Presence Of Extrahepatic Manifestations Research Articles

Registry of patients with autoimmune liver diseases in St. Petersburg: clinical and epidemiological data

BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics. AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations. MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov. RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases. CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.

Intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis: a multicenter cohort study.

The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama's classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher's exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P<0.0001). Different types of AE liver lesions are associated with differences in vascular/biliary involvement and extrahepatic manifestations. Vascular/biliary involvement and presence of distant extrahepatic manifestations depend on size of the HAE lesions and are more frequently detected in China. Different MRI morphological patterns influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.

Clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus etiology in the early stages of its formation

Background. Currently, the incidence of viral cirrhosis of the liver increases significantly, presenting an essential medical and social problem. This study aimed to clarify the clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus (HCV) etiology in the early stages of formation to improve the quality of diagnosis using a sample of patients from the regional hepatological center in Krasnodar (Specialized Clinical Infectious Diseases Hospital).&#x0D; Methods. In 2018, 1,307 patients with liver diseases of viral etiology were examined and treated at the hepatological center. A retrospective analysis of the monitoring results of 153 patients with hepatic cirrhosis of viral C etiology with HCV replication was performed; patients with mixed etiology of cirrhosis were excluded from the study. The enrolled participants included 89 women (58.2%) and 64 men (41.8%). The average age of the patients was 53.5 0.93 years. In accordance with the ChildPugh classification of hepatic cirrhosis, class A (I) was diagnosed in 92 (60.1%) patients, and class B (II) was revealed in 53 (34.6%) patients.&#x0D; Results. In 59.5% of cases, viral liver damage was first detected at the stage of outcome to cirrhosis. In 1/3 (32.5%) of the patients, the diagnosis of hepatic cirrhosis was established in the year of visit, and in another 27%, it was established during the first three years from the date of detection of hepatitis C markers. In less than in 1/5 (18.3%) of the patients, 924 years have passed from the discovery of hepatitis C markers to the establishment of hepatic cirrhosis. During the three-year follow-up period, the progression of cirrhosis with the transition to the next stage occurred in 6.5% of cases. In residents of Krasnodar Territory, among the leading epidemiological factors, including a monofactor epidemiological history and multifactorial nature with almost the same frequency, the alleged cause of infection was surgery (43%45%). Prosthetics, dental sanitation, and blood transfusion were indicated as possible infection factors with high incidence. Factors, such as drug addiction, childbirth, tattoos, occupational injuries in medical personnel, and abortions, were recorded in isolated cases. In the early diagnostics of compensated class A cirrhosis, the increased contents of alanine and aspartate aminotransferases showed diagnostic value. Mild increases in the levels of alpha-fetoprotein and direct bilirubin, moderate decreases in prothrombin index and platelets, dilation in the diameter of the portal (v. portae) and splenic (v. lienalis) veins to borderline values with an upper limit of norm with an increased size of the spleen, and esophageal varices, and development of the initial stage of hepatic encephalopathy were also noted. The presence of extrahepatic manifestations in 12% of the patients should be considered.&#x0D; Conclusion. Despite the high infection rate of the population with hepatitis C virus, late diagnostics of liver damage often occurred, and this finding is partly due to the late action of patients in seeking medical help. On the other hand, the widespread introduction of mandatory medical examination led to the active identification of sick people. For timely diagnosis, the presence of a history of risk factors for hepatitis infection must be considered, and attention must be focused on the abnormalities of blood biochemical parameters, ultrasound, and fibrogastroduodenoscopy data.

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Association of C-type lectin 18 levels with extrahepatic manifestations in chronic HCV infection

Mixed cryobulinemia (MC) is the most common chronic hepatitis C virus (HCV)-associated extrahepatic manifestation. C-type lectin 18 (CLEC18) is a novel secretory lectin that is abundantly expressed in hepatocytes and peripheral blood cells (PBCs). We investigated the associations between CLEC18 expression during HCV infection and the presence of extrahepatic manifestations. A total of 41 rheumatic patients with HCV infection (including 28 patients with MC syndrome), 45 rheumatic patients without infection, and 14 healthy subjects were enrolled. The CLEC18 levels in PBCs and serum were determined by using flow cytometry and enzyme-linked immunosorbent assay, respectively. Significantly higher CLEC18 levels were observed in patients with HCV infection (P < 0.001) and were positively correlated with HCV viral loads (γ = 0.56, P < 0.05). Among patients with HCV infection, significantly increased CLEC18 levels were observed in patients with MC syndrome, particularly in those with type II MC (P < 0.05). CLEC18 levels were associated with cryoglobulin and C4 levels (P < 0.05). CLEC18 was significantly associated with HCV infection, particularly in those with HCV-associated MC. CLEC18 levels were also positively correlated with MC disease activity, suggesting its involvement in MC pathogenesis. CLEC18 may be a novel indicator of HCV infection and a potential therapeutic target in rheumatic patients.

Variety of lung involvement in autoimmune liver diseases

The primary autoimmune liver diseases conventionally include primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis. Despite of primary autoimmune affection of different parts of the hepatobiliary system, in the recent decades, a lot of data has emerged indicating the presence of extrahepatic manifestations of these diseases, in particular, lung lesions, such as nodular and interstitial changes with possible progression and development of fibrosis and respiratory failure. In case of lungs disease, both pulmonary parenchyma and lung vessels, pleura, and intrathoracic lymph nodes can be involved. The most sensitive and specific procedure to assess the extent of the lung lesions and their evolution is high-resolution computed tomography. Due to the possibility of long-term asymptomatic course of the pulmonary disease with development of irreversible changes in patients with autoimmune liver diseases, it seems reasonable to conduct screening studies aimed at early detection and treatment of lung lesions in this population.

Hepatitis C infection with normal transaminases: Is the treatment worse than the disease?

Hepatitis C infection with normal transaminases: Is the treatment worse than the disease?