Severity Of Liver Dysfunction Research Articles

Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction.

This study aims to describe the distribution characteristics of voriconazole (VRC) plasma trough concentrations (Ctrough) in patients with liver dysfunction, identify factors influencing VRC Ctrough, and provide recommendations for the use of VRC in this population. We retrospectively collected medical records of hospitalized patients with liver dysfunction who used VRC and underwent therapeutic drug monitoring (TDM) at the First Hospital of Changsha. The severity of liver dysfunction was assessed by the Child-Pugh (CP) score. Multiple linear regression was employed to explore factors affecting VRC Ctrough in these patients. A total of 147 Ctrough from 102 patients with liver dysfunction were analyzed. Patients were categorized into a control group (n = 40), CP-A (n = 39), CP-B (n = 11), and CP-C group (n = 12). The initial probability of target attainment of Ctrough was 70.6%, with 6.9% of patients obtaining subtherapeutic Ctrough and 22.5% obtaining supertherapeutic Ctrough. The initial Ctrough in CP-A and B were 5.05 (0.64-9.57) mg/L and 5.37 (0.26-10.01) mg/L, respectively, significantly higher than the control group (P = 0.021 and P = 0.010). The proportion of VRC Ctrough of >5.5 mg/L in CP-A and B was 33.3% and 45.5%, respectively. Multiple linear regression analysis revealed that factors such as age ≥70 years, CP class, C-reactive protein (CRP), and direct bilirubin were significantly related to the initial VRC Ctrough. Among all measurements, patients with severe inflammation (CRP >100 mg/L), aged ≥70 years, and albumin levels of <30 or <25 g/L had significantly higher VRC Ctrough. The treatment success rate of VRC was 69.6% (71 of 102), and the rate of VRC-related adverse drug reactions was 29.4% (30 of 102). The recommended half-maintenance dose may lead to elevated VRC Ctrough in patients with CP-A and CP-B. TDM is essential for patients with advanced age, severe infections, or hypoalbuminemia to prevent excessive VRC trough levels.

Human Neutrophil Alpha-Defensins Promote NETosis and Liver Injury in Alcohol-Related Liver Cirrhosis: Potential Therapeutic Agents.

Background: Neutrophils are thought to play a pivotal role in the pathogenesis of many inflammatory diseases, such as hepatitis, liver cirrhosis, etc. Activated human neutrophils release human neutrophil peptides (HNP1-3) or alpha-defensins that are antimicrobial peptides in azurophil granules. Furthermore, HNP1-3 build a scaffold of neutrophil extracellular traps (NETs) and promote the process of programmed cell death called NETosis. Our study aimed to investigate the role of alpha-defensins in the pathogenesis of alcohol-related liver cirrhosis (ALC). Methods: The concentrations of alpha-defensins in the plasma of 62 patients with ALC and 24 healthy subjects were measured by ELISA. The patients with ALC were prospectively recruited based on the severity of liver dysfunction according to the Child-Pugh and Model of End-Stage Liver Disease-Natrium (MELD-Na) scores, modified Maddrey's Discriminant Function (mDF), and the presence of ALC complications. Results: The concentrations of alpha-defensins in plasma were significantly higher in the ALC patients than in the controls. The plasma levels of HNP1-3 correlated with the MELD and mDF scores. ALC subgroups with MELD > 20 and mDF > 32 displayed significantly higher HNP1-3 concentrations. The plasma levels of HNP1-3 revealed a good predictive AUC for hepatic encephalopathy and ascites development (0.81 and 0.74, respectively) and for patient survival (0.87) in those over 40 years of age. Conclusion: These findings suggest that alpha-defensins play an important role in the assessment of ALC.

Assessment of risk in portal hypertension surgery in patients with liver cirrhosis (literature review)

Severity of liver dysfunction, comorbidities, type and complexity of surgery, including elective or emergency surgery, are determinants of perioperative mortality and morbidity in patients with cirrhosis. Risk stratification is a powerful decision-making tool and should be a mandatory part of surgical practice. In this paper we briefly describe and define perioperative risk scores commonly used for portal hypertension surgery in terms of their predictive values and clinical applicability to predict morbi-, mortality postoperative.

Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease.

(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.

Correlation of Serum Testosterone Section Levels in Men with Severity of Liver Dysfunction in Chronic Liver DiseaseAn Observational Study at a Tertiary Care Centre in Uttarakhand, India

Introduction: Chronic Liver Disease (CLD) and/or cirrhosis of liver represent different liver disorders of varying severity in which liver injury, inflammation, and fibrosis continue for more than 6 months. Various aetiologies including drugs toxins, alcohol abuse, infections, autoimmune disorders, genetic and metabolic diseases are implicated for CLD. Regardless, the aetiology of the CLD, the serum testosterone falls as the disease advances. Aim: To study the serum testosterone level in male patients with CLD and its correlation with the severity of the disease. Materials and Methods: A prospective observational study was conducted on patients reporting to Himalayan Hospital in OPD and IPD between June 2021 to May 2022. A total of 58 male patients of CLD were recruited. All patients were examined with clinical history, physical examination, laboratory blood and biochemical and radiological investigations, including total serum testosterone estimation. Testosterone value of &lt;3 ng/mL was considered as low level. Child-Turcotte-Pugh (CTP) scores and Model for End-Stage Liver Disease-sodium (MELD-Na) scores were calculated to assess the severity of CLD. Results: The mean age of the patients was 47.87±10.3 years. The majority of patients, 52/58(89.65%), had low serum testosterone levels. As the severity of CLD increases, the testosterone falls progressively, and the finding was statistically significant (p-value=0.001). The mean testosterone levels (0.9±0.38) in patients with MELD-Na score of ≥20 was significantly (p-value=0.02) lower than the patients with MELDNa score of &lt;20. There was a strong negative correlation between low testosterone and CLD severity. Conclusion: Overall, 89.65% of the patients had a low testosterone level. Serum testosterone level can be an independent marker for the severity of CLD in male patients.

High plasma soluble thrombomodulin levels indicated poor prognosis of decompensated liver cirrhosis: a prospective cohort study.

ObjectiveHepatic sinusoidal endothelial injury is a prominent characteristic of liver cirrhosis. We determined plasma soluble thrombomodulin (sTM) levels in cirrhosis patients to evaluate the relationship between vascular injury and long-term prognosis.MethodsA prospective single-center study was performed. The participants were followed up for every 6 months or until death or transplantation. A chemiluminescent enzyme immunoassay was used to establish a baseline sTM.ResultsAmong the 219 patients with decompensated liver cirrhosis, 53.42% were caused by hepatitis B and hepatitis C. Plasma sTM levels were much higher in cirrhosis than in healthy controls and increased parallel with Child-Pugh classification (P < 0.01) and the amount of ascites (P = 0.04). After adjusting for sex, age, international normalized ratio, bilirubin, and other potential factors, multivariate Cox regression revealed that per TU/ml elevation of plasma sTM causes an increase of 8% in mortality, and per-SD elevation of thrombomodulin causes a 53% increase in mortality. As the mortality rates in low (5.90–12.60 TU/ml) and medium (12.70–18.00 TU/ml) sTM levels were similar, so we chose the cutoff of 18.00 TU/ml to divide into two groups, and K-M analysis indicated that patients with sTM >18.0 TU/ml demonstrated an additional 2.01 times death risk (95% CI, 1.13–7.93; P = 0.01) than those with sTM ≤18.0 TU/ml.ConclusionPlasma sTM in cirrhosis was significantly increased in parallel with the severity of liver dysfunction. sTM elevation than 18 TU/ml indicated a poor prognosis of decompensated liver cirrhosis.

Study on thyroid functions in chronic liver disease

In the present study, thyroid functions have been evaluated with all the clinically available indices and confirms the abnormalities in many parameters of thyroid function test in chronic liver disease patients. However euthyroid state is maintained virtually in all patients, probably as a result of low normal Free T3 and high normal FT4. Furthermore, serum T3 concentration appear to directly correlate with the severity of liver dysfunction.

Minimally invasive ways to treat and prevent gastroesophageal portal bleeding

Aim. To analyze the results of minimally invasive techniques to prevent and treat gastroesophageal bleeding in patients with cirrhosis.Materials and methods. The study included 997 patients with liver cirrhosis: Child-Pugh class A – 21.7%; class B – 48.8%; class C – 29.5%. Esophageal varices of Grades III–IV were diagnosed in 95.5% of the patients, while gastric varices were observed in 17.4% of the patients. The following methods were used: endoscopic ligation, endoscopic sclerotherapy, TIPS, laparoscopic azygoportal disconnection, and distal splenorenal anastomosis.Results. Following endoscopic procedures aimed at preventing the onset of gastroesophageal bleeding, variceal recurrence and bleeding were observed in 35.9% and 18.6% of cases, respectively. The efficacy of endoscopic ligation in case of bleeding amounted to 91.2%. Multiple endoscopic procedures provided means to treat esophageal and gastric varices in 56.2% of the patients. Rebleeding was observed in 9.3% of the patients, while esophageal and gastric varices persisted in 34.3% of the patients. TIPS was found to significantly reduce portal pressure and the grade of varices, with encephalopathy developing in 41.4% of the patients. In the long-term period, stent dysfunction was diagnosed in 22.5% of cases, while bleeding recurred in 10%. Laparoscopic azygoportal disconnection contributed to the regression of esophageal and gastric varices. In the long-term period, bleeding recurred in 42.3% of cases. Laparoscopic distal splenorenal anastomosis reliably prevented the recurrence of bleeding. No shunt thrombosis or lethal outcomes were observed, while the incidence of encephalopathy amounted to 14.7%.Conclusion. A sufficient number of minimally invasive methods are currently available in the treatment and prevention of gastroesophageal portal bleeding. A case-specific approach to the choice of measures aimed at treating and preventing gastroesophageal bleeding in patients with cirrhosis is required, taking into account the degree of decompensation of portal hypertension and the severity of liver dysfunction.

Impact of Liver Cirrhosis on Bone Metabolism

AbstractBone loss is an early and major problem in cirrhotic patients. The majority of cirrhotic patients demonstrate evidence of hepatic osteodystrophy (HOD). This includes decreased bone volume, turnover abnormalities, and rarely mineralization defects. Moreover, the degree of bone disease usually correlates with the severity of liver dysfunction. The mechanism of HOD is multifactorial. Vitamin D insufficiency/deficiency, secondary hyperparathyroidism, hypogonadism, inhibitors of bone formation, and mediators/promoters of bone resorption are frequent findings and essential coplayers in HOD. Early and proper identification of HOD is challenging. DXA is the most widely used tool; however, it has fundamental limitations. Bone turnover biomarkers are used to understand the mechanism of bone loss. Bone biopsy with histomorphometry is the gold standard to evaluate bone structure. The evidence for the effectiveness of nonpharmacological and pharmacological management of HOD is limited. Adequate nutrition, weight-bearing exercise, smoking cessation, and limitation of alcohol consumption improve bone health and quality of life. The use of antiresorptive therapies prevents bone loss particularly in patients with high bone turnover. However, osteoanabolics are essential in patients with low bone turnover. Herein, we are discussing the magnitude of the problem, pathogenesis, diagnosis of HOD, and various interventions to improve bone health in cirrhotic patients.

ROLE OF COLOR DOPPLER ULTRASONOGRAPHY IN THE EVALUATION OF PORTAL VENOUS HYPERTENSION

Chronic alcoholism, obesity and viral hepatitis (B &amp; C virus) are main causes for chronic liver disease. In cirrhotic patients, portal hypertension and its complications lead to signicant morbidity and mortality. Ultrasound technique, such as duplex ultrasonography ,spectral and color Doppler imaging are the modalities of choice. Study was undertaken to evaluate spectrum of color Doppler sonographic ndings in portal hypertension, to study ow metric changes in portal hypertension and to look for presence of various Porto-systemic collaterals. Result of study shows alcoholic liver disease as the main cause for liver cirrhosis. Maximum number of patients with splenorenal collaterals. Color Doppler sonography is a valuable non-invasive alternative which provides precise information in localizing and characterizing portal vein in patients with portal hypertension and identify the presence of various Porto-systemic collaterals. The hepatic vein damping index (DI) correlates well with the severity of liver dysfunction in terms of Child Pugh score.

In Decompensated Cirrhosis, Frailty is a Function of Sarcopenia, and Not of Etiology or Severity of Liver Dysfunction

In Decompensated Cirrhosis, Frailty is a Function of Sarcopenia, and Not of Etiology or Severity of Liver Dysfunction

A Prospective Study of Prevalence and Predictors of Cirrhotic Cardiomyopathy and Its Role in Development of Hepatorenal Syndrome

Cirrhotic cardiomyopathy (CCM) is a term used to collectively describe abnormal structural and functional changes in heart of patients with cirrhosis. The present study was undertaken to find the prevalence of CCM in patients with liver cirrhosis and its predictors. We also followed these patients to evaluate the role of CCM in the development of hepatorenal syndrome (HRS). This was a prospective study carried out in department of Gastroenterology, Sir Ganga Ram hospital, New Delhi. A total of 104 patients with liver cirrhosis were included. Liver cirrhosis was diagnosed on basis of clinical, biochemical, and imaging features. CCM was defined based on echocardiography. Dobutamine stress echocardiographyand hepatic venous pressure gradient (HVPG) were performed in patients who gave consent. HRSwas defined as per standard criteria. Patients with CCM were followed for development of HRS. Fifty (48%) patients were diagnosed with CCM. All patients had diastolic dysfunction, and none had systolic dysfunction. Median age of patients with CCM was significantly higher (59 [31-78y] vs. 52 [24-70y], P<0.05). Severity of liver disease (Child Turcotte Pugh scoreand model for end-stage liver disease score) and portal pressures (HVPG) did not differ in patients with or without CCM. Patients with CCM did not have increased incidence of HRS at the end of 6-month follow-up study. The presence of CCM was not related with the severity of liver dysfunction or portal pressures. Age was a significant determinant of CCM. Diastolic cardiac dysfunction does not influence the occurrence of HRS.

Biomarkers of extracellular matrix formation are associated with acute-on-chronic liver failure

Background & AimsAcute-on-chronic liver failure (ACLF) is characterised by organ failure(s), high short-term mortality, and, pathophysiologically, deranged inflammatory responses. The extracellular matrix (ECM) is critically involved in regulating the inflammatory response. This study aimed to determine alterations in biomarkers of ECM turnover in ACLF and their association with inflammation, organ failures, and mortality.MethodsWe studied 283 patients with cirrhosis admitted for acute decompensation (AD) with or without ACLF, 64 patients with stable cirrhosis, and 30 healthy controls. A validation cohort (25 ACLF, 9 healthy controls) was included. Plasma PRO-C3, PRO-C4, PRO-C5, PRO-C6, and PRO-C8 (i.e. collagen type III–VI and VIII formation) and C4M and C6M (i.e. collagen type IV and VI degradation) were measured. Immunohistochemistry of PRO-C6 was performed on liver biopsies (AD [n = 7], ACLF [n = 5]). A competing-risk regression analysis was performed to explore the prognostic value of biomarkers of ECM turnover with 28- and 90-day mortality.ResultsPRO-C3 and PRO-C6 were increased in ACLF compared to AD (p = 0.089 and p <0.001, respectively), whereas collagen degradation markers C4M and C6M were similar. Both PRO-C3 and PRO-C6 were strongly associated with liver function and inflammatory markers. Only PRO-C6 was associated with extrahepatic organ failures and 28- and 90-day mortality (hazard ratio [HR; on log-scale] 6.168, 95% CI 2.366–16.080, p <0.001, and 3.495, 95% CI 1.509–8.093, p = 0.003, respectively). These findings were consistent in the validation cohort. High PRO-C6 expression was observed in liver biopsies of patients with ACLF.ConclusionsThis study shows, for the first time, evidence of severe net interstitial collagen deposition in ACLF and makes the novel observation of the association between PRO-C6 and (extrahepatic) organ failures and mortality. Further studies are needed to define the pathogenic significance of these observations.Lay summaryThis study describes a disrupted turnover of collagen type III and VI in Acute-on-chronic liver failure (ACLF). Plasma biomarkers of these collagens (PRO-C3 and PRO-C6) are associated with the severity of liver dysfunction and inflammation. PRO-C6, also known as the hormone endotrophin, has also been found to be associated with multi-organ failure and prognosis in acute decompensation and ACLF.

Difficulties in assessing the severity of liver dysfunction for obstructive jaundice

A literature review is devoted to the current classifications of liver failure that occurs in obstructive jaundice. Modern methods of diagnosis and criteria for determining the time of development and assessing the severity of this disease, model assessment and prognosis of acute liver failure are also considered. Attention is paid to assessing the severity and determining the timing of the development of liver failure in extrahepatic cholestasis. In addition, there is no common understanding of the role of liver compensatory mechanisms involved in the development of this condition. There are no generally accepted views on the surgical tactics of treatment of patients with obstructive jaundice complicated by liver failure. The limits of application of step-by-step treatment of patients with neoplastic obstructive jaundice have not been reliably determined. All these issues require further research, search for universal tools for assessing liver failure, predicting postoperative complications for choosing the optimal surgical treatment tactics.

Association of lipid profile with decompensation, liver dysfunction, and mortality in patients with liver cirrhosis

Background and Aims Lipid metabolism is often disrupted in liver cirrhosis. The present study aimed to evaluate the impact of lipid profile on decompensation events, severity of liver dysfunction, and death in patients with liver cirrhosis. Methods In a cross-sectional study, 778 patients with lipid profile data were enrolled, and then were divided into 240 and 538 patients with and without liver cirrhosis, respectively. In a cohort study, 314 cirrhotic patients with lipid profile data, who were prospectively followed, were enrolled. Lipid profile included total cholesterol (TC), high density lipoprotein-cholesterol (HDL-c), low density lipoprotein-cholesterol (LDL-c), triglycerides (TG), and lipoprotein(a). Results In the cross-sectional study, cirrhotic patients with decompensation events had significantly lower levels of TC and lipoprotein(a) than those without; and cirrhotic patients with Child-Pugh class B and C had significantly lower levels of TC, HDL-c, LDL-c, and lipoprotein(a) than those with Child-Pugh class A. In the cohort study, there was an inverse association of survival with TC, HDL-c, and lipoprotein(a) levels; after adjusting for MELD score, TC (Hazard Ratio [HR]=1.703, P=0.034) and HDL-c (HR=2.036, P=0.005), but not lipoprotein(a) (HR=1.377, P=0.191), remained a significant predictor of death; when TC, HDL-c, lipoprotein(a), and MELD score were included in the multivariate Cox regression analysis, HDL-c (HR=1.844, P=0.024) was the only independent predictor of death. Conclusions Decreased levels in specific components of lipid profile indicate more decompensation events, worse liver function, and reduced survival in liver cirrhosis. MELD score combined with HDL-c should be promising for the assessment of outcomes of cirrhotic patients.

Clinical, neuropsychological and neurophysiological indices and predictors of hepatic encephalopathy (HE)

Background & aims The occurrence of overt hepatic encephalopathy (HE) marks a significant progression in the natural history of liver disease. The aims of the present study were: 1) to describe a large cohort of patients with cirrhosis in terms of neuropsychological/neurophysiological HE indices, and 2) to test if the severity of liver disease and/or any such indices [Psychometric Hepatic Encephalopathy Score (PHES), Scan test, electroencephalography (EEG)] predicted mortality/HE risk in a subgroup of such cohort. Method 461 patients with cirrhosis (59±10 years; 345 males) were included; information on previous overt HE episodes was available in 407. Follow up information on mortality/HE-related hospitalization in 134/127, respectively. Information on previous overt HE episodes and both mortality and HE-related hospitalization over the follow up in 124. Results Patients with a history of overt HE (60%) had poorer liver function, worse neuropsychiatric indices, higher ammonia levels and higher prevalence of portal-systemic shunt. The risk of HE-related hospitalization over the follow up was higher in patients with higher MELD score and worse Scan performance. Mortality was higher in those with higher MELD. Amongst patients without a history of overt HE, those with worse PHES had higher HE risk. Amongst patients with a history, those with higher MELD, better PHES and worse Scan performance had higher HE risk. Conclusions In patients without previous overt HE episodes, neuropsychological and neurophysiological tests predict HE, while in those with previous overt HE episodes, HE development largely depends on the severity of liver dysfunction.

Clinical, neuropsychological and neurophysiological indices and predictors of hepatic encephalopathy (HE).

The occurrence of overt hepatic encephalopathy (HE) marks a significant progression in the natural history of liver disease. The aims of the present study were to: 1) describe a large cohort of patients with cirrhosis in terms of neuropsychological or neurophysiological HE indices, and 2) test if the severity of liver disease and/or any such indices [Psychometric Hepatic Encephalopathy Score (PHES), Scan test, electroencephalography (EEG)] predicted mortality/HE risk in a subgroup of such cohort. Four hundred and sixty-one patients with cirrhosis (59±10years; 345 males) were included; information on previous overt HE episodes was available in 407. Follow-up information on mortality/HE-related hospitalization in 134/127 respectively. Information on previous overt HE episodes and both mortality and HE-related hospitalization over the follow-up in 124. Patients with a history of overt HE (60%) had poorer liver function, worse neuropsychiatric indices, higher ammonia levels and higher prevalence of portal-systemic shunt. The risk of HE-related hospitalization over the follow-up was higher in patients with higher MELD score and worse Scan performance. Mortality was higher in those with higher MELD. Among patients without a history of overt HE, those with worse PHES had higher HE risk. Among patients with a history, those with higher MELD, better PHES and worse Scan performance had higher HE risk. In patients without previous overt HE episodes, neuropsychological and neurophysiological tests predict HE, while in those with previous overt HE episodes, HE development largely depends on the severity of liver dysfunction.

Gender-related disparities in the frequencies of PD-1 and PD-L1 positive peripheral blood T and B lymphocytes in patients with alcohol-related liver disease: a single center pilot study.

BackgroundExposure to excessive alcohol consumption dysregulates immune signaling. The programed cell death 1 (PD-1) receptor and its ligand PD-L1 play a critical role in the protection against immune-mediated tissue damage. The aim of our study was evaluation of the PD-1/PDL-1 expression on peripheral T and B lymphocytes, its correlation with markers of inflammation and the severity of liver dysfunction in the course of alcohol-related liver disease (ALD).Material and MethodsFifty-six inpatients with ALD (38 males, 18 females, aged 49.23 ± 10.66) were prospectively enrolled and assigned to subgroups based on their: (1) gender, (2) severity of liver dysfunction (Child-Pugh, MELD scores, mDF), (3) presence of ALD complications, and followed for 30 days. Twenty-five age- and gender-matched healthy volunteers served as the control group. Flow cytometric analysis of the PD-1/PD-L1 expression on peripheral lymphocyte subsets were performed.ResultsGeneral frequencies of PD-1/PD-L1 positive T and B subsets did not differ between the ALD and control group. When patients were analyzed based on their gender, significantly higher frequencies of PD1/PD-L1 positive B cells in ALD females compared to controls were observed. ALD females presented with significantly higher frequencies of PD-1+ and PD-L1+ B cells, as well as PD-L1+ all T cell subsets in comparison with ALD males. The same gender pattern of the PD-1/PDL1 expression was found in the subgroups with mDF > 32 and MELD > 20. No correlations of PD-1+ and PD-L1+ lymphocyte percentages with mDF, CTP and MELD scores, nor with complications of ALD were observed. Significant correlations of PD-L1 positive B cell frequencies with conventional markers of inflammation were found.ConclusionsGender-related differences in the frequencies of PD-1/PD-L1 positive T and B cells were observed in patients with ALD. Upregulation of PD-1+/PD-L1+ lymphocytes paralleled both the severity of alcoholic hepatitis and liver dysfunction in ALD females.

Severity of Liver Involvement in Children with Dengue Infection

Background: Liver involvement in dengue infection is one of the clinical presentations.&#x0D; Objective: This study was undertaken to see severity of liver dysfunction in children with dengue infection.&#x0D; Methods: It is a cross sectional observational study conducted in 100 consecutive children with serologically positive dengue infection aged between 2 months to 14 years of age. Liver function tests were done in all patients and were studied the severity of deranged LFT with severity of dengue infection.&#x0D; Results: Out of 100 admitted children with dengue infection, deranged liver function tests found in 57(57.0%). ALT was above normal in 10 (29.4% of DF, 19 (57.6%) cases of DHF and 19(57.6%) cases of DSS respectively. AST was above normal level in 12(35.3%) cases of DF, 23(69.7%) cases of DHF and 22(66.7%) cases of DSS respectively. Low albumin was found in 41.0% of cases, 15(45.5%) cases of DHF and 19(57.6%) cases of DSS. INR was high only 4 cases of DSS. The bilirubin was normal in all cases except one died due to ALF due to DSS. The mean ALT and mean AST statistically higher in DHF and DSS in compare to DF (P-value 0.011 and 0.037) respectively. However, there was no significant difference in meal ALT and AST between DHF and DSS respectively. Overall mortality in 2 cases with DHF and DSS.&#x0D; Conclusion: Dengue infection is associated with variable level of liver dysfunction. The severity of liver dysfunction can predict the severity of dengue infection.&#x0D; Bangladesh Journal of Infectious Diseases 2020;7(2):90-94

Digestive system manifestations and clinical significance of coronavirus disease 2019: A systematic literature review.

A worldwide outbreak of coronavirus disease 2019 (COVID-19) has drawn global attention. Several reports have described the gastrointestinal (GI) manifestations in the infected patients. The systematic review was designed to highlight the gaps in our knowledge about the prevalence and clinical significance of GI symptoms in patients with COVID-19. We searched PubMed database and Google articles published in both English and Chinese up to June 3, 2020, using search terms "clinical features," "2019 novel coronavirus," "2019-nCoV," "COVID-19," or "SARS-Cov-2." Observational studies, case reports, or letters describing the clinical features or observational studies regarding the detection and/or isolation of severe acute respiratory syndrome coronavirus 2 viruses in stools were included. A total of 22 publications were finally selected. It was reported that GI symptoms occurred in about 3-40.7% of patients. GI manifestations included nausea, diarrhea, anorexia, vomiting, abdominal pain, belching, abdominal distension, and GI hemorrhage. Diarrhea was the most common GI symptom. Infected patients had various degrees of liver dysfunction, and the severity of liver dysfunction was significantly associated with the severity of the disease. Therapy focusing on digestive system like liver supportive therapy or nutrition support or probiotics has been demonstrated to be effective interventions, which greatly improve prognosis. Fecal-oral transmission route is a potential risk for transmission. GI symptoms are common in COVID-19. Strengthening the recognition on abnormalities in digestive system of patients with COVID-19 is crucial for early identification and timely treatment, especially for those atypical patients. Hygiene protection and keeping the drainpipe free flowing are necessary for everyone.