The Role of Red Cell Distribution Width as a Prognostic Marker in Chronic Liver Disease: A Literature Review.

Liver disease is one of the leading public health problems faced by healthcare practitioners regularly. As such, there has been a search for an inexpensive, readily available, non-invasive marker to aid in monitoring and prognosticating hepatic disorders. Recently, red blood cell distribution width (RDW) has been found to be associated with various inflammatory conditions with implications for its use as a potential marker for assessing disease progression and prognosis in multiple conditions. Multiple factors effect red blood cell production whereby a dysfunction in any process can lead to anisocytosis. Furthermore, a chronic inflammatory state leads to increased oxidative stress and produces inflammatory cytokines causing dysregulation and increased intracellular uptake and use of both iron and vitamin B12, which leads to a reduction in erythropoiesis causing an increase in RDW. This literature review reviews in-depth pathophysiology that may lead to an increase in RDW and its potential correlation with chronic liver diseases, including hepatitis B, hepatitis C, hepatitis E, non-alcoholic fatty liver disease, autoimmune hepatitis, primary biliary cirrhosis, and hepatocellular carcinoma. In our review, we examine the use of RDW as a prognostic and predictive marker for hepatic injury and chronic liver disease.

A Study of Patient Concerns in the Modern Therapeutic Era of Inflammatory Bowel Disease.

BACKGROUND: Patient concerns and preferences are important in the management of inflammatory bowel disease (IBD: Crohn's disease [CD], ulcerative colitis). In the absence of contemporary data, we aimed to determine patient concerns and preferences and establish if there are demographic or disease-related differences. METHODS: We surveyed patients with IBD at Massachusetts General Hospital between July and September 2023. The Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) and a set of supplemental questions rated on a visual analog scale (0-100 mm) were administered to patients and compared by age, disease type, sex, and surgery status. Additionally, a survey administered to treating providers gathered insight into the difference between patient and provider perceptions of concerns. RESULTS: A total of 350 patients and 30 providers completed the survey. The mean age was 47 years; 50% were female, 49% had CD, and 80% were on advanced IBD therapy. Effects of medication (median = 54), energy level (median = 53), and having an ostomy bag (median = 52) were rated highest by patients. Older patients rated most disease complication and treatment-related concerns similar to younger adults; those aged 35-59 years had the greatest level of concern for most questions. Sex, disease activity, and prior surgical history also impacted patients' concerns. Providers perceived patients' worries as higher than those rated by patients themselves. CONCLUSIONS: A shared decision-making model targeting the achievement of disease remission and addressing concerns rated highly by patients is important to meet the goal of care for patients with IBD.

The highest rated concerns among patients with inflammatory bowel disease were needing an ostomy, energy level, and concern with medications. Older patients had a similar level of disease-related concerns as younger patients. There has been no secular decrease in patient concerns.

Malicious Mushrooms.

Accidental ingestion of the toxic Death Cap mushroom, and others of the Amantina species, can occur due to their physical similarities with commonly edible fungi. Production of certain toxins which prevent protein synthesis can lead to fulminant organ failure and death. Although treatment is mostly supportive due to a lack of specific antidote, early recognition can aid in meaningful recovery. Nonspecific symptoms are generally present early in the course and, therefore, high index of suspicion is required. We present 2 cases of suspected Amanita phalloides poisoning leading to acute liver injury; one leading to resolvement of symptoms and the other being fatal.

An Unusual Presentation of Gastric Variceal Hemorrhage.

Acute upper gastrointestinal (GI) bleeding is a commonly encountered condition that can potentially be life-threatening. Endoscopy is the diagnostic modality of choice, but it is important to recognize it's shortcomings. We introduce a 61-year-old female who presented with hematemesis and syncope. She had a history of recurrent episodes of hematemesis and hospitalizations for the preceding 18 months, for which multiple endoscopies had been performed but had failed to demonstrate a source. A repeat esophagogastroduodenoscopy (EGD) performed at our facility was unremarkable. A CT scan demonstrated a lobulated mass-like filling defect in the gastric cardia consistent with solitary varix with an abnormal fold pattern. An upper GI follow-through series was performed to better characterize this varix. The patient subsequently underwent balloon-occluded retrograde transvenous obliteration with successful control of the source of bleeding. It is important to keep in mind that EGD while being the gold standard for the diagnosis of varices, has its limitations, and should be augmented with the use of non-traditional diagnostic modalities such as CT scans or radionuclide imaging.