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Hepatitis C Virus and Hepatocellular Carcinoma:A Narrative Review

Journal of Clinical and Translational Hepatology 2018年第1期6卷 79-84页

作者： Page Axley Zunirah Ahmed sujan ravi Ashwani K. Singa Department of Medicine University of Alabama at BirminghamBirminghamALUSA Division of Gastroenterology and Hepatology University of Alabama at BirminghamAL 35294-0012USA

Hepatocellular carcinoma(HCC)is a leading cause of liverrelated death *** C virus(HCV)infection is a major cause of advanced hepatic fibrosis and cirrhosis,with significantly increased risk for development of *** morbidity and mortality of HCV-related HCC remains high,as rates of HCV cirrhosis continue to *** long-term goal of antiviral therapy for chronic HCV is to reduce complications from cirrhosis,including *** advent of new direct-acting antivirals with high rates of virological clearance has revolutionized cure of HCV *** the development of HCC in HCV patients who achieve disease sustained virologic response is reduced,these patients remain at risk for HCC,particularly those patients with advanced fibrosis and *** review outlines the epidemiology of HCC in chronic HCV,various mechanisms,risk factors and pathophysiology that contribute to this disease process,screening recommendations,and the available data on the impact of new direct-acting antiviral treatment on the development on HCC.

关键词： Hepatitis C Hepatocellular carcinoma Direct-acting antiviral Viral hepatitis

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Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis

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Gastroenterology Report 2017年第3期5卷 232-236,I0003页

作者： sujan ravi Kaely S.Bade Mohsen Hasanin Ashwani K.Singal Department of Internal Medicine University of Alabama at BirminghamBirminghamALUSA Division of Gastroenterology and Hepatology University of MissouriColumbiaMOUSA Division of Gastroenterology and Hepatology University of Alabama at BirminghamBirminghamALUSA

*** hepatitis(AH),a unique clinical syndrome among patients with chronic and active alcohol use,is associated with high short-term *** elevated ammonia level is associated with mortality in patients with acute liver failure;however,its impact in AH has not been ***.A retrospective study was performed on patients admitted to a tertiary-care hospital with the discharge diagnosis of *** meeting criteria for AH were included in the final data *** logistic regression models were built to examine the impact of serum ammonia in predicting in-hospital mortality(IHM)and 30-day mortality(TDM).Subgroup analysis was also performed,which was limited to patients who had hepatic *** the 105 AH patients included,26(25%)died during the initial *** the 79 patients who survived initial hospitalization,30(39%)died within 30 *** about ammonia levels at admission was available for 82 *** these,25 patients had IHM and significantly higher ammonia level(97 vs.69 lmol/L,P<0.01).Among the 57 who survived hospitalization,ammonia levels were not significantly different(71 vs.67 lmol/L,P=0.69)in patients with and without *** addition of ammonia to the multivariate regression models including age,sex,cirrhosis,treatment and model for end-stage liver disease(MELD)score improved the C statistics for IHM from 0.708 to 0.801 and for TDM from 0.756 to 0.766,*** results were identical,even when limited to patients with hepatic *** patients with elevated ammonia levels at admission have higher IHM;however,they do not seem to play a significant role in 30-day mortality for patients who survived hospitalization.

关键词： alcoholic hepatitis hepatic encephalopathy ammonia mortality

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Use of automated irrigation pumps improves quality of bowel preparation for colonoscopy

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World Journal of Gastrointestinal Endoscopy 2016年第6期8卷 295-300页

作者： sujan ravi Rana Sabbagh Fadi Antaki Department of Internal Medicine University of Alabama at Birmingham Birmingham AL 35233 United States Division of Gastroenterology John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine Detroit MI 48201United States Detroit Medical Center DetroitMI 48201 United States

AIM: To evaluate the effectiveness of automated irrigation pumps(AIPs) in improving the quality of the bowel preparation and the yield of ***: A retrospective observational study was conducted at a single medical center. Outpatient colonoscopies performed during a 4-mo time period when AIPs were not in use, were compared to colonoscopies performed during control period. The main outcomes measured were quality of bowel preparation, procedures aborted due to poor preparation, recommendations to repeat at short interval due to suboptimal bowel preparation and adenoma detection ***: One thousand and thirty-seven colonoscopies were included. A higher proportion of cases did not achieve a satisfactory bowel preparation when AIPs were not used(24.4% vs 10.3%, P < 0.01). The number of procedures aborted due to inadequate preparation was not significantly different, however a repeat procedure at a short interval was recommended in a higher proportion of cases when AIPs were not used(21.3% vs 6.9%, P < 0.01). Good or excellent preparation was 2.91(95%CI: 2.04-4.15) times more likely when AIPs were used. Detection of polyps and adenomas was not significantly ***: AIP use during colonoscopy results in a higher proportion of colonic preparation rated as satisfactory, although polyp detection rate is not significantly affected. Recommendations for repeat colonoscopy at shorter interval significantly decrease with the use of AIPs. This study supports the use of the irrigation pumps in endoscopy units to improve the quality of colonoscopy.

关键词： Automated irrigation pumps Adenoma Quality Polyps Bowel preparation Surveillance interval Colonoscopy

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