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Recent Articles

2021-01-11 Mini Review

Stem cell therapy in children with acute liver failure: The dream could come true


Acute liver failure (ALF) in children is a severe disease with a high mortality rate. The current treatment strategies are still defective, with many cases die when liver transplantation is unavailable. The current protocol of steroids therapy improved the survival rate of hepatitis A virus (HAV)-related ALF. However, there is still a high mortality for non-HAV cases. Stem cell therapy (SCT) has been tried in experimental animals with ALF and in few adult studies with acute-on-chronic liver failure. No previous trials of SCT have been tested in children with ALF. The absence of SCT application in ALF in children could be due to some issues. These could be related to safety, sources, administration route, optimum dosage, efficacy, and survival. It is proposed that could be the future therapy if these obstacles have been well studied and solved.

Abstract Read Full Article HTML DOI: 10.29328/journal.acgh.1001024 Cite this Article

2021-02-01 Review Article

Systematic review and meta-analysis of drug induced liver injury secondary to biologic medications in inflammatory bowel disease


Introduction: Drug-induced Hepatotoxicity and biologic drugs have historically been challenging in IBD. We aim to study the prevalence of hepatotoxicity in adult patients using biologic medications.

Methodology: With the guidelines described by PRISMA-P, a detailed search strategy for each electronic database was developed based on PubMed, Medline, and Embase. We include RCTs that assessed the efficacy and hepatotoxicity of biologics in IBD patients. Hepatotoxicity was defined as AST and/or ALT >2x upper limit of normal or cholestasis. The Odds ratio (OR) was calculated with a 95% confidence interval (CI). Heterogeneity was assessed using the chi2 test and the I2 statistic.

Results: 862 records identified in total. After removing the duplicates 564 records were left for review. Four studies did not report on how participants were randomized to treatment groups or how allocation concealment was achieved, we rated these studies at unclear risk of bias for these domains. There was no presence of any heterogeneity among studies by (Chi2= 2.21, df = 6, p = 0.90, and I2 = 0%). Our meta-analysis was conducted on the fixed effects model, with the (0.770, 95% CI [-0.630, 0.957], and p = 0.02). Hepatotoxicity was not related to any TNF-α antagonist. Thiopurine induced liver injury occurred more frequently within the first months of treatment, 50% of cases within the first 3 months (11.4% vs. 2.3%, p < 0.05).

Conclusion: When hepatotoxicity occurred, the treatment was withdrawn in thirty one percent of patients. This group of patients had a dose-dependent hepatotoxicity rather than an immunologic hepatitis.

Abstract Read Full Article HTML DOI: 10.29328/journal.acgh.1001025 Cite this Article

2021-02-15 Case Report

Recurrent hydrothorax due to diaphragmatic perforation post hepatocellular carcinoma radiofrequency ablation: A case report


Radiofrequency ablation is one of the most commonly used therapies for potentially curative small hepatocellular carcinoma. Although radiofrequency is usually a safe procedure, severe and potentially fatal complications can happen. This is a case of a 72 years old woman with cirrhosis secondary to Metabolic Associated Fatty Liver Disease (MAFLD), who presented recurrent hydrothorax after treating hepatocellular carcinoma (HCC) with radiofrequency ablation (RFA), and in which diaphragmatic perforation was subsequently diagnosed. We reviewed the differential diagnosis and management in a pleural effusion after a radiofrequency procedure. Although diaphragmatic perforation is an uncommon complication after RFA procedure, this case aims to help clinicians being aware of non-habitual complications.

Abstract Read Full Article HTML DOI: 10.29328/journal.acgh.1001026 Cite this Article

2021-03-17 Case Report

Giant hepatic cystadenoma mimicking a hydatid cyst: A challenging preoperative diagnosis


Biliary cystadenoma is a rare cystic tumor of the liver. It has a high recurrence rate and malignant transformation risk in middle-aged women. Pre-operative diagnosis is difficult because of the lack of clinical, biological and radiological specificity. The confirmation of the diagnosis is made by the histopathological examination. Complete surgical resection is preferred because of the high risk of malignant transformation and recurrence.

Abstract Read Full Article HTML DOI: 10.29328/journal.acgh.1001027 Cite this Article