Oral nitrate reductase activity is not associated with development of non-alcoholic fatty liver disease [NAFLD] and non-alcoholic steatohepatitis [NASH]: a pilot study

NAFLD/NASH is a manifestation of metabolic syndrome and is associated with obesity/overweight. Not all obese/overweight individuals develop NASH. Gastro-esophageal reflux disease [GERD] is considered a gastrointestinal manifestation of the metabolic syndrome and is associated with obesity/ overweight. Again not all obese/overweight individuals develop GERD. Recent data show association of dietary nitrate content and oral nitrate reductase activity [NRA] with GERD. Nitrates need to be converted to nitrite [done in human beings by nitrate reductase of oral bacteria exclusively] to be active in metabolic pathways. To assess the relation between NASH/NAFLD and oral NRA. Oral NRA was measured in individuals with NASH [compatible abdominal ultrasound and two elevated ALT/AST levels over six months] and was compared with that of those without NASH. Oral NRA was measured according to a previously reported protocol. Eleven NASH patients and twelve controls were enrolled. Mean oral NRA activity were 2.82 vs. 3.51 microg nitrite-N formed per person per minute for cases and controls respectively [p=0.46]. According to our data, oral nitrite production is not different between individuals with and without NASH.

Diagnostic value of fecal calprotectin in patient with ulcerative colitis

Ulcerative colitis [UC] is characterized by recurrent episodes of inflammation limited to the mucosal layer of the colon. Calprotectin is a zinc and calcium binding protein derived from neutrophils and monocytes. It is easily detectable in tissue samples, body fluids, and stools, which makes it a potentially valuable marker of inflammation. The aim of the current study is to evaluate the value of fecal calprotectin [FC] as a marker of disease activity in patients with UC. Seventy three eligible subjects underwent ileocolonoscopy and multiple biopsies were obtained from different parts of the colon and terminal ileum. All patients underwent blood and stool sampling as well as an interview to assess the disease severity utilizing ulcerative colitis activity index [UCAI], subjectively. The diagnostic value of the FC in comparison with Mayo disease activity index as the gold standard technique, was then evaluated. Mean FC level increased linearly according to Mayo disease activity index [r=0.44, p<0.001] and was significantly different between levels of Mayo disease activity index [p=0.003]. In multivariate analysis, Mayo disease activity index, positive CRP and ESR were associated with FC level. FC level > 21.4 ng/ml was able to discriminate between active and inactive phases of UC according to Mayo disease activity index>2 with 72.3% sensitivity and 73.1% specificity. The combination of FC > 21.4 ng/ml and UCAI score of 7 had a 46.8% sensitivity and 88% specificity to diagnose Mayo disease activity index >2. Furthermore, FC level <21.4 ng/ml in combination with UCAI score of <3 showed a highly considerable specificity of 98% to discriminate the remission phase of UC [Mayo disease activity index <2], although with a low sensitivity [31%]. FC appears to be a non-invasive biomarker with moderate accuracy to discriminate the active phase of inflammatory bowel disease [IBD]. The value of FC especially in combination with UCAI is highly considerable to rule out the Mayo disease activity index >2

[Muscle cramps in cirrhotic patients: a cross-sectional study]

Background: muscle cramps are painful manifestations that occur in many cirrhotic patients. This study aims to evaluate the risk factors for developing muscle cramps

Materials and Methods: this cross-sectional study evaluated 24 cirrhotic patients [18 male, 6 female] during 15 months. Patients underwent careful examinations administered by the same person to determine the underlying cause of disease, presence of ascites, jaundice and encephalopathy as possible causes for muscle cramps. A specific questionnaire that contained demographic information, frequency, location, duration and time of muscle cramps was completed for each patient

Results: patients' mean ages were 45.1 years for females and 48.3 years for males. The frequency of muscles cramps was 37.5% [6 males, 3 females]. The most frequent time for the occurrence of cramps was at night and when patients were at rest [88%]. The calf muscle [77%] was the most involved muscle group that experienced cramping. Patients with muscle cramps had lower serum albumin level [p<0.01] and higher PT [p<0.05] compared to those who did not experience cramps

Conclusion: lower serum albumin level as well as increased PT was associated with muscle cramps in cirrhotic patients. However further studies are mandatory to confirm the findings of this study