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World Journal of Gastroenterology Dec 2016Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and... (Review)
Review
Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.
Topics: Abdominal Pain; Bile Duct Diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholangitis; Cholecystitis; Cholelithiasis; Constriction, Pathologic; Humans; Hypertension, Portal; Jaundice, Obstructive; Portal Vein; Portasystemic Shunt, Surgical; Portasystemic Shunt, Transjugular Intrahepatic
PubMed: 28018098
DOI: 10.3748/wjg.v22.i45.9909 -
Pancreas Jul 2016The aim of this study was to quantify the risk of pancreatic cancer in patients presenting in primary care with symptoms that may indicate pancreatic cancer. (Review)
Review
OBJECTIVES
The aim of this study was to quantify the risk of pancreatic cancer in patients presenting in primary care with symptoms that may indicate pancreatic cancer.
METHODS
We searched MEDLINE, PreMEDLINE, EMBASE, the Cochrane Library, Web of Science, and ISI Proceedings (1980 to August 2014) and PsychINFO (1980 to May 2013) for diagnostic studies of symptomatic adult patients in primary care. Study quality was assessed using QUADAS-II, and data were extracted to calculate the positive predictive values (PPVs) of symptoms, singly or in combination, for pancreatic cancer.
RESULTS
Eight studies with 3,438,363 patients were included. The PPV of jaundice was more than 4.1% in patients 40 years or older and increased with age, although only 30% of patients reported jaundice. The PPVs of other single symptoms were low, with the highest PPV being 1% for repeated attendance with abdominal pain in patients 60 years or older. Excluding jaundice, symptom combinations with high PPVs were those including weight loss, ranging from 1.5% to 2.7% in patients 60 years or older, apart from when weight loss was combined with malaise (PPV, 0.9%).
CONCLUSION
The only high-risk feature of pancreatic cancer in primary care was jaundice, and this clearly warrants investigation. Weight loss accompanied by a second symptom may warrant investigation, although this would probably require abdominal computed tomography.
Topics: Abdominal Pain; Adult; Diagnosis, Differential; Humans; Jaundice; Pancreatic Neoplasms; Primary Health Care; Risk Factors; Sensitivity and Specificity
PubMed: 26495795
DOI: 10.1097/MPA.0000000000000527 -
Phytomedicine : International Journal... Jun 2022Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation.
PURPOSE
To systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence.
METHODS
Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions.
RESULTS
A total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI = 0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis.
CONCLUSION
Yinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings.
Topics: Bilirubin; Drugs, Chinese Herbal; Humans; Infant, Newborn; Jaundice; Jaundice, Neonatal; Multicenter Studies as Topic; Phototherapy
PubMed: 35325827
DOI: 10.1016/j.phymed.2022.154051 -
BMC Gastroenterology Oct 2022Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis,...
BACKGROUND
Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines.
OBJECTIVES
To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination.
METHODS
For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction.
RESULTS
Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy.
CONCLUSION
Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks.
Topics: Humans; Chronic Disease; COVID-19; COVID-19 Vaccines; Hepatitis, Autoimmune; Liver Failure, Acute; Vaccination; Venous Thrombosis
PubMed: 36229799
DOI: 10.1186/s12876-022-02507-3 -
Reviews in Medical Virology Jul 2024Liver involvement is an unusual yet frequently overlooked dengue complication. Pivotal for an efficient clinical management, the early diagnosis of dengue-associated...
Liver involvement is an unusual yet frequently overlooked dengue complication. Pivotal for an efficient clinical management, the early diagnosis of dengue-associated liver involvement relies on an accurate description of its clinical and biological characteristics, its prognosis factors, its association with severe dengue and its clinical management. We conducted a systematic review by searching PubMed and Web of Science databases for original case reports, cohort and cross-sectional studies reporting the clinical and/or biological features of dengue-associated liver involvement. The study was registered in PROSPERO (CRD42021262657). Of the 2552 articles identified, 167 were included. Dengue-associated liver involvement was characterised by clinical features including abdominal pain, hepatomegaly, jaundice, nausea/vomiting, and an echogenic liver exhibiting hepatocellular necrosis and minimal inflammation. Elevated Aspartate Aminotransferase and Alanine Aminotransferase but also elevated bilirubin, Alkaline Phosphatase, gamma-glutamyl transferase, increased International Normalised Ratio, creatinine and creatine kinase, lower albumin and prolonged prothrombin and activated partial thromboplastin time were prevalent in dengue-associated liver involvement. Cardiovascular and haematological systems were frequently affected, translating in a strong association with severe dengue. Liver involvement was more common in males and older adults. It was associated with dengue virus serotype-2 and secondary infections. Early paracetamol intake increased the risk of liver involvement, which clinical management was mostly conservative. In conclusion, this systematic review demonstrates that early monitoring of transaminases, clinical assessment, and ultrasound examination allow an efficient diagnosis of dengue-associated liver involvement, enabling the early identification and management of severe dengue.
Topics: Humans; Dengue; Dengue Virus; Liver; Liver Diseases
PubMed: 38923215
DOI: 10.1002/rmv.2564 -
Vaccine Sep 2020Vaccination of pregnant women against hepatitis A virus (HAV) or hepatitis B virus (HBV) may benefit the mother and the fetus but is not routinely recommended. However,... (Review)
Review
BACKGROUND
Vaccination of pregnant women against hepatitis A virus (HAV) or hepatitis B virus (HBV) may benefit the mother and the fetus but is not routinely recommended. However, the risk associated with vaccination should be weighed against the risk of HAV or HBV infection. Data on safety profiles after hepatitis A, B or combined AB immunization during pregnancy are limited.
METHODS
We searched the GSK Worldwide Safety Database for adverse events (AEs) following immunization of pregnant women with HAV (Havrix, GSK), HBV (Engerix-B, GSK) or the combined hepatitis AB (Twinrix, GSK) vaccine since market authorization through 31 January 2018, covering at least 25 years. AE reports (spontaneous, post-marketing surveillance and clinical trial cases) in the GSK Worldwide Safety Database were identified using a systematic search and were reviewed by clinicians to ascertain pregnancy status at time of vaccination and characterize adverse pregnancy outcomes, including pregnancy-related AEs and AEs in infants regardless of the causality assessment.
RESULTS
Overall, 613, 700 and 363 pregnancies with exposure to Havrix, Engerix-B and Twinrix, respectively, were reported. Of these, 378, 339 and 194 were analyzed. The most frequently identified pregnancy outcomes were live infants (288, 223 and 151), spontaneous abortions (43, 57 and 26) and elective terminations (25, 24 and 9). A total of 19, 29 and 10 cases of congenital anomalies were reported. Of these, 17, 20 and 7 were major birth defects. The most commonly reported pregnancy-related AE and AE in infants were premature delivery (28) and jaundice (11), respectively. No maternal deaths were reported. Congenital anomalies were reported in all recorded infant deaths.
CONCLUSIONS
This review did not indicate any concerning pattern of adverse pregnancy outcomes following exposure to any of the 3 vaccines during pregnancy.
Topics: Female; Hepatitis A Vaccines; Hepatitis B; Hepatitis B Vaccines; Humans; Infant; Pregnancy; Vaccination; Vaccines, Combined
PubMed: 32741674
DOI: 10.1016/j.vaccine.2020.07.041 -
International Journal of Pediatrics 2022The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the... (Review)
Review
BACKGROUND
The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review.
METHODS
Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI).
RESULTS
Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: <50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06; = 66%), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13; = 84%), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78; = 83%). The heterogeneity across studies was mild to moderate.
CONCLUSIONS
The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice.
PubMed: 35356100
DOI: 10.1155/2022/9161074 -
The Cochrane Database of Systematic... Sep 2018There is general agreement that oxytocin given either through the intramuscular or intravenous route is effective in reducing postpartum blood loss. However, it is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is general agreement that oxytocin given either through the intramuscular or intravenous route is effective in reducing postpartum blood loss. However, it is unclear whether the subtle differences between the mode of action of these routes have any effect on maternal and infant outcomes. This is an update of a review first published in 2012.
OBJECTIVES
To determine the comparative effectiveness and safety of oxytocin administered intramuscularly or intravenously for prophylactic management of the third stage of labour after vaginal birth.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 September 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised trials comparing intramuscular with intravenous oxytocin for prophylactic management of the third stage of labour after vaginal birth. We excluded quasi-randomised trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
Three studies with 1306 women are included in the review and compared intramuscular versus intravenous oxytocin administered just after the birth of the anterior shoulder or soon after the birth of the baby. Studies were carried out in hospital settings in Turkey and Thailand and recruited women with singleton, term pregnancies. Overall, the included studies were at moderate risk of bias: none of the studies provided clear information on allocation concealment or attempted to blind staff or women. For GRADE outcomes the quality of the evidence was very low, with downgrading due to study design limitations and imprecision of effect estimates.Only one study reported severe postpartum haemorrhage (blood loss 1000 mL or more) and showed no clear difference between the intramuscular and intravenous oxytocin groups (risk ratio (RR) 0.11, 95% confidence interval (CI) 0.01 to 2.04; 256 women; very low-quality evidence). No woman required hysterectomy in either group in one study (no estimable data, very low-quality evidence), and in another study one woman in each group received a blood transfusion (RR 1.00, 95% CI 0.06 to 15.82; 256 women; very low-quality evidence). Other important outcomes (maternal death, hypotension, maternal dissatisfaction with the intervention and neonatal jaundice) were not reported by any of the included studies. There were no clear differences between groups for other prespecified secondary outcomes reported (postpartum haemorrhage 500 mL or more, use of additional uterotonics, retained placenta or manual removal of the placenta).
AUTHORS' CONCLUSIONS
Very low-quality evidence indicates no clear difference between the comparative benefits and risks of intramuscular and intravenous oxytocin when given to prevent excessive blood loss after vaginal birth. Appropriately designed randomised trials with adequate sample sizes are needed to assess whether the route of prophylactic oxytocin after vaginal birth affects maternal or infant outcomes. Such studies could be large enough to detect clinically important differences in major side effects that have been reported in observational studies and should also consider the acceptability of the intervention to mothers and providers as important outcomes.
Topics: Blood Transfusion; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Labor Stage, Third; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 30246877
DOI: 10.1002/14651858.CD009332.pub3 -
Translational Pediatrics Feb 2022With the improvement of living standards in recent years, people are paying increasing attention to neonatal jaundice. Yinzhihuang granule is a common Chinese herbal...
BACKGROUND
With the improvement of living standards in recent years, people are paying increasing attention to neonatal jaundice. Yinzhihuang granule is a common Chinese herbal drug for the treatment of neonatal jaundice. The aim of this paper was to study the efficacy of acupressure-assisted Yinzhihuang granule in the treatment of neonatal jaundice by meta-analysis.
METHODS
We performed a search in the databases of PubMed, Embase, Cochrane Library, Chinese Journal Full-text Database (CNKI), VIP, Wanfang Science and Technology Journal Full-text Database, and Chinese Biomedical Literature Search Database (CBM) for articles on the therapeutic effect of acupressure-assisted Yinzhihuang granule on neonatal jaundice from database establishment to October 2021. The software Endnote X9 was used to check and eliminate the articles, screen the articles according to the required inclusion and exclusion criteria, extract the data, and perform quality evaluation according to the risk of bias tool of Cochrane Collaboration. The software Stata 15.1 and RevMan 5.3 were used to record the data, and a meta-analysis was performed on the effective rate of acupressure-assisted Yinzhihuang granule in the treatment of neonatal jaundice, according to serum total bilirubin values after treatment and duration of jaundice. And show the efficacy of Yinzhihuang particles through these results. The reliability of the results was assessed by sensitivity analysis. Funnel plots were used to test the publication bias of the articles.
RESULTS
A total of 3 articles were included. The results of meta-analysis showed that when acupressure-assisted Yinzhihuang granule was used to treat neonatal jaundice, the effective rate of the test group was not significantly different from that in the control group; the serum total bilirubin level in the test group was significantly lower than that in the control group after treatment; the duration of jaundice in the test group was significantly shorter than that in the control group.
DISCUSSION
Acupressure combined with Yinzhihuang granule is effective in treating neonatal jaundice, which has a positive effect on reducing the level of serum total bilirubin and reducing the duration of jaundice.
PubMed: 35282023
DOI: 10.21037/tp-22-22 -
Journal of Minimal Access Surgery 2022Currently, there is no consensus on patient selection for ambulatory laparoscopic cholecystectomy (LC). This study is a systematic review of previously published patient... (Review)
Review
BACKGROUND
Currently, there is no consensus on patient selection for ambulatory laparoscopic cholecystectomy (LC). This study is a systematic review of previously published patient selection for ambulatory LC.
METHODS
A comprehensive search was done in PubMed, Web of Science, Embase and Google Scholar Database up to March 2020 to summarise previously reported medical or surgical selection criteria used for inclusion and exclusion of patients, as well as successful same-day discharge rates and readmission rate after discharge.
RESULTS
Fifty-nine studies with a total of 13,219 patients were included in this systematic review. In total, the median same-day discharge rate was 90% (range: 63%-99.4%), and median readmission rate was 2.22% (range: 0%-16.9%). The most considered medical criteria were American Society of Anesthesiologists classification I and II, age <70, and body mass index <35. Surgical criteria varied greatly. The top three accessible exclusion variables were (1) common bile duct stones, cholangitis, or jaundice (27 publications, 45.8%); (2) history of abdominal surgery (12 publications, 20.3%) and (3) history of pancreatitis (9 publications, 15.3%).
CONCLUSION
The results of the current study showed the variable patient selection in different centres, the medical aspect criteria may be expanded under adequate pre-anaesthetic assessment and preparation and the surgical aspect criteria should include more laboratory or imaging parameters to ensure the surgical safety.
PubMed: 35313430
DOI: 10.4103/jmas.jmas_255_21