Hepatocellular Carcinoma in Cirrhotic Versus Non-Cirrhotic Patients: A Retrospective Study of 483 Patients

Background and Aim: Although cirrhosis is a classical risk factor for the development of hepatocellular carcinoma (HCC), its absence does not exclude this risk. We aimed to assess the clinical characteristics and outcomes of cirrhotic HCC (C-HCC) and non-cirrhotic HCC (NC-HCC) patients. Methods: Patients consecutively included in a prospective HCC cohort (University Hospital Bern) were analysed. They were categorised into two groups, based on the basis of histology or combined radiological and laboratory characteristics. Results: 20.4% of patients were NC-HCC. This group was characterized by a higher median age and a higher female prevalence compared to the C-HCC group. Non-alcoholic fatty liver disease (NAFLD) (25.7%) and HBV infection (14.9%) were the main risk factors in this group, whereas alcohol abuse (26%) and HCV (21.6%) in C-HCC, P<0.001. 19.4% of them were diagnosed during a screening programme. Resection was performed in 54.5% of NC HCC patients despite the advanced stage (BCLC stage B and C). No statistically significant difference in survival rate was observed between C and NC-HCC patients (24 months vs. 33.9 months, P=0.162). In multivariate analysis, in the NC-HCC group each unit increase in BMI was associated with mortality while liver transplantation and resection were positively associated with survival. In the C-HCC group, the BCLC stage C was negatively associated with survival while all the therapeutic lines were negative factors for mortality. Conclusion: NC-HCC patients were diagnosed more often outside a screening programme. The patients were older, with a higher female prevalence and despite an advanced stage, were often amenable to surgery.

Study of effect of diabetes mellitus on classical risk factors for coronary artery disease

Background: Diabetes mellitus (DM) is increasingly prevalent in general population and is associated with increased risk for coronary artery disease (CAD). DM both directly and indirectly increases risk of CAD. Quantum of DM associated increase in classical risk factor for CAD is not exactly described. In present study, association of traditional risk for CAD and DM was analyzed.Methods: Total 150 patients with CAD were enrolled and divided into two group: group 1 with DM (84 patients) and group 2 without DM (66 patients). These two were compared and analyzed for classical risk factors for DM.Results: CAD with DM group had higher prevalence for traditional risk for CAD than CAD alone group: for Hypertension relative prevalence was 67.8 and 36.3% respectively (p<0.05); for Obesity it was 79.7 and 40.9% respectively (p<0.05) and for Dyslipidemia relative prevalence was 75 and 37.8% respectively (p<0.05).Conclusions: DM is major risk for CAD and it is also associated with increased prevalence for hypertension, obesity and dyslipidemia in affected population.

A case of alcohol-related emphysematous cystitis

Emphysematous cystitis (EC) is a very rare urinary tract infectious disease that can be fatal if not treated. In general, it frequently occurs in diabetic women and is thought to be associated with gas-producing bacteria. Type 2 diabetes mellitus, immunosuppression, drugs (mostly steroids), neurogenic bladder and instrumentation are the major risk factors of this type of infection. We present a case of emphysematous cystitis in a 53-year-old male, in which the patient does not have any classical risk factors associated with EC other than alcohol consumption. To the best of our knowledge, the only case in the literature where this type of infection develops without a classical risk factor and negative urine culture. It is also one of the rare EC cases that may be associated with alcohol use.

Spontaneous coronary artery wall haematoma: success of conservative management despite alarming extension: a case report

Background Spontaneous coronary artery dissection (SCAD) is a particular mode of presentation of acute coronary syndrome. It preferentially affects the young woman with little or no classical risk factor for atheromatous disease. Case summary In this report, we present a classical non-ST-segment myocardial infarction (NSTEMI) condition in link with a spontaneous coronary artery wall haematoma. A 43-year-old female patient who did not have any risk factors for atheromatous disease presented with NSTEMI. The coronary angiogram (CA) revealed a moderate smooth stenosis of the proximal left anterior descending artery (LAD) that ended just before the take-off of a septal branch. Intracoronary imaging by optical coherence tomography (OCT) visualized a large intramural haematoma reducing the coronary artery lumen. The patient was managed conservatively with antithrombotic regimen, nitrates, and close monitoring with repeated CA. Evolution was favourable despite striking extension of coronary haematoma towards distal LAD. She was then discharged and has been asymptomatic on follow-up visits. Planned repeat CA and OCT at 3 months showed a quite normal coronary artery appearance of the LAD with significant regression of haematoma. Discussion Precise data regarding SCAD epidemiology remains to be determined. The angiographic pattern of our case recalls the Type 2 described by Saw team. But OCT was necessary to confirm the diagnosis. We manage our patient conservatively with close monitoring, as largely suggested by current state of the art, regarding the good haemodynamic status, and absence of ongoing ischaemia despite an evolution severe stenosis.

Abstract 229: Mucosal Immunity Shapes the Lipoprotein Small-RNA Fingerprint from Commensal, Dietary and Environmental Microbiota

Cardiovascular disease (CVD) is a leading cause of mortality in developed countries and is a frequent comorbidity of numerous metabolic and inflammatory diseases that demands more effective therapies. Dyslipidemias are a classical risk factor for CVD, but emerging alternative functions of lipoproteins have implicated them in novel narratives for the pathophysiology of many diseases that warrant further study. Our lab has identified functional, intercellular gene regulatory networks mediated by extracellular transport of microRNAs (miRNA) by lipoproteins. Here, we quantified the landscape of small RNAs (sRNA) on human and animal lipoproteins and discovered that most lipoprotein-sRNAs are derived from microorganisms of multiple kingdoms, primarily bacteria. Based on these observations, our over-arching hypothesis is that lipoprotein-sRNA signatures are shaped by the interface of host tissues with resident, environmental and dietary microbiota, and likely participate in unique gene regulation networks that contribute to complex (patho)physiological traits. To investigate this hypothesis, we developed a sRNA-sequencing analysis pipeline that identifies and quantifies both host and non-host sRNAs. Using this bioinformatic tool, we identified and validated a number of lipoprotein-sRNAs derived from bacteria that are similar in size to miRNAs with identical seed regions, termed Doppelganger (Dopl)-miRNAs. We hypothesized that mucosal immunity contributes to non-host sRNAs on lipoproteins, as mucosal linings are a primary interface between host tissues and microorganisms. To this end, we investigated the lipoprotein-sRNAs of mice lacking the polymeric immunoglobulin receptor (pIgR -/- ), which is devoid of polymeric IgA and IgM at mucosal linings and models human respiratory and intestinal diseases. We report a global increase in lipoprotein-miRNAs juxtaposed with a profound decrease in bacterial sRNA and Dopl-miRNAs from specific taxa. This work unfurls novel links between microbiota, mucosal immunity, and lipoprotein-sRNA gene networks and emphasizes the potential for novel nucleic-acid based therapeutics.

Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery

Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding.Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets.Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.