Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major h... more Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major health problem worldwide. The prognosis of individual patients with ALD depends on the degree of pathological injury, the patient's nutritional status, the presence of complications of advanced disease, other comorbid conditions such as hepatitis C virus infection, and the patient's ability to eliminate destructive patterns of drinking. In studies that have examined the natural history of ALD on the basis of histological characteristics at diagnosis, patients with fatty liver have had the best outcome (70-80% survival rate at 4-5 years); those with alcoholic hepatitis (AH) or cirrhosis, an intermediate outcome (50-75% survival rate at 4-5 years), and those with cirrhosis combined with AH, the worst outcome (30-50% survival rate at 4-5 years) [1]. Considering all patients with ALD as a single group, the average 1-and 5-year survival rates are approximately 80 and 50%, respectively [2]. Alcoholic cirrhosis also appears to be an independent risk factor for hepatocellular carcinoma, albeit a weaker one than viral hepatitis [3-6]. Among alcoholics, men older than 50 years of age appear to be most vulnerable to the development of hepatocellular carcinoma [7]. In addition to providing general counseling for patients, estimating the prognosis of patients with ALD is particularly important in two clinical settings: (1) deter
International Journal of Case Reports and Images, 2016
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, mont... more International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.
This study shows that two doses of a recombinant hepatitis B vaccine (10 pg or 20 pg of HBsAg per... more This study shows that two doses of a recombinant hepatitis B vaccine (10 pg or 20 pg of HBsAg per dose), administered 6 months apart to young, healthy adults, can induce an antibody (anti-HBs) response similar to that expected with the standard three-dose regimen of this vaccine given at intervals of 0, 1, and 6 months. while only 46-67% of the vaccinees displayed a protective anti-HBs titer of 210 mIU ml-' prior to the receipt of the second dose at 6 months, virtually all were primed as 97-9970 of the subjects developed such a titer when tested a month after the second dose. Among vaccinees given 10 or 20 ,ug doses, respectively, the secondary rise in antibody followin B the second dose yielded geomettic mean titers (GMTs) of 1103 and 2538 mIU ml-, respectively. The study further demonstrated that a two-dose regimen of vaccination induced strong immunologic memory for HBsAg, as a booster dose of vaccine given 2 years later resulted in a rapid and vigorous anamnestic antibody response.
doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
Background: Shared etiological pathways of dopamine and serotonin neurotransmission play a centra... more Background: Shared etiological pathways of dopamine and serotonin neurotransmission play a central role in heavy alcohol intake and exacerbation in the symptoms of depression. We investigated the role of depression ratings and patterns of heavy drinking on the treatment efficacy of Quetiapine fumarate XR in lowering alcohol intake in alcohol use disorder (AUD) patients. Methods: One hundred and eight male and female heavy drinking AUD patients in the age range of 18 to 64 yrs. received 12 weeks of active treatment. Participants were grouped by the severity grading of depression using Montgomery Asberg Depression Rating Scale (MADRS) (clinically relevant≥8 [CR], clinically non-relevant≤7 [CNR]) at baseline. Drinking history and depression ratings were assessed at the patients visits. Results: Heavy drinking days (HDD) and total drinks (TD) were significantly fewer in CR patients at the treatment end. A true positive response in AUROC analysis supported the lowering of TD in CR patien...
Background: Clearance of HCV RNA at week 4 (rapid virologic response [RVR]) is highly predictive ... more Background: Clearance of HCV RNA at week 4 (rapid virologic response [RVR]) is highly predictive of SVR. We hypothesized that the magnitude of reduction of HCV RNA from baseline by treatment week (TW) 4 was predictive of increasing rates of SVR reaching a maximum with RVR. Methods: Chronic hepatitis C patients infected with genotype 1 were randomized (1:1:1) and treated for 48 weeks with PEG2b 1.5 μg/kg/wk or PEG2b 1.0 μg/kg/wk + RBV 800-1400 mg/d, or PEG2a 180 μg/wk + RBV 1000-1200 mg/d. Patients with virologic failure at TW 12 (<2 log 10 drop from baseline) or 24 (detectable) terminated therapy. HCV RNA levels were assessed at baseline and at TWs 2, 4, 12, 24, 48 and follow-up weeks 4, 12, and 24. The change in HCV RNA level for each patient was categorized according to log 10 change from baseline: <1 log 10 ; 1-<2 log 10 ; 2-<3 log 10 ; 3-<4 log 10 ; ≥4 log 10 and undetectable (<27 IU/mL, no HCV RNA detected) and assessed with regard to SVR rate. HCV RNA was assessed by Roche COBAS TaqMan (LLQ <27 IU/mL). Chi-square test was performed. Results: Patients (n = 3070) had similar characteristics across groups: male, 60%; Caucasian, 71%; Black, 19%; mean age, 47.5 years; mean weight, 83.4 kg; HCV RNA >600,000 IU/mL, 82%; F3/4, 11%. The number (%) of patients in each category and the observed SVR rate are shown in Table 3 and Figure 2 (below). The magnitude of change in HCV RNA at TW 4 was highly associated with the likelihood of SVR (P < 0.0001). Conclusions: Independent of PEG/RBV regimen, the magnitude of the change in HCV RNA after 4 weeks of treatment was predictive of subsequent SVR in adults infected with HCV genotype 1. Patients with a decline in HCV RNA from baseline ≥3 log 10 had a greater than 61% probability of SVR whereas those with a decline of <1 log 10 had a less than 5% probability of SVR. These data support the definition of "TW 4 null response" as achieving less than 1 log 10 decrease in HCV RNA from baseline and underscore the importance of monitoring HCV RNA response at TW 4 to determine an individual patient's probability of SVR. During treatment with PEG/RBV, clinicians should incorporate these TW 4 viral response data into clinical decision making for HCV genotype 1-infected patients. Note: Abstract has been updated since submission.
Therapeutic Advances in Gastroenterology, Sep 1, 2010
Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major h... more Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major health problem worldwide. The prognosis of individual patients with ALD depends on the degree of pathological injury, the patient's nutritional status, the presence of complications of advanced disease, other comorbid conditions such as hepatitis C virus infection, and the patient's ability to eliminate destructive patterns of drinking. In studies that have examined the natural history of ALD on the basis of histological characteristics at diagnosis, patients with fatty liver have had the best outcome (70-80% survival rate at 4-5 years); those with alcoholic hepatitis (AH) or cirrhosis, an intermediate outcome (50-75% survival rate at 4-5 years), and those with cirrhosis combined with AH, the worst outcome (30-50% survival rate at 4-5 years) [1]. Considering all patients with ALD as a single group, the average 1-and 5-year survival rates are approximately 80 and 50%, respectively [2]. Alcoholic cirrhosis also appears to be an independent risk factor for hepatocellular carcinoma, albeit a weaker one than viral hepatitis [3-6]. Among alcoholics, men older than 50 years of age appear to be most vulnerable to the development of hepatocellular carcinoma [7]. In addition to providing general counseling for patients, estimating the prognosis of patients with ALD is particularly important in two clinical settings: (1) deter
Alcohol influences nutritional status in humans by interacting with normal nutrient metabolism an... more Alcohol influences nutritional status in humans by interacting with normal nutrient metabolism and utilization. The alcoholic’s diet and the presence or absence of liver disease influence the alcoholic’s risk for malnutrition. Alcohol is a source of calories and therefore can be considered a nutrient. However, when chronically ingested in excess (excess being as little as 20 grams of alcohol’ per day for women and 40 grams per day for men [Zakim et al. 1990]), alcohol negatively affects the metabolism of macronutrients2 and micronutrients. In alcoholics,3 alcohol also leads to decreased intake of important nutrients and may adversely affect parts of the digestive system that are critical for ingestion, absorption, and eventual use of nutrients by the body. This article is intended to facilitate an understanding of the complex relationship between alcohol and malnutrition.
Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major h... more Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major health problem worldwide. The prognosis of individual patients with ALD depends on the degree of pathological injury, the patient's nutritional status, the presence of complications of advanced disease, other comorbid conditions such as hepatitis C virus infection, and the patient's ability to eliminate destructive patterns of drinking. In studies that have examined the natural history of ALD on the basis of histological characteristics at diagnosis, patients with fatty liver have had the best outcome (70-80% survival rate at 4-5 years); those with alcoholic hepatitis (AH) or cirrhosis, an intermediate outcome (50-75% survival rate at 4-5 years), and those with cirrhosis combined with AH, the worst outcome (30-50% survival rate at 4-5 years) [1]. Considering all patients with ALD as a single group, the average 1-and 5-year survival rates are approximately 80 and 50%, respectively [2]. Alcoholic cirrhosis also appears to be an independent risk factor for hepatocellular carcinoma, albeit a weaker one than viral hepatitis [3-6]. Among alcoholics, men older than 50 years of age appear to be most vulnerable to the development of hepatocellular carcinoma [7]. In addition to providing general counseling for patients, estimating the prognosis of patients with ALD is particularly important in two clinical settings: (1) deter
International Journal of Case Reports and Images, 2016
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, mont... more International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.
This study shows that two doses of a recombinant hepatitis B vaccine (10 pg or 20 pg of HBsAg per... more This study shows that two doses of a recombinant hepatitis B vaccine (10 pg or 20 pg of HBsAg per dose), administered 6 months apart to young, healthy adults, can induce an antibody (anti-HBs) response similar to that expected with the standard three-dose regimen of this vaccine given at intervals of 0, 1, and 6 months. while only 46-67% of the vaccinees displayed a protective anti-HBs titer of 210 mIU ml-' prior to the receipt of the second dose at 6 months, virtually all were primed as 97-9970 of the subjects developed such a titer when tested a month after the second dose. Among vaccinees given 10 or 20 ,ug doses, respectively, the secondary rise in antibody followin B the second dose yielded geomettic mean titers (GMTs) of 1103 and 2538 mIU ml-, respectively. The study further demonstrated that a two-dose regimen of vaccination induced strong immunologic memory for HBsAg, as a booster dose of vaccine given 2 years later resulted in a rapid and vigorous anamnestic antibody response.
doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
Background: Shared etiological pathways of dopamine and serotonin neurotransmission play a centra... more Background: Shared etiological pathways of dopamine and serotonin neurotransmission play a central role in heavy alcohol intake and exacerbation in the symptoms of depression. We investigated the role of depression ratings and patterns of heavy drinking on the treatment efficacy of Quetiapine fumarate XR in lowering alcohol intake in alcohol use disorder (AUD) patients. Methods: One hundred and eight male and female heavy drinking AUD patients in the age range of 18 to 64 yrs. received 12 weeks of active treatment. Participants were grouped by the severity grading of depression using Montgomery Asberg Depression Rating Scale (MADRS) (clinically relevant≥8 [CR], clinically non-relevant≤7 [CNR]) at baseline. Drinking history and depression ratings were assessed at the patients visits. Results: Heavy drinking days (HDD) and total drinks (TD) were significantly fewer in CR patients at the treatment end. A true positive response in AUROC analysis supported the lowering of TD in CR patien...
Background: Clearance of HCV RNA at week 4 (rapid virologic response [RVR]) is highly predictive ... more Background: Clearance of HCV RNA at week 4 (rapid virologic response [RVR]) is highly predictive of SVR. We hypothesized that the magnitude of reduction of HCV RNA from baseline by treatment week (TW) 4 was predictive of increasing rates of SVR reaching a maximum with RVR. Methods: Chronic hepatitis C patients infected with genotype 1 were randomized (1:1:1) and treated for 48 weeks with PEG2b 1.5 μg/kg/wk or PEG2b 1.0 μg/kg/wk + RBV 800-1400 mg/d, or PEG2a 180 μg/wk + RBV 1000-1200 mg/d. Patients with virologic failure at TW 12 (<2 log 10 drop from baseline) or 24 (detectable) terminated therapy. HCV RNA levels were assessed at baseline and at TWs 2, 4, 12, 24, 48 and follow-up weeks 4, 12, and 24. The change in HCV RNA level for each patient was categorized according to log 10 change from baseline: <1 log 10 ; 1-<2 log 10 ; 2-<3 log 10 ; 3-<4 log 10 ; ≥4 log 10 and undetectable (<27 IU/mL, no HCV RNA detected) and assessed with regard to SVR rate. HCV RNA was assessed by Roche COBAS TaqMan (LLQ <27 IU/mL). Chi-square test was performed. Results: Patients (n = 3070) had similar characteristics across groups: male, 60%; Caucasian, 71%; Black, 19%; mean age, 47.5 years; mean weight, 83.4 kg; HCV RNA >600,000 IU/mL, 82%; F3/4, 11%. The number (%) of patients in each category and the observed SVR rate are shown in Table 3 and Figure 2 (below). The magnitude of change in HCV RNA at TW 4 was highly associated with the likelihood of SVR (P < 0.0001). Conclusions: Independent of PEG/RBV regimen, the magnitude of the change in HCV RNA after 4 weeks of treatment was predictive of subsequent SVR in adults infected with HCV genotype 1. Patients with a decline in HCV RNA from baseline ≥3 log 10 had a greater than 61% probability of SVR whereas those with a decline of <1 log 10 had a less than 5% probability of SVR. These data support the definition of "TW 4 null response" as achieving less than 1 log 10 decrease in HCV RNA from baseline and underscore the importance of monitoring HCV RNA response at TW 4 to determine an individual patient's probability of SVR. During treatment with PEG/RBV, clinicians should incorporate these TW 4 viral response data into clinical decision making for HCV genotype 1-infected patients. Note: Abstract has been updated since submission.
Therapeutic Advances in Gastroenterology, Sep 1, 2010
Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major h... more Overview and Prognosis of Alcoholic Liver Disease Alcoholic liver disease (ALD) remains a major health problem worldwide. The prognosis of individual patients with ALD depends on the degree of pathological injury, the patient's nutritional status, the presence of complications of advanced disease, other comorbid conditions such as hepatitis C virus infection, and the patient's ability to eliminate destructive patterns of drinking. In studies that have examined the natural history of ALD on the basis of histological characteristics at diagnosis, patients with fatty liver have had the best outcome (70-80% survival rate at 4-5 years); those with alcoholic hepatitis (AH) or cirrhosis, an intermediate outcome (50-75% survival rate at 4-5 years), and those with cirrhosis combined with AH, the worst outcome (30-50% survival rate at 4-5 years) [1]. Considering all patients with ALD as a single group, the average 1-and 5-year survival rates are approximately 80 and 50%, respectively [2]. Alcoholic cirrhosis also appears to be an independent risk factor for hepatocellular carcinoma, albeit a weaker one than viral hepatitis [3-6]. Among alcoholics, men older than 50 years of age appear to be most vulnerable to the development of hepatocellular carcinoma [7]. In addition to providing general counseling for patients, estimating the prognosis of patients with ALD is particularly important in two clinical settings: (1) deter
Alcohol influences nutritional status in humans by interacting with normal nutrient metabolism an... more Alcohol influences nutritional status in humans by interacting with normal nutrient metabolism and utilization. The alcoholic’s diet and the presence or absence of liver disease influence the alcoholic’s risk for malnutrition. Alcohol is a source of calories and therefore can be considered a nutrient. However, when chronically ingested in excess (excess being as little as 20 grams of alcohol’ per day for women and 40 grams per day for men [Zakim et al. 1990]), alcohol negatively affects the metabolism of macronutrients2 and micronutrients. In alcoholics,3 alcohol also leads to decreased intake of important nutrients and may adversely affect parts of the digestive system that are critical for ingestion, absorption, and eventual use of nutrients by the body. This article is intended to facilitate an understanding of the complex relationship between alcohol and malnutrition.
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