Publications by authors named "Maria Papp"
Article Synopsis
- Autoimmune hepatitis (AIH) is a chronic liver disease treated with steroids and the thiopurine drug azathioprine (AZA), which is metabolized into active forms like 6-thioguanine (6-TG) and 6-methyl-mercaptopurine (6-MMP).
- This study focused on creating a quick and effective ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) method to analyze levels of 6-TG and 6-MMP in blood samples from AIH patients.
- The new method was validated following EMA guidelines and proved to be accurate and precise for monitoring these important metabolites, facilitating better treatment management for patients.
Article Synopsis
- In autoimmune hepatitis, achieving complete biochemical remission (CBR) is difficult with standard thiopurine dosing, prompting a study on optimizing thiopurine metabolite levels for better treatment outcomes.
- Analysis of 337 patients revealed that stable CBR correlates with higher levels of the active metabolite 6-thioguanine nucleotides (6TGN), with an optimal threshold of ≥223 pmol/0.2 mL linked to successful remission maintenance.
- Increasing azathioprine doses tends to promote the formation of a toxic metabolite (6-methylmercaptopurine), but combining allopurinol with low-dose thiopurines significantly raised 6TGN levels and decreased 6M
Introduction And Objectives: Autoimmune liver diseases (AILD) are rare causes hepatocellular carcinoma (HCC), and data on the efficacy and tolerability of anti-tumor therapies are scarce. This pan-European study aimed to assess outcomes in AILD-HCC patients treated with tyrosine kinase inhibitors (TKIs) or transarterial chemoembolization (TACE) compared with patients with more common HCC etiologies, including viral, alcoholic or non-alcoholic fatty liver disease.
Materials And Methods: 107 patients with HCC-AILD (AIH:55; PBC:52) treated at 13 European centres between 1996 and 2020 were included.
Article Synopsis
- - The R-LIVER registry, initiated by the European Reference Network on Hepatological Diseases, analyzed the presentation and outcomes of autoimmune hepatitis (AIH) in 231 patients across six European centers over a year.
- - After 6 months, 50% of patients achieved complete biochemical response (CBR), with a rise to 63% by the 12-month mark, but only 27% managed to achieve this without steroids during the first year.
- - Results indicate significant variability in AIH treatment, with many patients experiencing treatment changes due to intolerance, and highlight the need for improved strategies given the low CBR rates and challenges in steroid withdrawal.
Article Synopsis
- Increased serum lipase levels are key indicators for diagnosing acute pancreatitis (AP), but they can also indicate non-pancreatic hyperlipasemia (NPHL) due to other health issues, complicating the diagnosis for doctors.
- This study aimed to characterize NPHL in a large cohort of patients to find clinical and lab factors that affect the accuracy of lipase diagnosis and identify potential prognostic indicators.
- The study involved 808 patients, showing that while 392 had AP, 401 had NPHL from various causes, with sepsis and acute kidney injury being the most common, leading to recommendations for better diagnostic criteria.
Article Synopsis
- Human albumin is a treatment for complications related to cirrhosis, but its long-term use is expensive and burdensome, making it important to identify predictive biomarkers to determine which patients would benefit most from the treatment.
- The ALB-TRIAL is a multinational, double-blind study that aims to validate a biomarker panel to predict responses to human albumin in patients with cirrhosis and ascites, enrolling patients into high and low effect groups before randomizing them to treatment or placebo.
- The trial has received ethical approvals from multiple European countries and plans to share its findings through various channels after completion, ensuring transparency and accessibility of the results.
Article Synopsis
- Identifying anti-nuclear antibodies (ANAs) in mixed serum samples is challenging, and researchers aimed to clarify how different ANAs interfere with each other using artificial mixtures.
- They created 16 combinations of serum samples with different ANA patterns and tested them through various evaluation methods.
- Results showed that a homogeneous pattern significantly disrupts the identification of a speckled pattern, with higher titers causing greater interference; manual and on-screen evaluations performed better than computer-assisted analysis.
Article Synopsis
- There is a lack of discharge protocols for acute pancreatitis (AP) patients, which the Hungarian Pancreatic Study Group (HPSG) aims to address with a new, validated protocol based on laboratory data and symptoms.
- An international survey revealed that 87.5% of participating medical centers do not have discharge protocols, but those that do see shorter hospital stays and lower readmission rates.
- The HPSG discharge protocol resulted in the lowest average length of hospital stay and demonstrated safety through a low readmission rate, highlighting the need for developing and validating more standardized discharge protocols for AP care.
Article Synopsis
- Defective neutrophil regulation in inflammatory bowel disease (IBD) can lead to damage in the intestinal barrier, causing increased inflammation and pathogen accumulation, potentially influenced by the loss of tolerance to chitinase 3-like 1 (CHI3L1).
- The study aims to analyze the predictive value of anti-CHI3L1 autoantibodies (aCHI3L1) Ig subtypes in understanding disease progress, therapy choices, and patient outcomes in IBD.
- Results indicate a higher prevalence of IgA antibodies in Crohn's disease compared to ulcerative colitis and healthy controls, with secretory IgA also being significantly more common in both disease groups than in healthy individuals.
Article Synopsis
- Liver cirrhosis patients are prone to infections, which can impact their survival, but current detection methods are unreliable.
- A study examined various blood parameters, including WBC counts and C-reactive protein levels, to identify infections and predict short-term mortality in 233 hospitalized liver cirrhosis patients.
- Results showed that while C-reactive protein was the best indicator of infection, the neutrophil-to-lymphocyte ratio (NLR) effectively predicted short-term mortality, suggesting it could replace the standard WBC count in current assessments.
Article Synopsis
- - The study investigates the prevalence of acute cholangitis (AC) and cholecystitis (CC) among patients diagnosed with biliary acute pancreatitis (AP), using the 2018 Tokyo guidelines, highlighting a potential for overdiagnosis and overuse of medical interventions.
- - Results show that around 70% of biliary AP patients met the criteria for AC/CC; antibiotic use was high (77.4%), with low mortality in mild cases but significantly higher rates in severe cases.
- - The authors conclude that existing diagnostic criteria often overlap and may misclassify AP conditions, suggesting a need for clearer, disease-specific guidelines and randomized trials on antibiotic necessity in these patients.
Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis.
Gastroenterology
September 2023
Article Synopsis
- Patients discharged after acute pancreatitis (AP) face a significantly higher mortality risk than the general population, with a first-year mortality rate almost double that of in-hospital mortality.
- Key risk factors for post-discharge mortality include age, existing medical conditions, severity of illness, and certain lab results upon admission.
- Major causes of death in the first 90 days post-discharge are cardiac failure and AP-related infections, while later deaths are often linked to cancer-related issues and other infections, highlighting the need for comprehensive follow-up care.
Diagnosis of autoimmune diseases is in most cases challenging for clinicians as there is not a single specific laboratory or histological marker to diagnose or exclude the presence of the conditions. This review focused on the current knowledge of the role of autoantibodies' testing in various diseases, such as systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, undifferentiated connective tissues disease, primary biliary cholangitis and primary sclerosing cholangitis. Similarly, the prognostic and diagnostic values of autoantibodies testing in patients with interstitial lung disease have been reviewed.
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- Non-alcoholic fatty liver disease (NAFLD) has been redefined as metabolic-associated fatty liver disease (MAFLD), which is linked to an increased risk of acute pancreatitis (AP).
- In a study involving over 2,000 patients, 39% had MAFLD, which raised the odds of developing moderate-to-severe AP, although it didn't significantly impact in-hospital mortality.
- The severity of AP was influenced by the specific metabolic risk factors present, with a dose-dependent relationship observed—more criteria correlated with increased severity and outcomes for the disease.
Article Synopsis
- * The study will involve 240 patients and compare the effectiveness of a structured peer-delivered psychosocial support intervention alongside usual care against usual care alone, measuring outcomes like mental health-related quality of life, depression, and social support.
- * A mixed-methods evaluation will assess both effectiveness and implementation outcomes, incorporating surveys and focus groups to understand acceptability, feasibility, and the context of the intervention from the perspectives of patients, counselors, and healthcare providers.
Article Synopsis
- Current prognostic scores for acutely decompensated cirrhosis patients, especially those with acute-on-chronic liver failure, often underestimate mortality risk due to not accounting for systemic inflammation's impact.
- A study used serum metabolomics from two large European cohorts to identify key metabolites linked to short-term mortality, leading to the creation of two new predictive models.
- Both models significantly outperformed the existing MELDNa score in predicting death within 28 days of hospital admission, demonstrating better accuracy in patients with acute-on-chronic liver failure.
Article Synopsis
- In pediatric patients with acute pancreatitis (AP), having a family history of pancreatic diseases is linked to an earlier onset of recurrent acute pancreatitis (ARP) and chronic pancreatitis (CP), particularly peaking in children aged 6-17 years.
- Analysis of data from the Hungarian Pancreatic Study Group showed that those with a positive family history had a significantly higher rate of ARP/CP and a greater tendency for idiopathic AP in early childhood, along with increased alcohol and smoking rates in adolescence and early adulthood.
- Contrary to beliefs about adults, positive family history does not predict ARP or CP in adults; therefore, it should not be treated as a prognostic factor for them
Serological biomarkers for management of primary sclerosing cholangitis.
World J Gastroenterol
June 2022
Article Synopsis
- Primary Sclerosing Cholangitis (PSC) shows diverse clinical manifestations and poorly understood causes, with gut-liver interactions playing a significant role in its development.
- Recent studies on biomarkers linked to gut-biliary interactions may help identify specific PSC subgroups, improving diagnosis, treatment, and monitoring strategies.
- Key markers, such as alkaline phosphatase, IgG4, and soluble vascular adhesion protein-1, can indicate disease severity and prognosis, potentially guiding clinical management of PSC patients.
Article Synopsis
- Acute pancreatitis (AP) is a serious inflammation of the pancreas, and identifying patients at high risk of severe complications early is essential to prevent organ failure and death.
- The study developed a machine learning prediction model called EASY, using data from over 4,700 patients to offer quick assessments of severity through algorithms like XGBoost, achieving an average accuracy of 89.1%.
- The model identifies key risk factors such as respiratory rate, body temperature, and glucose level, and includes a user-friendly web application for easy access to its predictions.
Article Synopsis
- Excessive alcohol consumption is a major cause of recurrent acute pancreatitis (AP), but effective treatments to prevent its recurrence, like psychological therapies, are not widely implemented in practice.
- A study analyzed 99 patients with alcohol-induced AP, where a 30-minute brief intervention (BI) by a physician led to significant reductions in alcohol consumption and related blood markers (GGT and MCV).
- After one month, 79% of patients reported being alcohol-free, indicating that BI could be a promising method to help prevent future cases of AP, though further research is needed to optimize its use.
Article Synopsis
- * Advances in understanding the disease’s underlying mechanisms have shifted approaches to prevention and treatment, with improved diagnostic imaging techniques like CT scans playing a critical role in accurately diagnosing acute diverticulitis.
- * Recent findings suggest that high-fiber diets may not significantly aid recovery during acute diverticulitis, and traditional antibiotic treatments are being re-evaluated; guidelines recommend avoiding colonoscopy during acute episodes but suggest screening afterward to rule out colorectal cancer.
Article Synopsis
- * This international trial includes a randomized controlled aspect (REAPPEAR-T) and a cohort study (REAPPEAR-C), focusing on changes in alcohol use and smoking among hospitalized daily smokers with alcohol-related acute pancreatitis.
- * Participants will be monitored through questionnaires and regular health assessments, with the primary goal being to measure the recurrence rate of pancreatitis and overall mortality within two years, while also evaluating the program's cost-effectiveness.
Article Synopsis
- The rising incidence of acute pancreatitis (AP) has led to increased medical costs and a concerning 30% mortality rate in severe cases.
- A study involving 2461 patients revealed that hypoalbuminemia (low albumin levels) is common in AP, affecting 19% on admission and 35.7% during hospitalization.
- Severe hypoalbuminemia significantly increases the risk of complications and mortality, with a clear dose-dependent relationship to severity and hospital stay.
Article Synopsis
- * An analysis was conducted on 743 patients with culture-confirmed IPN, revealing a 20.9% mortality rate, with early infection (within the first 4 weeks) significantly linked to higher mortality rates.
- * Results indicate that both early infection and early open surgery are strong predictors of increased mortality, while other surgical methods showed no significant impact on death rates.
Article Synopsis
- Around 20% of patients with acute pancreatitis experience acute recurrent pancreatitis, and 10% may develop chronic pancreatitis, with no preventive measures established for idiopathic cases.
- The study aims to test the effects of a reduced fat diet versus a standard healthy diet on the recurrence of acute pancreatitis in patients who have had at least two previous episodes.
- Participants will be monitored for 2 years, with follow-ups to assess dietary impact on recurrence, mortality, body weight, and lipid levels.