Recurrent hepatic encephalopathy precipitated by urinary tract infection in patient with liver cirrhosis: a case report

Liver cirrhosis is a chronic liver injury marked by necro-inflammation and fibrogenesis. It is associated with several life-threatening complications. Hepatic encephalopathy remains to be one of the most debilitating complication of liver cirrhosis. The occurrence of hepatic encephalopathy may be directly related to endogenous worsening of liver function or occurs in the presence of specific precipitating factor. Infection such as urinary tract infection is a common precipitant of hepatic encephalopathy. We present a case of 66 year old female with recurrent hepatic encephalopathy in hepatitis B-related liver cirrhosis precipitated by urinary tract infection. Rapid and precise recognition of precipitating factor in hepatic encephalopathy is very substantial for implementation of preventive measures and optimal treatment plan in order to achieve better outcomes in liver cirrhosis patient.

Homogeneous batch micro-crystallization of proteins from ammonium sulfate

The emergence of X-ray free-electron lasers has led to the development of serial macromolecular crystallography techniques, making it possible to study smaller and more challenging crystal systems and to perform time-resolved studies on fast time scales. For most of these studies the desired crystal size is limited to a few micrometres, and the generation of large amounts of nanocrystals or microcrystals of defined size has become a bottleneck for the wider implementation of these techniques. Despite this, methods to reliably generate microcrystals and fine-tune their size have been poorly explored. Working with three different enzymes, L-aspartate α-decarboxylase, copper nitrite reductase and copper amine oxidase, the precipitating properties of ammonium sulfate were exploited to quickly transition from known vapour-diffusion conditions to reproducible, large-scale batch crystallization, circumventing the tedious determination of phase diagrams. Furthermore, the specific ammonium sulfate concentration was used to fine-tune the crystal size and size distribution. Ammonium sulfate is a common precipitant in protein crystallography, making these findings applicable to many crystallization systems to facilitate the production of large amounts of microcrystals for serial macromolecular crystallography experiments.

Acute kidney injury

Definition—for practical clinical purposes, acute kidney injury (AKI) is defined as a significant decline in renal excretory function occurring over hours or days, detected by either a fall in urinary output or a rise in the serum concentration of creatinine. Oliguria—defined (arbitrarily) as a urinary volume of less than 400 ml/day—is usually present, but not always. Clinical approach: diagnosis—all patients admitted to hospital with acute illness, but particularly older people and those with pre-existing chronic kidney disease, should be considered at risk of developing AKI. The most common precipitant is volume depletion. Serum creatinine and electrolytes should be measured on admission in all acutely ill patients, and repeated daily or on alternate days in those who remain so. Assessment—after treatment of life-threatening complications, the initial assessment of a patient who appears to have AKI must answer three questions: (1) is the kidney injury really acute? (2) Is urinary obstruction a possibility? And (3) is there a renal inflammatory cause? General aspects of management—the immediate management of a patient with renal impairment is directed towards three goals: (1) recognition and treatment of any life-threatening complications of AKI, (2) prompt diagnosis and treatment of hypovolaemia, and (3) specific treatment of the underlying condition—if this persists untreated then renal function will not improve. Specific causes of acute kidney injury—there are many possible causes of AKI, but in any given clinical context few of these are likely to require consideration. By far the most frequent are prerenal failure and acute tubular necrosis, which together account for 80 to 90% of cases of AKI seen by physicians.

Management of acute or chronic hepatic failure in the critically ill

Acute on chronic liver failure is characterized by an acute deterioration of liver function in a patient with previously compensated cirrhosis secondary to a precipitating event. It is most commonly associated with a very poor prognosis and early identification of the precipitating cause is essential to successfully attempt to reverse decompensation. The most common precipitant is infection and a high index of suspicion is required. Other management is largely supportive with close attention to renal dysfunction being particularly important. All patients admitted to the intensive care unit with complications of cirrhosis warrant consultation with a transplant centre to determine whether they fulfil the criteria for transplantation and for expert advice.

The Reasons for Suicide in Japan

A study of the reasons for suicide from 1978 to 1995 in Japan revealed strong trends over time and strong gender differences. For both men and women, suicides due to relationship problems became less common over the period; for men job stress became a more common precipitant, while for women psychiatric disorder became a more common precipitant. Years of high unemployment witnessed higher proportions of suicides due to economic hardship, lending support to the reliability and validity of these data.