Liver cirrhosis in a patient with alcohol dependence and autoimmune hepatitis.

BACKGROUND: Liver cirrhosis is the end-stage entity for a wide variety of chronic liver pathologies. These include viral hepatitis B and C, alcoholic liver disease, non-alcoholic fatty liver disease, hemochromatosis, Wilson disease, autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cirrhosis. In the majority of cases, liver cirrhosis remains completely asymptomatic until acute decompensation occurs. Patients may present complications of portal hypertension such as gastro-esophageal varices and upper digestive hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepato-renal syndrome. Establishing the right etiology of cirrhosis is of paramount importance as it helps the treating physician plan the best suitable treatment options and also improves overall outcome. CASE REPORT: We present a case of a chronic alcohol consumer, which, over time, resulted in alcoholic cirrhosis. Initial diagnosis comprised of alcoholic liver disease. However, a further look into the medical history of the patients indicated the presence of underlying autoimmune liver disease, such as autoimmune hepatitis, which might have also contributed to the chronic liver injury. CONCLUSIONS: Multiple factors can lead to liver cirrhosis. Although the most commonly found entity is alcoholism, it cannot be taken as a thumb rule for the only possible etiology. In-depth analysis and proper differential diagnosis should be carefully conducted in order not to miss out on other possible causes. As seen in our case, where an underlying autoimmune hepatitis was found to be the culprit, but due to a long history of alcohol consumption, it was masked at first instance.

Prevention is better than cure: identifying and dealing with the key features involved in the prevention of gestational diabetes - A bird's eye view.

Gestational diabetes (GDM) is considered to be the most common metabolic problem of pregnancy, which, if not recognized and treated on time, can lead to devastating effects on both the mother's health and the health of the fetus and the newborns. Many studies have revealed that the children born of GDM mothers or grandmothers have higher chances of developing diabetes type I or type II later in their life. Early identification of risk factors can help prevent the appearance of severe GDM and its complications witnessed both in the child and the mother. Obesity is one of the major risk factors that should not be ignored, and obese females should first undergo weight reduction plans in case of planned pregnancies. Other risk factors include a family history of DM arterial hypertension, significant weight gain during pregnancy, short sleep duration, women's exposure to stressful environments, changes in alpha and beta microbiota, and air pollution. Proper care should be provided to females of reproductive age both before and during pregnancy to avoid complications. Awareness programs for healthy lifestyles and diets, oral hygiene maintenance guides, and regular health check-ups can all be considered as a key to a healthy society. Expanding the analysis of gut microbiota in individuals at a heightened risk of GDM can hold particular value, especially during the preconception phase. The alterations in gut microbiota can serve as crucial factors in enhancing lifestyle modifications prior to conception. Further studies are required in this direction to decrease the prevalence of GDM, and efficient measures should be implemented before the consequences appear.

Serum biomarkers predictive of cirrhosis in alcoholic liver disease as an alternative to ARFI-SW elastography.

OBJECTIVE: Aspartate aminotransferase to platelet ratio index (APRI) and fibrosis 4 (FIB-4) index are noninvasive biomarkers that evaluate liver stiffness in patients with chronic viral hepatitis and are able to detect advanced hepatic fibrosis and cirrhosis. However, their usefulness in alcoholic liver disease (ALD), when compared with Acoustic Radiation Force Impulse- Shear Wave (ARFI-SW) elastography, is debatable. PATIENTS AND METHODS: We sifted the files of all enrolled patients with ALD that were admitted to our Emergency hospital between January 2019 and December 2020. All patients had undergone ARFI-SW elastography, and APRI and FIB-4 scores were calculated. The performance of APRI and FIB-4 scores in the prediction of cirrhotic patients according to ARFI-SW elastography was evaluated. RESULTS: In total, 120 patients with ALD were evaluated. All of them were male and Caucasian, with a mean age of 55.54±12.4 years. The mean ARFI-SW elastography score was 1.57±0.7 m/s, the median APRI score was 0.68 (0.1-11.6) and the median FIB-4 score was 1.8 (0.2-19.4). Stages of liver fibrosis according to ARFI-SW elastography were evaluated as F0-1 in 21 (10.5%), F2 in 35 (26%), F3 in 52 (17.5%), and F4 in 92 (46%) patients. Based on ARFI-SW elastography fibrosis stage classification, we estimated the optimal APRI and FIB-4 scores to predict the presence of liver cirrhosis (F4) by using ROC curve analysis and the Youden index. The optimal APRI score for F4 patients was calculated as >1.52 [area under the curve (AUC) 0.875, 95% CI 0.809-0.919; p<0.001], giving sensitivity (Se) 81.2%, specificity (Sp) 81.4%, positive predictive value (PPV) 76%, and negative predictive value (NPV) 86.1%. The optimal FIB-4 score for F4 patients was calculated as >2.77 (AUC 0.916, 95% CI 0.814-0.922; p<0.001), giving Se 83.8%, Sp 77%, 81.4 77%, and NPV 84.3%. CONCLUSIONS: APRI and FIB-4 scores can be used as screening tools in ALD for predicting cirrhosis instead of ARFI-SW elastography measurement, which is neither widely available nor an affordable method. Additional prospective studies are required in the future to confirm this finding.

Retention of aroma compounds from Mentha piperita essential oil by cyclodextrins and crosslinked cyclodextrin polymers.

In this paper, the controlled release of aroma compounds from cyclodextrins (CDs) and CD polymers was studied by multiple headspace extraction (MHE) experiments. Mentha piperita essential oil was obtained by Soxhlet extraction and identification of the major compounds was performed by GC-MS analysis. Menthol, menthone, pulegone and eucalyptol were identified as the major components. Retention of standard compounds in the presence of different CDs and CD polymers has been realised by static headspace gas chromatography (SH-GC) at 25 °C in the aqueous or gaseous phase. Stability constants for standard compounds and for compounds in essential oil have been also determined with monomeric CD derivatives. The obtained results indicated the formation of a 1:1 inclusion complex for all the studied compounds. Molecular modelling was used to investigate the complementarities between host and guest. This study showed that ß-CDs were the most versatile CDs and that ß-CD polymers could perform the controlled release of aroma compounds.