1) A study of 174 patients with severe alcoholic hepatitis found that those who received steroids plus N-acetylcysteine had improved one-month survival and a decreased risk of hepatic renal syndrome, though no overall improvement in six-month survival.
2) A randomized trial of 26 patients with severe alcoholic hepatitis who did not respond to medical therapy found that early liver transplantation improved six-month survival to 77% compared to 23% for matched non-transplanted controls.
3) Two studies found that rifaximin significantly improved cognitive function and quality of life in patients with minimal hepatic encephalopathy, with one study also finding an improvement in driving simulator performance with rifaximin treatment.
journal club is one of the important academic activity during MD/MS courses. Present PPT is a journal club presented on an article that compare two antihypertensives and the presentation also includes critical analysis of the article.
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
journal club is one of the important academic activity during MD/MS courses. Present PPT is a journal club presented on an article that compare two antihypertensives and the presentation also includes critical analysis of the article.
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the ...Mahdy Ali Ahmad Osman
A journal club on the Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the Management of
Hypertension A Paper Based Questionnaire Survey, research.
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Pesit trial New England Journal of MedicineDr fakhir Raza
first episode of syncope, should we do workup for Pulmonary embolism well simplified criteria D dimer level CT angiogram ventilation perfusion scanning
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the ...Mahdy Ali Ahmad Osman
A journal club on the Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the Management of
Hypertension A Paper Based Questionnaire Survey, research.
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Pesit trial New England Journal of MedicineDr fakhir Raza
first episode of syncope, should we do workup for Pulmonary embolism well simplified criteria D dimer level CT angiogram ventilation perfusion scanning
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
explaining the presently available criteria to define futility in liver transplantation and prposing future trends in the definition of futility in liver transplantation
3. • Individuals with PSC and UC are at higher risk for
colorectal neoplasia
• Retrospective studies have shown mixed results
• High-dose UDCA (28-30) increased SAE in PSC
4. High-dose UDCA and colon
cancer
• Methods:
• Patients with UC/PSC previously enrolled in a
high dose UDCS trial were analyzed
• 56 patients; 25 UDCA; 31 placebo
• Mean time – 4.4 y
• Results of surveillance colonoscopy and
pathology analyzed
5. High-dose UDCA and colon
cancer
• Results
• 9 of 25 (36%) of UDCA patients
developed neoplasia (1 ca, 1 high-grade,
7 low-grade)
• 3 of 31 (9.7%) of placebo patients
developed neoplasia (1 ca, 1 high grade,
1 low grade)
• Hazard risk 4.4; p=0.02
6.
7. High-dose UDCA and colon
cancer
• Conclusion
• Long term use of high-dose UDCA in
patients with PSC/UC is associated with
increased risk of colorectal neoplasia
8. • Although ¼ of patients with cirrhosis develop
PVT, best treatment option is not clear;
• Anticoagulation advocated for recent clots;
• Small studies suggested efficacy of TIPS
9. TIPS for Portal vein thrombosis
• Retrospective study of cirrhotic patients with
non-tumoral PVTs receiving TIPS;
• No anticoagulation was used.
• 70 patients (67% males, mean age 55)
• Mean Child’s score: 7.9; MELD 11.6;
• Hepatitis C – 53%;
• Decompensated portal hypertension was the
indication in 94%
10. TIPS for Portal vein thrombosis
• At mean f/u of 24 mo:
• 57% had complete recanalization;
• 30% had decreased thrombosis;
• 13% had no improvement.
• Of the patients with complete recanalization
97% maintained it for mean of 20.7 mo;
• Survival:
• 99% 1 mo
• 89% 12 mo
• 81% 24 mo
11.
12. TIPS for Portal vein thrombosis
• Conclusion:
• For non-tumoral PVT TIPS was safe
and effective in > 50% for at least 2
years;
• Concerns:
• No control group
• Relatively small group
13. • Steroids are treatment of choice for severe ETOH
hepatitis; however:
• 6 mo mortality approaches 65%
14. Steroids plus NAC in severe ETOH hepatitis
• Objectives and method
• 6 months survival of 174 patients with severe
ETOH hepatitis (Maddrey >32), randomized
to receive steroids with or without NAC
• All patients received 40 mg prednisone 28 d;
• NAC group received IV infusion for initial 5 d
15.
16. Steroids plus NAC in severe ETOH hepatitis
• Conclusion:
• Improved one month survival and
development of HRS however;
• No improvement in primary outcome –
overall survival at 6 months
17.
18. Early liver transplantation for
severe alcoholic hepatitis
• Studied the result of early OLT (<6 mo sobriety)
on 6 months survival of patients with severe
alcoholic hepatitis
• Admission criteria were
• Maddrey >32;
• No prior episodes of alcoholic hepatitis;
• Non-response to medical therapy (Lille >0.45);
• Adequate family support
• No psychiatric co-morbidities and strong
commitment
19. Early liver transplantation for
severe alcoholic hepatitis
• 26 patients
• Mean Lille score 0.88
• Mean non-response time 13 days
• Fewer than 2% of admitted patients were
selected
• 2.9% of grafts were used
20.
21.
22. Results
• 26 patients. 6 mo survival was higher than
matched, non-randomized 26 controls (77 vs
23%, p<0.001)
• 3 patients resumed drinking: at 720, 740 and
1140 days after transplant
Conclusion:
• Early liver transplantation can improve survival
in patients with a first episode of severe
alcoholic hepatitis not responding to medical
therapy
24. • 299 patients with recurrent HE
• (140 drug /159 placebo)
• At least 2 previous episodes; in remission
• Rifaximin 550 bid 6 mo
• End point
• Primary: time to 1st breakthrough HE
• Secondary: time to 1st admission due to HE
25. Minimal Hepatic Encephalopathy
• Not obvious cognitive deficits
• Impaired quality of life
• Difficult diagnosis, based on
neuropsychometric and neuropsychological
• Patients with MHE have little or no insight
into their condition, especially their ability to
drive
26. • Legal ramifications not yet evaluated
• Reviewed all 50 states BMVs regulations and
requirements for physicians to report potentially
impaired drivers
• Reviewed legal databases in search for lawsuits
against physicians or patients related to HE
27. Driving and MHE
• Few (6) states have regulations mandating
physicians to report; 25 grant immunity for
reporting
• Minimal HE would not fit criteria for medical
impairment for overt signs and symptoms are
not present
• No lawsuits were identified against
physicians / patients related to HE
• However…
30. • 94 patients received either rifaximin 400 mg or
placebo tid for 8 weeks
• More patients receiving rifaximin achieved
reversal of MHE (75.5% vs. 20% p<0.0001)
31. • Similar, 42 patients currently driving, received
either rifaximin 550 mg or placebo bid, 8 weeks.
• Percent reduction in total driving errors higher in
treatment group (76% vs. 31%, p=0.013)
32. Rifaximin and MHE
• Conclusions:
• Rifaximin significantly improves both
cognitive functions and HRQOL in patients
with MHE.
• Patients with MHE significantly improve
driving simulator performance after
treatment with rifaximin, compared with
placebo
34. • TZDs and antioxidants can lead to improvements in NASH
• Phase III, multicenter, double blind trial
• 247 nondiabetic NASH
• Pioglitazone (30 mg daily)
• Vitamin E (800 IU daily) or
• Placebo
• 96 weeks
35. NAFLD – spectrum from benign steatosis to
necroinflamatory changes and fibrosis;
Prevalence up to 39%
Progressive disease in approximately 15%
No definitive pharmacological treatment available
36. Atorvastatin plus vit E and
C for Nash
• 1,005 patients, both sexes, randomized to
• Atorvastatin 20, vitamin C 1 g and vitamin E
1,000 IU vs.
• Placebo, matching
• CT scan Liver to spleen (LS) ratios were
calculated on 455 patients at baseline and
follow-up
• Mean duration of follow-up was 3.6 years
37. Results
• 80 patients had NAFLD at baseline
• Baseline triglyceride (OR) = 1.003, P < 0.001)
and BMI (OR = 0.10, P < 0.001) were
independent predictors of NAFLD.
• Treatment with atorvastatin combined with
vitamins E and C significantly reduced the odds
of NAFLD at the end of follow-up, 70 vs. 34 %
(OR = 0.29, P < 0.001).
• 3 patients had increase in aminotransferases;
after 2 years, levels improved in 2 of 3.
38.
39. Conclusions
• Atorvastatin plus vitamins C and E lowered the
risk of moderate-to-severe hepatic steatosis by
70 % in a healthy population of 80 patients with
NAFLD at baseline after 4 years of therapy.
• Study limitations:
• Difficult to determine which of the cocktail
medications is/are active
• Measurement of steatosis is not gold standard
• Not evaluated in patients with significantly
abnormal liver enzymes
41. Conclusions
• Response-guided telaprevir combination
treatment for HCV infection – NEJM Sept 2011
• Telaprevir alone or with Peg-Riba reduces HCV
RNA in patients with geno 2 but not 3 – Gastro
Jun 2011
• Telaprevir for previously treated and untreated
HCV infection. NEJM Mar 2011
• Telaprevir for previously treated and untreated
HCV infection. NEJM Jun 2011