74 research outputs found
Evolving role of semaglutide in NAFLD: in combination, weekly and oral administration
Non alcoholic fatty disease (NAFLD) is the most common chronic liver disease that is managed in the liver departments. It seems that the prevalence of the disease is rising worldwide and as it has the same pathogenetic pathways with metabolic syndrome, treatments that target components of the metabolic syndrome seem promising for the therapy of NAFLD as well. In this review we discuss the evolving role of semaglutide, which is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that has been already approved for the treatment of type II diabetes mellitus (T2DM) and obesity
Primary Biliary Cirrhosis: Family Stories
Primary biliary cirrhosis (PBC) is a chronic immune-mediated cholestatic liver disease of unknown aetiology which affects mostly women in middle age. Familial PBC is when PBC affects more than one member of the same family, and data suggest that first-degree relatives of PBC patients have an increased risk of developing the disease. Most often, these familial clusters involve mother-daughter pairs, which is consistent with the female preponderance of the disease. These clusters provide evidence towards a genetic basis underlying PBC. However, clusters of nonrelated individuals have also been reported, giving strength to an environmental component. Twin studies have demonstrated a high concordance for PBC in monozygotic twins and a low concordance among dizygotic twins. In conclusion, studies of PBC in families clearly demonstrate that genetic, epigenetic, and environmental factors play a role in the development of the disease
Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis
and METAREACIR GroupInternational audienceBackgroundThe best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown.MethodsWe conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores).ResultsIn-ICU, in-hospital, and 6-month mortality was 42.7, 54.1, and 75.1%, respectively. Forty-eight patients (3.8%) underwent liver transplantation during follow-up. In-ICU mortality was lower in patients admitted for variceal bleeding (OR 0.46; 95% CI 0.36–0.59; p 19 at baseline (OR 8.54; 95% CI 2.09–34.91; p 26 (OR 3.97; 95% CI 1.92–8.22; p < 0.0001; PPV = 0.75), and hepatorenal syndrome (OR 4.67; 95% CI 1.24–17.64; p = 0.022; PPV = 0.88).ConclusionsPrognosis of cirrhotic patients admitted to ICU is poor since only a minority undergo liver transplant. The prognostic performance of general ICU scores decreases over time, unlike the Child–Pugh and MELD scores, even recorded in the context of organ failure. Infection-related parameters had a short-term impact, whereas liver and renal failure had a sustained impact on mortality
Securing sustainable funding for viral hepatitis elimination plans
The majority of people infected with chronic hepatitis C
virus (HCV) in the European Union (EU) remain undiagnosed and
untreated. During recent years, immigration to EU has further
increased HCV prevalence. It has been estimated that, out of the
4.2 million adults affected by HCV infection in the 31 EU/
European Economic Area (EEA) countries, as many as
580\xC2\xA0000 are migrants. Additionally, HCV is highly
prevalent and under addressed in Eastern Europe. In 2013, the
introduction of highly effective treatments for HCV with
direct-acting antivirals created an unprecedented opportunity to
cure almost all patients, reduce HCV transmission and eliminate
the disease. However, in many settings, HCV elimination poses a
serious challenge for countries' health spending. On 6 June
2018, the Hepatitis B and C Public Policy Association held the
2nd EU HCV Policy summit. It was emphasized that key
stakeholders should work collaboratively since only a few
countries in the EU are on track to achieve HCV elimination by
2030. In particular, more effort is needed for universal
screening. The micro-elimination approach in specific
populations is less complex and less costly than country-wide
elimination programmes and is an important first step in many
settings. Preliminary data suggest that implementation of the
World Health Organization (WHO) Global Health Sector Strategy on
Viral Hepatitis can be cost saving. However, innovative
financing mechanisms are needed to raise funds upfront for
scaling up screening, treatment and harm reduction interventions
that can lead to HCV elimination by 2030, the stated goal of the
WHO
Use of albumin infusion for cirrhosis-related complications: An international position statement
BACKGROUND & AIMS: Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy. METHODS: Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications. RESULTS: Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion. CONCLUSIONS: Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated. IMPACT AND IMPLICATIONS: Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion
Long-Term Survival under Arterial Chemoembolization and Sorafenib of a Patient with Hepatocellular Carcinoma and Tumor Atrial Thrombus: A Case Report and Literature Review
Hepatocellular carcinoma (HCC) is considered to be the fourth most
frequent cause of cancer-associated death globally. HCC might be
associated, especially in advanced stages, with the formation of tumor
thrombus (TT), which can be located in the portal vein, as well as in
hepatic and/or inferior vena cava (IVC) veins. Nevertheless, the
extension of TT to the right atrium (RA) is infrequent with an
unfavorable prognosis. We present a rare case of a male patient with HCC
and IVC TT extending to the RA. The atrial thrombus was the first
manifestation of HCC diagnosed by cardiac ultrasound. So far, the
patient has undergone 4 courses of transarterial chemoembolization in
combination with systemic therapy with sorafenib, and under this
therapeutic approach long-term survival has been achieved
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