V. Bertuzzo, M. Renzulli, A. Clemente, A. Cucchetti, L. Maroni, G. Frascaroli, S. Pellegrini, E. Dajti, Daniele Spinelli, Giuliano Peta, Anna Maria Ierardi, G. Carrafiello, L. Strigari, A. Colecchia, R. Golfieri, A. Pinna, M. Ravaioli, M. Cescon
Background: Sarcopenia, defined as low muscle mass with reduced function, is frequently encountered in cirrhotic patients and is a major predictor of adverse events, including post-liver transplant (LT) outcome. Objectives: This study assessed the impact of sarcopenia using computed tomography (CT)-based measurements on post-LT mortality and complications. Methods: From January 2008 to June 2016, 646 adult patients underwent 613 LTs at our institution. We analyzed the postoperative outcome of 287 patients who had pathologically proven cirrhosis on the explanted liver and who had performed a CT examination three months before LT. Psoas muscle density (PMD) was detected for every patient using standard instruments present in the radiological workstation and was related to postoperative survival rates and complications. Statistical analysis was carried out using the appropriate tests. Results: Postoperative mortality was 6.3%. At least one grade III-IV postoperative complication was experienced by 121 patients. Respiratory and infective complications occurred in 30 and 32 patients, respectively. Also, PMD was an independent predictor of postoperative mortality (P = 0.021), respiratory complications (P = 0.015), and infections (P = 0.010). The ROC analysis identified a PMD ≤ 43.72 HU as the best cutoff value for predicting 90-day mortality after LT. Conclusions: Psoas muscle density accurately predicted post-LT mortality and complications. Its ease and low-cost determination can allow widespread use of this parameter to improve clinical care and help with the decision to give these patients some priority on the transplant waiting list.
{"title":"Pre-transplant Psoas Muscle Density as a Ready-to-Use and Low-cost Predictor of Patient Survival After Liver Transplant","authors":"V. Bertuzzo, M. Renzulli, A. Clemente, A. Cucchetti, L. Maroni, G. Frascaroli, S. Pellegrini, E. Dajti, Daniele Spinelli, Giuliano Peta, Anna Maria Ierardi, G. Carrafiello, L. Strigari, A. Colecchia, R. Golfieri, A. Pinna, M. Ravaioli, M. Cescon","doi":"10.5812/HEPATMON.99690","DOIUrl":"https://doi.org/10.5812/HEPATMON.99690","url":null,"abstract":"Background: Sarcopenia, defined as low muscle mass with reduced function, is frequently encountered in cirrhotic patients and is a major predictor of adverse events, including post-liver transplant (LT) outcome. Objectives: This study assessed the impact of sarcopenia using computed tomography (CT)-based measurements on post-LT mortality and complications. Methods: From January 2008 to June 2016, 646 adult patients underwent 613 LTs at our institution. We analyzed the postoperative outcome of 287 patients who had pathologically proven cirrhosis on the explanted liver and who had performed a CT examination three months before LT. Psoas muscle density (PMD) was detected for every patient using standard instruments present in the radiological workstation and was related to postoperative survival rates and complications. Statistical analysis was carried out using the appropriate tests. Results: Postoperative mortality was 6.3%. At least one grade III-IV postoperative complication was experienced by 121 patients. Respiratory and infective complications occurred in 30 and 32 patients, respectively. Also, PMD was an independent predictor of postoperative mortality (P = 0.021), respiratory complications (P = 0.015), and infections (P = 0.010). The ROC analysis identified a PMD ≤ 43.72 HU as the best cutoff value for predicting 90-day mortality after LT. Conclusions: Psoas muscle density accurately predicted post-LT mortality and complications. Its ease and low-cost determination can allow widespread use of this parameter to improve clinical care and help with the decision to give these patients some priority on the transplant waiting list.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41440074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ghazaleh Shaker, Farid Azmoudeh-Ardalan, A. Jafarian, M. Safaei, N. Ayoobi Yazdi
Introduction: Hepatic epithelioid hemangioendothelioma (HEHE) is a discrete vascular tumor with an unpredictable natural course. This rare tumor is commonly found incidentally and not too often is mistaken radiologically and histologically for another tumor. No single treatment strategy has yet been established for it, partly due to its variable clinical course, ranging from an indolent tumor with prolonged survival to an aggressive, fatal disease. Case Presentation: Among 1,029 liver transplantation cases performed at our hospital between January 2001 and November 2019, three were done for HEHE. In this study, we present these three cases and review their clinical and histopathologic characteristics. Conclusions: Epithelioid hemangioendothelioma (EHE) of the liver is a low-grade malignant tumor with different presentations, treatment strategies, and outcomes. The histopathologic characteristics of HEHE can hide its vascular nature, thus leading to its confusion with other lesions. This tumor is unique in that its clinical and histopathologic features do not always correlate with its biologic behavior. There are not reliable criteria in predicting the clinical outcome of HEHE, which needs further research.
{"title":"Hepatic Epithelioid Hemangioendothelioma: A Review of Three Liver Transplant Recipients","authors":"Ghazaleh Shaker, Farid Azmoudeh-Ardalan, A. Jafarian, M. Safaei, N. Ayoobi Yazdi","doi":"10.5812/HEPATMON.114580","DOIUrl":"https://doi.org/10.5812/HEPATMON.114580","url":null,"abstract":"Introduction: Hepatic epithelioid hemangioendothelioma (HEHE) is a discrete vascular tumor with an unpredictable natural course. This rare tumor is commonly found incidentally and not too often is mistaken radiologically and histologically for another tumor. No single treatment strategy has yet been established for it, partly due to its variable clinical course, ranging from an indolent tumor with prolonged survival to an aggressive, fatal disease. Case Presentation: Among 1,029 liver transplantation cases performed at our hospital between January 2001 and November 2019, three were done for HEHE. In this study, we present these three cases and review their clinical and histopathologic characteristics. Conclusions: Epithelioid hemangioendothelioma (EHE) of the liver is a low-grade malignant tumor with different presentations, treatment strategies, and outcomes. The histopathologic characteristics of HEHE can hide its vascular nature, thus leading to its confusion with other lesions. This tumor is unique in that its clinical and histopathologic features do not always correlate with its biologic behavior. There are not reliable criteria in predicting the clinical outcome of HEHE, which needs further research.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44726885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: An association has been reported between hepatitis and glycogen storage problems. Glycogen storage disease (GSD) type I is induced by G6PD deficiency. Silymarin and baicalein, as herbal agents, have hepatoprotective and antioxidant potentials. Objectives: In this study, we assessed the effects of these herbs on liver glycogen storage problems and hepatitis. Methods: Twenty male rats kept under standard laboratory conditions were divided into four groups, including healthy (control) and hepatotoxicity treated with silymarin, baicalein, or none. The levels of ALT, AST, ALP, LDL, HDL, VLDL, TG, Cho, IL-1β, IL-6, and TNF-α were measured, and the expression levels of G6PD, CTGF, HMGB1, and P53 were determined. Also, liver histopathology was examined. Results: Treatment with silymarin and baicalein reduced the serum levels of ALT, AST, ALP, LDL, VLDL, TG, Cho, IL-1β, IL-6, and TNF-α. Silymarin increased G6PD gene expression, and both silymarin and baicalein reduced CTGF, P53, and HMGB1 gene expressions, but silymarin and baicalein had no effects on glycogen storage of hepatocytes. Conclusions: Baicalein and silymarin showed anti-inflammatory effects and could control inflammation and necrotic factors, but they did not affect hepatic glycogen storage.
{"title":"Effects of Silymarin and Baicalein on Glycogen Storage in the Hepatocytes of Rat Models of Hepatic Injury","authors":"Hongfei Yang, Didar Mehrabi Nasab, S. Athari","doi":"10.5812/HEPATMON.113114","DOIUrl":"https://doi.org/10.5812/HEPATMON.113114","url":null,"abstract":"Background: An association has been reported between hepatitis and glycogen storage problems. Glycogen storage disease (GSD) type I is induced by G6PD deficiency. Silymarin and baicalein, as herbal agents, have hepatoprotective and antioxidant potentials. Objectives: In this study, we assessed the effects of these herbs on liver glycogen storage problems and hepatitis. Methods: Twenty male rats kept under standard laboratory conditions were divided into four groups, including healthy (control) and hepatotoxicity treated with silymarin, baicalein, or none. The levels of ALT, AST, ALP, LDL, HDL, VLDL, TG, Cho, IL-1β, IL-6, and TNF-α were measured, and the expression levels of G6PD, CTGF, HMGB1, and P53 were determined. Also, liver histopathology was examined. Results: Treatment with silymarin and baicalein reduced the serum levels of ALT, AST, ALP, LDL, VLDL, TG, Cho, IL-1β, IL-6, and TNF-α. Silymarin increased G6PD gene expression, and both silymarin and baicalein reduced CTGF, P53, and HMGB1 gene expressions, but silymarin and baicalein had no effects on glycogen storage of hepatocytes. Conclusions: Baicalein and silymarin showed anti-inflammatory effects and could control inflammation and necrotic factors, but they did not affect hepatic glycogen storage.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41543580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamran B. Lankarani, B. Honarvar, Mohammad Hassan Zahedroozegar, A. Dehghan, M. R. Rouhezamin, Mojdeh Khorrami, Saeid Amiri zadeh fard, Vahid Seifi, B. Geramizadeh, H. Salahi, S. Nikeghbalian, A. Shamsaeefar, S. A. Malek-Hosseini
Background: Becoming infected with hepatitis A virus (HAV) is deadlier in patients with end-stage liver disease. Objectives: This study aimed to determine the seroprevalence of chronic immunity to HAV in liver transplant (LT) candidates to determine whether HAV vaccination is necessary for them or not. Methods: This cross-sectional study was conducted on adult LT candidates who were referred to the LT center of Shiraz, Iran. The patients were interviewed for filling the data collection forms. These forms consisted of demographic information, medical backgrounds, etiology of chronic liver disease, a model for end-stage liver disease (MELD) score, laboratory findings, and abdominal sonography report. Furthermore, a 3-cc blood sample was obtained from each patient, and anti-HAV IgG was detected by Enzyme-linked Immunosorbent assay (ELISA) using standard Diapro kits. Univariable and multivariable data analyses were performed using SPSS version 20. A P-value of less than 0.05 was considered the significant cutoff in regression analysis. Results: A total of 291 patients with a mean age of 47.73 ± 12.9 years were recruited in this study of whom, 197 (67.7%) patients were males, 237 (81.4%) were married, 229 (78.7%) were educated lower than 12 years, 250 (85.9%) were living in urban areas, and (221) 75.9% had access to sanitary water in their living area. anti-HAV IgG was detected in 269 (92.4%, 95% CI: 89.4 - 95.4%) patients. Multivariable analysis showed that lower knowledge of hepatitis A transmission routes (OR: 11.9, 95% CI: 1.39 - 101.8, P = 0.024), no waterpipe smoking (OR: 9.5, 95% CI: 1.6 - 55.5, P = 0.014), and older age (OR: 1.12, 95% CI: 1 - 1.24, P = 0.03) were the main predictors of HAV immunity, in sequence. Conclusions: Most LT candidates are HAV IgG positive, but due to the growing number of LT candidates and high mortality of HAV in non-immune cases, LT candidates should be checked for HAV IgG, especially younger or waterpipe smoking patients who are less immune. Also, all non-immune patients should be vaccinated against HAV, if possible.
{"title":"Immunoglobulin G Immunity to Hepatitis A Virus in Liver Transplant Candidates: A Serosurvey from Iran","authors":"Kamran B. Lankarani, B. Honarvar, Mohammad Hassan Zahedroozegar, A. Dehghan, M. R. Rouhezamin, Mojdeh Khorrami, Saeid Amiri zadeh fard, Vahid Seifi, B. Geramizadeh, H. Salahi, S. Nikeghbalian, A. Shamsaeefar, S. A. Malek-Hosseini","doi":"10.5812/HEPATMON.113001","DOIUrl":"https://doi.org/10.5812/HEPATMON.113001","url":null,"abstract":"Background: Becoming infected with hepatitis A virus (HAV) is deadlier in patients with end-stage liver disease. Objectives: This study aimed to determine the seroprevalence of chronic immunity to HAV in liver transplant (LT) candidates to determine whether HAV vaccination is necessary for them or not. Methods: This cross-sectional study was conducted on adult LT candidates who were referred to the LT center of Shiraz, Iran. The patients were interviewed for filling the data collection forms. These forms consisted of demographic information, medical backgrounds, etiology of chronic liver disease, a model for end-stage liver disease (MELD) score, laboratory findings, and abdominal sonography report. Furthermore, a 3-cc blood sample was obtained from each patient, and anti-HAV IgG was detected by Enzyme-linked Immunosorbent assay (ELISA) using standard Diapro kits. Univariable and multivariable data analyses were performed using SPSS version 20. A P-value of less than 0.05 was considered the significant cutoff in regression analysis. Results: A total of 291 patients with a mean age of 47.73 ± 12.9 years were recruited in this study of whom, 197 (67.7%) patients were males, 237 (81.4%) were married, 229 (78.7%) were educated lower than 12 years, 250 (85.9%) were living in urban areas, and (221) 75.9% had access to sanitary water in their living area. anti-HAV IgG was detected in 269 (92.4%, 95% CI: 89.4 - 95.4%) patients. Multivariable analysis showed that lower knowledge of hepatitis A transmission routes (OR: 11.9, 95% CI: 1.39 - 101.8, P = 0.024), no waterpipe smoking (OR: 9.5, 95% CI: 1.6 - 55.5, P = 0.014), and older age (OR: 1.12, 95% CI: 1 - 1.24, P = 0.03) were the main predictors of HAV immunity, in sequence. Conclusions: Most LT candidates are HAV IgG positive, but due to the growing number of LT candidates and high mortality of HAV in non-immune cases, LT candidates should be checked for HAV IgG, especially younger or waterpipe smoking patients who are less immune. Also, all non-immune patients should be vaccinated against HAV, if possible.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46398260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Chan, M. Hassali, Rosaida Md Said, H. Omar, Noor Aliza Mutalib, Frederick Walter De Rozario, M. Hassan
Background: Malaysia has been fully committed to the global endeavor to eliminate hepatitis C virus (HCV) infection by 2030. In early 2018, the Ministry of Health (MOH) embarked on a “one-size-fits-all strategy” by introducing generic versions of sofosbuvir and daclatasvir as the standard treatment for HCV infection in public hospitals nationwide. Objectives: To evaluate the outcomes of such an initiative in multiple aspects, including the number and characteristics of patients treated, the extent of evidence-based drug use, the treatment completion status, individual responses to treatment, common side effects of treatment, and its economic implications. Methods: The findings were generated from the data compiled by the MOH, capturing the information regarding the treatment provided to adult HCV-infected patients in 16 selected hospitals between April 2018 and March 2020, along with the drug costs incurred. Results: A total of 1,797 patients were treated, nearly four times more than the patients receiving interferon-based treatment across the country in the preceding two years. Approximately one-third of them had liver cirrhosis, and the main HCV genotypes were 3 (46.9%) and 1a (20.0%). Dosing, treatment duration and the addition of ribavirin to the treatment generally agreed with the recommendations of the MOH. More than 90% of the patients completed the treatment course, and a sustained virologic response (SVR) rate of 95.4% (95% CI: 94.2, 96.7%) was recorded in those with a known treatment outcome (n = 1,163). The SVR achievement did not vary across HCV genotypes and cirrhosis status, but those ≥ 50 years of age (adjusted OR: 2.13; 95% CI: 1.16, 3.92) were more likely to fail the treatment. Side effects were rare. Anemia and fatigue caused treatment discontinuation in only 0.3% of the patients. The total drug expenditure reached US$678,258.20, and the mean cost of a 12-week treatment course of sofosbuvir and daclatasvir (US$235.16) was lower than the cost expected by the MOH (US$300). Conclusions: The findings demonstrate a high degree of real-world effectiveness, safety, and affordability of the standard treatment, suggesting that such a government-led initiative was reasonable and timely and could be extended to include more public health institutions.
{"title":"A Two-Year Outcome Evaluation of Government-Led Initiative to Upscale Hospital-based Hepatitis C Treatment Using a Standard Two-Drug Regimen in Malaysia","authors":"H. Chan, M. Hassali, Rosaida Md Said, H. Omar, Noor Aliza Mutalib, Frederick Walter De Rozario, M. Hassan","doi":"10.5812/HEPATMON.113226","DOIUrl":"https://doi.org/10.5812/HEPATMON.113226","url":null,"abstract":"Background: Malaysia has been fully committed to the global endeavor to eliminate hepatitis C virus (HCV) infection by 2030. In early 2018, the Ministry of Health (MOH) embarked on a “one-size-fits-all strategy” by introducing generic versions of sofosbuvir and daclatasvir as the standard treatment for HCV infection in public hospitals nationwide. Objectives: To evaluate the outcomes of such an initiative in multiple aspects, including the number and characteristics of patients treated, the extent of evidence-based drug use, the treatment completion status, individual responses to treatment, common side effects of treatment, and its economic implications. Methods: The findings were generated from the data compiled by the MOH, capturing the information regarding the treatment provided to adult HCV-infected patients in 16 selected hospitals between April 2018 and March 2020, along with the drug costs incurred. Results: A total of 1,797 patients were treated, nearly four times more than the patients receiving interferon-based treatment across the country in the preceding two years. Approximately one-third of them had liver cirrhosis, and the main HCV genotypes were 3 (46.9%) and 1a (20.0%). Dosing, treatment duration and the addition of ribavirin to the treatment generally agreed with the recommendations of the MOH. More than 90% of the patients completed the treatment course, and a sustained virologic response (SVR) rate of 95.4% (95% CI: 94.2, 96.7%) was recorded in those with a known treatment outcome (n = 1,163). The SVR achievement did not vary across HCV genotypes and cirrhosis status, but those ≥ 50 years of age (adjusted OR: 2.13; 95% CI: 1.16, 3.92) were more likely to fail the treatment. Side effects were rare. Anemia and fatigue caused treatment discontinuation in only 0.3% of the patients. The total drug expenditure reached US$678,258.20, and the mean cost of a 12-week treatment course of sofosbuvir and daclatasvir (US$235.16) was lower than the cost expected by the MOH (US$300). Conclusions: The findings demonstrate a high degree of real-world effectiveness, safety, and affordability of the standard treatment, suggesting that such a government-led initiative was reasonable and timely and could be extended to include more public health institutions.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48357524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Dehnavi, H. Barghchi, F. Roudi, Mahmoud Belghaisi Naseri, Andisheh Nourozian Ostad, Zahra Khorasanchi, M. Nematy, F. Razmpour
Background: Nonalcoholic fatty liver disease (NAFLD) is a health problem growing in line with the rising prevalence of obesity in children and adolescents, which may be correlated with different metabolic abnormalities such as osteoporosis. Objectives: This study aimed to evaluate the possible relationship between NAFLD with body composition and bone mineral density (BMD) in obese and overweight adolescents. Methods: This cross-sectional study encompassed 70 adolescents aged 11 - 18 years and was conducted during March 2016 and September 2016 in Mashhad, Iran. Anthropometric parameters and blood biomarkers were measured. Fat mass, fat-free mass, and BMD were determined using dual-energy X‐ray absorptiometry (DXA) scans, and NAFLD was also assessed using Fibroscan. All statistical data were analyzed using SPSS software version 21. Multivariate linear regression assessed the relationship between liver fat content with bone-related indicators, and multivariate logistic regression detected the relationship between body composition and NAFLD. Results: Total and trunk fat mass were significantly correlated with higher NAFLD even after controlling for intervening factors (total fat mass, OR = 1.27; 95% CI, 1.016 to 1.59, P = 0.036; trunk fat mass, OR = 1.35; 95% CI, 0.97 to 1.88, P = 0.045). Moreover, liver fat content was significantly correlated with lower BMD Z-score after adjusting for gender, BMI Z-score, ALT, fat mass index, total lean mass, and physical activity (β = -0.285, P = 0.048). Conclusions: The findings of the present study suggest that excess adipose tissue is correlated with higher NAFLD. Moreover, liver steatosis may be correlated with decreased BMD Z-score in overweight/obese adolescents.
背景:非酒精性脂肪性肝病(NAFLD)是一种随着儿童和青少年肥胖患病率的上升而日益严重的健康问题，可能与不同的代谢异常(如骨质疏松症)有关。目的:本研究旨在评估肥胖和超重青少年NAFLD与体成分和骨密度(BMD)之间的可能关系。方法:这项横断面研究包括70名11 - 18岁的青少年，于2016年3月至2016年9月在伊朗马什哈德进行。测量人体测量参数和血液生物标志物。使用双能X线吸收仪(DXA)扫描确定脂肪量、无脂肪量和骨密度，并使用纤维扫描评估NAFLD。所有统计数据均采用SPSS软件21版进行分析。多元线性回归评估肝脏脂肪含量与骨相关指标的关系，多元logistic回归检测体成分与NAFLD的关系。结果:即使在控制了干预因素后，总脂肪量和躯干脂肪量与NAFLD升高也有显著相关(总脂肪量，OR = 1.27;95% CI, 1.016 ~ 1.59, P = 0.036;躯干脂肪量，OR = 1.35;95% CI, 0.97 ~ 1.88, P = 0.045)。此外，在调整性别、BMI z -评分、ALT、脂肪质量指数、总瘦质量和体力活动后，肝脏脂肪含量与较低的BMD z -评分显著相关(β = -0.285, P = 0.048)。结论:本研究结果表明，脂肪组织过多与NAFLD升高有关。此外，肝脏脂肪变性可能与超重/肥胖青少年的BMD z评分降低有关。
{"title":"On the Relationship Between Non-alcoholic Fatty Liver Disease with Body Composition and Bone Mineral Density in Overweight/Obese Adolescents","authors":"Z. Dehnavi, H. Barghchi, F. Roudi, Mahmoud Belghaisi Naseri, Andisheh Nourozian Ostad, Zahra Khorasanchi, M. Nematy, F. Razmpour","doi":"10.5812/HEPATMON.112184","DOIUrl":"https://doi.org/10.5812/HEPATMON.112184","url":null,"abstract":"Background: Nonalcoholic fatty liver disease (NAFLD) is a health problem growing in line with the rising prevalence of obesity in children and adolescents, which may be correlated with different metabolic abnormalities such as osteoporosis. Objectives: This study aimed to evaluate the possible relationship between NAFLD with body composition and bone mineral density (BMD) in obese and overweight adolescents. Methods: This cross-sectional study encompassed 70 adolescents aged 11 - 18 years and was conducted during March 2016 and September 2016 in Mashhad, Iran. Anthropometric parameters and blood biomarkers were measured. Fat mass, fat-free mass, and BMD were determined using dual-energy X‐ray absorptiometry (DXA) scans, and NAFLD was also assessed using Fibroscan. All statistical data were analyzed using SPSS software version 21. Multivariate linear regression assessed the relationship between liver fat content with bone-related indicators, and multivariate logistic regression detected the relationship between body composition and NAFLD. Results: Total and trunk fat mass were significantly correlated with higher NAFLD even after controlling for intervening factors (total fat mass, OR = 1.27; 95% CI, 1.016 to 1.59, P = 0.036; trunk fat mass, OR = 1.35; 95% CI, 0.97 to 1.88, P = 0.045). Moreover, liver fat content was significantly correlated with lower BMD Z-score after adjusting for gender, BMI Z-score, ALT, fat mass index, total lean mass, and physical activity (β = -0.285, P = 0.048). Conclusions: The findings of the present study suggest that excess adipose tissue is correlated with higher NAFLD. Moreover, liver steatosis may be correlated with decreased BMD Z-score in overweight/obese adolescents.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48466693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Grzegorzewska, W. Marcinkowski, W. Warchoł, A. Mostowska, Paweł P. Jagodziński
Background: In non-uremic populations, rs4803217 in the IFNL3 messenger RNA 3’ untranslated region or rs12980275 downstream of IFNL3 is connected with the spontaneous or therapeutic clearance of HCV and HBV, and rs12980275 is correlated with plasma IFN-λ3 levels. Moreover, rs12980275 is associated with the sustained virological response following antiviral therapy of chronic hepatitis C in hemodialysis patients. Objectives: We investigated IFNL3 polymorphisms, rs4803217 and rs12980275, for association with responsiveness to HBV vaccine and natural consequences of HBV and HCV exposure among hemodialyzed individuals. Methods: The capacity to produce protective anti-HBs titers was recognized if they were ≥ 10 IU/L after vaccination or natural exposure. The IFNL3 rs4803217 (G>T) and rs12980275 (A>G) genetic variants were analyzed using a high-resolution melting curve method in 1,337 hemodialysis subjects. Plasma IFN-λ3 was determined in 188 individuals using ELISA. The Kaplan-Meier method was applied for the analysis of survival probability. Results: The tested polymorphisms did not show associations with the capacity to generate protective anti-HBs titers after HBV vaccination or exposition and self-limitation of HBV exposure. Natural HCV clearance was connected with the IFNL3 rs4803217 GG genotype (OR: 3.036, 95% CI: 1.544 - 5.969, P = 0.001) and haplotypes comprising at least two more frequent alleles but without any variant allele of IFNL3/IFNL4 genetic variants (P < 0.05). Plasma IFN-λ3 levels were not directly influenced by IFNL3 rs4803217 and rs12980275, but differed concerning HBV/HCV serum markers (P = 0.00005) and firmly correlated with anti-HBs titers (r = 0.537, P = 4.15E-16). Both tested polymorphisms were not significantly associated with the survival of hemodialysis patients. Conclusions: Genotyping IFNL3 rs4803217 may be advantageous in the prognosis of natural HCV clearance but does not predict the self-limitation of HBV exposure, responsiveness to HBV vaccine, or hemodialysis patients’ mortality.
{"title":"Interferon-λ3 Gene Polymorphic Variants, rs4803217 and rs12980275, Responsiveness to HBV Vaccine and Outcome of HBV and HCV Exposure in Hemodialyzed Patients","authors":"A. Grzegorzewska, W. Marcinkowski, W. Warchoł, A. Mostowska, Paweł P. Jagodziński","doi":"10.5812/HEPATMON.100210","DOIUrl":"https://doi.org/10.5812/HEPATMON.100210","url":null,"abstract":"Background: In non-uremic populations, rs4803217 in the IFNL3 messenger RNA 3’ untranslated region or rs12980275 downstream of IFNL3 is connected with the spontaneous or therapeutic clearance of HCV and HBV, and rs12980275 is correlated with plasma IFN-λ3 levels. Moreover, rs12980275 is associated with the sustained virological response following antiviral therapy of chronic hepatitis C in hemodialysis patients. Objectives: We investigated IFNL3 polymorphisms, rs4803217 and rs12980275, for association with responsiveness to HBV vaccine and natural consequences of HBV and HCV exposure among hemodialyzed individuals. Methods: The capacity to produce protective anti-HBs titers was recognized if they were ≥ 10 IU/L after vaccination or natural exposure. The IFNL3 rs4803217 (G>T) and rs12980275 (A>G) genetic variants were analyzed using a high-resolution melting curve method in 1,337 hemodialysis subjects. Plasma IFN-λ3 was determined in 188 individuals using ELISA. The Kaplan-Meier method was applied for the analysis of survival probability. Results: The tested polymorphisms did not show associations with the capacity to generate protective anti-HBs titers after HBV vaccination or exposition and self-limitation of HBV exposure. Natural HCV clearance was connected with the IFNL3 rs4803217 GG genotype (OR: 3.036, 95% CI: 1.544 - 5.969, P = 0.001) and haplotypes comprising at least two more frequent alleles but without any variant allele of IFNL3/IFNL4 genetic variants (P < 0.05). Plasma IFN-λ3 levels were not directly influenced by IFNL3 rs4803217 and rs12980275, but differed concerning HBV/HCV serum markers (P = 0.00005) and firmly correlated with anti-HBs titers (r = 0.537, P = 4.15E-16). Both tested polymorphisms were not significantly associated with the survival of hemodialysis patients. Conclusions: Genotyping IFNL3 rs4803217 may be advantageous in the prognosis of natural HCV clearance but does not predict the self-limitation of HBV exposure, responsiveness to HBV vaccine, or hemodialysis patients’ mortality.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42140233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Shamsaeefar, N. Motazedian, F. Rahmanian, S. Nikeghbalian, S. Malek-hosseini
Background: The lack of consent to donate body organs leads to an increase in the death rate of patients on the waiting list for transplantation. Unwillingness of families is known as the main obstacle to organ donation, and the media has an essential role in motivating organ donation. Objectives: This study aimed to explore obstacles to obtaining consent for organ donation from transplant coordinators’ perspective throughout Iran. Methods: In this qualitative study, 13 in-depth semi-structured face-to-face interviews were conducted with transplant coordinators from November 2018 to March 2019. The participants were investigated using a purposive sampling method. The participants’ age and work experience ranged between 32 - 49 years and 6 - 25 years, respectively. Open-ended questions were asked from the participants in a private room. An experienced interviewer explained the study’s objectives to the coordinators, and each interview lasted on average 50 minutes. The interview scripts were analyzed using a content analysis method. Results: The findings highlighted the difficulty of obtaining consent from brain-dead patients’ families. The obstacles could be internal or external. External determinants were healthcare providers’ lack of empathy, inadequate consultation from doctors outside the hospital, media content, and uninformed comments from relatives. Internal determinants were hoping for recovery, denial, and disagreement among family members. Conclusions: The healthcare team should have a better connection with families to obtain organ donation consent from them. Therefore, a training program must be developed for the treatment team so that they show more supportive behavior and improve quality of care in hospitals before and after brain death.
{"title":"Obstacles to obtaining Informed Consent from the Perspective of Transplant Coordinators: A Qualitative Study","authors":"A. Shamsaeefar, N. Motazedian, F. Rahmanian, S. Nikeghbalian, S. Malek-hosseini","doi":"10.5812/HEPATMON.111210","DOIUrl":"https://doi.org/10.5812/HEPATMON.111210","url":null,"abstract":"Background: The lack of consent to donate body organs leads to an increase in the death rate of patients on the waiting list for transplantation. Unwillingness of families is known as the main obstacle to organ donation, and the media has an essential role in motivating organ donation. Objectives: This study aimed to explore obstacles to obtaining consent for organ donation from transplant coordinators’ perspective throughout Iran. Methods: In this qualitative study, 13 in-depth semi-structured face-to-face interviews were conducted with transplant coordinators from November 2018 to March 2019. The participants were investigated using a purposive sampling method. The participants’ age and work experience ranged between 32 - 49 years and 6 - 25 years, respectively. Open-ended questions were asked from the participants in a private room. An experienced interviewer explained the study’s objectives to the coordinators, and each interview lasted on average 50 minutes. The interview scripts were analyzed using a content analysis method. Results: The findings highlighted the difficulty of obtaining consent from brain-dead patients’ families. The obstacles could be internal or external. External determinants were healthcare providers’ lack of empathy, inadequate consultation from doctors outside the hospital, media content, and uninformed comments from relatives. Internal determinants were hoping for recovery, denial, and disagreement among family members. Conclusions: The healthcare team should have a better connection with families to obtain organ donation consent from them. Therefore, a training program must be developed for the treatment team so that they show more supportive behavior and improve quality of care in hospitals before and after brain death.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"21 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41620108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Karaşahin, I. Kalkan, T. Dal, S. Toplu, Murat Harputoğlu, A. Mete, Süheyla Kömür, Figen Sarigul, Yeşim Yıldız, Fatih Esmer, Ö. Kandemir, Selçuk Nazik, D. Inan, F. Akgul, S. Kaya, N. Tunc, Ş. Balın, Y. Bayindir, Y. Taşova, F. Akar, M. Ören, Merve Ayhan, Yakup Demir, M. Çelen
Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNA polymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t = 3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran’s Q, and McNemar’s tests were used. Results: The mean age of the patients was 47.40 ± 14.5, and 327 of them (68.1%) were male. A total of 78.1% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n = 340; 70.8 %), and 21.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months to t = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t = 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.1% in the sixth month, with the most common side effect being hair loss (1%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density.
{"title":"Real-life Data for Tenofovir Alafenamide Fumarate Treatment of Hepatitis B: the Pythagoras Cohort","authors":"O. Karaşahin, I. Kalkan, T. Dal, S. Toplu, Murat Harputoğlu, A. Mete, Süheyla Kömür, Figen Sarigul, Yeşim Yıldız, Fatih Esmer, Ö. Kandemir, Selçuk Nazik, D. Inan, F. Akgul, S. Kaya, N. Tunc, Ş. Balın, Y. Bayindir, Y. Taşova, F. Akar, M. Ören, Merve Ayhan, Yakup Demir, M. Çelen","doi":"10.5812/HEPATMON.104943","DOIUrl":"https://doi.org/10.5812/HEPATMON.104943","url":null,"abstract":"Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNA polymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t = 3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran’s Q, and McNemar’s tests were used. Results: The mean age of the patients was 47.40 ± 14.5, and 327 of them (68.1%) were male. A total of 78.1% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n = 340; 70.8 %), and 21.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months to t = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t = 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.1% in the sixth month, with the most common side effect being hair loss (1%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44535237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiao Zhou, Libo Yan, L. Du, Xiaoqiong Tang, Hong Tang
Background: Golgi membrane glycoprotein 73 (GP73) serum level is a potential biomarker for diagnosing significant fibrosis and cirrhosis in chronic liver diseases. Objectives: The current study aimed to evaluate the accuracy of GP73 serum levels as a biomarker in the diagnosis of significant liver fibrosis in patients with hepatitis B virus (HBV). A new promising algorithm was developed by combining LSM and GP73 to predict significant liver fibrosis. Methods: Information on the following parameters were obtained from 165 patients with HBV: liver stiffness measurement (LSM), serum GP73 level, and some other fibrosis criteria approved for clinical practice. The area under the curve (AUC) and sensitivity and specificity of GP73 were compared with LSM, aminotransferase-to-platelet ratio index (APRI), and 4-factor based fibrosis index (FIB-4) for diagnosing significant fibrosis. Results: Compared to the non-significant liver fibrosis patients, the HBV infected patients with significant fibrosis showed a higher level of serum GP73 [64.05 (24.41 - 144.39) versus 91.30 (31.81 - 200.05) ng/mL, P < 0.001]. Concerning significant fibrosis diagnosis, GP73 exhibited advantages regarding the AUC (0.702), sensitivity (69.3%), and specificity (66.0%). Besides, GP73 did not show any advantage over LSM and APRI, but it had a better performance than FIB-4 in significant fibrosis detection. For the newly developed algorithm combining GP73 with LSM, the AUC, sensitivity, and specificity were 0.848, 77.4%, and 83.5%, respectively; hence, it's superior to LSM (0.832, 72.6%, and 83.5%, respectively; P = 0.016) for diagnosing significant fibrosis. Conclusions: This study demonstrated that GP73 can be considered as a new effective biomarker for diagnosing liver fibrosis. The accuracy of significant fibrosis detection in patients with HBV infection can be improved by the new algorithm that contains GP73 and LSM.
{"title":"Combined Serum Golgi Membrane Glycoprotein 73 Improves the Accuracy of Transient Elastography for Significant Fibrosis Detection in Patients with Chronic HBV Infections","authors":"Qiao Zhou, Libo Yan, L. Du, Xiaoqiong Tang, Hong Tang","doi":"10.5812/HEPATMON.102039","DOIUrl":"https://doi.org/10.5812/HEPATMON.102039","url":null,"abstract":"Background: Golgi membrane glycoprotein 73 (GP73) serum level is a potential biomarker for diagnosing significant fibrosis and cirrhosis in chronic liver diseases. Objectives: The current study aimed to evaluate the accuracy of GP73 serum levels as a biomarker in the diagnosis of significant liver fibrosis in patients with hepatitis B virus (HBV). A new promising algorithm was developed by combining LSM and GP73 to predict significant liver fibrosis. Methods: Information on the following parameters were obtained from 165 patients with HBV: liver stiffness measurement (LSM), serum GP73 level, and some other fibrosis criteria approved for clinical practice. The area under the curve (AUC) and sensitivity and specificity of GP73 were compared with LSM, aminotransferase-to-platelet ratio index (APRI), and 4-factor based fibrosis index (FIB-4) for diagnosing significant fibrosis. Results: Compared to the non-significant liver fibrosis patients, the HBV infected patients with significant fibrosis showed a higher level of serum GP73 [64.05 (24.41 - 144.39) versus 91.30 (31.81 - 200.05) ng/mL, P < 0.001]. Concerning significant fibrosis diagnosis, GP73 exhibited advantages regarding the AUC (0.702), sensitivity (69.3%), and specificity (66.0%). Besides, GP73 did not show any advantage over LSM and APRI, but it had a better performance than FIB-4 in significant fibrosis detection. For the newly developed algorithm combining GP73 with LSM, the AUC, sensitivity, and specificity were 0.848, 77.4%, and 83.5%, respectively; hence, it's superior to LSM (0.832, 72.6%, and 83.5%, respectively; P = 0.016) for diagnosing significant fibrosis. Conclusions: This study demonstrated that GP73 can be considered as a new effective biomarker for diagnosing liver fibrosis. The accuracy of significant fibrosis detection in patients with HBV infection can be improved by the new algorithm that contains GP73 and LSM.","PeriodicalId":12895,"journal":{"name":"Hepatitis Monthly","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41376565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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