Infections ACLF Death Different clinical courses of acutely decompensated cirrhosis Pre-ACLF Unstable decompensated cirrhosis Stable decompensated cirrhosis 0 90 180 270 360 Days Highlights Patients with acutely decompensated cirrhosis without ACLF develop 3 different clinical courses. Patients with pre-ACLF develop ACLF within 90 days and have high systemic inflammation and mortality. Patients with unstable decompensated cirrhosis suffer from complications of severe portal hypertension. Patients with stable decompensated cirrhosis have less frequent complications and lower 1-year mortality risk.
In a retrospective analysis of almost 2000 patients, we found 60% to have SPSS; prevalence increases with deterioration of liver function. SPSS increase risk for HE and with a chronic course. In patients with preserved liver function, SPSS increase risk for complications and death. ClinicalTrials.gov ID NCT02692430.
The existence of latitudinal gradients in species richness and their abundance is known for many free living organisms but few cases have been reported for parasitic diseases. In addition, asymmetries between the Northern and Southern Hemispheres in several characteristics may affect the distribution and diversity of species at all ecological levels. In this respect, we study the distribution of several genera of blood parasites infecting birds along a latitudinal gradient that includes the world's southernmost forests ecosystems. Birds were mist-netted and sampled for blood in localities across Chile ranging from 33 degrees S to 55 degrees S during the years 2003-06. Overall, 26 bird species were sampled and 27 parasite lineages were identified. The latter belonged to three genera: Plasmodium (8), Haemoproteus (8) and Leucocytozoon (11). We found a positive significant relationship between prevalence and latitude for Leucocytozoon lineages and a negative relationship for Haemoproteus, Plasmodium and mixed infections. However, we did not find a significant relationship between parasite diversity and latitude. We found 18 lineages infecting only one species of host, and 19 lineages appear in only one of the localities of sampling. This pattern implies that some parasite lineages may evolve in isolation in some species/localities. In addition, specificity at the host-family level was only found for Haemoproteus lineages infecting birds in the family Emberizidae. Individuals of the long distance migrant bird white-crested elaenia (Elaenia albiceps), were found infected by the same parasite lineages in localities separated by 20 degrees of latitude. Infections by these lineages were detected in other sedentary birds including juveniles and nestlings of different bird species. Therefore, long distance migrants are able to distort the presence of latitudinal gradients of diseases due to the potential role of migrants in spreading infections. Geographical gradients in prevalence of avian haematozoa differ between parasite genera and hemispheres, probably in relation to the existence of appropriate vector-parasite-host interactions
p-TIPS must be the treatment of choice in CP-C patients with AVB. Due to the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients. This article is protected by copyright. All rights reserved.
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Congenital extrahepatic portosystemic shunt (CEPS) or Abernethy malformation is a rare condition in which splanchnic venous blood bypasses the liver draining directly into systemic circulation through a congenital shunt. Patients may develop hepatic encephalopathy (HE), pulmonary hypertension (PaHT), or liver tumors, among other complications. However, the actual incidence of such complications is unknown, mainly because of the lack of a protocolized approach to these patients. This study characterizes the clinical manifestations and outcome of a large cohort of CEPS patients with the aim of proposing a guide for their management. This is an observational, multicenter, international study. Sixty‐six patients were included; median age at the end of follow‐up was 30 years. Nineteen patients (28%) presented HE. Ten‐, 20‐, and 30‐year HE incidence rates were 13%, 24%, and 28%, respectively. No clinical factors predicted HE. Twenty‐five patients had benign nodular lesions. Ten patients developed adenomas (median age, 18 years), and another 8 developed HCC (median age, 39 years). Of 10 patients with dyspnea, PaHT was diagnosed in 8 and hepatopulmonary syndrome in 2. Pulmonary complications were only screened for in 19 asymptomatic patients, and PaHT was identified in 2. Six patients underwent liver transplantation for hepatocellular carcinoma or adenoma. Shunt closure was performed in 15 patients with improvement/stability/cure of CEPS manifestations. Conclusion: CEPS patients may develop severe complications. Screening for asymptomatic complications and close surveillance is needed. Shunt closure should be considered both as a therapeutic and prophylactic approach.
Acute-on-chronic liver failure (ACLF) AVB + ACLF High rebleeding rate (25.2%) in 42 days High mortality rate (51.0%) in 42 days Pre-emptive TIPS in AVB + ACLF Low rebleeding rate (4.5%) in 42 days Low mortality rate (13.6%) in 42 days Pre-emptive TIPS Acute Variceal Bleeding (AVB) Highlights Variceal bleeding is frequently associated with ACLF in cirrhosis. ACLF is independently associated with rebleeding and mortality. Patients with variceal bleeding and ACLF can benefit from a preemptive (early) TIPS.
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