Severe acute alcoholic hepatitis (AH) is a catastrophic disease in the natural history of alcoholic liver disease with a very high 180-day mortality. It can present as acute on chronic liver failure with worse prognosis in the presence of infections and higher grades of liver disease severity. The clinical scenario involves a patient with a recent history of heavy alcohol consumption within three months of presentation with jaundice and characteristic liver enzyme elevation pattern with coagulopathy, hepatic encephalopathy, variceal bleeding and sepsis that results in extrahepatic organ failures. Several liver disease severities and therapy response indicators are in clinical use. Even though not approved, the only recommended treatment option for patients with severe AH is corticosteroids, which is without long term survival benefit. Novel efficacious treatment options awaiting high-quality multi-center studies include liver transplantation (involves strict selection criteria), growth factor therapy and fecal microbiota transplantation. In this exhaustive review, we discuss the definitions, disease severity, histopathology, and treatment options – past, present, and future, in patients with severe alcoholic hepatitis.

Gut microbiota has been demonstrated to have a significant impact on the initiation, progression and development of complications associated with multiple liver diseases. Notably, nonalcoholic fatty liver diseases, including nonalcoholic steatohepatitis and cirrhosis, severe alcoholic hepatitis, primary sclerosing cholangitis and hepatic encephalopathy, have strong links to dysbiosisor a pathobiological change in the microbiota. In this review, we provide clear and concise discussions on the human gut microbiota, methods of identifying gut microbiota and its functionality, liver diseases that are affected by the gut microbiota, including novel associations under research, and provide current evidence on the modulation of gut microbiota and its effects on specific liver disease conditions.

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.