Liver Injury in Patients with COVID-19 without Underlying Liver Disease

SARS-CoV-2 shows a high affinity for the ACE-2 receptor, present on the epithelial cells of the upper and lower respiratory tract, within the intestine, kidneys, heart, testes, biliary epithelium, and—where it is particularly challenging—on vascular endothelial cells. Liver involvement is a rare manifestation of COVID-19. Material and Methods: We reviewed 450 patients admitted due to the fact of SARS-CoV-2 infection (COVID-19) including 88 with liver injury. Based on medical history and previous laboratory test results, we excluded cases of underlying liver disease. The analysis involved a clinical course of COVID-19 in patients without underlying liver disease as well as the type and course of liver injury. Results: Signs and symptoms of liver injury were present in 20% of patients, mostly presenting as a mixed-type pattern of injury with less common cases of standalone hepatocellular (parenchymal) or cholestatic injury. The liver injury symptoms resolved at the end of inpatient treatment in 20% of cases. Sixteen patients died with no cases where liver injury would be deemed a cause of death. Conclusions: (1) Liver injury secondary to COVID-19 was mild, and in in 20%, the signs and symptoms of liver injury resolved by the end of hospitalization. (2) It seems that liver injury in patients with COVID-19 was not associated with a higher risk of mortality. (3) The underlying mechanism of liver injury as well as its sequelae are not fully known. Therefore, caution and further monitoring are advised, especially in patients whose liver function tests have not returned to normal values.

A Rare Cause of Gastric Variceal Bleeding

A 68-year-old woman with stage III colon cancer status after right hemicolectomy and adjuvant FOLFOX (5-fluorouracil/leucovorin/oxaliplatin) chemotherapy was hospitalized for melena and found to have new-onset esophageal and gastric varices on esophagogastroduodenoscopy. Her workup did not reveal an underlying liver disease, but her liver biopsy showed noncirrhotic portal hypertension from obliterative portal venopathy (OPV). The development of OPV is likely from her use of oxaliplatin-based chemotherapy.

ASSOCIATION THROMBOCYTOPENIAAND ITS CO-RELATION IN CHRONIC LIVER DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL

INTRODUCTION: The prevalence of thrombocytopenia varies according to a number of factors, like patient population and severity of underlying liver disease. AIMS AND OBJECTIVES: To determine prevalence of thrombocytopenia in CLD patients and correlation of platelet count with child and pugh scores. MATERIALAND METHOD: General Medicine ward and OPD of N.R.S.M.C.H. , Kolkata, All patients admitted with CLD in Medicine ward and those attending OPD of N.R.S.M.C.H. , Kolkata, One year, 101 (one hundred and one) CONCLUSION: We found that mean Platelet count was low in Severe Thrombocytopenia which was statistically signicant.

Non-Alcoholic Fatty Liver Disease and COVID-19–Two Pandemics Hitting at the Same Time

The COVID-19 pandemic was and still is a global burden with more than 178,000,000 cases reported so far. Although it mainly affects respiratory organs, COVID-19 has many extrapulmonary manifestations, including, among other things, liver injury. Many hypotheses have been proposed to explain direct and indirect impacts of the SARS-CoV-2 virus on the liver. Studies have shown that around 15–30% of patients with COVID-19 have underlying liver disease, and 20–35% of patients with COVID-19 had altered liver enzymes at admission. One of the hypotheses is reactivation of an underlying liver disease, such as non-alcoholic fatty liver disease (NAFLD). Some studies have shown that NAFLD is associated with severe COVID-19 and poor outcome; nevertheless, other studies showed no significant difference between groups in comparing complications and clinical outcomes. Patients with NAFLD may suffer severe COVID-19 due to other comorbidities, especially cardiovascular diseases. The link between NAFLD and COVID-19 is not clear yet, and further studies and research are needed.

COVID-19 impact on liver: inter-organ cross-talk in an acute inflammation

Since coronavirus disease 2019 (COVID-19) has been a new disease, very less is known about the disease, and guidance for the treatment are often being made on the basis of an experiences or expert opinions. Now it is known that COVID-19 is caused by a new Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus which elicit infection to the cells by binding of the spike protein to angiotensin converting enzyme 2 (ACE2). Given the high transmissibility rate of the SARS-Cov-2 virus and known to have cytokine dysregulation by inducing an immune-mediated systemic inflammation, patients with underlying liver disease might be at an increased risk of severe infection and death. Here we report different mechanisms based on the organ cross-talk and other causes that how COVID-19 patients are prone to have liver injury.

Bacteraemia, antimicrobial susceptibility and treatment among Campylobacter-associated hospitalisations in the Australian Capital Territory: a review

Background Campylobacter spp. cause mostly self-limiting enterocolitis, although a significant proportion of cases require hospitalisation highlighting potential for severe disease. Among people admitted, blood culture specimens are frequently collected and antibiotic treatment is initiated. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. Methods Using linked hospital microbiology and administrative data we identified and reviewed Campylobacter-associated hospitalisations between 2004 and 2013. We calculated population-level incidence for Campylobacter bacteraemia and used logistic regression to examine factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. Results Among 685 Campylobacter-associated hospitalisations, we identified 25 admissions for bacteraemia, an estimated incidence of 0.71 cases per 100,000 population per year. Around half of hospitalisations (333/685) had blood culturing performed. Factors associated with bacteraemia included underlying liver disease (aOR 48.89, 95% CI 7.03–340.22, p < 0.001), Haematology unit admission (aOR 14.67, 95% CI 2.99–72.07, p = 0.001) and age 70–79 years (aOR 4.93, 95% CI 1.57–15.49). Approximately one-third (219/685) of admissions received antibiotics with treatment rates increasing significantly over time (p < 0.05). Factors associated with antibiotic treatment included Gastroenterology unit admission (aOR 3.75, 95% CI 1.95–7.20, p < 0.001), having blood cultures taken (aOR 2.76, 95% CI 1.79–4.26, p < 0.001) and age 40–49 years (aOR 2.34, 95% CI 1.14–4.79, p = 0.02). Non-susceptibility of isolates to standard antimicrobials increased significantly over time (p = 0.01) and was associated with overseas travel (aOR 11.80 95% CI 3.18–43.83, p < 0.001) and negatively associated with tachycardia (aOR 0.48, 95%CI 0.26–0.88, p = 0.02), suggesting a healthy traveller effect. Conclusions Campylobacter infections result in considerable hospital burden. Among those admitted to hospital, an interplay of factors involving clinical presentation, presence of underlying comorbidities, complications and increasing age influence how a case is investigated and managed.

I drank too much and now I can’t walk: a case of alcohol-induced dysautonomia

ABSTRACT Dysautonomia is a dysfunction of the autonomic nervous system, which mediates both sympathetic and parasympathetic functions of the human body. Alcohol has been established to affect the autonomic function through liver injury and accumulation of vasodilators. Alcohol can induce peripheral neurological diseases as well. This case report describes a patient who had a chronic history of alcoholism and uncontrolled diabetes mellitus presenting for orthostatic hypotension and peripheral neuropathy without underlying liver disease or other endocrinopathies. Although diabetes mellitus was controlled pharmacologically and risk factors for orthostatic hypotension were managed conservatively, his symptoms did not improve which indicated an alcohol-related autonomic dysfunction, shedding light on one of long-term complications of alcoholism.

Radioembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the fastest-growing cancer worldwide, causing significant morbidity and mortality. Surgical resection, ablation, or transplantation is the best treatment option for patients with HCC. However, only about one-fifth of patients are suitable for such primary curative treatments due to underlying liver disease or rapid extension of the tumor. Image-guided locoregional therapies may prove an important alternative in this scenario, particularly transarterial radioembolization (TARE) with yttrium-90 (Y-90). Based on many studies, TARE can be considered a curative treatment option for patients with early-stage HCC, a bridge to transplantation, and a method for downstaging tumors to give patients with unresectable HCC a chance to potentially receive a curative treatment. TARE can be also combined with other treatment modalities to provide a better quality of life in patients when compared with systemic therapy in patients with unresectable HCC. Here, we discuss the use of TARE in the approach to HCC patients who are in early, intermediate, or advanced stages.

Anatomical characteristics of the accessory hepatic lobe and its clinical-functional particularities

Riedel's lobe (ectopic lobe), also known as the accessory hepatic lobe, consists of an anatomical variation characterized by a tongue-shaped protrusion on the visceral surface of the liver right lobe, fixed by a pedicle. This variant draws attention in the clinical practice, as it can be mistaken for a tumor due to its elongated aspect. The aim of this research was to conduct a study on the anatomical characteristics and clinical and functional peculiarities of the accessory hepatic lobe. The paper is based on a integrative review and observational study on a cadaveric specimen. A cadaver with anatomical variation was used. Data were collected in PubMed, Scielo, and VHL. 257 articles were found in the databases, but only 13 were used for research. In careful review, two rare cases of the accessory lobe in the left lobe of the liver, hypoplastic left lobes, and agenesis of the right hepatic lobe, and often the clinical picture without changes in signs and symptoms were found. These morphological abnormalities' clinical impact is limited in the absence of underlying liver disease, cirrhosis, or known cancer. In case of complications or after the diagnosis of pedunculated tumors in the liver, laparoscopy is well indicated for removing these lobes or tumors.

Features Of Anemia In Patients With Chronic Liver Diseases

The features of the epidemiology, clinical picture, diagnosis and treatment of chronic diffuse liver diseases in combination with anemia are considered according to the literature on this problem. It has been shown that anemia aggravates the course, causes progression and worsens the prognosis of chronic diffuse liver diseases. The incidence of anemia in chronic diffuse liver diseases reaches 80%. Disclosure of the mechanisms of anemia in chronic diffuse liver diseases is necessary for timely correction and prevention of the progression of both pathological changes in red blood and underlying liver disease.