Gastroenterology & Hepatology Letters

Background. According to multiple reports, the incidence of thromboembolic complications has increased in patients infected with coronavirus disease 2019 (COVID-19), particularly in the elderly patients with severe illness and comorbid diseases such as diabetes and hypertension. Portal vein thrombosis (PVT) is a silent and rare venous thromboembolic disease occurring typically in patients with an underlying chronic liver disease, such as decompensated cirrhosis with or without hepatocellular carcinoma (HCC). This study aims to evaluate the incidence of occurrence of acute PVT in cirrhotic patients infected with COVID-19.

Methods. This observational study involved 70 cirrhotic patients who were classified into Group A comprising 28 cirrhotic patients infected with COVID19, and Group B comprising 42 age- and sex-matched patients with liver cirrhosis as controls. All patients underwent a thorough medical history and examination. Routine investigations included complete blood count, liver, and renal function tests. Furthermore, imaging techniques such as abdominal and Doppler ultrasonography were used to determine the presence of acute PVT. Levels of serum ferritin, D-dimer, and C-reactive protein were determined, and COVID-19 RT-PCR was conducted for patients of Group A only.

Results. Doppler ultrasound examination revealed a significant difference in the number of patients affected by PVT between the two groups. Three patients of Group A (10.7 %) and only one patient of Group B (2.3%) had PVT (P < 0.05).

Hepatocellular carcinoma (HCC) is a common malignant tumor. Chemotherapy is one of its principal modes of treatment, but multidrug resistance (MDR) poses an obstacle in HCC treatment. MDR is mainly mediated through drug transmembrane transporter activity, apoptosis inhibitory pathway abnormality, and changes in the intracellular enzyme. On top of that, phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) pathway dysregulation is also one of the most common mechanisms of MDR. This signaling pathway plays critical roles in the differentiation, proliferation, and apoptosis of cancer cells, and is a new target of MDR treatment. This review article discusses the mechanisms of MDR in HCC with a strong emphasis on the significance and role of PI3K/Akt pathway in MDR, and the reversal of MDR by inhibiting PI3K/Akt pathway.

Cortical visual impairment (CVI) is an extremely rare manifestation of hepatic encephalopathy (HE), which refers to neuropsychiatric abnormalities as a result of impaired detoxification function of liver. A 16-month-old female Syrian refugee who developed jaundice 4 weeks before referral to our hospital was diagnosed with hepatitis A based on her clinical presentation at a local facility. Overtime, her jaundice worsened, her lower limbs became edematous, and the family noticed sleep disturbances and irritability. On admission to a local hospital, she was deeply jaundiced and irritable, but showed no stigmata of chronic liver dysfunction. During hospitalization, the patient lost the ability to track objects and eventually her sight. However, the results of fundoscopic and neurological examinations were normal, except for a fine tremor. Her laboratory workup showed elevated liver enzymes and ammonia, and a prolongation of prothrombin time. Brain imaging revealed an abnormal signal intensity which is suggestive of metabolic etiology. The patient was diagnosed with CVI secondary to HE and transferred to the pediatric intensive care unit. After a few days of HE management, ammonia levels dropped and vision recovered. In conclusion, CVI may indicate HE in children.