Comparison of delta-tocotrienol and alpha-tocopherol effects on hepatic steatosis and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: A randomized double-blind active-controlled trial.

OBJECTIVE: We aimed to compare the efficacy of δ-tocotrienol with α-tocopherol in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). DESIGN AND INTERVENTIONS: This study was a double-blinded, active-controlled trial. The patients with NAFLD were randomly assigned to receive either δ-tocotrienol 300 mg or α-tocopherol 268 mg twice daily for 48 weeks. ENDPOINTS: The primary endpoints were change from baseline in fatty liver index (FLI), liver-to-spleen attenuation ratio (L/S ratio), and homeostatic model assessment for insulin resistance (HOMA-IR) at 48 weeks. Key secondary endpoints were change in markers of inflammation, oxidative stress, and hepatocyte apoptosis. Clinical assessment, biochemical analysis, and computed tomography scan of the liver were conducted at baseline, 24 and 48 weeks. RESULTS: A total of 100 patients (δ-tocotrienol = 50, α-tocopherol = 50) were randomized and included in the intention to treat analysis. Compared with baseline, there was a significant improvement (p < .001) in FLI, L/S ratio, HOMA-IR, and serum malondialdehyde in both groups at 48 weeks that was not significant between the two groups. However, there was a significantly greater decrease in body weight, serum interleukin-6, tumor necrosis factor-alpha, leptin, cytokeratin-18, and increase in adiponectin in the δ-tocotrienol group compared to the α-tocopherol group at 48 weeks (p < .05). No adverse events were reported. CONCLUSION: δ-tocotrienol and α-tocopherol exerted equally beneficial effects in terms of improvement in hepatic steatosis, oxidative stress, and insulin resistance in patients with NAFLD. However, δ-tocotrienol was more potent than α-tocopherol in reducing body weight, inflammation, and apoptosis associated with NAFLD. TRIAL REGISTRATION: Sri Lankan Clinical Trials Registry (https://slctr.lk/SLCTR/2019/038).

Effects of delta-tocotrienol supplementation on Glycemic Control, oxidative stress, inflammatory biomarkers and miRNA expression in type 2 diabetes mellitus: A randomized control trial.

The study aimed to ascertain the effects of delta-tocotrienol (δT3) supplementation on glycemic control, oxidative stress, inflammation and related micro-ribonucleic acid (miRNA) expression in patients with type 2 diabetes mellitus (T2DM). Total 110 patients of T2DM on oral hypoglycemic agents, were randomly divided into tocotrienol and placebo groups and given 250 mg δT3 or cellulose soft gel capsule once daily respectively for 24 weeks. Glycemic control, oxidative stress, inflammatory biomarkers, and miRNAs expression were measured in serum at baseline and end of the intervention by using standard laboratory methods. Compared to the placebo, δT3 supplementation resulted in a significant (p ≤ .05) reduction [mean difference (95% confidence interval)] in plasma glucose [-0.48 (-0.65, -0.30)], insulin [-1.19 (-1.51, -0.87)], homeostatic model assessment of insulin resistance [-0.67 (-0.86, -0.49)], glycosylated hemoglobin [-0.53 (-0.79, -0.28)], malondialdehyde [-0.34 (-0.45, -0.22)], high sensitive-C-reactive protein[-0.35 (-0.54, -0.16)], tumor necrosis factor-alpha [-1.22 (-1.62, -0.83)], and interleukin-6[-2.30 (-2.91, -1.68)]. More than twofold downregulation in miRNA-375, miRNA-34a, miRNA-21, and upregulation in miRNA-126, miRNA-132 expression was observed in the δT3 group compared to the placebo. The study demonstrated that δT3 supplementation in addition to oral hypoglycemic agents, improved glycemic control, inflammation, oxidative stress, and miRNA expression in T2DM without any adverse effect. Thus, δT3 might be considered as an effective dietary supplement to prevent long-term diabetic complications.

Accuracy of non-invasive 13C-Urea Breath Test compared to invasive tests for Helicobacter pylori detection.

OBJECTIVE: To compare the sensitivity, specificity and Positive Predictive Value (PPV) of histology, Campylobacter-Like Organism (CLO) test, culture and 13C-Urea Breath Test (UBT) for the diagnosis of Helicobacter pylori infection. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: District Headquarter Hospital, Rawalpindi, Military Hospital, Rawalpindi and Pakistan Institute of Science and Technology (PINSTECH), Nilore, Islamabad from June 2002 to 2003. PATIENTS AND METHODS: Three mucosal biopsy specimens were obtained during endoscopy of 90 symptomatic patients. Histology, CLO test and culture were performed on these specimens. Breath samples for 13C-UBT were collected and sent to RIAD, PINSTECH on the same day for isotope ratio mass spectrometry. For analysis purpose, each of the tests was fixed as the gold standard in turn and the others were then compared against it. In addition, any two as well as any three positive tests were then set as the gold standard and the other tests compared against them to calculate the sensitivity, specificity, accuracy and PPV of other tests. RESULTS: Urea breath test had the highest sensitivity, ranging from 95 to 100%, against all the gold standards with specificity ranging from 55 to 100%, whereas the sensitivity of histological examination was around 98% but it had comparatively lower specificity (49-89%). The CLO test had a sensitivity range of 86-100% and specificity of 67-100%. Culture had the minimum sensitivity (59-70%) but had highest specificity (96-100%) against all the gold standards. Age and gender had no effect on p-value of each test or in combination. CONCLUSION: The urea breath test has shown the highest ability to detect the organism with 95-100% sensitivity in symptomatic individuals and specificity, which is comparable to other tests.

Current radiologic interventions in hepatocellular carcinoma.

With the rising incidence of chronic liver disease caused by viral hepatitis, hepatocellular carcinoma is showing a corresponding rise worldwide. Surgery remains the mainstay of treatment, but patients unfit for surgery or liver transplantation form the bulk of those presenting with this disease. Palliative treatments are being used to treat those and radiological modalities form the mainstay of the treatment. Radiology plays a major role in the diagnosis, treatment and follow-up of hepatocellular carcinoma. Current radiological treatment modalities include percutaneous ethanol ablation, radiofrequency ablation and trans-arterial chemoembolization. This update highlights the recent advancements in the field and compares their relative merits and demerits.