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1. Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal

Author

Ananta Shrestha, Anurag Adhikari, Manjula Bhattarai, Ramanuj Rauniyar, Jose D. Debes, André Boonstra, Thupten K. Lama, Mamun Al Mahtab, Amna Subhan Butt, Sheikh Mohammad Fazle Akbar, Nirmal Aryal, Sapana Karn, Krishna Das Manandhar, and Birendra Prasad Gupta

Subjects
HIV, Blood donor, HEV, Kathmandu, Immunocompromised, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal. Methods We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls. Results We found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42–8.61, p

Published
2017
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2. Status of liver stiffness following directly acting antiviral treatment in patients with chronic hepatitis C: A Nepalese study

Author

Dilip Sharma, Sudhamshu KC, Ananta Shrestha, and Bikash Jaishi

Subjects
Chonic hepatitis, Directly acting antivirals, fibrosis, liver stiffness, Medicine (General), R5-920
Abstract

Background & Objectives:Chronic hepatitis C is one of the leading causes of chronic liver disease in our country. With the introduction of directly acting antivirals, many patients are benefitted these days. Transient elastography is one of the newer technologies for measuring liver stiffness and quantifying liver fibrosis and has excellent accuracy for the diagnosis of fibrosis in patients with chronic hepatitis C. Our study analyzes changes of liver stiffness and its associated factors in patients with chronic hepatitis C treated with directly acting antivirals (DAAs).Materials & Methods: One hundred and seven patients with chronic hepatitis C, who were treated with DAAs (Sofosbuvir 400 mg and velpatasvir 100mg) and have significant fibrosis (>7.0 kPa) at baseline were included. Liver stiffness was measured at the time of enrollment, and after completion of DAAs with fibroscan and changes of stiffness and its associated factors were analyzed. Results:The study showed significant decrease in liver stiffness at the end of treatment, which continued after treatment only in patients who achieved a sustained virological response.Conclusion: Liver stiffness decreased following 12 weeks of successful DAAs therapy in patients with chronic hepatitis C at the end of treatment who achieved sustained virological response.

Published
2017
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3. Its Congenital Hepatic Fibrosis; Not Cirrhosis At All

Author

Ananta Shrestha, Mamun Al-Mahtab, Salimur Rahman, Jahangir Sarkar, and Thupten K Lama

Subjects
Ductal plate malformation, Fibrosis, Portal hypertension, Medicine
Abstract

Congenital hepatic fibrosis is a rare condition characterized by extensive fibrosis of liver but with preserved normal lobular architecture inherited as autosomal recessive trait. We report a 19 year-old-female admitted to Bangabandhu Sheikh Mujib Medical University with the complaints of lump in upper abdomen since last 13 years and episodes of fever and abdominal pain for same duration. She was diagnosed with hepatic TB on hepatic histology. Congenital hepatic fibrosis is a rare cause of portal hypertension that presents during childhood. Prognosis of congenital hepatic fibrosis is good. Life threatening events in these patients are related with variceal bleeding and episodes of cholangitis. Owing to relatively good liver function these patients tolerate portosystemic shunt surgeries quite well.Though rare, congenital hepatic fibrosis should be included in the differential diagnosis of portal hypertension in early life.

Published
2018
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4. Hepatitis E should be considered a neglected tropical disease.

Author

Andrew S Azman, Iza Ciglenecki, Joseph F Wamala, Julia Lynch, Rakesh Aggarwal, Mahmudur Rahman, Sid Wong, Micaela Serafini, Ali M Moussa, Harry R Dalton, Ananta Shrestha, Rajendra Pant, Raquel Peck, and Emily S Gurley

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Published
2019
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5. Implications of Birth-Dose Vaccination against Hepatitis B Virus in Southeast Asia

Author

Sheikh Mohammad Fazle Akbar, Mamun Al Mahtab, Ferdousi Begum, Shaikh A. Shahed Hossain, Sukumar Sarker, Ananta Shrestha, Md. Sakirul Islam Khan, Osamu Yoshida, and Yoichi Hiasa

Subjects
hepatitis B vaccine, EPI, birth-dose vaccine, SEARO, Medicine
Abstract

The World Health Organization (WHO) South-East Asia Regional Office (SEARO) covers 11 countries with a combined population of about 2 billion people, making it the most populous of the six WHO regions. In 1992, the WHO advocated including the hepatitis B vaccine in the Expanded Program of Immunization (EPI) and vaccinating all infants and children three times within 1 year of birth (HepB3). Recently, the WHO advocate birth-dose hepatitis B vaccination (HepB-BD) as soon as possible after birth, preferably within 24 hours. In 2016, the SEARO endorsed a regional hepatitis B control goal with a target of hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020. Of the 11 SEARO countries, four achieved this target on schedule. Out of these four countries, two countries (Bangladesh and Nepal) have not adopted HepB-BD in EPI program. On the other hand, the coverage of HepB3 is not satisfactory in some SEARO countries, including India which adopted HepB-BD but could not achieve the overall target of SEARO. Thus, it is a point of debate whether emphasis should be placed on proper implementation of HepB3 or whether a new agenda of HepB-BD should be incorporated in developing countries of SEARO. The article discusses strengthening and expanding the Hepatitis B vaccination program in SEARO countries with an emphasis on HepB and HepB-BD programs.

Published
2021
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6. HBeAg negative chronic hepatitis B in South Asia

Author

Ananta Shrestha, Thupten Kelsang Lama, Sudhamshu KC, Dilip Sharma, Sandip Khadka, Guru Prasad Dhakal, and Birendra Prasad Gupta

Subjects
Medicine
Abstract

Chronic Hepatitis B (CHB) infection has an intermediate prevalence rate in South Asian countries, except for Nepal and Sri Lanka where it has a low rate. HBeAg negative CHB infection has been found to be more pronounced in this part of the world. As described previously, CHB infection has two phases with HBeAg positive and HBeAg negative based on ALT, DNA & biopsy. The latter was previously described to have a benign course. The later guidelines have distinguished HBeAg negative status into two categories with an inactive phase and a reactivation one. In this review article we have highlighted HBeAg Negative status burden in South Asian countries and shown that HBeAg negative CHB infection may not be as benign as previously thought. Furthermore , mutations at precore and basal core promoter region may contribute to disease severity in HBeAg negative CHB infection.

Published
2016
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7. Hepatitis E Epidemic, Biratnagar, Nepal, 2014

Author

Ananta Shrestha, Thupten K. Lama, Sneha Karki, Deepak R. Sigdel, Utsav Rai, Shyam K. Rauniyar, Mamun Al-Mahtab, Kazuaki Takahashi, Masahiro Arai, Sheikh M.F. Akbar, and Shunji Mishiro

Subjects
hepatitis E virus, HEV, viruses, epidemic, acute icteric hepatitis E, open reading frame 2, Medicine, Infectious and parasitic diseases, RC109-216
Published
2015
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8. A Unique Spontaneous Subcapsular Bilioma: Is it an idiopathic variety?

Author

Ananta Shrestha and Thupten Kelsang Lama

Subjects
Medicine (General), R5-920
Abstract

Spontaneous Subcapsular bilioma is an extrabiliary intrahepatic collection of bile in subcapsular location commonly occurring after biliary trauma or surgery. It rarely occurs in absence of any underlying biliary abnormality. We report a such a case with no known underlying biliary tract abnormality except for a solitary gall stone. We bring into discussion whether this type of bilioma can be labeled as idiopathic spontaneous variety in presence of gall stone. Keywords: bile; idiopathic; subcapsular bilioma.

Published
2013
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9. Low Viral Load Does Not Exclude Significant Liver Damage in Patients with Chronic HBV Infection in Bangladesh

Author

Mamun Al-Mahtab, Salimur Rahman, M Kamal, Ananta Shrestha, SM Fazle Akbar, Fazal Karim, and Swapan Chandra Dhar

Subjects
Low HBV DNA, Chronic hepatitis B, Hepatic necro-inflammation, Hepatic fibrosis, Medicine
Abstract

Background: In general, it is assumed that patients with chronic hepatitis B virus (HBV) infection with high viral load exhibit increased liver damages. Accordingly, the treatment guidelines emphasize on reducing viral load in chronic HBV carriers. The ethical and scientific basis of these observations was mainly accumulated from investigations from developed countries of the world. More than 80% chronic HBV carriers live in the developing nations of the world, but little is known about relationship between HBV viral load and extent of liver damages in these countries. In this study, we addressed this issue to provide insights about this. Methods: In this retrospective study we reviewed the records of 210 chronic hepatitis B (CHB) patients from our pool of 561 Bangladeshi CHB patients. All of these 210 patients had low HBV DNA (

Published
2009
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10. INASL–SAASL Consensus Statements on NAFLD Name Change to MAFLD

Author

Shivaram P. Singh, Ajay Duseja, Mamun al Mahtab, Prajna Anirvan, Subrat K. Acharya, Sheikh Mohammad Fazle Akbar, Amna S. Butt, Anuradha Dassanayake, Arka De, G.P. Dhakal, Saeed Hamid, Kaushal Madan, Manas K. Panigrahi, P.N. Rao, Sanjiv Saigal, Sanjaya K. Satapathy, null Shalimar, Ananta Shrestha, Akash Shukla, K.C. Sudhamshu, and Hasitha Wijewantha

Subjects
Hepatology
Published
2023
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11. Asia–Pacific association for study of liver guidelines on management of ascites in liver disease

Author

Virendra Singh, Arka De, Rohit Mehtani, Paolo Angeli, Rakhi Maiwall, Sanjaya Satapathy, Ashwini K. Singal, Anoop Saraya, B. C. Sharma, C. E. Eapen, P. N. Rao, Akash Shukla, null Shalimar, Narendra S. Choudhary, Diana Alcantara-Payawal, Vinod Arora, Guru Aithal, Anand Kulkarni, Akash Roy, Ananta Shrestha, null Mamun al Mahtab, Madunil A. Niriella, Tan Soek Siam, Chun-Qing Zhang, Lee Guan Huei, Ming-Lung Yu, Stuart K. Roberts, Cheng-Yuan Peng, Tao Chen, Jacob George, Vincent Wong, Yusuf Yilmaz, Sombat Treeprasertsuk, Juferdy Kurniawan, Seung Up Kim, Zobair M. Younossi, and Shiv Kumar Sarin

Subjects
Hepatology
Published
2023
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12. Holistic Approach in the Management of Nonalcoholic Fatty Liver Disease

Author

Ananta Shrestha and Shrijana Pradhananga

Abstract

Nonalcoholic fatty liver disease (NAFLD), in a few decades, is expected to be the commonest cause of end-stage liver disease and liver cancer surpassing all other etiologies. Urbanization and modern lifestyle have led to global epidemic of NAFLD with alarming prevalence rates across the globe. Its multisystemic involvement manifests as metabolic syndrome, diabetes, cardiovascular disease, end-stage liver disease, and hepatic and extrahepatic malignancies. The absence of promising therapy for halting disease progression in NAFLD is a challenge that is not only limited to liver disease but also other organs involved. It is unrealistic to expect any significant impact of pharmacotherapies in overall survival of NAFLD patients, given that the morbidity and mortality in these patients are contributed by conditions other than that of liver. Liver-centric approach in managing NAFLD will be futile unless the problem is dealt in a holistic manner. Lifestyle modifications have been repeatedly appraised in prevention and treatment of various diseases linked to metabolic syndrome including NAFLD. Despite being inexpensive and highly efficacious in prevention and treatment of different manifestations of NAFLD, lifestyle intervention often fails to gather sufficient interest among patients and physicians alike. This review intends to highlight pleiotropic nature of this disease, limitations of currently available pharmacotherapies and evidence that emphasizing lifestyle intervention is the only way to holistically deal in patients with NAFLD.Shrestha A, Pradhananga S. Holistic Approach in the Management of Nonalcoholic Fatty Liver Disease. Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S51-S58.

Published
2022

13. NAFLD vs MAFLD: South Asian NAFLD Patients don't Favor Name Change

Author

Ananta Shrestha, Anuradha S Dassanayake, Prajna Anirvan, Mamun A Mahtab, Shivaram P Singh, Amna S Butt, and Bashir A Shaikh

Abstract

There have been vociferous attempts to change the name of Nonalcoholic Fatty Liver Disease (NAFLD) to Metabolic Associated Fatty Liver Disease (MAFLD). Of the many arguments put forth in support of this, an important one is the presumed demand by patient groups insisting on the change. However, this claim does not have credible evidence to support it. Therefore, we decided to conduct a survey among South Asian NAFLD patients to understand their perspectives with regard to the change in nomenclature.The study was conducted at multiple centers across South Asia from January 2021 to June 2021. Patients were surveyed using an 8-question survey questionnaire and responses were categorized by multiple-choice format.Of 218 patients surveyed, 80.3% of the patients were not aware of the entity "NAFLD" before they were first diagnosed. Although 74.3% of patients admitted to being questioned about alcohol intake at the time of the first diagnosis, 75.9% of female patients were not questioned regarding this. After being labelled NAFLD, 92.1% of patients were never questioned again about alcohol intake. While 86.3% of patients found the term "NAFLD" consoling, 83% did not feel that "Non" in NAFLD trivialized their problem. In addition, only 6.9% of patients were scared of developing cardiovascular disease.The term "NAFLD" destigmatizes patients of the taboo associated with alcohol use. It was found to be consoling to most patients and they did not feel it trivialized their problem. A change of name without considering patients' perspectives and peculiarities specific to different populations will have enormous ramifications for both patients and physicians.Our survey clearly shows that patients are happy with the term "NAFLD" and it effectively destigmatizes them from the taboo of alcohol. This would lead to higher compliance with management and greater patient participation in future studies and trials.Singh SP, Anirvan P, Butt AS

Published
2022

14. ‘First week’ is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure

Author

Guan Huei Lee, Ananta Shrestha, Gamal Shiha, Kemal Fariz Kalista, Sombat Treeprasertsuk, Chen Yu, Pooja Jain, CE Eapen, Anand V. Kulkarni, V G Mohan Prasad, Ke Ma, Amna Subhan Butt, Guresh Kumar, Harshad Devarbhavi, Manoj Kumar, Rajan Vijayaraghavan, AKadir Dokmeci, Manoj Kumar Sahu, R. K. Dhiman, Pulivarthi Nageswara Rao, Mamun Al-Mahtab, Dong Joon Kim, Ajay Duseja, Samir Shah, Jose D. Sollano, Laurentius A. Lesmana, Shiv Kumar Sarin, Qin Ning, Diana A. Payawal, Zaigham Abbas, Vinod Arora, George K. K. Lau, Rinaldi Lesmana, Sunil Taneja, Piyush Kumar Sinha, Rakhi Maiwall, Ashish Goel, S. G. Tan, Ashok Choudhury, Fazal Karim, H. Ghazinyan, Saeed Hamid, Man-Fung Yuen, Zhongping Duan, Wasim Jafri, Viniyendra Pamecha, and Akash Shukla

Subjects
Adult, Male, medicine.medical_specialty, Hepatology, business.industry, Incidence (epidemiology), Acute-On-Chronic Liver Failure, Middle Aged, Prognosis, medicine.disease, Colorectal surgery, Liver Transplantation, Cohort Studies, Sepsis, Internal medicine, Cohort, Living Donors, medicine, Humans, In patient, business, Living donor liver transplantation, Progressive disease, Retrospective Studies
Abstract

Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT). Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant. The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p

Published
2021
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15. Comparative accuracy of prognostic models for short-term mortality in acute-on-chronic liver failure patients: CAP-ACLF

Author

Guan Huei Lee, Samir Shah, CE Eapen, Qin Ning, Anand V. Kulkarni, Harshad Devarbhavi, George K. K. Lau, Ananta Shrestha Prasad, Manish Sharma, Sombat Treeprasertsuk, Pk Rao, Jinhua Hu, Omesh Goyal, Vandana Midha, Zaigham Abbas, Saeed Hamid, Jose D. Sollano, Laurentius A. Lesmana, AS Butt, Mamun Al Mahtab, Ajit Sood, V G Mohan Prasad, Debashish Chowdhury, Manoj Kumar Sahu, Wasim Jafri, Yu Chen, Diana A. Payawal, Akash Shukla, Ajay Duseja, Cosmas Rinaldi A Lesmana, Osamu Yokosuka, Ashok Choudhury, Dong Joon Kim, Virendra Singh, R. K. Dhiman, Shiv Kumar Sarin, Sunil Taneja, Tao Chen, Fazal Karim, Soek Siam Tan, Abdul Kadir Dokmeci, Nipun Verma, Zhongping Duan, and Hasmik Ghazinian

Subjects
medicine.medical_specialty, Hepatology, business.industry, Acute-On-Chronic Liver Failure, Bayes Theorem, Odds ratio, Prognosis, medicine.disease, Colorectal surgery, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Bayesian information criterion, 030220 oncology & carcinogenesis, Internal medicine, Cohort, medicine, Humans, 030211 gastroenterology & hepatology, Akaike information criterion, business, Prognostic models, Progressive disease, APACHE
Abstract

Multiple predictive models of mortality exist for acute-on-chronic liver failure (ACLF) patients that often create confusion during decision-making. We studied the natural history and evaluated the performance of prognostic models in ACLF patients.Prospectively collected data of ACLF patients from APASL-ACLF Research Consortium (AARC) was analyzed for 30-day outcomes. The models evaluated at days 0, 4, and 7 of presentation for 30-day mortality were: AARC (model and score), CLIF-C (ACLF score, and OF score), NACSELD-ACLF (model and binary), SOFA, APACHE-II, MELD, MELD-Lactate, and CTP. Evaluation parameters were discrimination (c-indices), calibration [accuracy, sensitivity, specificity, and positive/negative predictive values (PPV/NPV)], Akaike/Bayesian Information Criteria (AIC/BIC), Nagelkerke-RThirty-day survival of the cohort (n = 2864) was 64.9% and was lowest for final-AARC-grade-III (32.8%) ACLF. Performance parameters of all models were best at day 7 than at day 4 or day 0 (p 0.05 for C-indices of all models except NACSELD-ACLF). On comparison, day-7 AARC model had the numerically highest c-index 0.872, best accuracy 84.0%, PPV 87.8%, RAPASL-ACLF is often a progressive disease, and models assessed up to day 7 of presentation reliably predict 30-day mortality. Day-7 AARC model is a statistically robust tool for classifying risk of death and accurately predicting 30-day outcomes with relatively lower prediction errors. Day-7 AARC score 12 may be used as a futility criterion in APASL-ACLF patients.

Published
2021
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16. Impact of metabolic risk factors on the severity and outcome of patients with alcohol‐associated acute‐on‐chronic liver failure

Author

Radha K. Dhiman, Virukalpatti Gopalratnam Mohan Prasad, Vandana Midha, Hasmik Ghazinian, Ajay Duseja, Ashish Goel, Salimur Rahman, Laurentius A Lesmana, Yu Chen, Guan Huei Lee, Yogesh Chawla, Cosmas Rinaldi A Lesmana, Akash Shukla, I. Paulson, Ananta Shrestha, Ashok Choudhury, Guresh Kumar, Omesh Goyal, Qin Ning, George K. K. Lau, Mohd Shahinul Alam, Amna Subhan Butt, Seng Gee Lim, Jinhua Hu, Sunil Taneja, Tao Chen, Mamun Al Mahtab, Manoj Kumar Sahu, Samir Shah, SM Jafri, Dong Joon Kim, Harshad Devarbhavi, Chetan Kalal, Zhongping Duan, Pooja Jain, Zaigham Abbas, Saeed Hamid, Chundamannil E. Eapen, Arka De, Shiv Kumar Sarin, Jose D. Sollano, Ajit Sood, Soek Siam Tan, Abdul Kadir Dokmeci, G Carpio, Ke Ma, and Diana A. Payawal

Subjects
Adult, Male, Alcoholic liver disease, medicine.medical_specialty, Multivariate analysis, Alcoholic hepatitis, Overweight, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Retrospective Studies, Hepatology, business.industry, Metabolic risk, Acute-On-Chronic Liver Failure, Type 2 Diabetes Mellitus, Middle Aged, Prognosis, medicine.disease, Obesity, Diabetes Mellitus, Type 2, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, medicine.symptom, Metabolic syndrome, business
Abstract

BACKGROUND Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. The present study evaluated this effect in patients with alcohol-associated acute-on-chronic liver failure (ACLF). METHODOLOGY One thousand two hundred and sixteen prospectively enrolled patients with ACLF (males 98%, mean age 42.5 ± 9.4 years, mean CTP, MELD and AARC scores of 12 ± 1.4, 29.7 ± 7 and 9.8 ± 2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia were available in 1028 (85%), 1019 (84%), 1017 (84%) and 965 (79%) patients respectively. RESULTS Overall, 392 (32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidaemia were present in 154 (15%), 142 (14%), 66 (7%) and 141 (15%) patients, respectively, with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6 ± 7.1 vs 29.2 ± 6.9, P = .007) and those with dyslipidaemia had higher AARC scores (10.4 ± 1.2 vs 9.8 ± 2, P = .014). Overweight/obesity was associated with increased day 30 mortality (HR 1.54, 95% CI 1.06-2.24, P = .023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality. On multivariate analysis, overweight or obesity was significantly associated with 30-day mortality (aHR 1.91, 95% CI 1.41-2.59, P

Published
2020
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18. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. Amir, Javier Ampuero, Noha Anas, Pietro Andreone, Soa Fy Andriamandimby, Mahmoud Anees, Peltec Angela, Manal Antonios, Wael Arafat, Jose Moreno Araya, Juan Armendariz-Borunda, Matthew J. Armstrong, Hassan Ashktorab, Patricia Aspichueta, Fathia Assal, Mira Atef, Dina Attia, Hoda Atwa, Reham Awad, Mohyeldeen Abd Elaziz Awad, Sally Awny, Obafemi Awolowo, Yaw Asante Awuku, Ibrahim Ayada, Than Than Aye, Sherif Ayman, Hedy Ayman, Hesham Ayoub, Hosny M. Azmy, Romiro P. Babaran, Omneya Badreldin, Ahmed Badry, İbrahim Halil Bahçecioğlu, Amira Bahour, Jiajia Bai, Yasemin Balaban, Muthuswamy Balasubramanyam, Khaled Bamakhrama, Jesus M Banales, Babu Bangaru, Jianfeng Bao, Jorge Suazo Barahona, Salma Barakat, Sandra Maria Barbalho, Bikwa Barbra, Beatriz Barranco, Francisco Barrera, Ulrich Baumann, Shamardan Bazeed, Eva Bech, Aourarh Benayad, Andreas Benesic, David Bernstein, Fernando Bessone, Susie Birney, Cyrille Bisseye, Martin Blake, Bilal Bobat, Leonilde Bonfrate, Dmitry S Bordin, Francisco Bosques-Padilla, Jerome Boursier, Boushab Mohamed Boushab, David Bowen, Patricia Medina Bravo, Paul N Brennan, Bisi Bright, Ilse Broekaert, Xabier Buque, Diego Burgos-Santamaría, Julio Burman, Luca Busetto, Chris D. Byrne, Patricia Anne I. Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. 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Dwawhi, Sho Eiketsu, Doaa El Amrousy, Ahmed El Deeb, Ghada El Deriny, Hesham Salah El Din, Salwa El Kamshishy, Mohamed El Kassas, Maissa El Raziky, Osama A Elagamy, Wafaa Elakel, Dina Elalfy, Hanaa Elaraby, Heba ElAwady, Reda Elbadawy, Hanaa Hassan Eldash, Manal S. Eldefrawy, Carol Lezama Elecharri, Amel Elfaramawy, Mohammed Elfatih, Mahmoud Elfiky, Mohamed Elgamsy, Mohamed Elgendy, Mohamed A. El-Guindi, Nagi Elhussieny, Ahmed Maher Eliwa, Zeineb Elkabbany, Hesham El-Khayat, Nehal M. El-Koofy, Alaa Elmetwalli, Amr Elrabat, Fathiya El-Raey, Fatma Elrashdy, Medhat Elsahhar, Esraa M. Elsaid, Shimaa Elsayed, Hany Elsayed, Aly Elsayed, Amr M. Elsayed, Hamdy Elsayed, Magdy El-Serafy, Ahmed M. Elsharkawy, Reem Yehia Elsheemy, Eman Elsayed Elshemy, Sara Elsherbini, Naglaa Eltoukhy, Reda Elwakil, Ola Emad, Shaimaa Emad, Mohamed Embabi, Ilkay Ergenç, Tatiana Ermolova, Gamal Esmat, Doaa M. Esmat, Enrique Carrera Estupiñan, Said Ettair, Tcaciuc Eugen, Mohammed Ezz-Eldin, Lidia Patricia Valdivieso Falcón, Yu-Chen Fan, Samah Fandari, Mahmoud Farag, Taghreed Mohamed Farahat, Eman M. Fares, Michael Fares, Eduardo Fassio, Hayam Fathy, Dina Fathy, Wael Fathy, Soheir Fayed, Dan Feng, Gong Feng, Miguel Fernández-Bermejo, Cristina Targa Ferreira, Javier Díaz Ferrer, Alastair Forbes, Rabab Fouad, Hanan M. Fouad, Tove Frisch, Hideki Fujii, Shuhei Fukunaga, Shinya Fukunishi, Hacer Fulya, Masato Furuhashi, Yasmine Gaber, Augusto Jose G. Galang, Jacqueline Cordova Gallardo, Rocío Galloso, Mahmoud Gamal, Reham Gamal, Hadeel Gamal, Jian Gan, Anar Ganbold, Xin Gao, George Garas, Tony Garba, Miren García-Cortes, Carmelo García-Monzón, Javier García-Samaniego, Amalia Gastaldelli, Manuel Gatica, Elizabeth Gatley, Tamar Gegeshidze, Bin Geng, Hasmik Ghazinyan, Salma Ghoneem, Luca Giacomelli, Gianluigi Giannelli, Edoardo G. 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Hawal, Jinfan He, Qiong He, Yong He, Fang-Ping He, Mona Hegazy, Adham Hegazy, Osama Henegil, Nelia Hernández, Manuel Hernández-Guerra, Fatima Higuera-de-la-Tijera, Ibrahim Hindy, Keisuke Hirota, Lee Chi Ho, Alexander Hodge, Mohamed Hosny, Xin Hou, Jiao-Feng Huang, Yan Huang, Zhifeng Huang, Yuan Huang, Ang Huang, Xiao-Ping Huang, Sheng Hui-ping, Bela Hunyady, Mennatallah A. Hussein, Osama Hussein, Shahinaz Mahmoud Hussien, Luis Ibáñez-Samaniego, Jamal Ibdah, Luqman Ibrahim, Miada Ibrahim, Ibrahim Ibrahim, Maria E. 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Falcon, L, Fan, Y, Fandari, S, Farag, M, Farahat, T, Fares, E, Fares, M, Fassio, E, Fathy, H, Fathy, D, Fathy, W, Fayed, S, Feng, D, Feng, G, Fernandez-Bermejo, M, Ferreira, C, Ferrer, J, Forbes, A, Fouad, R, Fouad, H, Frisch, T, Fujii, H, Fukunaga, S, Fukunishi, S, Fulya, H, Furuhashi, M, Gaber, Y, Galang, A, Gallardo, J, Galloso, R, Gamal, M, Gamal, R, Gamal, H, Gan, J, Ganbold, A, Gao, X, Garas, G, Garba, T, Garcia-Cortes, M, Garcia-Monzon, C, Garcia-Samaniego, J, Gastaldelli, A, Gatica, M, Gatley, E, Gegeshidze, T, Geng, B, Ghazinyan, H, Ghoneem, S, Giacomelli, L, Giannelli, G, Giannini, E, Giefer, M, Gines, P, Girala, M, Giraudi, P, Goh, G, Gomaa, A, Gong, B, Gonzales, D, Gonzalez, H, Gonzalez-Huezo, M, Graupera, I, Grgurevic, I, Gronbaek, H, Gu, X, Guan, L, Gueye, I, Guingane, A, Gul, O, Gul, C, Guo, Q, Gupta, P, Gurakar, A, Gutierrez, J, Habib, G, Hafez, A, Hagman, E, Halawa, E, Hamdy, O, Hamed, A, Hamed, D, Hamid, S, Hamoudi, W, Han, Y, Haridy, J, Haridy, H, Harris, D, Hart, M, Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022
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19. Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients

Author

Harshad Devarbhavi, Manish Sharma, Mamun Al Mahtab, Salimur Rahman, Samir Shah, Jose D. Sollano, Chandan Kumar Kedarisetty, Yogesh Chawla, Priyanka Jain, George K. K. Lau, Chetan Kalal, Chundamannil E. Eapen, Rakhi Maiwall, P Nagaraja Rao, Jinhua Hu, Akash Shukla, Osamu Yokosuka, Puja Bhatia, Hasmik Ghazinian, Man-Fung Yuen, Ashish Goel, Zhongping Duan, Manoj Kumar Sahu, Sunil Taneja, Ajit Sood, Sombat Treeprasertsuk, Laurentius A. Lesmana, Chen Yu, Dong Joon Kim, Wasim Jafri, Vandana Midha, Saeed Hamid, Ajay Duseja, Amna Subhan Butt, Shiv Kumar Sarin, Qin Ning, Zaigham Abbas, Radha K. Dhiman, Soek Siam Tan, Seng Gee Lim, Vivek A. Saraswat, D.A. Payawal, Ashok Choudhury, A. Kadir Dokmeci, Cosmas Rinaldi Adithya Lesmana, Ananta Shrestha, Gamal Shiha, Ji Dong Jia, Guan Huei Lee, and V G Mohan Prasad

Subjects
Adult, Male, medicine.medical_specialty, Alcoholic liver disease, Asia, Time Factors, Adolescent, Biopsy, Encephalopathy, Gastroenterology, Young Adult, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, Ascites, Humans, Medicine, Decompensation, Prospective Studies, Prospective cohort study, Aged, Hepatology, business.industry, Acute-On-Chronic Liver Failure, Middle Aged, Jaundice, Prognosis, medicine.disease, Survival Rate, Liver, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Chemical and Drug Induced Liver Injury, Morbidity, medicine.symptom, Steatohepatitis, business, Follow-Up Studies
Abstract

OBJECTIVES Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF. METHODS We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome was defined as death from decompensation. RESULTS Of the 3,132 patients with ACLF, drugs were implicated as a cause in 329 (10.5%, mean age 47 years, 65% men) and other nondrug causes in 2,803 (89.5%) (group B). Complementary and alternative medications (71.7%) were the commonest insult, followed by combination antituberculosis therapy drugs (27.3%). Alcoholic liver disease (28.6%), cryptogenic liver disease (25.5%), and non-alcoholic steatohepatitis (NASH) (16.7%) were common causes of underlying liver diseases. Patients with drug-induced ACLF had jaundice (100%), ascites (88%), encephalopathy (46.5%), high Model for End-Stage Liver Disease (MELD) (30.2), and Child-Turcotte-Pugh score (12.1). The overall 90-day mortality was higher in drug-induced (46.5%) than in non-drug-induced ACLF (38.8%) (P = 0.007). The Cox regression model identified arterial lactate (P < 0.001) and total bilirubin (P = 0.008) as predictors of mortality. DISCUSSION Drugs are important identifiable causes of ACLF in Asia-Pacific countries, predominantly from complementary and alternative medications, followed by antituberculosis drugs. Encephalopathy, bilirubin, blood urea, lactate, and international normalized ratio (INR) predict mortality in drug-induced ACLF.

Published
2019
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20. Liver Cancer in Nepal

Author

Ananta Shrestha

Subjects
Hepatitis B virus, medicine.medical_specialty, Advanced stage, Hepatocellular carcinoma, business.industry, Hepatitis C virus, Standard treatment, Incidence (epidemiology), Mini-Review, medicine.disease_cause, medicine.disease, Treatment modalities, digestive system diseases, Cancer registry, 03 medical and health sciences, 0302 clinical medicine, Nepal, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030211 gastroenterology & hepatology, Liver cancer, business, Developed country
Abstract

Hepatocellular carcinoma (HCC) is highly incidental in South Asian countries. Nepal, however, has low incidence for HCC owing to low prevalence for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Nepal lacked national cancer registry until 2003. Though there has been some effort in having one, the current registry incorporates twelve centers and may not properly represent the total cancer burden in the country. Serology for HBV and HCV is seen to be positive in nearly 25 to 30% and 5 to 10% of HCCs respectively. Clinical characteristics of HCCs in Nepal have been discussed in this mini-review and it features poor performance status and advanced stage at presentation, making only a small fraction of these subjects eligible for curative treatment options. Most of the standard treatment modalities are available in Nepal and appear to be reasonably affordable as compared with other developed nations. How to cite this article: Shrestha A. Liver Cancer in Nepal. Euroasian J Hepato-Gastroenterol 2018;8(1):63-65.

Published
2018
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21. Current trends in hepatitis B vaccination

Author

Yoichi Hiasa, Shahina Tabassum, Ananta Shrestha, Sakirul Islam Khan, Mamun Al-Mahtab, and S. M. F. Akbar

Subjects
Hepatitis, Hepatitis B virus, Hepatitis B vaccine, business.industry, medicine.disease, medicine.disease_cause, Virology, 03 medical and health sciences, 0302 clinical medicine, Chronic hepatitis, Hepatitis b vaccination, Immunology, medicine, Therapeutic vaccine, 030211 gastroenterology & hepatology, 030212 general & internal medicine, Liver cancer, business
Abstract

One of the major successes in the area of vaccinology is the emergence, development and usage of hepatitis B vaccine (a prophylactic vaccine against HBV). Hepatitis B vaccine has protected millions of individuals from acquiring HBV infection and has prevented liver cancer in the majority of vaccinated subjects. Although initially designed as prophylactic vaccines, accumulative evidence has shown that these vaccines may also be used to treat patients with chronic hepatitis B. At present, there are two main areas of discussion in hepatitis B vaccination; development of more effective prophylactic hepatitis B vaccine that can provide protection to all vaccine recipients, and designing hepatitis B-based therapeutic vaccines for treatment of chronic hepatitis B patients.

Published
2016
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22. Short article: Association between liver fibrosis and hepatitis E seroprevalence among HIV-positive individuals in Nepal

Author

Jose D. Debes, Shemal M. Shah, Birendra Prasad Gupta, Holly Rodin, Andre Boonstra, Ananta Shrestha, and Jagat Bahadur Baniya

Subjects
Adult, Liver Cirrhosis, Male, Adolescent, viruses, Liver fibrosis, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Severity of Illness Index, Virus, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Hepatitis E virus, Nepal, Non-alcoholic Fatty Liver Disease, Seroepidemiologic Studies, medicine, Seroprevalence, Humans, Prospective Studies, Hepatology, business.industry, Coinfection, Gastroenterology, virus diseases, Hepatitis E, medicine.disease, digestive system diseases, Increased risk, 030220 oncology & carcinogenesis, Immunology, 030211 gastroenterology & hepatology, Female, business
Abstract

Hepatitis E virus (HEV) seropositivity may confer an increased risk of liver fibrosis in immunosuppressed individuals. We studied this effect in HIV-infected individuals in Nepal, a country hyperendemic for HEV.We prospectively evaluated 200 HIV-positive individuals. Serum samples were tested for components of fibrosis scores and cytokeratin-18.Of 200 patients, 43% were HEV-immunoglobulin G+. The mean fibrosis-4 score was 8.02 in the HEV-positive and 1.17 in the HEV-negative group (P0.001). The mean nonalcoholic fatty liver disease score was 2.12 in the HEV-positive and -2.53 in the HEV-negative group (P=0.02). The mean aminotransferase-platelet ratio index score was 0.37 in the HEV-positive and 0.38 in the HEV-negative group (P=0.9). The mean cytokeratin-18 levels were 119.9 in the HEV-positive group and 158.6 in the HEV-negative group (P=0.08).We found higher fibrosis-4 and nonalcoholic fatty liver disease scores in HEV-HIV-positive individuals, suggesting an increased liver fibrosis profile in this group. Further studies using liver stiffness measurements should be carried out.

Published
2018

23. THU-045-Natural history of sepsis, organ failure and organ dysfunction in critically ill patients with acute on chronic liver failure

Author

Radha K. Dhiman, Ke Ma, Seng Gee Lim, Yu Chen, Ajit Sood, Pooja Jain, Yogesh Chawla, Manjul Mishra, Rinaldi Lesmana, Ananta Shrestha, A. Kadir Dokmeci, DongJoon Kim, Saeed Hamid, Omesh Goyal, S. G. Tan, I. Paulson, Amna Subhan, Shahinul Alam, Ajay Duseja, Sunil Taneja, George K. K. Lau, Joyes s, Sombat Treeprasertsuk, Hasmik Ghazinian, Vandana Midha, C. E. Eapen, Man-Fung Yuen, Ashok Choudhury, Harshad Devarbhavi, Zaigham Abbas, Akash Shukla, Wasim Jafri, Tao Chen, Salimur Rahman, M. Sahoo, V Gm, Deepak Amarapurkar, Guan Huei Lee, Chetan Kalal, Shiv Kumar Sarin, Guresh Kumar, Zhongping Duan, Qin Ning, Diana A. Payawal, Vijayraghavan Rajan, Mamun Al-Mahtab, Jinhua Hu, G Carpio, Ashish Goel, Laurentius A. Lesmana, and Samir Shah

Subjects
Natural history, Sepsis, medicine.medical_specialty, Hepatology, business.industry, Critically ill, Organ dysfunction, medicine, Acute on chronic liver failure, medicine.symptom, business, Intensive care medicine, medicine.disease
Published
2019
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24. Impact of organ failure in patients with acute on chronic liver failure (ACLF) and the newly defined AARC liver failure score in predicting 90 days survival-results from APASAL-ACLF research consortium (AARC)

Author

YK Chawla, Pooja Jain, Ashok Choudhury, A. Kadir Dokmeci, Apurva Pande, N.R. Padaki, Fazal Karim, H. Ghazinyan, I. Paulson, Salimur Rahman, H. Deverbhavi, Soek Siam Tan, D.A. Payawal, Deepak Amarapurkar, George K. K. Lau, Manoj Kumar, Vivek A. Saraswat, Man-Fung Yuen, Shiv Kumar Sarin, Samir Shah, Zhongping Duan, Ananta Shrestha, Jinhua Hu, Qin Ning, Osamu Yokosuka, Wasim Jafri, CE Eapen, M. Sahoo, Dong Joon Kim, Sombat Treeprasertsuk, Akash Shukla, S. Joyes, GH Lee, Zaigham Abbas, Laurentius A. Lesmana, V. Gm, G. Kumar, and Chetan Kalal

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, Liver failure, medicine, Acute on chronic liver failure, In patient, business, Gastroenterology
Published
2018
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25. THU-053-Usefulness of lactate-free Asian Pacific Association for The Study of Liver acute-on-chronic liver failure research consortium ACLF score for predicting short-term mortality in patient with alcoholic liver disease

Author

Do Seon Song, Tae Yeob Kim, Hee Yeon Kim, Eileen L Yoon, Dong Joon Kim, Ji-Dong Jia, Ashok Choudhury, Mamun Al-Mahtab, Harshad Devarbhavi, Zhongping Duan, Yu Chen, CE Eapen, Ashish Goel, Qin Ning, Ke Ma, Yogesh Chawla, Radha Krishan Dhiman, Ajay Duseja, Sunil Taneja, Saeed Sadiq Hamid, Amna Subhan, Wasim Jafri, Soek-Siam Tan, Hasmik Ghazinian, Deepak Amarapurkar, Sombat Treeprasertsuk, Guan Huei Lee, Seng Gee Lim, Jinhua Hu Hu, Laurentius A. Lesmana, Rinaldi Lesmana, Akash Shukla, Samir Shah, Chetan Kalal, Manoj Sahoo, Zaigham Abbas, Joyes s, Gian Carpio, Md. Fazal Karim, George Lau, Nagaraja Rao Padaki, Diana Payawal, A. Kadir Dokmeci, Man-Fung Yuen, V GM, Osamu Yokosuka, Ananta Shrestha, Priyanka Jain, Irene Paulson, and Shiv Kumar Sarin

Subjects
Alcoholic liver disease, medicine.medical_specialty, Scoring system, Hepatology, Receiver operating characteristic, business.industry, Short term mortality, medicine.disease, Liver disease, Internal medicine, Cohort, medicine, Acute on chronic liver failure, In patient, business
Abstract

Aims: Asian Pacific Association for the Study of Liver (APASL) acute-on-chronic liver failure (ACLF) Research Consortium (AARC) proposed new prognostic scoring system of ACLF in cluding lactate. However, lactate is not routinely checked in clinical practice of patient with ACLF in Korea. Therefore, we aimed to investigate the predictive accuracy of lactate-free AARC-ACLF score for predicting short-term mortality in patients with alcoholic liver disease. Methods: A total of 749 ALD patients who had liver failure (bilirubin≥5mg/dL and INR≥1.5) in AARC database were in vestigated. Diagnostic performances for short-term mortality were compared according to the area under receiver operating characteristic (AUROC) curve. Predictive accuracy of lactate-free AARC-ACLF score were compared with other prognostic scores in 143 ALD patients with liver failure and 60 ALD patients with ACLF according to AARC definition in Korean ACLF cohort. Results: Among 749 patients, 30-day and 90-day mortality were 40.3% and 51.5%. There were no significant differences in AUROC for predicting 30-day and 90-day mortality between AARC-ACLF score and lactate-free AARC-ACLF score (30-day mortality: 0.752 vs. 0.751, P=0.918, 90-day mortality: 0.728 vs. 0.736, P=0.346). In Korean ACLF cohort, the AUROCs of lactate-free AARC-ACLF score for predicting 28-day and 90- day mortality were 0.861 and 0.846 in ALD with liver failure, and 0.884 and 0.874 in ALD patients with ACLF according to AARC definition, respectively. In Korean ALD patients with liver failure and ACLF according to AARC definition, diagnostic per formance of lactate-free AARC-ACLF score for predicting 28- day and 90-day mortality was comparable to those of Model for End-stage Liver Disease (MELD), MELD-Na, Chronic Liver Failure-Sequential Organ Failure Assessment score. Conclusions: Lactate-free AARC-ACLF score is as excellent as AARC-ACLF score in predicting short-term mortality in ALD patients with liver failure of AARC database and Korean ACLF cohort.

Published
2019
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26. THU-279-The prognostic stratification using acute-on-chronic liver failure scoring systems for predicting short-term mortality in patients with alcoholic hepatitis

Author

Yu Chen, Ajay Duseja, Qin Ning, Seng Gee Lim, Hasmik Ghazinian, Rinaldi Lesmana, Deepak Amarapurkar, Shiv Kumar Sarin, Akash Shukla, Chetan Kalal, Yogesh Chawla, Guan Huei Lee, Radha K. Dhiman, Osamu Yokosuka, Mamun Al-Mahtab, Dong Joon Kim, Ashok Choudhury, Ashish Goel, Amna Subhan, M. Sahoo, Diana A. Payawal, Man-Fung Yuen, Zhongping Duan, Sunil Taneja, Laurentius A. Lesmana, Harshad Devarbhavi, Jidong Jia, Wasim Jafri, Samir Shah, G Carpio, Saeed Hamid, S. G. Tan, CE Eapen, I. Paulson, George K. K. Lau, Zaigham Abbas, Ke Ma, V. Gm, Jinhua Hu Hu, Ananta Shrestha, Sombat Treeprasertsuk, Nagaraja Rao Padaki, Joyess, Do Seon Song, Karim Mf, Pooja Jain, and A. Kadir Dokmeci

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, medicine, Short term mortality, Alcoholic hepatitis, Acute on chronic liver failure, In patient, medicine.disease, business, Gastroenterology, Prognostic stratification
Published
2019
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27. Viral Hepatitis in Nepal: Past, Present, and Future

Author

Ananta Shrestha

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, Mini Review, Public health, Kinetic of hepatitis, Developing country, Hepatitis C, Hepatitis B, medicine.disease, medicine.disease_cause, Hepatitis E, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Hepatitis E virus, Health care, medicine, 030212 general & internal medicine, Intensive care medicine, business, Viral hepatitis, Kathmandu valley
Abstract

Over the last four decades, the diagnosis and therapy of viral hepatitis has evolved substantially all over the world. Although Nepal is a developing nation, it has been keeping pace with these developments in terms of the implementation of diagnostic and therapeutic strategies. However, because of a lack of infrastructure and logistics, Nepal still depends on its neighboring countries for molecular diagnostics in viral hepatitis B and C. Though most of the recent antivirals for hepatitis B and directly acting antivirals for hepatitis C are available at a highly subsidized cost, affordability still remains an issue. A lack of comprehensive national program for hepatitis B and C has been a major barrier for access to health care in patients with chronic viral hepatitis. Similarly, hepatitis E still remains an important public health issue with major epidemics at periodic intervals. Recent developments in understanding hepatitis E virus have unveiled important aspects of the virus, particularly with regard to why these epidemics occur. In this manuscript we try to elaborate the evolution in understanding, diagnosing, and treating viral hepatitis in Nepal. How to cite this article Shrestha A. Viral Hepatitis in Nepal: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):59-61.

Published
2016
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28. Immune therapy for hepatitis B

Author

Ananta Shrestha, Sheikh Mohammad Fazle Akbar, Md. Sakilur Islam Khan, Ruksana Raihan, and Mamun Al-Mahtab

Subjects
0301 basic medicine, business.industry, Context (language use), General Medicine, Hepatitis B, medicine.disease, Immune therapy, Clinical trial, 03 medical and health sciences, Immune Modulators, Therapeutic approach, 030104 developmental biology, 0302 clinical medicine, Immune system, Immunology, medicine, 030211 gastroenterology & hepatology, Review Articles on Treatment for Hepatitis B, business, Drug toxicity
Abstract

Although several antiviral drugs are now available for treatment of patients with chronic hepatitis B (CHB), sustained off-treatment clinical responses and containment of CHB-related complications are not achieved in majority of CHB patients by antiviral therapy. In addition, use of these drugs is endowed with substantial long term risk of viral resistance and drug toxicity. The infinite treatment regimens of antiviral drugs for CHB patients are also costly and usually unbearable by most patients of developing and resource-constrained countries. Taken together, there is a pressing need to develop new and innovative therapeutic approaches for CHB patients. Immune therapy seems to be an alternate therapeutic approach for CHB patients because impaired or distorted or diminished immune responses have been detected in most of these patients. Also, investigators have shown that restoration or induction of proper types of immune responses may have therapeutic implications in CHB. Various immunomodulatory agents have been used to treat patients with CHB around the world and the outcomes of these clinical trials show that the properties of immune modulators and nature and designing of immune therapeutic regimens seem to be highly relevant in the context of treatment of CHB patients. In this review, the general properties and specific features of immune therapy for CHB have been discussed for developing the guidelines of effective regimens of immune therapy for CHB.

Published
2016

29. Current Treatment of Acute and Chronic Hepatitis E Virus Infection: Role of Antivirals

Author

Ananta, Shrestha, Birendra, P Gupta, and Thupten, K Lama

Subjects
0301 basic medicine, medicine.medical_specialty, Sanitation, Epidemiology, media_common.quotation_subject, Mini Review, Disease, medicine.disease_cause, Virus, 03 medical and health sciences, 0302 clinical medicine, Hepatitis E virus, Hygiene, medicine, media_common, business.industry, Antiviral drugs, Therapy, Hepatitis E, medicine.disease, Virology, 030104 developmental biology, 030211 gastroenterology & hepatology, business, Developed country
Abstract

Hepatitis E virus (HEV) infection results in nearly 20 million new infections, resulting in 70,000 deaths globally each year. Previously thought as a disease limited to developing nations with poor sanitation and hygiene, it is increasingly recognized that even the most developed nations are not spared. A clear dichotomy in epidemiology of HEV is noted between developing and industrialized nations. The HEV genotypes 1 and 2 are common in Asia and Africa and are transmitted mainly by contaminated drinking water. Sporadic as well as large-scale epidemics of acute hepatitis have been noted with HEV genotype 1 infection in developing countries of Asia and Africa. On the contrary, HEV genotypes 3 and 4 are common in industrialized nations and unlike genotypes 1 and 2, they are transmitted by consumption of raw meat products, fruits, and blood transfusion. Large epidemics have not been reported with HEV genotypes 3 and 4 and manifestation is usually indolent, though severe acute hepatitis has been reported. How to cite this article: Shrestha A, Gupta BP, Lama TK. Current Treatment of Acute and Chronic Hepatitis E Virus Infection: Role of Antivirals. Euroasian J Hepato-Gastroenterol 2017;7(1):73-77.

Published
2016

30. Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B

Author

Shahinul Alam, Golam Mustafa, Mobin Khan, Akm Khorshed Alam, Nooruddin Ahmad, and Ananta Shrestha

Subjects
Hepatitis B virus, Pathology, medicine.medical_specialty, Hepatology, medicine.diagnostic_test, biology, business.industry, virus diseases, Hepatitis B, medicine.disease_cause, medicine.disease, Gastroenterology, digestive system diseases, Alanine transaminase, HBeAg, Fibrosis, Internal medicine, Liver biopsy, Biopsy, medicine, biology.protein, business, Viral load
Abstract

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level and age are used in the evaluation of chronic hepatitis B (CHB). Aim: We designed this study to evaluate liver histology with ALT and its relation with age and HBV DNA. Methods: During the period of October 2006 to July 2009, 499 CHB patients were included in this study with detectable HBV DNA at PCR. Of these, 181 had normal ALT, 200 had ALT [>(1 × ULN) 4 and 31 (10.8%) had fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%) had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting significant histological changes. Further, HAI and fibrosis were significantly greater in the age of >30 years. Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of 2 × ULN.

Published
2011
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31. Ciprofloxacin-induced Stevens-Johnson syndrome: First report from Bangladesh

Author

Mamun-Al-Mahtab, Salimur Rahman, Jahangir Sarkar, Mobin Khan, Akmat Ali, and Ananta Shrestha

Subjects
medicine.medical_specialty, business.industry, Stevens johnson, Disease, Jaundice, medicine.disease, Rash, Dermatology, Surgery, Ciprofloxacin, stomatognathic diseases, medicine, General Earth and Planetary Sciences, Erythema multiforme, medicine.symptom, Red eye, business, Stomatitis, General Environmental Science, medicine.drug
Abstract

Stevens-Johnson syndrome, otherwise known as erythema multiforme majus, was first described in 1922 by Stevens and Johnson as a febrile illness with stomatitis, purulent conjunctivitis, and skin lesions. Case report: We report a 28-year-old married woman who presented with fever and was advised ciprofloxacin tablet. After taking two doses of the tablet, she developed papulo-vesicular rash involving the trunk and the upper and lower limbs, including mucous membranes. She also developed a painful red eye. She eventually developed jaundice and her case was ultimately diagnosed as ciprofloxacin-induced Stevens-Johnson syndrome. Discussion: Medications appear to be the most common cause of Stevens-Johnson syndrome. It commonly affects multiple organs. Treatment for Stevens-Johnson syndrome is as diverse as the symptoms and it should be begun by withdrawing any offending agent identified. Conclusion: Stevens-Johnson syndrome is a potentially fatal multiorgan disease. This aspect of the condition is bes...

Published
2010
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32. Genotypes of HCV in Bangladesh: Experience from a Tertiary Centre

Author

Niaz M. Sharif, Ananta Shrestha, Mamun-Al-Mahtab, Fazal Karim, Salimur Rahman, and Mobin Khan

Subjects
education.field_of_study, medicine.medical_specialty, business.industry, Treatment duration, Hepatitis C virus, Population, HCV genotypes, Chronic liver disease, medicine.disease, medicine.disease_cause, Response to treatment, Gastroenterology, Internal medicine, Genotype, Immunology, medicine, Decompensation, education, business
Abstract

Introduction: Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide including Bangladesh. Approximately 0.84% of our population is infected with HCV. Genotypes of HCV are important in the determination of treatment duration and in predicting the response to treatment in HCV infection. Methodology: 61 consecutive patients who presented to us with chronic hepatitis C (CHC) and who could afford treatment and having no features of decompensation were included in the study. Results: Of the 61 study subjects, 46 were males and 15 females. They were between 12 and 70 years of age. Of them 41% had genotype 3, 31% had mixed genotypes 3 + 4 and 21% had genotype 1. Patients also had genotypes 2, 4, 5 and mixed genotypes 5 + 6, the figure being 1.6% in each case. Conclusion: Genotype 3 is the commonest HCV genotype in Bangladesh, while we also have a high prevalence of mixed HCV genotypes.

Published
2008
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33. Hepatitis E virus outbreak in postearthquake Nepal: is a vaccine really needed?

Author

S. M. F. Akbar, Shobhana Shrestha, Birendra Prasad Gupta, K. G. Maharjan, Binaya Sapkota, S. Khadka, Anurag Adhikari, T. K. Lama, P. Karmacharya, and Ananta Shrestha

Subjects
Hepatology, business.industry, 030231 tropical medicine, Outbreak, Hepatitis E, medicine.disease, medicine.disease_cause, Virology, Disease Outbreaks, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Hepatitis E virus, Nepal, medicine, Earthquakes, 030212 general & internal medicine, business
Published
2016

34. Acute hepatitis E virus infection in human immunodeficiency virus–positive men and women in Nepal: Not quite a rare entity

Author

Binaya Sapkota, Anurag Adhikari, Birendra Prasad Gupta, Ananta Shrestha, and Thupten Kelsang Lama

Subjects
Male, 0301 basic medicine, Human Immunodeficiency Virus Positive, HIV Infections, medicine.disease_cause, Virus, 03 medical and health sciences, 0302 clinical medicine, Nepal, Hepatitis E virus, Humans, Medicine, 030212 general & internal medicine, Hepatology, business.industry, Acute hepatitis E, Rare entity, Hepatitis B, Hepatitis E, medicine.disease, Virology, 030104 developmental biology, Immunology, Female, business
Published
2016
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35. Epidemiology of Viral Hepatitis and Liver Diseases in Nepal

Author

Ananta Shrestha

Subjects
Hepatitis B virus, education.field_of_study, Cirrhosis, business.industry, Hepatitis C virus, Mini Review, Population, Outbreak, medicine.disease_cause, medicine.disease, Virology, Hepatitis E virus, Nepal, Hepatocellular carcinoma, medicine, business, education, Viral hepatitis, Epidemiology
Abstract

Geographical and ethnic diversity in Nepal has led to interesting epidemiology of viral hepatitis and liver diseases. Before the epidemic of Biratnagar that occurred in April to June 2014, Kathmandu was the only known endemic region for hepatitis E virus infection (HEV), where at least four previous epidemics have been documented since 1973. Due to rapid urbanization with still low socioeconomic condition, other major cities are appreciated to be at increasing risk of outbreaks. Characteristics of HEV epidemics and genetic changes of HEV during last decade have been studied. While hepatitis A virus infection was only common during childhood till recent years, it is re-emerging as an important etiology of acute hepatitis in young adults. Nepal is classified as low endemic region for hepatitis B virus infection (HBV) with overall seroprevalence of 1.1%. But, some ethnic groups and geographical areas have high prevalence rates. Despite low endemicity, HBV accounts for majority of cases of hepatocellular carcinoma and liver cirrhosis in the country. Similarly, though hepatitis C virus (HCV) is present in only 0.4% of general population, high seroprevalence was found among intravenous drug abusers many of them with HIV coinfection. Apart from hepatitis viruses, alcohol use also contributes significantly to liver cirrhosis and chronic liver failure. A unique form of hepatic venous outflow obstruction called 'hepatic vena cava syndrome' has been identified as an important etiology of liver cirrhosis and hepatocellular carcinoma. How to cite this article Shrestha A. Epidemiology of Viral Hepatitis and Liver Diseases in Nepal. Euroasian J Hepato-Gastroenterol 2015;5(1):40-42.

Published
2014

36. A Unique Spontaneous Subcapsular Bilioma: Is it an idiopathic variety?

Author

Thupten Kelsang Lama and Ananta Shrestha

Subjects
Pathology, medicine.medical_specialty, lcsh:R5-920, genetic structures, business.industry, GALL STONE, General Medicine, Gastroenterology, digestive system, eye diseases, BILIARY TRACT ABNORMALITY, Internal medicine, Medicine, sense organs, Abnormality, business, lcsh:Medicine (General)
Abstract

Spontaneous Subcapsular bilioma is an extrabiliary intrahepatic collection of bile in subcapsular location commonly occurring after biliary trauma or surgery. It rarely occurs in absence of any underlying biliary abnormality. We report a such a case with no known underlying biliary tract abnormality except for a solitary gall stone. We bring into discussion whether this type of bilioma can be labeled as idiopathic spontaneous variety in presence of gall stone.Keywords: bile; idiopathic; subcapsular bilioma.

Published
2013

37. High prevalence of hepatitis B virus infection and inferior vena cava obstruction among patients with liver cirrhosis or hepatocellular carcinoma in Nepal

Author

Hiroaki Okamoto, Kazunori Endo, Fumio Tsuda, Ananta Shrestha, Masaharu Takahashi, Shobhana Shrestha, and Santosh Man Shrestha

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, HBsAg, Hepatitis B virus, Cirrhosis, Carcinoma, Hepatocellular, Alcohol Drinking, Genotype, Molecular Sequence Data, Vena Cava, Inferior, Budd-Chiari Syndrome, medicine.disease_cause, Inferior vena cava, Gastroenterology, Risk Assessment, Orthohepadnavirus, Nepal, Risk Factors, Internal medicine, Carcinoma, medicine, Prevalence, Humans, Aged, Aged, 80 and over, Hepatology, biology, Base Sequence, business.industry, Liver Neoplasms, virus diseases, Sequence Analysis, DNA, Middle Aged, medicine.disease, biology.organism_classification, Hepatitis B, Hepatitis C, digestive system diseases, medicine.vein, Hepadnaviridae, Hepatocellular carcinoma, Female, business
Abstract

Background: Little is known about the prevalence of hepatitis B virus (HBV) DNA and the genotype distribution among patients with liver diseases in Nepal, where obstruction of the hepatic portion of the inferior vena cava (IVCO) is common. The aim of the present paper was to assess the roles of HBV infection and IVCO in liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in Nepal. Methods: Serum samples from 121 patients (89 male, 32 female; age, 55.0 ± 13.6 years) with or without IVCO consisting of 70 LC patients and 51 HCC patients in Nepal, were tested for HBV-DNA. Results: The HBV-DNA was detected in 68 patients (56%) including 20 hepatitis B surface antigen (HBsAg)-negative patients: 33 LC patients (47%) and 35 HCC patients (69%) had detectable HBV-DNA (P = 0.0303). Among the 89 patients with IVCO, HBV-DNA was detected in HCC patients significantly more frequently than in LC patients (80%vs 43%, P = 0.0005). The frequency of HBV viremia was significantly higher among HCC patients with IVCO than those without (80%vs 44%, P = 0.0236), and that of HBV viremia with IVCO was significantly higher among HCC patients than among LC patients (55%vs 27%, P = 0.0153). The HBV genotypes A and D were predominant, and genotype A was significantly more frequent among HCC patients than among LC patients (22%vs 6%, P = 0.0090). Among HCC patients, those with genotype A HBV were significantly younger than those with genotype D (43 ± 13 vs 57 ± 12 years, P = 0.0252). Conclusion: Hepatitis B virus alone (especially genotype A) or in concert with IVCO may be responsible for development of HCC in Nepal.

Published
2007

38. Study of type 2 diabetes mellitus cases at Nepal Medical College Teaching Hospital

Author

Sanjib, Dhungel, Krishna Chandra, Devkota, Pramod, Chhetri, Praveen, Bhattarai, and Ananta, Shrestha

Subjects
Adult, Aged, 80 and over, Blood Glucose, Male, Blood Pressure, Comorbidity, Middle Aged, Risk Assessment, Body Mass Index, Cholesterol, Diabetes Mellitus, Type 2, Nepal, Risk Factors, Humans, Female, Hospitals, Teaching, Aged
Abstract

A total of 110 cases attending diabetic clinic at Nepal Medical College Teaching Hospital were studied. Associated risk factors and co-morbid conditions were analyzed. Among them 63.6% have systolic BP more than 130 mm of Hg and 24.5% have diastolic BP more than 85 mm of Hg reflecting hypertension as most common co-morbid condition. Various complications of diabetes in studied subjects are highlighted. Eighty percent of patients have fasting blood sugar more than 110 mg% and 93.0% have post-prandial blood sugar more than 140 mg% reflecting poor overall glycemic control despite the use of medication.

Published
2005

39. Study of cases of hypertension admitted at Nepal Medical College Teaching Hospital

Author

Sanjib, Dhungel, Ananta, Shrestha, Prabeen, Bhattarai, and Badri, Paudel

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Comorbidity, Middle Aged, Hospitalization, Pulmonary Disease, Chronic Obstructive, Nepal, Hypertension, Diabetes Mellitus, Prevalence, Humans, Female, Hospitals, Teaching, Aged, Retrospective Studies
Abstract

Hundred cases of hypertension admitted to medical ward at Nepal Medical College and Teaching Hospital were studied and analysed. They constituted 9.4% of the total admitted patients in the medical ward. Association of hypertension with other diseases is highlighted. Thirty two percent of these hypertensives were diabetic and 22.0% of hypertensives also had Chronic obstructive airway disease (COAD). Different types of complications of hypertension seen in the studied subjects are mentioned. Only 19.0% of hypertensives had their blood pressure controlled and the rest were uncontrolled hypertensives.

Published
2004

40. Case Report of Autoimmune Hepatitis from a Tertiary Centre in Bangladesh

Author

Kamal, Salimur Rahman, Mamun Al-Mahtab, Uttam Kumar Barua, Akm Faizul Huq, Mobin Khan, and Ananta Shrestha

Subjects
business.industry, Unknown aetiology, Autoimmune Chronic Hepatitis, Immunology, Genetic predisposition, HLA-DR3, Medicine, General Medicine, Autoimmune hepatitis, business, medicine.disease, Chronic liver disease, Decompensated cirrhosis
Abstract

Autoimmune hepatitis is defined as chronic liver disease of unknown aetiology with aberrant autoreactivity and genetic predisposition, characterized by female predominance, circulating auto-antibodies, hypergammaglobulinaemia and association with HLA DR3 and HLA DR4 [1]. We present two patients with autoimmune. The first patient is a young lady who was diagnosed with autoimmune chronic hepatitis. The second patient, on the other hand, is an elderly gentleman who presented to us with autoimmune hepatitis related decompensated cirrhosis of liver. doi: 10.3329/blj.v1i1.2652 Bangladesh Liver Journal Vol.1(1) 2009 p.53-54

Published
1970
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