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Viral hepatitis in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Interested readers may refer to the several excellent textbooks on hepatology, review articles, and guidelines published by American Association for the Study of Liver Diseases (AASLD). This chapter will focus only on hepatitis B and C. Brief mention of hepatitis E will be made. Other viral hepatitis like herpes simplex virus hepatitis will not be covered.
Gut function and failure
Published in Philip Woodrow, Nursing Acutely Ill Adults, 2015
Although symptoms of failure are usually relatively slow to develop, compared with other organs, effects can be widespread, and devastating. The All-Party Parliamentary Hepatology Group (APPHG, 2014) identify liver disease as one of the five biggest killer diseases in the UK, and the only one increasing, with average age of death being 59 and falling, and suggest that the main causes (alcohol, obesity and viral hepatitis) are all preventable. Aspects of care for acute and chronic failure can often be managed in general hospitals, but liver failure may need transplantation or other specialist interventions, so tertiary centres should be involved. If transplantation is not an option for end-stage liver disease, then palliation is indicated.
Use of Amnion Epithelial Cells in Metabolic Liver Disorders
Published in Ornella Parolini, Antonietta Silini, Placenta, 2016
Roberto Gramignoli, Fabio Marongiu, Strom Stephen C.
A powerful shift in medical intervention may be produced by regenerative medicine. Regenerative medicine has already been shown to dramatically transform healthcare, especially in hepatology, considering the liver’s innate regenerative capacity. In particular, cell-based therapies are rapidly moving into clinical application and attempting to maximize the potential for repair, regeneration, or both. Cellular transplantation avoids the mortality and morbidity associated with the myriad of potential technical complications commonly described in vascularized organ transplants and in the procedure itself. Cells can be infused through minimally invasive procedures, compared to orthotopic organ transplantation. Preliminary clinical proof-of-concept for cell transplantation already exists. The routes of administration have been either local or systemic. The infusion of single-cell suspension into the circulatory system has the advantage of potentially being performed even on severely ill patients with relatively low risk. Once infused, the transplanted cells migrate and integrate into the host tissue, which in a large part of the documented cases colocalized with the liver. Nevertheless, systemic administration requires accurate evaluation to avoid entrapment of infused cells in the lung or microvasculature, resulting in embolism or thrombotic events. Cellular therapies have several additional advantages compared to the whole organ replacement: multiple infusions of cells are not only a possibility but also common practice and proposed as necessary in multiple cases; cell batches for transplant can be banked and cryopreserved for almost instant availability, avoiding concerns on procedural timing. Another significant benefit is that native organ is not removed. As proved in liver-based approaches, transplanted cells would not need to provide complete liver support, allowing temporal support and enhancement in organ regeneration in patients with fulminant liver failure. This support is of particular relevance also for patients with metabolic liver diseases, in which regeneration does not play a main role in disease correction. For example, a patient affected by OTC deficiency, a urea cycle defect, has a mutation in the enzyme ornithine transcarbamylase (OTC) that causes ammonia to accumulate in the blood, while the affected hepatocytes maintain the capacity to perform all other necessary liver functions. In the unlikely scenario of donor cellular graft failure or inefficient cell function, the native liver is retained, allowing the patient to simply return to his pretransplant condition.
Cohort profile: decoding the epidemiology of liver disease in Sweden (DELIVER)
Published in Scandinavian Journal of Gastroenterology, 2022
Hannes Hagström, Ying Shang, Axel Wester, Linnea Widman
Data on the natural history of diseases are important in determining prognosis and the clinical course. Obtaining accurate data on the prevalence, incidence and outcomes of diseases can however be challenging. Most countries lack specific data sources to correctly identify specific diseases and to ascertain outcomes with low degree of bias. Common problems include selection bias, where only a certain type of patients can be included, such as studies from tertiary setting academic hospitals or from insurance databases. Another issue is often lack of appropriate follow-up time, which might induce further selection bias [1], and is especially important in hepatology, given the many times long disease course of chronic liver diseases [2, 3]. Further, many countries lack systems to track patients when they change care providers or move within the country.
Association between IFN-λ 3 Gene Polymorphisms and Outcome of Treatment with Direct Acting Antivirals in Chronic HCV-Infected Egyptian Patients
Published in Immunological Investigations, 2021
Islam El-Garawani, Sobhy Hassab El-Nabi, Marwa Gadallah, Eman Abdelsameea
The study plan was reviewed and approved by the Ethical Committee at National Liver Institute, Menoufia University (No: 00139/2018). The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Patients were enrolled from the outpatient unit of Hepatology and Gastroenterology Unit, National Liver Institute hospital, Menoufia University, Egypt. All patients included in the study were aged between 18 and 70 years old and had chronic HCV infection with detectable levels of HCV RNA. Treatment‐naïve patients were eligible for inclusion. Patients with cirrhosis having albumin <3 g/dL or total serum bilirubin >2 mg/dL or platelet count <50 000 mm3 were excluded. Patients with coexisting hepatitis B virus or human immunodeficiency virus infections, history of malignancy within the last 2 years and organ transplant patients were also excluded. An informed consent was obtained from all participants included in the study.
Thromboelastography in mild, chronic liver disease: challenging conventional coagulation tests preceding liver biopsy
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
LR Veronese, M Miller, WC Spearman
A prospective observational study design was used to investigate the coagulation profile of patients presenting for liver biopsy. The research was approved by the University of Cape Town Human Research Ethics Committee (ref no. 376/2015). A convenience sampling method was used to recruit participants. Patients who presented to the hepatology unit at Groote Schuur hospital for liver biopsy between August 2015 and February 2016 were approached, consented and included in the study. Blood samples were taken by venepuncture by the hepatology team. Four and a half millilitres (ml) of blood were taken into a citrated tube, mixed properly to avoid clotting and taken to the laboratory immediately. Samples were left to de-calcify for 30 minutes, then checked for clots and one millilitre of blood was activated with kaolin. The sample was re-calcified with 20 microlitres of calcium chloride. All of our samples were run within 60 minutes (within 4 hours is the acceptable time-frame to perform a TEG on a citrated sample).