SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Cirrhosis

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Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs.

Concepts: Cirrhosis, Liver, Physician, Primary care physician

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Long-term treatment with retrotranscriptase (RT) inhibitors eventually leads to the development of drug resistance. Drug-related mutations occur naturally and these can be found in hepatitis B virus (HBV) carriers who have never received antiviral therapy. HBsAg are overlapped with RT domain, thus nucleot(s)ide analogues (NAs) resistance mutations and naturally-occurring mutations can cause amino acid changes in the HBsAg. Twenty-two patients with chronic hepatitis B were enrolled; three of them were previously treated with NAs and 19 were NAs-naïve treated. HBV reverse transcriptase region was sequenced; genotyping and analysis of missense mutations were performed in both RT domain and HBsAg. There was predominance of genotype H. Drug mutations were present in 18.2% of patients. Classical lamivudine resistance mutations (rtM204V/rtL180M) were present in one naïve-treatment patient infected with genotype G. New amino acid changes were identified in drug resistance sites in HBV strains from patients infected with genotype H; rtQ215E was present in two naïve-NAs treatment patients and rtI169M was identified in a patient previously treated with lamivudine. Mutations at sites rt169, rt204, and rt215 resulted in the Y161C, I195M, and C206W mutations at HBsAg. Also, new amino acid changes were identified in B-cell and T-cell epitopes and were more frequent in HBsAg compared to RT domain. In conclusion, new amino acid changes at antiviral resistance sites, B-cell and T-cell epitopes in HBV genotype H were identified in Mexican patients. J. Med. Virol. 2015. © 2015 Wiley Periodicals, Inc.

Concepts: DNA, Cirrhosis, Hepatitis, Hepatitis C, Hepatitis B, Hepatitis A, Hepatitis B virus, Lamivudine

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We present a case of a 66-year-old woman with decompensated alcoholic liver cirrhosis and poorly controlled non-insulin-dependent diabetes mellitus who was admitted with a 1 day history of altered mental status, high-grade fevers, worsening jaundice and generalised malaise with subsequent development of hypotension requiring intensive care. She was diagnosed with severe babesiosis with high-grade parasitaemia. She was also found to have Lyme disease coinfection. Despite aggressive therapeutic measures including appropriate antibiotics and multiple exchange blood transfusions, she developed septic shock and fulminant multiple organ failure with eventual demise. In this article, we highlight multiple tick-borne illnesses in a vulnerable host, in this case an elderly patient with liver cirrhosis, as risk factors for severe morbidity and potentially fatal outcomes.

Concepts: HIV, Cirrhosis, Hepatitis, Liver, Bilirubin, Hepatitis C, Hepatitis B, Sepsis

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Fatty liver is an important clinical feature not only in alcoholic and non-alcoholic fatty liver diseases, but in other chronic liver diseases as well. Our aim was to elucidate the effect and relationship between habitual alcohol intake and obesity in the development of fatty liver disease.

Concepts: Medicine, Cancer, Obesity, Cirrhosis, Metabolic syndrome, Hepatology, Non-alcoholic fatty liver disease, Fatty liver

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Chronic hepatitis C is a leading cause of chronic liver disease, cirrhosis and hepatocellular carcinoma. DNA methylation and histone covalent modifications constitute crucial mechanisms of genomic instability in human disease, including liver fibrosis and hepatocellular carcinoma. The present work studies the consequences of HCV induced histone modifications in early stages of infection.

Concepts: DNA, Cancer, Cirrhosis, Hepatitis, Hepatocellular carcinoma, Hepatology, Hepatitis C, Hepatitis B

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GS-9620 is an oral agonist of toll-like receptor 7, a pattern-recognition receptor whose activation results in innate and adaptive immune stimulation. We evaluated the safety, pharmacokinetics, and pharmacodynamics of GS-9620 in patients with chronic hepatitis B.

Concepts: Immune system, Innate immune system, Cirrhosis, Hepatitis, Hepatitis C, Hepatitis B, Hepatitis A

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We aimed to describe the imaging findings of a spontaneous portohepatic venous shunt. This is a rare entity, especially when it is not associated with risk factors such as portal hypertension or liver trauma. We report the case of a 67-year-old woman admitted to our clinic for progressive asthenia, loss of appetite, and progressive upper abdominal pain. We performed several blood tests, abdominal ultrasonography, contrast-enhanced abdominal ultrasonography, and abdominal computed tomographic scan to establish and confirm the diagnosis. Findings of ultrasound revealed a cystic mass in the right liver lobe. Liver enzymes were normal, and viral hepatitis markers as well as serology for Echinococcus granulosus were negative. There were no signs of liver cirrhosis or portal hypertension. Abdominal ultrasound and contrast-enhanced ultrasound established the diagnosis of portohepatic venous shunt; this was also confirmed by abdominal computed tomographic scan. Because the patient did not present any risk factors, the diagnosis was of spontaneous portohepatic venous shunt.

Concepts: Medical imaging, Cirrhosis, Hepatitis, Liver, Gastroenterology, Hepatology, Bilirubin, Medical ultrasonography

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Liver transplantation is an important and established treatment option for chronic hepatitis C virus (HCV) related end-stage liver disease (HCV-related ESLD). This study describes trends in elective liver transplantation among persons with HCV-related ESLD.

Concepts: Cohort study, Cirrhosis, Hepatitis, Hepatocellular carcinoma, United Kingdom, Hepatitis C, Hepatitis A, Hepatitis C virus

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The successful evolution of paediatric liver transplantation means that increasing numbers of young people survive into adulthood. Non-adherence to medication regimens leading to liver dysfunction, graft loss and patient death are prevalent in this vulnerable group. Insight into young people’s experiences of living with a liver transplant (LTx) is vital to improve outcomes and guide future work in this area. Through semi-structured interviews, this study explored the experiences of living with a LTx for 13 young people transplanted as children and adolescents. Interviews were analysed using Interpretative Phenomenological Analysis, revealing that young people felt different from their peers as a result of their LTx. Young people’s perceptions of their scar, experiences of illness symptoms and taking medications acted as triggers of differences. This led to an ongoing struggle to be normal when faced with typical activities for young people and to attempts to take back control. Findings support the implementation of routine psychosocial screening to identify additional support needs and the development of a peer mentoring programme to allow young people to gain social support, thus reducing feelings of being different. It is hoped that such initiatives will have positive consequences for quality of life, self-management and adherence to medications.

Concepts: Medicine, Cirrhosis, Liver, Organ transplant, Interpretative phenomenological analysis, Pharmaceutical drug, Liver transplantation, Liver dialysis

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