Determinants, profile and outcomes of hepatitis A virus-associated severe acute liver injury in adults.

BACKGROUND AND OBJECTIVES: Hepatitis A virus (HAV)-related hepatitis is witnessing an epidemiological transition with increasing trends in adults. While uncomplicated hepatitis remains common, evidence suggests it to be a growing cause for acute liver failure (ALF). In between the two extremes exists severe acute liver injury (s-ALI) which has a propensity to transition to ALF. We aimed at describing the clinical profile of patients with HAV-related s-ALI and identifying potential predictors of progression to ALF. METHODS: This was a single-center retrospective analysis of adult patients admitted with HAV-related s-ALI between April 2022 and December 2023. Demographic and laboratory parameters were compared between patients with only s-ALI and those with ALF. Predictors of progression from s-ALI to ALF were identified using logistic regression. RESULTS: Forty-three patients satisfied criteria of s-ALI, of which 33 (76.7%) had only s-ALI, while 10 (23.3%) had ALF. Patients with s-ALI had lesser leukocytosis (6.3 ± 3 vs. 13.2 ± 4.8), less incidence of acute kidney injury (9.1% vs. 40%) and lower model for end-stage liver disease (MELD) (20 [18-24.5] vs. 31.5 [26-42]), arterial lactate (2.1 [1.3-3.1] vs. 6.3 [5.2-8.0]), arterial ammonia (94 [72-118] vs. 299 [188-573]), procalcitonin (0.5 [0.28-1.25] vs. 3.2 [1.2-6.1]) and ferritin (482 [213-1633] vs. 5186 [1341-11,053]) compared to HAV-ALF (p < 0.05 for all). Three patients (9.09%) with s-ALI progressed to ALF of whom one (3%) died. Baseline ammonia levels (unadjusted odds ratio [OR] 1.03 [1.01-1.06]) and leukocyte count (OR 1.00 [1.00-1.01]) tended to be associated with ALF progression, although none was significant after multi-variable adjustment. Ammonia levels had an area under receiver operating curve of 0.816 (0.64-0.93) (p = 0.009) (cut-off of 144 µmol/L). Additional comorbidities did not impact overall outcomes. CONCLUSION: HAV presents as s-ALI in young adults, with almost one in 10 progressing to ALF. Baseline ammonia may be an important predictor of progression even in s-ALI, but mandates larger well-designed studies.

Endovascular management of massive hemoptysis due to covid-19 related pulmonary artery pseudoaneurysm: A rare entity.

Pulmonary artery pseudoaneurysms are rare causes of massive hemoptysis, even less common in setting of COVID-19 pneumonia. We describe and discuss an index case of cavitating COVID-19 pneumonia complicated by a pulmonary artery pseudoaneurysm without concomitant pulmonary thromboembolism. The patient presented with severe hemoptysis and was managed by endovascular coil embolization. Good technical and clinical success was achieved with complete resolution of hemoptysis.

Role of Static and Dynamic Intra-abdominal Pressure Monitoring in Acute Pancreatitis: A Prospective Study on Its Impact.

OBJECTIVE: This study was aimed to determine the relationship between static and dynamic intra-abdominal pressure (IAP) with the mortality and outcome of acute pancreatitis. METHODS: From July 2017 to December 2018, 150 patients admitted at the Institute of Gastrosciences and Liver and diagnosed as acute pancreatitis were included in the study. Intra-abdominal pressure was measured for the first few days, and mean value of day 1 (static IAP) and highest value on day 2 and day 3 (dynamic IAP) were calculated and categorized into intra-abdominal hypertension and abdominal compartment syndrome. RESULTS: A statistical relationship was observed between static and dynamic IAP with the severity and mortality of acute pancreatitis. Both static and dynamic IAPs tended to be higher in nonsurvivors (83.33% and 88.88%, respectively) compared with survivors (51.51% and 63.63%, respectively). Higher IAP had more severe disease. However, IAP did not correlate with the evidence of sepsis or serum procalcitonin levels. CONCLUSION: Determination of static IAP is an easy, useful, and inexpensive method to determine and predict the mortality of acute pancreatitis. Prevention and/or early detection of intra-abdominal hypertension helps in reducing the mortality in acute pancreatitis.

Endoscopic Management with a Novel Over-The-Scope Padlock Clip System.

BACKGROUND/AIMS: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system. METHODS: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients. RESULTS: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed. CONCLUSION: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

Melioidosis: Series of Eight Cases.

OBJECTIVE: Melioidosis caused by the Gram-negative bacterium Burkholderia pseudomallei is a very serious infection and has been sporadically reported from the Indian subcontinent. This disease entity can have acute and chronic presentations involving different organ systems. The purpose of this study is to analyze the risk factors, clinical presentations, therapy and outcome of culture proven cases of melioidosis. METHODS: We carried out a retrospective study of eight culture proven cases of melioidosis at a tertiary care hospital in West Bengal. RESULTS: In this series we have found that melioidosis presents with a variety of symptoms ranging from acute presentations in the form of fulminant septicaemia, multiple abscesses in internal organs, osteomyelitis to more chronic form of the infection masquerading as tuberculosis. Bone and joint involvement are particularly common. Diabetes mellitus and chronic alcoholism are significant risk factors. CONCLUSIONS: India or parts of India are possibly endemic areas for melioidosis. Lack of awareness and the diversity of its presentation are probably responsible for underdiagnosis and under reporting.