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Portal vein thrombosis in cirrhotic patients-it is always the small pieces that make the big picture

World Journal of Gastroenterology 2018年第39期24卷 4419-4427页

作者： irina girleanu Anca Trifan Carol Stanciu Cǎtǎlin Sfarti Department of Gastroenterology “Grigore T Popa”University of Medicine and PharmacyIa.i 700115Romania Institute of Gastroenterology and Hepatology “St.Spiridon”University HospitalIa.i 700115Romania

Portal vein thrombosis(PVT) is a frequent and serious complication in patients with liver cirrhosis(LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease(compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex endpoints such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.

关键词： Portal vein thrombosis Liver cirrhosis Classification Risk factors Anticoagulation

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Role of ammonia in predicting the outcome of patients with acuteon- chronic liver failure

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World Journal of Clinical Cases 2021年第3期9卷 552-564页

作者： Stefan Chiriac Carol Stanciu Camelia Cojocariu Ana-Maria Singeap Catalin Sfarti Tudor Cuciureanu irina girleanu Razvan Alexandru Igna Anca Trifan Department of Gastroenterology “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology "St.Spiridon"Emergency HospitalIasi 700111Romania Intensive Care “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania

BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute hepatitis.Moreover,VA has been associated with poor prognosis and high mortality in these clinical settings.However,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly established.AIM To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care center.METHODS We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for ACLF.The study was conducted in“St.Spiridon”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January 2019.The APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established accordingly.West-haven classification was used for HE.Statistical analysis was performed using IBM SPSS version 22.0.RESULTS Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%men.Child-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade III.HE was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade IV.Overall mortality was 7.8%.VA was 103(78-148)μmol/L.Receiver operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney injury,severe HE(grade III or IV),VA≥152.5μmol/L,M

关键词： Venous ammonia Hepatic encephalopathy Acute-on-chronic liver failure Asian Pacific Association for the Study of the Liver Acute-on-chronic Liver Failure Research Consortium score Cirrhosis Mortality

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Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第35期23卷 6500-6515页

作者： Anca Trifan Carol Stanciu irina girleanu Oana Cristina Stoica Ana Maria Singeap Roxana Maxim Stefan Andrei Chiriac Alin Ciobica Lucian Boiculese Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital“Grigore T.Popa”University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital Department of Research Faculty of Biology“Alexandru Ioan Cuza”University of Iasi Department of Preventive Medicine and Interdisciplinarity “Grigore.T.Popa”University of Medicine and Pharmacy

AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q statistic.Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies(I^2 = 85.4%, P < 0.001) a

关键词： Proton pump inhibitors Clostridium difficile infection Risk Systematic review Meta-analysis

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Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

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World Journal of Clinical Cases 2021年第33期9卷 10180-10188页

作者： Camelia Cojocariu irina girleanu Anca Trifan Andrei Olteanu Cristina Maria Muzica Laura Huiban Stefan Chiriac Ana Maria Singeap Tudor Cuciureanu Catalin Sfarti Carol Stanciu Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”University HospitalInstitute of Gastroenterology and HepatologyIasi 700115Romania

BACKGROUND Clostridium difficile infection(CDI)has increased in prevalence during the last years.The coronavirus disease 2019(COVID-19)pandemic has negatively influenced patient outcomes.The majority of the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)-infected patients received antibiotics during hospitalization.AIM To analyze the factors that influenced CDI development after SARS-CoV-2 infection.METHODS Between March 2020 to December 2020,we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital.The diagnosis of CDI was based on the presence of diarrhea(≥3 watery stools within 24 h)associated with Clostridium difficile toxins A or B.We excluded patients with other etiology of acute diarrhea.RESULTS Among the total 447(12.5%)patients with CDI,most were male(54.3%)and mean age was 59.7±10.8 years.Seventy-six(17.0%)had history of COVID-19,most being elderly(COVID-19:62.6±14.6 years vs non-COVID-19:56.8±17.6 years,P=0.007),with history of alcohol consumption(43.4%vs 29.4%,P=0.017),previous hospitalizations(81.6%vs 54.9%,P<0.001)and antibiotic treatments(60.5%vs 35.5%,P<0.001),requiring higher doses of vancomycin and prone to recurrent disease(25.0%vs 13.1%,P=0.011).Age over 60 years[odds ratio(OR):2.591,95%confidence interval(CI):1.452-4.624,P=0.001],urban residence(OR:2.330,95%CI:1.286-4.221,P=0.005),previous antibiotic treatments(OR:1.909,95%CI:1.083-3.365,P=0.025),previous hospitalizations(OR:2.509,95%CI:1.263-4.986,P=0.009)and alcohol consumption(OR:2.550,95%CI:1.459-4.459,P=0.001)were risk factors of CDI in COVID-19.CONCLUSION CDI risk is unrelated to history of SARS-CoV-2 infection.However,previous COVID-19 may necessitate higher doses of vancomycin for CDI.

关键词： COVID-19 infection Clostridium difficile infection Risk factors Antibiotic use Pandemic Recurrence

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Impact of Clostridium difficile infection on inflammatory bowel disease outcome: A review

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World Journal of Gastroenterology 2014年第33期20卷 11736-11742页

作者： Anca Trifan Carol Stanciu Oana Stoica irina girleanu Camelia Cojocariu "Gr. T. Popa" University of Medicine and Pharmacy "St. Spiridon" Emergency Hospital Institute of Gastroenterology and Hepatology 7000111 Iasi Romania "St. Spiridon" Emergency Hospital Institute of Gastroenterology and Hepatology 7000111 Iasi Romania "Gr. T. Popa" University of Medicine and Pharmacy 7000111 Iasi Romania

Although a considerable number of studies support a substantial increase in incidence, severity, and healthcare costs for Clostridium difficile infection(CDI) in inflammatory bowel disease(IBD), only few evaluate its impact on IBD outcome. Medline and several other electronic databases from January 1993 to October 2013 were searched in order to identify potentially relevant literature. Most of the studies showed that IBD patients with CDI present a greater proportion of worse outcomes than those without CDI. These patients have longer length of hospital stay, higher rates of colectomies, and increased mortality. Patients with ulcerative colitis are more susceptible to CDI and have more severe outcomes than those with Crohn's disease. However, studies reported variable results in both short-and long-term outcomes. Contrasting results were also found between studies using nationwide data and those reporting from single-center, or between some NorthAmerican and European studies. An important limitation of all studies analyzed was their retrospective design. Due to contrasting data often provided by retrospective studies, further prospective multi-center studies are necessary to evaluate CDI impact on IBD outcome. Until then, a rapid diagnosis and adequate therapy of infection are of paramount importance to improve IBD patients' outcome. The aim of this article is to provide up to date information regarding CDI impact on outcome in IBD patients.

关键词： Clostridium difficile infection Ulcerative colitis

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Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication

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World Journal of Gastroenterology 2013年第42期19卷 7476-7479页

作者： Anca Trifan irina girleanu Camelia Cojocariu Catalin Sfarti Ana Maria Singeap Carmen Dorobat Lucia Grigore Carol Stanciu "Gr. T. Popa" University of Medicine and Pharmacy 700111 IasiRomania Institute of Gastroenterology and Hepatology "St. Spiridon" Emergency Hospital700111 IasiRomania "St. Parascheva" Clinical Hospital of Infectious Diseases 700111 IasiRomania

Helicobacter pylori(H.pylori)is one of the most common chronic bacterial infections in humans,affecting half of world’s population.Therapy for H.pylori infection has proven to be both effective and safe.The oneweek triple therapy including proton pump inhibitor,clarithromycin,and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H.pylori infection in countries with low clarithromycin resistance.Generally,this therapy is well-tolerated,with only a few and usually minor side effects.However,rare but severe adverse effects such as pseudomembranous colitis have been reported,Clostridium difficile(C.difficile)infection being the main causative factor in all cases.We report the cases of two women who developed pseudomembranous colitis after a 1-wk triple therapy consisting of pantoprazole 20 mg bid,clarithromycin 500 mg bid,and amoxicillin 1 g bid to eradicate H.pylori infection.A limited colonoscopy showed typical appearance of pseudomembranous colitis,and the stool test for C.difficile toxins was positive.Rapid resolution of symptoms and negative C.difficile toxins were obtained in both patients with oral vancomycin.No relapse occurred during a four and eleven-month,respectively,follow up.These cases suggest that physicians should have a high index of suspicion for pseudomembranous colitis when evaluate patients with diarrhea following H.pylori eradication therapy.

关键词： Helicobacter pylori eradication Triple therapy Clostridium difficile Pseudomembranous colitis Vancomycin

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An Evaluation of the Main Physical Features and Circulation Patterns in the Black Sea Basin

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Journal of Marine Science 2021年第1期3卷 8-18页

作者： Alina girleanu Eugen Rusu “Dunarea de Jos”University of Galati Faculty of EngineeringMechanical Engineering DepartmentGalatiRomania

Having as target the semi-enclosed basin of the Black Sea,the primary purpose of the existing paper is to present an overview of its extensive physical features and circulation patterns.To achieve this goal,more than five decades of data analysis-from 1960 to 2015-were taken into consideration and the results were validated against acknowledged data,both from satellite data over the last two decades and in-situ measurements from first decades.The circulation of the Black Sea basin has been studied for almost 400 years since the Italian Count Luigi Marsigli first described the“two-layer”circulation through the Bosphorus Strait in the year 1681.Since climate change projections for the Black Sea region foresee a significant impact on the environment in the coming decades,a set of adaptation and mitigation measures is required.Therefore more research is needed.Nowadays,the warming trend adds a sense of immediate urgency because according to the National Oceanic and Atmospheric Administration’s National Centre for Environmental Information,July 2020 was the second-hottest month ever recorded for the planet.Its averaged land and ocean surface temperature tied with July 2016 as the secondhighest for the month in the 141-year NOAA’s global temperature dataset history,which dates back to 1880.It was 0.92°C above the 20th-century average of 15.8°C,with only 0.01°C less than the record extreme value measured in July of 2019.

关键词： Black Sea basin Circulation patterns Historical data Climate change Extreme values

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