Malaria is an endemic mosquito-borne disease in sub-Saharan regions, including Cameroon. Due to the obligatory hepatic stage of its pathogenic agents, malaria can induce liver damage if not properly treated. Hence, we assessed the impact of malaria infection on liver transaminases among febrile patients consulting at the Deido District Hospital, Douala-Cameroon, in regard to their attitude towards the practice of preventive measures, treatment, and management of malaria. Over 10 weeks, 150 febrile patients and 28 healthy individuals serving as the control group were enrolled and their blood samples screened for Plasmodium species by Giemsa Staining and liver injury evaluated by measuring the serum level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities. The socio-demographic characteristics of participants and their attitude towards the practice of preventive measures, treatment, and management of malaria were collected using a structured- questionnaire. Among tested febrile patients, 113 (75%) were malaria-positive. Females were more affected (65.5%) than males; the most affected age group were adults between 30-60 years (55.8%). A significant association (p˂0.05; relative risk [RR] = 1.424 or p˂0.05; RR = 1.947) was found between malaria infection and non-use of mosquito nets or insecticides, respectively. The serum level of ALT and AST activities in malaria-positive were significantly (p<0.05) increased, compared to healthy or malaria-negative individuals. Furthermore, transaminase activity was significantly (p<0.05) elevated in non-practitioners of preventive measures; and in patients who engaged in auto-medication or traditional medication, compared to those who sought treatment from health centers. Our findings demonstrated that non-practice of preventive measures, improper treatment and management of malaria infection can lead to an abnormal increase in serum level of transaminases which may reflect liver injury.
{"title":"Liver injury in malaria infected patients in Douala-Cameroon and its association with poor medical practice","authors":"Arnaud Fondjo Kouam, Noé Auguste Nseké Ngoumé, Armelle Gaelle Kwesseu Fepa, Zerubabel Wainfen, Eléonore Ngounou, Borris Rosnay Tietcheu Galani, Nembu Erastus Nembo, Pascal Dieudonné Djamen Chuisseu, Fréderic Nico Njayou, Paul Fewou Moundipa","doi":"10.1186/s43066-023-00300-9","DOIUrl":"https://doi.org/10.1186/s43066-023-00300-9","url":null,"abstract":"Malaria is an endemic mosquito-borne disease in sub-Saharan regions, including Cameroon. Due to the obligatory hepatic stage of its pathogenic agents, malaria can induce liver damage if not properly treated. Hence, we assessed the impact of malaria infection on liver transaminases among febrile patients consulting at the Deido District Hospital, Douala-Cameroon, in regard to their attitude towards the practice of preventive measures, treatment, and management of malaria. Over 10 weeks, 150 febrile patients and 28 healthy individuals serving as the control group were enrolled and their blood samples screened for Plasmodium species by Giemsa Staining and liver injury evaluated by measuring the serum level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities. The socio-demographic characteristics of participants and their attitude towards the practice of preventive measures, treatment, and management of malaria were collected using a structured- questionnaire. Among tested febrile patients, 113 (75%) were malaria-positive. Females were more affected (65.5%) than males; the most affected age group were adults between 30-60 years (55.8%). A significant association (p˂0.05; relative risk [RR] = 1.424 or p˂0.05; RR = 1.947) was found between malaria infection and non-use of mosquito nets or insecticides, respectively. The serum level of ALT and AST activities in malaria-positive were significantly (p<0.05) increased, compared to healthy or malaria-negative individuals. Furthermore, transaminase activity was significantly (p<0.05) elevated in non-practitioners of preventive measures; and in patients who engaged in auto-medication or traditional medication, compared to those who sought treatment from health centers. Our findings demonstrated that non-practice of preventive measures, improper treatment and management of malaria infection can lead to an abnormal increase in serum level of transaminases which may reflect liver injury.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22DOI: 10.1186/s43066-023-00301-8
Kulbhushan Haldeniya, S. R. Krishna, Annagiri Raghavendra, Pawan Kumar Singh
Colonic perforation usually presents with classical signs of peritonitis. However, isolated retroperitoneal colonic perforation can present with varied clinical signs and symptoms and pose diagnostic challenges. Pneumo-mediastinum and abdominal subcutaneous emphysema can be one of the presenting signs of colonic perforation. A 33-year-old male presented with abdominal distension and extensive subcutaneous emphysema over the abdomen, pneumo-mediastinum, and pneumo-scrotum secondary to sigmoid colon perforation from a foreign body. The patient did not have classical signs of peritonitis. Being vigilant about the potential of colonic perforation is crucial when observing a significantly increasing subcutaneous emphysema across different parts of the body. Attending clinicians should always keep intraabdominal pathology in mind when a direct cause for these symptoms cannot be found and the patient’s symptoms become progressive.
{"title":"Pneumo-mediastinum, pneumoperitoneum, and pneumo-scrotum with extensive increasing subcutaneous emphysema: a rare presentation of colonic perforation","authors":"Kulbhushan Haldeniya, S. R. Krishna, Annagiri Raghavendra, Pawan Kumar Singh","doi":"10.1186/s43066-023-00301-8","DOIUrl":"https://doi.org/10.1186/s43066-023-00301-8","url":null,"abstract":"Colonic perforation usually presents with classical signs of peritonitis. However, isolated retroperitoneal colonic perforation can present with varied clinical signs and symptoms and pose diagnostic challenges. Pneumo-mediastinum and abdominal subcutaneous emphysema can be one of the presenting signs of colonic perforation. A 33-year-old male presented with abdominal distension and extensive subcutaneous emphysema over the abdomen, pneumo-mediastinum, and pneumo-scrotum secondary to sigmoid colon perforation from a foreign body. The patient did not have classical signs of peritonitis. Being vigilant about the potential of colonic perforation is crucial when observing a significantly increasing subcutaneous emphysema across different parts of the body. Attending clinicians should always keep intraabdominal pathology in mind when a direct cause for these symptoms cannot be found and the patient’s symptoms become progressive.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver cirrhosis (LC) has a significant impact in quality of life, and it is frequently linked to loss of a job, mood fluctuations, anxiety, low self-esteem, and despair. Recent LC treatment primarily focuses on clinical manifestations rather than the patient’s quality of life. By analyzing quality of life, one can learn about the disease’s emotional, physical, and lifestyle effects. To find the relationship between quality of life with the severity of liver cirrhosis. The research was conducted as an observational study with cross-sectional data being collected. The study’s participants were recruited from Saiful Anwar Hospital’s outpatient and inpatient clinics. The individuals completed a chronic liver disease questionnaire to assess their quality of life, and the Child-Pugh score was used to determine the severity of their liver disease. The data was analyzed using Kruskal-Wallis and the rank Spearman test, with a significance level of 0.05. There were 54 individuals, with an average age of 53.71 years and a male-to-female ratio of 74%. The results showed that there was a significant difference between the Child-Pugh A, Child-Pugh B, and Child-Pugh C groups in all aspects of the chronic liver disease questionnaire (p = 0.000). The rank Spearman test revealed a substantial link between quality of life and liver cirrhosis severity (r: −0.817). The severity of LC is associated with the quality of life of the patients.
{"title":"Association between the severity of liver cirrhosis with quality of life and its impact on clinical practice","authors":"Syifa Mustika, Jefri Pratama Susanto, Cosmas Rinaldi Adithya Lesmana","doi":"10.1186/s43066-023-00299-z","DOIUrl":"https://doi.org/10.1186/s43066-023-00299-z","url":null,"abstract":"Liver cirrhosis (LC) has a significant impact in quality of life, and it is frequently linked to loss of a job, mood fluctuations, anxiety, low self-esteem, and despair. Recent LC treatment primarily focuses on clinical manifestations rather than the patient’s quality of life. By analyzing quality of life, one can learn about the disease’s emotional, physical, and lifestyle effects. To find the relationship between quality of life with the severity of liver cirrhosis. The research was conducted as an observational study with cross-sectional data being collected. The study’s participants were recruited from Saiful Anwar Hospital’s outpatient and inpatient clinics. The individuals completed a chronic liver disease questionnaire to assess their quality of life, and the Child-Pugh score was used to determine the severity of their liver disease. The data was analyzed using Kruskal-Wallis and the rank Spearman test, with a significance level of 0.05. There were 54 individuals, with an average age of 53.71 years and a male-to-female ratio of 74%. The results showed that there was a significant difference between the Child-Pugh A, Child-Pugh B, and Child-Pugh C groups in all aspects of the chronic liver disease questionnaire (p = 0.000). The rank Spearman test revealed a substantial link between quality of life and liver cirrhosis severity (r: −0.817). The severity of LC is associated with the quality of life of the patients.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138542384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The most common cause of benign biliary stricture is bile duct injury after cholecystectomy. Benign biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritis, and cholangitis ultimately leading to biliary cirrhosis. The average duration for stricture development after cholecystectomy is around 7 months. This is a case report of a benign biliary stricture presenting 14 years after laparoscopic conversion to open cholecystectomy without the development of recurrent cholangitis and secondary biliary cirrhosis.
{"title":"An interesting case report of delayed presentation of post-cholecystectomy benign biliary stricture","authors":"Kulbhushan Haldeniya, Niranjan Rajkumar Gandhi, Haritha Gorantla, Sindhura Bukka","doi":"10.1186/s43066-023-00303-6","DOIUrl":"https://doi.org/10.1186/s43066-023-00303-6","url":null,"abstract":"Background The most common cause of benign biliary stricture is bile duct injury after cholecystectomy. Benign biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritis, and cholangitis ultimately leading to biliary cirrhosis. The average duration for stricture development after cholecystectomy is around 7 months. This is a case report of a benign biliary stricture presenting 14 years after laparoscopic conversion to open cholecystectomy without the development of recurrent cholangitis and secondary biliary cirrhosis.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Pylori is one of the commonest infectious diseases worldwide. In recent years, PPI-based triple therapy has been described to be losing its efficacy against H. pylori due to high rates of antibiotic resistance, antibiotics-associated side effects, and low compliance. Probiotics are suggested to improve the H. pylori eradication rate when added to H pylori therapy. Probiotics have anti-inflammatory and anti-oxidative mechanisms that may improve bowel microecology and interact with the microbial flora of the gastrointestinal tract to produce a beneficial effect in H Pylori eradication. Probiotics may be also responsible for the reduction of the adverse effects related to H. pylori therapy that may result in treatment failure. In our study, we assessed the role of probiotics in improving the H. Pylori eradication rate and reducing side effects after antibiotic-based therapy. One hundred fifty-nine patients positive for H. pylori stool antigen and had never received previously H. pylori eradication therapy, were included in the study, 59 patients received triple therapy alone (Standard group) and 100 patients received triple therapy and probiotics (study group). One hundred fifty patients completed the treatment. Quantification of Lactobacilli and Bifidobacteria concentration in stool was done by PCR before and after therapy. Eradication of H. pylori was assessed in each group by H. pylori stool antigen after 4 weeks of finishing therapy. H Pylori eradication rate was higher in patients who received probiotics with standard therapy compared to those who received standard therapy alone. The improvement in the eradication rate was statistically significant when probiotics were received after standard therapy (81.04% versus 71.19%, P-Value 0.021). Short-term diarrhea after antibiotics therapy was significantly lower in patients who received probiotics especially when given before antibiotic therapy (7.50% versus 25.50%, P-value 0.0001). Probiotics may play a role to restore gut dysbiosis as evidenced by stool PCR for Lactobacilli and Bifidobacteria before and after therapy. Probiotics have a beneficial role to improve the eradication rate of H. pylori, particularly when given after standard therapy. Adding probiotics was associated as well with less diarrhea as a side effect of antibiotic therapy. The trial has been registered on the Pan African Clinical Trial Register website, No of registration, PACTR202304859303467. Registered 24 April 2023 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25434 .
幽门螺杆菌是世界上最常见的传染病之一。近年来，基于ppi的三联疗法由于抗生素耐药率高、抗生素相关副作用和低依从性而失去了对幽门螺杆菌的疗效。建议在幽门螺杆菌治疗中添加益生菌，以提高幽门螺杆菌的根除率。益生菌具有抗炎和抗氧化机制，可以改善肠道微生态，并与胃肠道微生物菌群相互作用，产生有益的幽门螺杆菌根除作用。益生菌也可能对减少与幽门螺杆菌治疗相关的可能导致治疗失败的不良反应负责。在我们的研究中，我们评估了益生菌在提高幽门螺杆菌根除率和减少抗生素治疗后副作用方面的作用。159例幽门螺杆菌粪便抗原阳性且从未接受过根除幽门螺杆菌治疗的患者被纳入研究，59例患者单独接受三联治疗(标准组)，100例患者接受三联治疗和益生菌治疗(研究组)。150名患者完成了治疗。采用PCR方法检测治疗前后粪便中乳酸杆菌和双歧杆菌的浓度。治疗结束4周后，采用幽门螺杆菌粪便抗原法评估各组幽门螺杆菌根除情况。与单独接受标准治疗的患者相比，接受标准治疗的益生菌患者的幽门螺杆菌根除率更高。标准治疗后给予益生菌对根除率的改善有统计学意义(81.04% vs 71.19%， p值0.021)。抗生素治疗后短期腹泻在服用益生菌的患者中显著降低，尤其是在抗生素治疗前服用益生菌的患者(7.50% vs 25.50%， p值0.0001)。益生菌可能在恢复肠道生态失调中发挥作用，治疗前后的粪便乳酸杆菌和双歧杆菌PCR证实了这一点。益生菌对提高幽门螺杆菌的根除率有有益的作用，特别是在标准治疗后给予。作为抗生素治疗的副作用，添加益生菌也与减少腹泻有关。该试验已在泛非临床试验注册网站注册，注册号为PACTR202304859303467。注册于2023年4月24日-追溯注册，https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25434。
{"title":"Can probiotics play a role in Helicobacter pylori (H. Pylori) eradication?","authors":"Sameh Mohamed Fakhry, Mohamed Abdel-Hameed Kandyl, Adel Ferig Hashish, Wafaa Kandeel, Ahmed Mostafa El-Shenawy, Hoda Samir El-Sayed, Mohamed Kamal Dewidar, Sameh Mohamed Badr, Nayra Shaker Mehanna","doi":"10.1186/s43066-023-00294-4","DOIUrl":"https://doi.org/10.1186/s43066-023-00294-4","url":null,"abstract":"H. Pylori is one of the commonest infectious diseases worldwide. In recent years, PPI-based triple therapy has been described to be losing its efficacy against H. pylori due to high rates of antibiotic resistance, antibiotics-associated side effects, and low compliance. Probiotics are suggested to improve the H. pylori eradication rate when added to H pylori therapy. Probiotics have anti-inflammatory and anti-oxidative mechanisms that may improve bowel microecology and interact with the microbial flora of the gastrointestinal tract to produce a beneficial effect in H Pylori eradication. Probiotics may be also responsible for the reduction of the adverse effects related to H. pylori therapy that may result in treatment failure. In our study, we assessed the role of probiotics in improving the H. Pylori eradication rate and reducing side effects after antibiotic-based therapy. One hundred fifty-nine patients positive for H. pylori stool antigen and had never received previously H. pylori eradication therapy, were included in the study, 59 patients received triple therapy alone (Standard group) and 100 patients received triple therapy and probiotics (study group). One hundred fifty patients completed the treatment. Quantification of Lactobacilli and Bifidobacteria concentration in stool was done by PCR before and after therapy. Eradication of H. pylori was assessed in each group by H. pylori stool antigen after 4 weeks of finishing therapy. H Pylori eradication rate was higher in patients who received probiotics with standard therapy compared to those who received standard therapy alone. The improvement in the eradication rate was statistically significant when probiotics were received after standard therapy (81.04% versus 71.19%, P-Value 0.021). Short-term diarrhea after antibiotics therapy was significantly lower in patients who received probiotics especially when given before antibiotic therapy (7.50% versus 25.50%, P-value 0.0001). Probiotics may play a role to restore gut dysbiosis as evidenced by stool PCR for Lactobacilli and Bifidobacteria before and after therapy. Probiotics have a beneficial role to improve the eradication rate of H. pylori, particularly when given after standard therapy. Adding probiotics was associated as well with less diarrhea as a side effect of antibiotic therapy. The trial has been registered on the Pan African Clinical Trial Register website, No of registration, PACTR202304859303467. Registered 24 April 2023 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25434 .","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-16DOI: 10.1186/s43066-023-00297-1
Heba El Sayed Kasem, Ehab Ahmed Abdelatty, Ahmed Mohamed Mokhtar Yahia, Ezzat Mohamed Abdalla
NAFLD is a spectrum of disorders ranging from hepatic steatosis to nonalcoholic steatohepatitis (NASH), NASH related cirrhosis and hepatocellular carcinoma (HCC). There is sparse data on the prevalence CKD in Egyptian patients with NAFLD. The aim of this study is to estimate the prevalence of CKD in the subjects with NAFLD and to assess the risk factors of CKD among them. A cross-sectional study was conducted on 430 patients from the Internal Medicine Department, Menoufia University Hospitals, including 215 patients with NAFLD, and 215 patients without NAFLD. NAFLD was diagnosed by abdominal ultrasonography. The liver fibrosis was assessed by NAFLD fibrosis score (NFS) and fibrosis-4 index (FIB-4). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or abnormal albuminuria (urinary albumin-to-creatinine ratio ⩾ 30 mg/gm). The logistic regression analysis was performed to examine the association between NAFLD and risk of CKD. The prevalence of CKD was higher in individuals with NAFLD than in those without NAFLD (38.1% vs 7.4%, p < 0.001). Logistic regression analysis demonstrated that both NAFLD and CKD were risk factors of each other. The presence of hypertension, high levels of BMI and waist circumference were the other independent risk factors of NAFLD. While the presence of DM, and the high level of BMI were the other significant risk factors of CKD in the NAFLD group. The presence and severity of NAFLD are associated with an increased risk of CKD.
NAFLD是一系列疾病，从肝脂肪变性到非酒精性脂肪性肝炎(NASH)、NASH相关肝硬化和肝细胞癌(HCC)。关于埃及NAFLD患者CKD患病率的数据很少。本研究的目的是估计NAFLD患者CKD的患病率，并评估其中CKD的危险因素。我们对Menoufia大学附属医院内科的430例患者进行了横断面研究，包括215例NAFLD患者和215例非NAFLD患者。通过腹部超声诊断NAFLD。采用NAFLD纤维化评分(NFS)和纤维化-4指数(FIB-4)评价肝纤维化程度。CKD被定义为肾小球滤过率(eGFR) < 60 ml/min/1.73 m2和/或异常蛋白尿(尿白蛋白与肌酐比值大于或等于30 mg/gm)。进行logistic回归分析以检验NAFLD与CKD风险之间的关系。NAFLD患者的CKD患病率高于非NAFLD患者(38.1% vs 7.4%， p < 0.001)。Logistic回归分析显示NAFLD与CKD互为危险因素。高血压、高BMI和高腰围是NAFLD的其他独立危险因素。而糖尿病的存在和高BMI水平是NAFLD组CKD的其他重要危险因素。NAFLD的存在和严重程度与CKD的风险增加有关。
{"title":"The association between non-alcoholic fatty liver disease and chronic kidney disease in Egyptian patients","authors":"Heba El Sayed Kasem, Ehab Ahmed Abdelatty, Ahmed Mohamed Mokhtar Yahia, Ezzat Mohamed Abdalla","doi":"10.1186/s43066-023-00297-1","DOIUrl":"https://doi.org/10.1186/s43066-023-00297-1","url":null,"abstract":"NAFLD is a spectrum of disorders ranging from hepatic steatosis to nonalcoholic steatohepatitis (NASH), NASH related cirrhosis and hepatocellular carcinoma (HCC). There is sparse data on the prevalence CKD in Egyptian patients with NAFLD. The aim of this study is to estimate the prevalence of CKD in the subjects with NAFLD and to assess the risk factors of CKD among them. A cross-sectional study was conducted on 430 patients from the Internal Medicine Department, Menoufia University Hospitals, including 215 patients with NAFLD, and 215 patients without NAFLD. NAFLD was diagnosed by abdominal ultrasonography. The liver fibrosis was assessed by NAFLD fibrosis score (NFS) and fibrosis-4 index (FIB-4). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or abnormal albuminuria (urinary albumin-to-creatinine ratio ⩾ 30 mg/gm). The logistic regression analysis was performed to examine the association between NAFLD and risk of CKD. The prevalence of CKD was higher in individuals with NAFLD than in those without NAFLD (38.1% vs 7.4%, p < 0.001). Logistic regression analysis demonstrated that both NAFLD and CKD were risk factors of each other. The presence of hypertension, high levels of BMI and waist circumference were the other independent risk factors of NAFLD. While the presence of DM, and the high level of BMI were the other significant risk factors of CKD in the NAFLD group. The presence and severity of NAFLD are associated with an increased risk of CKD.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138542387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Alagille syndrome is a rare autosomal-dominant disorder, representing 10 to 15% of the causes of neonatal cholestasis with no gender predominance. The diagnosis is based on the association of liver, heart, eye, skeleton abnormalities, and characteristic facial appearance. Case presentation An 18-year-old male patient, with a family history of benign recurrent intrahepatic cholestasis in a brother, was diagnosed at birth with bile duct paucity. He consulted in adulthood for cholestatic jaundice and pruritus. Physical exam found cutaneous jaundice, particular face, skeletal abnormality of fingers, posterior embryotoxon, and splenomegaly. An echocardiogram found cardiovascular abnormalities. The diagnosis of Alagille syndrome was made in front of five major criteria. A liver biopsy revealed a cirrhosis liver. Upper gastrointestinal endoscopy revealed grade II esophageal varices of portal hypertension. Laboratory tests revealed bicytopenia related to hypersplenism, hypoferritinemia, cytolysis with cholestasis, high bilirubin levels, low prothrombin time, hypoalbuminemia, decreased factor V activity, and hypocholesterolemia. The patient had vitamin K supplementation and was put on ursodeoxycholic acid, propranolol for the liver disease, a high protein hypercaloric diet for malnutrition, vitamin D supplementation and bisphosphonate for the osteoporosis, therapeutic abstention with monitoring for the asymptomatic cardiac disease. After a year of treatment, the patient had an overall health status improvement. Abdominal ultrasound found liver nodules. A biliary MRI showed a multinodular liver. The complement by CT hepatic angiography did not show any nodules while the MRI angiography revealed multiple dysplastic nodules. A liver biopsy was performed and found regenerative nodules. Conclusion The treatment of Alagille syndrome is based on managing the cholestasis and its complications, especially pruritus because it can have a significant impact on quality of life. Due to the complexity of presentation and multi-organ involvement, management of cases with Alagille syndrome should be done by a multidisciplinary team. Liver disease is responsible for morbidity while cardiac disease is a mortality risk factor in this population.
{"title":"Alagille syndrome and liver: an adult case report","authors":"Oussama Kharmach, Mohamed Borahma, Fatima-Zohra Ajana","doi":"10.1186/s43066-023-00298-0","DOIUrl":"https://doi.org/10.1186/s43066-023-00298-0","url":null,"abstract":"Abstract Background Alagille syndrome is a rare autosomal-dominant disorder, representing 10 to 15% of the causes of neonatal cholestasis with no gender predominance. The diagnosis is based on the association of liver, heart, eye, skeleton abnormalities, and characteristic facial appearance. Case presentation An 18-year-old male patient, with a family history of benign recurrent intrahepatic cholestasis in a brother, was diagnosed at birth with bile duct paucity. He consulted in adulthood for cholestatic jaundice and pruritus. Physical exam found cutaneous jaundice, particular face, skeletal abnormality of fingers, posterior embryotoxon, and splenomegaly. An echocardiogram found cardiovascular abnormalities. The diagnosis of Alagille syndrome was made in front of five major criteria. A liver biopsy revealed a cirrhosis liver. Upper gastrointestinal endoscopy revealed grade II esophageal varices of portal hypertension. Laboratory tests revealed bicytopenia related to hypersplenism, hypoferritinemia, cytolysis with cholestasis, high bilirubin levels, low prothrombin time, hypoalbuminemia, decreased factor V activity, and hypocholesterolemia. The patient had vitamin K supplementation and was put on ursodeoxycholic acid, propranolol for the liver disease, a high protein hypercaloric diet for malnutrition, vitamin D supplementation and bisphosphonate for the osteoporosis, therapeutic abstention with monitoring for the asymptomatic cardiac disease. After a year of treatment, the patient had an overall health status improvement. Abdominal ultrasound found liver nodules. A biliary MRI showed a multinodular liver. The complement by CT hepatic angiography did not show any nodules while the MRI angiography revealed multiple dysplastic nodules. A liver biopsy was performed and found regenerative nodules. Conclusion The treatment of Alagille syndrome is based on managing the cholestasis and its complications, especially pruritus because it can have a significant impact on quality of life. Due to the complexity of presentation and multi-organ involvement, management of cases with Alagille syndrome should be done by a multidisciplinary team. Liver disease is responsible for morbidity while cardiac disease is a mortality risk factor in this population.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135042012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Liver biopsy is crucial to know if the tumor is benign or malignant. This paper has reviewed the literature clinically shedding lights on the present biopsy procedure, requirements, and potential challenges. This study has emphasized the role of navigation during liver biopsy. It has discussed the various imaging modalities used for biopsy. The potential limitations of imaging modalities have been discussed in detail. It is found that liver biopsy could be effective when fusion imaging is used instead of a single imaging modality.
{"title":"Complexities in liver biopsy: the role of navigation and fusion imaging","authors":"Serah Jessy Mathew, Anchal Nayak, Sagnika Dash, Sarada Prasad Dakua","doi":"10.1186/s43066-023-00293-5","DOIUrl":"https://doi.org/10.1186/s43066-023-00293-5","url":null,"abstract":"Abstract Liver biopsy is crucial to know if the tumor is benign or malignant. This paper has reviewed the literature clinically shedding lights on the present biopsy procedure, requirements, and potential challenges. This study has emphasized the role of navigation during liver biopsy. It has discussed the various imaging modalities used for biopsy. The potential limitations of imaging modalities have been discussed in detail. It is found that liver biopsy could be effective when fusion imaging is used instead of a single imaging modality.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135868959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Endoscopic variceal ligation (EVL) is a crucial procedure for the primary and secondary prevention of variceal bleeding. The objective of this study was to evaluate the efficacy and tolerability of EVL in the prevention of variceal bleeding. Methods This was a retrospective, single-center study over 8 years, from January 2013 to December 2020, including all patients who came for EVL in primary or secondary prevention. Results Fifty-seven patients (male/female: 39/18) were included. The mean age of the patients was 40.02 ± 12.32 years (range: 19–68). Portal hypertension was secondary to cirrhosis in 13 patients (22.8%) and to a non-cirrhotic cause in 44 patients (77.2%). EVL was indicated for primary and secondary prevention in 5.3% and 94.7%, respectively. All patients had received propranolol with a mean daily dose of 108.07 ± 38.52 mg (extremes: 80–160). Eradication of varices was achieved in 33 patients (57.9%) with an average of 3.06 ± 0.70 sessions (extremes: 1–5) and an average duration of 10.12 ± 6.21 months (extremes: 1–24). Ten patients (17.5%) had variceal bleeding, and one patient (1.8%) died. There was no significant difference between patients with cirrhotic and non-cirrhotic portal hypertension in terms of varices eradication, variceal bleeding, and mortality. Gender ( HR : 37.18; CI : 0.14–18.4; p = 0.009) and the number of previous bleeds ( HR : 1.34; CI : 1.01–1.80; p = 0.041) were independent predictors of variceal bleeding during EVL. Dysphagia (73.7%) and retrosternal pain (78.9%) were the main adverse events after ligation. Conclusion EVL is an efficient technique to eradicate varices. Its tolerance is good with post-ligation signs that are rapidly regressive.
{"title":"Endoscopic variceal ligation in primary and secondary prevention of variceal bleeding: a retrospective study in Digestive Endoscopy Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar","authors":"Chantelli Iamblaudiot Razafindrazoto, Nitah Harivony Randriamifidy, Jolivet Auguste Rakotomalala, Sedera Radoniaina Rakotondrasoa, Behoavy Mahafaly Ralaizanaka, Henintsoa Rakotoniaina, Antsa Fihobiana Randrianiaina, Mialitiana Rakotomaharo, Domoina Harivonjy Hasina Laingonirina, Sonny Maherison, Anjaramalala Sitraka Rasolonjatovo, Andry Lalaina Rinà Rakotozafindrabe, Tovo Harimanana Rabenjanahary, Soloniaina Hélio Razafimahefa, Rado Manitrala Ramanampamonjy","doi":"10.1186/s43066-023-00295-3","DOIUrl":"https://doi.org/10.1186/s43066-023-00295-3","url":null,"abstract":"Abstract Introduction Endoscopic variceal ligation (EVL) is a crucial procedure for the primary and secondary prevention of variceal bleeding. The objective of this study was to evaluate the efficacy and tolerability of EVL in the prevention of variceal bleeding. Methods This was a retrospective, single-center study over 8 years, from January 2013 to December 2020, including all patients who came for EVL in primary or secondary prevention. Results Fifty-seven patients (male/female: 39/18) were included. The mean age of the patients was 40.02 ± 12.32 years (range: 19–68). Portal hypertension was secondary to cirrhosis in 13 patients (22.8%) and to a non-cirrhotic cause in 44 patients (77.2%). EVL was indicated for primary and secondary prevention in 5.3% and 94.7%, respectively. All patients had received propranolol with a mean daily dose of 108.07 ± 38.52 mg (extremes: 80–160). Eradication of varices was achieved in 33 patients (57.9%) with an average of 3.06 ± 0.70 sessions (extremes: 1–5) and an average duration of 10.12 ± 6.21 months (extremes: 1–24). Ten patients (17.5%) had variceal bleeding, and one patient (1.8%) died. There was no significant difference between patients with cirrhotic and non-cirrhotic portal hypertension in terms of varices eradication, variceal bleeding, and mortality. Gender ( HR : 37.18; CI : 0.14–18.4; p = 0.009) and the number of previous bleeds ( HR : 1.34; CI : 1.01–1.80; p = 0.041) were independent predictors of variceal bleeding during EVL. Dysphagia (73.7%) and retrosternal pain (78.9%) were the main adverse events after ligation. Conclusion EVL is an efficient technique to eradicate varices. Its tolerance is good with post-ligation signs that are rapidly regressive.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135863510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-25DOI: 10.1186/s43066-023-00286-4
Akira Imoto, Takeshi Ogura, Daisuke Masuda, Ken Narabayashi, Toshihiko Okada, Yosuke Abe, Toshihisa Takeuchi, Takuya Inoue, Kumi Ishida, Sadaharu Nouda, Kazuhide Higuchi, Usama M. Abdelaal
Abstract Background/aims The natural history of pancreatic branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) is still unknown. This retrospective study aims to determine the morphological changes of BD-IPMNs with attention to the history of surgical resection for extrapancreatic malignancies. Methods and materials This study included 427 subjects with BD-IPMN at the Osaka Medical College from January 2001 to December 2019; 134 patients were included. The predictive factors for the progression of BD-IPMN based on morphological changes were evaluated by univariate as well as multivariate analyses. Furthermore, the clinical features of BD-IPMNs with progressive lesions during follow-up were investigated. Results The average interval of follow-up was 35.8 months (with a range between 12.1 and 157 months). Disease progression occurred in 6 subjects (4.5%). In two of them (1.5%), IPMN-related invasive carcinoma was found. Multivariate analysis demonstrated that surgical resection for extrapancreatic malignancies was a significant predictor of BD-IPMN progression. Conclusion The history of resection of extrapancreatic malignancies should be considered during the follow-up of BD-IPMN.
{"title":"Progression of pancreatic branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) after surgery for extrapancreatic malignancies","authors":"Akira Imoto, Takeshi Ogura, Daisuke Masuda, Ken Narabayashi, Toshihiko Okada, Yosuke Abe, Toshihisa Takeuchi, Takuya Inoue, Kumi Ishida, Sadaharu Nouda, Kazuhide Higuchi, Usama M. Abdelaal","doi":"10.1186/s43066-023-00286-4","DOIUrl":"https://doi.org/10.1186/s43066-023-00286-4","url":null,"abstract":"Abstract Background/aims The natural history of pancreatic branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs) is still unknown. This retrospective study aims to determine the morphological changes of BD-IPMNs with attention to the history of surgical resection for extrapancreatic malignancies. Methods and materials This study included 427 subjects with BD-IPMN at the Osaka Medical College from January 2001 to December 2019; 134 patients were included. The predictive factors for the progression of BD-IPMN based on morphological changes were evaluated by univariate as well as multivariate analyses. Furthermore, the clinical features of BD-IPMNs with progressive lesions during follow-up were investigated. Results The average interval of follow-up was 35.8 months (with a range between 12.1 and 157 months). Disease progression occurred in 6 subjects (4.5%). In two of them (1.5%), IPMN-related invasive carcinoma was found. Multivariate analysis demonstrated that surgical resection for extrapancreatic malignancies was a significant predictor of BD-IPMN progression. Conclusion The history of resection of extrapancreatic malignancies should be considered during the follow-up of BD-IPMN.","PeriodicalId":11620,"journal":{"name":"Egyptian Liver Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135113274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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