Background and Aims: To eliminate the anti-definition of non-alcoholic fatty liver disease (NAFLD), positive clinical criteria for metabolic associated fatty liver disease are recently proposed. In this study, we examine the validation and utilization of these criteria.
METHODS: Two cohorts of 316 consecutive patients were recruited, including 242 patients previously diagnosed to have NAFLD and 74 patients with concomitant NAFLD and chronic hepatitis C (CHC) The validity of the proposed criteria for MAFLD, namely presence of hepatic steatosis with one of three criteria, overweight/obesity, diabetes or evidence of metabolic dysregulation was assessed. Fibrosis was assessed using, fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS). The impact of MAFLD on the clinical outcomes in CHC patients was also investigated.
Results: The clinical criteria captured 240 patients (99.2%). 215 (88.8%) met either overweight or diabetes and 25 (10.3%) met the presence of 2 criteria of metabolic dysfunction. In patients, with dual etiologies, in the multivariable analysis adjusting for age, sex, BMI, ALT, AST and diabetes, the presence of MAFLD were significantly associated with increase high FIB-4 score of fibrosis (Odds ratio [95% confidence interval], 3.77 [1.49-9.48], P < 0.005) when compared to those with MAFLD only.
CONCLUSION: The proposed criteria for diagnosis of MAFLD is well validated and easily applicable to the entire spectrum of disease including non-obese subjects. Patients with lean MAFLD have favorable metabolic and fibrosis characteristics compared to their obese counterpart, while patients with concomitant MAFLD and CHC had severe metabolic and fibrosis characteristics compared to patients with MAFLD alone.
In BDC patients with ENBD or PTCD, repeated BAC is useful, and six times was the optimum number of repeat samplings. Although the sensitivity of BAC is not sufficient for the preoperative diagnosis of malignant biliary stricture, the three independent factors noted above predict positive yields and indicate whether or not BAC should be repeated up to six times.
Background: variceal bleeding (VB) is a medical emergency. Endoscopic variceal ligation (EVL) performed quickly is beneficial. Evenafter EVL, somatostatin is still utilized in the VB band for 2–5 days. The advantage of continuing somatostatin after EVL is uncertainsince EVL is the main method for achieving hemostasis.Aim and objectives: to determine if continuing somatostatin after EVL is effective in reducing mortality and rebleeding.Subjects and methods: In this study, 75 patients with variceal bleeding were divided into two treatment groups (TG); TG2 & TG5,which received somatostatin (250 micrograme bolus + a continuous infusion of 500 micrograme/h) for two days and five days,respectively, and one control group (TG0), which received 0.9 percent normal saline and was monitored for six weeks.Result: There were a total of 8 rebleeds; they happened more often in the TG0 (4%) and TG2 (2.6%) and TG5 (4%) groups, albeit notstatistically significantly (P=0.751). The treatment group substantially experienced more adverse drug reactions (ADRs) than the controlgroup (P=0.003). Diarrhoea was the most frequent ADR, followed by hyperglycemia and bradycardia, with 14 patients mentioning twoor more ADR. In comparison to the control group, ADR was considerably greater in the treatment groups. As the days of somatostatinmedication increased, the length of the hospital stay rose considerably (P=0.041).Conclusion: We conclude that in acute VB, there is no justification for continuing somatostatin after EVL since it had no beneficialeffect on preventing rebleeding and, instead, increased the risk of ADR and length of hospital stay.
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