Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series

BACKGROUND፡ This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients.METHODS: We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020.RESULTS: After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included,78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality.CONCLUSION: The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease

The survival rate survey of the patients undergoing liver transplants

Introduction: Liver transplantation is a widely distinguished and highly practical therapy for liver cirrhosis. In any case, liver transplant surgery assumes a risk of influential complications. In this way, the survival rate of liver transplant patients at Razi Healing Center in Rasht from 2017 to 2022 was investigated. Materials and Methods: In this retrospective cohort study, liver transplant patients referred to Razi Hospital in Rasht, Iran, from 2017 to 2022 were studied. Patient demographic and clinical information were collected. Survival was determined using Kaplan-Meier estimates. Log rank was used to determine differences between study groups in survival. Results: Out of 46 patients who underwent liver transplantation surgery, 54.3% of patients survived. Also, the most common causes of death for the samples of this study were COVID-19 and hemorrhage. Patients with autoimmune cirrhosis due to hepatitis have a significantly higher risk of death than those with cirrhosis due to other factors. Postoperative vascular thrombosis was found to be significantly associated with reduced patient survival. Patient outcomes improved significantly in the second part of the six-year liver transplant study. The study highlights the importance of increasing experience in liver transplant surgery and postoperative care to improve outcomes. Conclusion: According to the results of this study, patients with autoimmune cirrhosis due to hepatitis have a higher risk of death than those with cirrhosis due to other causes. In addition, postoperative vascular thrombosis is believed to significantly reduce patient survival. The study highlights the importance of increasing experience in liver transplant surgery and postoperative care to improve outcomes for these patients

Giant thymolipoma of mediastinum and neck – initially misdiagnosed as liposarcoma by core needle biopsy

Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through “posterolateral thoracotomy.” Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution

Epigenetic profiling of MUTYH, KLF6, WNT1 and KLF4 genes in carcinogenesis and tumorigenesis of colorectal cancer

Colorectal cancer (CRC) is distinguished by epigenetic elements like DNA methylation, histone modification, histone acetylation and RNA remodeling which is related with genomic instability and tumor initiation. Correspondingly, as a main epigenetic regulation, DNA methylation has an impressive ability in order to be used in CRC targeted therapy. Meaningly, DNA methylation is identified as one of most important epigenetic regulators in gene expression and is considered as a notable potential driver in tumorigenesis and carcinogenesis through gene-silencing of tumor suppressors genes. Abnormal methylation situation, even in the level of promoter regions, does not essentially change the gene expression levels, particularly if the gene was become silenced, leaving the mechanisms of methylation without any response. According to the methylation situation which has a strong eagerness to be highly altered on CpG islands in carcinogenesis and tumorigenesis, considering its epigenetic fluctuations in finding new biomarkers is of great importance. Modifications in DNA methylation pattern and also enrichment of methylated histone signs in the promoter regions of some certain genes like MUTYH, KLF4/6 and WNT1 in different signaling pathways could be a notable key contributors to the upregulation of tumor initiation in CRC. These epigenetic alterations could be employed as a practical diagnostic biomarkers for colorectal cancer. In this review, we will be discuss these fluctuations of MUTYH, KLF4/6 and WNT1 genes in CRC