Review Article
Early Interventions Slow the Progression of Cirrhosis After Acute Variceal Bleeding
Matkuliev Utkirbek Ismoilovich,
Batirov Davronbek Yusupovich,
Umarov Zafarbek Zaripboyevich*
,
Raximov Anvar Polatbaevich,
Yakubov Yaxyo,
Fuzail Ahmad
Issue:
Volume 14, Issue 4, August 2026
Pages:
56-60
Received:
28 April 2026
Accepted:
7 May 2026
Published:
24 July 2026
Abstract: Background: Acute variceal bleeding (AVB) is a life-threatening manifestation of portal hypertension and an important precipitant of acute decompensation in cirrhosis. The present review evaluates whether early post-bleed interventions can reduce not only early mortality and rebleeding but also the subsequent downward spiral of cirrhosis progression. Methods: A narrative review was conducted using recent society guidance and high-level evidence published mainly between 2022 and 2026, including Baveno VII, AASLD guidance, APASL recommendations, EASL guidance on acute-on-chronic liver failure and TIPS, individual patient data meta-analyses, randomized trials and selected real-world studies. Institutional cohort observations from prior doctoral research were integrated to illustrate long-term clinical trajectories after first and recurrent bleeding. Results: Early standard care - restrictive transfusion, vasoactive therapy, antibiotic prophylaxis and timely endoscopic variceal ligation - acts beyond hemostasis by reducing infection, systemic inflammation, treatment failure and organ dysfunction. In high-risk AVB, pre-emptive TIPS within 24-72 hours is consistently associated with lower rebleeding and improved survival when patients are selected appropriately. Cohort data also indicate that patients with a previous bleeding episode have higher long-term rebleeding and functional deterioration, while stepwise endoscopic-endovascular escalation may reduce recurrent bleeding. Conclusions: Early interventions after AVB may slow cirrhosis progression by interrupting repeated bleeding, inflammation and decompensation cycles. Future studies should standardize progression endpoints, including MELD-Na change, ACLF occurrence, readmission, recurrent bleeding and transplant-free survival.
Abstract: Background: Acute variceal bleeding (AVB) is a life-threatening manifestation of portal hypertension and an important precipitant of acute decompensation in cirrhosis. The present review evaluates whether early post-bleed interventions can reduce not only early mortality and rebleeding but also the subsequent downward spiral of cirrhosis progressio...
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Research Article
Systematic Review and Meta-analysis of Neonatal Hyperbilirubinemia in Ethiopia
Issue:
Volume 14, Issue 4, August 2026
Pages:
61-71
Received:
18 June 2026
Accepted:
6 July 2026
Published:
6 August 2026
DOI:
10.11648/j.ajcem.20261404.12
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Abstract: Neonatal hyperbilirubinemia is a common neonatal disorder worldwide and represents an important contributor to newborn morbidity, especially in low- and middle-income countries such as Ethiopia. Although multiple primary studies have investigated this condition, nationally representative and updated pooled evidence regarding its magnitude and determinants in Ethiopia is still limited. Methods: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered in the PROSPERO database (registration number: CRD420251108378). A comprehensive search of electronic databases, including PubMed, Google Scholar, Cochrane Library, and Embase, was undertaken to identify eligible studies. Observational studies that reported the prevalence and/or determinants of neonatal hyperbilirubinemia among newborns in Ethiopia were included. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Meta-analysis was performed using a random-effects model to estimate the pooled prevalence of neonatal hyperbilirubinemia and the pooled effect estimates of associated factors. Statistical analyses were conducted using STATA version 14. The extent of heterogeneity among studies was evaluated using the I2 statistic, and potential publication bias was assessed through funnel plot inspection and Egger’s statistical test. Results: A total of nine studies involving 2,476 neonates were included in this systematic review and meta-analysis. The pooled prevalence of neonatal hyperbilirubinemia in Ethiopia was 27.77% (95% CI: 21.29-34.26%). The meta-analysis identified several factors significantly associated with neonatal hyperbilirubinemia, including male sex (AOR = 2.10; 95% CI: 1.37-2.83), neonatal sepsis (AOR = 3.01; 95% CI: 1.40-4.61), and prematurity (AOR = 2.24; 95% CI: 1.21-3.27). These findings indicate that male neonates and those with underlying clinical conditions, particularly sepsis and prematurity, had higher odds of developing neonatal hyperbilirubinemia. Conclusion: Evidence suggested that low pooled neonatal hyperbilirubinemia. The findings highlight a significant association between male neonates, neonatal sepsis, and prematurity with neonatal hyperbilirubinemia. Routine early screening and timely management of neonatal hyperbilirubinemia should be strengthened in Ethiopia. Health facilities need adequate phototherapy and laboratory services. Policymakers should prioritize neonatal care resources, and further high-quality community-based research should be conducted.
Abstract: Neonatal hyperbilirubinemia is a common neonatal disorder worldwide and represents an important contributor to newborn morbidity, especially in low- and middle-income countries such as Ethiopia. Although multiple primary studies have investigated this condition, nationally representative and updated pooled evidence regarding its magnitude and deter...
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Research Article
Clinical Audit on Documentation Completeness After Regional Nerve Block at Hawassa University Comprehensive Specialized Hospital
Issue:
Volume 14, Issue 4, August 2026
Pages:
72-81
Received:
1 June 2026
Accepted:
22 June 2026
Published:
11 August 2026
DOI:
10.11648/j.ajcem.20261404.13
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Abstract: Background: A regional nerve block is a type of anesthesia in which local anesthetic medications are injected near a nerve to prevent nerve impulse transmission. Recording what a professional does is one of the indicators of excellent practice. Documentation and recordkeeping assist professionals in reducing unethical behaviour, becoming aware of ethical issues at work, reducing patient complications, and improving service. The goal of this clinical audit is to assess the level of documentation after regional nerve block according to standards at Hawassa University Comprehensive Specialized Hospital. Methods: This clinical audit was conducted retrospectively on the completeness of documentation after regional nerve block for patients who received regional nerve block for analgesia and anesthesia purposes between April 20, 2023, and May 15, 2023, as part of quality improvement. For data collection, a checklist is created based on NYSORA, ASRA, and AAGBI guidelines. Result: Of the 67 record sheets, documentation of patient identity (sex, age, and name) (80.6%), availability of standard monitoring (n=45, 67.2%), name of nerve block (n=48, 71.6%), use of local anesthesia (n=41, 61.2%), and baseline vital signs (n=43, 64.2%) were recorded above 60%. However, the level of documentation of allergies and coagulation history, test dose, time-out performed before needle insertion, post-procedure instructions to the patient or parents, dose of epinephrine, events during the procedure, starting and ending time of the procedure, and adjuvants used were not recorded. Conclusion and recommendation: The practice of recording after peripheral nerve blocks at Hawassa University Comprehensive Specialized Hospital falls below the standard. This could be due to the lack of a separate sheet for peripheral nerve block and a lack of awareness. As a result, all anesthetists who will be involved in regional nerve blocks should receive training, and the standards should be re-audited to ensure compliance.
Abstract: Background: A regional nerve block is a type of anesthesia in which local anesthetic medications are injected near a nerve to prevent nerve impulse transmission. Recording what a professional does is one of the indicators of excellent practice. Documentation and recordkeeping assist professionals in reducing unethical behaviour, becoming aware of e...
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