Beta-adrenergic receptor antagonists (β-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective β-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt assess whether carvedilol can be used instead of propranolol in patients with cirrhosis. Carvedilol is a promising agent among the beta blockers of recent time that has shown significant effects in portal hypertension hemodynamics. It has also demonstrated an effective profile in its clinical application specifically for the prevention of variceal bleeding. Carvedilol has more potent desired physiological effects when compared to Propranolol. However, it is uncertain at the present juncture whether the improvement in hemodynamics also translates into a decreased rate of disease progression and complications when compared to propranolol. Currently Carvedilol shows promise as a therapy for portal hypertension but more clinical trials need to be carried out before we can consider it as a superior option and a replacement for propranolol. Core tip: Carvedilol is a promising agent among the beta blockers of recent time that has shown significant effects in portal hypertension hemodynamics. For primary prophylaxis of variceal bleeding, the effects of carvedilol were compared to band ligation in a few trials and showed some promise, but there has been no comparison with propranolol. Patients not responding to propranolol have shown clinical response to carvedilol, opening a new window of clinical application. For secondary prophylaxis of variceal bleeding, carvedilol has been shown to be effective. However no head-tohead trials comparing propranolol and carvedilol for variceal re-bleeding were found in literature.

Cerebral phaeohyphomycosis is a fungal brain infection with a high fatality rate. It is caused by dematiaceous fungi and is increasingly recognized as a cause of serious illness in both immunocompetent and immunocompromised patients. We report cerebral phaeohyphomycosis in a liver transplant recipient. He was treated with multiple surgeries and antifungals and made a complete recovery. This report highlights that early and aggressive surgical intervention and extended antifungal coverage can have a positive outcome even in immunocompromised patients. The fungal infection in immunocompromised patients should be considered and treated aggressively.

BackgroundCOVID-19 pandemic has globally affected healthcare including the transplantation programmes.Materials and methodsWe retrospectively studied the impact of COVID-19 on live liver donor (LLD) programme at liver transplant centre in Gambat, Pakistan. Standard operative procedures (SOPs) including COVID-19 nasopharyngeal swab PCR, CT scans, personal protective equipment use, 6-feet distancing were developed for LLD and transplant team to mitigate COVID-19 exposure. We compared the complications, healthcare utilisation (hospital stay, readmission) and mortality between two LLD cohorts—before and during COVID-19 pandemic from March 2019 to December 2020.ResultsDuring study period 300 LLD surgeries were performed. There was an increase in rate of LLDs from 132 (44%) in pre-COVID to 168 (56%) during COVID-19 era. Average numbers of transplants per month performed during pre-COVID and during COVID-19 era were 10.1 and 14, respectively. No donor has developed COVID-19 infection during hospitalisation. Rate of all LLD complications (32 (21.47%) and 49 (29.16%), p=0.43), uneventful discharges (120/168 (71.4%) and 88/132 (66.6%), p<0.05), mean hospital stay (6±2 days and 5±2 days, p=0.17) and readmission (5 (4%) and 3 (1.8%), p=0.43) were similar during the pre-COVID and COVID-19 era. No donor mortality was observed during study period.ConclusionWith the implementation of mindful SOPs, rate of LLD increased without any case of COVID-19 infection. Our SOPs were helpful in continuation of LLD programme in a developing country during COVID-19 pandemic.

Objective The study quantified the occurrence and intensity of hyponatremia in decompensated chronic liver disease patients Study design: Descriptive Cross sectional study Place and Duration: Department of Gastroenterology, Centre for Liver Diseases, Holy Family Hospital (CLD, HFH) for a total 6 months duration Methodology: Patients aged 13-75 years, both male and female presenting with Clinical, biochemical, and Ultrasonographic findings of cirrhosis were included in this study. Patients' ages, genders, levels of serum hyponatremia, rates of complications, Child-Pugh scores, and other contextual data were recorded in a standardized proforma. The tests were conducted in the hospital's lab, and a pathologist looked over the results. Results: Among 120 study cases, 72 (60 %) patients were male and 48 (40 %) were female patients. The mean age was 50.83 ± 10.50 years; ranging from 30 years to 70 years. Of these 120 study cases, 32 (26.7 %) were from rural areas while 88 (73.3 %) were from urban areas, 35 (29.2%) were poor, 69 (57.5%) were middle income and 16 (13.3%) were having rich socioeconomic status. Child-Pugh class B was noted in 77 (64.2 %) and Child-Pugh class C was noted in 43 (35.8%) of our study cases. The mean serum sodium level was 131.25 ± 4.34 mmol/L ranging from 118 mmol/L to 141 mmol/L and hyponatremia was noted in 64 (53.3%) of our study cases. Mild hyponatremia was noted in 12 (10%), moderate hyponatremia in 28 (23.3%) and severe hyponatremia in 24 (20%) of our study cases. Hepatic encephalopathy was noted in 16 (13.3%), spontaneous bacterial peritonitis in 36 (30%), variceal bleeding in 44 (36.7%) and Hepatorenal syndrome in 24 (20%). Conclusion: Our study found that people with liver cirrhosis were more likely to be hyponatremic than those without the condition. Hyponatremia was associated with being older age, having problems, and being labelled as a Child-Pugh class C. It was also revealed that the number of problems was strongly correlated with the degree to which the hyponatremia had progressed. Nurses, doctors, and anybody else providing care for cirrhotic patients should all keep a close check on their patients' sodium levels. Keywords: Hyponatremia, liver cirrhosis, Serum Sodium, Child-Pugh

BACKGROUND Since the beginning of corona virus disease 2019 (COVID-19) pandemic, there has been a widespread use of remdesivir in adults and children. There is little known information about its outcomes in patients with end stage renal disease who are on dialysis. AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis. METHODS A retrospective, multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1, 2020 and December 31, 2020. Primary endpoints were oxygen requirements, time to mortality and escalation of care needing mechanical ventilation. RESULTS A total of 45 patients were included in the study. Twenty patients received remdesivir, and 25 patients did not receive remdesivir. Most patients were caucasian, females with diabetes mellitus and hypertension being the commonest comorbidities. There was a trend towards reduced oxygen requirement (beta = -25.93, X 2 (1) = 6.65, P = 0.0099, probability of requiring mechanical ventilation (beta = -28.52, X 2 (1) = 22.98, P < 0.0001) and mortality (beta = -5.03, X 2 (1) = 7.41, P = 0.0065) in patients that received remdesivir compared to the control group. CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.