ABSTRACT
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to the obesity epidemic. However, non-obese MASLD (body mass index [BMI] < 25 kg/m2 for Asians) is not uncommon, especially among Asian American populations. Preliminary research has demonstrated sarcopenia, a muscle-wasting syndrome, to be a major risk factor for non-obese Chinese MASLD. This study examined serum creatinine (SCr), a sarcopenia biomarker, and other prominent MASLD biomarkers for their ability to predict moderate to severe fibrosis (≥7.5 kPa or ≥F2 fibrosis) in the Chinese American MASLD population. METHODS: A total of 296 Chinese American MASLD patients were categorized by BMI and fibrosis severity. As per World Health Organization guidelines for Asians, we identified obese MASLD (BMI ≥ 25 kg/m2) in 191 subjects (64.5%) and non-obese MASLD (BMI < 25 kg/m2) in 105 subjects (35.5%). Multivariate logistic regressions were performed to ascertain which biomarkers served as independent predictors of ≥F2 fibrosis. Wilcoxon signed-rank tests were conducted to compare MASLD cohorts (stratified by gender) and the healthy adult population on SCr distribution. RESULTS: The obese MASLD cohorts had higher rates of ≥F2 fibrosis and type 2 diabetes mellitus compared to their older, non-obese counterparts. For obese MASLD patients, higher age (P < 0.05), increased BMI (P < 0.01), increased AST (P < 0.05), and decreased platelets (P < 0.05) independently predicted ≥F2 fibrosis. For non-obese MASLD patients, lowered SCr (P < 0.05) levels served as the main predictor of ≥F2 fibrosis. Female MASLD patients had markedly lower SCr distributions (P < 0.001) compared to the healthy female population, with 26.8% having SCr levels below the normal range. CONCLUSIONS: In summary, SCr was the predominant predictor of moderate to severe fibrosis in non-obese Chinese American MASLD patients. The high rate of decreased SCr levels in Chinese American MASLD women suggests that this population may be at higher risk for muscle mass loss, which can lead to liver fat accumulation.
ABSTRACT
PURPOSE: This study aims to assess the postoperative results, variability, and complications of a hundred deep anterior lamellar keratoplasty cases. Study design and duration: This is an observational study. The study was conducted at Pak International Medical College (PIMC) for a duration of four years (January 2019-January 2023). METHODOLOGY: Our study collected information on a hundred cases of deep anterior lamellar keratoplasty (DALK) utilizing Anwar's big bubble technique, consisting of patients with keratoconus, superficial corneal scars, and macular dystrophy. Consenting patients had their pre and postoperative visual acuities and keratometry readings recorded. Overall success and complications were recorded and compared with the present literature. RESULTS: Big bubble formation was achieved in 87% (n = 87) eyes and not achieved in 13% (n=13). There was a significant reduction in keratometry values after the procedures as well as improved vision in all patients, with 84% reporting significant improvement. Descemet membrane exposure was achieved in 91% (n=91). Complications included the failure of Anwar's big bubble formation in 13% (n=13) patients and the failure to expose Descemet's in nine patients (9%). CONCLUSION: DALK using the big bubble technique is a safe and effective procedure in patients with corneal diseases who have a healthy Descemet membrane and endothelium.