EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.

Abstract Introduction long term suppressive antibiotic treatment may be the only feasible option for patients with infective endocarditis (IE) not suitable for surgery. Case reports we present three cases of prosthetic valve endocarditis (PVE) caused by Enterococcus faecalis and Streptococcus gallolyticus which could not undergo surgical intervention due to high risk. Despite this, patients were successfully managed only by medical approach. Following intravenous targeted antimicrobial therapy, patients received chronic suppressive antimicrobial therapy (SAT) for at least twelve months with oral amoxicillin. In all cases, no further febrile episodes nor bacteraemia were observed and in two cases a complete positron emission tomography (PET) response was achieved. Due to a priori uncertainty about antimicrobial exposure during oral SAT, serum bactericidal titres (SBTs) were obtained and compared to those obtained during parenteral therapy. Conclusions long term oral amoxicillin was effective and well-tolerated. SBTs after switch to oral therapy were quite heterogeneous, in some cases not reaching the conventionally established titre to assess bactericidal effect (1:8). Key points endovascular infection in non-suitable-for-surgery patients can be managed with long-term oral suppressive therapy. serum bactericidal assay confirmed high effectiveness of parenteral antibiotic therapy. serum bactericidal assay showed highly variable titres during oral therapy.

https://www.tandfonline.com/doi/pdf/10.1080/23744235.2023.2216271?needAccess=true&role=button

The possible role of serum bactericidal titres in long-term suppressive antibiotic treatment for infective endocarditis: report of three cases

Comments on the review 'Care of patients with hepatitis C and HIV co-infection' by Soriano et al.

This chapter reviews the natural history of chronic viral hepatitis, focuses on pathogenesis, and outlines the characteristics of the complications and the management. Hepatitis B virus (HBV) is recognized as one of a family of animal viruses called hepadnaviruses and is classified as hepadnavirus type 1. The aims of treatment for chronic HBV (CHB) are to achieve sustained suppression of HBV replication and remission of liver disease. The ultimate goal is to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma (HCC). The current standard of care is combination pegylated interferon (PEG) and weight-based ribavirin (RBV). Viral clearance needs to be achieved prior to the development of cirrhosis to have a marked impact on the development of HCC. There is a single prospective population-based study of the risk of HCC in patients with hepatitis C. In this study of 12,008 men, being anti-HCV positive conferred a 20-fold increased risk of HCC compared to being anti-HCV negative. Liver transplantation remains the most effective treatment because it removes the tumor and eliminates the risk for new tumors, and it prevents liver failure. Another analysis showed that spontaneous reductions over time in HBV DNA levels from 300 to 100,000 copies/ml to <300 copies/ml, after controlling for other risks, eliminated the additional risk of developing HCC, based on the baseline HBV DNA level.

Sequelae of chronic viral hepatitis.

Members of the Italian Cohort Naive for Antiretrovirals-Hepatitis Study Group.

http://www.ejropen.com/article/S2352047723000230/pdf

Raffaele Bruno

Papers

The possible role of serum bactericidal titres in long-term suppressive antibiotic treatment for infective endocarditis: report of three cases

Comments on the review 'Care of patients with hepatitis C and HIV co-infection' by Soriano et al.

Sequelae of chronic viral hepatitis.

Members of the Italian Cohort Naive for Antiretrovirals-Hepatitis Study Group.

Performance of an AI algorithm during the different phases of the COVID pandemics: what can we learn from the AI and vice versa.