Association Of Low Gfr And Non-Alcoholic Hepatosteatosis On Fibroscan Of Liver.

BACKGROUND: Chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD) are becoming a health concern, owing to their increasing incidence and prevalence. Both entities are linked to poor outcomes and increased costs, hence greatly impacting the healthcare system and economy. Therefore, it is imperative to establish the link between the two, so as to prevent disease progression and complications. METHODS: The study was an observational retrospective study done in Karachi, from November 2021 to May 2022. It was conducted on 255 patients who were diagnosed with NAFLD, and the presence of CKD was then determined by calculating their GFRs. RESULTS: Out of the 255 patients diagnosed with hepatosteatosis, 76% had a normal GFR, 20% had a mild decrease and 4% were noted to have a moderate reduction in their GFR. When cross-tabulated with CAP score, it was found that 28% had S1 grade steatosis, out of which 85% had a normal GFR, 13% had a mild decrease and 2% had a moderate decrease in GFR. 22% had S2 grade steatosis, out of which 76% had a normal GFR, 18% had a mild decrease and 6% had a moderate reduction in GFR. 50% patients had S3 grade steatosis, out of which 70% had a normal GFR, 25% had a mild decrease and 5% had a moderate reduction in GFR. CONCLUSIONS: There is an association present between NAFLD and the development of low GFR. Therefore, it is important that patients diagnosed with NAFLD are regularly screened for CKD, so as to prevent its development and complications.

Addition of bismuth to standard triple therapy for Helicobacter pylori eradication: a randomised controlled trial.

OBJECTIVE: To compare the effect of addition of bismuth to the standard triple therapy for eradication of Helicobacter pylori (H. pylori) in a randomised controlled trial. METHODS: The study was performed from June 2018-May 2019, in the two outpatient departments located at two different campuses of Ziauddin university hospitals (ZUH) Karachi. Ethical approval was obtained from the Ethics Review Committee of ZUH. It was designed as a randomized control trial in a parallel fashion. Arm A received triple therapy including amoxicillin, clarithromycin, and omeprazole for two weeks and Arm B received quadruple therapy adding colloidal bismuth subcitrate to the triple therapy. A stool antigen test was done six weeks post treatment to confirm H. pylori eradication. RESULTS: A total of 196 participants were included, out of which 102(52%) were males and 94 (48%) were females. Among the patients receiving quadruple therapy, 92/98(93.8%) had negative posttreatment stool antigen results, while among triple therapy recipients 83/98 (84.6%) had negative stool antigen results, according to intention-to-treat analysis (p value=0.038; odds ratio 2.77, 95% CI 1.03-7.47). However, p-value changed to 0.082 (odds ratio 2.40, 95% CI 0.87-6.60) in per-protocol analysis as stool antigen results were not available in two patients in the triple therapy arm. No difference in the side-effect profiles of either arm was noted. CONCLUSIONS: Eradication rates of H. pylori may be modestly improved by addition of bismuth to the standard triple therapy. CLINICAL TRIAL NUMBER: 03968302 (clinicaltrials.gov).

Effect of Non-alcoholic Fatty Liver Disease on Transaminase Levels and Transient Elastography in Patients with Chronic Hepatitis B.

Objective To investigate the effects of non-alcoholic fatty liver disease on aminotransferase (ALT) levels and transient elastography in patients with chronic hepatitis B (CHB). Methods A cross-sectional study of 230 patients with CHB and ALT levels up to two times the upper limits of normal, of one-year duration, from June 2018 to May 2019. The demographic, clinical, and laboratory characteristics of each patient were collected. Transient elastography was performed to evaluate controlled attenuation parameter (CAP or steatosis) and liver stiffness (fibrosis). Results A total of 161 (70%) patients were overweight, with over two-thirds (166; 72.2%) having elevated ALT >35 U/L. Three-fourths of the patients (178; 77.4%) had a hepatitis B virus (HBV) deoxyribonucleic (DNA) level of less than 2000 IU/ml. Steatosis was detected in 166 (72.2%) patients while fibrosis of F2 or more in 88 (38.3%). Multivariate regression analysis showed that weight, homeostatic model assessment of insulin resistance (HOMA-IR), and elevated ALT levels of more than 35 were independently associated with higher CAP values (p= 0.019, 0.001, and 0.004, respectively). Age, insulin levels, and platelet counts were independently associated with liver elasticity (p=0.00, 0.002, and 0.028, respectively). HBV DNA levels did not show any significant association with CAP score, liver stiffness, and HOMA-IR or ALT level. Among those with an elevated ALT of 35 or above (n=166), 124 patients had HBV DNA levels less than 2000 IU/ml. Out of these, 97 (78.2%) patients had steatosis and 51 (41.1%) had F2 or more fibrosis. Conclusion A significant number of patients with CHB with mildly elevated ALT levels are overweight, have significant steatosis and fibrosis, but low HBV DNA levels. This aspect is important while making decisions regarding hepatitis B treatment.