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Journal Cover Journal of Clinical and Experimental Hepatology
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   Full-text available via subscription Subscription journal
     ISSN (Print) 0973-6883
     Published by Elsevier Homepage  [2563 journals]
  • Association of Serum Bilirubin with Aging and Mortality
    • Authors: Brigid S. Boland; Mamie H. Dong, Ricki Bettencourt, Elizabeth Barrett-Connor, Rohit Loomba
      Pages: 1 - 7
      Abstract: Background and aims: Bilirubin, a breakdown product of heme metabolism, has been shown to be protective against cardiovascular mortality; however, it is also a marker of liver function. There are limited data on the longitudinal changes in bilirubin with aging in a population-based cohort of older adults. This study was designed to determine whether serum bilirubin changes with age in older adults, and to evaluate whether age attenuates the association between bilirubin and mortality.Methods: This is a prospective cohort study of 2364 participants with a mean age of 70 years, who completed a research clinic visit from 1984 to 1987, and 1703 participants who returned for a second research visit approximately 8 years later. Cross-sectional and longitudinal multivariable-adjusted analyses were performed to examine the association between serum bilirubin, aging, and mortality.Results: In cross-sectional analyses, when the cohort was divided into quartiles of age, higher baseline serum bilirubin levels were associated with older age in analyses adjusted for sex, body mass index (BMI), alanine aminotransferase (ALT), albumin, and metabolic traits (P-value
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-01-09
      DOI: 10.1016/j.jceh.2014.01.003
      Issue No: Vol. 4, No. 1 (2014)
  • Acute Kidney Dysfunction in Patients with Chronic Hepatitis C Virus
           Infection: Analysis of Viral and Non-viral Factors
    • Authors: Sanjaya K. Satapathy; Chandra S. Lingisetty, Susan E. Williams
      Pages: 8 - 13
      Abstract: Background: Multiple studies have shown a relationship between chronic hepatitis C infection and chronic kidney disease. The prevalence, severity, underlying etiologies and predictors of acute kidney dysfunction (AKD) events in patients with hepatitis C has not been studied.Methods: We investigated viral and non-viral factors in the development renal dysfunction in 468 HCV patients retrospectively over a period of observation ranging from 3 months to 6 yrs.Results: A total of 124 AKD events occurred in 63 patients. On regression analysis; gender, race, alcohol abuse, HIV (Human immune deficiency virus) status, body mass index, baseline viral load (HCV–PCR), and genotype did not predict an event of AKD. Decompensated liver disease, history of IVDU, diabetes mellitus and baseline creatinine were independent predictors of AKD.Conclusion: Development of AKD in patient with hepatitis C virus infection is independent of the genotype and viral load at baseline and is mostly predisposed by known prevalent factors in patients with hepatitis C such as diabetes, hypertension and intravenous drug use. Decompensated liver disease is the single most viral-related factor that predisposes for AKD.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-02-03
      DOI: 10.1016/j.jceh.2014.01.004
      Issue No: Vol. 4, No. 1 (2014)
  • Assessment of the Model for End-stage Liver Disease (MELD) Score in
           Predicting Prognosis of Patients with Alcoholic Hepatitis
    • Authors: Sundeep K. Goyal; Vinod K. Dixit, Ashok K. Jain, Pradeep K. Mohapatra, Jayant K. Ghosh
      Pages: 19 - 24
      Abstract: Background: Traditionally, Maddrey discriminant function (DF) score has been used for stratifying the prognosis of alcoholic hepatitis. Recently, the Model for end-stage liver disease (MELD) score has been applied to alcoholic hepatitis and some investigators consider MELD score as a better prognostic indicator. Another new prognostic approach, Lille model has been also suggested to accurately identify patients at high risk of death. Therefore, this prospective study was aimed to compare MELD, DF, Child–Turcotte–Pugh (CTP) scores and Lille model for predicting the short-term mortality in Indian patients with alcoholic hepatitis.Methods: We calculated the DF, CTP, MELD and Lille scores in patients hospitalized with alcoholic hepatitis & evaluated if the scores predicted in-hospital mortality.Results: A total of 104 patients were enrolled and thirty-two (30.7%) patients died during the hospitalization (2–30 days). Admission DF score (OR 1.1, P  14 at admission and >12 at day 7 had high sensitivity and specificity in predicting short-term mortality (96%, 89% and 95%, 98% respectively). The cutoff of 0.45 for the Lille model was able to identify 79% of the observed deaths, whereas DF score ≥32 for DF were able to identify 85%.Conclusion: MELD score, as a predictive model for assessment of short-term mortality in alcoholic hepatitis is better than CTP and comparable to DF and Lille model.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-02-14
      DOI: 10.1016/j.jceh.2014.02.006
      Issue No: Vol. 4, No. 1 (2014)
  • Gaucher Disease
    • Authors: Aabha Nagral
      Pages: 37 - 50
      Abstract: Gaucher disease is the commonest lysosomal storage disease seen in India and worldwide. It should be considered in any child or adult with an unexplained splenohepatomegaly and cytopenia which are seen in the three types of Gaucher disease. Type 1 is the non-neuronopathic form and type 2 and 3 are the neuronopathic forms. Type 2 is a more severe neuronopathic form leading to mortality by 2 years of age. Definitive diagnosis is made by a blood test–the glucocerebrosidase assay. There is no role for histological examination of the bone marrow, liver or spleen for diagnosis of the disease. Molecular studies for mutations are useful for confirming diagnosis, screening family members and prognosticating the disease. A splenectomy should not be performed except for palliation or when there is no response to enzyme replacement treatment or no possibility of getting any definitive treatment. Splenectomy may worsen skeletal and lung manifestations in Gaucher disease. Enzyme replacement therapy (ERT) has completely revolutionized the prognosis and is now the standard of care for patients with this disease. Best results are seen in type 1 disease with good resolution of splenohepatomegaly, cytopenia and bone symptoms. Neurological symptoms in type 3 disease need supportive care. ERT is of no benefit in type 2 disease. Monitoring of patients on ERT involves evaluation of growth, blood counts, liver and spleen size and biomarkers such as chitotriosidase which reflect the disease burden. Therapy with ERT is very expensive and though patients in India have so far got the drug through a charitable access programme, there is a need for the government to facilitate access to treatment for this potentially curable disease. Bone marrow transplantation is an inferior option but may be considered when access to expensive ERT is not possible.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-02-13
      DOI: 10.1016/j.jceh.2014.02.005
      Issue No: Vol. 4, No. 1 (2014)
  • Autophagy Modulation As a Potential Therapeutic Target for Liver Diseases
    • Authors: Pankaj Puri; Alok Chandra
      Pages: 51 - 59
      Abstract: Autophagy is a critical intracellular pathway which maintains cellular function by lysosomal degradation of damaged proteins and organelles besides elimination of invading pathogens. Its primary function is to prevent cell death. Autophagy has diverse physiological functions namely; starvation adaptation, prevention of tumorigenesis, energy homeostasis, intracellular quality control and degradation of abnormal intracellular protein aggregates. Understanding the molecular mechanisms of autophagy has given key insights into the pathogenesis of various diseases like Non Alcoholic Steato-Hepatitis, Hepatitis B and C infections, Alpha-1 antitrypsin deficiency and hepatocellular carcinoma. Pharmacological modulation of autophagy may have a therapeutic potential in management of these liver diseases.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-21
      DOI: 10.1016/j.jceh.2014.04.001
      Issue No: Vol. 4, No. 1 (2014)
  • Pseudoparallel Channel Sign on Ultrasonography in Alcoholic Hepatitis
    • Authors: Vijay Bodh; Navin Kalra, Radha K. Dhiman
      Pages: 68 - 70
      Abstract: A 27-year-old male presented with yellowish discoloration of eyes and urine for 1 month with a history of hematemesis 1 month back. He had history of chronic alcohol consumption, of around 80–100 g/day ethanol for last 8 years with last intake 20 days ago. Physical examination revealed pallor, deep icterus, hepatomegaly of 5 cm below right costal margin, smooth and mildly tender and a hepatic bruit on auscultation. There was no splenomegaly and free fluid in the abdomen. Hemoglobin was 8.7 g/dL, total leukocyte count 16,000/mm3, platelet count 174,000/mm3, and prothrombin time was 18 s prolonged with an INR 2.22. Liver function tests revealed total bilirubin of 15 with a conjugated fraction of 8 mg/dL with aspartate aminotransferase level of 223 IU/mL, alanine aminotransferase of 69 IU/mL, alkaline phosphatase of 135 IU/mL and serum albumin of 2.6 g/dL. His renal parameters were normal. His viral markers (hepatitis B surface antigen and antibody to hepatitis C virus) were negative. Upper gastrointestinal endoscopy showed grade II–III esophageal varices with cherry red spots for which variceal band ligation was performed. His Maddrey's discriminant score was 97.8 and model for end stage liver disease score was 27. His ultrasound showed large liver with irregular surface, heterogenous echotexture and splenomegaly. Ultrasonography also demonstrated the findings, which were suggestive of alcoholic hepatitis.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-21
      DOI: 10.1016/j.jceh.2014.04.002
      Issue No: Vol. 4, No. 1 (2014)
  • Preclinical Liver Bud Engineering towards Clinical Target for Liver
    • Pages: 71 - 74
      Abstract: Takebe T, Sekine K, Enomura M, Koike H, Kimura M, Ogaeri T, Zhang RR, Ueno Y, Zheng YW, Koike N, Aoyama S, Adachi Y, Taniguchi H. Vascularized and functional human liver from an iPSC-derived organ bud transplant. Nature. 2013;499:481–484.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-21
      DOI: 10.1016/j.jceh.2014.02.151
      Issue No: Vol. 4, No. 1 (2014)
  • Shortcut Route for Generation of Functional Hepatocyte Cells from Human
           Skin Allogenically for Autologous Treatment of Chronic Liver Diseases
    • Authors: Shibashish Giri; Augustinus Bader
      Pages: 74 - 78
      Abstract: Zhu Sa, Rezvani Mb, Harbell Jc, Mattis ANb,d,e, Wolfe ARf, Benet LZf, Willenbring Hb,c,d, Ding Sa,g. Mouse liver repopulation with hepatocytes generated from human fibroblasts. Nature. 2014;508(7494):93–97.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-21
      DOI: 10.1016/j.jceh.2014.03.051
      Issue No: Vol. 4, No. 1 (2014)
  • Hepatobiliary Quiz—9 (2014)
    • Authors: Swastik Agrawal; Radha K. Dhiman
      Pages: 79 - 80
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-16
      DOI: 10.1016/j.jceh.2014.03.053
      Issue No: Vol. 4, No. 1 (2014)
  • Hepatobiliary Quiz—9 (2014)
    • Authors: Swastik Agrawal; Radha K. Dhiman
      Pages: 81 - 84
      Abstract: Correct answers: 1 and 3
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2014-04-16
      DOI: 10.1016/j.jceh.2014.03.054
      Issue No: Vol. 4, No. 1 (2014)
  • HLA DRB1 Alleles Discriminate the Manifestation of Autoimmune Hepatitis as
           Type 1 or Type 2 in North Indian Population
    • Authors: Navchetan Kaur; Ranjana W. Minz, Shashi Anand, Biman Saikia, Ritu Aggarwal, Ashim Das, Babu R. Thapa, Yogesh K. Chawla
      Pages: 14 - 18
      Abstract: Background: Autoimmune hepatitis is a polygenic disorder of unknown etiology, where genetic factors affect the occurrence and clinical phenotype of the disease. It has been reported as a rare disease entity in the Indian subcontinent. This study was undertaken to investigate the association of HLA alleles with autoimmune hepatitis type 1 and type 2 in north Indian population and to analyze if distinct human leukocyte antigen (HLA) alleles help in characterization of the subtypes of autoimmune hepatitis.Methods: Sixty-eight patients with autoimmune hepatitis and 128 healthy controls were recruited in the study. Out of 68 patients, 55 were diagnosed with autoimmune hepatitis type 1 and 13 with autoimmune hepatitis type 2. The patients and the controls were typed for HLA class II alleles by PCR-SSP method.Results: HLA DRB1*04 and DRB1*08 were found to be significantly associated with autoimmune hepatitis type 1 in north Indian population. It was also observed that DRB1*04, DRB1*13 were significantly associated with pediatric autoimmune hepatitis type 1 and DRB1*08 was significantly associated with adult autoimmune hepatitis type 1. DRB1*14 was significantly associated with autoimmune hepatitis type 2.Conclusion: The study indicates that autoimmune hepatitis in north Indian population is associated with HLA alleles that may help to discriminate the subtypes as autoimmune hepatitis type 1 and type 2. The study also highlights the ethnic variations in the Indian subcontinent in context to the genetic association of HLA with autoimmune diseases.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2013-12-09
      DOI: 10.1016/j.jceh.2013.12.002
      Issue No: Vol. 4, No. 1 (2013)
  • Progressive Familial Intrahepatic Cholestasis
    • Authors: Anshu Srivastava
      Pages: 25 - 36
      Abstract: Progressive familial intrahepatic cholestasis (PFIC) is a group of rare disorders which are caused by defect in bile secretion and present with intrahepatic cholestasis, usually in infancy and childhood. These are autosomal recessive in inheritance. The estimated incidence is about 1 per 50,000 to 1 per 100,000 births, although exact prevalence is not known. These diseases affect both the genders equally and have been reported from all geographical areas. Based on clinical presentation, laboratory findings, liver histology and genetic defect, these are broadly divided into three types—PFIC type 1, PFIC type 2 and PFIC type 3. The defect is in ATP8B1 gene encoding the FIC1 protein, ABCB 11 gene encoding BSEP protein and ABCB4 gene encoding MDR3 protein in PFIC1, 2 and 3 respectively. The basic defect is impaired bile salt secretion in PFIC1/2 whereas in PFIC3, it is reduced biliary phospholipid secretion. The main clinical presentation is in the form of cholestatic jaundice and pruritus. Serum gamma glutamyl transpeptidase (GGT) is normal in patients with PFIC1/2 while it is raised in patients with PFIC3. Treatment includes nutritional support (adequate calories, supplementation of fat soluble vitamins and medium chain triglycerides) and use of medications to relieve pruritus as initial therapy followed by biliary diversion procedures in selected patients. Ultimately liver transplantation is needed in most patients as they develop progressive liver fibrosis, cirrhosis and end stage liver disease. Due to the high risk of developing liver tumors in PFIC2 patients, monitoring is recommended from infancy. Mutation targeted pharmacotherapy, gene therapy and hepatocyte transplantation are being explored as future therapeutic options.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2013-11-11
      Issue No: Vol. 4, No. 1 (2013)
  • Embolization of Portosystemic Shunt for Treatment of Recurrent Hepatic
    • Authors: Rajesh Gopalakrishna; Preetham S. Hurkadli, Nazar K. Puthukudy, Harikumar R. Nair
      Pages: 60 - 62
      Abstract: Hepatic encephalopathy in the setting of advanced chronic liver disease, occurs following a precipitating factor and generally responds to correction of the precipitating factor and anticoma measures. We report the case of a lady with Child A cirrhosis who presented with frequent episodes of hepatic encephalopathy without any precipitating factors. She was found to be having a large portosystemic shunt. The shunt was obliterated by coil embolotherapy following which there was no further episodes of encephalopathy.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2013-12-09
      DOI: 10.1016/j.jceh.2013.12.001
      Issue No: Vol. 4, No. 1 (2013)
  • Combined Uphill and Downhill Varices as a Consequence of Rheumatic Heart
           Disease: A Unique Presentation
    • Authors: Yogesh P. Harwani; Ajit Kumar, Akash Chaudhary, Manoj Kumar, Padmavathi R. Choudeswari, Vishnu V. Kankanala, Nayana Joshi, Chintan Kansagra, Sandip Shah, Abhisheka Tripathi
      Pages: 63 - 65
      Abstract: Hemorrhage from downhill varices is a rare manifestation. The etiology of downhill varices is due to superior vena cava obstruction while uphill varices are secondary to portal hypertension. We report a rare case of 55-year-old female with bleeding downhill varices not associated with obstruction or compression of superior vena cava, but was due to severe pulmonary artery hypertension secondary to chronic rheumatic heart disease.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2013-11-06
      Issue No: Vol. 4, No. 1 (2013)
  • Grave's Disease and Primary Biliary Cirrhosis—An Unusual and
           Challenging Association
    • Authors: Shiran Shetty; Senthilkumar Rajasekaran, Leela Venkatakrishnan
      Pages: 66 - 67
      Abstract: Jaundice in Grave's diseases is uncommon, but when it does occur, complication of thyrotoxicosis (heart failure/infection) or intrinsic liver disease should be considered. Grave's disease can cause asymptomatic elevation of liver enzymes, jaundice and rarely acute liver failure. It is associated with other autoimmune diseases like autoimmune hepatitis, or primary biliary cirrhosis. The cause of jaundice in Grave's disease is multifactorial.
      Citation: Journal of Clinical & Experimental Hepatology 4, 1 (2014)
      PubDate: 2013-08-12
      DOI: 10.1016/j.jceh.2013.08.001
      Issue No: Vol. 4, No. 1 (2013)
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