Gallbladder Disease Research Articles

Helicobacter pylori relationship in cases of coexistence of gastritis and gallbladder disease

Purpose: We aimed to investigate the effect of Helicobacter Pylorii (HP) on the development of gallbladder diseases and cholelithiasis and its relationship with gastritis.
 Methods: 282 gastritis cases with follow-up and operated gallbladder material were included in the study. All histomorphological findings, presence of HP and other variables were compared. Active inflammation and presence of HP were examined in the gastritis group. The gallbladder (GB) disease group was evaluated in terms of cholelithiasis, inflammation, cholesterolosis, intestinal and pyloric metaplasia, and the presence of HP.
 Results: Gallbladder HP (+) was higher in female patients than in male patients. The presence of HP in the GB was significantly higher in patients with cholelithiasis than patients without cholelithiasis. The incidence of HP in the GB was higher in patients with active gastritis than in patients with inactive gastritis. The presence of HP in the GB was found to be higher in patients with HP on gastric biopsy. HP was found to be less in cases without cholesterolosis in the GB (p

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico.

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

Modern interpretation of anatomical differences of liver, gallbladder and bile ducts of the children of different age groups

This article discusses gall bladder and liver diseases that are common in young children and adults. In addition, the anatomical differences of the liver, gall bladder and bile ducts were discussed.

Impact of Coronavirus Disease 2019 on Clinical Outcomes of Robotic Cholecystectomy.

The coronavirus disease 2019 (COVID-19) pandemic strained the health care sector, putting severe constraints on surgical departments. In this study, we evaluate the impact of the pandemic on the outcomes of patients undergoing robotic cholecystectomy (RC). Patients who underwent RC 1 year before and after March 2020 were included in this retrospective study and assigned accordingly to the pre or post-COVID group. Pre, intra, and postoperative variables were compared between groups. In total, 110 patients were assigned to the pre-COVID group versus 80 in the post-COVID group. There were no differences in the demographics, except for a higher rate of previous gallbladder disease in the pre-COVID group (35.5% vs 13.8,% P < 0.001). The post-COVID group had a higher rate of emergent RCs (62.5% vs 39.1%, P = 0.002). Operative times were greater in the post-COVID group due to the more frequent participation of clinical fellows in the cases. The median hospital length of stay for both groups was 1 day, with higher rates of same-day discharge (pre-COVID 40.9% vs post-COVID 57.5%, P = 0.028). Complications were comparable between both groups, with no recorded cases of COVID-19 contraction within the virus incubation period. The median follow-up was 10 months for the entire cohort. During the COVID-19 pandemic, an increase in emergent cases, as well as higher rates of same-day discharge, were recorded, with no impact on postoperative outcomes in patients undergoing RC.

Factors influencing delayed discharge after day-surgery laparoscopic cholecystectomy: the DeDiLaCo study protocol.

Laparoscopic cholecystectomy (LC) is the gold standard for most benign gallbladder diseases. Early discharge (<24 hours) has the same outcomes as longer (>24 hours) hospital stay. Nevertheless, the rate of delayed discharge >24 hours range from 4.6% to 37%. The primary endpoint of this Italian nationwide study is to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours and identify potential limiting factors of early discharge. Results from these analyses will be used to select patients who can be safely discharged on the same day after surgery. Secondary endpoints will be to evaluate the patient's quality of life (QoL), assess the direct health costs associated with late discharge, and quantify the patient's involvement in the treatment process. This prospective, observational study was conducted following a resident-led model and the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. All patients were treated according to the local hospital protocol and received routine care as standard therapy. We expected to obtain the enrollment of at least 500 patients based on an assumed difference in discharge delay between the reference and the recruitable population of 6% and the identification of factors related to discharge failure within 24 h. Early discharge after LC leads to advantages both in terms of clinical outcomes and quality of life of the patient, and it is highly effective in terms of health costs and shortening the waiting list. However, clinical reality differs from the results of randomized studies by a complex series of non-objectionable real-world data influencing treatment plans. Therefore, we expected to identify independent predictors and factors of failure of early discharge. Clinical reality often differs from randomized trial results. In Italy, the vast majority of delayed discharges after LC may not be related to surgery and can be prevented both with logistical reorganization and with a readjustment of the trust reimbursement policies.

1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB

Abstract Aim Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access. Method A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention. Result 85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2. Conclusions Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure

696 “The Doctor Will See You… Soon”: The Impact of the COVID-19 Pandemic on Acute Biliary Surgery and Patient Experience

Abstract Aim Managing biliary disease acutely is cost effective and has high patient satisfaction. Our unit has established a successful “hot” gallbladder pathway, but COVID-19 and reduced operating capacity has potentially impacted this. This study compares rates of “hot” cholecystectomy, patient satisfaction and quality of life (QoL) impact pre and during COVID-19 pandemic, to determine whether performance has been affected. Method Quantitative data on time from diagnosis to surgery was collected from September to March in 2016-17 and 2021-22. A QoL questionnaire was piloted and distributed to eligible patients in March-April 2017 and 2022, enquiring about symptoms, mental health, anxiety, and patient experience. Results Mean wait for non-elective cholecystectomy was 2.4 days (range 0-8) in 2016-17, versus 6 days (range 0-86) in 2021-22. 100% (n = 57) of patients in 2016-17 had surgery within 8 days, compared with 83% (n = 53) in 2021-22. Median number of “hot” cholecystectomies weekly was unchanged. Patient satisfaction was sustained; 92% of patients in 2022 would “definitely” recommend the service, compared to 100% in 2017. 33% of patients in 2022 reported that mental health was impacted “extremely” or “quite a lot”, compared with 27% in 2017. 38% of patients in 2022 were “extremely” anxious about recurrent symptoms before surgery, compared to 27% in 2017. 33% of patients felt that COVID-19 impacted access to services for gallbladder disease. Conclusions The “hot” cholecystectomy service has been impacted by COVID-19, but performance remains high. It is still possible to deliver a successful service despite COVID constraints. Despite increased delays, patients remain very satisfied with their care.

Gall bladder diseases: a study of histopathological spectrum of cholecystectomy specimens from rural tertiary hospital in Telangana state during COVID pandemic

Background: The debate of “is it worth spending the busy pathologist’s time on gall bladder specimens” has been there for decades. The selective approach may result in missing discrete pathologies such as premalignant lesions. We are presenting an interesting series of gall bladder histopathology diagnosed at our institute in the past two years. Methods: This is a retrospective study done at Bhaskar Medical College between 2020-2022 (specifically chosen as this is the period of COVID pandemic). This study included 43 patients who underwent cholecystectomy. All confirmed cases of acute abdomen operated for other reasons and trauma were excluded. Sections were taken from neck, fundus, body and cross section of cystic duct of each cholecystectomy specimen. The whole gallbladder was submitted and screened for the invasion in ICPN case. These sections were processed through routine paraffin embedding, microtome cutting and H&amp;E staining for evaluation of spectrum of various gallbladder lesions. Results: In our study, 25 cases showed lymphoplasmacytic infiltration with fibrosis, 9 cases showed ulceration, congested blood vessels and neutrophilic infiltration. We encountered few rare cases like eosinophilic cholecystitis, xanthogranulomatous cholecystitis, and Intracholecystic papillary neoplasm (ICPN)”. Pyloric metaplasia was seen in 27.9% cases, which is also higher Conclusions: Our study emphasizes the need for the routine examination of these specimens, to have a detailed understanding of the etiology to prevent/predict the other associated medical conditions. We also could find 2% of the cases having pre-malignant lesions and 28% having metaplasia, which if missed shall progress to malignant conditions.

The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study

BackgroundThe telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy.MethodsWe conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment.ResultsWe identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%.ConclusionsOur series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.

Ginsenoside Rg1 alleviates ANIT-induced cholestatic liver injury by inhibiting hepatic inflammation and oxidative stress via SIRT1 activation

Ethnopharmacological relevanceGinseng (Panax ginseng C. A. Mey) is a common traditional Chinese medicine used for anti-inflammation, treating colitis, type 2 diabetes, diarrhea, and recovering hepatobiliary function. Ginsenosides, the main active components isolated from ginseng, possess liver and gallbladder diseases therapeutic potential. Aims of the studyCholestatic liver injury (CLI) is a liver disease induced by intrahepatic accumulation of toxic bile acids and currently lacks clinically effective drugs. Our previous study found that ginsenosides alleviated CLI by activating sirtuin 1 (SIRT1), but the effective ingredients and the underlying mechanism have not been clarified. This study aimed to identify an effective ingredient with the most significant activation effect on SIRT1 from the five major monomer saponins of ginsenosides: Rb1, Rd, Rg1, 20s-Rg3, and Rc further explore its protective effects on CLI, and elaborate its underlying mechanism. Materials and methodsDiscovery Studio 3.0 was used to conduct molecular docking between monomer saponins and SIRT1, and further detect the influence of monomer saponins on SIRT1 activity in vitro. Finally, it was determined that Rg1 had the most significant stimulative effect on SIRT1, and the hepatoprotective activity of Rg1 in CLI was explored in vivo. Wild-type mice were intragastrically α-naphthylisothiocyanate (ANIT) to establish an experimental model of intrahepatic cholestasis and Rg1 intervention, and then liver injury and cholestasis related indexes were detected. In addition, Liver-specific SIRT1 gene knockout (SIRT1-/-) mice were administered with ANIT and/or Rg1 to further investigate the mechanism of action of Rg1. ResultsThe results of molecular docking and in vitro experiments showed that all the five ginsenoside monomers could bind to the active site of SIRT1 and promote SIRT1 activity in HepG2 cells. Among them, Rg1 exhibited the most significant stimulation of SIRT1 activity in cholestasis. Besides, it could ameliorate ANIT-induced inflammation and oxidative stress in HepG2 cells. Therefore, we investigated the hepatoprotective effect and mechanism of Rg1 on CLI. Results showed that Rg1 reversed the ANIT-induced increase in biochemical parameters, improved liver pathological injury, and decreased liver lipid accumulation, reactive oxygen species and pro-inflammatory factor levels. Mechanistically, Rg1 induced SIRT1 expression, followed by promoted the activity of Nrf2 and suppressed the activation of NF-κB. Interestingly, the hepatoprotective effect of Rg1 was blocked in SIRT1-/- mice. ConclusionRg1 mitigated ANIT-induced CLI via upregulating SIRT1 expression, and our results suggested that Rg1 is a candidate compound for treating CLI.

OPEN VERSUS LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A SYSTEMATIC REVIEW

Background: Acute cholecystitis is an inflammatory disease caused by gallstones that can range from mild to severe, with septic sepsis as a complication. It is the sixth most prevalent gastrointestinal disorder and is responsible for 0.2% to 0.5% of all fatalities. 16% of men and 50% of women in their 70s have gallbladder disease, which is a risk factor. Various treatment modalities, such as open or laparoscopic cholecystectomy, are available.&#x0D; Aim: The purpose of this review is to compare the advantages and disadvantages of open cholecystectomy and laparoscopic cholecystectomy in the acute management of cholestitis.&#x0D; Methods: We conducted a comprehensive search of multiple electronic reference databases (PubMed, ScienceDirect, Web of Science, and Cochrane). The inclusion criteria were English-language articles with full-text availability and articles published between 2018 and 2023. The studies analyzed complications and a variety of other parameters to determine the benefits and drawbacks of each method.&#x0D; Results : A total of 5 studies were included. Various complications can be used as parameters to determine the superiority of each method. Four out of 5 studies found that laparoscopic was superior to open cholecystectomy. The hospitalization time of laparoscopic patients was lower (LC 1.67±0.9 days; OC 3.2±1.8) with a lower amount of bleeding during surgery &gt;100 ml compared to open laparoscopic (Intra operative bleeding (OC (n=8) vs LC (n=0)).&#x0D; Conclusion: Considering the advantages and disadvantages of the described complication parameters, laparoscopic procedures are superior and preferable to the use of open cholesistectomy in cases of acute cholesystitis.

Association of fecal zonulin and calprotectin levels with cardiovascular risk factors and target organ damage in a sample of patients with metabolic disorders

Surrogate markers quantifying the severity of intestinal inflammation (fecal calprotectin) and permeability (fecal zonulin) are currently considered nontraditional cardiovascular risk factors.Aim. To study the associations of fecal zonulin and calprotectin levels with cardiovascular risk factors and target organ damage among participants with metabolic disorders from a population sample of St. Petersburg residents aged 35-75 years.Material and methods. In-depth phenotyping was performed on patients from a cohort of St. Petersburg residents metabolic disorders (overweight, hyperglycemia) invited for reexamination as part of the ESSE-RF epidemiological study. All patients underwent a questionnaire examination (physical activity, smoking, alcohol consumption, sleep, stress, anxiety and depression, assessment of digestive system complaints, frequency of food consumption). In addition, blood pressure and pulse measurements, anthropometry, biochemical and hormonal blood tests, echocardiography, applanation tonometry, volume sphygmography, duplex carotid scanning, and determination of fecal zonulin and calprotectin levels were carried out.Results. The examined cohort (n=86; mean age, 56 [44,7;63,5] years; men, 49,5%) was characterized by a high prevalence of abdominal obesity (80,2%), dyslipidemia (low-density lipoproteins &gt;3 mmol/l — 76,7%, triglycerides ³1,7 mmol/l — 43%, total cholesterol &gt;4,9 mmol/l — 77,9%) and insulin resistance (64%) with slight sex differences. An increase in calprotectin occurs in 23,3% of patients, zonulin — in 30,3%, while an increase in calprotectin and/or zonulin occurs in almost half of those examined (47,7%). Fecal calprotectin levels are associated with indicators of dyslipidemia, obesity, inflammation and atherosclerotic vascular disease, as well as dietary patterns and socioeconomic indicators. Zonulin levels are associated with N-terminal probrain natriuretic peptide levels and the presence of vitamin D deficiency, gallbladder disease, and dietary patterns.Conclusion. Increase of at least one marker of intestinal permeability and inflammation occur in approximately half of the participants with metabolic disorders from a population sample of St. Petersburg residents. In addition to the association of calprotectin and zonulin with metabolic risk factors and dietary patterns, calprotectin levels were associated with atherosclerotic changes in the carotid arteries.

Gallbladder Drainage: IR and GI Perspective

AbstractCholecystitis and gallbladder disease are an important, growing, and costly problem. As interventional radiology (IR) and gastroenterology (GI) have evolved and become even more minimally invasive and technically capable, we play an increasingly important role in the management of cholecystitis, particularly in nonsurgical and palliative settings. This review highlights the modern and future role of IR and GI in gallbladder drainage for the management of acute cholecystitis.

Impact of the COVID-19 Pandemic on the Management of Gallbladder, Biliary Tract, and Pancreatic Diseases.

Introduction Biliary diseases are a major acute general surgical burden. Laparoscopic cholecystectomy is the gold standard surgical procedure, although it was discontinued during an outbreak. Effective management permits decisive therapy, symptom alleviation, and fewer hospitalizations and complications. Throughout the initial COVID-19 situation, surgical procedures for patients were delayed. Invasive services were required to employ conservative or non-operative therapy, which could lead to increased recurring presentations and biliary-pancreatic problems. Aim Examining the impact of COVID-19 on the outcomes and hospitalizations of patients suffering from gallstone, biliary tract, and pancreatic diseases. Methods The retrospective analysis included patients with the following ICD-10 codes who presented to our unit: cholelithiasis (K80), cholecystitis (K81), and acute pancreatitis (K85). We compared the interval of the first COVID-19 pandemic wave, from March to August 2020, with the period before the pandemic, referred to as Pre-COVID-19. After applying exclusion criteria, a total of 868 patients were enrolled in the trial, having initially recruited around 1,400 individuals using these codes. Patients with inaccurate coding, cancer, or non-stone disease were excluded (e.g., alcoholic pancreatitis). The demographic information, admission details, investigations, surgical therapy, operating specifics, and postoperative complications of the patients were noted. Changes in surgical management, patient representation, and postoperative complications were the key outcomes. Results A statistically significant (p<0.05) rise was seen in repeat presentations in the COVID group, most likely due to the failure of definitive treatment. The other outcome is the distribution of presentations was comparable, patients with acute cholecystitis and gallstone pancreatitis showed statistically significant (p<0.05) lower rates of definitive therapy. Conclusion During the COVID period, all surgeries except those for cancer were halted. Unknown causes led to several consequences related to the gallbladder, biliary tract, and pancreas. Patients with cholecystitis, gallstone pancreatitis, and pancreatic inflammation experienced a lower probability of treatment. The increase in hospitalizations and self-presentations indicated that definitive therapy, designed to restrict COVID-19 exposure, actually increased patient risk. Despite this risk, we had no COVID-19 instances in our cohort. The evaluation of the long-term consequences of the pandemic on acute pancreatitis and its care will require a large-scale, multicenter investigation.

The Association Between Common Bile Duct Diameter and the Severity of Coronary Artery Atherosclerosis, Based on Calcium Score

Objective: The aim was to assess the relationship between the coronary calcium score and the common bile duct (CBD) diameter, to determine whether the increase in CBD diameter in patients without hepatobiliary disease could represent cardiovascular disease, or the extent of atherosclerosis in coronary arteries. Materials and Methods: The study cohort consisted of 103 patients referred for computed tomographic angiography (CTA) for coronary artery assessment. None of the patients had a gallbladder, biliary, or pancreatic disease or surgery history. The Agatston score determined the rates of arterial calcification. The diameter of the CBD was measured for a sonogram. Results: There was a statistically significant relatively strong correlation between calcium score and CBD diameter ( r = 0.44, P = .001), independent of baseline variables, such as demographics and cardiovascular risk profiles. In the multivariable regression model, advanced age (beta = 0.825, P = .005), history of hypertension (beta = 0.591, P = .034), and history of coronary stenting (beta = 1.339, P = .001) were shown to be the main determinants of CBD dilatation. Conclusion: A statistically significant correlation existed between the CBD diameter and calcium score, within the coronary arteries and this could represent a shared pathophysiology between CBD dilatation and the severity of coronary atherosclerosis.

PROSPECTS OF HEPATOPROTECTIVE EFFECT OF SESQUITERPENE LACTONE ABSINTIN

Liver and gallbladder diseases are among the most common in the world today. Liver disorders occupy one of the most important places in the pic-ture of general human pathology, having a fairly high risk of developing adverse complications. Preparations and biologically active additives based on Artemisia absinthium and the components extracted from it have recently become very popular. The group of sesquiterpene lactones is of the greatest interest to researchers. The object of this review article is to analyze domestic and foreign publications showing the pharmacological activity and pro-spects of using absinthin, which is part of the group of sesquiterpene lactones of A. absinthium, as a hepatoprotector. An analysis of the literature re-vealed that absinthin has an antitoxic effect, reduces lipid peroxidation in liver tissues and restores the activity of protective antioxidant enzymes su-peroxide dismutase (SOD) and glutathione peroxidase (GPx) to a normal level. The generalization of literature data showing the pharmacological effect of the substance indicates the ability of absinthin to reduce the level of toxic effects of fatty acids and cholesterol on hepatocytes. It was also revealed that absinthin is able to have an antiproliferative effect on human adenocarcinoma cells. The positive effect observed when using absinthin character-izes the prospects of its practical application as a drug or biologically active additive with hepatoprotective and antitumor effect.

Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study.

Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis.The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examinedthe abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.

Comparison between Open Cholecystectomy, 4-Port Laparoscopic Cholecystectomy and One-Port Laparoscopic Cholecystectomy: A Literature Review

Cholecystectomy is the most commonly performed surgical procedure to treat gallbladder disease. In recent decades, the technique of laparoscopic cholecystectomy has been developed, which has proven to be a less invasive alternative with better results compared to traditional open cholecystectomy. However, laparoscopic one-port cholecystectomy has recently been introduced as an even less invasive variant. In this literature review article, a comprehensive comparison is made between open cholecystectomy, 4-port laparoscopic cholecystectomy and one-port laparoscopic cholecystectomy, evaluating the epidemiology, clinical significance, definition, surgical technique, advantages and complications of each approach.

Current Insights Regarding Intestinal Failure-Associated Liver Disease (IFALD): A Narrative Review.

Intestinal failure-associated liver disease (IFALD) is a spectrum of liver disease including cholestasis, biliary cirrhosis, steatohepatitis, and gallbladder disease in patients with intestinal failure (IF). The prevalence of IFALD varies considerably, with ranges of 40-60% in the pediatric population, up to 85% in neonates, and between 15-40% in the adult population. IFALD has a complex and multifactorial etiology; the risk factors can be parenteral nutrition-related or patient-related. Because of this, the approach to managing IFALD is multidisciplinary and tailored to each patient based on the etiology. This review summarizes the current knowledge on the etiology and pathophysiology of IFALD and examines the latest evidence regarding preventative measures, diagnostic approaches, and treatment strategies for IFALD and its associated complications.