Publications by authors named "Arun Valsan"
Background: Wilson's disease (WD) results from pathogenic ATP7B gene variations, causing copper accumulation mainly in the liver, brain, and kidneys.
Objectives: In India, despite studies on ATP7B variants, WD often goes undiagnosed, with the prevalence, carrier rate, and mutation spectrum remaining unknown.
Methods: A multicenter study examined genetic variations in WD among individuals of Indian origin via whole exome sequencing.
Article Synopsis
- Hospitalized patients with acute decompensation of cirrhosis are at high risk for progressing to acute-on-chronic liver failure, which significantly increases mortality rates; this study aimed to find key predictors of this progression.
- The research spanned two years and included 625 patients across India, dividing them into a derivation-cohort and a validation-cohort to develop and compare predictive models against established scores like MELD3.0.
- Findings showed that about 32.2% of patients progressed to ACLF, with higher bilirubin and leukocyte counts among those affected, and a new PRE-ACLF Model was more effective in predicting ACLF risk than existing scores.
Background And Aims: Machine learning (ML) can identify the hidden patterns without hypothesis in heterogeneous diseases like acute-on-chronic live failure (ACLF). We employed ML to describe and predict yet unknown clusters in ACLF.
Methods: Clinical data of 1568 patients with ACLF from a tertiary care centre (2015-2023) were subjected to distance-, density- and model-based clustering algorithms.
Background And Aims: Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension.
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- - The gut microbiota consists of around 100 trillion microbes, possessing a genetic diversity greater than the human genome, and plays significant roles in metabolism, immune function, and disease progression.
- - The relationship between gut microbiota and liver health is a focus of the discussion, highlighting its connection to various chronic liver diseases, although specific scientific evidence is still limited.
- - The review also explores ways to potentially modify gut microbiota to influence the development and progression of liver diseases, based on recent research findings.
Farnesoid X receptor (FXR) was identified as an orphan nuclear receptor resembling the steroid receptor in the late '90s. Activation of FXR is a crucial step in many physiological functions of the liver. A vital role of FXR is impacting the amount of bile acids in the hepatocytes, which it performs by reducing bile acid synthesis, stimulating the bile salt export pump, and inhibiting its enterohepatic circulation, thus protecting the hepatocytes against the toxic accumulation of bile acids.
View Article and Find Full Text PDFBackground/aims: The aim of this study was to prospectively evaluate stereotactic body radiotherapy (SBRT) with robotic radiosurgery in hepatocellular carcinoma patients with macrovascular invasion (HCC-PVT).
Materials And Methods: Patients with inoperable HCC-PVT, good performance score (PS0-1) and preserved liver function [up to Child-Pugh (CP) B7] were accrued after ethical and scientific committee approval [Clinical trial registry-India (CTRI): 2022/01/050234] for treatment on robotic radiosurgery (M6) and planned with Multiplan (iDMS V2.0).
Background/aims: This study delved into cirrhosis-related infections to unveil their epidemiology, risk factors, and implications for antimicrobial decisions.
Methods: We analyzed acutely decompensated cirrhosis patients (n = 971) from North India between 2013-2023 at a tertiary center. Microbiological and clinical features based on infection sites (EASL criteria) and patient outcomes were assessed.
Hepatocellular carcinoma (HCC) is the primary malignancy of hepatocytes and the second most common cause of cancer-related mortality across the globe. Despite significant advancements in screening, diagnosis, and treatment modalities for HCC, the mortality-to-incidence ratio remain unacceptably high. A recent study indicates that a minor population of HCCs are AFP negative or express the normal range of AFP levels.
View Article and Find Full Text PDFBackground: Ashwagandha herb is commonly used in Ayurveda and a "fad" dietary supplement for a host of indications based on low levels of evidence. Recently, ashwagandha was implicated in multiple reports of herb-induced liver injury (HILI), mainly from the United States. We present the first, and currently largest, series of ashwagandha-HILI from multiple centers in India.
View Article and Find Full Text PDFBackground: We evaluated the prevalence, risk factors, and impact of bacterial/fungal infections in acute liver failure (ALF) patients.
Methods: We analyzed clinical, biochemical, and microbiological data of ALF patients with and without bacterial/fungal infections admitted at an institute over the last 5 years.
Results: We enrolled 143 patients, 50% males, median age 25 years, with acute viral hepatitis (32.
Background & Aims: The reported burden of multidrug-resistant organism (MDRO) infections is highest in patients with cirrhosis from India. We evaluated whether colonisation at multiple barriers predisposes to such infections and poor outcomes in patients with cirrhosis.
Methods: We prospectively performed swab cultures, antimicrobial susceptibility testing (AST), and genotype testing for MDROs from various sites (rectum, nose, composite-skin, and central-line) in patients with cirrhosis (2020-2021) on admission and follow-up at a tertiary institute.
Hepatocellular carcinoma (HCC) is often recognized as an inflammation-linked cancer, which possesses an immunosuppressive tumor microenvironment. Curative treatments such as surgical resection, liver transplantation, and percutaneous ablation are mainly applicable in the early stage and demonstrate significant improvement of survival rate in most patients. However, 70-80% of patients report HCC recurrence within 5 years of curative treatment, representing an important clinical issue.
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- Telemedicine is being evaluated for its effectiveness in providing consultations for hepatobiliary disorders, showing promising results with 82% of consultations deemed suitable.
- The study identified factors influencing consultation suitability, where skilled occupation, higher education, and certain liver diseases like chronic hepatitis B, C, and NAFLD were linked to higher suitability, while conditions like cirrhosis and biliary obstruction were less suitable.
- Machine learning models, particularly the decision tree, effectively predicted consultation suitability, helping to categorize which patients could be effectively managed via telemedicine.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide yet predicting non-obese NAFLD is challenging. Thus, this study investigates the potential of regional fat percentages obtained by dual-energy X-ray absorptiometry (DXA) in accurately assessing NAFLD risk. Using the United States National Health and Nutrition Examination Survey (NHANES) 2011−2018, multivariate logistic regression and marginal analysis were conducted according to quartiles of regional fat percentages, stratified by gender.
View Article and Find Full Text PDFObjectives: We evaluated the magnitude and factors contributing to poor outcomes among cirrhosis patients with fungal infections (FIs).
Methods: We searched PubMed, Embase, Ovid and WOS and included articles reporting mortality in cirrhosis with FIs. We pooled the point and relative-risk (RR) estimates of mortality on random-effects meta-analysis and explored their heterogeneity (I ) on subgroups, meta-regression and machine learning (ML).