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Journal of Clinical and Experimental Hepatology

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ISSN (Print) 0973-6883
Published by Elsevier

[2564 journals]

Editorial Board
- Pages: iii - iii
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-03-01
  DOI: 10.1016/S0973-6883(13)00476-3
  Issue No: Vol. 3, No. 1 (2013)
The Third Year: Thrice As Good!
- Authors: Radha K. Dhiman
  Pages: 1 - 1
  Abstract: The Journal of Clinical and Experimental Hepatology (JCEH) has completed two years of publication and is entering its third year. It has the enviable record of not having missed or delayed a single issue so far. It has gone from strength to strength with every issue, which is thicker, slicker and better received than the previous one. It is now poised to do even better in its third year.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-03-01
  DOI: 10.1016/j.jceh.2013.03.001
  Issue No: Vol. 3, No. 1 (2013)
Quo Vadis: From Oxidative Stress to Gamma-Glutamyltransferase Upregulation to Mortality
- Authors: Rohini Mehta; Aybike Birerdinc, Zobair Younossi
  Pages: 2 - 3
  Abstract: Serum levels of the hepatobiliary enzyme gamma-glutamyltransferase or gamma-glutamyl transpeptidase (GGT) have recently been associated with hepatic involvement of patients with atherosclerotic cardiovascular disease (CVD). In the current issue of JCEH, Loomba et al. report a study showing that elevated serum GGT (>51 U/L in men and >33 U/L in women) seems to be an independent predictor of CVD, liver mortality and all-cause mortality in older adults (mean age 70 years). These observations were made in a prospective study of 2,364 individuals. The study results indicate that individuals with elevated GGT were more likely to be obese, hypertensive with higher systolic blood pressure, dyslipidemic, and diabetic. These risk factors are associated with the profile of an individual with metabolic syndrome who may have a very high likelihood of having underlying non-alcoholic fatty liver disease (NAFLD).
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-03-01
  DOI: 10.1016/j.jceh.2013.02.004
  Issue No: Vol. 3, No. 1 (2013)
Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection
- Authors: Barjesh C. Sharma; Ameet K. Banka, Ajit Rawat, Siddharth Srivastava
  Pages: 19 - 23
  Abstract: Background: Gastric varices are found in patients with portal hypertension. Incidence of bleeding from gastric varices is relatively low, but tends to be more severe, and is associated with higher mortality than esophageal variceal bleeding.Aims and objectives: To compare the prevalence and types of gastric varices in cirrhosis versus extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection.Methods: Eighty six patients presenting with bleeding from gastric varices between August 2010 and August 2011 were retrospectively analyzed.Results: Of 86 patients, 65% (n = 56) were cirrhotics and 35% (n = 30) had EHPVO. Distribution of types of gastric varices showed GOV1 in 14% (n = 8) of cirrhotics vs. 7% (n = 2) of EHPVO, GOV2 in 80% (n = 45) of cirrhotics vs. 53% (n = 16) of EHPVO, IGV1 in 40% (n = 12) of patients with EHPVO vs. 4% (n = 2) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 3.7 ± 2.58 ml over a median of 1 session (range: 1–8). The total volume of glue required was lower in cirrhotics (3.2 ± 2 ml vs. 4.7 ± 3.1 ml, p 1 sessions of glue injection as compared to 17 (57%) of EHPVO patients. Over mean follow up of 12 months, rebleeding (9% vs. 10%) and mortality (11% vs. 3%) were similar in patients with cirrhosis and EHPVO.Conclusions: In patients with bleeding from gastric varices, GOV2 is more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for gastric varix obturation.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-01-28
  DOI: 10.1016/j.jceh.2013.01.002
  Issue No: Vol. 3, No. 1 (2013)
Profile of Hepatitis B Virus, Hepatitis C Virus, Hepatitis D Virus and Human Immunodeficiency Virus Infections in Hemodialysis Patients of a Tertiary Care Hospital in Uttarakhand
- Authors: Garima Mittal; Pratima Gupta, Bhaskar Thakuria, Gulshan K. Mukhiya, Manish Mittal
  Pages: 24 - 28
  Abstract: Background and aim: Viral hepatitis and human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality in hemodialysis (HD) patients. The present study was performed to assess the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and HIV infections in hemodialysis patients of a tertiary care hospital in Uttarakhand.Methods: All patients undergoing maintenance HD at our center were screened for hepatitis B surface antigen (HBsAg), antibody to HCV (anti-HCV), antibody to HDV (anti-HDV) and HIV antibody by ELISA. Detailed history regarding age, sex, duration of dialysis, blood transfusions, number of dialysis centers, dialyzer reuse and laboratory data was recorded.Results: A total of 118 patients (79 males and 39 females) were followed for 18 months with screening for the presence of HBV, HCV and HIV infections. At baseline, 12 (10.2%) patients were positive for HBsAg, 19 (16.1%) for anti-HCV and 2 (1.7%) for HIV antibody. Over 18 months, one additional patient became HBsAg positive and an additional 17 became anti-HCV-positive to give a total of 36 HCV-positive patients. Dual HBV and HCV infection was seen in 5 (4.2%) and anti-HDV antibodies were found in 1 (0.9%) patient. History of blood transfusions, duration of HD, dialyzer reuse and dialysis at multiple centers were found to be important risk factors for anti-HCV positivity.Conclusions: Implementation and adherence to universal work precautions by dialysis staff is imperative to prevent transmission of these infections.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-11
  DOI: 10.1016/j.jceh.2013.02.003
  Issue No: Vol. 3, No. 1 (2013)
Protective Effect of Black Tea Infusion on Aflatoxin-Induced Hepatotoxicity in Mice
- Authors: Anamika Jha; Rajesh Krithika, Dave Manjeet, Ramtej J. Verma
  Pages: 29 - 36
  Abstract: Background: Aflatoxins are a group of mycotoxins produced by Aspergillus flavus and Aspergillus parasiticus and are potent inducers of hepatotoxicity.Objective: The present study was carried out to investigate the effect of black tea infusion on aflatoxin—induced hepatotoxicity in male mice.Methods: A 2% black tea infusion in drinking water was prepared and orally administered along with aflatoxin (750 and 1500 μg/kg body weight) for 30 days. Morphological investigation, body weight and organ weight calculations and histopathological analysis were carried out. Serum hepatic marker enzymes namely alanine aminotransferase and aspartate aminotransferase were estimated.Results: The results clearly indicated that aflatoxin treatment for 30 days caused significant dose-dependent reduction in body weight and increase in liver weight. The activities of ALT and AST were found to be elevated while protein content was found to be decreased in aflatoxin-treated mice as compared to vehicle control. Histopathological analysis showed hepatocellular necrosis and cytoplasmic vacuolization along with fatty infiltration in toxin-treated animals. Results revealed significant (p
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-01-23
  DOI: 10.1016/j.jceh.2012.12.003
  Issue No: Vol. 3, No. 1 (2013)
Successful Treatment of Rapid Onset, Symptomatic de novo Non-alcoholic Steatohepatitis Following Liver Transplantation: A Case Report
- Authors: Justin R. Cuschieri; Bijo K. John, Ronald Miick, Jorge A. Ortiz, Nikroo Hashemi
  Pages: 70 - 74
  Abstract: A 45 year old female with a body mass index (BMI) of 24 underwent successful liver transplantation (LT) for alcoholic cirrhosis using a donor liver from an obese woman with microvesicular steatosis (80%) and minimal macrovesicular steatosis (5–10%) on liver biopsy. Ascites and hepatosplenomegaly developed soon after LT with progressive increase of serum alkaline phosphatase to 1340 IU/L while aspartate aminotransferase (AST), and alanine transaminase (ALT), and total bilirubin remained normal. Imaging showed marked hepatomegaly, extensive fatty infiltration of the liver, and compression of the hepatic veins with narrowing of the intrahepatic inferior vena cava (IVC). Liver biopsy on post-operative day 39 revealed 90–100% macrovesicular steatosis, steatohepatitis, and portal fibrosis. A hepatic venogram showed a 10 cm segment of intrahepatic IVC stenosis that was stented, improving portal venous pressure measurements. However, portal hypertension requiring diuretic therapy and multiple paracenteses remained. By 3 months after LT, her liver had grown to 22 cm, transaminases increased 2–4 times the upper limit of normal with a 2:1 AST to ALT ratio. Liver biopsy at post-LT day 82 showed no change in steatosis and steatohepatitis despite corticosteroid withdrawal and interval periportal and perisinusoidal fibrosis. 12 weeks after LT, the patient was found to have low apolipoprotein B (65 mg/dL), high-density lipoprotein (HDL) (
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-01-28
  DOI: 10.1016/j.jceh.2013.01.001
  Issue No: Vol. 3, No. 1 (2013)
A patient with unexplained ascites
- Authors: Pankaj Tyagi; Praveen Sharma, Ashish Kumar, Rinkesh K. Bansal, Vikas Singla, Naresh Bansal, Anil Arora
  Pages: 75 - 75
  Abstract: Sixty-two-year old male presented with history of low-grade fever, progressive abdominal swelling, weight loss and anorexia from the last one year. Patient was evaluated for the ascites in the peripheral hospital but diagnosis could not be made. Patient underwent contrast-enhanced computed tomography (CECT) abdomen for the workup (A), which helped in the diagnosis.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-11
  DOI: 10.1016/j.jceh.2013.01.006
  Issue No: Vol. 3, No. 1 (2013)
Interferon-Free Regimens for Chronic Hepatitis C—A Step Forward
- Authors: Ajay Duseja
  Pages: 76 - 78
  Abstract: Poordad F, Lawitz E, Kowdley KV, Cohen DE, Podsadecki T, Siggelkow S, Heckaman M, Larsen L, Menon R, Koev G, Tripathi R, Pilot-Matias T, Bernstein B. Exploratory study of oral combination antiviral therapy for hepatitis C. N Engl J Med. 2013 Jan 3; 368(1):45–53.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-11
  DOI: 10.1016/j.jceh.2013.02.002
  Issue No: Vol. 3, No. 1 (2013)
Hepatobiliary Quiz-5 (2013)
- Authors: Swastik Agrawal; Radha K. Dhiman
  Pages: 79 - 80
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-04
  DOI: 10.1016/j.jceh.2013.01.003
  Issue No: Vol. 3, No. 1 (2013)
Hepatobiliary Quiz-5 (2013)
- Authors: Swastik Agrawal; Radha K. Dhiman
  Pages: 81 - 85
  Abstract: Answers to Multiple Choice Questions No worsening of liver disease occurs in the majority of women suffering from chronic hepatitis B virus (HBV) infection during pregnancy and liver enzymes frequently normalize. Due to pregnancy related immunosupression there is an overall increase in median HBV DNA levels and decreased alanine aminotransferase (ALT) levels. A significant increase in liver disease activity after pregnancy, defined as a three times increase in alanine aminotransferase (ALT) occurs in 45% of patients within 6 months after delivery. Mother to child transmission of hepatitis B occurs in 70–90% cases if mother is HBeAg positive but only
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-04
  DOI: 10.1016/j.jceh.2013.01.004
  Issue No: Vol. 3, No. 1 (2013)
Scalloping of Liver in a Patient with Ascites: Pseudomyxoma Peritonei
- Pages: 87 - 87
  Abstract: Axial contrast-enhanced computer tomography (CECT) showed the classical and diagnostic image of scalloping of the liver surface which is seen in pseudomyxoma peritonei (B). Section shows abundant mucin with a fragment of epithelial clusters lined by tall columnar mucin secreting cells ().
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2013-02-11
  DOI: 10.1016/j.jceh.2013.02.001
  Issue No: Vol. 3, No. 1 (2013)
Serum γ-Glutamyltranspeptidase Predicts All-cause, Cardiovascular and Liver Mortality in Older Adults
- Authors: Rohit Loomba; Iliana Doycheva, Ricki Bettencourt, Benjamin Cohen, Christina L. Wassel, David Brenner, Elizabeth Barrett-Connor
  Pages: 4 - 11
  Abstract: Background: Serum γ-glutamyltranspeptidase (GGT), a marker of fatty liver disease (FLD), predicts mortality in young adults. However, the association between serum GGT and mortality in older adults is unclear.Objectives: To examine if elevated serum GGT predicts all-cause, cardiovascular disease (CVD), and liver mortality in community-dwelling older adults.Design and setting: A prospective cohort study including 2364 participants (mean age 70 years, BMI-24.5 kg/m2, 54% women) from the Rancho Bernardo Study who attended a research visit in 1984–87 when multiple metabolic co-variates were ascertained including serum GGT. They were followed for a mean (±standard deviation) of 13.7 (±6.2) years.Measurement: Multi-variable-adjusted Cox-proportional hazards analyses were conducted to examine the association between elevated serum GGT (>51 U/L in men and >33 U/L in women) and all-cause, CVD, and liver mortality.Results: In these older men and women, cumulative mortality was 56.2% (n = 1329) with CVD and liver mortality accounting for 49.4% and 2.3% of all deaths, respectively, over 32,387 person-years of follow-up. In multivariate analyses (adjusted for age, sex, alcohol use, body mass index, total cholesterol, HDL cholesterol, serum triglyceride, smoking status, systolic blood pressure, diabetes mellitus, serum interleukin-6, and C-reactive protein), serum GGT elevation was significantly associated with all-cause (HR, 1.55, 95%CI, 1.21–1.98), CVD (HR, 1.51, 95%CI, 1.04–2.17), and liver mortality (HR, 9.10, 95%CI, 3.42–24.26).Conclusions: In community-dwelling older adults, serum GGT is an independent predictor of all-cause, CVD, and liver mortality.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-10-22
  Issue No: Vol. 3, No. 1 (2012)
Patients with Nonalcoholic Fatty Liver Disease (NAFLD) have Higher Oxidative Stress in Comparison to Chronic Viral Hepatitis
- Authors: Amit Kumar; Arun Sharma, Ajay Duseja, Ashim Das, Radha K. Dhiman, Yogesh K. Chawla, Krishan K. Kohli, Anil Bhansali
  Pages: 12 - 18
  Abstract: Introduction: Oxidative stress and cytokines play an important role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). We compared the presence of oxidative stress and cytokines in 25 patients with NAFLD with 25 age, sex and BMI-matched patients with chronic viral hepatitis (CVH) and 25 healthy volunteers (HV).Methodology: Oxidative stress was studied biochemically by markers of lipid peroxidation and biochemical assessment of anti-oxidant status and various cytokines were studied by ELISA.Results: Patients with NAFLD had significantly higher levels of malondialdehyde (MDA) (p = 0.000) and conjugated dienes (CD) (p = 0.000) in comparison to HVs. Patients with NAFLD also had significantly higher MDA levels (p = 0.000) in comparison to CVH patients. Patients with NAFLD had significantly lower GSH levels (p = 0.004) in comparison to HVs. Patients with NAFLD had higher GPx activity (p = 0.028) in comparison to HVs. Catalase activity was significantly decreased in both NAFLD (p = 0.001) and CVH patients (p = 0.000) in comparison to HVs. Patients with NAFLD had significantly higher SOD activity (p = 0.000) in comparison to CVH patients. There was no difference in serum levels of IL-1β and TNF-α amongst three groups. Patients with CVH were found to have higher IL-8 serum levels (p = 0.039) in comparison to HVs. CVH patients also had higher TGF-β levels (p = 0.002) in comparison to both NAFLD patients and HVs.Conclusion: Differences in the markers of oxidative stress and anti-oxidant status between NAFLD, CVH and healthy volunteers suggest presence of higher oxidative stress in patients with NAFLD.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-11-05
  Issue No: Vol. 3, No. 1 (2012)
Hepatotoxicity Related to Anti-tuberculosis Drugs: Mechanisms and Management
- Authors: Vidyasagar Ramappa; Guruprasad P. Aithal
  Pages: 37 - 49
  Abstract: Development of idiosyncratic hepatotoxicity is an intricate process involving both concurrent as well as sequential events determining the direction of the pathways, degree of liver injury and its outcome. Decades of clinical observation have identified a number of drug and host related factors that are associated with an increased risk of antituberculous drug-induced hepatotoxicity, although majority of the studies are retrospective with varied case definitions and sample sizes. Investigations on genetic susceptibility to hepatotoxicity have so far focused on formation and accumulation reactive metabolite as well as factors that contribute to cellular antioxidant defense mechanisms and the environment which can modulate the threshold for hepatocyte death secondary to oxidative stress. Recent advances in pharmacogenetics have promised the development of refined algorithms including drug, host and environmental risk factors that allow better tailoring of medications based on accurate estimates of risk–benefit ratio. Future investigations exploring the pathogenesis of hepatotoxicity should be performed using human tissue and samples whenever possible, so that the novel findings can be translated readily into clinical applications.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-12-20
  DOI: 10.1016/j.jceh.2012.12.001
  Issue No: Vol. 3, No. 1 (2012)
Model for End-stage Liver Disease
- Authors: Ashwani K. Singal; Patrick S. Kamath
  Pages: 50 - 60
  Abstract: Model for end-stage liver disease (MELD) score, initially developed to predict survival following transjugular intrahepatic portosystemic shunt was subsequently found to be accurate predictor of mortality amongst patents with end-stage liver disease. Since 2002, MELD score using 3 objective variables (serum bilirubin, serum creatinine, and institutional normalized ratio) has been used worldwide for listing and transplanting patients with end-stage liver disease allowing transplanting sicker patients first irrespective of the wait time on the list. MELD score has also been shown to be accurate predictor of survival amongst patients with alcoholic hepatitis, following variceal hemorrhage, infections in cirrhosis, after surgery in patients with cirrhosis including liver resection, trauma, and hepatorenal syndrome (HRS). Although, MELD score is closest to the ideal score, there are some limitations including its inaccuracy in predicting survival in 15–20% cases. Over the last decade, many efforts have been made to further improve and refine MELD score. Until, a better score is developed, liver allocation would continue based on the currently used MELD score.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-12-03
  DOI: 10.1016/j.jceh.2012.11.002
  Issue No: Vol. 3, No. 1 (2012)
Living Donor Liver Transplant is a Transparent Activity in India
- Authors: Subash Gupta
  Pages: 61 - 65
  Abstract: Living donor liver transplant (LDLT) has progressed rapidly in India with at least two major centers performing over 200 transplants annually. There have been concerns regarding donor safety as donor deaths have been reported worldwide. In India, there is a possible underreporting of donor complications and mortality leading to the allegation that LDLT is a clandestine activity.Deceased donor liver transplantation activity may be less transparent as there are no national guidelines for retrieval and allocation of organs. LDLT is for a named person and as the activity can only be conducted in major hospitals with involvement of over 100 medical personnel in each operation, it cannot be a clandestine operation. Government regulations require licensing of hospitals following inspection by senior doctors and reporting of transplant activity periodically.About 2500 living donor liver transplants have been conducted in India and there have been 7 donor deaths reported in India. Rather than not being transparent, donor morbidity and mortality has received excessive media attention.Most liver transplant activity in India is well organized with clearance from hepatologists and anesthetists. Unrelated donation needs to be cleared from a State appointed Authorization Committee. Foreigners cannot be transplanted without State clearance and approval of the concerned embassy. The donor risk is discussed and the success of the recipient operation is also explained to all patients.The ever-increasing popularity of the operation in spite of the high cost and the requirement for donation from a family member suggests that many patients are living healthy life after transplantation. Overall LDLT is a transparent activity in India.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-10-16
  Issue No: Vol. 3, No. 1 (2012)
Living Donor Liver Transplant is not a Transparent Activity in India
- Authors: Sudeep Naidu
  Pages: 66 - 69
  Abstract: Living donor liver transplant has gained rapid popularity in India as a life saving procedure for end stage liver disease. The undoubted benefit for the recipient is clouded by a few unfavorable outcomes in donors which have led to allegations of lack of transparency. These factors are easily remediable with an attitude of self audit and self disclosure by transplant centers, enabling a truly informed consenting procedure.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-10-16
  Issue No: Vol. 3, No. 1 (2012)
High Incidence of Telaprevir-associated Severe Rash Leading to Discontinuation
- Authors: Marina Núñez
  Pages: 86 - 86
  Abstract: Telaprevir postmarketing experience is accumulating after more than one year of use since approval by the FDA. The clinical trials had revealed skin rash as one of the most characteristic side effects of telaprevir. Although mild-to-moderate rash was frequent, only was severe enough to cause discontinuation in 5–7% of patients in those trials. In my practice, the incidence of severe telaprevir-associated rash has been much higher. The first thirty-three patients treated with telaprevir along with pegylated interferon and ribavirin were evaluated. Of them, 23 (70%) were male; 16 (48.5%) white, 15 (45.5%) black, 1 (3%) Native American and 1 (3%) Asian; three were HIV-co-infected; and the age range was 28–70 yearsold. Severe rash was defined as that involving more than 50% of body surface or rash with the appearance of major systemic signs or symptoms. Out of the 33 patients, three (9.3%) developed a severe telaprevir-associated severe rash leading to telaprevir discontinuation within the first week of therapy (cases 1–3 of ). Of note, severe rash within the first few days of telaprevir was more frequent among females (2/10, 20%) compared to males (1/23, 4.3%). Three other patients developed severe rash between weeks 6–12 (cases 4–6 of ). All in all, the total incidence of severe rash leading to telaprevir discontinuation was 18% (6/33). The allergic reaction resolved after telaprevir discontinuation in all cases. Additional information is included in . Therefore, this severe side effect was much more frequent in this small series than previously reported. It is unclear if the high incidence of rash in females within the first week of therapy, which in the two cases had manifestations beyond the skin, represents a true association or it is a spurious finding. It is unknown if drug allergic reactions early into treatment have the same mechanism as late rashes. The higher incidence of severe rash in our series is not explained by disparity in the proportion of females since it was comparable to the trials (29–45%). Given the negative consequences of severe rash (risks to the patients, treatment failure, increased costs), it would be helpful to be able to predict it based on factors. Additional data from larger series are awaited.
  Citation: Journal of Clinical & Experimental Hepatology 3, 1 (2013)
  PubDate: 2012-12-26
  DOI: 10.1016/j.jceh.2012.12.002
  Issue No: Vol. 3, No. 1 (2012)