Disparities in Liver Transplantation for Nonalcoholic Steatohepatitis in Women.

Background: Nonalcoholic steatohepatitis (NASH) is the fastest-growing indication for liver transplantation (LT). Sex disparities among patients with cirrhosis on the LT waitlist are well known. We wanted to understand these disparities further in women with end-stage liver disease patients listed for NASH cirrhosis in a contemporary cohort.

Type 1 Autoimmune Pancreatitis Unmasked by COVID-19 Vaccine.

Autoimmune pancreatitis is a rare fibro-inflammatory disease with 2 distinct subtypes of which each has their own clinical presentation, risk factors, and histopathological patterns. We present a case of newly diagnosed type 1 autoimmune pancreatitis in a symptomatic 54-year-old man with stable ulcerative colitis 1 month after COVID-19 vaccination. Previous reports have indicated that vaccinations can trigger autoimmune disease in predisposed individuals.

Gastro-caval fistula after distal esophageal resection: a case report and review of the literature.

Peptic ulceration with fistula formation into the inferior vena cava is rare, difficult to diagnose, and associated with high mortality. The nonspecific signs and symptoms make diagnosis challenging, delaying optimal treatment. Although there have been reports on duodeno-caval fistulas, gastric communication with the inferior vena cava is very rare.

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis.

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Multiple drugs and techniques have been studied for the prevention of PEP. Topical epinephrine has shown mixed results and is still not widely accepted as an alternative for prevention of PEP.

Drug and herbal/dietary supplements-induced liver injury: A tertiary care center experience.

Background: Drug-induced liver injury (DILI) and herbal/dietary supplements (HDS) related liver injury present unique diagnostic challenges. Collaboration between the clinician and the pathologist is required for an accurate diagnosis and management.

Aim: To report our experience on the clinical-pathological findings of hepatic injury caused by drugs/HDS.

Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis.

Background And Aims: Acute cholangitis is characterized by abdominal pain, fever, and jaundice. Most patients respond to medical management with intravenous hydration and antibiotics. About 20% to 30% require biliary drainage, and ERCP is the procedure of choice.

Safety and efficacy of a minimally invasive cell sampling device ('Cytosponge') in the diagnosis of esophageal pathology: a systematic review.

Esophageal adenocarcinoma is an increasingly common cause of morbidity and mortality in developed countries. Most cases are considered the consequence of chronic gastroesophageal reflux disease, with subsequent Barrett's metaplasia and dysplasia. Because progression from Barrett's metaplasia to cancer occurs over many years, endoscopic screening and surveillance programs have been established, albeit with little or no consideration for cost-effectiveness.

Non-alcoholic Fatty Liver Disease: A Review of Anti-diabetic Pharmacologic Therapies.

Non-alcoholic fatty liver disease (NAFLD), the most common cause of liver disease, affects approximately 75 to 100 million Americans. Patients with concurrent NAFLD and type 2 diabetes mellitus have a higher risk of progressing to advanced fibrosis and non-alcoholic steatohepatitis compared to non-diabetics. Lifestyle modifications, including weight loss, remain the mainstay of treatment for NAFLD, as there are no medications currently indicated for this disease state.

Early biliary drainage is associated with favourable outcomes in critically-ill patients with acute cholangitis.

Introduction: Acute cholangitis (AC) is a clinical condition that requires prompt medical management with IV fluids, antibiotics, and biliary drainage (BD). The optimal timing for BD remains unclear.

Aim: To investigate the effect of biliary drainage timing on clinical outcomes in AC.

Effects of infection on post-transplant outcomes: living versus deceased donor liver transplants.

Introduction: Post-transplant infections have been studied widely but data on comparisons of deceased donor liver transplants (DDLT) and living donor liver transplants (LDLT), type and timings of infections, and their relations to outcomes are not explored.

Material And Methods: We analysed data from 612 participants of the Adult-to-Adult Living Donor Liver Transplantation Study (A2ALL), a retrospective data set of LDLT and DDLT. We compared the type and timing of the first post-transplant infection in relation to transplant outcomes between the two groups.

Helicobacter pylori Infection: An Update for the Internist in the Age of Increasing Global Antibiotic Resistance.

Helicobacter pylori infects approximately half the world's population and is especially prevalent in the developing world. H. pylori is an important cause of global ill health due to its known etiological role in peptic ulcer disease, dyspepsia, gastric cancer, lymphoma, and more recently, recognized in iron deficiency anemia and idiopathic thrombocytopenic purpura.

Rising Rate of Liver Transplantation in the Baby Boomer Generation with Non-alcoholic Steatohepatitis in the United States.

Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next decade. We aimed to study the trends in NASH-related LT among persons born between 1945 and 1965, the baby boomer (BB) generation. We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004-2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with NASH.

Prognostic Significance of Elevated Cardiac Troponin in Acute Gastrointestinal Bleeding.

Background: Acute gastrointestinal bleeding (AGIB) is responsible for over 140,000 hospitalizations annually. Cardiovascular-related deaths account for 30% of the patients surviving the initial episode of AGIB. The purpose of this study was to identify the impact of elevated troponin on short-term mortality and length of stay (LOS) of these patients.

Hepatic encephalopathy: what the multidisciplinary team can do.

Hepatic encephalopathy (HE) is a complex disease requiring a multidisciplinary approach among specialists, primary care team, family, and caregivers. HE is currently a diagnosis of exclusion, requiring an extensive workup to exclude other possible etiologies, including mental status changes, metabolic, infectious, traumatic, and iatrogenic causes. The categorization of HE encompasses a continuum, varying from the clinically silent minimal HE (MHE), which is only detectable using psychometric tests, to overt HE, which is further divided into four grades of severity.

The importance of a multidisciplinary approach to hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners.

A Case of Ileus and ST Segment Elevation.

ST segment elevation is associated with non-cardiac pathologies but is not as well reported as myocardial infarction. We present a case of a 63-year-old man who was admitted for an overdose on cyclobenzaprine with signs of anti-cholinergic toxicity. He developed signs of ileus on imaging and became progressively obtunded.

Fluid Choice Matters in Critically-ill Patients with Acute Pancreatitis: Lactated Ringer's vs. Isotonic Saline.

Objectives: To investigate the effect of different crystal- loid solutions on clinical outcomes in critically-ill patients with acute pancreatitis (AP).

Methods: We conducted a retrospective study of patients with AP admitted to the ICU using the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. We investigated the effect of fluid type; lactated ringer's (LR) vs.

Typhidot - A blessing or a menace.

Objectives: Typhoid remain an increasing problem in Third world countries like Pakistan. A reliable, easy and affordable rapid diagnostic test is a need for our clinicians, many of whom consider Typhidot to be promising. Typhidot has been used as the only tool to diagnose typhoid fever by general practitioners and consultants despite its low sensitivity and specificity causing misdiagnosis and treatment.

Effects of papaya leaves on thrombocyte counts in dengue--a case report.

Dengue fever is on the rise in developing nations like India, Pakistan, Sri Lanka and Bangladesh. There is no antiviral chemotherapy or vaccine for dengue virus and management of the disease is done on supportive measures. The decline in the thrombocyte count leads to dengue haemorrhagic fever accounting for complications and mortality.

Medical students perception of their medical environment-expected versus actual perceptions--a cross sectional study.

Objective: To compare the expected (perceptions of their environment at the beginning of their 1st year) versus actual perceptions (perceptions at the end of 1st year) of 1st year students at Dow University of Health Sciences.

Methods: The 'expected' perceptions of the students were recorded at the beginning of their 1st year (n = 411) of medical education when they entered the medical school using Dundee Ready Educational Environment Measure (DREEM). DREEM is a validated and self-administered inventory which focuses on learning, teachers, self-confidence and academic as well as social environment.

Hepatitis patients lost to follow-up at a liver centre in a tertiary care hospital of Karachi, Pakistan--a cross-sectional descriptive study.

Objective: To investigate the causes for loss-to-follow-up of hepatitis patients at a liver centre of a tertiary care hospital.

Methods: A representative sample of 165 patients who were lost to follow-up during 2009 to 2010 was chosen and a cross-sectional descriptive study was performed. All hepatitis patients included were screened for antibody to hepatitis C virus (HCV Ab) and hepatitis B virus surface antigen (HbsAg), and were tested through polymerase chain reaction (PCR) and genotyping.