Annals of hepatology最新文献

{"title":"Acute Liver Failure Triggered by Idiosyncratic Drug-Induced Liver Injury Associated with Ibuprofen Consumption. Case Report.","authors":"Luis R. Alvarez-Martín , Luis A. Esquivel-Pacheco , Alexis V. Hinostroza-Pezo , Karla J. Arroyo-García , Montserrat D. Moreno-Huesca , Adrian Z. Feria-Avendaño , Carlos A. Galván-Castro","doi":"10.1016/j.aohep.2025.101813","DOIUrl":"10.1016/j.aohep.2025.101813","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Drug-induced liver injury (DILI) refers to hepatic function alterations associated with drugs. The idiosyncratic form can progress from remission to acute liver failure (ALF).</div><div>The objective is to present the case of a patient with ALF secondary to idiosyncratic DILI due to ibuprofen consumption.</div></div><div><h3>Materials and Patients</h3><div>A 43-year-old woman with no history of alcohol, herbal, or drug consumption. She presented with asthenia, adynamia, and unquantified fever, self-medicating with ibuprofen 1.2 g/day. Subsequently, she developed right hypochondrium pain and generalized jaundice without discontinuing ibuprofen. Four weeks after the onset of symptoms, she developed choluria, acholia, and hyporexia, with laboratory findings showing mild thrombocytopenia (platelets 109,000 u/L), transaminasemia (aspartate aminotransferase 890 U/l, alanine aminotransferase 1183 U/l, alkaline phosphatase 311 U/l), direct hyperbilirubinemia (total bilirubin: 7.8 mg/dl, direct: 6.8 mg/dl), and prolonged prothrombin time. Hepatotropic virus and HIV infections were ruled out, as well as autoimmune liver diseases. Hepatic ultrasound showed a starry sky pattern and splenomegaly. Magnetic resonance cholangiopancreatography revealed only hepatosplenomegaly. Liver biopsy showed intense inflammation with polymorphonuclear and lymphocytic infiltrate, total acinar involvement, cholestasis, and hepatocellular necrosis, compatible with acute severe hepatitis and accentuated cholestasis probably secondary to DILI. Management with ursodeoxycholic acid and prednisone (50 mg/day) was initiated without improvement, with a torpid evolution due to the development of hepatic encephalopathy, coagulopathy, and upper gastrointestinal bleeding.</div></div><div><h3>Results</h3><div>DILI has an estimated annual incidence of 2.5 cases/100,000 inhabitants, considered a diagnosis of exclusion, with complementary studies useful to increase diagnostic suspicion. In this context, the R factor should be calculated to characterize the type of liver injury. Liver biopsy is useful and shows three patterns: necroinflammatory, cholestatic, and mixed. Idiosyncratic reactions occur in susceptible individuals, are dose-independent, and mostly occur 5-90 days after drug intake. Ibuprofen is associated with a mixed pattern in this presentation. DILI is one of the main causes of ALF, defined by the appearance of hepatic encephalopathy between 7-28 days after the onset of jaundice, with coagulopathy and moderate elevation of transaminases and bilirubin. In this case, a woman with no history of liver disease, recent ibuprofen intake, and acute liver damage was observed. During her evaluation, alcoholic, infectious, and autoimmune pathologies were ruled out, revealing a mixed pattern of liver injury (necroinflammatory and cholestatic) on imaging and histopathological studies. In patients with ALF secondary to DILI, early liver transplanta","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101813"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of oxidative stress according to the pattern of alcohol consumption and in alcoholic liver disease.","authors":"Adrián Flores-Sánchez ,&nbsp;Abigail Hernández-Barragán ,&nbsp;Daniela Colector-Sesatti ,&nbsp;Andrea Garcia-Avalos ,&nbsp;Moisés Martínez-Castillo ,&nbsp;Marisela Hernández-Santillan ,&nbsp;Jaqueline Córdova-Gallardo ,&nbsp;José L. Pérez-Hernandez ,&nbsp;Fátima Higuera-De la Tijera ,&nbsp;Gabriela Gutiérrez-Reyes","doi":"10.1016/j.aohep.2025.101835","DOIUrl":"10.1016/j.aohep.2025.101835","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Alcohol and its metabolites induce damage in the liver, such as: activation of the immune response and oxidative stress. Objective: To evaluate the redox state through markers of oxidative stress in patterns of alcohol consumption and alcohol-related liver disease (ALD).</div></div><div><h3>Materials and Patients</h3><div>A cross-sectional and multicenter study was conducted, with the inclusion of individuals displaying various patterns of alcohol consumption. Participants were categorized based on responses to questionnaires (AUDIT and DSM-IV), as well as an individualized survey, along with clinical and biochemical data. Six distinct groups were established: Risk (RI), Abuse (Ab), Alcoholism (OH), as well as ALD: alcohol liver cirrhosis (CiOH) and alcoholic hepatitis (HA), in addition to a control group (CT). Stress markers, including reduced glutathione (GSH) and oxidized glutathione (GSSG), were assessed in peripheral blood and we calculated GSH/GSSG ratio, lipid peroxidation via malondialdehyde formation, and protein oxidized by carbonylated protein were quantified. Statistical analysis was performed utilizing the Mann-Whitney U test, with statistical significance set at p&lt;0.05.</div></div><div><h3>Results</h3><div>The subjects were classified into RI (22), Ab (4), OH (28), CiOH (76), HA (16), and CT (100). The GSH was found to decrease significantly in the EHA groups vs CT. In contrast, GSSG increased in the RI, Ab, OH, and CiOH groups compared to CT, indicating that alcohol consumption favors an oxidizing state, confirmed by the negative GSH/GSSG ratio. Additionally, the GSH/GSSG ratio in the OH group showed a greater imbalance than in patients with EHA. On the other hand, protein oxidation increased in EHA, with high levels of carbonylated proteins observed in OH, CiOH, and HA compared to CT, Ab, and RI. Furthermore, lipoperoxidation measured by Malondialdehyde showed increased levels of OH and CiOH compared to the other study groups.</div></div><div><h3>Conclusions</h3><div>Excessive alcohol consumption, with or without liver damage, promotes the oxidation of proteins and lipids. Additionally, alcohol favors the oxidized form of the main endogenous antioxidant, GSH. Therefore, it is necessary to control the redox balance through antioxidant treatment.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101835"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Cardiovascular Risk Score with Alterations in Carotid Intima-Media Thickness in Patients with MASLD","authors":"José L. Vargas-Basurto ,&nbsp;Ana D. Cano-Contreras ,&nbsp;Héctor R. Ordaz-Alvarez ,&nbsp;Genesis P. Martinez-Perez ,&nbsp;Kevin D. Gonzalez-Gomez ,&nbsp;Jose M. Remes-Troche","doi":"10.1016/j.aohep.2025.101800","DOIUrl":"10.1016/j.aohep.2025.101800","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;MASLD is associated with cardiovascular disease due to systemic inflammation and endothelial dysfunction. Carotid intima-media thickness (CIMT) and atherosclerosis are considered markers of generalized atherosclerosis and increased cardiovascular risk (CVR). The objective of this study is to describe the correlation between CVR and changes in CIMT in patients with MASLD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;This observational, cross-sectional, analytical study was conducted at the Instituto de Investigaciones Médico-Biológicas liver clinic from January 2023 to April 2024. Patients who met the eligibility criteria provided informed consent and underwent the following procedures: transitional liver elastography (TE), carotid Doppler ultrasound (USG), somatometric measurements, and biochemical tests. Cardiovascular risk scores (Framingham, ASCVD, SCORE2) and FIB-4 were calculated. Participants were categorized into two groups based on carotid intima-media thickness, altered CIMT (&gt;1.1 mm) and normal CIMT (&lt;1.1 mm). A TE value &gt;8 Kpa indicated a risk of advanced fibrosis. Numerical variables were reported as measures of central tendency and dispersion, while categorical variables were presented as frequencies and percentages. The Kolmogorov-Smirnov test assessed data distribution and the Levene test evaluated homoscedasticity. For group comparisons, Student's t-test or Wilcoxon test was used for numerical variables, and chi-square or Fisher's exact test for categorical variables. ROC curves were generated to analyze cardiovascular risk and atherosclerosis. Spearman's test was employed to evaluate correlations. Statistical analysis was conducted using SPSS version 26.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This study included 51 patients: 17 (33.33%) with altered CIMT (age 58 [48-72], 58.8% women) and 34 (66.66%) without alterations (age 51.5 [30-68], 79.4% women). Pathological histories, elastography results, biochemical data, and CVR scores are summarized in Table 1. Patients with altered CIMT exhibited a higher age (58 [48-72] vs. 51.5 [30-68], p=0.005), higher LDL concentrations (133.93±37.46 vs. 109.47±41.86 mg/dL, p=0.047), and elevated CVR scores: Framingham (5.8 [3.0-12.3] vs. 1.7 [0.57-5.05], p=0.037), ASCVD (8.4 [5.4-17.25] vs. 3.7 [1.95-10.2], p=0.047), and SCORE2 (8.1 [4.75-12.9] vs. 3.8 [1.7-6.85], p=0.012). Advanced fibrosis (&gt;8 kPa) was more prevalent among patients with altered CIMT (55.6% vs. 21.4%, p=0.037) and was associated with higher CVR scores: ASCVD (15.7 [7.75-24.75] vs. 4.45 [1.97-9.67], p=0.001) and SCORE2 (11.3 [4.85-17.1] vs. 3.95 [2.3-8.12], p=0.004). Sub-analysis showed significant correlations of &gt;8 kPa and high FIB-4 with SCORE2 (r=0.574, p=0.040) and (r=0.564, p=0.045), respectively. Patients with &gt;8 kPa were more likely to have atherosclerosis (OR 4.58, 95% CI: 1.01-20.6, p=0.037) and altered CIMT (OR 4.2, 95% CI: 1.1-16.2, p=0.026). The are","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101800"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Injury Induced by Peumus boldus with Fatal Outcome. Case Report","authors":"Emmanuel Reyes-Ferreira,&nbsp;Hugo E. González-Chávez,&nbsp;Karen S. Arrazola-Mendoza,&nbsp;Francisco De la Peña-Camacho,&nbsp;Luis H. Vargas-Torrescano,&nbsp;Jorge L. Castrejón-Mora","doi":"10.1016/j.aohep.2025.101878","DOIUrl":"10.1016/j.aohep.2025.101878","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Peumus boldus is a plant native to South America traditionally used to treat gastrointestinal ailments. There are reports of hepatotoxicity from prolonged consumption. We describe the case of a patient with liver damage induced by Peumus boldus, with a torpid evolution and fatal outcome, highlighting the awareness of the adverse effects of this plant.</div></div><div><h3>Materials and Patients</h3><div>A 48-year-old woman with a history of type 2 diabetes on insulin glargine treatment and a surgical history of cholecystectomy 12 years prior for cholelithiasis, without other relevant history. She began three weeks prior with asthenia, adynamia, hyporexia, nausea, fever, jaundice, and right hypochondrial pain. Upon questioning, exposure to an herbal supplement based on Peumus boldus during the previous 15 days was related. Upon admission with vital signs BP: 101/82 mmHg, HR: 98 bpm, RR: 21 rpm, Temperature: 38.2°C, SaO2 90%. On physical examination, generalized jaundice, dark urine, and pale stools were noted. Laboratories showed a cholestasis clinical pattern (R Factor of 1.0, with ALT of 62 U/L, ALP of 184 U/L). Despite discontinuing the herbal supplement, she progressed with progressive cholestasis on follow-up, leading to the initiation of glucocorticoids without improvement. Complementary studies were conducted, ruling out infectious and autoimmune diseases, as well as a transjugular liver biopsy reporting non-alcoholic steatohepatitis with morphological data of toxic-induced lesions with moderate activity.</div></div><div><h3>Results</h3><div>During her clinical course, with persistence of generalized jaundice and right hypochondrial abdominal pain, grade 2 ascites, and encephalopathy characterized by disorientation in time and circumstance, behavioral alterations, and eventually somnolence tendency, for which she was brought by family members to the emergency service of our hospital. During her hospital stay, she showed a tendency to hypotension, without adequate response to vasopressor treatment, with clinical and laboratory evidence of renal function deterioration, and worsening liver function parameters with BT of 22.1 mg/dl, DB 20.5 mg/dl, IB 1.6 mg/dl, ALT 64 U/L, ALP 188 U/L, Platelets 59,000 cells/mm3, PT 27.5 seconds, and INR 2.54. After 65 days from the onset of symptoms, despite the treatment used, a fatal outcome occurred.</div></div><div><h3>Conclusions</h3><div>Despite a growing number of reports of hepatotoxicity induced by Peumus boldus, it is not listed in databases intended for such purposes as LiverTox. This case highlights the importance of raising awareness about the hepatotoxic risks of herbal products.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101878"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Cardiovascular Risk in Patients with Fatty Liver: Impact of Hepatic Cirrhosis","authors":"Arely Gayosso-Godinez,&nbsp;Raúl Contreras-Omaña","doi":"10.1016/j.aohep.2025.101839","DOIUrl":"10.1016/j.aohep.2025.101839","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>According to the literature, cardiovascular events have been described as the leading cause of death in patients with fatty liver associated with metabolic dysfunction (MASLD). The main objective of this study is to assess and compare cardiovascular risk in two groups of patients: those diagnosed with fatty liver without cirrhosis and those with liver cirrhosis attributable to fatty liver. The aim is to determine if there is a significant difference in cardiovascular risk between these groups, identify the most relevant cardiovascular risk factors, and explore possible associations between progression to liver cirrhosis and increased cardiovascular risk.</div></div><div><h3>Materials and Patients</h3><div>A retrospective cross-sectional study was conducted from 2020 to 2024, involving a total of 289 patients, of whom 165 were diagnosed with MASLD without cirrhosis and 125 patients were diagnosed with cirrhosis associated with fatty liver. In the first group, the grade of hepatic steatosis was determined by imaging methods, and cardiovascular risk assessment scales such as GLOBORISK and PREVENT were applied to both groups, conducting a comparative analysis between these study groups. Additionally, variables such as sex, age, weight, height, obesity, sedentary lifestyle, glomerular filtration rate, smoking, diabetes, hypertension, total cholesterol levels, LDL, HDL, and triglyceride levels were evaluated.</div></div><div><h3>Results</h3><div>In the present study, 165 patients diagnosed with MASLD were evaluated using two cardiovascular assessment scales: PREVENT and GLOBORISK. According to the PREVENT scale, 86 patients (52.1%) exhibited a low cardiovascular risk, with 50.9% also showing mild hepatic steatosis confirmed by imaging studies. Using the GLOBORISK scale, it was determined that 117 patients (70.9%) had a low level of cardiovascular risk. On the other hand, a total of 124 patients with hepatic cirrhosis associated with fatty liver were included. According to the evaluation using the PREVENT scale, it was found that 64 patients (51.6%) had an intermediate cardiovascular risk, and according to the GLOBORISK model, 45 patients (36.2%) were classified with a moderate risk. When contrasting between the group of patients with cirrhosis and those with only fatty liver, the first group has a 3.6 times higher likelihood (OR 3.6) of presenting a moderate to severe cardiovascular risk compared to those without cirrhosis (P=0.00).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that patients with cirrhosis associated with fatty liver have a 3.6 times higher prevalence of moderate to severe cardiovascular risk compared to patients without cirrhosis but with fatty liver. This suggests a need for closer monitoring of cardiovascular events alongside liver disease monitoring.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101839"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune hepatitis with overlap of primary biliary cirrhosis as the cause of esophageal varices in a geriatric patient, case report.","authors":"Martha A. López-Hernández ,&nbsp;José A. Novoa-Búrquez ,&nbsp;Vanessa Camacho-García ,&nbsp;Alma E. Enríquez-Valeriano ,&nbsp;Francisco A. Félix-Téllez ,&nbsp;Juan M. Díaz-Castillón ,&nbsp;Daniela G. Fausto-Murillo ,&nbsp;Margarita Ortiz ,&nbsp;Santos González-Luna ,&nbsp;Diego A. Zúñiga-Tamayo ,&nbsp;Héctor I. Cruz-Neri","doi":"10.1016/j.aohep.2025.101811","DOIUrl":"10.1016/j.aohep.2025.101811","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;A case is presented of an elderly female patient, without risk factors or comorbidities, who debuts with apparent gastrointestinal bleeding, leading to a diagnosis of autoimmune pathology. The aim is to highlight the importance of a comprehensive approach to pathologies in functional geriatric patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and Methods&lt;/h3&gt;&lt;div&gt;A female patient in the seventh decade of life, housewife, with reference to unspecified leukemia in hereditary family history. Denies having tattoos. In her past medical history, the only notable are a cholecystectomy performed 25 years ago without complications and a right breast cyst resection done 30 years ago with histopathological study negative for malignancy. Denies alcohol consumption, denies history of blood transfusion, and no use of non-steroidal anti-inflammatory drugs. With cervico-vaginal cytology performed 4 months ago with a normal report. Functional and independent for activities of daily living, with depressive disorder associated with recent unresolved grief, unestimated weight loss in the last 2 years.&lt;/div&gt;&lt;div&gt;She attends a geriatric outpatient consultation due to sporadic episodes of evacuations with melenic characteristics starting 3 months ago, with the last episode occurring 3 weeks prior. Denies episodes of epistaxis, gingival bleeding, abnormal uterine bleeding, petechiae, or bruises; denies night sweats or fever; presents to medical evaluation with evidence of unspecified-grade anemia; iron and folic acid oral supplementation is initiated. In our service consultation, hemoglobin is reported as 5 g/dl, leading to the decision for admission for further management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Endoscopy was performed with a report of upper esophageal varices descending to the distal third. Management continues with a joint approach with the Gastroenterology service. Serologies for hepatitis C and B viruses are negative, liver function tests show a cholestatic pattern, and a CT scan reveals reactive changes in the liver as well as splenomegaly. Due to the absence of risk factors, a comprehensive approach for autoimmune hepatitis is initiated, with positive antinuclear and anti-mitochondrial antibodies at a titer of 1:3200, IgG 4734, IgM 887, and anti-SP100 224. Hepatic Doppler ultrasound with elastography shows moderate fibrosis (Metavir score 3). Liver biopsy reports portal lymphoplasmacytic hepatitis with damage to the limiting plate, ductular proliferation, intense lobular damage (binucleation, ballooning, and hepatocyte degeneration), and portal fibrosis (F1). Based on this, a diagnosis of autoimmune hepatitis with overlap of primary biliary cholangitis is made, and targeted management is initiated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Emphasizing the importance of continuing to address pathologies in patients regardless of age group and in an interdisciplinary manner is crucial. In our study population, functio","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101811"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of fibrosis and steatosis determined by transient elastography and controlled attenuation parameter (Fibroscan®) in diabetic patients","authors":"Kevin S. Vázquez-Hernández ,&nbsp;Andres Burak-Leipuner ,&nbsp;Alfredo I. Servin-Caamaño ,&nbsp;Javier A. Romero-Bermúdez ,&nbsp;Laura E. Ceceña-Martínez ,&nbsp;José L. Pérez-Hernández ,&nbsp;María C. Castañeda-Aguilar ,&nbsp;Fátima Higuera-de la Tijera","doi":"10.1016/j.aohep.2025.101815","DOIUrl":"10.1016/j.aohep.2025.101815","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Globally, a higher prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported in diabetics (55.5%) compared to the general population (25%). In Mexico, there is a lack of studies on diabetes (DM2) in this subgroup. Objective: To determine the prevalence of hepatic fibrosis and steatosis determined by FibroScanâ in patients with DM2.</div></div><div><h3>Materials and Patients</h3><div>An observational, descriptive, cross-sectional study included patients who attended the clinic for DM2 between August 2018 and March 2024 and underwent FibroScan® to determine the absence/presence and degree of fibrosis and steatosis. Patients were excluded if they had risky alcohol consumption, hepatitis B/C, any type of previously diagnosed hepatopathy or cirrhosis, or consumption of medications other than those for metabolic syndrome (MS). Descriptive statistics were used, and the prevalence of FibroScan® determined steatosis and fibrosis was estimated.</div></div><div><h3>Results</h3><div>A total of 298 patients were evaluated, 195 (64.5%) women, with a mean age of 55.6±10.8 years. Of these, 284 (95.3%) agreed to undergo FibroScan® examination, none had risky alcohol consumption, 146 (51.4%) were smokers, 114 (40.1%) were overweight, 75 (25.6%) had grade I obesity, 34 (12%) had grade II obesity, and 14 (4.9%) had grade III obesity. 106 (56.3%) were hypertensive, 177 (62.3%) had dyslipidemia, and 168 (59.2%) met the criteria for MS. Regarding the FibroScan® parameters, 109 (38.4%) had steatosis: S1 in 34 (12%), S2 in 33 (11.6%), and S3 in 42 (14.8%). There was fibrosis in 155 (56.4%): F1 in 42 (14.8%), F2 in 40 (14.1%), F3 in 26 (9.2%), and F4 in 47 (16.5%). The biochemical parameters of this cohort are shown in Table 1. There was no relationship between the duration of DM2, the stage of disease control, recent adherence to treatment, and the presence or stage of steatosis or fibrosis (p=N.S.).</div></div><div><h3>Conclusions</h3><div>The prevalence of MASLD associated steatosis and fibrosis is high in Mexican diabetic patients and occurs independently of disease control, disease duration, and recent adherence to treatment.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101815"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and epidemiologic characteristics of pregnant women with liver disease in a tertiary hospital.","authors":"Yelba G. Céspedes-Saballos ,&nbsp;Diego F. Abendaño-Rivera ,&nbsp;Vilma Hernández-Garza ,&nbsp;Deborah E. Espinoza-López ,&nbsp;Viridiana López-Ladrón de Guevara ,&nbsp;Santiago Camacho-Hernández ,&nbsp;Fátima Higuera-de-la-Tijera","doi":"10.1016/j.aohep.2025.101869","DOIUrl":"10.1016/j.aohep.2025.101869","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>It has been demonstrated that approximately 3% of pregnant women are affected by some type of liver disorder. The aim of this study is to determine the clinical and epidemiological characteristics of pregnant patients who developed liver disease during their pregnancy or liver pathology unrelated to pregnancy.</div></div><div><h3>Materials and Patients</h3><div>The study is a retrospective and observational analysis of a cohort composed of 72 pregnant women diagnosed with liver pathologies. These patients were seen in the gynecology and obstetrics service of the Hospital General de México between January 2023 and May 2024. The selection of the participants was based on their admission during the aforementioned period and the presence of a diagnosis of liver disease associated with pregnancy or under investigation. Data collection was carried out using forms designed for this purpose, through the review of the patients' clinical records, which classifies the source of information as secondary. Data analysis was performed using SPSS statistical software version 23. A descriptive approach was used for the analysis, presenting qualitative variables in terms of frequency and percentage, while measures of central tendency, such as mean and standard deviation, were calculated for quantitative variables.</div></div><div><h3>Results</h3><div>Data were collected from 72 files of pregnant patients who developed liver disease during pregnancy or liver pathology unrelated to pregnancy. The average age was 28.36, 28.36+-6.96 (26.75-29.97). 66.7% were multipregnant and 31.9% were primigravida. Regarding associated comorbidities, 59.7% did not present any comorbidity, while 40.3% presented some comorbidity, with subclinical hypothyroidism being the most frequent at 9.7%. Regarding nutritional status, 40.3% were obese, 6.9% overweight, and 27.8% normal weight. In the viral panel, 30.6% were non-reactive for HAV, HBV, and HCV, and up to 65.3% were not tested. Imaging studies showed the absence of intra- and extra-hepatic duct dilatation in 25%, on the other hand, 31.1% did not undergo imaging studies. The 87.5% presented some pathology related to pregnancy, the main ones being intrahepatic cholestasis (30.6%), preeclampsia with severe features (27.8%), HELLP syndrome (18.1%), and only 13.9% pathologies not related to pregnancy, the main ones being metabolic hepatic steatosis (5.6%) and viral hepatitis (2.8%).</div></div><div><h3>Conclusions</h3><div>In our study, liver pathology in pregnant women has similar characteristics to those reported in the world literature, with those related to pregnancy predominating over pre-existing pathologies. It should be emphasized that all pregnant women should be approached for such pathology and thus avoid complications in both mother and child.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101869"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kasabach-Merritt syndrome in an adult treated by embolization prior to liver transplantation: a case report.","authors":"Xóchitl García-León,&nbsp;René Malé-Velázquez,&nbsp;Esteban Martínez-Villaseñor,&nbsp;Álvaro Calleros-Camarena","doi":"10.1016/j.aohep.2025.101845","DOIUrl":"10.1016/j.aohep.2025.101845","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Hepatic hemangioma, the most common benign tumor of the liver. Large ones may develop Kasabach Merrit syndrome (KM) if associated with coagulopathy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;to describe diagnostic approach and treatment of hemangioma with KM syndrome in an adult with complications during pregnancy, treated with embolization and liver transplantation, review of the literature.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;A 35-year-old woman referred from Durango by angiology to the hepatology department for a failed laparoscopic biopsy attempt due to the presence of unspecified vascular lesions which presented bleeding due to severe coagulation disorders, controlled in her hospital of origin. During the consultation, imaging and biochemical characteristics of thrombocytopenia and anemia were evaluated and KM syndrome was considered, complementing the diagnosis with Leukocytes 5.3 × 103/uL, HB 10.3 g/dL, Hto 29.8%, VCM 99.2 fL, HCM 34.3 pg platelets 111 × 103/uL, Cr 0.61mg/dL, BT 1. 05mg/dl, FA 64 U/L, GGT 55 U/L AST 15 U/L, ALT 20 U/L, albumin 4.82g/dL, fibrinogen 52, dimer D 49.46 ug/dl, AFP 1.21 ng/ml, carcinoembryonic 0.94 ng/ml, Ca 19-9 2. 0 U/ml TP 14.6 INR 1.0, it was decided to perform a biopsy to rule out hemangioepithelioma, presenting severe hemorrhage requiring transarterial embolization on two occasions. Subsequently, she returned to the clinic with a normoevolutive pregnancy and a considerable increase in the size of the lesions, requiring cesarean section due to placenta accrete, again generating hemorrhage and development of ascites. Due to the hepatic deterioration, a protocol for transplantation was established and successfully performed in March 2024, with a total reversal of the coagulation disorders after the procedure and currently with no alterations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Hepatic hemangiomas are mostly asymptomatic and small; those larger than 10 cm are considered giants and present with non-specific symptoms such as abdominal pain, fatigue, etc. They are diagnosed by tomography (CT) or magnetic resonance imaging (MRI); in CT they are observed as relatively well-defined hypodense nodules, hypoattenuated in relation to parenchyma and centripetal peripheral enhancement with contrast medium, with complete and persistent opacification in late sections. It presents complications such as intralesional hemorrhage, mass effect in adjacent structures, and rupture with intraperitoneal hemorrhage. Some lesions may develop KM syndrome, a vascular disease characterized by thrombocytopenia, microangiopathic hemolytic anemia, coagulopathy and hepatic vascular lesions. The pathogenesis is due to the sequestration of platelets and coagulation factors in the abnormal endothelium of the vascular lesion. It requires biopsy to rule out malignant neoplasms (hemangioepithelioma). Occurs in neonates, rarely in adults. Transarterial embolization and chemoembolization c","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101845"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TSH and its Correlation in the Development of Fibrosis in Patients with Hypothyroidism in a Tertiary Care Hospital","authors":"Aranzazu G. Pérez Castañeda ,&nbsp;Jose A. Velarde Ruiz Velasco ,&nbsp;José R. Barrientos Ávalos ,&nbsp;Juan M. Aldana Ledesma ,&nbsp;Edgar S. García Jiménez","doi":"10.1016/j.aohep.2025.101826","DOIUrl":"10.1016/j.aohep.2025.101826","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Fatty liver disease and hypothyroidism are two prevalent conditions in Mexico that pose significant public health challenges. The increase in their incidence over the past decades is due to changes in lifestyle, diet, and access to healthcare. Although hypothyroidism does not directly cause hepatic fibrosis, it is related to the body's metabolic function. Hypothyroidism can slow down metabolism and lead to lipid accumulation in the liver, a condition known as hepatic steatosis or fatty liver. This condition can progress to steatohepatitis and eventually to hepatic fibrosis, characterized by scar tissue formation. If left untreated, fibrosis can advance to liver cirrhosis with severe complications. Hypothyroidism and fatty liver disease share common risk factors such as obesity, type 2 diabetes, and metabolic disorders. Proper treatment of hypothyroidism and early identification of fatty liver are crucial to prevent progression to fibrosis. It is essential for individuals with hypothyroidism to monitor their liver health and adopt a healthy lifestyle to avoid liver complications. Currently, there are enough studies that validate the association between hypothyroidism and the development of fatty liver with varying degrees of hepatic fibrosis. To identify clinical-demographic characteristics in patients with hypothyroidism evaluated in the endocrinology service and to identify the presence of fibrosis through non-invasive evaluation.</div></div><div><h3>Materials and Patients</h3><div>Patients with hypothyroidism aged 18 to 80 years of both sexes evaluated by the Endocrinology service with a complete medical record, who do not have risk of alcohol consumption, hepatotropic virus infections, or use of drugs causing hepatotoxicity.</div></div><div><h3>Results</h3><div>A review of 85 patients with complete medical records was carried out, and a correlation analysis with numerical variables in the SPSS system found that TSH levels do not correlate with the development of hepatic fibrosis, with a Pearson's r = -0.074 (p = 0.519), which is not significant.</div></div><div><h3>Conclusions</h3><div>In this case series, we report that there is no direct correlation between TSH levels and the development of hepatic fibrosis. However, it is important to highlight that metabolic comorbidities favor the development of fatty liver and, consequently, the possibility of developing hepatic fibrosis. In this series of cases, four cases of advanced fibrosis were found, so it is important to emphasize requesting complete studies in patients with hypothyroidism and to complement with imaging studies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101826"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}