Association of low serum 25-Hydroxy vitamin D [25(OH) d] with hepatic encephalopathy in patients with decompensated liver cirrhosis.

BACKGROUND AND STUDY AIMS: The mechanism of hepatic encephalopathy is complex and has not been conclusively established. Recent studies support lower serum 25-Hydroxy Vitamin D [25(OH) D] levels in patients with hepatic encephalopathy. This study aimed to evaluate the association between serum 25(OH) D and hepatic encephalopathy in patients with decompensated cirrhosis of liver. PATIENTS AND METHODS: A total of 70 cirrhosis patients (35 cases of hepatic encephalopathy and 35 patients without encephalopathy as control, mean age 53.07 ± 12.99 years, 67 % male) were recruited for this study. Assessment of the severity of cirrhosis was done by using a model for end-stage liver disease(MELD) and Child Turcotte Pugh (CTP) scores, and assessment of the severity of hepatic encephalopathy was done according to West Haven criteria. Serum 25 (OH) D level was measured by Chemiluminescent Microparticle Immuno Assay(CMIA). RESULTS: The mean serum 25(OH) D level among hepatic encephalopathy patients was significantly lower in comparison to the control group without encephalopathy (18.76 ± 8.84 nmol/L vs 31.19 ± 13.9 nmol/L, P<0.0001). 91.4 % of hepatic encephalopathy patients had moderate to severe 25(OH)D deficiency as compared to 51.4 % in the control group. There was a significant correlation observed between the severity of the 25 (OH) D deficiency and the severity of liver disease (r =  - 0.35, P = 0.002). No statistically significant difference in serum 25(OH) D levels was found among patients with different hepatic encephalopathy grades (P = 0.416). CONCLUSION: A significant association was found between a low serum 25(OH) D leveland hepatic encephalopathy. It requires further large-scale multicenter studies to establish it as a risk factor and predictor of hepatic encephalopathy.

Salinity hazard drives the alteration of occupation, land use and ecosystem service in the coastal areas: Evidence from the south-western coastal region of Bangladesh.

Understanding the salinity effects on the rural livelihood and ecosystems services are essential for policy implications and mitigations. Salinity-driven modulation in land use and land cover, community traditional occupations, and ecosystem service have been elucidated in the present investigation. The study was carried out in the south-western region of Bangladesh as a representative case using focus group discussions, questionnaire survey, and remote sensing techniques. The findings showed that salinity-induced land use changes seriously threatened ecosystem services, employment and livelihoods. Shrimp farming was found to have replaced the majority of agricultural and bare lands, which led to the poor locals losing their land. The increasing land transformation to shrimp ponds as a coping strategy with salinity was not reported to be a viable option as maximum marginal poor people were unable to run the capital-intensive shrimp aquaculture. Eventually, many rich people occupied the cropland for shrimp farming which forced the traditional farmers and fishermen to leave their job and sell their labor. Many of the traditional services derived from the ecosystems were drastically reduced or got lost. The ultimate effect on the traditional livelihoods of the communities increased vulnerability and reduced resilience. The findings could aid in formulating realistic policies and action for ensuring the future resilience of the community through an appropriate adaptation strategy, such as introducing salinity-tolerant crops and integrated farming to safeguard the interest of the poor farmers. Despite the geographical locality of the study, its implications are global given the identical salinity concerns in other emerging nations' coastal regions.