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Unraveling the Impact of Direct-Acting Antivirals on Hepatitis-Linked Cirrhosis: A Comprehensive Analysis of Fibrosis, Child Score, and Disease Progression

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Open Journal of Gastroenterology 2024年第6期14卷 203-212页

作者： Hajar Cherkaoui Maryam Elkhayari maria lahlali Asmae Lamine Nada Lahmidani Amine Mekkaoui Mounia Elyousfi Dafr Allah Benajah Mohammed El Abkari Adil Ibrahimi Hakima Abid Department of Hepato-Gastroenterology Hassan II University Hospital Fez Morocco Faculty of Medicine and Pharmacy of Fez USMBA Fez Morocco

The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological response in only 45% of cases with significant side effects. The advent of direct-acting antivirals has changed the prognosis of cirrhotic patients with hepatitis C. DAAs have ensured a sustained viral response in the majority of patients. Our work aims to see the evolution of hepatitis C patients at the cirrhosis stage under DAA. We conducted a retrospective study over 15 years (January 2009, January 2024) including all patients with post-viral cirrhosis C, whom we divided into two groups: group A, cirrhotic patients who received ribavirin and interferon, and group B, patients on DAA. From January 2009 to January 2024, we conducted a study of 182 patients with viral hepatitis C, including 102 cirrhotic patients. The mean age was 55 years. 66% of patients were initially treated with the ribavirin interferon combination, while 34% received direct-acting antivirals (DAAs). Since the introduction of DAAs, the most commonly used regimens have been sofosbuvir/daclatasvir with or without ribavirin and sofosbuvir/ledipasvir with or without ribavirin. Group A achieved sustained virological response (SVR) in 60% of cases, with notable side effects. In Group B, SVR was 98.18%, with improved tolerability and fewer side effects than previous treatments. Fifteen patients developed hepatocellular carcinoma (HCC), with a significantly lower mortality rate in those treated with DAAs compared with pegylated dual therapy (p: 0.001).

关键词： Post-Viral Cirrhosis C Pegylated Interferon Direct Acting Antivirals Sustained Viral Response Child Score Fibrosis

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Dunbar Syndrome and Hypoxic Hepatitis: An Unusual Presentation

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Open Journal of Gastroenterology 2024年第6期14卷 226-232页

作者： Hajar Cherkaoui Ismail Chaouech Yousra El Abidi Haroun Robleh Asmae Lamine maria lahlali Nada Lahmidani Amine Mekkaoui Mounia Elyousfi Dafr Allah Benajah Adil Ibrahimi Mohammed El Abkari Nizar Bouardi Mohammed Maaroufi Hakima Abid Department of Gastroenterology University Hospital Hassan II Fez Morocco Faculty of Medicine and Pharmacy Fez Morocco Department of Radiology University Hospital Hassan II Fez Morocco

Hypoxic hepatitis, also known as ischemic hepatitis, is characterized by acute hepatocellular injury due to inadequate oxygen delivery to the liver. Celiac trunk stenosis can lead to hepatic ischemia and subsequent liver damage. We present the case of an 81-year-old patient with a history of hypertension, ischemic heart disease, hypothyroidism, and biliary lithiasis, who developed hypoxic hepatitis secondary to Dunbar syndrome and a stenosis of the superior mesenteric artery. The patient improved symptoms and liver function tests with conservative management, including intravenous fluids and supportive care. Long-term management involved continued antiplatelet therapy and statins, with consideration of further interventions for celiac trunk stenosis. This case underscores the importance of recognizing Dunbar syndrome as well as superior mesentery trunk stenosis as a potential cause of hypoxic hepatitis. It highlights the need for multidisciplinary management in such cases.

关键词： Dunbar Syndrome Hypoxic Hepatitis Stenosis of Mesentery Artery

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Chronic Viral Hepatitis C: Before and after Direct Acting Antivirals (DAA) in Morocco

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Open Journal of Gastroenterology 2022年第3期12卷 55-63页

作者： Hakima Abid Maryam Khayari Hajar Cherkaoui maria lahlali Nada Lahmidani Mounia Elyousfi Nourdin Aqodad Sidi Adil Ibrahimi Mohamed El Abkari Hepato-Gastroenterology Unit University Hospital Hassan II Fez Morocco Laboratory of Human Pathology Biomedicine and Environment Fez Morocco Faculty of Medicine and Pharmacy Sidi Mohammed Ben Abdellah University Fez Morocco Hepato-Gastroenterology Unit University Hospital Ibn Zohr Agadir Morocco

For a long time, a combination of interferon and ribavirin has been used to treat viral hepatitis C, but the sustained virological response was only achieved in 45% of cases and side effects were serious [1]. Direct acting antivirals (DAA) have provided a cure for almost everyone with hepatitis C, with few side effects. The Purpose of Our Work is to compare the results of treatment for viral hepatitis C before and after DAA. Patients and Methods: This is a retrospective study, bringing together all patients with chronic viral hepatitis C treated between January 2009 and March 2020 at the University Hospital Hassan II in Fez, Morocco. The epidemiological, clinical, biological, virological characteristics of the included patients were collected from the two groups: A, treated with interferon and ribavirin or by triple therapy and B, treated with DAA. Results: 162 patients were included, the average age was 55 y/o, with 90 women and 72 men. 88 patients (54.3%) were already cirrhotic, of which 61 were compensated and 27 were decompensated. Genotype 1 was dominant with a frequency of 71.6%, 107 patients (66%) initially treated with old HCV treatments and 55 (34%) treated with DAA. Sustained viral response was obtained in 59 cases (55.14%) in group A versus 54 cases (98.18%) in group B with a very significant difference (p < 0.0001). Treatment failure was observed in 14 patients (13.1%) in group A and only one patient, i.e. 2% in group B (p = 0.019). 14 patients relapsed in group A (13.1%) versus 0 patient in group B (p = 0.003). The tolerance of the treatment was excellent in group B as a whole with only five patients (9%) reported side effects which were minor, not leading to the discontinuation of treatment while the side effects were major in 49 patients (45.7%) in group A with led to the permanent discontinuation of treatment in 6 patients. The difference in side effects between the two groups was very significant with (p Conclusion: Our study has shown the superiority of DAA in terms of efficacy and tolerance com

关键词： Viral Hepatitis C Pegylated Dual Therapy Direct Acting Antivirals Tolerance

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Dieulafoy’s Lesion of the Duodenum: The Management of This Unusual Location

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Case Reports in Clinical Medicine 2022年第7期11卷 268-272页

作者： Rajae Bounour Amal Mejait maria lahlali Asmae Lamine Hakima Abid Hakima Abid Amine Mekkaoui Mounia Elyousfi Dafrallah Benajeh Mohamed El Abkari Sidi Adil Ibrahimi Nada Lahmidani Hepato-Gastroenterology Department CHU Hassan II Fez Morocco

Dieulafoy lesion (DL) is a rare source of gastrointestinal tract bleeding that can affect any site of the gastrointestinal tract, particularly the stomach and less commonly the duodenum. Early endoscopy during a bleeding episode is essential for an accurate diagnosis and sometimes multiple endoscopies are needed to establish the diagnosis. In this report, we describe a case of duodenal DL detected and treated by endoscopy. We report the case of a 65-year-old patient admitted for massive upper gastrointestinal bleeding due to a Dieulafoy lesion of the duodenum. Endoscopic diagnosis and treatment were possible and hemostasis was achieved by injecting adrenaline and placing 3 clips. Various effective endoscopic techniques are available to control bleeding, the combination of injection therapy and mechanical therapy reduces the risk of recurrence.

关键词： Dieulafoy’s Lesion Endoscopy Hemostatic Clips

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What Impact Does COVID-19 Have in Cirrhotics?

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Open Journal of Gastroenterology 2021年第1期11卷 16-27页

作者： Hakima Abid Hajar Cherkaoui maria lahlali Nada Lahmidani Mohammed El Abkari Sidi Adil Ibrahimi Department of Hepato-gastroenterology Hassan II University Hospital Fez Morocco Faculty of Medicine and Pharmacy of Fez University of Sidi Mohammed Ben Abdellah Fez Morocco

SARS-Cov-2 is a novel coronavirus discovered in Wuhan, China in late 2019 and responsible for respiratory distress. Aim: study the impact of COVID-19 among patients with cirrhosis. Patients and methods: We conducted a prospective study for a period of 9 months (April 1st-December 1st) that included cirrhotic patients infected with SARS-Cov-2 followed in the gastroenterology department in the University Hospital Hassan II. Results: Among 1437 patients hospitalised for SARS-Cov-2, 8 cirrhotic patients were included in a period of 9 months (April 1st-December 1st). The mean age is 55 y/o and most are female (n = 6). The aetiology of cirrhosis is mostly HCV (n = 3), HBV (n = 2). Half of the infected patients had acute bleeding (one of them had hepatic encephalopathy) and one patient had respiratory distress. Most of the patients had a negative PCR at the end of the hospital stay (n = 5). The mortality rate was 25% and patients were followed up for a period of 4 months. Conclusion: In the studied population, clinical manifestations were essentially a decompensation of cirrhosis.

关键词： SARS-Cov-2 Cirrhosis Decompensation Severity

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Portal Vein Thrombosis in Non Cirrhotic Patients: Experience of Gastroenterology and Hepatology Department University Hospital Hassan II

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Open Journal of Gastroenterology 2020年第12期10卷 349-356页

作者： Nada Lahmidani mariam El Khayari maria lahlali Asmae Lamine Hakima Abid Mounia El Yousfi Dafr Allah Benajah Sidi Adil Ibrahimi Mohammed El Abkari Department of Gastroenterology and Hepatology School of Medicine and Pharmacy of Fez University Hospital Hassan II University Sidi Mohammed Ben Abdallah Fez Morocco

Portal thrombosis (PT) is a rare condition of heterogeneous etiologies. The aim of our work is to study the epidemiological and etiological profile of portal thrombosis in non cirrhotic patients through the experience of our department. Patients and Methods: This is a retrospective study over a 9-year period (January 2009-July 2018), 54 cases of PT in non cirrhotic patients were collected in the department of Hepato-Gastro-Enterology of the HASSAN II Fez Hospital, 73 cases of PT were excluded among cirrhotic patients. Results: We collected 54 cases of PT cases;the average age was 45 years, with an F/M ratio of 1.42. PT was revealed by abdominal pain in 20 cases, complications of portal hypertension in 24 cases, and ultrasound discovery in 10 asymptomatic cases. Main underlying causes of PT were: A proteine S deficiency in 7 cases, Acute pancreatitis in 5 cases, colonic cancer in 4 cases, pancreatic cancer in 4 cases, Hydatic liver Echinococcoses (3 cases), anti phospholipid syndrom (3 cases), myeloproliferative syndrom (2 cases) and jak mutation 2 in 1 case, non identified etiology was reported in 20 cases (37%). Treatment was based on anticoagulation, treatment of portal hypertension complications, and etiological treatment in cases where etiological diagnosis was certainly posed. Conclusion: PT is a rare but serious condition, according to our study neoplastic causes are predominant followed by protein S deficiency. Etiological investigations have to be wide and early treatment is the best option to avoid extension and complication.

关键词： Portal Thrombosis Etiology Anticoagulant Non Cirrhotic

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Biodegradability of bioplastics in different aquatic environments:A systematic review

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Journal of Environmental Sciences 2024年第8期142卷 169-181页

作者： maria Cristina Lavagnolo Valentina Poli Anna maria Zampini Valentina Grossule Department of Civil Environmental and Architectural Engineering-Laboratory of Environmental EngineeringUniversity of PadovaLungargine Rovetta 8Padova 35100Italy

Bioplastics were first introduced as environmentally friendly materials,with properties similar to those of conventional plastics.A bioplastic is defined as biodegradable if it can be decomposed into carbon dioxide under aerobic degradation,or methane and CO_(2)under anaerobic conditions,inorganic compounds,and new cellular biomass,by the action of naturally occurring microorganisms.This definition however does not provide any information on the environmental conditions,timescale and extent at which decomposition processes should occur.With regard to the aquatic environment,recognized standards have been established to assess the ability of plastics to undergo biodegradation;however,these standards fail to provide clear targets to be met to allow labelling of a bioplastic as biodegradable.Moreover,these standards grant the user an extensive leeway in the choice of process parameters.For these reasons,the comparison of results deriving from different studies is challenging.The authors analysed and discussed the degree of biodegradability of a series of biodegradable bioplastics in aquatic environments(both fresh and salt water)using the results obtained in the laboratory and from on-site testing in the context of different research studies.Biochemical Oxygen Demand(BOD),CO_(2)evolution,surface erosion and weight loss were the main parameters used by researchers to describe the percentage of biodegradation.The results showed a large variability both in weight loss and BOD,even when evaluating the same type of bioplastics.This confirms the need for a reference range of values to be established with regard to parameters applied in defining the biodegradability of bioplastics.

关键词： Biodegradation Bioplastic Plastic Natural environment Plastic waste

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History of chronic gastritis:How our perceptions have changed

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World Journal of Gastroenterology 2024年第13期30卷 1851-1858页

作者： Dmitry Bordin maria Livzan Department of Pancreatic Biliary and Upper GI Tract DiseasesA.S.Loginov Moscow Clinical Scientific CenterMoscow 111123Russia Department of Propaedeutic of Internal Diseases and Gastroenterology Russian University of MedicineMoscow 127006Russia Department of Outpatient Therapy and Family Medicine Tver State Medical UniversityTver 170100Russia Department of Internal Medicine and Gastroenterology Omsk State Medical UniversityOmsk 644099Russia

Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular patient.Modern classification approach with the definition of the stage of gastritis determines the need,activities and frequency of dynamic monitoring of a patient.However,this attitude to the patient suffering from CG was far from always.The present publication is a literature review describing the key milestones in the history of CG research,from the description of the first observations of inflammation of the gastric mucosa,assessment of gastritis as a predominantly functional disease,to the advent of endoscopy of the upper digestive tract and diagnostic gastric biopsy,assessment of the role of Helicobacter pylori infection in progression of inflammatory changes to atrophy,intestinal metaplasia,dysplasia and GC.

关键词： Chronic gastritis Intestinal metaplasia Dysplasia Gastric cancer Helicobacter pylori

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Tocotrienol isoforms:The molecular mechanisms underlying their effects in cancer therapy and their implementation in clinical trials

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Journal of Integrative Medicine 2024年第1期22卷 1-11页

作者： maria Younes Ghady Loubnane Christopher Sleiman Sandra Rizk Department of Natural Sciences Lebanese American UniversityByblosLebanon

Tocotrienols are found in a variety of natural sources,like rice bran,annatto seeds and palm oil,and have been shown to have several health-promoting properties,particularly against chronic diseases such as cancer.The incidence of cancer is rapidly increasing around the world,not only a result of continued aging and population growth,but also due to the adoption of aspects of the Western lifestyle,such as high-fat diets and low-physical activity.The literature provides strong evidence that tocotrienols are able to inhibit the growth of various cancers,including breast,lung,ovarian,prostate,liver,brain,colon,myeloma and pancreatic cancers.These findings,along with the reported safety profile of tocotrienols in healthy human volunteers,encourage further research into these compounds’potential use in cancer prevention and treatment.The current review provided detailed information about the molecular mechanisms of action of different tocotrienol isoforms in various cancer models and evaluated the potential therapeutic effects of different vitamin E analogues on important cancer hallmarks,such as cellular proliferation,apoptosis,angiogenesis and metastasis.MEDLINE/PubMed and Scopus databases were used to identify recently published articles that investigated the anticancer effects of vitamin E derivatives in various types of cancer in vitro and in vivo along with clinical evidence of adjuvant chemopreventive benefits.Following an overview of pre-clinical studies,we describe several completed and ongoing clinical trials that are paving the way for the successful implementation of tocotrienols in cancer chemotherapy.

关键词： Vitamin E Tocotrienols Cancer Molecular mechanism Clinical trials

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Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients

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World Journal of Gastroenterology 2024年第19期30卷 2502-2504页

作者： maria Elena Riccioni Clelia Marmo Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy CEMAD Centro Malattie Dell’Apparato Digerente Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy

Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.

关键词： Gastrointestinal bleeding Small bowel bleeding Recurrent bleeding Rebleeding risk Rebleeding Outpatient management

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