Chronic Disease Patients Research Articles

STUDY OF SERUM SODIUM LEVELS AND ITS CLINICAL SIGNIFICANCE IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS ADMITTED IN A TERTIARY CARE CENTRE OF NORTH EASTERN STATE, TRIPURA

Introduction: Chronic Liver Disease is a major source of death and morbidity globally. Hyponatremia is one of the most common electrolyte abnormalities in chronic liver disease patients. Various studies have established a correlation between serum sodium levels and survival in these patients. Hyponatremia is a marker of severity in CLD patients and studies have shown its relationship with MELD score and Child Pugh score. The complications of DCLD and mortality also increases with hyponatremia. The aim of this study was to study the serum sodium levels in patients with DCLD and to establish its significance. Materials And Methods: Data was collected from 100 patients admitted in medical wards. Patients were divided into 3 groups based on serum sodium levels and the relevant parameters analyzed among the groups. OBSERVATIONS: Among 100 patients, 45 had serum sodium levels ≥136 mEq/L, while 32 had serum sodium levels between 131 and 135 mEq/L and 23 patients had serum sodium level ≤130. No patients had serum sodium levels greater than 145. Serum sodium levels were associated strongly with the severity of liver disease as assessed by Child Pugh and MELD scores. Serum sodium ≤130 indicated the existence of Hepatic Encephalopathy, Hepatorenal Syndrome and Spontaneous Bacterial Peritonitis. Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 had increased mortality. Conclusion: Hyponatremia is more common in DCLD and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and GI bleeding. Lower serum sodium levels were associated with increased MELD and Child Pugh score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease.

CLINICAL PATTERNS AND OUTCOMES IN CIRRHOTIC YEMENI PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE

Acute-on-chronic liver failure (ACLF) is a clinical condition of abrupt hepatic decompensation in chronic liver disease patients that is associated with extra-hepatic organ failures and a higher mortality rate. This study aimed to identify the clinical patterns and outcomes in cirrhotic Yemeni patients with ACLF. This prospective cohort study was carried out on 160 cirrhotic patients admitted between May 2023 and May 2024 to the Internal Medicine Department in Al-Sadaqah General Teaching Hospital in Aden governorate, Yemen. Based on the European Association for Study of Liver's Chronic Liver Failure Consortium EASL-CLIF criteria, patients were divided into Group A: 54 patients with ACLF. Group B: 106 patients without ACLF. The prevalence of ACLF is 33.8%. The mean age was 41.54± 8.11 years in ACLF and 39.22± 8.14 years in non-ACLF patients. The proportion of males in ACLF was 51.9% vs. 57.5% in non-ACLF patients. The most common causes of cirrhosis were cryptogenic (58.8%) and autoimmune hepatitis (25.6%). A significant correlation was found between prior hospitalization, decompensation, and the increased risk of developing ACLF. The most common complications were jaundice, hepatic encephalopathy, renal failure, signs of bacterial infection, ascites, and gastrointestinal bleeding, respectively. The main precipitating events for ACLF were bacterial infection, especially SBP (48.1%), GIT bleeding (24.1%), and no identified precipitating events (24.1%). The most common organ failures were renal (70.4%), liver (42.6%), and cerebral (31.5%). ACLF patients showed higher levels of WBCs, bilirubin, and serum creatinine. Mortality rates were significantly higher in ACLF patients compared to non-ACLF at both 28 days (33.3% vs. 5.7%) and 90 days (685% vs. 23.6%). This study demonstrated that ACLF patients have worse prognoses, higher mortality rates, increased ICU admission, lower survival, and higher rates of organ failure than non-ACLF patients.

GLCV-NET: An automatic diagnosis system for advanced liver fibrosis using global–local cross view in B-mode ultrasound images

Background and objective: Advanced liver fibrosis is a critical stage in the evaluation of chronic liver disease (CLD), holding clinical significance in the development of treatment strategies and estimating the disease progression. Methods:This paper proposes an innovative Global–Local Cross-View Network (GLCV-Net) for the automatic diagnosis of advanced liver fibrosis from ultrasound (US) B-mode images. The proposed method consists of three main components: 1. A Segmentation-enhanced Global Hybrid Feature Extractor for segmenting the liver parenchyma and extracting global features; 2. A Heatmap-weighted Local Feature Extractor for selecting candidate regions and automatically identifying suspicious areas to construct local features; 3. A Scale-adaptive Fusion Module to balance the contributions of global and local scales in evaluating advanced liver fibrosis. Results:The predictive performance of the model was validated on an internal dataset of 1003 chronic liver disease (CLD) patients and an external dataset of 46 CLD patients, both subjected to liver fibrosis staging through pathological assessment. On the internal dataset, GLCV-Net achieved 86.9% accuracy, 85.0% recall, 85.4% precision, and 85.2% F1-score. Further validation on the external dataset confirmed its robustness, with scores of 86.1% in accuracy, 83.1% in recall, 80.8% in precision, and 81.9% in F1-score. Conclusion:These results underscore the GLCV-Net’s potential as a promising approach for non-invasively and accurately diagnosing advanced liver fibrosis in CLD patients, breaking through the limitations of traditional methods by integrating global and local information of liver fibrosis, significantly enhancing diagnostic accuracy.

Cost-Effectiveness of Hepatitis E Vaccination Strategies among Patients with Chronic Liver Diseases in China: A Model-Based Evaluation.

Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis worldwide, primarily transmitted through contaminated water and food. In patients with chronic liver disease (CLD), HEV infection might worsen the prognosis. This study aimed to evaluate the cost-effectiveness of hepatitis E vaccination strategies in CLD patients. A decision tree-Markov cohort model was used to assess the cost-effectiveness of universal-vaccination, vaccination-following-screening, and no-vaccination strategies in 100,000 CLD patients over their lifetimes, simulating cohorts aged ≥16 years, ≥40 years, and ≥60 years, based on the licensed vaccination ages and typical ages of CLD onset, from a societal perspective. Model parameters were retrieved and estimated from previous publications and government data. The outcomes included HEV-related cases, costs, and the incremental cost-effectiveness ratio (ICER). Compared to no-vaccination, universal-vaccination reduced HEV-related cases by 32.8% to 39.6%, while vaccination-following-screening reduced them by 38.1% to 49.3%. Furthermore, universal-vaccination showed ICERs of USD 6898.33, USD 6638.91, and USD 6582.69 per quality-adjusted life year (QALY) for cohorts aged ≥16, ≥40, and ≥60 years, respectively. Moreover, the vaccination-following-screening strategy significantly enhanced cost-effectiveness, with ICERs decreasing to USD 6201.55, USD 5199.46, and USD 4919.87 per QALY for the cohorts. Additionally, one-way sensitivity analysis identified the discount rate and utility for CLD patients as the key factors influencing ICER. Probabilistic sensitivity analysis indicated the vaccination-following-screening strategy was cost-effective with probabilities of 92.50%, 95.70%, and 95.90% for each cohort. Hepatitis E vaccination in CLD patients costs less than GDP per capita for each QALY gained in China. The vaccination-following-screening strategy may be the optimal option, especially in those over 60 years.

Evaluation of Rehabilitation Outcomes in Patients with Chronic Neurological Health Conditions Using a Machine Learning Approach.

Background: Over one billion people worldwide suffer from neurological conditions that cause mobility impairments, often persisting despite rehabilitation. Chronic neurological disease (CND) patients who lack access to continuous rehabilitation face gradual functional decline. The International Classification of Functioning, Disability, and Health (ICF) provides a comprehensive framework for assessing these patients. Objective: This study aims to evaluate the outcomes of a non-hospitalized neuromotor rehabilitation project for CND patients in Italy using the Barthel Index (BI) as the primary outcome measure. The rehabilitation was administered through an Individual Rehabilitation Plan (IRP), tailored by a multidisciplinary team and coordinated by a physiatrist. The IRP involved an initial comprehensive assessment, individualized therapy administered five days a week, and continuous adjustments based on patient progress. The secondary objectives include assessing mental status and sensory and communication functions, and identifying predictive factors for BI improvement using an artificial neural network (ANN). Methods: A retrospective observational study of 128 CND patients undergoing a rehabilitation program between 2018 and 2023 was conducted. Variables included demographic data, clinical assessments (BI, SPMSQ, and SVaMAsc), and ICF codes. Data were analyzed using descriptive statistics, linear regressions, and ANN to identify predictors of BI improvement. Results: Significant improvements in the mean BI score were observed from admission (40.28 ± 29.08) to discharge (42.53 ± 30.02, p < 0.001). Patients with severe mobility issues showed the most difficulty in transfers and walking, as indicated by the ICF E codes. Females, especially older women, experienced more cognitive decline, affecting rehabilitation outcomes. ANN achieved 86.4% accuracy in predicting BI improvement, with key factors including ICF mobility codes and the number of past rehabilitation projects. Conclusions: The ICF mobility codes are strong predictors of BI improvement in CND patients. More rehabilitation sessions and targeted support, especially for elderly women and patients with lower initial BI scores, can enhance outcomes and reduce complications. Continuous rehabilitation is essential for maintaining progress in CND patients.

Use of complementary and alternative medicine in patients with chronic liver diseases in Germany- a multicentric observational study

BackgroundThe use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany.MethodsThis is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the “Big five” model, “Hospital Anxiety and Depression”-, “Multidimensional Health Locus of Control”- score). Uni- and multivariate analyses assessed factors associated to CAM use.ResultsOverall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use.ConclusionsCAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur.

Correlation Between Clinical Assessment and Postmortem Lung Biopsy in Patients With Pulmonary Infiltrates and Respiratory Failure.

Pulmonary complications commonly cause mortality in critically ill patients with acute and chronic liver diseases in the intensive care unit. Pneumonia is the most common clinical diagnosis supported by radiological and microbiological results, which are subjective and often with poor yield. The study aimed to correlate clinical diagnosis and postmortem lung histology in patients with liver disease with respiratory failure. Records of acute and chronic liver disease patients with respiratory failure-associated mortality and postmortem lung biopsy from September 2009 to March 2020 were analyzed. Clinical diagnosis supported by radiological and/or microbiological data was compared with histology. One hundred eight patients (age 46.83±12.96 years), males 80 (74.1%), 63 (58.3%) cirrhosis of the liver, 30 (27.8%) acute-on-chronic-liver-failure, and 9 (8.3%) acute liver failure, were analyzed. Of the 76 patients (70.37 % of the total) with pneumonia, 33 (43.4 %) had histological evidence of pneumonia. Other histological diagnoses in these patients were normal or nonspecific changes in 27 (35.5 %) and alveolar hemorrhage in 13 (17.1 %). In the remaining 32 patients, histological diagnosis of pneumonia was evident in nine patients (28.1%). Using postmortem histology as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive valuefor clinical diagnosis of pneumonia were found to be 78.57%, 34.85%, 43.42%, and 71.88% respectively. The kappa statistics for agreement between the two was 0.12 (95% C.I. -0.04 to 0.27) suggesting poor agreement. Age and histological pneumonia predicted significant missed diagnosis. There is poor agreement between clinical diagnosis and postmortem histology. Postmortem lung biopsy helps with the unexplained cause of death.

Study of Knowledge, Attitude, and Practices of Use of Masks among Health-care Workers at a Tertiary Care Center in Mumbai

ABSTRACT Introduction: Airborne transmission of infectious diseases poses a significant public health challenge. Nosocomial outbreaks of airborne infections such as influenza H1N1, H5N1, and drug-resistant tuberculosis (TB) variants have been documented, with substantial morbidity and mortality attributed to inadequate airborne infection control strategies. N-95 respirators and surgical masks (face masks) are the examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contamination of the face. Aim and Objectives: The aim of this study was to assess the knowledge, practices, and attitude of health-care workers (HCWs) regarding the use of mask, especially N-95 mask. Materials and Methods: A prospective, was conducted over a period of 6 months at a tertiary care hospital. This study was carried out in the department of microbiology of a tertiary care hospital over a period of 6 months. A total of 500 HCWs from various departments of the hospital were included in the study. HCWs were given a questionnaire based on N-95 respirator usage, and participation was voluntary. Results: The analysis of survey data provides insightful perspectives on respondents’ comprehension and attitudes toward airborne infection transmission and the usage of N-95 masks. 68.6% of respondents recognized that all listed diseases (measles, TB, and chickenpox) were spread by the airborne route. 55.6% of respondents correctly acknowledged that all masks, including surgical masks, N-95 masks, and cotton masks, do not offer airborne protection. 76.0% of respondents acknowledged that N-95 masks possess a high filtration efficiency against 0.3-micron particles, 58.3% correctly identified that “N” in N-95 stands for “not resistant to oil,” and 90.8% acknowledged that the N-95 respirator as the most common type of respirators. 41.7% correctly acknowledged that N-95 masks with an exhalation valve are not recommended for use. 22.2% of respondents incorrectly believe that wearing a face mask can lead to carbon dioxide poisoning, and 52.1% of respondents correctly identified that pulmonary TB patients need not be provided with N-95 masks in isolation rooms. 76.8% of respondents understood that fit testing is required every time one dons an N-95 mask. 95.5% of respondents recognized the necessity of hand hygiene before donning and after doffing N-95 masks. 82.7% of respondents agreed regarding the necessity for consultation before N-95 mask usage for chronic lung disease and asthma patients. 93.7% are aware that there is a protocol for donning and doffing N-95 masks. 71.3% of respondents understood that extended use involves wearing the same N-95 respirator for repeated close contact encounters without removing the mask between patient encounters, while 64.4% correctly define reuse as using the same N-95 respirator for multiple encounters but removing it after each encounter.

Effectiveness of Health Behaviour Modification for Chronic Non-communicable Disease Patients with Health Coaches at Khiensa Hospital, Surat Thani Province

Background: Patients with chronic noncommunicable diseases often struggle to control their blood sugar and blood pressure levels, and they frequently experienced physical, mental, and self-care practice issues that needed to be addressed. However, they may not receive adequate guidance, or the guidance they receive may be mismatched to their needs, or they may be misunderstandings between providers and patients. Therefore, medical treatment alone is insufficient; lifestyle and behavioural changes are also required throughout treatment. Objectives: This quasi-experimental study aimed to investigate the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching at Khiensa Hospital, Surat Thani Province. Methods: The study included 550 participants who underwent a three-month health behaviour change process for patients with chronic non-communicable diseases. Each group of ten participants was supervised by a single health coach. Health literacy, health behaviour modification, and blood sugar levels were assessed before and after participating in the process using structured questionnaires. The data were analyzed by using a paired t-test to compare the mean scores of the effectiveness of health behaviour modification for chronic non-communicable disease patients through health coaching using STATA. Result: The results showed that the average health literacy scores related to chronic noncommunicable diseases increased significantly from 162.0 to 170.2 after intervention. Similarly, the average health behaviour modification scores increased significantly from 51.4 to 55.1. Furthermore, average blood sugar levels decreased from 114.1 mg/dl to 109.2 mg/dl. Our statistical analysis revealed that the significant differences in the average scores of health literacy, health behaviour modification, and blood sugar levels before and after participating in the process (t=170.3, 151.6, and 95.0, respectively, p&lt;0.001). Conclusion: The Ministry of Public Health should develop policies to support and prioritize holistic patient care and promote proactive health promotion services for patients through intensive health promotion program activities led by health coaches to enhance the effectiveness of care for chronic non-communicable disease patients.

Dissimilar Trypanosoma cruzi genotype-specific serological profile assessed by Chagas-Flow ATE IgG1 upon benznidazole etiological treatment of chronic Chagas disease.

The present study aimed to verify the impact of etiological treatment on the genotype-specific serological diagnosis of chronic Chagas disease patients (CH), using the Chagas-Flow ATE IgG1 methodology. For this purpose, a total of 92 serum samples from CH, categorized as Not Treated (NT, n = 32) and Benznidazole-Treated (Bz-T, n = 60), were tested at Study Baseline and 5Years Follow-up. At Study Baseline, all patients have the diagnosis of Chagas disease confirmed by Chagas-Flow ATE IgG1, using the set of attributes ("antigen/serum dilution/cut-off"; "EVI/250/30%"). The genotype-specific serodiagnosis at Study Baseline demonstrated that 96% of patients (44/46) presented a serological profile compatible with TcII genotype infection. At 5Years Follow-up monitoring, NT and Bz-T presented no changes in anti-EVI IgG1 reactivity. However, significant differences were detected in the genotype-specific IgG1 reactivity for Bz-T. The most outstanding shift comprised the anti-amastigote TcVI/(AVI), anti-amastigote TcII/(AII) and anti-epimastigote TcVI/(EVI) reactivities. Regardless no changes in the genotype-specific serology of NT (TcI = 6%; TcII = 94%), distinct T. cruzi genotype-specific sero-classification was detected for Bz-T samples at 5Years Follow-up (TcII = 100%) as compared to Baseline (TcII = 97%; TcVI = 3%). The anti-trypomastigote TcI/(TI) was the attribute accountable for the change in genotype-specific sero-classification. In conclusion, our findings of dissimilar T. cruzi genotype-specific serology upon Bz-treatment re-emphasize the relevance of accomplishing the genotype-specific serodiagnosis during clinical pos-therapeutic management of chronic Chagas disease patients.

Prediction of Clinical Trajectory in HCV-Related ACLD after SVR: Role of Liver Stiffness in a 5-Years Prospective Study.

The prediction of liver-related events (LRE) after sustained virological response (SVR) in HCV-advanced chronic liver disease (ACLD) patients is crucial. We aimed to evaluate incidence and risk factors of LRE in HCV-cirrhotic patients after SVR and to assess dynamic changes of liver stiffness in participants without LRE at the end of follow-up. We enrolled 575 consecutive patients with HCV-ACLD treated with DAAs and followed up for 5 years after SVR12. Overall, 98 (17%) patients developed any type of event, and HCC was the most frequent LRE. The incidence rate was 1.6 per 100 person-years (p/y) for both HCC and hepatic decompensation. Baseline LSM ≥ 20 kPa was the only independent predictor of hepatic decompensation, while LSM ≥ 20 kPa and male sex were independent predictors of HCC development. Among the 341 participants without LRE and with paired LSM, any LSM reduction was observed in 314 (92.1%), and half of them showed a decrease of LSM ≥ 20%. Among patients without LRE, 27.3% of participants without ≥20% LSM decrease at 2 years achieved the 5-year goal; in contrast, 31.6% of participants with ≥20% LSM decrease at 2 years lost it at 5 years. These findings provide evidence that baseline LSM is a tool to stratify patients at risk of developing LRE; the dynamic changes of LSM value suggest the need for monitoring this parameter over time.

Palliative care in terminally ill advanced chronic liver disease patients.

While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have acomparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, alack of confidence in prescribing medication and alack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. Basic palliative care, along with active disease management, is best delivered by the treating hepatologists. This includes discussions about disease progression and advance care planning, alongside the active management of disease complications. Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.

Effects of Acupressure on Psychological Symptoms in Chronic Disease Patients: A Scoping Review

Research related to the effects of acupressure on psychological problems in patients with chronic diseases has been conducted by previous researchers. However, so far reviews on this topic are still limited. The purpose of this review is to obtain an overview of the extent of the effects of acupressure on psychological symptoms of chronic disease sufferers based on the results of research that has been conducted. The method used is a scoping review, determining the research questions to be reviewed using the PICO (Population, Intervention, Comparison, Outcome) framework. The keywords used in the article search are "Acupressure" AND "Acupoints" AND "Psychological Symptoms" AND "Chronic disease" OR "Chronic ilness". Several databases used in this study such as Pubmed (n = 14), Science Direct (n = 495), Ebsco (n = 82), Proquest (n = 562), Scopus (n = 973) were then eliminated and screened into 10 articles studied. The review analysis was carried out using the Arksey and O'Malley theory approach. Based on the results of the analysis of 10 articles, it was found that acupressure has a positive effect in helping to reduce symptoms and improve the psychological condition of patients with chronic diseases, including relieving patient symptoms such as depression and anxiety in patients undergoing hemodialysis and breast cancer, reducing pain in osteoarthritis patients, overcoming insomnia which is often accompanied by anxiety disorders, emotional disorders (worry, nervousness, irritability), treating depression, anxiety, and insomnia in acute stroke patients, improving stress index, and sleep efficiency in the elderly with essential hypertension, reducing anxiety in female patients with coronary artery disease (CAD), decreasing the average stress score and improving the quality of life in patients with type 2 diabetes mellitus, increasing the quality of life and reducing emotional disorders in patients with polycystic ovary syndrome (PCOS). The conclusion of the journal review shows that acupressure has the effect of improving psychological conditions by reducing symptoms of anxiety, depression, stress, sleep disorders or insomnia and helping to improve the quality of life in patients with chronic diseases.

The Role of Wearable Devices in Chronic Disease Monitoring and Patient Care: A Comprehensive Review.

Wearable health devices are becoming vital in chronic disease management because they offer real-time monitoring and personalized care. This review explores their effectiveness and challenges across medical fields, including cardiology, respiratory health, neurology, endocrinology, orthopedics, oncology, and mental health. A thorough literature search identified studies focusing on wearable devices' impact on patient outcomes. In cardiology, wearables have proven effective for monitoring hypertension, detecting arrhythmias, and aiding cardiac rehabilitation. In respiratory health, these devices enhance asthma management and continuous monitoring of critical parameters. Neurological applications include seizure detection and Parkinson's disease management, with wearables showing promising results in improving patient outcomes. In endocrinology, wearable technology advances thyroid dysfunction monitoring, fertility tracking, and diabetes management. Orthopedic applications include improved postsurgical recovery and rehabilitation, while wearables help in early complication detection in oncology. Mental health benefits include anxiety detection, post-traumatic stress disorder management, and stress reduction through wearable biofeedback. In conclusion, wearable health devices offer transformative potential for managing chronic illnesses by enhancing real-time monitoring and patient engagement. Despite significant improvements in adherence and outcomes, challenges with data accuracy and privacy persist. However, with ongoing innovation and collaboration, we can all be part of the solution to maximize the benefits of wearable technologies in healthcare.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Compensated advanced chronic liver disease in patients with metabolic dysfunction-associated steatotic liver disease: association with cardiometabolic factors

Aim. Тo study cardiometabolic factors and the PNPLA3 I148M (rs738409 C&gt;G) gene polymorphism in association with the compensated advanced chronic liver disease (cACLD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).Materials and methods. А retrospective cross-sectional study was conducted. The total of 108 patients with MASLD (33 men and 75 women aged 28 to 89 years) involved were divided into two groups based on results of transient elastography: group 1 – with the presence of cACLD (liver stiffness ≥ 8.0 kPa) – 18 patients and group 2 – without cACLD (&lt;8.0 kPa) – 90 patients. Cardiometabolic risk factors and the PNPLA3 I148M (rs738409 C&gt;G) gene polymorphism were studied in both groups. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, and a logistic regression model was constructed for the detection of cACLD.Results. Compared to group 2, patients with cACLD had statistically significant higher prevalence of: arterial hypertension (p &lt; 0.05), type 2 diabetes mellitus (p &lt; 0.01), obesity (p &lt; 0.05), dyslipidemia (p &lt; 0.05), and PNPLA3 gene polymorphism (p &lt; 0.05). The OR for cACLD in individuals with arterial hypertension was 5.58 (95% CI: 1.21–25.71; p &lt; 0.05), with type 2 diabetes mellitus – 4.58 (95% CI: 1.59–13.21; p &lt; 0.01), with obesity – 3.83 (95% CI: 1.17–12.52; p &lt; 0.05), with dyslipidemia – 6.12 (95% CI: 1.33–28.20; p &lt; 0.05), in the presence of a polymorphic variant of the PNPLA3 gene in a hetero or homozygous state – 3.9 (95% CI: 1.28–11.89; p &lt; 0.05). The binary logistic regression model for detecting cACLD included type 2 diabetes mellitus, dyslipidemia, and waist circumference. The area under the ROC curve was 0.81 (95% CI: 0.70–0.92), sensitivity was 72.2%, specificity was 74.4%, and accuracy was 84.3%.Conclusion. Type 2 diabetes mellitus, dyslipidemia, and waist circumference are the determining factors for the development of cACLD in patients with MASLD. The PNPLA3 I148M gene polymorphism does not play a leading role in the development of progressive MASLD in the study cohort.

Redox Homeostasis and Non-Invasive Assessment of Significant Liver Fibrosis by Shear Wave Elastography.

Hepatic fibrosis with various origins can be estimated non-invasively by using certain biomarkers and imaging-based measurements. The aim of our study was to examine redox homeostasis biomarkers and liver stiffness measurements for the assessment of significant liver fibrosis in different etiologies of chronic liver diseases. A cohort study consisting of 88 chronic liver disease patients of both sexes (age 49.1 ± 14.7 years) was performed. Cytokine profiles as well as redox homeostasis characteristics were determined. Liver fibrosis stages were assessed with shear wave elastography. The plasma levels of four cytokines showed no significant alteration between the four fibrotic stages; however, higher values were measured in the F2-4 stages. Free sulfhydryl group concentration, the marker of redox homeostasis, was lower in significant fibrosis (F0-F1: 0.36 ± 0.06 vs. F2-4: 0.29 ± 0.08 mmol/L, p < 0.05). Higher chemiluminescence values, as free radical-antioxidant parameters, were detected in advanced fibrosis stages in erythrocytes (F0-F1: 36.00 ± 37.13 vs. F2-4: 51.47 ± 44.34 RLU%). These data suggest that oxidative stress markers can predict significant fibrosis, with the aim of reducing the number of protocol liver biopsies in patients unlikely to have significant disease; however, their role in distinguishing between the certain fibrosis groups needs further studies.

Splenic and Liver Elastography in Prediction of Esophageal Varices and Variceal Severity in Patients with Chronic Liver Disease: A Diagnostic Validation Study

Abstract Objective The aim of this study was to assess the value of shear wave elastography (SWE) to predict the presence of esophageal varices (EVs) and to predict high-grade EV in patients with chronic liver disease (CLD). Methods A cross-sectional observational study was conducted. One hundred twenty-one CLD patients were recruited. Liver stiffness (LS) and splenic stiffness (SS) were measured using SWE. Results Evaluation of LS is superior to SS in predicting the presence of EV. Evaluation of SS is more valuable than LS in grading EV. Conclusion LS and SS have good diagnostic performance in predicting and grading varices. SWE is simple to incorporate into standard ultrasonography assessments in patients with CLD. SWE can be used as an adjunct to upper gastrointestinal endoscopy to screen and monitor CLD patient.

A Comparative Analysis of Heart Rate Variability Indices in Patients with Liver Cirrhosis.

Cardiac autonomic dysfunction (AD) in reference to chronic liver disease (CLD) has become widely accepted as a symptomatic burden. This study will be undertaken to measure heart rate variability (HRV) indices and detect the severity of cardiac autonomic dysfunction in CLD patients. This study was conducted on 150 patients with liver cirrhosis and compared with 110 healthy controls. Information concerning medical history, radiological and laboratory findings was extracted for interpretation and association among both groups. The HRV was assessed by recording with a polygraph (RMS Polyrite D, version 1.0), which was based on the principle of electrocardiography. Heart rate variability indices like standard deviation of each interval normal-to-normal (SDNN), percentage of successive RR intervals that differ by >50 ms (pNN50%), high frequency (HF), low frequency (LF), and the LF/HF ratio were found to be remarkably low in cases with CLD in comparison to the healthy control group (p < 0.05). The Child-Pugh (CP) score was class C (10-15) in 52%, class B (7-9) in 30%, and class A (5-6) in 18% of patients. The CP score in CLD patients had a statistically significant negative correlation with SDNN (r = -0.5429, p < 0.001), root mean square of successive differences (RMSSD) (r = -0.375, p < 0.001), pNN50% (r = -0.6037, p < 0.001), HF (r = -0.2033, p = 0.0125), and LF (r = -0.3674, p < 0.001). SDNN, pNN50%, and LF parameters were lowest in alcohol-related CLD, highest in hepatitis C virus (HCV)-related CLD, and intermediate in hepatitis B virus (HBV)-related CLD. Our study concluded that liver cirrhosis patients have reduced HRV compared to healthy individuals. A decrease in HRV highlights people at risk of death. This is a variable that can be used to track patients over time and aid in transplant selection.

Relationship Between Depression and Medication Adherence Among Chronic Disease Patients in the Middle East.

Background and aim Medication adherence is a crucial factor in the management of chronic diseases. Depression is a common psychiatric disorder that has been correlated with poor adherence to medication. Adherence to medication in patients with chronic diseases is a well-known concern among the medical community, particularly when considering the adverse outcomes of adherence failure in such patients. Therefore, this study aims to investigatethe relationship between depression and medication adherence among chronic disease patients in the Middle East. Methodology This cross-sectional study was conducted between January 2024 and April 2024 among patients with chronic diseasesfrom the Middle East. The data were collected through convenient sampling using structured online-based questionnaires that included demographic information, type of chronic condition, medication adherence (measured by the Adherence to Refills and Medications Scale (ARMS)), and depression severity (measured by the Patient Health Questionnaire-9 (PHQ-9)). Statistical analyses were conducted to examine the associations between these variables. Results The study involved492 participantswith chronic diseases and found significant associations between demographic factors and medication adherence. Female participants were more likely to be non-adherent than males (p = 0.001), and younger participants aged 20-30 years exhibited higher non-adherence rates (46.7%) compared to older participants, 61 years and above (16.1%, p = 0.001). Non-working individuals showed higher non-adherence (45.4%) compared to retired individuals (21.5%, p = 0.003). Depression severity was inversely related to medication adherence; participants with severe depression were significantly more likely to be non-adherent (relative risk (RR) = 8.41, 95% confidence interval (CI): 4.26-16.57, p < 0.001). In addition, certain chronic conditions were more impactful on medication adherence and depression rates, such as patients withrheumatoid disease that had lower rates of none to minimal depression (8.6%) and higher rates of moderately severe - severe depression each (28.6%). Meanwhile, asthma patients showed notably lower adherence rates (41.0%) and higher levels of severe depression (24.6%). Conclusion The study highlights the intricate relationships between demographic factors, chronic conditions, medication adherence, and depression in patients with chronic diseases in the Middle East. Gender, age, occupational status, and marital status significantly influence adherence and depression levels. Depression is a significant factor associated with decreased levels of adherence among patients with chronic conditions. Regular screening todetect and manage depression among chronically ill patients is advised to help improve medication adherence.