ABSTRACT
During the coronavirus disease 2019 pandemic, Ayurvedic herbal supplements and homeopathic immune boosters (IBs) were promoted as disease-preventive agents. The present study examined the clinical outcomes among patients with chronic liver disease who presented with complications of portal hypertension or liver dysfunction temporally associated with the use of IBs in the absence of other competing causes. This single-center retrospective observational cohort study included patients with chronic liver disease admitted for the evaluation and management of jaundice, ascites, or hepatic encephalopathy temporally associated with the consumption of IBs and followed up for 180 days. Chemical analysis was performed on the retrieved IBs. From April 2020 to May 2021, 1022 patients with cirrhosis were screened, and 178 (19.8%) were found to have consumed complementary and alternative medicines. Nineteen patients with cirrhosis (10.7%), jaundice, ascites, hepatic encephalopathy, or their combination related to IBs use were included. The patients were predominantly male (89.5%). At admission, 14 (73.75%) patients had jaundice, 9 (47.4%) had ascites, 2 (10.5%) presented with acute kidney injury, and 1 (5.3%) had overt encephalopathy. Eight patients (42.1%) died at the end of the follow up period. Hepatic necrosis and portal-based neutrophilic inflammation were the predominant features of liver biopsies. IB analysis revealed detectable levels of (heavy metals) As (40%), Pb (60%), Hg (60%), and various hepatotoxic phytochemicals. Ayurvedic and Homeopathic supplements sold as IBs potentially cause the worsening of preexisting liver disease. Responsible dissemination of scientifically validated, evidence-based medical health information from regulatory bodies and media may help ameliorate this modifiable liver health burden.
Subject(s)
COVID-19 , Complementary Therapies , Hepatic Encephalopathy , Jaundice , Female , Humans , Male , Ascites/etiology , Complementary Therapies/adverse effects , COVID-19/complications , Hepatic Encephalopathy/etiology , Jaundice/complications , Liver Cirrhosis/complications , Liver Cirrhosis/therapy , Pandemics , Retrospective StudiesABSTRACT
La ictericia es un hallazgo frecuente en el paciente con malaria. Según la Organización Mundial de la Salud, se considera un signo de peligro cuando se acompaña de aumento importante de las bilirrubinas y comúnmente se relaciona con disfunción hepática y lesión de otros sistemas. La lesión hepática en estos pacientes es frecuente, está asociada a otras complicaciones, y es reversible si se identifica y se trata a tiempo. Con este trabajo se pretende revisar el valor semiológico de la ictericia como indicador de malaria complicada, explicar su patogénesis y los mecanismos de daño hepático; además, hacer un enfoque del paciente con hepatopatía palúdica, diferenciando la disfunción hepática de la falla y la encefalopatía hepáticas.
Jaundice is a common finding in malaria patients. According to the World Health Organization, it is considered a sign of danger when accompanied by an important increase of bilirubin and it is frequently related to hepatic dysfunction and injury to other organs. Liver injury in these patients is common and it is associated with other complications. If it is identified and treated early, it is reversible. This paper reviews the semiological value of jaundice as an indicator of complicated malaria; it explains its pathogenesis and the mechanisms of liver damage. It also focuses on the patient with hepathopathy, distinguishing hepatic dysfunction, hepatic failure and hepatic encephalopathy.
Subject(s)
Humans , Hepatic Encephalopathy , Liver Failure , Jaundice , Liver Diseases , Malaria , Bilirubin , Homeopathic Pathogenesy , Ranunculaceae , Indicators and Reagents , LiverABSTRACT
A encefalopatia hepática (EH) é um distúrbio funcional do sistema nervoso central (SNC) as»sociado à insuficiência hepática, de fisiopatolo»gia multifatorial e complexa. A EH associada àcirrose é atualmente classificada em episódica, persistente ou mínima. Seu diagnóstico deve ser baseado no achado de sinais e sintomas de cir»rose hepática e na exclusão de doenças do SNC. As medidas terapêuticas atualmente empregadas para o manejo da EH incluem identificação e re»moção dos fatores precipitantes, orientação nu»tricional, agentes farmacológicos e medidas pro»filáticas visando a prevenção de novos episódios de EH. Avaliação de elegibilidade para transplan»te de fígado deve ser considerada. As principais drogas usualmente empregadas para o tratamen»to da EH são os dissacarídeos não absorvíveis e antibióticos. Novas intervenções terapêuticas pro»missoras recentemente avaliadas para o tratamen»to de EH incluem a administração de L-ornitina»L-aspartato e, em casos selecionados, o uso de diálise extracorpórea de albumina (MARS) e oclu»são de shunts por radiologia intervencionista.
Subject(s)
Humans , Male , Female , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/physiopathology , Ammonia/metabolism , Hepatic Encephalopathy/therapy , Liver Transplantation , Homeopathic Therapeutic ApproachesABSTRACT
Esta revisäo aborda as mais frequentes urgências gastroenterológicas (hemorragia digestiva alta, pancreatite, insuficiência hepática aguda, peritonite bacteriana espontânea e encefalopatia hepática) na prática clínica, com ênfase em aspectos diagnósticos e terapêuticos