Liver transplantation (LT) is a lifesaving treatment. Because of the shortage of donor organs, some patients will not survive long enough to receive a transplant. The identification of LT candidates at increased risk of short-term mortality without transplantation may affect listing decisions. Functional capacity, determined with cardiopulmonary exercise testing (CPET), is a measure of cardiorespiratory reserve and predicts perioperative outcomes. This study examined the association between functional capacity and short-term survival before LT and the potential for CPET to predict 90-day mortality without transplantation. A total of 176 patients who were assessed for nonacute LT underwent CPET. Ninety days after the assessment, 10 of the 164 patients who had not undergone transplantation were deceased (mortality rate 5 6.1%). According to a comparison of survivors and nonsurvivors, the Model for End-Stage Liver Disease score, UK Model for End-Stage Liver Disease (UKELD) score, age, anaerobic threshold, and peak oxygen uptake (VO 2 ) were significant univariate predictors of 90-day mortality without transplantation, but only the UKELD score and peak VO 2 retained significance in a multivariate analysis. The mean peak VO 2 was significantly lower for nonsurvivors versus survivors (15.2 6 3.3 versus 21.2 6 5.3 mL/minute/kg, P < 0.001). According to a receiver operating characteristic (ROC) curve analysis, peak VO 2 performed well as a diagnostic test (area under the ROC curve 5 0.84, 95% confidence interval 5 0.76-0.92, sensitivity 5 0.90, specificity 5 0.74, P < 0.001). The optimal cutoff value for predicting mortality was 17.6 mL/minute/kg. The positive predictive value of a peak VO 2 17.6 mL/minute/kg for 90-day mortality was greatest for patients with high UKELD scores: 38% of the patients with a UKELD score 57 and a peak VO 2 17.6 mL/minute/kg died, whereas only 6% of the patients with a UKELD score 57 and a peak VO 2 > 17.6 mL/minute/kg died (P 5 0.03). In conclusion, patients assessed for LT with an impaired functional capacity have poorer short-term survival; this is particularly true for individuals with worse liver disease severity.
Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.
BSG abstracts compared to 18 gauge needle. Despite being a larger bore needle, it is not associated with an increased rate of complications. We recommend using 16 gauge co-axial needles routinely for percutaneous liver biopsies. Disclosure of Interest None Declared.
This eleventh review of global reporting of ADRs for drugs used to treat COVID-19 is as before mainly descriptive in nature. It includes reviews for the drugs that were initially included in WHO Solidarity trial to find an effective COVID-19 treatment and other drugs used for a COVID-19 indication where the number of reports in VigiBase exceeds 100. Regarding remdesivir, a major increase in reports was seen in this review. Notable numbers of reports for several non-labelled ADR terms have been shared within the system, described in the remdesivir section of the document. Concerning the other drugs reviewed, ADR-patterns are consistent with those described in earlier reports and mostly within the labelling for the respective drugs. Reports have been shared from all WHO regions, with the largest number now originating in the WHO region of the Americas with 45% of the shared reports (Table 2). WHO has announced the discontinuation of the hydroxychloroquine (HCQ) and lopinavir;ritonavir arms of the Solidarity trial as per the recommendation from the international steering committee 1 . The decision applies only to the conduct of the Solidarity trial in hospitalized patients and does not affect the possible evaluation in other studies of hydroxychloroquine or lopinavir;ritonavir in nonhospitalized patients or as pre-or post-exposure prophylaxis for COVID-19.
1.5%) who were tested for HDV serology had acute HDV co infection. Conclusion In our hepatitis B population, we estimate that there is a 6.1% seroprevalence rate of hepatitis D and 1.5% acute hepatitis D co-infection. There is also a room for improvement in hepaitis D screening within our trust and more study is needed to identify barriers in screening and robust public health measures may be needed to follow up this population.
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