Fatty Infiltration Of Liver Research Articles

The study of lipotropic action of extract from fruit prunus domestica «Prunofit» byanimal models of alcoholic liver diseases

Searchingof drugs that normalize the function of the digestive glands are important because disruption of digestion underlie the pathogenesis of many diseases such as gastroesophageal reflux disease, hepatitis, gastric ulcer, irritable bowel syndrome, cancer etc. The use of herbal objects containing fibres is a promising direction for solving of the mentioned problem. We were attracted by fruits of Prunus domestica which are rich in fibres (homo- and heteropolsaccharides) and are used in folk medicine as a laxative and hepatoprotective agent.
 The aim of this experimental study was to investigate the lipotropic properties of «Prunofit» extract. The study of lipotropic properties of the «Prunofit» was carried out in the conditions of subacute toxic liver damage caused by the introduction of ethanol.The content of total lipids (TL), total cholesterol (TCh), triacylglycerols (TGs), unsaturated fatty acids (UFA) and total phospholipids (TPL) were determined in liver and blood serum.
 Obtained results of the lipotropic properties study of the «Prunofit» extract at a dose of 200 mg/kg against the background of alcoholic liver damage showed a decrease in the intensity of lipolysis, fatty hepatosis, and manifestations of hyperlipidemia. It has occurred due to a decrease in the content of total lipids, cholesterol, triglycerides and free fatty acids in the homogenate rat liver by 27.9%, 7.2%, 27.5% and 38%, respectively, and rat serum by 28%, 42.2%, 8.15%, 47.1%, respectively, compared with the control pathology. Against the background of model pathology, «Prunofit» extract tended to increase the content of total phospholipids in the liver homogenate by 37.34% and in serum by 30.2% compared with the control pathology. According to its ability to inhibit fatty liver infiltration, the «Prunofit» extract was at the level of the reference drug «Methionine» at a dose of 155 mg/kg.

X-ray computer densitometry in the diagnosis of fat hepatosis

Currently, the problem of reducing the risk of developing fat liver hepatosis from exposure to household and industrial toxicants among the working-age population continues to be an important medical and social problem, since not timely diagnosis of the disease can lead to its progressive course with the development of inflammatory changes, necrosis and liver fibrosis up to cirrhosis and hepatocellular cancer. In this regard, the search for methods and techniques that optimize the diagnosis of fat hepatosis is relevant. Modern methods of radiation diagnostics of liver density characteristics can significantly reduce subjectivity in the assessment of changes due to the use of quantitative indicators. The aim of study - improving the quality of x-ray diagnostics of fat liver disease based on a precision assessment of the density of the liver parenchyma using computed tomography. A comparative retrospective analysis of the results of a comprehensive clinical and radiological examination of 115 men of working age in the range of 40-55 years was performed. The main group (48 people) - employees of machine-building plants: shapers, stumpers, fitters-assemblers who had industrial contact with such factors as local vibration, dust, noise, muscle strain, burdened with a long alcoholic history and the presence of signs of metabolic syndrome: hyperlipidemia, impaired tolerance to carbohydrates, diabetes, abdominal obesity. The comparison group included representatives of auxiliary professions without clinical signs of pathology (47 people), comparable in age and experience with the main group. X-ray examinations were performed using computer tomographs: "HI Spead CT/e Dual" by GE Medical Systems and "Aqulion 64" by Toshiba. To measure the liver density in Hounsfield units (HU), the ROI (zone of interest) tool was used, which allows determining the desired value over areas of different dimensions. Measurements were performed on computer screens in 4 zones of interest at 4 levels of scanning of the liver lobes (apex, level of the caval gate, level of the left lobe, level of the portal gate) with the calculation of the average values of the density index (IDH) and density gradients (IDG) relative to the aorta, spleen and kidney. Analysis of the results of a posteriori CT densitometry of various parts of the liver within the framework of the developed algorithm, including the use of absolute and relative (gradient) x-ray density indicators of hepatic, vascular (aorta),splenic and renal structures, allowed us to expand our understanding of the quantitative density characteristics both in normal and in patients with signs of diffuse fat hepatosis (FH). It was found that the liver parenchyma density indicators can be a kind of (conditional), sometimes the only indicators of the degree of severity of changes that objectively manifest positive or negative dynamics of pathophysiological processes and, in particular, at the initial stages of the development of the studied pathology. Density differences in the right and left liver parenchyma in the control group (conditional norm) in terms of absolute density and its gradient, regardless of the level of scanning, were insignificant (statistically unreliable). In patients with clinical signs of fatty liver infiltration at the stage of steatosis, in the absence of x-ray morphologically detectable structural changes, a decrease in IDH and the dynamics of its increase (recovery) at various stages of observation were revealed. Even with comparatively equal IDH of the evaluated departments, the IDG of different people differed, manifesting the individuality of metabolic processes occurring in the body, in particular in the liver, is a kind of indicator of their direction and severity. The significance of density indicators as predictors of the subsequent stages of the pathology under consideration was particularly evident in the analysis of the results of primary diagnostics and its development in the dynamics of observations. The application of the developed methodological approach allowed us to expand our understanding of the possibilities of KT-liver densitometry in patients with metabolic syndrome (hyperlipidemia, impaired carbohydrate tolerance, diabetes mellitus, abdominal obesity) in the diagnosis of fatty liver disease (FLD) at various stages of examination, including in the early subclinical phases of pathology development. The results obtained indicate the predominant role of ethyl alcohol as a hepatotoxicant in the development of FLD in the estimated cohort of the working-age population. The use of an original algorithm for evaluating tissue density makes it possible to significantly ensure the objectivity of the interpretation of research results.

EFFECT OF YAMANIKADI CHOORNAM IN NON-ALCOHOLIC FATTY LIVER DISEASE: A CASE STUDY

Non-alcoholic fatty liver is defined as the accumulation of fat in the liver parenchyma without inflammation in the absence of excess alcohol consumption. Its prevalence is increasing in the society due to westernized and changing life style. Higher incident rate are there among the obese and diabetic patients. As per the records from W.H.O, the number of chronic liver diseases including NAFLD had a steady growth in recent years. NAFLD exist as a risk factor in patients with heart diseases, kidney diseases and cancer. In Ayurveda, liver diseases are mentioned under the contexts of Udara and Kamala. NAFLD can be considered as a santarpanothavyadhi in which there is agnimandya and kaphamedo dushti. Eventually when sthanasramsaya takes place in the liver, the disease will manifest. A 60 year old male patient, with complaints of poor appetite, right upper quadrant discomfort and fatigue came with an USG report which showed grade II fatty infiltration of liver. On investigation slight elevation of SGPT was noted. Patient was advised to take Yamanikadi Choornam daily twice in the dose of 5 gm choorna with hot water as Anupana for 45 days. Yamanikadi Choornam is a formulation mentioned in Bhaishajya Ratnavali, Plihayakrut rogadhikar, having kaphamedohara deepana, pachana and hepatoprotective property. The fatty infiltration of the liver was found reduced to grade I and the liver function got normal at the time of completion of the treatment. The drug Yamanikadi Choorna was effective in improving liver function and reducing the fatty infiltration of the liver.

Effect of laparoscopic sleeve gastrectomy on metabolic syndrome in adolescent obesity

Metabolic syndrome (MeS) is a group of physiological, biochemical, clinical, and metabolic factors which increase the incidence of atherosclerosis, type 2 diabetes mellitus, and early mortality. Overall prevalence of MeS is around 3.3%, 11.9% in overweight, 29.2% in obese, and less than 1% in non-obese children. Nearly, 90% of obese children and adolescents have at least one parameter of MeS. Clinical and metabolic evaluation of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG). Prospective study included analysis of data from 35 adolescents (12–19 years) with body mass index (BMI) above 99th percentile for age and sex. All of them had metabolic syndrome and were submitted to LSG between 2015 and 2017. Anthropometric measurements, clinical and laboratory assessment were performed, preoperatively, 6, 12, and 24 months postoperatively. Mean age was 16.43 years and mean preoperative weight and BMI were 132.68 kg and 48.90, respectively. Mean excess weight loss (EWL) was 54.11 kg after 12 months’ and 51.19 kg after 24-months post-LSG, corresponding to 74 and 73 EWL%, respectively, as well as mean BMI loss (BML) of 19.89 and 18.7 kg/m2. LSG improved fatty infiltration of liver in 93% of cases and other comorbidities in 100% of patients. Laparoscopic sleeve gastrectomy (LSG) proved as a safe and effective procedure for adolescent obesity and its related metabolic morbidities.

Predicting Nonalcoholic Fatty Liver Disease through a Panel of Plasma Biomarkers and MicroRNAs in Female West Virginia Population.

(1) Background: Nonalcoholic fatty liver disease (NAFLD) is primarily characterized by the presence of fatty liver, hepatic inflammation and fibrogenesis eventually leading to nonalcoholic steatohepatitis (NASH) or cirrhosis. Obesity and diabetes are common risk factors associated with the development and progression of NAFLD, with one of the highest prevalence of these diseased conditions in the West Virginia population. Currently, the diagnosis of NAFLD is limited to radiologic studies and biopsies, which are not cost-effective and highly invasive. Hence, this study aimed to develop a panel and assess the progressive levels of circulatory biomarkers and miRNA expression in patients at risk for progression to NASH to allow early intervention strategies. (2) Methods: In total, 62 female patients were enrolled and blood samples were collected after 8–10 h of fasting. Computed tomography was performed on abdomen/pelvis following IV contrast administration. The patients were divided into the following groups: Healthy subjects with normal BMI and normal fasting blood glucose (Control, n = 20), Obese with high BMI and normal fasting blood glucose (Obese, n = 20) and Obese with high fasting blood glucose (Obese + DM, n = 22). Based on findings from CT, another subset was created from Obese + DM group with patients who showed signs of fatty liver infiltration (Obese + DM(FI), n = 10). ELISA was performed for measurement of plasma biomarkers and RT-PCR was performed for circulating miRNA expression. (3) Results: Our results show significantly increased levels of plasma IL-6, Leptin and FABP-1, while significantly decreased level of adiponectin in Obese, Obese + DM and Obese + DM(FI) group, as compared to healthy controls. The level of CK-18 was significantly increased in Obese + DM(FI) group as compared to control. Subsequently, the expression of miR-122, miR-34a, miR-375, miR-16 and miR-21 was significantly increased in Obese + DM and Obese + DM(FI) group as compared to healthy control. Our results also show distinct correlation of IL-6, FABP-1 and adiponectin levels with the expression of miRNAs in relation to the extent of NAFLD progression. (4) Conclusion: Our results support the clinical application of these biomarkers and miRNAs in monitoring the progression of NAFLD, suggesting a more advanced diagnostic potential of this panel than conventional methods. This panel may provide an appropriate method for early prognosis and management of NAFLD and subsequent adverse hepatic pathophysiology, potentially reducing the disease burden on the West Virginia population.

Associação da doença hepática gordurosa não-alcoólica e do modelo de avaliação da homeostase de resistência à insulina

Objetivo: Correlacionar os valores do Modelo de Avaliação da Homeostase de Resistência à Insulina (HOMA-IR) com graus da esteatose hepática não alcoólica. Métodos: Estudo clínico e prospectivo, aprovado pelo Comitê de Ética através do protocolo 2.314.735 e realizado no período entre outubro de 2017 e julho de 2018, em um centro de referência em ultrassonografia em Aracaju-SE. Foram dosadas a glicemia em jejum e a insulina sérica de todos os pacientes. A seguinte fórmula foi usada para o cálculo do HOMA-IR: (glicemia em jejum X insulina basal X 0,0555)/22,5. Resultados: De 114 pacientes, 7 foram enquadrados nos critérios de exclusão, sendo a amostra final 107. A presença de esteatose hepática não alcoólica foi encontrada em 90 (84,11%) pacientes. Deles, 40 correspondiam ao grau 1; 42 ao grau 2 e 8 apresentaram grau 3. O HOMA-IR foi calculado e se mostrou diretamente proporcional à gravidade da esteatose hepática. A ausência de infiltração gordurosa hepática teve uma média do HOMA-IR de 1,30; o grau 1 de 2,23; o grau 2 de 3,00 e o grau 3 de 8,05. Conclusão: O HOMA-IR é um parâmetro não invasivo que pode ser usado para ajudar na avaliação da gravidade da esteatose hepática não alcoólica.

Hepatobiliary manifestations in children with inflammatory bowel disease: A single-center experience in a low/middle income country.

BACKGROUNDThere has been a worldwide increase in the reported incidence of inflammatory bowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB) manifestations of IBD have been well-studied in children in industrialized and developed countries but are infrequently reported in low- and middle-income countries (LMIC) such as Egypt.AIMTo determine the prevalence of the HB manifestations in a cohort of Egyptian children with IBD.METHODSThis cross-sectional observational study was carried out over a period of 6 mo (between June 2013 to December 2013) at the Paediatric Hepatology and Gastroenterology Units of Cairo University Children's Hospital, which is the largest paediatric tertiary care centre in the country.RESULTSThe study included 48 patients with confirmed IBD based upon clinical, laboratory, endoscopic and histopathological features, 29 (60.4%) were male. Twenty-four patients (50%) had ulcerative colitis (UC), 11 (22.9%) had Crohn's disease (CD) and 13 (27.1%) had unclassified-IBD (IBD-U), which was formerly known as indeterminate colitis. The mean age of the patients at the time of presentation was 8.14 (± SD 4.02) years and the mean age at the time of study enrolment was 10.16 (± SD 4.19) years. All patients were screened for HB manifestations by physical examination, liver function tests, imaging and liver biopsy when indicated. HB disorders were confirmed in 13 patients (27.1%). Transaminases were elevated in 3 patients (6.3%). Two patients (4.2%) had elevated biliary enzymes (one was diagnosed as primary sclerosing cholangitis (PSC) and the other was diagnosed with PSC/autoimmune hepatitis overlap syndrome and the third patient had hepatitis C virus infection. Ten patients (20.8%) had bright echogenic liver on ultrasound suggesting fatty infiltration as a sequel of malnutrition or medication toxicity.CONCLUSIONThe commonest HB disorders in Egyptian children with IBD were abnormal liver function tests, fatty infiltration and PSC. These HB manifestations in paediatric patients in LMIC may be relatively more common than in industrialized countries. Therefore, IBD patients in LMIC should be meticulously screened for liver disease to allow prompt diagnosis and management.

Non-drug treatment of non-alcoholic fatty liver disease: evaluation of effectiveness with ultrasound steatometry

Objective. Evaluation of the effectiveness of non-drug treatment in patients with non-alcoholic fatty liver disease using the method of quantitative ultrasound steatometry.Material and methods. We examined 118 patients aged 18–75 years, including 52 (44 %) men and 66 (56 %) women using a single diagnostic algorithm of four stages: questioning and collecting complaints, assessing the quality of life, clinical examination, non-invasive bioimpedansometry, followed by assessment of fat mass index, ultrasound examination of the liver in the B-mode, quantitative ultrasound steatometry by evaluating the attenuation coefficient of the ultrasonic wave. Individual non-drug therapy is prescribed to patients in the form of an individual program of therapeutic nutrition and physical activity. A dynamic assessment of the decrease in the proportion of adipose tissue and the severity of fatty liver infiltration was carried out at points of 6, 12, 18, 24 months. A liver biopsy followed by histological analysis on an SAF scale was performed in 32 patients.Results. To assess the effectiveness of non-drug treatment in patients, a tendency of reducing the proportion of fat content and the severity of fatty infiltration in the liver was observed. All patients were divided into two groups according to their level of compliance with the prescribed treatment. Decrease in the proportion of adipose tissue in patients with a high level of compliance – up to 76.2 %, in patients with a low level of compliance – up to 89.1 % of the initial values. Decrease in fatty liver infiltration in patients with a high level of compliance – up to 80.2 %, in patients with a low level of compliance – up to 92.1 % of the initial one.Conclusion. Ultrasound steatometry is an informative method for non-alcoholic fatty liver disease screening. The correlation of quantitative ultrasound diagnostics data for steatosis with a biopsy at stage S0 corresponds to r = 0.85; at stage S1 r = 0.72, at S2 r = 0.73, at stage S3 corresponds to r = 0.84, which indicates the high informativity of this method.

Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza

ObjectivesThe aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.SettingThe study was conducted in Gaza’s main hospital, Al-Shifa Hospital.ParticipantsDuring the last...

Association between non-alcoholic fatty liver disease and obstructive sleep apnea.

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is an emerging liver disease and currently the most common cause of incidental abnormal liver tests. The pathogenesis of NAFLD is multifactorial and many mechanisms that cause fatty liver infiltration, inflammation, oxidative stress and progressive fibrosis have been proposed. Obstructive sleep apnea (OSA) may be linked with the pathogenesis and the severity of NAFLD.AIMTo study the association between NAFLD and OSA considering also the efficacy of continuous positive airway pressure (CPAP) treatment.METHODSA PubMed search was conducted using the terms “non-alcoholic fatty liver disease AND (obstructive sleep apnea OR obstructive sleep disorders OR sleep apnea)”. Research was limited to title/abstract of articles published in English in the last 5 years; animal and child studies, case reports, commentaries, letters, editorials and meeting abstracts were not considered. Data were extracted on a standardized data collection table which included: First author, publication year, country, study design, number of patients involved, diagnosis and severity of OSA, diagnosis of NAFLD, patient characteristics, results of the study.RESULTSIn total, 132 articles were initially retrieved on PubMed search and 77 in the last five years. After removal of irrelevant studies, 13 articles were included in the qualitative analysis. There was a total of 2753 participants across all the studies with a mean age between 42 and 58 years. The proportion of males ranged from 21% to 87.9% and the mean body mass index ranged from 24.0 to 49.9 kg/m2. The results of this review showed an increased prevalence of NAFLD in patients with diagnosis of OSA, even in the absence of coexisting comorbidities such as obesity or metabolic syndrome. Furthermore, the severity of NAFLD is associated with the increase in OSA severity. Effective CPAP treatment, although not always decisive, may stabilize or slow NAFLD progression with benefits on metabolic and cardiovascular functions.CONCLUSIONIn NAFLD patients, although asymptomatic, it is recommended to systematically perform polysomnography in order to early and better treat them before the development of potentially life threatening systemic dysfunctions.

MON-685 Lipodystrophy, a Forgotten Syndrome

Background: Lipodystrophy comprises a group of heterogenous congenital and acquired disorders. These disorders may present as a complete or partial loss of adipose tissue. The magnitude of lipoatrophy correlates with the severity of the associated metabolic disturbances, which include severe insulin resistance, progressive liver disease, severe dyslipidemia, among others. The most prevalent form of lipodystrophy is related to antiviral use in patients with HIV. However, lipodystrophy occurring unrelated to medication side effect is often missed due to the heterogeneity and rarity of this disorder. Clinical Case: 31 year old female with medical history of type 2 diabetes mellitus, hypertension, mixed dyslipidemia and polycystic ovarian syndrome who was referred to our clinics due to difficult to control hyperglycemia. Family history was limited. She was diagnosed with diabetes mellitus at 12 years old after presenting with polyuria, polydipsia and polyphagia requiring oral antidiabetic therapy. Following poor response, she was started on insulin therapy. At 23 years old, the patient had an episode of pancreatitis associated with hypertriglyceridemia and eruptive xanthomas. Insulin pump therapy with regular U-100 insulin, total daily dose of 308 units, was initiated but failed to improve glycemic control. The patient was referred to our Endocrinology clinics due to high insulin resistance and a glycosylated hemoglobin (A1C) at 12% (n < 6.5%). Physical examination revealed a body mass index of 23 kg/m2, abnormal fat distribution predominantly over the neck and face, and acanthosis nigricans. Abdominal ultrasound revealed fatty liver infiltration consistent with intrabdominal fat deposition. Due to the constellation of the aforementioned findings, the diagnosis of partial lipodystrophy syndrome was presumed. She was started on antidiabetic therapy with metformin, pioglitazone and insulin pump therapy with U-500 insulin, and high-dose statin therapy plus fenofibrate for dyslipidemia. At follow up, the patient showed improvement in glycemic control and an improved lipid profile. She was referred to a geneticist for evaluation. Conclusion: Lipodystrophy syndromes are a group of heterogenous disorders, which may often be overlooked due to their rarity and lack of familiarity by physicians. The diagnosis of lipodystrophy is based on history, abnormal body fat distribution, and metabolic profile. The metabolic disturbances seen in these patients are mainly due to the lack of adipose tissue, which results in impaired energy storage. Early recognition of these syndromes is important because intensive treatment of hyperlipidemia and diabetes prevents development of severe complications. In this case we highlight this rare condition and the successful use of new therapeutic technology with insulin pumps and U-500 insulin in the glycemic control of a patient with lipodystrophy.

MON-597 Non-Alcoholic Fatty Liver Disease Determined by MRI and Its Association with Metabolic Variables in Non-Diabetic Subjects

Non-alcoholic fatty liver disease determined by MRI and its association with metabolic variables in non-diabetic subjectsBackground: Non-alcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic steatosis (liver fat accumulation higher than 5% of liver weight) in the absence of other causes. Liver biopsy is recognized as a gold standard for diagnosis, but it is limited by the risks of serious complications. Besides that, the increasing prevalence of NASH led to improved imaging methods, such as Magnetic Resonance Imaging (MRI), that enable quantitative assessment of steatosis by quantifying the hepatic fat fraction (HFF), even with steatosis levels as low as 5.56%.Objective: The aim of this study was to evaluate the metabolic profile of patients without T2DM according to hepatic steatosis measured by MRI.Methods: This was cross-sectional study conducted in an Endocrinology Unity in Minas Gerais, Brazil. The study complied with the WMA Declaration of Helsinki and was approved by the Ethical Committee on Human Subject Research from the Faculty Patos de Minas. We recruited non-diabetic subjects aged above 20 years with hepatic steatosis detected by liver sonography. Exclusion criteria were alcohol consumption of more than 20 grams/day for female and 30 grams/day for male, ferritin serum levels above 1000 mg/dL, positive serology for hepatitis B or C and intake of medications known to produce hepatic steatosis. Included subjects underwent HFF quantification by MRI, and the degree of liver fatty infiltration was estimated by using chemical shift imaging. The following biochemical variables were assessed: fasting glucose and HbA1c, HOMA-IR, lipids, AST, ALT and GGT. Analysis: we grouped individuals according to the quartile of HFF and compared clinical and biochemical variables between the groups.Results: A total of 30 subjects (18 male and 12 females) were included. All subjects were overweight (10% overweight and 90% obese); 7 (23.3%) had 3 criteria and 16 (53.3%) had two criteria for MS. The only variable assessed herein that was different between males and females was HDL-c (40.5 vs 50.5 mg/dL, respectively, p=0.0255). ALT serum levels were significantly higher in subjects in the fourth quartile of HFF, when compared to those in the third quartile (76 vs 47 UI/L, respectively, p=0.037). The other clinical of biochemical variables assessed did not differ between the quartiles of HFF.Conclusion: our preliminary findings indicate that the biochemical variables related to metabolic homeostasis are poor predictors of the degree of liver fat in overweight non-diabetic subjects. Although screening for NAFLD is still a matter of debate, our results suggest that future discussions about this should take into account that excess body weight per se, independently from biochemical abnormalities, should be considered in the recommendations for screening non-diabetic subjects.

Ultrasound quantitative liver steatometry in overweight patients: the possibilities of improved technique

Objective : to assess the state of the liver parenchyma in patients with fat overweight using the quantitative ultrasound steatometry method. Material and methods : 118 patients aged 19–75 years were examined, 52 of them men (44%) and 66 women (56%) due to a single 7 (8) stages diagnostic algorithm: questioning and complaints collecting, quality of life, clinical inspection, non-invasive bioimpedancemetry with subsequent assessment of fat mass index, ultrasound liver examination in B-mode, quantitative ultrasound steatometry with ultrasound wave attenuation coefficient evaluation, dual-energy X-ray absorptiometry in the «Whole body» mode, liver biopsy with histological microscopic specimens on SAF and NAS scales assessment. The control group consisted of 46 patients with a normal ration of fat mass and without ultrasound signs of fatty liver infiltration. Results : there were no signs of liver steatosis in 4 patients (3,4%) with a clinical picture of metabolic syndrome were detected using instrumental diagnostic methods. The sensitivity and specificity of B-mode were 60,4% and 72,8%, respectively, quantitative ultrasound steatometry — 90,7% and 92,4%, dual-energy X-ray absorptiometry in the «Whole body» mode — 88,7% and 90,1%. Conclusion : Ultrasound steatometry is an informative method for non-alcoholic fatty liver disease screening. The correlation of quantitative ultrasound diagnostics data for steatosis with a biopsy at stage S0 corresponds to r=0,87; at stage S1 r=0,69, S2 r=0,75, at stage S3 corresponds to r=0,86, which indicates the high informativeness of this method; Dual-energy X-ray absorptiometry in the «Whole body» mode can be used as an alternative to multislice computed tomography to identify components of the metabolic syndrome due to low radiation exposure.

Hypolipidemic Effect of Cinnamon (Cinnamomum zeylanicum) Bark Ethanolic Extract on Triton X-100 induced Hyperlipidemia in Albino Rats

Hyperlipidemia is the greatest risk factors that precipitate coronary heart disease. Medicinal may confer hypolipidemic effects in order to compliment the cardiovascular diseases treatment regimen. The aim of this study was to investigate hypolipidemic effect of cinnamon bark ethanolic extract in Triton X-100 induced hyperlipidemic in rats. Twenty five adult male albino rats (150-250 g) were randomly divided into five groups: group A stand as negative control, group B stand as positive control, groups C and D received 250 and 500 mg/kg cinnamon extract respectively and group E received atorvastatin 10 mg/kg after of induction of hyperlipidemia by Triton X-100 for seven days. The results was showed a significant (p<0.05) hypolipidemic effect on cholesterol and triglycerides of cinnamon extract in groups administered 250 and 500 mg/kg compared with the negative and positive control group. Also the hepatic histopathological study was showed that the cinnamon ethanol extract has preventive effect from liver fatty infiltration and granular degeneration.

Патоморфологічні зміни в організмі ящірки прудкої (Lacerta agilis) за асоційованого перебігу ешерихіозу та стафілококозу

Bacterial infections occupy a leading place among all diseases of reptiles. The study of these diseases in the organism of sand lizard (Lacerta agilis), which can be a carrier of infections, has not been deeply conducted. Thus, the investigation of diseases of bacterial etiology in lizards is actual. The article presents the results of the study of pathomorphological changes in the sand lizard organism during the associative course of escherichiosis and staphylococcosis. The results of research indicates the prevalence of dangerous pathogens among reptiles that can cause infectious diseases in humans and animals. The pathoanatomical dissection of reptile corpses, the histological examination of internal organs and the investigation of conditionally pathogenic microflora of sand lizard using bacteriological studies were carried out. According to the results of autopsy, focal serous pneumonia, fatty hepatosis, acute catarrhal gastroenterocolitis, flatulence, nephritis and splenitis were found in the organism of sand lizards. The histological examination of lungs revealed small focal cells of serous and fibrinous pneumonia in the form of accumulations in the lumen of the alveoli of an amorphous eosinophilic mass with sieve-like impurities of fibrin, single neutrophils and lymphocytes. Polymorphic cellular infiltrates were detected. In the liver, diffuse fine-grained and focal coarse-grained fatty infiltration of hepatocytes, hyperplasia of Kupffer cells and small-focal cellular infiltrates were registered. In the kidneys, inflammatory hyperemia, extracapillary serous glomerulonephritis, interstitial nephritis with polymorphic cellular infiltrates, hydropic dystrophy and necrosis of nephrocytes were observed. In the spleen, pathological changes were manifested in the form of hyperemia, edema of the connective and reticular tissue, focal necrosis of the reticular tissue and leukocyte infiltration of the red pulp. There was the hyperplasia of lymph nodes. In the median and posterior sections of the digestive tube, catarrhal inflammation, connective tissue edema, hydropic dystrophy and necrosis of epithelial cells, alterative processes, inflammatory infiltration and lymph nodes hyperplasia were detected.

Usefulness of Preoperative Trans-Abdominal Ultrasound Prior to Bariatric Surgery

An enlarged left lobe of liver can complicate bariatric surgery. Preoperative ultrasound of the abdomen is routinely performed in bariatric patients to measure the liver, particularly the left lobe, as well as to record any ancillary findings such as gallstones. Our study aims to evaluate the reliability of ultrasound in evaluating the craniocaudal length of the left lobe of the liver vis-a-vis intraoperative measurements. It also aims to assess the impact of ancillary findings detected on ultrasound, on the pre-surgical preparation and follow-up of such patients. Forty patients who were to undergo bariatric surgery in our hospital between June 2018 and May 2019 were included in this study. All of these patients underwent preoperative ultrasound. The measurements of the left lobe of liver evaluated on ultrasound were compared with the intraoperative measurements. Mean preoperative BMI for the forty patients was 41.47 kg/m2. On applying the paired t test, the left liver lobe measurements calculated by our ultrasound technique correlated with intraoperative measurements. The left liver lobe length measured less than 15 cm in all 40 patients. Ultrasound detected ancillary findings in 8 (20%) patients. Ultrasound showed fatty infiltration of liver in approximately 80% of the patients with a trend towards increasing incidence of fatty change with increasing BMI. Our study showed that left liver lobe measurements calculated by preoperative ultrasound correlate with intraoperative measurements. Ancillary ultrasound findings helped the surgeon in preparing for the bariatric surgery and may modify the follow-up protocol in such patients.

P2645Cardiovascular risk in patients with essential hypertension and nonalcoholic fatty liver disease comorbidity

Abstract Very often acute myocardial infarction and stroke are recorded among patients with essential hypertension (EH) and non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatosis (NASP), comorbidity. The aim of the study was to improve cardiovascular risk assessment in patients with combination of second stage EH and NASP, using the metabolism indexes, structural-functional indicators of heart and blood vessels. According to the study results of 170 patients with second stage of EH (98 (57.6%) were women and 72 (42.4%) - men), mean age 49.3±0.5) it was found that NASP was confirmed in 109 (64.1%) patients (SteatoTest - 0.41 units (S1-S2)). Total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL); very low (LDL) and low density (LDL) lipoproteins; atherogenic index (IA); lipoprotein (a) (Lp (a)), insulin, HOMA index, tumor necrosis factor α (TNFα)), adiponectin were determined among all patients. The instrumental examination included electrocardiography, echocardiography, daily blood pressure monitoring (DBPM), carotid arteries ultrasound, calculation of endothelial dysfunction index (EDI) (as the ratio of endothelial-dependent to endothelial-independent vasodilation) and arterial wall stiffness (AS). Statistical processing of the results was conducted by Microsoft Excel, STATISTICA for Windows 10.0 programs. The proaterogenic lipid spectrum changes (TC (7.7%, p=0.0009), TG (19.8%, p=0.02), LDL (11,8%, p=0.0009), IA (8,8%, p=0.04), increased levels of Lp (a) (58.0%, p=0.0007) TNFα (51.4%, p=0.01), insulin resistance (HOMA index - 3.3 units), decreased adiponectin level (44.3%, p=0.0002) were reported in patients with II stage EH and NASP comorbidity compared to patients with EH without fatty liver infiltration (p&lt;0.05). Higher systolic (SBP) and pulse arterial pressure (PBP) (both office measurement and DBPM), daily SBP index “nondipper” (63.3% of patients, p&lt;0.05); increased by 2 times the frequency of the registration of atherosclerotic plaques in both carotid arteries (p&lt;0.05), increase in AS (15.7%, p=0.002) and EDI reduction (−12.5%, p=0.01) were determined in patients with II stage EH and concomitant NASP compared with EH patients without NASP. True (p&lt;0.ehz748.096601) direct correlation bonds were established between the NASP and the level of TC (rs=0.38), TG (rs=0.31), LDL (rs=0.31), Lp (a (rs=0.51), insulin resistance (rs=0.47), TNF-α (rs=0.49), night SBP and PBP (rs=0.33 and rs=0.29), variability night SBP, AS (rs=0.41), reverse – with the level of adiponectin (rs=−0.48) and EDI (rs=−0.58). Thus, in patients with second stage EH NAFLD is associated with negative metabolic changes and structural and functional desorders of heart and blood vessels and can be considered as an additional factor of the overall cardiovascular risk increasing in patients with EH.

SARCOPENIA AND SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE.

Non-alcoholic fatty liver disease is characterized by deposition of lipids in the hepatic parenchyma exceeding 5% of liver weight in the absence of other conditions, such as viral or alcoholic hepatitis and metabolic disease. Non-alcoholic fatty liver disease is the most common form of chronic liver disease in several countries. In addition to liver complications, recent studies have shown a relation between liver fat and sarcopenia. Determine the association between sarcopenia and the severity of non-alcoholic hepatic steatosis diagnosed by abdominal ultrasonography. A clinical, cross-sectional study was conducted with a sample of male and female adults (18 to 70 years of age) submitted to ultrasonography for the investigation of non-alcoholic hepatic steatosis. Evaluations were also performed for the determination of upper and lower limb muscle strength. Data analysis was performed with the aid of the SPSS 22.0 program and involved ANCOVA and the Bonferroni post hoc test, with P-value <0.05 considered indicative of statistical significance. One hundred two patients were submitted to abdominal ultrasonography, 57.8% of whom presented some degree of non-alcoholic hepatic steatosis. The presence and degree of fatty liver infiltration were significantly associated with the sarcopenic index, determined by the ratio between upper and lower limb strength and BMI (P=0.009 and post-test P=0.028 for upper limbs; P=0.006 and post-test P=0.013 for lower limbs). In the present study, an association was found between the sarcopenic index and non-alcoholic hepatic steatosis, with an inversely proportional relation between this index and the severity of fatty infiltration. This finding offers further evidence of the metabolic interaction of the liver, adipose tissue and muscle.

Correlation of BMI and elevated liver enzyme levels with severity of fatty liver infiltration on ultrasound in Sangrur, Punjab

Obesity is a common disorder in our country. It leads to many health risks. Ultrasonography can accurately assess the severity of fatty infiltration in liver. The liver enzymes (AST, ALT) are also altered in triglyceride overload. This study aims to assess the severity of fatty liver on US (Ultrasonography) with increased BMI and to investigate the association of severity of fatty liver with liver enzymes. A comparative prospective study was conducted on 179 patients. Severity of fatty liver was graded on Ultrasonography as follows- Group A- Normal liver, Group B- Grade 1 fatty changes, Group C-Grade 2 fatty changes and Group D-Grade 3 fatty changes. BMI of each patient was calculated. Patients with known liver disease were excluded. Serum liver enzyme levels were recorded. There was significant correlation between value of liver enzymes and increasing BMI. Also, Patients with more BMI have higher grade of fatty infiltration. Keywords: Obesity, AST, ALT, Ultrasonography

Practical Use of Transient Elastography in Screening for Nonalcoholic Steatohepatitis in a Japanese Population.

Background and Aims: Fatty infiltration of liver may induce insulin resistance (IR), and a proportion of patients with nonalcoholic fatty liver disease (NAFLD) is diagnosed with nonalcoholic steatohepatitis. Transient elastography is gaining popularity as a means of non-invasively determining both liver stiffness (fibrosis level) and degree of fatty infiltration, expressed as controlled attenuation parameter (CAP) value.Methods: The aims of this study were to investigate the association between IR and level of fatty liver, and to identify the group at a greater risk of nonalcoholic steatohepatitis using transient elastography and other noninvasive fibrosis markers. A total of 169 patients without chronic hepatitis B and C were analyzed.Results: The CAP value was significantly associated with IR (HOMA-IR ≥2.5; AUROC = 0.81), and the optimal cut-off to discriminate IR was 264 dB/m. The liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index values were significantly higher for CAP ≥264 than in CAP <264. The 9 patients among the overall 169 patients (5.3%) and among the 102 NAFLD patients (8.8%) who showed ≥264 dB and ≥7.0 kPa in transient elastography could represent good candidates for liver biopsy.Conclusions: Evaluation of NAFLD based on CAP values was useful in diagnosing IR. About 9% of NAFLD patients in a Japanese outpatient clinic with a few metabolic complications might be considered good candidates for liver biopsy to confirm nonalcoholic steatohepatitis.