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    Case Report Open Access
    A Male Case of Renal Amyloidosis
    Ziryab Imad Taha, Mohammed Elmujtba Adam Essa, Asaad Tageldein Idris Abdelhalim, Mohey Aldein Ahmed Elamin Elnour, Allaa Ahmed Osman Eltayeb, Shaza Adel Awad Mohammed Elwakeel, Abdelkareem Abdallah Ahmed
    Journal of Exploratory Research in Pharmacology , Published online November 24, 2020. doi:10.14218/JERP.2020.00031
    Abstract
    Amyloidosis is a group of rare, serious disorders caused by deposition of amyloid protein in tissues, such as the kidney, heart and brain. However, there is no case reported from Sudan. [...] Read more.
    Amyloidosis is a group of rare, serious disorders caused by deposition of amyloid protein in tissues, such as the kidney, heart and brain. However, there is no case reported from Sudan. Here, we report one male case of renal amyloidosis, possibly secondary to abdominal tuberculosis (Tb). A male, 30 years of age, complained of systemic body swelling, shortness of breath, and decreased urine output with abnormal color for 2 months. He had been diagnosed with abdominal Tb 10 years prior, for which he received systemic anti-Tb treatment. Clinical examination exhibited anasarca, particularly in the abdomen. Abdominal ultrasound indicated massive ascites, and echocardiography indicated the ejection fraction reduced to 60%. Renal biopsy revealed renal amyloidosis. The patient was treated with ceftriaxone, furosemide, prednisolone, pantoprazole, spironolactone, calcium and mycophenolate mofetil, and his condition improved. The patient was discharged 2 weeks after treatments. Hence, this is the first case of renal amyloidosis, possibly secondary to abdominal Tb, in Sudan. This case report should serve as an alert to physicians working in high-prevalence Tb regions. Full article
    Opinion Open Access
    A Proposal of Early Diagnosis and Early Management in Dengue Infection and Possible COVID-19
    Manote Arpornsuwan, Matinun Arpornsuwan
    Exploratory Research and Hypothesis in Medicine, Published online November 23, 2020. doi:10.14218/ERHM.2020.00059
    Abstract
    Dengue infection may lead to various sequels, such as undifferentiated fever, dengue fever, or dengue hemorrhagic fever, progressive illness, and death. It also causes significant [...] Read more.
    Dengue infection may lead to various sequels, such as undifferentiated fever, dengue fever, or dengue hemorrhagic fever, progressive illness, and death. It also causes significant economic burden associated with healthcare costs and loss of labor. Usually, the treatment of dengue infection is supportive therapy and not a specific treatment, while it is often clinically difficult to predict whether dengue-infected patients will progress to severe disease or not. We propose integrated management strategies for early dengue virus infection based on our 5-year experience in early management of dengue infection, literature reviews, and research studies (over the last 10 years). This proposal consists of 4 aspects: (1) rehydration with oral rehydration therapy; (2) reduction of the proinflammatory cytokines, including tumor necrosis factor-α and interleukin-6 with oral cytokine inhibitors (i.e. pentoxifylline and doxycycline); (3) inhibition of dengue virus replication, viral load reduction, nonstructural protein 1 antigen clearance with doxycycline and ivermectin; and (4) restoration of the immune function by vitamin D and zinc supplementation. The major benefit of these drugs and supplements is that they are already approved by regulatory bodies, affordable, and clinically safe. They result in better clinical and laboratory outcomes, including reductions in hospitalization and cost of treatment. Another benefit is that this strategy may be used for other virus-induced hypercytokinemia, such as coronavirus disease and Ebola. Full article
    Review Article Open Access
    Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis
    Manus Rugivarodom, Phunchai Charatcharoenwitthaya
    Journal of Clinical and Translational Hepatology, Published online November 11, 2020. doi:10.14218/JCTH.2020.00067
    Abstract
    Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic [...] Read more.
    Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dysfunction have emerged as key factors in the pathogenesis of PVT. The contribution of PVT to hepatic decompensation and mortality in cirrhosis is debatable; however, the presence of an advanced PVT increases operative complexity and decreases survival after transplantation. The therapeutic decision for PVT is often determined by the duration and extent of thrombosis, the presence of symptoms, and liver transplant eligibility. Evidence from several cohorts has demonstrated that anticoagulation treatment with vitamin K antagonist or low molecular weight heparin can achieve recanalization of the portal vein, which is associated with a reduction in portal hypertension-related events and improved survival in cirrhotic patients with PVT. Consequently, interest in direct oral anticoagulants for PVT is increasing, but clinical data in cirrhosis are limited. Although the most feared consequence of anticoagulation is bleeding, most studies indicate that anticoagulation therapy for PVT in cirrhosis appears relatively safe. Interestingly, the data showed that transjugular intrahepatic portosystemic shunt represents an effective adjunctive therapy for PVT in cirrhotic patients with symptomatic portal hypertension if anticoagulation is ineffective. Insufficient evidence regarding the optimal timing, modality, and duration of therapy makes nontumoral PVT a challenging consequence of cirrhosis. In this review, we summarize the current literature and provide a potential algorithm for the management of PVT in patients with cirrhosis. Full article

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    Review Article Open Access
    Current Management of Alcoholic Hepatitis and Future Therapies
    Behnam Saberi, Alia S. Dadabhai, Yoon-Young Jang, Ahmet Gurakar, Esteban Mezey
    Journal of Clinical and Translational Hepatology, Published online June 28, 2016. doi:10.14218/JCTH.2016.00006
    Abstract
    Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. [...] Read more.
    Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. It encompasses a spectrum of disease, including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis. AH can range from mild to severe disease, with severe disease being defined as: Discriminant Function (DF) ≥ 32, or Model for End-stage Liver Disease (MELD) ≥ 21, or presence of hepatic encephalopathy. Management of the mild disease consists mainly of abstinence and supportive care. Severe AH is associated with significant mortality. Currently, there is no ideal medical treatment for this condition. Besides alcohol cessation, corticosteroids have been used with conflicting results and are associated with an inherent risk of infection. Overall steroids have shown short term benefit when compared to placebo, but they have no obvious long term benefits. Pentoxifylline does not improve survival in patients with severe AH and is no longer recommended based on the results of the STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) trial. Anti-tumor necrosis factor (TNF) agents are associated with increased risk of life threatening infections and death. Currently, early stage trials are underway, mainly targeting novel pathways based on disease pathogenesis, including modulation of innate immune system, inhibition of gut-liver axis and cell death pathways, and activation of transcription factor farnesyl X receptor (FXR). Future treatment may lie in human induced pluripotent stem cell (iPSC) technology, which is currently under investigation for the study of pathogenesis, drug discovery, and stem cell transplantation. Liver transplantation has been reported with good results in highly selected patients but is controversial due to limited organ supply. Full article
    Review Article Open Access
    Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update
    Eric Yoon, Arooj Babar, Moaz Choudhary, Matthew Kutner, Nikolaos Pyrsopoulos
    Journal of Clinical and Translational Hepatology, Published online June 15, 2016. doi:10.14218/JCTH.2015.00052
    Abstract
    Hepatic injury and subsequent hepatic failure due to both intentional and non-intentional overdose of acetaminophen (APAP) has affected patients for decades, and involves the cornerstone [...] Read more.
    Hepatic injury and subsequent hepatic failure due to both intentional and non-intentional overdose of acetaminophen (APAP) has affected patients for decades, and involves the cornerstone metabolic pathways which take place in the microsomes within hepatocytes. APAP hepatotoxicity remains a global issue; in the United States, in particular, it accounts for more than 50% of overdose-related acute liver failure and approximately 20% of the liver transplant cases. The pathophysiology, disease course and management of acute liver failure secondary to APAP toxicity remain to be precisely elucidated, and adverse patient outcomes with increased morbidity and mortality continue to occur. Although APAP hepatotoxicity follows a predictable timeline of hepatic failure, its clinical presentation might vary. N-acetylcysteine (NAC) therapy is considered as the mainstay therapy, but liver transplantation might represent a life-saving procedure for selected patients. Future research focus in this field may benefit from shifting towards obtaining antidotal knowledge at the molecular level, with focus on the underlying molecular signaling pathways. Full article
    Review Article Open Access
    Current Knowledge on Hepatitis E
    María Teresa Pérez-Gracia, Mario García, Beatriz Suay, María Luisa Mateos-Lindemann
    Journal of Clinical and Translational Hepatology, Published online June 15, 2015. doi:10.14218/JCTH.2015.00009
    Abstract
    Although only a single serotype of hepatitis E virus (HEV), the causative agent of hepatitis E, has been identified, there is great genetic variation among the different HEV isolates [...] Read more.
    Although only a single serotype of hepatitis E virus (HEV), the causative agent of hepatitis E, has been identified, there is great genetic variation among the different HEV isolates reported. There are at least four major recognized genotypes of HEV: genotypes 1 and 2 are mainly restricted to humans and linked to epidemic outbreaks in nonindustrialized countries, whereas genotypes 3 and 4 are zoonotic in both developing and industrialized countries. Besides human strains, genotype 3 and 4 strains of HEV have been genetically characterized from swine, sika deer, mongooses, sheep, and rabbits. Currently, there are approximately 11,000 human and animal sequences of HEV available at the International Nucleotide Sequence Database Collaboration. HEV is the major cause of waterborne outbreaks of hepatitis in areas of poor sanitation. Additionally, it is responsible for sporadic cases of viral hepatitis in not only endemic but industrialized countries as well. Transmission of HEV occurs predominantly by the fecal-oral route, although parenteral and perinatal routes have been reported. HEV infection develops in most individuals as a self-limiting, acute, icteric hepatitis; with mortality rates around 1%. However, some affected individuals will develop fulminant hepatic failure, a serious condition that is frequently fatal without a liver transplant. This complication is particularly common when the infection occurs in pregnant women, where mortality rates rise dramatically to up to 25%. Among the preventive measures available to avoid HEV infection, two separate subunit vaccines containing recombinant truncated capsid proteins of HEV have been shown to be highly effective in the prevention of disease. One of them, HEV 239, was approved in China, and its commercialization by Innovax began in November 2012 under the name Hecolin®. Full article
Special Features

Call for Papers for Special Issue ‘Coronavirus Disease (COVID-19) and the Liver’

Journal: Journal of Clinical and Translational Hepatology
Special Issue: Coronavirus Disease (COVID-19) and the Liver
Submission deadline: December 31, 2020
Publication date: March 25, 2021

Call for Papers for Prevention & Control of Coronavirus Disease (COVID-19)

Journal: Exploratory Research and Hypothesis in Medicine
Special Issue: Prevention & Control of Coronavirus Disease (COVID-19)
Submission deadline: December 31, 2020
Publication date: March 25, 2021

Call for Papers for Special Issue ‘Treatment of Coronavirus Disease (COVID-19)’

Journal: Journal of Exploratory Research in Pharmacology
Special Issue: Treatment of Coronavirus Disease (COVID-19)
Submission deadline: December 31, 2020
Publication date: March 25, 2021