105 research outputs found
Editorial: can quantitative fibrosis assessment be used to enhance prediction of outcomes in patients with alcohol‐related liver disease?
No full text
The effect of increasing intestinal short‐chain fatty acid concentration on gut permeability and liver injury in the context of liver disease: A systematic review
No full textBACKGROUND AND AIM: The gut barrier protects the liver through tight junctions, which are disrupted in liver disease either from dysbiosis, inflammation, or the effects of ingested compounds such as alcohol. Strengthening of the gut barrier may ameliorate liver injury of varying etiologies. Short chain fatty acids (SCFAs) have been shown to improve gut barrier function. This systematic review aims to synthesize all studies that have trialed SCFA supplementation as a therapy for liver disease. METHODS: A systematic review assessing the impact of SCFA supplementation on liver injury and intestinal permeability was conducted. All forms of intervention that specifically increased intestinal SCFA concentration and measured both liver injury and permeability were eligible. Two independent reviewers assessed each study for outcomes, risk of bias, and quality using checklists relevant to the study's methodology. RESULTS: Seventeen studies were identified; two utilized a human model (15 murine). Fifty‐eight markers of liver injury were identified, with 26 different measures of permeability. Given the numerous designs, no meta‐analysis was possible. SCFA supplements included oral and enteral butyrate, probiotics, and prebiotics. Fourteen studies demonstrated improved permeability. All studies showed a significant amelioration of liver injury. CONCLUSIONS: Short chain fatty acid supplementation to reduce intestinal permeability represents a potential therapy in a variety of liver disease models. A large number of outcome measures were reported however not all are practical in human studies. Future work should evaluate methods to increase luminal SCFA concentrations and the effect of this on gut permeability and liver inflammation in people with liver disease
Alcohol’s Impact on the Gut and Liver
No full textAlcohol is inextricably linked with the digestive system. It is absorbed through the gut and metabolised by hepatocytes within the liver. Excessive alcohol use results in alterations to the gut microbiome and gut epithelial integrity. It contributes to important micronutrient deficiencies including short-chain fatty acids and trace elements that can influence immune function and lead to liver damage. In some people, long-term alcohol misuse results in liver disease progressing from fatty liver to cirrhosis and hepatocellular carcinoma, and results in over half of all deaths from chronic liver disease, over half a million globally per year. In this review, we will describe the effect of alcohol on the gut, the gut microbiome and liver function and structure, with a specific focus on micronutrients and areas for future research
Recurrent Chronic HEV in Severe Combined Immunodeficiency
No full textSevere combined immunodeficiency (SCID) is a group of genetic disorders characterized by significant impairment of T cell differentiation, with or without abnormal B and NK cell differentiation. Without hematopoietic stem cell transplant (HSCT), the condition usually leads to an early death, typically due to infections. The most frequent genetic cause of SCID affects the common gamma chain, necessary for cytokine signaling. A similar phenotype is observed with mutations in the Janus-associated kinase 3 (JAK3) gene, the immediate downstream signaling molecul
Early Clinical and Subclinical Visual Evoked Potential and Humphrey's Visual Field Defects in Cryptococcal Meningitis.
No full textCryptococcal induced visual loss is a devastating complication in survivors of cryptococcal meningitis (CM). Early detection is paramount in prevention and treatment. Subclinical optic nerve dysfunction in CM has not hitherto been investigated by electrophysiological means. We undertook a prospective study on 90 HIV sero-positive patients with culture confirmed CM. Seventy-four patients underwent visual evoked potential (VEP) testing and 47 patients underwent Humphrey's visual field (HVF) testing. Decreased best corrected visual acuity (BCVA) was detected in 46.5% of patients. VEP was abnormal in 51/74 (68.9%) right eyes and 50/74 (67.6%) left eyes. VEP P100 latency was the main abnormality with mean latency values of 118.9 (±16.5) ms and 119.8 (±15.7) ms for the right and left eyes respectively, mildly prolonged when compared to our laboratory references of 104 (±10) ms (p<0.001). Subclinical VEP abnormality was detected in 56.5% of normal eyes and constituted mostly latency abnormality. VEP amplitude was also significantly reduced in this cohort but minimally so in the visually unimpaired. HVF was abnormal in 36/47 (76.6%) right eyes and 32/45 (71.1%) left eyes. The predominant field defect was peripheral constriction with an enlarged blind spot suggesting the greater impact by raised intracranial pressure over that of optic neuritis. Whether this was due to papilloedema or a compartment syndrome is open to further investigation. Subclinical HVF abnormalities were minimal and therefore a poor screening test for early optic nerve dysfunction. However, early optic nerve dysfunction can be detected by testing of VEP P100 latency, which may precede the onset of visual loss in CM
Unraveling the Legal Knots around Inter-country Adoptions in De Gree v Webb
No full textWith reference to the case of De Gree v Webb 2007 SCA 87 (RSA) and developments in the field of international and South African child law, this contribution examines some challenges posed to the judiciary in particular with regard to inter-country adoptions and the application of the best interests of the child principle in this context. In traversing the area of inter-country adoption law against the background of provisions from related international treaties, the author alludes to some key aspects that may require attention in South Africa in years to come. Pending the promulgation of regulations in terms of the Children’s Act the author furthermore comments on the role that co-operative governance and implementation of the 2006 Guidelines for Inter-Country Adoption may play. 
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Unraveling the Legal Knots around Inter-country Adoptions in De Gree v Webb
No full textWith reference to the case of De Gree v Webb 2007 SCA 87 (RSA) and developments in the field of international and South African child law, this contribution examines some challenges posed to the judiciary in particular with regard to inter-country adoptions and the application of the best interests of the child principle in this context. In traversing the area of inter-country adoption law against the background of provisions from related international treaties, the author alludes to some key aspects that may require attention in South Africa in years to come. Pending the promulgation of regulations in terms of the Children’s Act the author furthermore comments on the role that co-operative governance and implementation of the 2006 Guidelines for Inter-Country Adoption may play.
 
Unravelling the legal knots around inter-country adoptions in de Gree v webb
No full textWith reference to the case of De Gree v Webb 2007 SCA 87 (RSA) and developments in the field of international and South African child law, this contribution examines some challenges posed to the judiciary in particular with regard to inter-country adoptions and the application of the best interests of the child principle in this context. In traversing the area of inter-country adoption law against the background of provisions from related international treaties, the author alludes to some key aspects that may require attention in South Africa in years to come. Pending the promulgation of regulations in terms of the Children’s Act the author furthermore comments on the role that co-operative governance and implementation of the 2006 Guidelines for Inter-Country Adoption may play
Ethnicity and the Mental Health Act 1983
No full textBackground Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess.
Aims To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates.
Method Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated.
Results In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence.
Conclusions Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported
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