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Summary: Background & Aim: Malnutrition is a common problem among cirrhotic patients. There is currently no gold standard of nutritional assessment tools. The purpose of present study was to compare various nutritional screening and assessment tools for predicting the composite outcome of mortality and complications in cirrhotic patients. Methods: A total of 94 patients with cirrhosis underwent nutritional screening by Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), Liver Disease Undernutrition Screening Tool (LDUST), Malnutrition Universal Screening Tool (MUST), Prognostic Nutritional Index (PNI–O), Nutritional Risk Index (NRI), Spanish Society of Parenteral and Enteral Nutrition (SENPE) and Controlling Nutritional Status (CONUT). Nutritional assessment was performed using body mass index (BMI), triceps skinfold (TSF), midarm circumference (MAC), midarm muscle circumference (MAMC), six-minute walk test (6MWT), Subjective Global Assessment (SGA), and Royal Free Hospital Subjective Global Assessment (RFH-SGA). Patients were followed up for 1 year. Result: When compared with other nutrition screening tools, NRI and CONUT had the highest sensitivity (83.3%). NRI also demonstrated the highest negative predictive value (90.7%) and accuracy, reflected by an area under the curve of 0.800, in predicting the composite outcome of mortality and complications of cirrhosis. LDUST and PNI–O showed the highest specificity (89.1%) and positive predictive value (74.1%). In the realm of nutritional assessment, RFH-SGA had the highest sensitivity (73.3%) and negative predictive value (86.4%). BMI demonstrated the highest specificity (98.5%) and positive predictive value (83.3%). SGA showed the highest accuracy, as indicated by an area under the curve of 0.794. Conclusions: NRI and SGA exhibited the highest accuracy in predicting the composite outcome of mortality and complications among cirrhotic patients.

The authors report a case of colorectal liver metastasis which is one of the uncommon causes of liver tumor with central scar in a young female. Our patient presented with right upper abdominal discomfort and palpable liver mass for about 2 months. She did not have underlying disease. She had used oral contraceptive pills for 14 years. Physical examination revealed only liver span 16 centimeters (cm). Multidetector-row computed tomography demonstrated 3 masses and the largest one measured 10.7x 8.3x 7 cm in diameter with lobulated contour, hypodensity enhancing pattern, and a central scar at segment II and IVa of liver. Magnetic resonance imaging (MRI) of the largest mass showed hyposignal intensity on T1-weighted and slightly hypersignal intensity in T2-weighted MRI. This mass also had a large central scar which was hyposignal intensity on T1-weighted and hypersignal intensity in T2-weighted MRI. Liver biopsy showed scattered infiltration of atypical epithelium with glandular formation. Immunohistochemical analysis was compatible with colorectal cancer. Colonoscopy was performed and revealed large mass at distal part of sigmoid colon. The patient was scheduled to undergo surgical operation and receive chemotherapy. To our knowledge, colorectal metastasis of liver should be considered as a cause of liver tumor with central scar.

Iron is one of the common causes of pill-induced esophagitis with a proposed mechanism involving direct esophageal injury. Diagnostic endoscopic finding includes finding an intact pill or its residue on endoscopy, but they are rarely found. Pathology typically reveals luminal brown-black crystalline materials adjacent to the injured surface epithelium or in combination with luminal fibroinflammatory exudate. Brown crystalline material on Perl’s staining is the typical finding of iron-induced esophagitis. Crucial treatment is cessation of medication. We report an elderly woman diagnosed with iron-induced esophageal ulcer whose ulcers improved while iron medication was maintained.

Transverse myelitis refers to the inflammatory process involving the spinal cord. Clinical features can be either acute or subacute onset that results in neurological deficits such as weakness and/or numbness of extremities as well as autonomic dysfunctions. While there are some etiologies related, a viral infection is common. However, the hepatitis A virus rarely causes myelitis. This report provides details of a hepatitis A infectious patient who developed myelitis as comorbidity. Although, the disability was initially severe, the patient successfully recovered with corticosteroid treatment.

Hepatitis B infection is a serious global health problem. Chronic kidney disease patients with hepatitis B infections are associated with high rates of mortality and morbidity. The problems with vaccinating hemodialysis patients are that they have been shown to have lower seroconversion rates, lower peak antibodies, and antibody decline faster than in healthy persons. Patients with chronic kidney disease should be vaccinated as early as possible. Four double doses of vaccination are recommended. Anti-HBs should be monitored every 12 months in vaccinated hemodialysis patients. Additional strategies to improve seroconversion rates are third generation hepatitis B vaccine, combined hepatitis B and hepatitis A vaccine, intradermal injection, and adjuvants.

Objective Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. Methods One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. Results Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38–29.71 and p < 0.001, OR = 13.65, 95% CI 4.71–39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. Conclusions Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Iron is one of the common causes of pill-induced esophagitis with a proposed mechanism involving direct esophageal injury. Diagnostic endoscopic finding includes finding an intact pill or its residue on endoscopy, but they are rarely found. Pathology typically reveals luminal brown-black crystalline materials adjacent to the injured surface epithelium or in combination with luminal fibroinflammatory exudate. Brown crystalline material on Perl’s staining is the typical finding of iron-induced esophagitis. Crucial treatment is cessation of medication. We report an elderly woman diagnosed with iron-induced esophageal ulcer whose ulcers improved while iron medication was maintained.

Background: The oral capsule formulation of vancomycin (Vancin-S) recently became available in Thailand; therefore, information on its effectiveness and safety in treating Clostridioides difficile infection (CDI) has not been available. Objective: To evaluate CDI outcomes and to access safety at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) following recommended oral vancomycin capsule treatment. Materials and Methods: Retrospective review of MSMC patients prescribed oral vancomycin capsule between December 1, 2022 and August 31, 2023. Inclusion and exclusion criteria were applied, analyzing CDI outcomes post-oral vancomycin capsule treatment and within 90 days thereafter. Safety of oral vancomycin capsule usage was also assessed. Results: Of the 41 patients prescribed oral vancomycin capsule, 13 met inclusion criteria and did not meet with exclusion criteria. There were eight definite and five probable CDI cases, with 12 initial treatments and one initial fulminant treatment. The incidence of CDI in the MSMC was 21.33 person-year. Clinical improvements were observed by the tenth day, with one patient experiencing residual symptoms, subsequently testing negative for CDI. All patients were cured. The oral vancomycin capsule treatments were well-tolerated without significant adverse effects. No CDI recurrence was detected among 12 cases followed up within 90 days post-treatment. Conclusion: The oral vancomycin capsule demonstrates safety and potential efficacy for CDI treatment in Thailand. [ABSTRACT FROM AUTHOR]

Wandering spleen is rare. It is caused by incomplete development or increasing laxity of splenic ligament. Clinical manifestations vary from asymptomatic abdominal mass to acute abdomen. Surgery is the mainstay of treatment. We report a case of wandering spleen who presented with pelvic mass resembling ovarian tumor. [ABSTRACT FROM AUTHOR]

Pazopanib is a tyrosine kinase inhibitor used for the treatment of advanced renal cell carcinoma and advanced soft tissue sarcoma. The authors describe a patient with advanced renal cell carcinoma who developed severe hypertension and severe left ventricular systolic dysfunction after starting pazopanib therapy with subsequent recovery of left ventricular ejection fraction upon treatment interruption. [ABSTRACT FROM AUTHOR]

Background: Malnutrition in cirrhosis has a significant negative impact on morbidity and mortality. There is no agreed gold standard of the screening tool. Study comparing the diagnostic properties of nutritional assessment tools in cirrhotic patients is limited. The Subjective Global Assessment (SGA) is one of the global assessment tools. It is used to assess nutritional status in different patient populations. Objective: To evaluate the diagnostic properties of different nutritional screening tools compared with SGA in cirrhotic patients. Materials and Methods: A cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center. All cirrhotic patients were enrolled. The nutritional status was evaluated by the SGA, the Royal Free Hospital Subjective Global Assessment (RFH-SGA), the Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST), the Malnutrition Universal Screening Tool (MUST), the Prognostic Nutritional Index (PNI-O), the Nutritional Risk Index (NRI), the Spanish Society of Parenteral, the Enteral Nutrition (SENPE), and the Controlling Nutritional Status (CONUT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate RFH-SGA, RFH-NPT, LDUST, MUST, PNI-O, NRI, SENPE, and CONUT compared with SGA. Results: Ninety-four cirrhotic patients were included. The mean age was 60.82 (SD 10.11) years. Patients with cirrhosis Child Turcotte Pugh (CTP) A, B, and C were 62, 21, and 11, respectively. Twenty-five patients (28.7%) were malnourished according to SGA, five with CTP A cirrhosis, twelve with CTP B cirrhosis, and ten with CTP C cirrhosis. The present study also showed that NRI had the highest sensitivity (100%) and LDUST had the highest specificity (94%). Conclusion: NRI is an effective tool with high sensitivity for identifying malnutrition in early stage of cirrhosis. [ABSTRACT FROM AUTHOR]