Acute fatty liver of pregnancy:Over six months follow-up study of twenty-five patients

AIM:To evaluate the prognosis of patients with acute fatty liver of pregnancy(AFLP)6 mo or longer after discharge.METHODS:The records of pregnant patients diagnosed with AFLP at Beijing Ditan Hospital over a 16-year period were reviewed in November 2012.Patients weremonitored using abdominal ultrasound,liver and kidney functions,and routine blood examination.RESULTS:A total of 42 patients were diagnosed with AFLP during the study period,and 25 were followed.The mean follow-up duration was 54.5 mo(range:6.5-181 mo).All patients were in good physical condition,but one patient had gestational diabetes.The renal and liver functions normalized in all patients after recovery,including in those with pre-existing liver or kidney failure.The ultrasound findings were normal in12 patients,an increasingly coarsened echo-pattern and increased echogenicity of the liver in 10 patients,and mild to moderate fatty liver infiltration in 3 patients.Cirrhosis or liver nodules were not observed in any patient.CONCLUSION:Acute liver failure and acute renal failure in AFLP patients is reversible.Patients do not require any specific long-term follow-up after recovery from AFLP if their liver function tests have normalized and they remain well.

Extracorporeal membrane oxygenation in curing a young man after modified Fontan operation:A case report

BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics.After successful operation,patients typically recover the ability to engage in general physical activity.As a better ventilatory strategy,extracorporeal membrane oxygenation(ECMO) provides gas exchange via an extracorporeal circuit,and is increasingly being used to improve respiratory and circulatory function.After the modified Fontan operation,circulation is different from that of patients who are not subjected to the procedure.This paper describe a successful case using ECMO in curing influenza A infection in a young man,who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago.The special cardiac structure and circulatory characteristics are explored in this case.CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man,who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago.The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection.He was initially treated by veno-venous(VV) ECMO,which was switched to veno-venous-arterial ECMO(VVA ECMO) 5 d later.As circulation and respiratory function gradually improved,the VVA ECMO equipment was removed on May 1,2018.The patient was successfully withdrawn from artificial ventilation on May 28,2018 and then discharged from hospital on May 30,2018.CONCLUSION After the modified Fontan operation,circulation is different compared with that of patients who are not subjected to the procedure.There are certainly many differences between them when they receive the treatment of ECMO.Due to the special cardiac structure and circulatory characteristics,an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

Background: Recent studies reported that patients with coronavirus disease-2019(COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TBil) have been shown.Methods: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group(n=79) and severe group(n=26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.Results: 56.2%(59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4%(96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range(ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group(P<0.05). The percentage of the patients with elevated both ALT and AST was 12.7%(10/79) in mild cases vs. 46.2%(12/26) in severe cases(P=0.001). 34.6%(9/26) severe group patients started to have abnormal ALT after admission, and 73.3%(77/105) of all patients had normal ALT before discharge.Conclusions: Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3×ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.

Acute Onset Pancreatitis in the Third Trimester of Pregnancy in HBV Carrier Women Taking Telbivudine for Blocking Mother-to-Infant Transmission

Acute pancreatitis in pregnancy(APIP) is rare and the reasons for APIP are biliary disease and congenital or acquired hypertriglyceridemia, which could occur during any trimester but more than 50% cases happened during the third trimester. In this report, one case of a young pregnant woman, a HBV carrier in her 37 th week + 5 d of gestation, was admitted to Emergency Department due to acute abdominal pain, vomiting and diarrhea. The patient was in antiretroviral treatment with telbivudine from 28 weeks of gestation to prevent motherto-child transmission of HBV. Laboratory tests demonstrated hypertriglyceridemia, abdominal computed tomography scan revealed peripancreatic edema. Hyperlipidemic pancreatitits was primary diagnosed and the patient was admitted to the intensive care unit. Considering the possible role in the pathogenesis of pancreatitis, telbivudine was interrupted after birth giving. After supportive treatment, her condition gradually improved. Since it is the first description of APIP during treatment with telbivudine, the association between pregnancy, hyperlipidemia, telbivudine and acute pancreatitis has been well investigated.