Lifrarbólga A á Íslandi

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesInngangur: Faraldrar af völdum lifrarbólgu A veiru (hepatitis A virus, HAV) komu endurtekið upp á Íslandi á fyrrihluta 20. aldar en síðan þá hafa fá tilfelli greinst og engir þekktir faraldrar komið upp síðan 1952. Síðustu íslensku rannsóknir á lifrarbólgu A frá því um 1990 sýndu lágt nýgengi sýkingar og lækkandi algengi mótefna. Markmið rannsóknarinnar var að kanna nýgengi og birtingarmynd lifrarbólgu A á Íslandi og uppruna smits, er­lendis eða innanlands. Efniviður og aðferðir: Klínískum upplýsingum var safnað afturskyggnt úr sjúkraskrám um einkenni við greiningu, blóðprufuniðurstöður og mögulegar smitleiðir hjá öllum einstaklingum með jákvæð lifrarbólgu A IgM mótefni í gagnagrunni veirufræðideildar Landspítala á 11 ára tímabili, 2006-2016. Niðurstöður: Alls greindust 12 manns með bráða lifrarbólgu A á tímabilinu en framkvæmdar voru 6691 mæling á heildarmótefnum og 1984 mælingar á IgM mótefnum. Níu (75%) höfðu verið erlendis innan 7 vikna frá upphafi einkenna. Algengustu einkennin voru gula (10/12, 83%), hiti (67%) og ógleði og/eða uppköst (58%). Alls lögðust 50% inn á sjúkrahús og 42% fengu hækkun á INR/PT. Allir lifðu af sýkinguna án fylgikvilla. Ályktun: Að meðaltali greindist um eitt tilfelli af bráðri lifrarbólgu A árlega á Íslandi en mjög margar mótefnamælingar voru gerðar. Mikill meirihluti tilfella greindist hjá einstaklingum sem höfðu nýlega dvalið erlendis. Ef sjúklingar hafa gulu, hita og ógleði er ástæða til að kanna lifrarbólgu A sýkingu. Lifrarbólga A er ekki landlæg á Íslandi.Senda grein,Prenta greinEnglishFacebookTwitter Introduction: Hepatitis A virus (HAV) epidemics occurred repeatedly in Iceland in the early 20th century, but since then few cases have been reported and no epidemics since 1952. The latest Icelandic studies on HAV from around 1990 showed low incidence of infection and de­- creasing prevalence of antibodies. The objective of this study was to determine the incidence, clinical presentation and origin of HAV, abroad or in Iceland. Material and methods: A retrospective search was undertaken on all patients with positive anti-HAV IgM during the 11 years period of 2006-2016 in the virological database of the National University Hospital of Iceland. Clinical data was collected from medical records on symptoms at diagnosis, blood test results and possible route of transmission. Results: A total of 12 individuals were diagnosed with acute hepatitis A during the period and 6691 HAV total andibody tests and 1984 HAV IgM antibody tests were performed. Nine (75%) had been abroad within 7 weeks from initial symptoms. The most common symptoms were jaundice (83%), fever (67%) and nausea and/or vomiting (58%). 50% were admitted to a hospital. 42% had elevated INR/PT. Everyone sur­vived without complications. Conclusion: Annually, approximately one case of acute hepatitis A was diagnosed in Iceland during the study period but a very high number of antibody tests were performed. The majority of cases occurred among individuals who had recently been abroad. If patients have jaundice, fever and nausea, testing for HAV infection should be undertaken. HAV is not endemic in Iceland

The Impact of Sex on the Response to Proton Pump Inhibitor Treatment

Publisher Copyright: © 2023 by the authors.Proton pump inhibitor (PPI) treatment is responsible for substantial gastrin elevation secondary to reduced intragastric acidity. Due to the increasing global prevalence of PPI users, concerns have been raised about the clinical significance of continuous gastrin elevation and its potential long-term side effects. Hypergastrinemia secondary to PPIs has trophic effects on gastric mucosa, leading to enterochromaffin-like cell hyperplasia and gastric (fundic) polyp formation, and it is believed to provoke acid rebound following PPI withdrawal that induces PPI overutilization. Previous studies have found higher gastrin release following PPI therapy in females compared with males, and sex differences have also been demonstrated in pharmacokinetic parameters and dose requirements for acid reflux. It is conceivable that females might be at increased risk of PPI overuse, because they often receive higher milligram-per-kilogram doses. The prevalence of PPI use is more common among females, and the female sex is a risk factor for adverse drug reactions. This non-systematic review outlines the current knowledge of the impact of biological sex on the response to PPIs. The aim is to highlight the female sex as a potential risk factor that could be a step toward precision medicine and should be considered in future research on the response to PPI treatment.Peer reviewe

Checkpoint inhibitor-induced hepatotoxicity : Role of liver biopsy and management approach

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.Immunological checkpoint inhibitors (ICIs) have revolutionized therapy of many different malignanices. Concomitant immune-mediated adverse effects are common and can affect many organs such as the skin, lungs, gastrointestinal and endocrine organs as well as the liver. Liver injury has been reported in 3%-8% of patients with grade III-IV hepatitis in retrospective studies. The liver injury is characterized by hepatocellular injury resembling autoimmune hepatitis biochemically but not immunologically as patients with ICI induced hepatoxicity rarely have auto-antibodies or IgG elevation. The role for liver biopsy (LB) in patients with suspected liver injury due to ICIs is controversial and it is not clear whether results of a LB will change clinical management. LB can be helpful when there is diagnostic uncertainty and pre-existing liver disease is suspected. Although there are no distinctive histological features, the finding of granulomas and endothelitis may suggest a specific type of hepatitis induced by ICIs. The natural history of hepatotoxicity of ICI therapy is not well known. Recent studies have demonstrated that 33%-50% of patients improve spontaneously with discontinuation of ICIs. In patients with jaundice and/or coagulopathy corticosteroids are used. The high doses of corticosteroids with 1-2 mg/kg/d of methylprednisolone recommended by the oncological societies are controversial. Recently it has shown that initial treatment with 1 mg/kg/d provided similar liver tests improvement which was also associated with a reduced risk of steroid-induced adverse effects in comparison with higher-dose regimens. Secondary immunosuppression mostly with mycophenolate mofetil has been reported to be helpful.Peer reviewe

Hepatocellular Jaundice due to Hydroxycut in Monozygotic Twins

Publisher Copyright: © 2023 Indian National Association for Study of the LiverLiver injury associated with the use of a number of different of herbal and dietary supplements are increasingly recognized. It is though often unclear which of the sometimes multiple ingredients are responsible for the liver injury. Several case reports have been published on suspected liver injury due to Hydroxycut, which is a multi-ingredient supplement often used to induce weight loss. However, the hepatotoxic potential of Hydroxycut has though been disputed, and steatotic liver disease has also been implicated in patients who are found to have elevated liver enzymes while on Hydroxycut. We report clinically apparent liver injury with jaundice associated with the use of Hydroxycut in monozygotic twins with remarkably similar type of liver injury. Both had the genotype HLA-B 35:01 allele, a risk factor for green-tea extract induced liver injury, which is included in Hydroxycut.Peer reviewe

Acute lower gastrointestinal bleeding : A population-based five-year follow-up study

Publisher Copyright: © Author(s) 2019.Background: Data on the natural history of acute lower gastrointestinal bleeding (ALGIB) are lacking. We evaluated five-year bleeding risk and mortality in ALGIB patients and controls. Furthermore, we aimed to find predictors of rebleeding. Methods: This was a population-based retrospective case-control study conducted at the National University Hospital of Iceland, and included every individual who underwent endoscopy in 2010–2011. ALGIB was defined as rectal bleeding leading to hospitalisation or occurring in a hospitalised patient. Controls were randomly selected from those who underwent endoscopy in the same time period but who did not have GIB, and were matched for sex and age. Patients were followed up five years after index bleeding. Rebleeding was defined as ALGIB >14 days after index bleeding. Results: In total, 2294 patients underwent 2602 colonoscopies in 2010–2011. Of those, 319 (14%) had ALGIB. The mean age for cases and controls was 64 and 65 years (±19.3–20.7), respectively, and females accounted for 51–52% of the study population. For ALGIB patients, the five-year risk of a bleeding was 20% (95% confidence interval (CI) 15–24%) compared to 3% (95% CI 1–5%) in controls (log rank < 0.0001; co-morbidity-adjusted hazard ratio (HR) 6.9 (95% CI 3.4–14)). Only 37% of bleeders had the same cause of index bleeding and rebleeding. In ALGIB patients, age and inflammatory bowel disease (IBD) were predictors of rebleeding, with odds ratios per 10 years of 1.3 (95% CI 1.1–1.6) and 4.3 (95% CI 1.5–12), respectively. Bleeders did not have a higher risk of five-year mortality compared to controls (HR = 1.2; 95% CI 0.87–1.6). Conclusions: One fifth of ALGIB patients had rebleeding during follow-up. Age and IBD were independent predictors of rebleeding. ALGIB was not associated with lower five-year survival.Peer reviewe

The Evolving Profile of Idiosyncratic Drug-Induced Liver Injury

Funding Information: Conflicts of interest This author discloses the following: Rajender Reddy has received grant/research support from BMS, EXACT Sciences, NASH-TARGET, HCC-TARGET, Intercept, Mallinckrodt, Grifols, Sequana, and BioVie; serves on advisory committee/review panel for Mallinckrodt, NovoNordisk, Genfit, and Spark Therapeutics; and Data and Safety Monitoring Board from Novartis and Astra Zeneca. The remaining authors disclose no conflicts. Publisher Copyright: © 2023 AGA InstituteIdiosyncratic drug-induced liver injury (DILI) is an infrequent but important cause of liver disease. Newly identified causes of DILI include the COVID vaccines, turmeric, green tea extract, and immune checkpoint inhibitors. DILI is largely a clinical diagnosis of exclusion that requires evaluation for more common causes of liver injury and a compatible temporal association with the suspect drug. Recent progress in DILI causality assessment includes the development of the semi-automated revised electronic causality assessment method (RECAM) instrument. In addition, several drug-specific HLA associations have been identified that can help with the confirmation or exclusion of DILI in individual patients. Various prognostic models can help identify the 5%-10% of patients at highest risk of death. Following suspect drug cessation, 80% of patients with DILI fully recover, whereas 10%-15% have persistently abnormal laboratory studies at 6 months of follow-up. Hospitalized patients with DILI with an elevated international normalized ratio or mental status changes should be considered for N-acetylcysteine therapy and urgent liver transplant evaluation. Selected patients with moderate to severe drug reaction with eosinophilia and systemic symptoms or autoimmune features on liver biopsy may benefit from short-term corticosteroids. However, prospective studies are needed to determine the optimal patients and dose and duration of steroids to use. LiverTox is a comprehensive, freely accessible Web site with important information regarding the hepatotoxicity profile of more than 1000 approved medications and 60 herbal and dietary supplement products. It is hoped that ongoing "omics" studies will lead to additional insight into DILI pathogenesis, improved diagnostic and prognostic biomarkers, and mechanism-based treatments.Peer reviewe

Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM : An Emerging Cause

Funding Information: This article was supported by the COST Action CA17112—Prospective European Drug Induced Liver Injury Network (ProEuroDILINet) (G.B., V.V. and E.S.B.) and by the Ministry of Science, Technological Development, and Innovation of the Republic of Serbia No. 451-03-47/2023-01/200015 (V.V.). Publisher Copyright: © 2023 by the authors.Herb-induced liver injury (HILI) caused by herbal supplements, natural products, and products used in traditional medicine are important for differential diagnoses in patients with acute liver injury without an obvious etiology. The root of Withania somnifera (L.) Dunal, commonly known as ashwagandha, has been used in Ayurvedic medicine for thousands of years to promote health and longevity. Due to various biological activities, ashwagandha and its extracts became widespread as herbal supplements on the global market. Although it is generally considered safe, there are several reported cases of ashwagandha-related liver injury, and one case ended with liver transplantation. In this paper, we review all reported cases so far. Additionally, we describe two new cases of ashwagandha hepatotoxicity. In the first case, a 36-year-old man used ashwagandha capsules (450 mg, three times daily) for 6 months before he developed nausea, pruritus, and dark-colored urine. In the second case, a 30-year-old woman developed pruritus after 45 days of using ashwagandha capsules (450 mg). In both cases, serum bilirubin and liver enzymes (aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) were increased. The liver injury pattern was hepatocellular (R-value 11.1) and mixed (R-value 2.6), respectively. The updated Roussel Uclaf Causality Assessment Method (RUCAM) (both cases with a score of seven) indicated a “probable” relationship with ashwagandha. Clinical and liver function improvements were observed after the discontinuation of ashwagandha supplement use. By increasing the data related to ashwagandha-induced liver injury, these reports support that consuming ashwagandha supplements is not without its safety concerns.Peer reviewe

Metachronous Colorectal Cancer in Icelandic MSH6 and PMS2 Lynch Syndrome Carriers in 1955-2017 : A Population-based Study

Funding Information: Funding The study was partially funded by the Research Fund at Landspitali University Hospital. The funder had no role in the design of the study, collection, analysis, and interpretation of the data or in writing the manuscript.Peer reviewe