Management of betablocked patients after sustained virological response in hepatitis C cirrhosis.

Management of betablocked patients after sustained virological response in hepatitis C cirrhosis. World J Gastroenterol. 2019 Jun 07;25(21):2665-2674 Authors: Abadía M, Montes ML, Ponce D, Froilán C, Romero M, Poza J, Hernández T, Fernández-Martos R, Olveira A, “La Paz Portal Hypertension” Study Group Investigators Abstract BACKGROUND: Current guidelines do not address the post-sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM: To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk of stopping betablockers in this population. METHODS: Inclusion criteria were age> 18 years, HCV cirrhosis (diagnosed by liver biopsy or transient elastography> 14 kPa), sustained virological response after direct-acting antivirals, and baseline oesophageal varices under stable, long-term treatment with betablockers as primary or secondary bleeding prophylaxis. Main exclusion criteria were prehepatic portal hypertension, isolated gastric varices, and concomitant liver disease. Blood tests, transient elastography, an...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research

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In this report, we describe two patients with anticentriole antibodies-positive SSc-PAH who were treated with pulmonary vasodilators. Both cases were elderly women with poor physical conditions and clinical findings of SSc. Case 1 was resistant to combination therapy with pulmonary vasodilators; in Case 2, hemodynamic improvement was obtained by upfront combination therapy at an early stage. Because anticentriole antibodies-positive SSc-PAH rapidly deteriorates, careful hemodynamic observation and timely aggressive use of pulmonary vasodilators should be considered. PMID: 32224603 [PubMed - in process]
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Authors: Sugimoto K, Yoshihisa A, Nakazato K, Yokokawa T, Misaka T, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Ishida T, Takeishi Y Abstract Pulmonary hypertension (PH) caused by left-sided heart disease (LHD-PH) is classified into 2 types: isolated post-capillary PH (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH). However, the impact of pulmonary vascular resistance (PVR) or diastolic pressure gradient (DPG) on the prognosis of LHD-PH has varied among previous studies. Thus, we verified the significance of PVR or DPG on the prognosis of LHD-PH in our series.We analyzed 243 consecutive LHD-PH patients. The...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Authors: Stević M, Vlajković M, Veličković F, Stanojević G, Nestorović M, Petrović F Abstract A 69 year old patient was admitted to hospital with massive gastrointestinal hemorrhage. The clinical presentation of the patient, except for bleeding, was dominated by the presence of neurofibromatosis type 1 - Von Recklinghausen disease. The patient was referred to multislice computed tomography (CT) angiography, magnetic resonance imaging (MRI), esophagogastroduodenoscopy and colonoscopy, which were performed without successful detection of the bleeding site. The MRI examination showed the existence of a tumor lo...
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
Conclusion: To facilitate transparent consent, single-centre rather than pooled outcome data should be utilized. PMID: 32223494 [PubMed - as supplied by publisher]
Source: Scandinavian Journal of Urology - Category: Urology & Nephrology Tags: Scand J Urol Source Type: research
No abstract available
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research
This article discusses how image analysis and machine learning have enabled comprehensive characterization of kidney morphology for development of automated diagnostic and prognostic renal pathology applications. Recent findings The primordial digital pathology informatics work employed classical image analysis and machine learning to prognosticate renal disease. Although this classical approach demonstrated tremendous potential, subsequent advancements in hardware technology rendered artificial neural networks ‘(ANNs) the method of choice for machine vision in computational pathology’. Offering rapid and re...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research
Conclusion Massive SI and immune cell paralysis associated with ACLF represent the extreme severity of CAID in response to an infectious or sterile challenge. The severe immune disturbance plays a pivotal role in the pathogenesis of the distinctive features of ACLF: organ failure and bacterial infection susceptibility. Excessive SI in ACLF results from the massive activation and dysfunction of an innate immune system challenged by increased PAMPs and DAMPs. SI leads to cell and tissue immunopathology contributing to hepatic and extrahepatic organ failure. Concomitantly, the course of ACLF is associated with a disproportio...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Abstract Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic si...
Source: World Journal of Gastroenterology - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Portal hypertension is a common complication of chronic liver disease. Its relevance comes from the fact that it determines most complications leading to death or liver transplantation in patients with cirrhosis of the liver: bleeding from esophageal or gastric varices, ascites and renal dysfunction, sepsis and hepatic encephalopathy. Portal hypertension results from increased resistance to portal blood flow through the cirrhotic liver. This is caused by two mechanisms: (1) distortion of the liver vascular architecture due to the liver disease causing structural abnormalities (nodule formation, remodeling of liver sinusoid...
Source: Digestive Diseases - Category: Gastroenterology Source Type: research
Background and aim: Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension (PHT) and its complications in patients with hepatitis C virus (HCV)-related cirrhosis. Patients and methods: After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presentin...
Source: Egyptian Liver Journal - Category: Gastroenterology Tags: Original articles Source Type: research
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