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Article ; Online: Preparative Fasting Orders for Medical/Surgical Interventions and Imaging Studies: Time to Review and Revise!

McClave, Stephen A / Marsano-Obando, Luis S

2022 Volume 24, Issue 2, Page(s) 37–41

Abstract: Purpose of the review: Preparative fasting orders arose out of a purported need to enhance imaging studies, reduce interference of food with intended medical/surgical interventions, and protect the patient from vomiting and aspiration pneumonia. This ... ...

Abstract	Purpose of the review: Preparative fasting orders arose out of a purported need to enhance imaging studies, reduce interference of food with intended medical/surgical interventions, and protect the patient from vomiting and aspiration pneumonia. This review discusses the frequency, appropriateness, and efficacy of fasting orders in meeting those needs and whether their use should be modified in the future. Recent findings: Nil per os (NPO) orders are overused, as they are often inappropriate, typically excessive, and routinely create barriers which may increase risk for patients. Fasting orders are used more often for medical procedures than for surgical operations or imaging studies. One fourth of NPO orders are inappropriate, and the intended procedure or study is canceled 20% of the time usually for a change in plans or scheduling error and rarely because of patient eating. Nausea/vomiting associated with contrast media or imaging studies is rare, self-limited, and not linked to preparatory fluid or food ingestion. Prolonged fasting reduces patient cooperation and satisfaction, and may contribute to a higher rate of complications. Each institution should review and revise preparative fasting orders. Drinking of fluids should be allowed without restriction. Truncated periods of solid food restriction may be required due to technical reasons related to specific imaging studies, and for procedures or surgical operations which require sedation or general anesthesia. Inappropriate and prolonged fasting should be avoided, as they create barriers to adequate nutritional therapy and impose added risk with regard to patient outcomes.
MeSH term(s)	Contrast Media ; Fasting/adverse effects ; Humans ; Nausea ; Preoperative Care ; Tomography, X-Ray Computed ; Vomiting
Chemical Substances	Contrast Media
Language	English
Publishing date	2022-03-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2041376-2
ISSN	1534-312X ; 1522-8037
ISSN (online)	1534-312X
ISSN	1522-8037
DOI	10.1007/s11894-022-00841-w
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Article ; Online: Malnutrition and Alcohol-Associated Hepatitis.

McClain, Craig J / Rios, Cristian D / Condon, Sally / Marsano, Luis S

Clinics in liver disease

2021 Volume 25, Issue 3, Page(s) 557–570

Abstract: Malnutrition is common in alcohol-associated hepatitis (AH); almost all patients with severe AH have some component of malnutrition. The classic phenotype of malnutrition in AH is sarcopenia, but this has become more difficult to discern clinically as ... ...

Abstract	Malnutrition is common in alcohol-associated hepatitis (AH); almost all patients with severe AH have some component of malnutrition. The classic phenotype of malnutrition in AH is sarcopenia, but this has become more difficult to discern clinically as patients have become more obese. Patients with AH are often drinking 10 to 15 standard drinks per day. This substantial alcohol consumption becomes a major source of calories, but these are considered "empty" calories that contain little nutritional value. Malnutrition is associated with liver complications, such as hepatic encephalopathy, and worse liver outcomes. Nutrition support can improve nutrition status and reduce complications.
MeSH term(s)	Hepatic Encephalopathy ; Hepatitis, Alcoholic ; Humans ; Malnutrition/epidemiology ; Malnutrition/etiology ; Nutritional Status ; Nutritional Support
Language	English
Publishing date	2021-05-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	1472315-3
ISSN	1557-8224 ; 1089-3261
ISSN (online)	1557-8224
ISSN	1089-3261
DOI	10.1016/j.cld.2021.03.002
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Article ; Online: Association of Hypomagnesemia and Liver Injury, Role of Gut-Barrier Dysfunction and Inflammation: Efficacy of Abstinence, and 2-Week Medical Management in Alcohol Use Disorder Patients.

Winrich, Evan J / Gala, Khushboo S / Rajhans, Abhas / Rios-Perez, Christian D / Royer, Amor J / Zamani, Zarlakhta / Parthasarathy, Ranganathan / Marsano-Obando, Luis S / Barve, Ashutosh J / Schwandt, Melanie L / Vatsalya, Vatsalya

International journal of molecular sciences

2022 Volume 23, Issue 19

Abstract: 1) We investigated the involvement of serum magnesium level in early alcoholic liver disease (ALD), gut barrier dysfunction, and inflammation in alcohol use disorder (AUD) patients; and lastly, the efficacy of 2-week abstinence and medical management to ...

Abstract	(1) We investigated the involvement of serum magnesium level in early alcoholic liver disease (ALD), gut barrier dysfunction, and inflammation in alcohol use disorder (AUD) patients; and lastly, the efficacy of 2-week abstinence and medical management to alleviate hypomagnesemia. (2) Forty-eight heavy drinking AUD patients (34 males (M)/14 females (F)) participated in this study. Patients were grouped by serum alanine aminotransferase (ALT) level (a marker of liver injury) as group 1 (Group 1 (Gr.1); ALT ≤ 40 U/L, 7M/8F, without any indication of early-stage ALD) and group 2 (Group 2 (Gr.2); ALT > 40 U/L, 27M/6F or early-stage ALD). These patients were sub-divided within each group into patients with normal magnesium (0.85 and more mmol/L) and deficient magnesium (less than 0.85 mmol/L) levels. All participants were assessed at baseline (BL) and received standard medical management for 2 weeks with reassessment at the treatment end (2w). (3) Female participants of this study showed a significantly lower baseline level of magnesium than their male counterparts. Gr.2 patients showed a greater propensity in the necrotic type of liver cell death, who reported higher chronic and recent heavy drinking. Magnesium level improved to the normal range in Gr.2 post-treatment, especially in the hypomagnesemia sub-group (0.77 ± 0.06 mmol/L (BL) vs. 0.85 ± 0.05 mmol/L (2w), p = 0.02). In Gr.2, both apoptotic (K18M30) and necrotic (K18M65) responses were significantly and independently associated with inflammasome activity comprising of LBP (Lipopolysaccharide binding-protein) and TNFα (Tumor necrosis factor -α), along with serum magnesium. (4) In AUD patients with liver injury, 2-week medical management seems to improve magnesium to a normal level. This group exhibited inflammatory activity (LBP and TNFα) contributing to clinically significant hypomagnesemia. In this group, the level of magnesium, along with the unique inflammatory activity, seems to significantly predict apoptotic and necrotic types of hepatocyte death.
MeSH term(s)	Alanine Transaminase ; Alcoholism/complications ; Female ; Humans ; Inflammasomes ; Inflammation/complications ; Lipopolysaccharides ; Liver Diseases, Alcoholic/therapy ; Magnesium ; Male ; Tumor Necrosis Factor-alpha
Chemical Substances	Inflammasomes ; Lipopolysaccharides ; Tumor Necrosis Factor-alpha ; Alanine Transaminase (EC 2.6.1.2) ; Magnesium (I38ZP9992A)
Language	English
Publishing date	2022-09-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms231911332
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Article ; Online: Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System?

McClave, Stephen A / Gualdoni, Jill / Nagengast, Annie / Marsano, Luis S / Bandy, Kathryn / Martindale, Robert G

Current gastroenterology reports

2020 Volume 22, Issue 1, Page(s) 1

Abstract: Purpose of review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal ... ...

Abstract	Purpose of review: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. Recent findings: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.
MeSH term(s)	Clinical Protocols ; Critical Care/methods ; Critical Illness/therapy ; Enteral Nutrition ; Gastrointestinal Diseases/physiopathology ; Gastrointestinal Diseases/therapy ; Humans ; Prognosis ; Severity of Illness Index
Language	English
Publishing date	2020-01-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2041376-2
ISSN	1534-312X ; 1522-8037
ISSN (online)	1534-312X
ISSN	1522-8037
DOI	10.1007/s11894-019-0736-z
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Article: Hepatitis.

Marsano, Luis S

Primary care

2003 Volume 30, Issue 1, Page(s) 81–107

Abstract: Hepatitis is a common disorder with diverse etiology. Hepatitis can be classified as acute when duration is short and as chronic when it lasts more than 6 months. It can also be suspected to be chronic because of its cause. When evaluating a patient with ...

Abstract	Hepatitis is a common disorder with diverse etiology. Hepatitis can be classified as acute when duration is short and as chronic when it lasts more than 6 months. It can also be suspected to be chronic because of its cause. When evaluating a patient with hepatitis, investigation for viral etiologies is usually the first step, however it is important not to forget the other possibilities of drug- or chemical-related injury, as well as the multiple immune, metabolic and toxic causes of hepatitis. In this article, we have dedicated the larger part of our discussion to viral etiologies. There has been enormous progress over the past few years in the management of viral hepatitis, especially of viral hepatitis B and C. In this article, we discussed current therapeutic options in the management of these relatively common disorders and provided some recommendations in preventing transmission of these infections.
MeSH term(s)	Acute Disease ; Adult ; Antiviral Agents/therapeutic use ; Disease Transmission, Infectious/prevention & control ; Hepatitis Antibodies/immunology ; Hepatitis B/drug therapy ; Hepatitis B/virology ; Hepatitis C/drug therapy ; Hepatitis C/virology ; Hepatitis, Chronic/diagnosis ; Hepatitis, Chronic/drug therapy ; Hepatitis, Chronic/virology ; Hepatitis, Viral, Human/diagnosis ; Hepatitis, Viral, Human/drug therapy ; Hepatitis, Viral, Human/transmission ; Hepatitis, Viral, Human/virology ; Humans ; Medical History Taking ; Primary Health Care ; RNA, Viral/immunology ; Risk Factors ; United States
Chemical Substances	Antiviral Agents ; Hepatitis Antibodies ; RNA, Viral
Language	English
Publishing date	2003-06-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604005-6
ISSN	1558-299X ; 0095-4543
ISSN (online)	1558-299X
ISSN	0095-4543
DOI	10.1016/s0095-4543(02)00061-1
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Article ; Online: Gut-liver axis, nutrition, and non-alcoholic fatty liver disease.

Kirpich, Irina A / Marsano, Luis S / McClain, Craig J

Clinical biochemistry

2015 Volume 48, Issue 13-14, Page(s) 923–930

Abstract: Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of diseases involving hepatic fat accumulation, inflammation with the potential progression to fibrosis and cirrhosis over time. NAFLD is often associated with obesity, insulin resistance, ... ...

Abstract	Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of diseases involving hepatic fat accumulation, inflammation with the potential progression to fibrosis and cirrhosis over time. NAFLD is often associated with obesity, insulin resistance, and diabetes. The interactions between the liver and the gut, the so-called "gut-liver axis", play a critical role in NAFLD onset and progression. Compelling evidence links the gut microbiome, intestinal barrier integrity, and NAFLD. The dietary factors may alter the gut microbiota and intestinal barrier function, favoring the occurrence of metabolic endotoxemia and low grade inflammation, thereby contributing to the development of obesity and obesity-associated fatty liver disease. Therapeutic manipulations with prebiotics and probiotics to modulate the gut microbiota and maintain intestinal barrier integrity are potential agents for NAFLD management. This review summarizes the current knowledge regarding the complex interplay between the gut microbiota, intestinal barrier, and dietary factors in NAFLD pathogenesis. The concepts addressed in this review have important clinical implications, although more work needs to be done to understand how dietary factors affect the gut barrier and microbiota, and to comprehend how microbe-derived components may interfere with the host's metabolism contributing to NAFLD development.
MeSH term(s)	Gastrointestinal Microbiome ; Gastrointestinal Tract/microbiology ; Gastrointestinal Tract/pathology ; Humans ; Liver/pathology ; Non-alcoholic Fatty Liver Disease/microbiology ; Non-alcoholic Fatty Liver Disease/pathology ; Non-alcoholic Fatty Liver Disease/therapy ; Nutritional Physiological Phenomena ; Obesity/microbiology ; Obesity/therapy
Language	English
Publishing date	2015-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	390372-2
ISSN	1873-2933 ; 0009-9120
ISSN (online)	1873-2933
ISSN	0009-9120
DOI	10.1016/j.clinbiochem.2015.06.023
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Article: Acute Liver Failure from Herpes Simplex Virus in an Immunocompetent Patient Due to Direct Inoculation of the Peritoneum.

Chaudhary, Dhruv / Ahmed, Shifat / Liu, Nanlong / Marsano-Obando, Luis

ACG case reports journal

2017 Volume 4, Page(s) e23

Abstract: Herpes simplex virus (HSV) hepatitis is a rare cause of acute liver failure (ALF). It carries a mortality rate of 80% if untreated, thus early identification and treatment are critical. Without high clinical suspicion, HSV hepatitis is difficult to ... ...

Abstract	Herpes simplex virus (HSV) hepatitis is a rare cause of acute liver failure (ALF). It carries a mortality rate of 80% if untreated, thus early identification and treatment are critical. Without high clinical suspicion, HSV hepatitis is difficult to diagnose. A 48-year-old Hispanic female presented with a 4-day history of abdominal pain and a vaginal cuff tear requiring laparoscopic repair. She subsequently developed postsurgical disseminated HSV, resulting in ALF. Acyclovir was initiated, but she was resistant to treatment. She was given additional foscarnet and responded without requiring a liver transplant.
Language	English
Publishing date	2017-02-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2814825-3
ISSN	2326-3253
ISSN	2326-3253
DOI	10.14309/crj.2017.23
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Article: Alcoholic, Nonalcoholic, and Toxicant-Associated Steatohepatitis: Mechanistic Similarities and Differences.

Joshi-Barve, Swati / Kirpich, Irina / Cave, Matthew C / Marsano, Luis S / McClain, Craig J

Cellular and molecular gastroenterology and hepatology

2015 Volume 1, Issue 4, Page(s) 356–367

Abstract: Hepatic steatosis and steatohepatitis are common histologic findings that can be caused by multiple etiologies. The three most frequent causes for steatosis/steatohepatitis are alcohol (alcoholic steatohepatitis, ASH), obesity/metabolic syndrome ( ... ...

Abstract	Hepatic steatosis and steatohepatitis are common histologic findings that can be caused by multiple etiologies. The three most frequent causes for steatosis/steatohepatitis are alcohol (alcoholic steatohepatitis, ASH), obesity/metabolic syndrome (nonalcoholic steatohepatitis, NASH), and environmental toxicants (toxicant-associated steatohepatitis, TASH). Hepatic steatosis is an early occurrence in all three forms of liver disease, and they often share common pathways to disease progression/severity. Disease progression is a result of both direct effects on the liver as well as indirect alterations in other organs/tissues such as intestine, adipose tissue, and the immune system. Although the three liver diseases (ASH, NASH, and TASH) share many common pathogenic mechanisms, they also exhibit distinct differences. Both shared and divergent mechanisms can be potential therapeutic targets. This review provides an overview of selected important mechanistic similarities and differences in ASH, NASH, and TASH.
Language	English
Publishing date	2015-07
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2352-345X
ISSN	2352-345X
DOI	10.1016/j.jcmgh.2015.05.006
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Article ; Online: Alcoholic liver disease and malnutrition.

McClain, Craig J / Barve, Shirish S / Barve, Ashutosh / Marsano, Luis

Alcoholism, clinical and experimental research

2011 Volume 35, Issue 5, Page(s) 815–820

Abstract: Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients ... ...

Abstract	Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.
MeSH term(s)	Animals ; Energy Intake/physiology ; Humans ; Liver Diseases, Alcoholic/complications ; Liver Diseases, Alcoholic/metabolism ; Liver Diseases, Alcoholic/therapy ; Malnutrition/complications ; Malnutrition/metabolism ; Malnutrition/therapy ; Nutritional Status/physiology ; Nutritional Support/methods
Language	English
Publishing date	2011-02-01
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	428999-7
ISSN	1530-0277 ; 0145-6008
ISSN (online)	1530-0277
ISSN	0145-6008
DOI	10.1111/j.1530-0277.2010.01405.x
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Article: Deferasirox induced liver injury in haemochromatosis.

Aslam, Naeem / Mettu, Parveen / Marsano-Obando, Luis S / Martin, Anthony

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

2010 Volume 20, Issue 8, Page(s) 551–553

Abstract: Durg-induced liver injury is a common side-effect of many medicines. It is particularly problem when the original condition under treatment is already causing liver damage. This report describes the hepatotoxicity induced by Deferasirox in a patient with ...

Abstract	Durg-induced liver injury is a common side-effect of many medicines. It is particularly problem when the original condition under treatment is already causing liver damage. This report describes the hepatotoxicity induced by Deferasirox in a patient with haemochromatosis with a discussion of possible pathogenetic mechanism.
MeSH term(s)	Benzoates/adverse effects ; Benzoates/therapeutic use ; Chemical and Drug Induced Liver Injury/etiology ; Female ; Hemochromatosis/diagnosis ; Hemochromatosis/drug therapy ; Humans ; Iron Chelating Agents/adverse effects ; Iron Chelating Agents/therapeutic use ; Middle Aged ; Triazoles/adverse effects ; Triazoles/therapeutic use
Chemical Substances	Benzoates ; Iron Chelating Agents ; Triazoles ; deferasirox (V8G4MOF2V9)
Language	English
Publishing date	2010-08
Publishing country	Pakistan
Document type	Case Reports ; Journal Article
ZDB-ID	2276646-7
ISSN	1681-7168 ; 1022-386X
ISSN (online)	1681-7168
ISSN	1022-386X
DOI	04.2010/JCPSP.551553
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