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Purpose: Clostridioides difficile infection (CDI) is one of the most common health care-associated infections in the United States. Studies revealed a higher mortality when CDI is associated with liver cirrhosis. We aim to present the outcomes of CDI among patients with and without liver cirrhosis and to analyze the association of Model for End-Stage Liver Disease (MELD) and Child-Pugh (CPT) scoring with the severity of CDI. Methods: A retrospective observational study was conducted in hospitalized patients with CDI diagnosed via a 2-step method - glutamate dehydrogenase (GDH) and toxin polymerase chain reaction (PCR). Patients with liver cirrhosis were identified based on ICD codes and chart review. MELD and CPT scores were calculated using laboratory parameters at the time of hospitalization. We compared CDI-related mortality in patients with and without cirrhosis and reviewed the CDI severity distribution in cirrhosis patients. Results: A total of 526 patients were included in the study, of which 478 (90.87%) were non-cirrhotic and 48 (9.13%) were cirrhotic patients. Mortality rate was higher in cirrhosis group compared to the non-cirrhosis group (39.6% vs. 14.6%,P = 0.001). Among cirrhosis patients, those who survived had lower MELD score compared to the expired group (14.9 vs. 18.58, P = 0.106). There was no correlation of mortality based on CPT score in the cirrhosis group (P = 0.062). In post hoc analysis comparing the severity of CDI to liver cirrhosis, cirrhosis patients are more likely to present with severe-complicated disease. Multivariate logistic regression identified liver cirrhosis, severe-complicated CDI and serum albumin level as independent predictors of mortality. Conclusion: Our study noted a more severe disease presentation and higher mortality in patients with cirrhosis admitted with CDI. Further studies are required for better understanding of the clinical course of CDI in cirrhosis and to evaluate the need for early intervention in this patient group.

Background: The liver is a hub of metabolism and detoxification of substances. Since many redox reactions take place in the liver, it is prone to oxidative damage. Unlike conventional agents, botanicals act through several mechanisms in preventing oxidative damage. Among these Phytolacca dodecandra is the most commonly used agent in Ethiopian folk medicine. Objective: To evaluate antioxidant and hepatoprotective activities of the 80% methanol extract of P. dodecandra root. Methods: Male mice were divided into six groups and treated accordingly. Negative control was given 2% Tween 80, toxicant control administered with carbon tetrachloride (CCl4), positive control treated with silymarin 100 mg/kg, and test groups were treated with 100, 200, and 400 mg/kg of the extract. Then, serum levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, albumin, total protein, and bilirubin were determined. Determination of the change in body weight and liver weight, histopathologic examination of the liver, and in vitro and in vivo antioxidant assays were also carried out. Results: The levels of ALP, ALT, AST, GGT, LDH, and bilirubin were significantly reduced, while albumin and total protein were significantly increased after treatment with P. dodecandra root extract at the doses of 200 and 400 mg/kg in CCl4 intoxicated mice. Cholesterol metabolism and lipoprotein synthesis capabilities of the liver of mice were also returned to normal in the two doses. Besides, the 200 and 400 mg/kg doses were able to return the normal architecture and morphology of hepatocytes. Furthermore, the plant extract was found to scavenge free radicals in vitro and inhibit lipid peroxidation in vivo. Conclusion: The results suggest that the 80% methanol extract of P. dodecandra root can be used for the management of liver disease.

Background: There are controversies on the causal role of H. pylori in duodenal ulceration. Helicobacter pylori are curved gram-negative microaerophilic bacteria found at the layer of gastric mucous or adherent to the epithelial lining of the stomach. It's a public health significance bacteria starting from discovery, and the prevalence and severity of the infection varies considerably among populations. H. pylori are a risk for various diseases, while the extent of host response like gastric inflammation and the amount of acid secretion by parietal cells affects the outcome of infection. Method: Relevant literature were searched from databases such as Google Scholar, PubMed, Hinari, Web of Science, Scopus, and Science Direct. Result: The review evidence supports a strong causal relation between H. pylori infection and duodenal ulcer, as patients are more likely to be infected by virulent strains which later cause duodenal ulceration. Thus, eradication of H. pylori infection decreases the incidence of duodenal ulcers, and prevents its recurrence by reducing both basal gastrin release and acid secretion without affecting parietal cell sensitivity. On the other hand, some studies show that H. pylori infection is not associated with the development of duodenal ulcers and such a lack of association revealed that duodenal ulceration has different pathogenesis. Conclusion: Despite controversies observed in the causal role of H. pylori to duodenal ulceration by various studies, Hill criteria of causation proved the presence of a causal relation between H. pylori infection and duodenal ulcers. Other factors are also responsible for the development of duodenal ulcers and such factors are responsible for the differences in the prevalence of the diseases.