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Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

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World Journal of hepatology 2024年第1期16卷 17-32页

作者： yash R Shah hassam Ali Angad Tiwari David Guevara-Lazo Natalia Nombera-Aznaran Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani harishankar Gopakumar Amir h Sohail SriLakshmiDevi Kanumilli Ernesto Calderon-Martinez Geetha Krishnamoorthy Nimish Thakral Dushyant Singh Dahiya Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology and hepatology University of Illinois College of Medicine at PeoriaPeoriaIL 61605United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Digestive Diseases and Nutrition University of KentuckyLexingtonKY 40536United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(hE)by leveraging beneficial bacterial displacement to restore a balanced gut *** prevalence of hE varies with liver disease severity and *** pathogenesis involves ammonia toxicity,gut-brain communication disruption,and *** aims to restore gut microbiota balance,addressing these ***'s efficacy has been explored in various conditions,including *** suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate *** has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver *** include improved liver function,cognitive function,and the slowing of disease ***,larger,controlled studies are needed to validate its effectiveness in these *** have shown cognitive improvements through FMT,with potential benefits in cirrhotic ***,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of *** evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor *** large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and *** FMT holds potential for hE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

关键词： hepatic encephalopathy Fecal microbiota transplant Cognitive impairment Liver cirrhosis Chronic liver disease

Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 148-156页

作者： Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani hassam Ali Sahib Singh.yash.R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma Shyam Thakkar Department of Internal Medicine University of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Division of Gastroenterology and hepatology University of MissouriColumbiaMO 65212United States Department of Rheumatology Medical College of GeorgiaAugusta UniversityNorth AugustaGA 30912United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Division of Gastroenterology and hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Interventional Oncology&Surgical Endoscopy GI Oncology Tumor Site TeamParkview Cancer InstituteParkview HealthFort WayneIN 46845United States Section of Gastroenterology&hepatology West Virginia University School of MedicineMorgantownWV 26505United States

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic *** and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related *** To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning *** This is a cohort study using the 2018-2020 National Readmission *** aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical *** hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and *** primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to *** used univariate and multivariate regression models for *** A total of 9448 patients were admitted for any indications of *** and non-frail patients were 3445(36.46%)and 6003(63.53%)*** for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(Phe 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared

关键词： Endoscopic retrograde cholangiopancreatography Nonagenarians Frailty Mortality healthcare burden

Remimazolam for sedation in gastrointestinal endoscopy:A comprehensive review

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 385-395页

作者： Dushyant Singh Dahiya Ganesh Kumar Syeda Parsa Manesh Kumar Gangwani hassam Ali Amir humza Sohail Saqr Alsakarneh Umar hayat Sheza Malik yash R Shah Bhanu Siva Mohan Pinnam Sahib Singh Islam Mohamed Adishwar Rao Saurabh Chandan Mohammad Al-haddad Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityMO 66160United States Department of Internal Medicine Chandka Medical CollegeSindh 77280Pakistan Department of Gastroenterology and hepatology University of Arkansas For Medical SciencesLittle RockAR 72205United States Division of Gastroenterology Hepatology and NutritionEast Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Department of Internal Medicine Geisinger Wyoming Valley Medical CenterWilkes BarrePA 18711United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Sinai hospitalBaltimoreMD 21215United States Department of hepatology University of MissouriColumbiaMO 65211United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Division of Gastroenterology and hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Gastroenterology and hepatology Indiana University School of MedicineIndianapolisIN 46202United States

Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient ***,benzodiazepines and opioids continue to be widely ***,in recent years,Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal(GI)*** is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural *** has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase,volume of distribution,total body clearance,and negligible drug-drug *** also has satisfactory efficacy and has achieved high rates of successful sedation in GI ***,studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol,which is currently a gold standard for procedural sedation in most parts of the ***,the use of Propofol is associated with hemodynamic instability and respiratory *** contrast,Remimazolam has lower incidence of these adverse effects intra-procedurally and hence,may provide a safer alternative to Propofol in procedural *** this comprehensive narrative review,highlight the pharmacologic characteristics,efficacy,and safety of Remimazolam for procedural *** also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.

关键词： Remimazolam Endoscopy Sedation Outcomes Efficacy Safety Pharmacokinetics

Liver transplant in primary sclerosing cholangitis:Current trends and future directions

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世界肝病学杂志:英文版(电子版) 2023年第8期15卷 939-953页

作者： yash R Shah Natalia Nombera-Aznaran David Guevara-Lazo Ernesto Calderon-Martinez Angad Tiwari SriLakshmiDevi Kanumilli Purva Shah Bhanu Siva Mohan Pinnam hassam Ali Dushyant Singh Dahiya Department of Internal Medicine Trinity Health OaklandPontiacMI 48341United States Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Postgraduate Education Harvard Medical SchoolBostonMA 02115United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Primary sclerosing cholangitis(PSC)is a chronic and progressive immunemediated cholangiopathy causing biliary tree inflammation and scarring,leading to liver cirrhosis and end-stage liver *** of PSC is challenging due to its nonspecific symptoms and overlap with other liver *** the rising incidence of PSC,there is no proven medical therapy that can alter the natural history of the *** liver transplantation(LT)is the most effective approach for managing advanced liver disease caused by PSC,post-transplantation recurrence of PSC remains a ***,ongoing research aims to develop better therapies for PSC,and continued efforts are necessary to improve outcomes for patients with *** article provides an overview of PSC’s pathogenesis,clinical presentation,and management options,including LT trends and future *** also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with ***,the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is *** research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

关键词： Primary sclerosing cholangitis Liver transplantation Management Psychosocial outcomes Pathogenesis

Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)

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World Journal of Critical Care Medicine 2020年第2期9卷 31-42页

作者： Rahul Kashyap Kirtivardhan Vashistha Chetan Saini Taru Dutt Dileep Raman Vikas Bansal harpreet Singh Geeta Bhandari Nagarajan Ramakrishnan harshit Seth Divya Sharma Premkumar Seshadri Mradul Kumar Daga Mohan Gurjar yash Javeri Salim Surani Joseph Varon 无 Department of Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Infectious Disease Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Allegheny General HospitalPittsburghPA 15212United States Department of Radiology Mayo ClinicRochesterMN 55905United States Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 14061United States Department of Neurology Mayo ClinicRochesterMN 55905United States and Department of PsychiatryHennepin County Medical CenterMinneapolisMN 55415United States Department of Medicine Cloud Physician HealthcareBangalore 560038India Department of Critical Care Medicine Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Maulana Azad Medical College&Associated HospitalsNew DelhiDelhi 110002India Department of Anesthesiology Government Medical CollegeHaldwaniNainital 263129India Department of Critical Care Medicine Apollo HospitalsChennai 600006India Department of hospitalist Medicine Allegany ClinicAllegany Health NetworkPittsburghPA 15222United States Premkumar Seshadri Department of MedicineMAAGF HealthcareChennai 600024India Department of Internal Medicine and Center for Occupational and Environment health Maulana Azad Medical CollegeNew DelhiDelhi 110002India Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014India Department of Critical Care Medicine Regency Super Speciality HospitalLucknow 208005India Nayati healthcare New DelhiDelhi 110065India Department of Pulmonary and Critical Care Medicine Texas A&M UniversityCollege StationTX 77843United States Department of Critical Care United Memorial Medical CenterHoustonTX 77091United States ININ-2018 Investigators Team

BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city *** To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement *** The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,*** survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate *** completing and submitting the survey,providers gave their consent for research *** study was deemed eligible for category-2 Institutional Review Board exempt *** There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 *** had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only *** responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were *** consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse *** than 80%of the ICUs were open,and mixed *** followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet *** In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing

关键词： Intensive care unit Critical care India Survey Intensive care unit survey Intensive care unit needs

Development and Validation of New RP-hPLC Method for the Estimation of Alfuzosin hydrochloride in Bulk and Tablet Dosage Form

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American Journal of Analytical Chemistry 2013年第1期4卷 34-43页

作者： Vandana P. Patil Subhash J. Devdhe Suwarna h. Kale Vijay J. Nagmoti Sadanand D. Kurhade Yuvraj R. Girbane Mahesh T. Gaikwad yash Institute of Pharmacy Aurangabad India

A reverse phase high performance liquid chromatographic method (hPLC) has been developed for the estimation of Alfuzosin hydrochloride (ALh) in the pharmaceutical formulation using RP-C18 column. The mobile phase (Tetrahydrofuran, Acetonitrile and buffer (ph 3.50) was pumped at a flow rate of 1.5 ml/min in the ratio of 1:20:80 and the eluents were monitored at 254.0 nm. Linearity was obtained in the concentration range of 80 - 120 μg/mL for ALh. The method was statistically validated and RSD was found to be less than 2% indicating high degree of accuracy and precision of the proposed hPLC method. Due to its simplicity, rapidness, high precision and accuracy, the proposed hPLC method may be used for determination of Alfuzosin hydrochloride in bulk drugs and in pharmaceutical dosage form.

关键词： Alfuzosin hCl RP-hPLC Linearity Precision Accuracy Robustness Ruggedness

Daclatasvir plus asunaprevir in treatment-na?ve patients with hepatitis C virus genotype 1b infection

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World Journal of Gastroenterology 2018年第12期24卷 1361-1372页

作者： Lai Wei Fu-Sheng Wang Ming-Xiang Zhang Ji-Dong Jia Alexey A Yakovlev Wen Xie Eduard Burnevich Jun-Qi Niu Yong Jin Jung Xiang-Jun Jiang Min Xu Xin-Yue Chen Qing Xie Jun Li Jin-Lin hou hong Tang Xiao-guang Dou yash Gandhi Wen-hua hu Fiona McPhee Stephanie Noviello Michelle Treitel Ling Mo Jun Deng Peking University People’s hospital and Peking University hepatology Institute Beijing 100044China Qingdao Municipal hospital Qingdao 266011Shandong ProvinceChina Guangzhou No.8 People’s hospital Guangzhou 510060Guangdong ProvinceChina Beijing Youan hospital Capital Medical UniversityBeijing 100069China Shanghai Ruijin hospital Jiaotong University School of MedicineShenyang 200025Liaoning ProvinceChina TheFirst Affiliated hospital with Nanjing Medical University Nanjing 210029Jiangsu ProvinceChina hepatology Unit Nanfang HospitalSouthern Medical UniversityGuangzhou 510515Guangdong ProvinceChina West China hospital Sichuan UniversityChengdu 610041Sichuan ProvinceChina China Medical University Shengjing HospitalShenyang 110004Liaoning ProvinceChina Bristol-Myers Squibb PrincetonNJ 08540United States Bristol-Myers Squibb WallingfordCT 06492United States 302 Military hospital of China Beijing 100039China Bristol-Myers Squibb Shanghai 200040China the Sixth People’s hospital of Shenyang Shenyang 110006Liaoning ProvinceChina Beijing Friendship hospital Capital Medical UniversityBeijing 100050China Saint-Petersburg State healthcare Institution'Clinical Infectious hospital n.a.S.P.Botkin’ Saint-Petersburg 191167Russia Beijing Ditan hospital Capital Medical UniversityBeijing 100015China I.M.Sechenov First Moscow State Medical University Moscow 119991Russia The First hospital of Jilin University Jilin 1300021Jilin ProvinceChina SMG-SNU Boramae Medical Center Seoul 07061South Korea

AIM To assess daclatasvir plus asunaprevir(d UAL) in treatment-na?ve patients from China's Mainland, Russia and South Korea with hepatitis C virus(hCV) genotype 1 b infection. METhODS Patients were randomly assigned(3:1) to receive 24 wk of treatment with d UAL(daclatasvir 60 mg once daily and asunaprevir 100 mg twice daily) beginning on day 1 of the treatment period(immediate treatment arm) or following 12 wk of matching placebo(placebodeferred treatment arm). The primary endpoint was a comparison of sustained virologic response at posttreatment week 12(SVR12) compared with the historical SVR rate for peg-interferon plus ribavirin(70%) among patients in the immediate treatment arm. The first 12 wk of the study were blinded. Safety was assessed in d UAL-treated patients compared with placebo patients during the first 12 wk(doubleblind phase), and during 24 wk of d UAL in both arms *** In total, 207 patients were randomly assigned to immediate(n = 155) or placebo-deferred(n = 52) treatment. Most patients were Asian(86%), female(59%) and aged hem, 13% had cirrhosis, 32% had IL28 B non-CC genotypes and 53% had baseline hCV RNA levels of ≥ 6 million IU/m L. Among patients in the immediate treatment arm, SVR12 was achieved by 92%(95% confidence interval: 87.2-96.0), which was significantly higher than the historical comparator rate(70%). SVR12 was largely unaffected by cirrhosis(89%), age ≥ 65 years(92%), male sex(90%), baseline hCV RNA ≥ 6 million(89%) or IL28 B non-CC genotypes(96%), although SVR12 was higher among patients without(96%) than among those with(53%) baseline NS5 A resistanceassociated polymorphisms(at L31 or Y93 h). during the double-blind phase, aminotransferase elevations were more common among placebo recipients than among patients receiving d UAL. during 24 wk of d UAL therapy(combined arms), the most common adverse events(≥ 10%) were elevated alanine aminotransferase and upper respiratory tract infection; emergent

关键词： Asunaprevir Daclatasvir Direct-acting antiviral Chronic hepatitis C Liver disease NS3 NS5A Genotype 1b