Laura Alba

Predictors of hematological abnormalities in patients with chronic hepatitis C treated with interferon and ribavirin

Hematological abnormalities including neutropenia, anemia, and thrombocytopenia are commonly seen in patients with chronic hepatitis C treated with pegylated interferon and ribavirin. The aim of this study was to identify factors which would help to predict the development of hematological abnormalities in patients with chronic hepatitis C treated with pegylated interferon and ribavirin. During a 4-year period, all patients with chronic hepatitis C started on treatment with pegylated interferon and ribavirin were identified. Patients were defined as having hematological abnormalities if they had the presence of either anemia, neutropenia, thrombocytopenia, or a combination of the above during treatment with pegylated interferon and ribavirin. A total of 136 patients with chronic hepatitis C were included in this study. Fifty-two (38.2%) of the patients developed significant hematological abnormalities during treatment with pegylated interferon and ribavirin with 28 (20.6%), 30 (22.1%), and 11 (8.1%) developed neutropenia, anemia, and thrombocytopenia, respectively. Genotype 1, history of hypertension, low baseline platelet count, low baseline hemoglobin, as well as a raised creatinine were significant factors associated with the development of hematological abnormalities. Significant hematological abnormalities are commonly present in patients with chronic hepatitis C treated with pegylated interferon and ribavirin. This study identifies pretreatment parameters that may help identify high-risk patients who are more likely to develop hematological abnormalities during treatment for chronic hepatitis C.

Treatment with Ω-3 fatty acids but not exendin-4 improves hepatic steatosis

Background Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the Western world. The aim of this study was to evaluate the biochemical and histological effects of Ω-3 fatty acid and exendin-4 treatment on NAFLD in an animal model. Methods Sixty-three 8-week-old outbred Sprague–Dawley male rats were used for this study. Three animals were used as procedure controls, and 30 rats were fed a methionine and choline deficient (MCD) diet and 30 were fed a regular chow diet. In each group of 30 animals, 10 served as controls, 10 received exendin-4, and 10 received Ω-3 fatty acids. After 75 days of treatment, the animals were euthanized, the tissues and serum were harvested, and the livers were formalin-fixed for histology. Results The MCD diet was exceptionally efficient at producing fatty livers. The MCD control animals had a liver steatosis score of 38±6.7 (of 50 possible); treatment with exendin-4 was not associated with a significant reduction of steatosis (44±5.16, P=0.07) and the Ω-3 fatty acid treatment was associated with a significant decrease in the liver steatosis score (15.6±13.46, P<0.001) compared with both the controls and the exendin-4 groups. The Ω-3 fatty acid treatment increased serum aspartate aminotransferase significantly, whereas exendin-4 had no effect. Conclusion In an animal model of NAFLD, the Ω-3 fatty acid therapy was associated with significant improvement in hepatic steatosis compared with exendin-4. These data suggest that Ω-3 fatty acid supplements may have a potential therapeutic role in patients with NAFLD.

Effect of exendin (exenatide)—GLP 1 receptor agonist on the thyroid and parathyroid gland in a rat model☆

Exenatide or Exendin-4 is a 39-amino acid agonist of the glucagon like peptide (GLP-1) receptor approved for the adjunctive treatment for type 2 diabetes. Recent reports suggest that GLP-1 agonists may also have distant effects including C-cell thyroid hyperplasia. The aim of this study was to evaluate the effect of exendin-4 on the thyroid and parathyroid cells in a rat model. Rat thyroids were stained for calcitonin, H&E and for carcinoembryonic antigen (CEA). Thyroid C-cell hyperplasia was graded on H&E stained slides using cell size and secretory granule numbers, morphological features of the parathyroid glands and the serum calcium concentrations of the rats were also evaluated. Counts of stained cells/high power field and intensity of staining were recorded by two pathologists. Data were analyzed by ANOVA/post-tests. C cell hypertrophy was elevated in exenatide-treated vs. untreated animals (22.5 ± 8.7 vs. 10.5 ± 2.7 cells/HPF). CEA staining failed to show effects by exendin. Calcitonin staining was significantly elevated in exenatide treated controls (P<0.001). Parathyroid glands were histologically normal in both groups, and serum calcium levels were within normal range in all animals. In summary, exenatide was associated with C cell hyperplasia and increased calcitonin staining of thyroids, but was unrelated to CEA levels. These data raise important concerns about the effects of exenatide which, given its wide clinical use, should be clarified with urgency.

Transfusion-related acute hepatic enzyme elevation: a new disease entity?

Raised liver enzymes are one of the most common reasons for consultation with a hepatologist by primary care physicians. One phenomenon we have observed is an increase in transaminases immediately after blood transfusion in patients with no known liver disease. Transfusion of blood and blood products has been associated with increased vascular permeability and acute lung injury [1,2]. The aim of our study was to evaluate the changes in hepatic biomarkers after blood transfusion.

The Use of Acetylcystine in Esophageal Food Impaction

The Use of Acetylcystine in Esophageal Food Impaction Esmat Z. Sadeddin, Christian Dang, Lassy Nisha, Laura Alba, Stuart Chen, Alexandra Laya, Wendell Clarkston Esophageal food impaction is a problem that faces the gastroenterologists in people with underlying esophageal strictures or altered esophageal anatomy. The only effective treatment so far is endoscopic removal of the food impacted or surgical intervention if the previous modalities failed. We describe here the use of acetylcystine in dissolving food impaction after failure of endoscopic treatment Case 1: Mrs. K.E is 40 year old female with previous history of multiple esophageal surgeries. Presented to the ER with food impaction after chicken meal. On exam there was a large soft lump in her neck suggestive of the food bolus, emergency EGD was performed which showed large food bolus impacted in the mid third of her esophagus, multiple attempts to remove it was unsuccessful. Termination of the procedure was decided, patient was sent back to the floor and was started on 15 cc of acetylcystine in 50 cc of water to give 5 cc every 5 min till finished every 8 hours. after 24 hour, repeat EGD showed complete resolution of the food bolus and patent esophagus Case 2: Mr. J.H is 50 year old male patient with old history of reflux esophagitis, presented with history of food impaction turkey sandwich, he was complaining of chest pain and difficulty to swallow. Emergency EGD showed large food bolus impacted in the distal esophagus that was difficult to remove secondary for being cement-like which made difficult to be grasped by forceps and was large for a snare to hold. After termination of the procedure, the patient was sent to the telemetry unit for close observation and surgery consult was obtained for possible surgical intervention, meanwhile the patient was started on acetylcystine with the same previous regimen. Repeat EGD in 24 hour showed complete clearance of his esophagus with evidence of underlying esophageal peptic stricture. Discussion: Food impaction in the esophagus is not uncommon problem that we face in our institution however, endoscopic treatment is usually sufficient and result in quick recovery and discharge from the hospital. Recently, we had more cases of food impaction that is difficult to treat secondary for being large in size or cement like structure. There was few reported cases of using acetylcystine in the treatment of stomach bezoar with success, using its mucolytic characteristics in dissolving the food bolus. The acetylcysteine softens the bezoars allowing an easier and faster fragmentation by mechanical means. Depending on this theory, we used it in treating difficult cases of food impaction of the esophagus with success so far. However more studies are needed to prove or disprove the efficacy of acetylcystine in this settings.