Search

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. As a result, deficiencies in fat-soluble vitamins are rarer in industrialised countries than in countries with limited resources. However, even in the latter, certain groups of individuals are affected, such as newborns or growing children, pregnant or breast-feeding women and elderly or isolated subjects. Vitamin A, D, E and K deficiencies are also relatively common in people with digestive tract disorders, in patients suffering from chronic pathologies or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical symptoms. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet and treatment of the cause. [ABSTRACT FROM AUTHOR]

Background: Pain is a significant problem in adults living with advanced liver disease, having limited guidance available for its clinical management. While pain is considered a multidimensional experience, there have been limited reviews of the pain literature in advanced liver disease conducted with a multidimensional framework. Aims: The goal of this scoping review was to identify and map the multidimensional domains of pain in adults with advanced liver disease using the biopsychosocial model. Methods: We used Arksey and O’Malley’s scoping framework. A search was conducted in MEDLINE, Embase, AMED, and CINAHL databases and the gray literature using specific eligibility criteria (1990–2019). Citation selection and data extraction were performed by two independent reviewers and in duplicate. Results: Of the 43 studies that met inclusion criteria, 51% were from North America and 93% utilized quantitative methods. The combined studies reported on 168,110 participants with ages ranging between 23 to 87 years. Only 9% reported an objective scoring system for liver disease severity. Few studies reported pain classification (9%) and intensity (16%). Pain prevalence ranged between 18% and 100%, with pain locations including joint, abdomen, back, head/neck, and upper/lower extremities. We identified and mapped 115 pain factors to the biopsychosocial model: physical (81%), psychological (65%), and sociocultural (5%). Only 9% measured pain using validated multidimensional tools. Pharmacological intervention (92%) prevailed among pain treatments. Conclusions: Pain is not well understood in patients with advanced liver disease, having limited multidimensional pain assessment and treatment approaches. There is a need to systematically examine the multidimensional nature of pain in this population.

Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease that features morphologically intact kidneys, where regulatory mechanisms have minimized glomerular filtration and maximized tubular resorption and urine concentration. The syndrome occurs almost exclusively in patients with ascites. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation is the most appropriate therapeutic method, nevertheless, only a few patients can receive it. The first line treatment includes terlipressin plus albumin. Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term. Other therapies include transjugular intrahepatic portosystemic shunts (TIPS), dialysis and peritoneovenous shunts which are most commonly done when patients are awaiting a liver transplant or when there is the possibility of improvement in liver function.

Transition is a coordinated and progressive process aiming at the transfer of a young patient from a pediatric care to the adult health system. Transfer of medical care to adult facilities is a complex task requiring multiple involvements of both paediatric and adult care providers, taking into account the medical, psychosocial and educational needs of the youth. The Transition Working Group of the French Network for Rare Liver Diseases (Filfoie) proposes recommandations and tools in order to optimize the transition process and transfer of young people with chronic liver disease from child-centred to adult-centred healthcare services. [ABSTRACT FROM AUTHOR]

Transition is a coordinated and progressive process aiming at the transfer of a young patient from a pediatric care to the adult health system. Transfer of medical care to adult facilities is a complex task requiring multiple involvements of both paediatric and adult care providers, taking into account the medical, psychosocial and educational needs of the youth. The Transition Working Group of the French Network for Rare Liver Diseases (Filfoie) proposes recommandations and tools in order to optimize the transition process and transfer of young people with chronic liver disease from child-centred to adult-centred healthcare services. [ABSTRACT FROM AUTHOR]

We report a rare case of bilateral multiple bilateral vitreous, pre-retinal and intra-retinal haemorrhages after bouts of coughing in a 47 year old female patient with high international normalized ratio (INR) due to alcoholic liver disease. Patient has been complaining of 2 weeks history of reduced vision to her liver physician who referred her to local eye unit. She reported that the vision deteriorated following intense coughing. She was found to have bilateral vitreous, pre-retinal and intra-retinal haemorrhages. liver disease. The patient was kept under ophthalmic observation. The vitreous, preretinal and intraretinal haemorrhages resolved spontaneously and his vision recovered fully Alcoholic liver disease is becoming more common. Clinicians should be aware that the combination of increased intravenous pressure due to persistent coughing and possible early portal hypertension and a pathological increase in INR can lead to severe multiple multi-layered retinal haemorrhage. The haemorrhages, however, will resolve spontaneously in most cases. In foveal involving pre-retinal haemorrhage, YAG- laser membranotomy was shown to speed up visual recovery in previous reports.

This article sheds light on the experiences of people waiting for a liver transplant. I argue that waiting lists serve as a technological tool to deal with the uncertainties inherent in medicine, but like Hercules fi ghting Hydra, one tamed uncertainty is merely replaced by two new ones. Drawing on ethnographic material from Germany, I argue that these lists retain those waiting in a temporal limbo of uncertain duration and outcome, making them spatially, temporally and existentially immobile.

INTRODUCTION: Highly active antiretroviral therapy (HAART) has improved survival of human immunodeficiency virus (HIV) patients. Concurrent morbidities from liver diseases among these patients have also been observed due to co-infection with hepatitis B and C viruses (HBV and HCV). HAART reduces liver-associated morbidities and mortalities in such patients. Unfortunately free testing of HBV and HCV are not provided alongside free HIV testing and treatment in Nigeria. We assessed the seroprevalence of HBV and HCV among HIV patients presenting for treatment in our center.

Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

When to transplant a patient with alcoholic liver disease? Alcoholic liver disease is the leading cause of cirrhosis in France, but there is only a minority of patients who have access to liver transplantation. Although still controversial, this disease is a validated indication of liver transplantation with survival similar to that of other indications. The survival benefit of transplantation is limited to patients with severe decompensation. A period of abstinence is essential before accessing to the waiting list, but the 6-month abstinence rule is not a strong criterion for predicting the recurrent alcohol consumption after transplantation. In the future, an indication of liver transplantation may be punctually made in case by-case basis in case of steroid-resistant alcoholic hepatitis. The spectrum of post-transplant relapse is a heterogeneous continuum starting with low-level point real consumption, which has little impact on patient and graft survival, up to massive consumption which substantially decreases patient long-term survival. Only a minority of patients experience massive relapse after transplantation. The prevention of relapse need an early addictive specialized management that must begin before the liver transplantation., Competing Interests: S. Dharancy déclare avoir des liens d’intérêts avec Gilead, Bayer, Novartis, Chiesi et Astellas, (interventions ponctuelles), et être membre d’un comité scientifique pour Nanobiotix.

Introduction: Chronic liver diseases (CLDs) are a worldwide problem. Morbidity and mortality due to CLDs could be avoided or reduced by targeting the main risk factors, including obesity and alcohol use., Methods: To describe the evolution of the key determinants of CLDs in Quebec, we studied the trends in obesity, alcohol use, viral hepatitis B and C, CLD mortality and hospitalization rates, and the liver cancer incidence rate between January 1, 1981, and December 31, 2009., Results: We observed an increase in the obesity indicators among young men and in alcohol use among adolescent girls and middle-aged women. The overall hepatitis B and C incidence and CLD mortality rates are falling. However, liver cancer and mortality rates, especially among men and the elderly, are on the rise., Conclusion: These results highlight the importance of targeted public health interventions and of maintaining or improving access to care for CLDs.