Gastroentrology & Hepatology

Non-alcoholic steatohepatitis (NASH) is a progressive liver disease characterized by steatosis, inflammation, and hepatocellular injury that can lead to fibrosis and cirrhosis. Despite its rising global prevalence, effective pharmacological treatments remain limited. Resmetirom (MGL-3196), a selective thyroid hormone receptor-β (THR-β) agonist, has emerged as a promising candidate by targeting hepatic lipid metabolism and reducing liver fat accumulation. This systematic review critically evaluates the efficacy and safety of Resmetirom in adults with biopsy-confirmed NASH by synthesizing evidence from randomized controlled trials and observational studies. A comprehensive search of PubMed, Cochrane Library, and Embase identified 26 eligible studies, with ten included in quantitative synthesis. Results from Phase 2 and Phase 3 trials demonstrate significant reductions in hepatic fat measured by magnetic resonance imaging-proton density fat fraction (MRI-PDFF), improvements in nonalcoholic fatty liver disease activity scores (NAS), and favorable biomarker changes such as reductions in ALT, AST, and LDL cholesterol. Most adverse events were mild-to-moderate gastrointestinal symptoms, with serious adverse events being rare. However, data on long-term fibrosis outcomes and comparative effectiveness remain limited. Overall, Resmetirom shows meaningful clinical promise in improving liver health in NASH, but further high-quality, long-duration studies are needed to validate its impact on fibrosis and long-term clinical outcomes.

Fecal Microbiota Transplantation (FMT) is a therapeutic procedure involving the transfer of fecal material from a healthy donor into the gastrointestinal tract of a recipient. Initially recognized for its remarkable efficacy in treating recurrent Clostridioides difficile infection (CDI), FMT has gained significant interest for its potential beyond this indication. This review explores the underlying mechanisms of FMT, its established and emerging clinical applications, the current landscape of donor screening and administration methods, critical safety and ethical considerations, and the promising future directions of this evolving therapy. While highly effective for recurrent CDI, the application of FMT to other complex conditions like inflammatory bowel disease, irritable bowel syndrome, and metabolic disorders remains investigational, highlighting the need for further rigorous research and standardization.

Aim: The microbiome has been shown to be pivotal in the development of metabolic associated fatty liver disease (MAFLD). Few have examined the relationship of the microbiome specifically with steatosis grade. Therefore, our aim was to characterize the association of the microbiome with MAFLD steatosis severity while adjusting for metabolic comorbidities including diabetes. Methods: We enrolled patients with MAFLD at the West Los Angeles Veterans Affair Hospital. All patients underwent ultrasound elastography, fasting serum collection, and fecal sampling for 16S sequencing. We examined the associations of microbial diversity and composition with advanced steatosis, defined as a CAP score of ≥ 300 dB/m, with or without the presence of metabolic comorbidities. Results: Seventy-five patients were enrolled. African American were less likely to have advanced steatosis than either Hispanics or Whites (P = 0.001). Patients with more advanced steatosis had higher fasting serum triglyceride (...

The aim of this study was investigation of oral and dental side effects of diabetes mellitus (DM) on oral health-related quality of life (OHQoL) in patients with DM type 2. In this descriptive, analytic study 121 patients were participated by consecutive method based on the type of diabetes and the age. After the subjects received adequate explanations about the necessity of carrying out such a study, a questionnaire was handed into each patient who gave their consent to take part in the study. Oral lesions consisted of ulcers, erythema, leukoplakia, erythroplakia, candidiasis, angular cheilitis, median rhomboid glossitis, and denture stomatitis based on oral examination. The OHQoL were surveyed by oral health impact profile (OHIP-14) questionnaire. Data were analyzed by Pearson's correlation test, T-test, and χ 2 by SPSS software. RESULTS: A total of 121 patients with diabetes were evaluated in this study [31 males (25.6%) and 90 females (74.4%)]. In this study, there was no significant correlation between OHQoL and decayed, missing, and filled teeth (DMFT), periodontal disease index (PDI). OHQoL was associated with higher ages and higher levels of blood sugar (P = 0.002, P = 0.016). The average of OHIP score significantly was increased by xerostomia experience (P = 0.010). In this survey, the influence of oral manifestation on OHQoL was low. Xerostomia was the most important symptom in diabetic patients that causes decreasing OHQoL. Age and blood sugar had more influence on this matter as well.

Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%.The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.

Peptides are a rapidly growing class of therapeutics with many advantages over conventional small molecule drugs. Dextrorotary (D)-peptides, with increased enzymatic stability and prolonged plasma half-life in comparison with natural L-peptides, are considered to have great potential as recognition molecules and therapeutic agents. However, the in vivo efficacy of current therapeutic D-peptides is hindered by their inefficient cellular uptake in diseased tissues. Methods: To overcome physiological and cellular barriers to D-peptides, we designed a gold-based ultra-small nanocarrier coupled with polylysine (PLL) and a receptor-targeted peptide to deliver therapeutic D-peptides. Using a D-peptide p53 activator (DPA) as a proof of concept, we synthesized, functionalized and characterized gold-and DPA-based nanoparticles termed AuNP-DPA. Results: AuNP-DPA were effectively enriched in tumor sites and subsequently internalized by cancer cells, thereby suppressing tumor growth via reactivating p53 signaling. More importantly, through a series of in vivo experiments, AuNP-DPA showed excellent biosafety without the common side effects that hinder p53 therapies in clinic trials. The present study not only sheds light on the development of AuNP-DPA as a novel class of antitumor agents for drugging the p53 pathway in vivo, but also supplies a new strategy to use D-peptides as intracellular PPI inhibitors for cancer-targeted therapy.

Roughly one third of all human cancers are attributable to the functional inhibition of the tumor suppressor protein p53 by its two negative regulators MDM2 and MDMX, making dual-specificity peptide antagonists of MDM2 and MDMX highly attractive drug candidates for anticancer therapy. Two pharmacological barriers, however, remain a major obstacle to the development of peptide therapeutics: susceptibility to proteolytic degradation in vivo and inability to traverse the cell membrane. Here we report the design of a fluorescent lanthanide oxyfluoride nanoparticle (LONp)-based multifunctional peptide drug delivery system for potential treatment of acute myeloid leukemia (AML) that commonly harbors wild type p53, high levels of MDM2 and/or MDMX, and an overexpressed cell surface receptor, CD33. We conjugated to LONp via metal-thiolate bonds a dodecameric peptide antagonist of both MDM2 and MDMX, termed PMI, and a CD33-targeted, humanized monoclonal antibody to allow for AML-specific intr...

Viral hepatitis is a significant global public health issue. This study was carried out to determine the prevalence and ntritional risk factors for HAV, HBV, and HCV infections in Babylon Governorate. A statistics of 328 patients with confirmed viral hepatitis attended different health institutions in Babylon governorate were collected form Department of Public Health of Babylon Governorate and included in this study. It was a trial to assess nutritional status of the patients. There were 41.16%, 40.24%, and 18.60% of patients are diagnosed with type A, B, and C viral hepatitis respectively. A significant association between hepatitis infections and vaccine intake, transmission methods (contact with infected patient, accident, and blood transfusion), and laboratory tests (sALT). In Conclusion Viral Hepatitis in Babylon necessitate broader vaccination coverage and tailored public health initiatives. A comprehensive approach including vaccination, screening, education, and nutrition s...

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immun...

Despite world-class sophisticated technologies, robotics, artificial intelligence, and machine learning approaches, cancer-associated mortalities and morbidities have shown continuous increments posing a healthcare burden. Drug-based interventions were associated with systemic toxicities and several limitations. Natural bioactive compounds derived nanoformulations, especially nanoquercetin (nQ), are alternative options to overcome drug-associated limitations. Moreover, the EVs-based cargo targeted delivery of nQ can have enormous potential in treating hepatocellular carcinoma (HCC). EVs-based nQ delivery synergistically regulates and dysregulates several pathways, including NF-κB, p53, JAK/STAT, MAPK, Wnt/β-catenin, and PI3K/AKT, along with PBX3/ERK1/2/CDK2, and miRNAs intonation. Furthermore, discoveries on possible checkpoints of anticancer signaling pathways were studied, which might lead to the development of modified EVs infused with nQ for the development of innovative treatments for HCC. In this work, we abridged the control of such signaling systems using a synergetic strategy with EVs and nQ. The governing roles of extracellular vesicles controlling the expression of miRNAs were investigated, particularly in relation to HCC.

Hepatitis B virus (HBV) has ten genotypes (A–J) and over 40 sub-genotypes based on the divergence of ≥ 8% and 4 to < 8% in the complete genome respectively. These genotypes and sub-genotypes influence the disease prognosis, response to therapy and route of viral transmission. Besides, infection with mixed genotypes and recombinant genotypes has also been reported. This study aimed at mapping the de novo genotypes and correlate them with the immigration trends in order to inform future research on the underlying reasons for the relative distribution of HBV genotypes from a large sample size pooled from many primary studies. Data was extracted from 59 full research articles obtained from Scopus, PubMed, EMBASE, Willy library, African Journal Online (AJOL) and Google Scholar. Studies that investigated the genotypes, sub-genotypes, mixed genotypes and recombinant were included. The Z-test and regression were used for the analysis. The study protocol is registered with PROSPERO under ...

The incidence of hepatocellular carcinoma (HCC) and HCC-related deaths has increased over the last few decades. There are several risk factors of HCC such as viral hepatitis (B, C), cirrhosis, tobacco and alcohol use, aflatoxin-contaminated food, pesticides, diabetes, obesity, nonalcoholic fatty liver disease (NAFLD), and metabolic and genetic diseases. Diagnosis of HCC is based on different methods such as imaging ultrasonography (US), multiphasic enhanced computed tomography (CT), magnetic resonance imaging (MRI), and several diagnostic biomarkers. In this review, we examine the epidemiology of HCC worldwide and in Egypt as well as risk factors associated with the development of HCC and, finally, provide the updated diagnostic biomarkers for the diagnosis of HCC, particularly in the early stages of HCC. Several biomarkers are considered to diagnose HCC, including downregulated or upregulated protein markers secreted during HCC development, circulating nucleic acids or cells, metab...

Non-alcoholic steatohepatitis (NASH) is a clinical condition characterized by inflammation and swelling of the hepatocytes. If not adequately treated, NASH can lead to the development of fibrosis and liver cancer. Currently, drug therapies used in the management of NASH patients are deficient and non-specific. Patients' adherence to a healthy lifestyle with a low-calorie diet is a crucial element in the treatment of NASH. The Mediterranean diet is a diet that, more than any other, has indicated beneficial effects in this pathology. The proposed review summarizes the evidence regarding the beneficial effects of consuming the Mediterranean diet typical foods in NASH.

Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know the exact mechanisms by which only a selected group of patients with ALD progress to the final stage of HCC, the role of the gut microbiota within the progression to HCC has been intensively studied in recent years. To date, we know that alcohol-induced gut dysbiosis is an important feature of ALD with important repercussions on the severity of this disease. In essence, an increased metabolism of ethanol in the gut induced by an excessive alcohol consumption promotes gut dysfunction and bacterial overgrowth, setting a leaky gut. This causes the translocation of bacteria, endotoxins, and ethanol metabolites across the enterohepatic circulation reaching the liver, where the recognition of the pathogen-associated molecular patterns via specific Toll-like receptors of liver cells will induce the activation of the nuclear factor kappa-B pathway, which releases pro-inflammatory cytokines and chemokines. In addition, the mitogenic activity of hepatocytes will be promoted and cellular apoptosis will be inhibited, resulting in the development of HCC. In this context, it is not surprising that microbiota-regulating drugs have proven effectiveness in prolonging the overall survival of patients with HCC, making attractive the implementation of these drugs as co-adjuvant for HCC treatment.

A total of 132 patients who had dynamic magnetic resonance imaging (MRI)/computed tomography (CT) images in the Picture Archiving and Communication Systems (PACS) with liver nodule were included in the study, 37 of whom had histopathology results. Five radiologists who participated in the study, interpreted liver nodules independently on different PACS stations according to the LIRADS reporting system and its main parameters. We determined that level of inter-observer agreement in the LR-1, LR-5, and LR-5V categories was higher than in the LR-2, LR-3, and LR-4 categories (κ = 0.522, 0.442, and 0.600 in the LR-1, LR-5, and LR-5V categories, respectively; κ = 0.082, 0.298, and 0.143 in the LR-2, LR-3, and LR-4 categories, respectively). The parameter that we observed to have the highest level of inter-observer agreement was venous thrombus (κ = 0.600). Our study showed that LIRADS achieves an acceptable inter-observer reproducibility in terms of clinical practice although it is insufficient at intermediate risk levels. We think that the prevalence of its use will be further increased with training related to the subject and the assignment of numerical values that express the probability of malignancy for each category and including the ancillary features in the algorithm according to clearer rules.

Choledochal cysts (CDC) are congenital dilatations of extra hepatic biliary system with or without involving intrahepatic bile ducts. Traditionally classified into five types with emerging type VI, involving dilatation of cystic duct, which is the rarest. It is seen in middle-aged females. Most are symptomatic with common symptom being abdominal pain. Magnetic resonance cholangiopancreatography (MRCP) is diagnostic. Surgical treatments range from cholecystectomy to Roux en Y hepaticojejunostomy. They are at a risk of malignant transformation. Hence should be looked for when encountered with congenital biliary system anomalies. We presented a case of a young male with type VI B CDC and its management. A brief case report with review of literature is presented.

Background: Super selective transarterial chemoembolization (TACE) has emerged as a bridging therapy for early hepatocellular carcinoma (HCC) patients awaiting liver transplantation. This study aimed at assessing the expression profiles of circulating MiR-210 and MiR-373 as potential predictors of response to TACE bridging therapy in a group of Egyptian HCC cases on top of chronic hepatitis-C infection, awaiting liver transplantation. Methods: Fifty-three HCC cases awaiting liver transplantation referred for TACE, were followed up for three months, resulting in forty-five responders and eight non-responders based on modified response evaluation criteria in solid tumors (mRECIST). Circulating pre TACE MiR-210 and MiR-373 expressions were determined using reverse transcription quantitative polymerase chain reaction. Results: Circulating pre TACE MiR-373, but not MiR-210, was significantly higher in non-responders than responders. Receiver operating characteristics (ROC) curve analysis of MiR-373, pre-TACE tumor volume, inflammatory score, and albumin bilirubin (ALBI) grade revealed highest sensitivity for pre-TACE tumor volume (cutoff>11.49 cm 3 ) and highest specificity for pre-TACE . Multivariate logistic regression revealed pre TACE MiR-373 as a significant independent predictor of TACE response after adjusting for pre TACE tumor volume. Conclusion: Circulating pre-TACE MiR-373 could assist as a noninvasive predictor marker of response to TACE bridging therapy in early HCC patients awaiting liver transplantation.

The hepatitis C virus causes serious morbidity and mortality and is a global public health concern. Aim: To ascertain adult patients' awareness of hepatitis C in a specialist eye clinic in Anambra State, Nigeria. Methods: A pretested, semi-structured questionnaire administered by interviewers and also selfadministered by participants was used in this prospective, descriptive, cross-sectional study to ascertain the awareness of hepatitis C among adults visiting a specialist eye clinic in Anambra State, Nigeria. Descriptive variables and tests of significance were used in the analysis of data on socio demographics, awareness, and knowledge of hepatitis C. The COUTH Ethics committee granted ethical approval. Results: Because they met the inclusion criteria, 264 people in total took part in this survey. With an age range of 20-87 years, there were 110 (41.7%) males and 154 (58.3%) females, with a ratio of 1:1.4. The average age was 60.6 +/-14.8 years. The majority of the 149(56.4%) participants were unaware of HCV infection while 258 (97.8%) were unaware of the method by which HCV is spread. In Nigeria, adult patients who visit eye clinics have low knowledge of hepatitis C.

The association between the incidence of hepatocellular carcinoma (HCC) and type 2 diabetes (T2DM) has been reported in some molecular biological and epidemiological studies. The Keap1-Nrf2 pathway and selective autophagy play central roles in oxidative stress. Additionally, collaboration with the autophagy-adaptor p62 and Keap1-Nrf2 pathway has been reported in hepatocarcinogenesis. This preliminary study aimed to clarify whether the p62-Keap1-Nrf2 pathway was activated in patients with non-B non-C HCC and T2DM. METHODS: Between May 2003 and July 2013, from among 93 consecutive patients with HCC who underwent liver resection, we retrospectively identified 13 patients (14%) with non-B non-C HCC and T2DM who were enrolled in the study. All patients were negative for hepatitis virus C antibody and hepatitis B antigen and were complicated with T2DM. We performed routine staining and immunohistochemical analysis of p62, Nrf2, and Keap1 activation in liver specimens on surgically resected specimens in both cancerous and non-cancerous liver tissues, and correlated the findings with annotated clinicopathologic data. Results: All patients met the criteria for metabolic syndrome. The median survival was 54 months and the median time to radiologic progression was 23 months. HCC grading was classified as well-differentiated in 1, moderately-differentiated in 11, and poorly-differentiated in 1. In non-cancerous liver tissue , eight of 13 patients (62%) met the criteria for non-alcoholic steatohepatitis according to a non-alcoholic fatty liver disease activity score (NAS) and liver tissue was normal in the remaining five patients (38%). Overall, we detected activation of at least one of p62, or Keap1 or Nrf2 in 11 patients (85%) in cancerous liver tissue as well as in non-cancerous liver tissue. Only two patients showed no activation. Furthermore, activation of all three was detected in seven patients (54%) in cancerous liver tissue, and in three patients (23%) in non-cancerous liver tissue. Conclusion: Although the results of the current study must be evaluated in consideration of the important limitation of the relatively small sample size, our results showed a close association between activation of the p62-Keap1-Nrf2 pathway and hepatocarcinogenesis in patients with non-B non-C HCC and T2DM.

Chronic hepatitis C (CHC) infection is associated with increased TIM-3, PD-1 immune checkpoint receptors expression that inhibits adaptive T cells and increases NK cell cytotoxicity against T helper cells, both resulting T cell exhaustion. Elimination of the virus with direct-acting antivirals (DAAs) may modify host immune response via altering these immune checkpoint receptors’ expression. We conducted a prospective study to analyze changes in TIM-3, PD-1 and their ligands galectin-9, PD-L1 expression by peripheral blood T cell subpopulations, NK cell subpopulations, and monocytes by multicolor flow cytometry in 14 CHC patients successfully treated with 12 weeks of dasabuvir, ombitasvir, and paritaprevir/ritonavir plus ribavirin. Blood samples were collected before, at the end of treatment, and 12 and 24 weeks later. Sustained virological response (SVR) was associated with increased percentage of peripheral blood CD3+ T and CD8+ cytotoxic T lymphocytes and decreased percentage of N...

Pyrexia of unknown origin usually requires extensive diagnostic and therapeutic investigations. At times, even after these extensive procedures, the patient’s condition might go undiagnosed. There is no limit to the spectrum of diseases or infections that present as fever of unknown origin. This case report showcases one such case of undiagnosed pyrexia, which later turned out to be due to a large amoebic liver abscess. Although amoebic liver abscesses are not uncommon, the presentation in the current scenario was uncommon.

Background and Aims: Data regarding risk factors and long-term outcomes of U.S. patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MA-SLD) are limited. This study aimed to investigate the role of clinical and histologic risk factors on long-term outcomes in patients with MASLD. Methods: A retrospective cohort study of 451 adults with biopsy-proven MASLD was conducted at a U.S. academic hospital from 2012 to 2020. An experienced pathologist evaluated the index liver biopsy. Patients with a prior liver transplant or alternative etiologies of chronic liver disease were excluded. The duration of the risk exposure was determined from the date of the index liver biopsy to an outcome event or the last follow-up examination. Outcome events of interest included incident liver-related events, liver decompensation, and all-cause mortality. Results: In the final cohort of 406 patients followed for a median of 3.7 years (interquartile range: 4.8 years), 35 patients died, 41 developed hepatic decompensation, and 70 experienced a liver-related event. Among histologic risk factors, stage 3 (adjusted Hazard ratio (aHR) 2.68, 95% confidence interval (CI) 1.18-6.11) and stage 4 (aHR 6.96, 95% CI 3.55-13.64) fibrosis were associated with incident liver-related events compared to stage 0-1 fibrosis. Stage 4 (aHR 8.46, 95% CI 3.26-21.99) fibrosis alone was associated with incident liver decompensation events compared to stage 0-1 fibrosis. Among clinical risk factors, hypertension (aHR 2.58, 95% CI 1.05-6.34) was associated with incident liver decompensation. Conclusions: In a U.S. single-center cohort of patients with biopsy-proven MASLD, advanced fibrosis was the primary risk factor for incident liver decompensation and liverrelated events.

S obzirom na brojne prednosti pred ostalim postupcima oslikavanja, ultrazvučni je pregled najčešći dijagnostički postupak današnjice. Kod ultrazvučnog praćenja onkoloških bolesnika ponekad se vide avaskularne ili hipovaskularne prstenaste ("target") promjene jetrenog parenhima koje imaju hipoehogeni obrub ("halo") i, manje ili više, hiperehogeno središte. U diferencijalnoj dijagnostici solitarnih prstenastih jetrenih promjena uglavnom treba misliti na hemangiom, te pseudoleziju (pseudotumor), osobito kod lokacije u IV. segmentu lijevoga režnja difuzno steatotične jetre. Multifokalne su prstenaste jetrene promjene najčešće sekundarne etiologije, porijeklom od različitih neoplastičnih procesa, pretežno bronhogenog i kolorektalnog karcinoma. Svakako se preporučuje daljnja slikovna obrada, prvenstveno računalna tomografija (CT) s primjenom kontrastnoga sredstva prema višefaznom protokolu ili, katkad, magnetna rezonancija (MR), te, eventualno, biopsija jetre u slučaju nepoznatog sijela primarnoga tumora, te istodobnog postojanja nekoliko različitih novotvorina.

In 2015, the Chinese Society of Hepatology and the Chinese Society of Gastroenterology published a consensus on primary biliary cholangitis (PBC). In the past years, numerous clinical studies have been published in the field of PBC. To guide the clinical diagnosis and management of PBC patients, the Chinese Society of Hepatology invited a panel of experts to assess the new clinical evidence and formulate the current guidelines.

With the rising epidemic of obesity, metabolic syndrome, and type 2 diabetes mellitus in China, metabolic dysfunctionassociated non-alcoholic fatty liver disease has become the most prevalent chronic liver disease. This condition frequently occurs in Chinese patients with alcoholic liver disease and chronic hepatitis B. To address the impending public health crisis of non-alcoholic fatty liver disease and its underlying metabolic issues, the Chinese Society of Hepatology and the Chinese Medical Association convened a panel of clinical experts to revise and update the "Guideline of prevention and treatment of non-alcoholic fatty liver disease (2018, China)". The new edition, titled "Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (Version 2024)", offers comprehensive recommendations on key clinical issues, including screening and monitoring, diagnosis and evaluation, treatment, and followup for metabolic dysfunction-associated fatty liver disease and metabolic dysfunction-associated steatotic liver disease. Metabolic dysfunction-associated fatty liver disease is now the preferred English term and is used interchangeably with metabolic dysfunction-associated steatotic liver disease. Additionally, the guideline emphasizes the importance of multidisciplinary collaboration among hepatologists and other specialists to manage cardiometabolic disorders and liver disease effectively.

Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCV-positive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care ...

Hepatocellular carcinoma (HCC) is the most common cancer associated with chronic liver disease and cirrhosis. The most common cause of HCC is chronic hepatitis C virus infection and many studies in Europe, Asia and North America have focused on its etiology, epidemiology, diagnostic tools, and therapeutic options. However, little is known about these issues in Latin America. The aim of this review is to address these aspects of HCC in Latin America. The main risk factors associated with developing HCC in this region are: age, concomitant cirrhosis, hepatitis C infection, obesity and hereditary disease such as hemochromatosis. On the other hand, screening tests and diagnostic methods of HCC are mostly serum alpha fetoprotein quantification, liver ultrasound, computed tomography, magnetic resonance, and histopathology. Novel diagnostic methods include gut microbiota analysis and the use of nanotechnology and they continue to be tested. Finally, according to the Barcelona Clinic Liver Cancer, curative treatments used in HCC patients are mainly liver resection, liver transplantation, and local ablation, each with advantages and disadvantages. In conclusion, clear strategies are urgently needed to understand the extent of HCC and related problems in this part of the world. This review provides greater knowledge of HCC for the proper design of preventive programs by taking into consideration specific characteristics of our population. Also, this review allows for an understanding of individualizing treatments according to the patient's needs.

Hepatitis B virus (HBV) vaccination is proven to offer 90%-100% protection in individuals who generate adequate antibody responses. In light of this, the World Health Organization (WHO) has recommended routine HBV vaccination, particularly for high-risk populations such as healthcare workers (HCWs), to mitigate the risk of infection. Nigeria has developed national guidelines for the prevention, care, and treatment of HBV and hepatitis C virus (HCV), incorporating HCW vaccination as a key preventive strategy within healthcare environments. Despite being a readily identifiable group for targeted vaccination efforts, HCWs often exhibit suboptimal compliance with vaccination protocols due to various influencing factors. This study aimed to assess the general knowledge, perceived risk of HBV infection, vaccination status, and overall risk perception among HCWs at

Hepatitis B virus (HBV) vaccination is proven to offer 90%-100% protection in individuals who generate adequate antibody responses. In light of this, the World Health Organization (WHO) has recommended routine HBV vaccination, particularly for high-risk populations such as healthcare workers (HCWs), to mitigate the risk of infection. Nigeria has developed national guidelines for the prevention, care, and treatment of HBV and hepatitis C virus (HCV), incorporating HCW vaccination as a key preventive strategy within healthcare environments. Despite being a readily identifiable group for targeted vaccination efforts, HCWs often exhibit suboptimal compliance with vaccination protocols due to various influencing factors. This study aimed to assess the general knowledge, perceived risk of HBV infection, vaccination status, and overall risk perception among HCWs at

Spontaneous remission, defined as the complete or partial regression of a malignant tumor without any treatment intervention, is a rare phenomenon in advanced metastatic carcinoma. We present a unique case of spontaneous remission in a patient with metastatic carcinoma, highlighting the potential role of the immune system in tumor control. This case report underscores the need for further investigation into the mechanisms underlying spontaneous remission and its implications for immunotherapy.

Alkoholna bolest jetre (engl. alcoholic liver disease, ALD) među najčešćim je kroničnim jetrenim bolestima, a uz hepatitis C i nealkoholni steatohepatitis vodeći je uzročnik ciroze jetre u razvijenim zemljama svijeta (1). Etiologiju kronične jetrene lezije nužno je razjasniti zbog specifičnosti liječenja različitih entiteta i preveniranja nastanka završne, ireverzibilne faze, odnosno ciroze jetre i hepatocelularnog karcinoma. Na ALD nas, uz anamnestičke podatke, mogu usmjeriti i biomarkeri jer štetna i opasna konzumacija alkohola, a koja podrazumijeva više od dva alkoholna pića na dan za žene i tri za muškarce (2), uzrokuje odstupanja u nalazima laboratorijske obrade bilo zbog direktnoga toksičnog učinka alkohola na jetru, krvotvorne organe ili druge organske sustave, bilo zbog malnutricije koja je često prisutna kod populacije koja svakodnevno konzumira alkohol ili su posljedica uznapredovale jetrene bolesti. Iako biomarkeri mogu biti karakteristični za ALD, oni nisu dijagnostički zbog p 19

Atresia coli is a rare congenital abnormality that result in an inability to pass feces since birth. Signs of colic progressed during 24 hours of first life in this defect. The equine large intestine consists of the following segments: cecum, large colon, and small colon. Colon is the segment of intestine that most often involved (Atresia coli). The popular theory related to the pathogenesis of intestinal atresia is vascular accident. If the foal can't pass meconium during 12 hours after birth, it could be described as 'retained meconium'. Atresia coli can be diagnosed by clinical signs, physical examinations and diagnostic imaging. Surgical prognosis of atresia coli is poor. In this study a Darehshouri foal was presented with signs of colic and absence of meconium repelling. The final diagnosis of partial agenesis of the right dorsal colon (type III colon atresia) was confirmed during laparotomy. End to end anastomosis between remained right dorsal and transverse colon was done.

Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at

Sarcopenia is a known risk factor for poor prognosis in chronic pancreatitis, however the impact of sarcopenia in acute pancreatitis (AP) is unknown. This systematic review examines the prognostic impact of sarcopenia on clinical outcomes in patients with acute pancreatitis. outcomes in patients with acute pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) has been a significant development in gastrointestinal endoscopy. I did my first ERCP at SKIMS on December 5, 1982, and over the last 40 years, I have performed 10,100 ERCP procedures, including 600 Sphincter of Oddi manometries (SOM), and 3200 therapeutic ERCPs. We were confronted with many clinical challenges that needed answers by applying ERCP as a primary diagnostic tool. These studies gave birth to and/or recognition of several clinical syndromes. The hepatobiliary and pancreatic ascariasis (HBPA) as a clinical disease was recognized in 1985. The nematode, Ascaris lumbricoides, was the most common cause of hepatobiliary and pancreatic diseases in Kashmir, and its impact on healthcare, clinical profile, management policies, and control measures was identified. Kashmir was recognized as an endemic zone for recurrent pyogenic cholangitis (RPC), which constituted 12.5% of all biliary diseases. RPC in this population was found essentially to be an aftermath of HBPA. A subset of patients with hepatic hydatidosis with rupture into the biliary tract was recognized at ERCP and primarily treated by endotherapy. Cholangiographic abnormalities in children with portal cavernoma evolved into the recognition of portal biliopathy. Extensive studies of the sphincter of Oddi manometry in patients with unexplained biliary and/or pancreatic pain following cholecystectomy identified the entity of the sphincter of Oddi dyskinesia (SOD). In a cross-over trial, Nifedipine, compared with a placebo, showed a significant clinical response in 20 of 28 such patients. ERCP studies done in patients with tropical calcific pancreatitis showed an anomalous union of bile and pancreatic ducts. Forty of the 220 patients with liver transplantation had biliary complications namely biliary leaks, bile duct strictures, SOD, and recurrence of underlying primary biliary cholangitis. Biliary complications caused considerable morbidity and mortality in patients with liver transplantation.
Keywords: ERCP; Portal biliopathy; ascariasis; recurrent pyogenic cholangitis; sphincter of Oddi dyskinesia.

Despite of the advances in clinical imaging and applied research in proteomic biomarkers, liver cancer, especially hepatocellular carcinoma remains detected at the very late and advanced stages when curable treatments are unavailable and ineffective. In this regard, there are still huge unmet medical needs in developing and clinically validating those highpotential protein biomarkers preferably in liquid biopsy samples. This review provides a glimpse of emerging biomarkers together with detection tools and techniques which are potentially commercially available to the markets. We also discuss several diagnostic biomarkers having therapeutic potential for developing first-in-class medicines.

UTIs are a common health issue typically treated with antibiotics. However, the growing antibiotic resistance of Escherichia coli, responsible for 75% of UTI cases, presents a major challenge. This increasing resistance highlights the need for alternative treatments, with herbal medicine emerging as a promising option. UTIs (Ṭa’diya Majra-i-Bawl) are managed using plant-based remedies known for their antiseptic (Da’fe Ufoonat), antiinflammatory (Muhallilat), and diuretic (Mudirrat) properties. Polyherbal formulations combining these medicinal herbs are believed to be effective against Escherichia coli infections. This case study aimed to evaluate the therapeutic potential of an Unani polyherbal formulation as a natural and effective UTI remedy. It was conducted on a patient with UTI symptoms, who was treated with a formulation containing 50% hydro-alcoholic extracts of Karonda (Carissa carandas), Khar-e-Khasak (Tribulus terrestris), Mako (Solanum nigrum), Beekh-e-Kasni (Cichorium intybus), Bhumi Amla (Phyllanthus niruri), and Chirayata Shireen (Swertia chirata). The patient received two capsules of 500 mg and Qurs-e-Kafoor (two tablets) twice daily for 21 days. Post-treatment assessment showed significant improvement in symptoms and urine analysis, with no recurrence observed during follow-up. The Unani formulation proved highly effective for UTI treatment, was well tolerated, and caused no adverse effects.
KEYWORDS: UTIs, Ṭa’diya Majra-i-Bawl, Qurs-e-Kafoor, Da’fe Ufoonat, Muhallilat, Unani polyherbal formulation.

Background: Postoperative ileus after appendectomy causes gas storage, distention, nausea, vomiting, and even pain. Gum chewing is one of the ways that can reduce the duration of temporary ileus. The aim of this study is to determine the effect of gum chewing on bowel movements following appendectomy. Materials and Methods: This randomized double-blind clinical trial was done on 46 patients undergoing appendectomy that were divided into equal treatment and control groups. The treatment group chewed gum three times, each time for 20 minutes, 4, 10 , and 18 hours after recovery from anesthesia. The control group, however, did not receive any special treatments. The bowel sounds were monitored every two hours using stethoscope. Also, through running interviews with two hour intervals, data were collected regarding the first passage of flatus and defecation. Data were analyzed through SPSS and t-test. Results: On average, the first bowel sounds in treatment and control groups were, respectively, heard at 2.08±0.41 and 3.13±1.45 hours, whereas gas passage in treatment and control groups was reported at 26.8±14.59 and 50.08±13.92 hours, respectively. Also, the first defecation in the treatment group occurred at 18.91±10.77 hour but in the control group this happened at 29.21±12.11 hour. Based on these observations, a significant difference was seen between the two groups in terms of the test results (p=0.002). The findings of this study showed that chewing gum can help bowel movements after appendectomy.

recent guidelines recommend that all cirrhotic patients without previous variceal hemorrhage undergo endoscopic screening to detect esophageal varices. The aim of this study is to evaluate clinical, laboratory and ultrasound parameters to detect esophageal varices. this is a cross sectional study. Fourty seven consecutive cirrhotic patients without history of variceal hemorrhage underwent upper endoscopy. Physical examination, laboratory and ultrasonography to find portal vein diameter and anterioposterior splenic measurement of each patient were also recorded. esophageal varices was detected in 36 of the 47 patients (76.6%). Using bivariate analysis we found that a platelet count of 82,000/ul (90.9% sensitivity; 41.7% specificity), portal vein diameter of 1.15 cm (75% sensitivity; 54.5% pecificity) and an anteroposterior splenic measurement of 10.3 cm (83.3% sensitivity; 63.6% specificity) were predictive factors for esophageal varices in liver cirrhosis. our data show that platele...

Simona Anzivino, Giuseppe Quaini, Valeria Pisetta, Paolo Masci, Annalisa Bertoldi Giandomenico Nollo 1 IRCS-HTA group, PAT-FBK, via Sommarive 18, 38123 Trento, Italy, anzivino@fbk.eu 2 BIOTech-DII, University of Trento, via Calepina 14-I, 38122 Trento, Italy 3 Medicaltech S.r.l., Via F. Zeni 8, 38068 Rovereto (TN), Italy 4 High Assurance Software Laboratory (HASLab), INESC TEC and Universidade do Minho, Portugal 5 S.S. Cardiologia Riabilitativa Azienda Provinciale per i Servizi Sanitari, Trento, Italy

Aim: This study aimed to compare mini-invasive liver resection (MILR) (laparoscopic/robotic approach) and open liver resection (OLR) for hepatocellular carcinoma (HCC) in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review. The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR. The main endpoints were Child-Pugh score, serum total bilirubin level, comorbidity, presence/absence of cirrhosis, minor/major resection, challenge segment approach, operative time, estimated intraoperative blood loss, liver failure rate, morbidity according to the Clavien-Dindo classification, length of hospital stay (LOS), postoperative mortality, number of lesions, tumor size, readmission rate, recurrence rate and survival at 1, 3 and 5 years after operation. Meta-analyses provided pooled relative risks and mean differences for these outcomes. Cut-off for "elderly age" was set at 65 years old. Results: Eight studies that evaluated 3051 patients who underwent liver resection for HCC, with 950 undergoing MILR and 2101 OLR, were included after the screening process. Blood loss, morbidity, and LOS showed statistical significance in favor of MILR. In particular, with respect to OLR, MILR decreased on average blood loss by 161.43 mL (95%CI: 250.24-72.61), risk of morbidity by 42% (P < 0.01), LOS by 4 days (95%CI: 7-2), postoperative mortality risk by 47% (although not significantly, P = 0.06). Major resections were significantly more common in the OLR group (P < 0.0001). Recurrence, although not significant (P = 0.06), must also be emphasized. The two surgical approaches were comparable with regard to the other outcomes investigated. Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes, where it may promote the extension of liver resection to HCC patients with borderline liver function. MILR may be considered an important treatment option with significant benefits in the elderly and fragile patients. However, large well-designed prospective comparative studies or randomized controlled trials would be necessary to further confirm our conclusions.

Chronic hepatitis C virus (HCV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma (HCC) worldwide. The recent advancement of direct-acting Antiviral Agents (DAAs) in hepatitis C therapy, resulted in sustained virological response rates of over 90% in treated patients in different stages of liver fibrosis. The efficacy of DAAs treatment has also been confirmed in real-life cohorts that include subjects with decompensated cirrhosis and therefore seems a promising step to a significant reduction in the recurrence of HCC in patients who achieved complete destruction of the HCC nodules by local therapy. We present a 72-year old patient with HCVrelated liver cirrhosis who successfully responded to DAAs treatment after complete destruction of an early HCC nodule.

Dear Editor,

Functional gastrointestinal disorders (FGDs) are commonly seen in the spectrum of gastrointestinal conditions as a substrate per se. On the other hand, managing hepatology diseases does not typically involve targeting functional manifestations as a specific treatment goal since these are not generally considered purely functional sui generis disorders. Instead, they are seen as intrinsic parts of liver disease. A prominent example of this is pruritus, which may be associated with different etiologies such as primary sclerosing cholangitis, primary biliary cholangitis, or jaundice of various origins.1 Our group of authors recognizes the necessity of clarifying this issue in depth and suggests introducing the term functional hepatology disorder (FHD) for a spectrum of diseases analogous to FGDs.

Emphysematous liver abscesses (ELAs), characterized by the presence of gas within the hepatic parenchyma, are an uncommon and potentially lifethreatening entity. ELAs with clinical presentations mimicking hollow viscus perforation pose a diagnostic conundrum for clinicians. This series highlights the diagnostic challenges posed by such atypical presentations and emphasizes the importance of considering hepatic pathology in the differential diagnosis of pneumoperitoneum. Our objective is to provide a comprehensive analysis of the diverse clinical presentations, diagnostic challenges, and therapeutic strategies employed in managing this unique subset of liver abscesses.