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Hepatology and Pancreatic Science

ISSN: 2573-4563

Open Access

Article in Press

35th International Conference on Psychiatry and Mental Health on May 18-19 2020 (2020)

    Editorial Pages: 1 - 5

    Gastro Congress 2020 Market Analysis

    Annie Shergill

    Gastroenterology is the branch of medicine Related to the GI tract (stomach and intestines) and the accessory organs of digestion (from the mouth to the anus) focused on the digestive system and its disorders. Some of the conditions treated under this specialty include but are not limited to Crohn’s disease, Gastroesophageal reflux disease (GERD), inflammatory bowel disease, irritable bowel syndrome, peptic ulcer disease, celiac disease, colon cancer, heartburn, gastric cancer, diverticulitis, and ulcerative colitis. Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas. For more details, please visit: https://europegastroenterology.gastroconferences.com/ The global gastrointestinal therapeutics market size is expected to reach USD 65.1 billion by 2025, according to a new report by Grand View Research, Inc., registering a 6.6% CAGR during the forecast period. Growing geriatric population prone to gastrointestinal indications is one of the key factors anticipated to contribute to market growth. According to a report by WHO, colon cancer caused nearly 694,000 deaths in 2014.

    Value Added Abstracts Pages: 1 - 2

    Gastro Congress 2019: HBsAg and Anti-HCV Prevalence among Pregnant Women Accessing Antenatal Care in a Tertiary Healthcare Facility in Central Nigeria

    Oti BV

    Background: Hepatitis B and C viral infections during pregnancy are associated with high risk of maternal complications and mortality. Almost 40,000 children are born every year to HCV-infected women, resulting in up to 4000 new perinatally infected children yearly [6]. Several studies have shown an improvement in the biochemical markers of liver damage in HCV infected women during pregnancy . НLs phenomenon was seen during hemo dilution in pregnancy because the transaminase levels returned to pre-pregnancy levels shortly D�?�?er delivery. However, changes in the immune response during pregnancy can possibly play a sLJnLficDnt role in HCV interaction [8]. Contrary to the improved indices of liver dysfunction, a linear increase in HCV viremia has been reported throughout pregnancy [9], a fact that may be compatible with impaired immune reactivity. Several studies around the world have recommended that pregnant women should be screened for hepatitis B and C before delivery, as this reduces another generation from being infected by the viruses Нe sexual transmission of hepatitis B and C has also been described, and the transmission of the hepatitis B virus has been found to be the more prevalent in this regard [12]. Many countries have already adopted proper blood screening procedures that have minimized the risk of such viruses being transmitted through blood transfusion HBV and HCV positive mothers with an HBsAg and anti-HCV positive status can vertically transmit the infections to their infants [There is high prevalence of vertical transmission causing fetal and neonatal hepatitis which can have serious effects on the neonate, leading to impaired physical and mental health later in life. This study was aimed at evaluating HBsAg and Anti-HCV prevalence of these viruses among pregnant women accessing antenatal care in Federal Medical Centre, Keffi, Nigeria.

    Materials and methods: Study area and population Нe study area for this research was Ke . �?¹ It is approximately 68 Km from Abuja, the Federal Capital Territory and 128 Km from LDfiD, the capital of Nasarawa State. Ke  �?¹ is located between latitude 8 5’N of the equator and longitude 7 8’E and situated on an altitude of 850 M above sea level [17]. A total of 200 pregnant women accessing antenatal care at Federal Medical Centre Ke �?¹ participated in this prospective cross sectional study D�?�?er an informed consent were obtained from each participant. НeLr demographic information was obtained by oral interview before sample collection. Sample collection About 5 ml of blood was collected from each participant by venipuncture into a labeled plain tube. НLs was allowed to clot at room temperature and spun for 5 minutes at 3000 rpm. Нe sera were harvested into well labeled cryovials and stored at -200°C until ready for use. This prospective cross sectional study took place between May-July 2016. A total of 200 blood samples were collected from pregnant women after informed consent and self-administered questionnaires were completed. Blood samples were analyzed using HBsAg and anti-HCV immunochromatographic screening kits (Fastep Polymed Therapeutics Inc, USA). Chi square test (Smith’s Statistical Package Version 2.80,California, USA) was used for assessing the association of risk factors with the infections.

     

    Results: The overall level of positivity for both viruses in the study population was 14.0%. The prevalence of HBsAg was 8.0% while Anti-HCV was 6.0% and no woman was coinfected with the 2 viruses. The infection rate was highest among those aged 21-30 years old and 31-40 years old for HBV and HCV respectively (p>0.05). Нese might be attributed to socio-demographic dL�?�?�?´erences, cultural and behavioural dL�?�?�?´erences for the risk factors of HBV infections, methodological dL�?�?�?´erence and natural dL�?�?�?´erence linked with various geographical situations. Of note is also the fact that the prevalence reported in this study did not account for occult HBV infection. Similarly, the anti-HCV detection in this study was 6.0. It helps in making useful decision and sourcing of information concerning health and healthy living. More improved level of hygiene is related to higher levels of education. Mutagoma et al. [8] in Rwanda and Desalgn et al. [18] in Ethiopia reported same in a similar study. Нe infections were not associated with stage of pregnancy (p>0.05). It was highest (15.6%) in 2nd trimester pregnant women for HBV infection while HCV prevalence was highest among pregnant women on their 1st trimester (8.6%). НLs might be due to vertical transmission which is thought to be a major route of transmission among pregnant women in endemic areas. Such was also reported in similar study in Tanzania [19,21] and in Ghana [16]. Types of marriage, parity and surgical/dental procedure are not possible predictors for Hepatitis B and C viruses among the study population (p>0.05) although surgical/dental procedure was a predictor for HCV infection (p There was a statistically significant association between the viral infections and history of blood transfusion (p<0.05). Surgical/dental procedure was also a predictor for HCV infection (p<0.05) and was not a predictor for HBV infection (p>0.05) in this study. However, educational status, stage of pregnancy, type of marriage, parity and scarification marks did not show any statistically significant association with HBV and HCV infections (p>0.05), although there werearithmetic differences among the studied risk factors (p>0.05).

    Conclusion: The study confirms a high prevalence of HBsAg and Anti-HCV among pregnant women in Central  Nigeria which is a serious public health problem that cannot be downplayed. Therefore, there is need for establishment of public health measures in order to reduce disease burden and vertical transmission, including routine screening of all pregnant women for these viruses.

    Value Added Abstracts Pages: 1 - 1

    Preoperative Preparation of Super-obese

    Sandeep C Mutha

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    The incidence of obesity is increasing like epidemic. 65%of adults in USA are obese and approximately 5.2-37% in different states India. One out of five children is obese (COED- organisation of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculo-skeletal etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism etc. Morbidly obese are with BMI more than 40Kg/sq.m or super-obese with BMI more than 50Kg/sq.m are to be preoperatively prepared for better perioperative outcome. In superobese patients preoperative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment. Preoperative workup aims at controlling systemic diseases, optimising cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. Regular assessment and Psychological support during preoperative optimization prepares the super obese patient physically and mentally to undergo complex bariatric surgery

    Value Added Abstracts Pages: 1 - 1

    Preoperative Preparation of Super-obese.

    Sandeep C Mutha

    Share this article

    The incidence of obesity is increasing like epidemic. 65%of adults in USA are obese and approximately 5.2-37% in different states India. One out of five children is obese (COED- organisation of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculo-skeletal etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism etc. Morbidly obese are with BMI more than 40Kg/sq.m or super-obese with BMI more than 50Kg/sq.m are to be preoperatively prepared for better perioperative outcome. In superobese patients preoperative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment. Preoperative workup aims at controlling systemic diseases, optimising cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. Regular assessment and Psychological support during preoperative optimization prepares the super obese patient physically and mentally to undergo complex bariatric surgery..

    35th International Conference on Psychiatry and Mental Health (2020)

      Editorial Pages: 0 - 1

      Editorial Note | Hepatology and Pancreatic Science

      Dr. Amr Hawal

      About the Journal

      Hepatology and Pancreatic Science (HPS) is an academic journal that encompasses a wide range of current research under the scope of the journal which aims to offer a promising platform for the researchers and scientists to make their valuable contributions towards the journal.

      Hepatology and Pancreatic Science is a Scholarly Open Access Journal that aims to publish the relevant and reliable source of information in the form of original articles, review articles, case reports, short communications, etc. in the journal is freely available without any restrictions or any other subscriptions for researchers all over the world.

      The journal is using the Editorial Manager System for online manuscript submission, review and tracking. Editorial board members of Hepatology and Pancreatic Science or outside experts review manuscripts; at least two independent reviewer’s approval followed by the editor approval is required for the acceptance of any citable manuscript.

      Open Access, a broad-based journal was founded on two key tenets: To publish the most exciting researches with respect to the subject of Hepatology and Pancreatic science which considers manuscripts latest advances on liver, pancreas and related disorders. Secondly, to provide a rapid turn-around time possible for reviewing and publishing and to disseminate the articles freely for research, teaching and reference purposes. Journal of Hepatology and Pancreatic science always makes valuable research advancements available in the field of Hepatology Pancreatic science.

      Authors are encouraged to share their ideas and valuable research outcomes through this platform and provide the global readers updated and most important information in the mode of original articles, review articles, case reports, short communications, etc. Top quality articles are expected from the global research community which will aid in achieving high impact factor.

      Why Special Issue

      This special issue has been introduced to recognize those researchers who are with us from the starting of the Conference and kept their believe with us regarding the quality of the conference and the publication. Their continuous support make the Conference as well as the supporting journal to the conference successful and recognized by the international experts. Here in honor to those supporters, those speakers, those submitters, those researchers we are releasing the special issue with the abstracts accepted for the conference, full length articles submitted to the conference and with the short communication submitted to the conference.

      Special Issue Pages: 1 - 2

      Minimally-invasive methods of acute pancreatic post necrotic pseudocyst treatment

      Nazar Omelchuk

      Statement of the Problem: Acute necrotic pancreatitis (ANP) remains complicated problem of urgent surgery because of high frequency of systemic, purulent and septic complications, mortality rate, which is in patients with infected pancreonecrosis 14.7-26.4%.

      Purpose: The purpose of this study is to evaluate efficiency and establish indications for minimally invasive methods of treatment of post-necrotic pseudocyst of pancreas. Methodology & Theoretical Orientation: For diagnostics ultrasonography was used, diagnostic laparoscopy, helical CT with contrast strengthening. Endoscopic interventions were applied by duodenoscopes “Olympus” under control of X-ray machine “Siemens BV 300”. Cystodigestive fistulas were created by prickly papilotoms. For providing of long passability of cystodigestive fistula were used two endoprostheses like “pig tail” sized 10 Ft with length 5-6 cm. For transpapillary drainage were used pancreatic endoprostheses like “pig tail”, sized 5-7 Ft with length 5 cm.

      Findings: In 82 (68.2%) patients were applied minimally invasive methods of treatment; Percutaneous external drainage in 38 (46.3 %) patients, endoscopic transmural drainage of post- necrotic pseudocyst in 22 (26.85%) patients. Combined endoscopic interventions were applied in 22 (26.85%) patients. In particular, endoscopic transmural drainage with temporary stenting of pancreatic duct in 11 (50%) patients, endobiliary stenting with temporary stenting of pancreatic duct in 5 (22.7%) patients, temporary stenting of pancreatic duct in 4 (18.2%) patients, endoscopic transmural drainage with percutaneous external drainage in 2 (9.1%) patient.

      Conclusion & Significance: Usage of combined minimally invasive methods of treatment of  acute necrotic pancreatitis complicated by post-necrotic pseudocyst help to improve results of treatment, reduction of complications amount, contraction of stationary treatment terms and improving of life quality.

      Special Issue Pages: 2 - 3

      Parietization of colon following Tuberculous Ascites

      Shailesh Kumar

      A 46 years old menopausal female presented to surgical OPD with the complaints of recurrent pain abdomen with vomiting and fever off and on. Pt was a treated case of Koch’s abdomen. There was no history of jaundice and other co- morbidities. On examinations, she had tenderness in Right hypochondrium (RHC) on deep palpation. Rest of the parameters were normal. On Investigation, ultrasonography of abdomen revealed multiple gallstones with Normal CBD. Rest of the abdomen and pelvis were normal. Her blood and urinary examinations were within normal limits. X-ray chest revealed features suggestive of healed tuberculosis. Pt was posted for laparoscopic cholecystectomy. After pneumo-peritoneum, 10 mm optical port was placed in periumbilical area. On diagnostic laparoscopy, whole of the colon was densely adhered to the pariety. Liver, gall bladder and spleen were nor not visible. As falciform ligament and liver was not visible, two working port were inserted in the mid clavicular line both side around 3 inches below the costal margin in an anticipation to de-parietization of the transverse colon to assess the feasibility to proceed. We broke the adhesion between the transverse colon and pariety in the midline and preceded to de-parietisation the whole transverse colon with the help of ultrasonic scissor. After that we could visualised the Liver and Gall bladder and preceded with the laparoscopic cholecystectomy abdominal cavity is the sixth most common extra peritoneal site of tuberculosis. There are different studies that support the crucial role of diagnostic laparoscopy in the diagnosis of abdominal tuberculosis. The diagnostic laparoscopy revealed ascetic fluid, violin string adhesion of peritoneum and omental thickness. Peritoneal involvement is a common features and more than half of the patients presents with ascites, lymphadenopathy and stranding of the mesenteric fat. Laparoscopy is normally accepted as an accurate and prompt diagnostic tool in case of suspected abdominal tuberculosis.

      Special Issue Pages: 3 - 5

      Pathophysiology and management of Esophageal Varices in current practice

      Balwant Singh Gill

      Esophageal varices: Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow and increased portal venous blood inflow. The most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease correlates with the presence of varices and risk of bleeding.

       

      Bleeding esophageal varices: No single treatment for bleeding Esophageal varices is appropriate for all patients and situations. An algorithm for management of the patient with acute bleeding is presented in this article. The options for long-term, definitive therapy and the criteria for selection of each are discussed.

      Pathophysiology and management of esophageal varices: Esophageal varices are one of the most common and severe complications of chronic liver diseases. New aspects in epidemiology, pathogenesis and treatment of varices are reviewed. Sclerotherapy is the first-line treatment for acute hemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of first bleeding. β-Blockers or sclerotherapy may be used for prophylaxis of recurrent bleeding. However, prophylactic treatment regimens do not have a major impact on survival. Combination treatment, new drugs or new devices may help to improve the efficacy of prophylactic measures

       

       

      Endoscopic therapy for esophageal varices: Among therapeutic endoscopic options for Esophageal varices (EV), Endoscopic variceal ligation (EVL) has proven more effectiveness and safety compared with endoscopic sclerotherapy and is currently considered as the first choice. In acute EV bleeding, vasoactive therapy (either with terlipressin or somatostatin) prior to endoscopy improves outcomes; moreover, antibiotic prophylaxis has to be generally adopted. Variceal glue injection (cyanoacrylates) seems to be effective in the treatment of esophageal as well as in gastric varices. Prevention of rebleeding can be provided both by EVL alone or combined with non-selective β-blockers. Moreover, EVL can be adopted for primary prophylaxis, with no differences in mortality compared with drugs, in subjects with large varices and unfit for a β-blocker regimen. A meta�?�analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding: Despite publication of several randomized trials of prophylactic variceal ligation, the effect on bleeding�?�related outcomes is unclear. We performed a meta�?�analysis of the trials, as identified by electronic database searching and cross�?�referencing. Both investigators independently applied inclusion and exclusion criteria and abstracted data from each trial. Standard meta�?�analytic techniques were used to compute relative risks and the number needed to treat (NNT) for first variceal bleed, bleed�?�related mortality and all�?�cause mortality. Among 601 patients in 5 homogeneous trials comparing prophylactic ligation with untreated controls, relative risks of first variceal bleed, bleed�?�related mortality and all�?�cause mortality were 0.36 (0.26�?�0.50), 0.20 (0.11�?�0.39) and 0.55 (0.43�?�0.71), with respective NNTs of 4.1, 6.7 and 5.3. Among 283 subjects from 4 trials comparing ligation with β�?�blocker therapy, the relative risk of first variceal bleed was 0.48 (0.24�?�0.96), with NNT of 13; However, there was no effect on either bleed�?�related mortality (relative risk [RR], 0.61).

      Special Issue Pages: 5 - 7

      Post ERCP complications based on the severity of acute cholangitis according to Tokyo guideline staging 2018

      Raouf Gharbi, Bogdan Miutescu, AlexandruVatau, Iulia Ratiu, Hajdaramataj Ela and Ioan Sporea

      Introduction: Acute cholangitis (AC) is a pathological condition characterized by an ascending bacterial infection of the biliary ductal system with the obstruction caused by varies etiologies. Endoscopic retrograde cholangiopancreatography (ERCP) is performed as a therapeutic procedure for biliary drainage in acute cholangitis but associated with higher rates of complications respective to other endoscopic procedures. These complications include pancreatitis, bleeding, trauma and cardiopulmonary problems.

      Aim: The aim of this study is the detection of any significant relationship between the Tokyo guideline 2018 staging of acute cholangitis and the complications associated with the ERCP modality

      Materials & Methods: 283 patients had been diagnosed with acute cholangitis and underwent ERCP, between January 2015 and February 2018 encountered at the Gastroenterology and Hepatology Department of Timisoara Emergency County Hospital, 43% of the patients are males (n=122), 57% of the patients are females (n=161). The minimal age of the patients which is 17 years old and the maximal one being 92 years old, the average age of the patients involved in the study is 64 years old. The severity assessment and the staging of all acute cholangitis cases were based on the TG13/18; “Grade I” (Mild) comprises 179 patients (63% of the patients), “Grade II” (Moderate) comprises 63 patients (22 % of the patients), whereas “Grade III” (severe) comprises 41 patients (15% of patients). Inclusion in the study was based on the diagnosis of “Acute cholangitis” in the patient’s medical charts. Subsequently, the required data were extracted from the patient’s medical charts. Furthermore, the patients that did not undergo therapeutic ERCP were excluded.

      Results: ERCP complications are reported only in 34 patients (12%) out of 283 which underwent ERCP. The most common complication was postsphincterotomy hemorrhage, observed in 17 patients (6% of the patients), acute pancreatitis in 14 patients (5.3% of pacients), other complication in 3 patients (1.06%). According to TG18, 11 from 41 Patients with severe AC had Post ERCP complications (26.8%), 8 from 63 Patients with moderate AC (12.6%) and 15 from 179 Patients with mild AC (8.3%).

      Conclusion: ERCP is the gold standard and first line therapy for acute cholangitis in the department of gastroenterology and hepatology of the county hospital Timisoara but it remains a procedure with many complications. The TG18 could predict higher risk of complication according to the severity of AC.

       

      Special Issue Pages: 7 - 8

      Nitric oxide donor, S-nitrosoglutathione, to maintain intestinal barrier integrity: Potential therapeutic candidate for prevention of inflammation recurrences

      Romain Schmitt

      Nitric oxide (NO) is known to play a pivotal role to maintain the intestinal barrier integrity, such as regulation of oxidative stress, healing, mucus secretion, immune system regulation, etc. Snitrosoglutathione (GSNO), a nitric oxide donor is naturally secreted by enteric glial cells after stimulation of the vagus nerve. GSNO is known to prevent inflammatory events and to preserve intestinal barrier integrity. We have highlight in a Ussing chamber model that there is a concentration-dependant effect of NO on rat ileon intestinal permeability: A low concentration of GSNO (0.1 µm) significantly decreases the permeability of sodium fluorescein after two hours when compared to high concentrations (100 µm). This effect is not observed in the presence of glutathion equivalent concentrations. Moreover, GSNO degradation and absorption on isolated rat intestine were studied and we found that an enzymatic activity of gamma-glutamyltranspeptidase expressed on intestinal epithelioma (and also by microbiota), is involved in GSNO intestinal permeability. Also, the inhibition of endogenous secretion of NO by using N-nitro-Larginine methyl ester (NO synthases inhibitor) showed us that NO observed effect in intestinal permeability comes from exogenous supply with GSNO. From these results, GSNO could be proposed as an innovative prophylactic agent, in order to prevent relapses of inflammation for inflammatory bowel diseases patient in clinical remission.

      Special Issue Pages: 8 - 9

      The effect of vitamin D supplementations on TNF-A, serum Hs-CRP and NF-?B in patients with ulcerative colitis: A randomized, double-blind, placebocontrolled pilot study

      Azita Hekmatdoost

      Background & Objective: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is an immune-mediated chronic intestinal disorder with an unknown etiology. The overexpression of proinflammatory factors such as proinflammatory cytokines is believed to have pivotal role in development of UC. Among them tumor necrosis factor alpha (TNF-α) is identified as a key cytokine. Also it has indicated that the levels of expression of NF-κB reflect development and progression of UC. It has no cure until now and the purposes of treatments are to alleviate signs, lengthening remission and improvement in quality of life in these patients. Different mechanisms for the effects of vitamin D on inherent and acquired immune systems are supposed to reduce inflammation, promote immunological tolerance and increase the intestinal epithelial integrity. Thus this study was designed to determine the effects of vitamin D supplementation on TNF-α, serum hs-CRP and NF-κB in patients with UC.

      Materials & Methods: In this randomized, doubleblind, placebo-controlled study, 50 patients with UC were divided into two groups which the case group received two pearls of vitamin D (2000IU) once/day for 12 weeks and the control group received one placebo capsule and one pearl of vitamin D (1000IU) per day. Serum inflammatory markers, serum hs-CRP and NF-κB were assessed at baseline and the end of the study. Dietary intake and physical activity of patients is assessed by a valid questionnaire. Anthropometric and diet measurements were assessed in this study. The SPSS was used for data analysis.

      Results: In this study, 24 patients in case group and 22 in control group. Among 50 participants completed the intervention. At the beginning of study, no significant differences were seen in baseline variables between two groups. At the end of 12 weeks there were no significant differences in serum hs-CRP, TNF-α between the case and control group after adjustment for confounders. The level of NF-κB in both groups increased, but this increase in the low dose group was statistically significant at the end of the study comparing to the beginning (P value=0.006).

      Conclusion: Supplementation with 2000IU vitamin D daily for 12 weeks made no changes in serum hs-CRP. Serum TNF-α, remained with no change in both groups after adjustment. We recommend supplementation of vitamin D with appropriate dosage in all patients with UC in order to take advantage of its great therapeutic benefits

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