carbon granular enterosorbent carboline in the complex treatment of patients with gout with or without concomitant NAFLD in the exacerbation phase contributes to a faster cureing dynamics of clinical and laboratory manifestations of the disease.

Short term Outcome of Coronary Artery Bypass Surgery in Patients with Impaired Left Ventricular Systolic Function

Abstract Background: Coronary artery bypass graft surgery (CABG) in patients with left ventricular dysfunction was associated with improved survival compared to medical treatment. We aimed to evaluate the short-term outcome of CABG in patients with an ejection fraction of ≤ 40%. Methods: Forty patients with ejection fraction (EF) ≤40% underwent CABG between December 2015 and August 2019. Patients with moderate to severe mitral regurgitation, concomitant severe liver and kidney impairment, re-operative CABG, who had concomitant procedures with CABG were excluded. The mean age was 56.72±12.44 years; 30 patients (75%) were males. Twenty-six patients (65%) were diabetics, 28 patients (70%) were hypertensive, 18 patients (45%) were dyslipidemic, 22 patients (55%) were smokers and 4 patients (10%) were obese. The preoperative ejection fraction ranged from 20% to 40%, with a mean of 34.62% Results: Mean cardiopulmonary bypass time was 90.8 minutes, and ischemic time was 49.8 minutes. Seventeen patients (42.5%) needed inotropic support intraoperatively, and 16 patients (40%) needed an intra-aortic balloon. Five patients (12.5%) had postoperative ischemia, one patient (2.5%) had re-exploration for bleeding, and one patient (2.5%) had acute renal failure. The mean ICU stay was 70.5± 45.63 hours, hospital stay was 8.9± 4 days, and three patients (7.5%) had operative mortality. After 6 months operatively, the ejection fraction improved to reach a mean value of 39.87± 5.02% compared to the preoperative ejection fraction of 32.8± 8.8%. (p<0.001) Conclusion: Coronary artery bypass grafting can be performed safely in patients with depressed left ventricular function with low short-term morbidity and mortality.

CORRECTION OF ALBENDAZOLE DOSAGE AFTER LIVER ECHINOCOCCTOMY

Purpose. To improve the quality of treatment of patients with liver echinococcosis by optimizing postoperative chemotherapy. Material and methods. 226 patients with liver echinococcosis were admitted to the surgical department of the 2nd Clinic of the Samarkand State Medical Institute in 2009-2017. Patients were divided into two groups. In 2009-2012, 112 (49.5%) patients were operated on and were included into a control group. In 2013-2017, 114 (50.5%) patients were followed -up and were included into a study group. In the control group, postoperative chemotherapy was made by the standard protocol. In the studied group, Albendazole dosage was corrected according to the initial functional state of the liver. Due to positive findings in the experimental group, Albendazole was used at the dosage 5 mg / kg / day in patients with verified chronic liver disease and if liver enzymes were elevated before surgery. Results. Adverse reactions of Albendazole chemotherapy, by clinical and laboratory parameters, could develop in 52.7% - due to the preparation toxic effect and concomitant chronic diffuse liver pathology- while under dose correction, this figure is reduced to 18.3%. Conclusion. The proposed dose correction in patients with signs of liver insufficiency normalizes biochemical parameters and reduces toxic manifestations during chemotherapy. Of these 144 patients, long-term observations revealed echinococcosis relapse in 6 (4.2%) patients.