Endothelial dysfunction in adolescents and young adults with nonalcoholic liver disease

Nonalcoholic liver disease is a global public health problem that increases cardiovascular morbidity and mortality in these patients. This paper discusses endothelial dysfunction among patients (adolescents and young adults) with nonalcoholic liver disease. On the one hand, evidence suggests that cardiovascular disease is the leading cause of mortality in patients with advanced nonalcoholic liver disease and that nonalcoholic fatty liver is associated with an increased risk of cardiovascular disease independent of the presence of cardiovascular risk factors and metabolic syndrome components. On the other hand, nonalcoholic liver disease, especially the non-inflammatory form of nonalcoholic steatohepatitis, may not only be a marker of cardiovascular damage but also a factor involved in its pathogenesis. Such patients are candidates not only for the treatment of liver disease but also for the early treatment of cardiovascular risk factors because many of them, especially those with severe nonalcoholic liver disease, will develop major cardiovascular events and may eventually die of cardiovascular disease before the advanced liver disease occurs

Clinical Features and Risk Factors of Autoimmune Liver Involvement in Pediatric Inflammatory Bowel Disease

OBJECTIVES:Autoimmune liver disease is reported in up to 7.8% of children with inflammatory bowel disease. A distinct inflammatory bowel disease phenotype has been suggested in adults and in small pediatric cohorts. The aim of the study was to evaluate the features of inflammatory bowel disease associated with autoimmune liver diseases and to analyze the characteristics of the liver disease. METHODS:Information on patients was obtained from the Italian Pediatric Inflammatory Bowel Disease Registry. Data of patients with and without autoimmune liver disease were compared. RESULTS:Autoimmune liver disease was detected in 6.8% of the 677 patients enrolled and was significantly associated with the diagnosis of ulcerative colitis (83%), with pancolonic involvement (84%), and with perinuclear antineutrophil cytoplasmic antibody positivity (41%) (all Ps < 0.05). Autoimmune liver disease was defined as sclerosing cholangitis in 61% of the patients and as an overlap syndrome in 33%. Concomitant intra- and extrahepatic biliary involvement was reported in 61% of cases, whereas exclusive extrahepatic lesions were reported in 21%. Hepatobiliary complications were observed in 9% of the patients during follow-up. CONCLUSIONS:Autoimmune liver disease, especially sclerosing cholangitis, was significantly more common in patients with extensive ulcerative colitis. Although complications are relatively rare in the pediatric age, monitoring is recommended

The SCottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011

Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50-59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses

Machine Learning with Abstention for Automated Liver Disease Diagnosis

This paper presents a novel approach for detection of liver abnormalities in an automated manner using ultrasound images. For this purpose, we have implemented a machine learning model that can not only generate labels (normal and abnormal) for a given ultrasound image but it can also detect when its prediction is likely to be incorrect. The proposed model abstains from generating the label of a test example if it is not confident about its prediction. Such behavior is commonly practiced by medical doctors who, when given insufficient information or a difficult case, can chose to carry out further clinical or diagnostic tests before generating a diagnosis. However, existing machine learning models are designed in a way to always generate a label for a given example even when the confidence of their prediction is low. We have proposed a novel stochastic gradient based solver for the learning with abstention paradigm and use it to make a practical, state of the art method for liver disease classification. The proposed method has been benchmarked on a data set of approximately 100 patients from MINAR, Multan, Pakistan and our results show that the proposed scheme offers state of the art classification performance.Comment: Preprint version before submission for publication. complete version published in proc. 15th International Conference on Frontiers of Information Technology (FIT 2017), December 18-20, 2017, Islamabad, Pakistan. http://ieeexplore.ieee.org/document/8261064

Patients’ preferences for nutrition-related health outcomes in liver disease : a preliminary study using an electronic questionnaire

Background: Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients’ needs are associated with better health outcomes but no studies investigating patients’ preferences for nutrition-related outcomes in liver disease have been published. The aim of this study was to identify nutrition-related health outcomes that are important to patients with liver disease. Methodology: An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results: Fifty-one patients participated (22 men / 29 women). Responses indicated a wide range of preferred nutrition-related outcomes with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, and on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions: The study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.Peer reviewedFinal Accepted Versio

Waist circumference in Liver Disease

Background Central fat accumulation is important in Non-alcoholic Fatty Liver Disease (NAFLD) etiology. It is unknown weather any commonly used waist circumference (WC) measurement protocol (mp), as whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WC mp to be used in patients with NAFLD, based on three-fold criterion. Material and methods Body fat (BF) was assessed through Dual Energy X-ray Absorptiometry (DXA) in 28 patients with NAFLD (19 males, 51 + 13 yrs, and 9 females, 47 + 13 yrs). WC was measured using four different WC mp (WC1-narrowest torso, WC2- just above iliac crest, WC3- mid-distance between iliac crest and last rib and WC4- at the umbilicus). Results All WC measurements were highly correlated particularly with central BF depots, including trunk BF (r=0.78; r=0.82; r=0.82; r=0.84; respectively for WC1, WC2, WC3 and WC4) abdominal BF (r=0.78; r=0.78; r=0.80; r=0.72; respectively for WC1, WC2, WC3 and WC4) and central abdominal BF (r=0.76; r=0.77; r=0.78; r=0.68; respectively for WC1, WC2, WC3 and WC4), controlling for age, sex and body mass index. There were no differences between the correlation coefficients obtained between all studied WC measurements and each whole and central analyzed BF variable. Conclusion All studied WC mp seem suitable for use in patients with NAFLD, particularly as central BF clinical assessment tool, though not interchangeably. Hence biological and precision criteria alone did not sanction the superiority of any WC mp. Practical criteria may endorse WC measured at the iliac crest.info:eu-repo/semantics/publishedVersio

Alpha-1 antitrypsin deficiency

α-1 antitrypsin is synthesised in the liver and protects lung alveolar tissues from destruction by neutrophil elastase. α-1 antitrypsin deficiency is a common autosomal recessive condition (1:1600 to 1:1800) in which liver disease results from retention of abnormal polymerised α-1 antitrypsin in the endoplasmic reticulum of hepatocytes, and emphysema results from alveolar wall damage. The clinical consequences of α-1 antitrypsin deficiency in childhood are haemorrhagic disease in infancy, cholestasis in infancy, or chronic liver disease. Lung disease attributable to α-1 antitrypsin deficiency does not occur in childhood, but is closely linked to smoking in adults. Membranoproliferative glomerulonephritis, panniculitis, and necrotising vasculitis are associations with α-1 antitrypsin deficiency in adult life

Vitamin D3 supplementation of a high fat high sugar diet ameliorates prediabetic phenotype in female LDLR–/–and LDLR+/+mice

© 2017 The Authors. Immunity, Inflammation and Disease Published by John Wiley & Sons Ltd. INTRODUCTION: Fatty liver disease is prevalent in populations with high caloric intake. Nutritherapeutic approaches are being considered, such as supplementary Vitamin D 3 , to improve aspects of metabolic syndrome, namely fatty liver disease, hyperlipidemia, and insulin resistance associated with obesity. METHODS: We analyzed female LDLR -/- and LDLR +/+ mice on a 10-week diabetogenic diet for markers of fatty liver disease, metabolic strain, and inflammation. RESULTS: The groups on a high fat high sugar diet with supplementary Vitamin D 3 , in comparison with the groups on a high fat high sugar diet alone, showed improved transaminase levels, significantly less hypertriglyceridemia and hyperinsulinemia, and histologically, there was less pericentral hepatic steatosis. Levels of non-esterified fatty acids and lipid peroxidation products were significantly lower in the group supplemented with additional Vitamin D 3 , as were systemic markers of inflammation (serum endotoxin and IL-6). M2 macrophage phenotype predominated in the group supplemented with additional Vitamin D 3 . Beneficial changes were observed as early as five weeks’ supplementation with Vitamin D 3 and extended to restoration of high fat high sugar diet induced decrease of bone mineral density. CONCLUSION: In summary, Vitamin D 3 was a significantly beneficial dietary additive to blunt a prediabetic phenotype in diet-induced obesity of female LDLR -/- and LDLR +/+ mice

Nephrogenic systemic fibrosis risk and liver disease.

Objective. Evaluate the incidence of nephrogenic systemic fibrosis (NSF) in patients with liver disease in the peritransplant period. Materials and Methods. This IRB approved study retrospectively reviewed patients requiring transplantation for cirrhosis, hepatocellular carcinoma (HCC), or both from 2003 to 2013. Records were reviewed identifying those having gadolinium enhanced MRI within 1 year of posttransplantation to document degree of liver disease, renal disease, and evidence for NSF. Results. Gadolinium-enhanced MRI was performed on 312 of 837 patients, including 23 with severe renal failure (GFR < 30 mL/min/1.73 cm(2)) and 289 with GFR > 30. Two of 23 patients with renal failure developed NSF compared to zero NSF cases in 289 patients with GFR > 30 (0/289; P < 0.003). High dose gadodiamide was used in the two NSF cases. There was no increased incidence of NSF with severe liver disease (1/71) compared to nonsevere liver disease (1/241; P = 0.412). Conclusion. Renal disease is a risk factor for NSF, but in our small sample our evidence suggests liver disease is not an additional risk factor, especially if a low-risk gadolinium agent is used. Noting that not all patients received high-risk gadolinium, a larger study focusing on patients receiving high-risk gadolinium is needed to further evaluate NSF risk in liver disease in the peritransplant period

To identify and examine the different causes of liver disease in Sri Lanka

© 2017 The Authors. Published by International Journal of Science and Research. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://www.ijsr.net/get_abstract.php?paper_id=ART20178732Liver disease is one of the main causes for deaths in Sri Lanka, this is the second most common disease causing deaths in hospitals in Sri Lanka after the heart disease. Sri Lanka ranks eighty-nine (89) in the world rankings for liver disease causing 3349 deaths according to the data published by the World Health Organization (WHO) for the 2014 calendar year and an average of 15.28 deaths per hundred thousand. The two most common forms of this disease is non-alcoholic fatty liver disease and alcoholic fatty liver disease. The data collected by the WHO is analyzed and the different causes for the liver disease is identified between the period of 1980-2010, using the different factors responsible for the cause of the disease data is distinguished. Of the data collected and analyzed most causes of liver disease in Sri Lanka is due to the non-alcoholic fatty liver disease (NAFLD) or alcoholic fatty liver disease which leads to severe complications such as renal failure, liver cirrhosis and eventually deat