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Dr. Salem Y Mohamed is an assistant professor of internal medicine, in the Gastroenterology and Hepatology unit at the University of Zagazig, Egypt. He received his M.B., B.C H and his M.D. from Zagazig University. He is a consultant physician at the teaching hospital of the same university. In addition to teaching, Dr. Salem is a regular reviewer for many scientific, medical journals, e.g., Journal of Gastroenterology and Hepatology from bed to bench, Journal of Gastroenterology and Hepatology research, The 2016 and 2017 Judging Process for The Undergraduate Awards: Undergraduate Awards. Patron: President Michael D. Higgins Dublin, Ireland, A reviewer at NIH, Southampton, England, World Journal of Surgical Oncology and Journal of Gastrointestinal Cancer
Acute on chronic liver failure (ACLF) is a distinct clinical syndrome characterized by liver failure due to an acute hepatic injury on an underlying chronic liver disease with high 28-day mortality. Acute insults include alcohol, hepatotropic viruses, and drugs whereas the underlying chronic liver disease is cirrhosis due to alcohol, hepatitis B or C, or NASH. After an acute insult, persistent inflammation, systemic inflammatory response syndrome and the cytokine storm have a central role in the pathogenesis of liver failure and subsequent organ failure.
Abstinence, antiviral therapy, and withdrawal of harmful drug are specific therapies that could help ameliorate or reverse the liver failure. Liver transplantation is the definitive treatment, and a good outcome is achieved with early transplantation in carefully selected patients; liver dialysis and plasmapheresis can help as ‘bridge therapies.' What about the magnitude of the problem in the Middle East and Africa? Is there any difference between the definitions of ACLF, risk factors, and presentations in different parts of the world?