No abstract

Although it is often functional at presentation, acute renal failure has a poor prognosis in patients with cirrhosis. The role of inflammation, a key event in the outcome of cirrhosis, has never been studied in this setting. We aimed to investigate the predictive factors of mortality in patients with cirrhosis and acute functional renal failure, specifically in relation to inflammatory events. One hundred consecutive patients with cirrhosis from 5 French hospitals were prospectively included at the day of onset of acute renal failure. Medical history, treatments, and procedures during the month before inclusion were recorded. Physical examination, blood and urinary chemistries, and renal ultrasound examination were performed. The presence of systemic inflammatory response syndrome (SIRS), infection, and sepsis was assessed. The primary outcome was in-hospital mortality. The mechanism of renal failure was functional in 83 patients. Causes of renal failure were hypovolemia (34%), hepatorenal syndrome without ongoing infection (17%), hepatorenal syndrome with ongoing infection (16%), nephrotoxicity (2%), and multifactorial (31%). SIRS was observed in 41% of patients, 56% of them with infection. In-hospital mortality was 68% in patients with SIRS and 33% in patients without (P ‫؍‬ 0.001). In multivariate analysis, only model for end-stage liver disease score and presence of SIRS, but not infection, remained associated with a poor outcome. Conclusion: The presence of SIRS, with or without infection, is a major independent prognostic factor in patients with cirrhosis and acute functional renal failure. This suggests that preventing and treating SIRS could decrease mortality in patients with cirrhosis and acute renal failure. (HEPATOLOGY 2007;46:1872-1882

Introduction: The Coronavirus disease-2019 (COVID-19) pandemic is a global health crisis and surgeons are at increased occupational risk of contracting COVID-19. The impact of the disease on prevalent general surgical practice is uncertain and continues to evolve. Aims/Objectives: To study the impact of COVID-19 on general surgical practice in India and the future implications of the pandemic. Methods: A survey questionnaire was designed and electronically circulated one month after India entered a national lockdown during covid-19 pandemic, among members of Indian Association of Gastro-intestinal Endosurgeons (IAGES), a surgical association with nearly eight thousand members. Survey questions pertaining to pre-COVID era surgical practices, impact on current practice and nancial implications were asked. Responses were collected and statistically analyzed. Results: 153 surgeons completed the survey, of which only 9.2% were females. 41% surgeons were more than 20 years into practice. 36.6% were into private practice at multiple hospitals (free-lancers). 41.8% had mainly laparoscopic practice with mean outpatient consultation of 26 patients/day and elective surgeries of 43 cases /month prior to lockdown. Post lock-down, daily outpatient consults reduced to 4 patients/day and 77% had not performed even a single elective procedure. 52% were taking hydroxychloroquine (HCQ) as chemoprophylaxis. 56.9% stated they are using personal protective equipment for all cases while 71.5% stated there are insu cient guidelines for future surgical practice in terms of safety. 52% surgeons stated a drop of more than 75% of their monthly income while 22% faced 50-75% reduction. 33% of respondents own a hospital and are expecting a monthly nancial liability of 2.25 Million rupees (nearly 30,000 US dollars). Conclusion: COVID 19 has led to a drastic reduction in outpatient and elective surgical practices. There is a de nite need for guidelines regarding safety for future surgical practices and solutions to overcome the nancial liabilities in the near future.

Background:The direct comparison of CA19.9, circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has never been performed for the diagnosis of solid pancreatic tumours (SPTs).Methods:We included 68 patients with a SPT referred for EUS-FNA. CTCs were analysed using size-based platform and ctDNA using digital PCR. The sensitivity, specificity, negative and positive predictive values were evaluated for each marker and their combination.Results:SPTs corresponded to 58 malignant tumours (52 pancreatic adenocarcinoma (PA) and 6 others) and 10 benign lesions. The sensitivity and specificity for PA diagnosis were 73% and 88% for EUS-FNA, 67% and 80% for CTC, 65% and 75% for ctDNA and 79% and 93% for CA19.9, respectively. The positivity of at least 2 markers was associated with a sensitivity and specificity of 78% and 91%, respectively. CtDNA was the only marker associated with overall survival (median 5.2 months for ctDNA+ vs 11.0 months for ctDNA−, P=0.01).Conclusions:CA19.9 alone and in combination with ctDNA and/or CTC analysis may represent an efficient method for diagnosing PA in patients with SPTs. Further studies including a larger cohort of patients with both malignant and benign lesions will be necessary to confirm these promising results.