Botros, Y., H. A. Hafez, R. Fouad, M. E. Negoly, I. W. Gamal Shiha, and G. E. Esmat, "The Effect of Eltrombopag (Promecta) on Thrombocytopenia in Egyptian Patients with Chronic Hepatitis C ", Gastroenterology and Hepatology Research, vol. 5, issue 3, 2016. Abstract

AIM: Chronic hepatitis C is the leading cause of chronic liver disease and cirrhosis in Egypt. Thrombocytopenia is one of its complications which may postpone or interfere with diagnostic and therapeutic procedures. One of the treatment options of thrombocytopenia is Eltrombopag, Eltrombopag is an orally bioavailability, low molecular weight non-peptide growth factor that is a selective c-Mpl agonist. We aimed to evaluate the ability of Eltrombopag to increase platelet counts in patients with HCV-related thrombocytopenia and to compare it with the use of haematinics.
METHODS: The study was conducted on 54 patients with HCV related chronic liver disease and thrombocytopenia (platelet count ˂75.000 /μL). All patients were subjected to complete history taking, clinical evaluation, laboratory investigations and abdominal ultrasonography. Patients were divided into three groups, group (I) twenty four patients received Eltrombopag, group (II) received vitamin B12 and folic acid and group (III) who did not receive any haematenics and considered as a control group

Safi, W., M. Elnegouly, R. Schellnegger, K. Umgelter, F. Geisler, W. Reindl, B. Saugel, A. Hapfelmeier, and A. Umgelter, "Infection and Predictors of Outcome of Cirrhotic Patients after Emergency Care Hospital Admission.", Annals of hepatology, vol. 17, issue 6, pp. 948-958, 2018. Abstract

INTRODUCTION AND AIMS: We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions.

MATERIAL AND METHODS: We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike's Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account.

RESULTS: 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26.0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure [Hazard Ratio (HR) = 0.15], albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3 vs. 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients.

CONCLUSION: Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.

M, A., E. M, H. A. MS, E. M, M. HM, and Y. A, "Transluminal retroperitoneal endoscopic necrosectomy with the use of hydrogen peroxide and without external irrigation: a novel approach for the treatment of walled-off pancreatic necrosis.", Surg Endosc, vol. 27, issue 10, pp. 3911-3920, 2013. Abstract

Transluminal retroperitoneal endoscopic necrosectomy (TREN) is an attractive NOTES technique alternative to surgery for treatment of walled-off pancreatic necrosis (WOPN). The main limitations to this technique are the need for repeated sessions, prolonged external irrigation, and EUS availability. In our study, we introduced new modifications, including the use of hydrogen peroxide, and abandoning the use of EUS and external irrigation.
METHODS:

This is a retrospective study of outcome of consecutive patients who underwent TREN for WOPN between April 2011 and August 2012. The technique included (1) non-EUS-guided transluminal drainage, and (2) direct endoscopic debridement using hydrogen peroxide and different accessories. No external irrigation was used.
RESULTS:

Ten patients were included. Initial clinical and technical success was achieved in all patients. Complete radiological success and long-term clinical efficacy was achieved in nine patients (1 patient had an inaccessible left paracolic gutter collection and died 62 days after endotherapy). Mean number of sessions was 1.4 (range 1-2). Complications included bleeding, which was self-limited in three patients and endoscopically controlled in one. All patients avoided surgery, and no recurrence was reported during median follow-up of 289 (range 133-429) days.
CONCLUSIONS:

TREN is a safe and effective treatment for WOPN and could be performed safely without EUS guidance in selected cases. Hydrogen peroxide played a major role in reduction of number of sessions and timing. External irrigation of WOPN is not necessary, if adequate debridement could be achieved.