Liver transplantation is the best solution for patients suffering from end stage liver disease. The magnitude of liver disease in Egypt in remarkable due to HCV infection. The pool of donors does not cover the increasing need for this modality. Deceased program although it has been approved legally since 2010 but still not activated and the detailed regulations are not yet established due to resistance of some groups as religious and human rights. In this review, we show the progress of liver transplantation in Egypt since its start in 1991 and aiming to start the deceased program soon.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Cystinosis is a rare autosomal recessive lysosomal disorder with an estimated incidence of 1 per 100 000 to 200 000 live births
The gene responsible for the disease, CTNS, was identified in 1998
Kidney involvement is the most serious clinical event, because it leads to end stage renal disease (ESRD) before the age of 20 in more than 90 % of patients
Liver Fibrosis: Difficulties in Diagnostic and Treatment: A Review-Crimson Pu...CrimsonGastroenterology
Early discovery of liver fibrosis and cirrhosis is becoming more relevant because of enhanced incidence of hepatocellular carcinoma. There a many underlying factors in developing liver fibrosis (i.e. viral hepatitis, steatohepatitis). Diagnosis of liver fibrosis is difficult; chronic liver failure and less distinct fibrosis stages can be underestimated, when laboratory routine parameters and native ultrasound of the liver are unsuspicious. Liver biopsy is a common element of diagnostic workup in hepatic cirrhosis, alongside clinical examination and abdominal ultrasound, and is the accepted diagnostic gold standard. But there is no unitary system of histological classification used to evaluate the degree of fibrosis, and individual systems are often validated only for individual disease entities. On the other hand liver biopsy is of less tolerance for patients. In the last years serological markers for detecting liver fibrosis were developed with different validity. Various imaging modalities have been proposed as methods for assessing liver fibrosis
by liver stiffness measurement. They are sufficient to approve the suspicious of liver fibrosis and/or to uncover unknown chronic liver failure. Studies showed the clinical usefulness of acoustic radiation force impulse shear wave elasticity imaging (ARFI-SWEI) is efficient as a preventive screening method to uncover fibrosis. The ARFI-SWEI system is integrated in an ultrasound device has a good accuracy and high reproducibility. Therapy of liver fibrosis depends on underlying disease and degree of liver failure. When liver failure can be cured liver fibrosis can regress. Direct antifibrotic drugs are
actually not available but in progress.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Case study authors: Tofa Abdullahi, Godwin Atser, Isabelle Baltenweck, Jens-Peter Barnekow Lillesø, Zewdie Bishaw, Elohor Diebiru-Ojo, Carlo Fadda, Alessandra Galie, Sita Ghimire, Lars Graudal, Aynalem Haile, Jon Hellin, Ramni Jamnadas, Alpha Kamara, Karen Marshall, Margaret McEwan, Adamu Molla, Baloua Nebie, Kwame Ogero, Chris Ojiewo, Lucky Omoigui, Michael Peters, Srinivasulu Rajendran, Cristiano Rossignoli, Lateef Sanni, Kelvin Mashisia Shikuku, Reuben Solomon, Abiro Tigabie, and Aboubacar Toure
Facilitated by: Walter de Boef, Tom van Mourik, Boudy van Schagen, and Marja Thijssen
Detecting Early Liver Fibrosis - A Nutshell for Primary CareJarrod Lee
This presentation summarizes the latest technologies for detecting early liver fibrosis and their role in healthcare today. It is aimed at primary care doctors, to help them better utilize these new developments for their patients.
Role of Radiotherapy in HCC. What do the guidelines say ? A comprehensive review of guidelines and other studies on role of radiotherapy in hepatocellular carcinoma.
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tu...Premier Publishers
PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95% for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p= 0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for survival and LC.
Cystinosis is a rare autosomal recessive lysosomal disorder with an estimated incidence of 1 per 100 000 to 200 000 live births
The gene responsible for the disease, CTNS, was identified in 1998
Kidney involvement is the most serious clinical event, because it leads to end stage renal disease (ESRD) before the age of 20 in more than 90 % of patients
Liver Fibrosis: Difficulties in Diagnostic and Treatment: A Review-Crimson Pu...CrimsonGastroenterology
Early discovery of liver fibrosis and cirrhosis is becoming more relevant because of enhanced incidence of hepatocellular carcinoma. There a many underlying factors in developing liver fibrosis (i.e. viral hepatitis, steatohepatitis). Diagnosis of liver fibrosis is difficult; chronic liver failure and less distinct fibrosis stages can be underestimated, when laboratory routine parameters and native ultrasound of the liver are unsuspicious. Liver biopsy is a common element of diagnostic workup in hepatic cirrhosis, alongside clinical examination and abdominal ultrasound, and is the accepted diagnostic gold standard. But there is no unitary system of histological classification used to evaluate the degree of fibrosis, and individual systems are often validated only for individual disease entities. On the other hand liver biopsy is of less tolerance for patients. In the last years serological markers for detecting liver fibrosis were developed with different validity. Various imaging modalities have been proposed as methods for assessing liver fibrosis
by liver stiffness measurement. They are sufficient to approve the suspicious of liver fibrosis and/or to uncover unknown chronic liver failure. Studies showed the clinical usefulness of acoustic radiation force impulse shear wave elasticity imaging (ARFI-SWEI) is efficient as a preventive screening method to uncover fibrosis. The ARFI-SWEI system is integrated in an ultrasound device has a good accuracy and high reproducibility. Therapy of liver fibrosis depends on underlying disease and degree of liver failure. When liver failure can be cured liver fibrosis can regress. Direct antifibrotic drugs are
actually not available but in progress.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Case study authors: Tofa Abdullahi, Godwin Atser, Isabelle Baltenweck, Jens-Peter Barnekow Lillesø, Zewdie Bishaw, Elohor Diebiru-Ojo, Carlo Fadda, Alessandra Galie, Sita Ghimire, Lars Graudal, Aynalem Haile, Jon Hellin, Ramni Jamnadas, Alpha Kamara, Karen Marshall, Margaret McEwan, Adamu Molla, Baloua Nebie, Kwame Ogero, Chris Ojiewo, Lucky Omoigui, Michael Peters, Srinivasulu Rajendran, Cristiano Rossignoli, Lateef Sanni, Kelvin Mashisia Shikuku, Reuben Solomon, Abiro Tigabie, and Aboubacar Toure
Facilitated by: Walter de Boef, Tom van Mourik, Boudy van Schagen, and Marja Thijssen
Detecting Early Liver Fibrosis - A Nutshell for Primary CareJarrod Lee
This presentation summarizes the latest technologies for detecting early liver fibrosis and their role in healthcare today. It is aimed at primary care doctors, to help them better utilize these new developments for their patients.
Role of Radiotherapy in HCC. What do the guidelines say ? A comprehensive review of guidelines and other studies on role of radiotherapy in hepatocellular carcinoma.
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tu...Premier Publishers
PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95% for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p= 0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for survival and LC.
Immunosuppressed allograft recipients have three to five folds increase in cancer risk as compared to age matched general population. The most common malignancies encountered are Non Melanotic Skin Cancer, Post Transplant Lymphoproliferative Disorder and Kaposi's Sarcoma. Duration of immunosuppressive therapy and/or type of immunosuppressive agents are important controllable factors which have an impact in the development of tumors. Oncogenic viruses have an important role in the development of these malignancies.
Immunosuppressed allograft recipients have three to five folds increase in cancer risk as compared to age matched general population. The most common malignancies encountered are Non Melanotic Skin Cancer, Post Transplant Lymphoproliferative Disorder and Kaposi's Sarcoma. Duration of immunosuppressive therapy and/or type of immunosuppressive agents are important controllable factors which have an impact in the development of tumors. Oncogenic viruses have an important role in the development of these malignancies.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
A Retrospective Analysis of Complications of Pelvic Exenteration - A Single I...Premier Publishers
To analyse complications in patients who underwent pelvic exenteration procedures performed in our, between January 2013 – December 2018. A retrospective analysis of the baseline characteristics, surgical outcomes, complication rates of 51 patients who had undergone pelvic exenteration procedures between January 2013 and December 2018 was made. The results analysed using chi-square test. Of the 51 patients, 38 were operated for primary malignancy and 13 underwent exenteration for recurrences. Seventeen patients were operated by laparoscopy whereas the rest underwent open procedures. The diagnosis for which exenteration had been done included cancers of cervix (37), urinary bladder (5), rectum (4), urethra (1), vagina (3), and ovary (1). Bleeding was the most common complication encountered. Hypokalaemia, surgical site infections, urine leak and sepsis were seen in early post-operative period. The morbidity rate (major) was 33.3% and the mortality rate was 5.8% in our centre. The late outcome was inadequately evaluated as most patients lost follow-up. Pelvic exenteration is the only surgical option available for advanced pelvic malignancies and the morbidity pattern differs based on diagnosis, extent of resection and the type of diversion procedure. In a high-volume centre, the morbidity and mortality rates are acceptable compared with international standards.
Correlation of Base-Line Trough Tacrolimus Level With Early RejectionCrimsonpublisherssmoaj
The study was done at Muljibhai Patel Urological Hospital, Nadiad, Gujarat. It is a tertiary health care centre, for nephrology, with a well established hemodialysis unit. We have done about 1950 renal transplantation so far. Acute rejection is the most significant risk factor for chronic rejection and potential surrogate for long-term graft failure. Aim of our study was to analyze the association between the baseline through (C0) tacrolimus level in the first day post transplant, with early rejection in living donor transplants [1-10].
Similar to Liver Transplantation in Egypt-Crimson Publishers (20)
Alcoholic Chronic Pancreatitis or Intraductal Papillary Mucinous Neoplasm: Wh...CrimsonGastroenterology
Intraductal Papillary Mucinous Neoplasm (IPMN) is an intraductal mucin-producing neoplasm, with
an increasing incidence. IPMNs may have clear malignant potential and exhibit a broad histological
spectrum ranging from adenoma to invasive carcinoma. In contrast to the ductal adenocarcinoma, IPMNs
have in general a better clinical prognosis. The clinical presentation of IPMN and Chronic Pancreatitis
(CP) are often indistinguishable. Misdiagnosis of IPMN in patients with CP can lead to serious delays in
the appropriate management. In patients with history of alcoholic CP, the possible presence of IPMN
could not to be excluded. Due the high frequency of malignancy in IPMN, surgical approach should be
considered. Assessment for potential IPMN is mandatory in patients with CP. All patients with CP must
have a clinical assessment at least every 6 months, with abdominal US at least every year. In symptomatic
patients with IPMN and severe abdominal pain, early pancreaticoduodenectomy must be strongly
considered.
Anti-CTLA-4 Induced Inflammatory Bowel Disease: Is There A More Etiological T...CrimsonGastroenterology
Anti-CTLA-4 Induced Inflammatory Bowel Disease: Is There A More Etiological Treatment? Lessons From CTLA-4 Haploinsufficiency by Georgios Germanidisin Gastroenterology Medicine & Research: Structure
We read with great interest the article by Bamias G et al. [1] entitled “Immunological Characteristics of Colitis Associated with Anti-CTLA-4 Antibody Therapy’’ [1], and we would like to address some issues regarding possible future use of a more etiological treatment for this colitis, namely abatacept. The immunological characteristics of anti-CTLA-4 and anti-PD-1-related colitis have been up to now poorly described [1,2].
Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an inhibitory T cell receptor, similar to CD28 in structure, expressed by activated and regulatory T cells (Tregs). CTLA-4 is constitutively expressed on CD4+CD25+ Tregs, and such expression is important for Tregmediated suppression of T cell proliferation. Abatacept is a soluble fusion protein which links the CTLA-4 extracellular domain to the Fc region of the IgG molecule. CTLA-4 immunoglobulin (Ig) fusion protein and neutralizing CTLA-4 antibody are used to modulate immunity in autoimmune and cancer patients, respectively.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Cyclical Vomiting Syndrome in Children by Maheeba Abdulla in Gastroenterology Medicine & Research: Endoscopic Testing
Cyclic vomiting is considered a variant of migraine, first described by Gee in 1881[1]. Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent, discrete, self-limited episodes of vomiting and is defined by symptom-based criteria and the absence of positive laboratory, radiographic, and endoscopic testing [2]. The attacks of vomiting are interspersed with normal periods. The duration of vomiting episodes is from hours to days, with spontaneous resolution if left untreated. The episodic occurrence of emesis may be precipitated by stress and fatigue. The attacks begin in childhood and often wane in frequency with progression into young and middle adult life [3].The differential diagnoses include idiopathic CVS, gastrointestinal disorders, and extraintestinal disorders, including brain stem neoplasm, abdominal epilepsy, and metabolic disorders.
Crimson Publishers-Alcohol Abstinence and Relapse in ALD Patients, Predicting...CrimsonGastroenterology
Alcohol Abstinence and Relapse in ALD Patients, Predicting the Unpredictable by Neeraj Nagaich in Gastroenterology Medicine & Research: Liver Disease
Objectives: Alcoholism is a chronic relapsing disorder. Alcoholism is common, and continues to be the source of great cost to afflicted individuals, their families and the community at large. Alcohol dependence is characterized by a prolonged course of alcohol-related problems and a persistent vulnerability to relapse. Even though there is an improvement in multiple domains of life after alcohol treatment, the risk of relapse remains high following treatment. This prospective and retrospective study of 451 patients with alcohol use disorders was done with an intent to assess various factors affecting remission and relapse and improve outcome for individuals with alcohol dependence. Demographic variables, clinical parameters and certain psychosocial factors were evaluated. Early identification of risk factors may help us in defining a more rigorous follow up protocol in these sub group of patients.
Method: Patients with ethanol related liver disease and alcohol dependence were enrolled after their presentation in gastroenterology clinic and followed thereafter at 1, 3, 6, and 12 months. Initial assessments included USG abdomen LFT RFT, UGI Endoscopy and other relevant investigations. Semi structured clinical interviews, the Symptom Checklist 90-Revised (SCL90-R), Addiction Severity Index (ASI), the Beck Depression Inventory (BDI) were recorded. High-Risk Alcoholism Relapse Scale based score was calculated.2Patients were reassessed at six and twelve months to determine treatment outcome (abstinence status and duration of continuous abstinence). Data were coded, validated and analyzed using descriptive statistics.
Results: A majority of the sample 70 percent (n=315) had significant psychiatric symptoms at intake: 22 percent (N=70) presented with depressive symptoms, 17 percent (N=15) with anxiety symptoms, and 41 percent (N=192) with combined depressive and anxiety symptoms. Forty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients had worse prognosis than less symptomatic cohort at intake, including those who presented with depression symptoms alone; in the latter group, 60 percent were abstinent at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake.
Crimson Publishers: Radiation Proctitis-Experience at a Tertiary Care Centre ...CrimsonGastroenterology
Radiation Proctitis-Experience at a Tertiary Care Centre of North India by Parveen Malhotra in Gastroenterology Medicine & Research: Radiotherapy
Introduction: Proctitis is a troublesome complication in patients receiving radiotherapy in pelvic malignancies. This is a prospective study done to evaluate the efficacy of 4% formalin in treatment of radiation proctitis and complications associated with it.
Method: Patients with rectal bleeding post radiotherapy for gynaecological malignancy were analysed in our institution from June 2010-May 2011. 50ml of 4% formalin was sprayed through colonoscopy with mucosal contact time of 10 min and observed for 4hrs for any complication.
Results: A total of 22 patients with mean age 57 (range 40-65) years, moderately built with radiation proctitis were subjected to 4% formalin and followed up for 12 (range 1-36) months. Mean interval between radiotherapy and presenting symptoms was 15 (range 6 -24) months. Cessation of bleeding occurred in 77.27% cases after mean of 2(range 1-4) cycles of spray with hemoglobin rise of 2gm% (range 1.1-2.9). 5 patients complained of intense pain relieved with analgesics and one had seizure. There was only one mortality in a patient who got operated for recto-vaginal fistula and expired on 5th post-operative day due to septicemia.
Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
Crimson Publishers: The Impact of Chronic Diseases on Patients and Their Fami...CrimsonGastroenterology
The Impact of Chronic Diseases on Patients and Their Families: Case of Ulceratice Colitis and Crohn’s Disease by Maria Tsoukka in Gastroenterology Medicine & Research: Bowel Disease
Background: The purpose of the study is to identify the potential psychological effects of ulcerative colitis and Crohn’s disease on patients and their family environment.Aim: The objective aims of this current research are to identify the causal factors creating psychological problems among patients and their family members, exploring ways to eliminate them and create a general picture for their psychological condition in relation to the diseases at a Pancyprian level.Methods: The Greek translation of the Hospital Anxiety and Depression Scale (HADS) and the Greek translation of the Health Survey (SF-12) will be used for evaluating the psychological effects of ulcerative colitis and Crohn disease on patients and their families. In addition, the Greek translation of the inflammatory Bowel Disease Questionnaire will be used only on the patients. The questionnaires will be handed out to the patients and their attendants in Gastroenterology dispensaries all over Cyprus. Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
Crimson Publishers: Insulin Therapy and Cardiovascular Outcome Trials (CVOTs)...CrimsonGastroenterology
The therapeutic management of diabetes may on its own increase the risk of cardiovascular (CV) risk markers – directly or indirectly – through their pharmacological actions (e.g. side effects as hypoglycaemia), or some metabolic changes (e.g. Weight-Gain, increased BP, etc.). As these risks may not have been anticipated or immediately noticed during clinical trials, 1 post hoc analyses and epidemiological follow up of clinical trials have raised concerns about the CV safety of some drugs used in the management of diabetes.
Crimson Publishers: Improved Version of Cancer Evo-Dev, a Novel Scientific Hy...CrimsonGastroenterology
Chronic but active inflammation, which is activated and maintained by stimulants such as infection and the interactions of stimulants with genetic predisposition, facilitates the occurrence and recurrence of cancers of various histotypes. Chronic inflammation, apparent or unapparent, is indispensible for the development of most malignancies, which has been clarified in hepatitis B virus (HBV)-induced hepatocellular carcinoma (HCC). Based on our previous work and the advances of researches on HBV-induced HCC and other inflammation-associated cancers, we presented the framework of a novel cancer theory termed Cancer Evolution and Development (Cancer Evo-Dev) [1-3]. Actually, Cancer Evo-Dev can be applied in cancers of many histotypes.
Transgastric ERCP with Rendezvous Technique by Mikkel Jessen in Gastroenterology Medicine & Research
Two patients with gastric bypass Roux-en-Y (GBY) presented symptoms of post-prandial upper abdominal pain. Both patients had elevated liver enzyme levels and hyperbilirubinemia. MRCP was performed on both patients demonstrating cholecystolithiasis and gallstones in the common bile duct (CBD). A combined procedure was planned for both patients with laparoscopic cholecystectomy and perioperative Transgastric Rendezvous ERCP.
Crimson Publishers: Dietary Supplements as a Possible Trigger of Autoimmune H...CrimsonGastroenterology
Introduction: Autoimmune hepatitis (AIH) etiology remains unknown, but in genetically predisposed individuals, diverse agents may trigger the disease. Herbal and drug induced AIH have been reported in recent years probable due to the increase in self-medication. More studies are necessary to define if drugs and herbal/dietary supplements unmask and induce AIH or drug-induced hepatitis with autoimmune features.
Purpose: We report an autoimmune hepatitis case possibly induced by herbal/dietary supplements intake.
Case-report: A 55-year-old female presented with a 15-day course of jaundice and increased aminotransferases. Immunologic panel showed antinuclear antibody titer of 1:320 and serum immunoglobulin G (IgG) level approximately 2 times the upper limit of normal. She reported regular daily ingestion of Herbalife® products for 6 months which were discontinued when symptoms began. Laboratory tests worsened despite the fact that patient had stopped supplements usage, and a liver biopsy was performed. Histology was suggestive of both AIH and drug induced liver disease. The patient fulfilled criteria for probable AIH based on the revised criteria for diagnosing autoimmune hepatitis, and improved with prednisolone and azathioprine therapy, with progressive laboratory improvement and symptoms remission.
Discussion: Herbal/dietary supplements induced AIH has been previously reported, but the causality is not yet well established. Worsening of aminotransferases despite supplement suspension, histological findings and favorable response with corticosteroid treatment, supported the hypothesis of AIH induced by the used supplement. This case report aims to demonstrate the possible causality between herbal/dietary supplements and liver injury, including autoimmune hepatitis.
Gastroenterology Medicine & Research-Crimson Publishers: Can we Optimize Immu...CrimsonGastroenterology
Immunotherapy is revolutionizing oncology, with a simple guiding principle: the host immune system has the potential to eradicate cancer, treatment consisting in optimizing immune actors' functions. Although significant results were demonstrated in patients with melanoma or lung cancer, objective response rate (ORR) is only 20% in digestive oncology. However, we can improve this situation by a better knowledge of anti-tumor immunity. For example, ORR is multiplied by two to three in case of PD-L1 (programmed death-ligand 1) overexpression or microsatellite instability (MSI). In a near future, we will certainly be able to take into account other biomarkers for building composite scores for assigning to each patient with digestive cancer an 'immune identity card' able to strongly predict immunotherapy efficacy.
Crimson Publishers: Reply To: Comments on "Transabdominal Preperitoneal (TAPP...CrimsonGastroenterology
Reply To: Comments on “Transabdominal Preperitoneal (TAPP) Versus Totally Extraperitoneal (TEP) for Laparoscopic Hernia Repair: A Meta-Analysis” by Feng Xian Wei in Gastroenterology Medicine & Research
Crimson Publishers: Interferon-Free Therapy for Hepatits C in Brazil and Sust...CrimsonGastroenterology
Introduction: Hepatitis C has been treated with interferon and ribavirin for over a decade with described global sustained virological response rates of 33% to 56%. Direct acting antiviral drugs available since 2013 in USA and 2015 in Brazil are changing this reality.
Purpose: Analyze the real-life efficacy and safety of interferon-free therapy.
Methods: Repot six cases of different treatments guided by north-american and european guildelines.
Results: Every reported patient achieved sustained virological response. The only adverse event was anemia in one patient.
Conclusion: Direct-acting antiviral drugs will dramatically change the population which can be treated and increase sustained virological response rates.
Crimson Publishers: Safety of Everolimus in Living Donor Liver Transplantatio...CrimsonGastroenterology
Safety of Everolimus in Living Donor Liver Transplantation Recipients with Severe Renal Dysfunction with Low Estimated Glomerular Filtration Rate: Can Everolimus Help in Renal Recovery? by Long-Bin Jeng* in Gastroenterology Medicine & Research
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
2. How to cite this article: Mai I Mehrez. Liver Transplantation in Egypt. Gastro Med Res. 1(1). GMR.000503. 2017. DOI: 10.31031/GMR.2017.01.000503
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late mortality was 16.2% and its most frequent cause was sepsis
(7.2%). On the other hand, the overall 6-months, 1-, 3- 5- and
7-year survival of our patients were 109(65.3%), 102 (61.1%), 95
(56.9%), 94 (56.3%) and 92 (55.1%) respectively [8].
Complications
The study done in National liver institute Menoufya in 2015
showed that the overall post-operative complication rate was
86.2%, and this high rate occurred due to including all types of
complications (single, multiple, minor, major, complications treated
medically, by intervention endoscopy, radiology and that treated
surgically).
There was a trend towards significant mortality among biliary
complicated cases which reached 43.7%. While vascular problems
such as thrombosis and stenosis of the hepaticartery, portal vein,
and hepatic vein were 21.6%. Small for size syndrome was the most
frequent cause of in hospital mortality with incidence of 12.6% the
second was sepsis 4.3%. Other complications like renal impairment
with incidence of 21%, neurological problems in 26.3% did not
affect survival.
Acute rejection which is a common cause of graft failure
was 19.2%. The higher incidence of acute rejection in our study
occurred due to adjusting the immunosuppressant dose to their
lower limit for fear of neurotoxicity and nephrotoxicity and to avoid
the occurrence of sepsis. HCV recurrence 19.2% in our study. This
low incidence was due to putting strict criteria for detecting HCV
recurrence, these are the biochemical, serological and histological
evidences of recurrence, so we did not mention that HCV recurrence
occurred until the patient fulfill all the previous parameters [8].
Conclusion
LDLT is successfully done in Egypt with similar results
worldwide. We hope this success encourages the start of a solid
deceased program to cope with the patient needs.
References
1. Boraschi P, Donati F (2004) Complications of orthotopic liver
transplantation: imaging findings, Abdomen Imaging 29(2): 189-202.
2. Mohamoud YA, Mumtaz GR, Riome S, Miller D, Abu-RLJ (2013) The
epidemiology of hepatitis C virus in Egypt: a systematic review and data
synthesis. BMC Infect Dis 13: 288.
3. El-Meteini M, Fayez A, Fathy M, Abdalaal A, Safaan H, et al. (2003) Living
related liver transplantation in Egypt: an emerging program. Transplant
Proc 35(7): 2783-2786.
4. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, et al. (1990)
Successful Liver Transplantation from a Living Donor to Her Son. N Engl
J Med 322(21): 1505-1507.
5. Amer K, Marwan E (2016) Living donor liver transplantation in Egypt.
Hepato Biliary Surg Nutr 5(2): 98-106.
6. Yosry M, Abdel-R, Esmat G, El-Serafy M, Omar A, et al. (2009) Recurrence
of hepatitis C virus (genotype 4) infection after living-donor liver
transplant in Egyptian patients. Exp Clin Transplant 7(3) 157-163.
7. Yosry, Esmat, El Serafy M, Omar A, Doss W, et al. (2008) Outcome of
Living Donor Liver transplantation for Egyptian Patients with Hepatitis
C (Genotype 4)-Related Cirrhosis. Transplantation proceedings 40(5):
1481-1484.
8. Gad EH, Al Sebaey A, Lotfy M, Eltabbakh M, Sherif AA (2015)
Complications and mortality after adult to adult living donor liver
transplantation: A retrospective cohort study. Annals of Medicine and
Surgery 4(2): 162-171.