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Background: Acute-on-chronic liver failure (ACLF) is an increasingly recognised entity that includes the acute deterioration of chronic liver disease usually associated with a precipitating event, development of one or more organ failure and high short-term mortality. Methods: This is a prospective observational study. Clinical data of patients admitted with ACLF at Goa Medical College between November 2019 to November 2021 are summarized and analyzed using relevant statistical tests. Results: A total of 70 patient抯 data was collected. Most common cause of underlying chronic liver disease was alcohol (85.7%) followed by hepatitis B (4.3%), autoimmune diseases (4.3%), cryptogenic (4.3%) and hepatitis C (1.4%). Infections were the most common precipitating factors for ACLF (42.8%) followed by alcohol (28.5%), upper gastrointestinal bleeding (21.42%), drug (AKT) induced (1.42%), unknown cause (10%). Conclusions: Infection and alcohol were found to be important precipitating factors. A multicentre study involving larger numbers of patients are required to know further details and to form a standard treatment protocol.
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The connotation of theory of"toxin"in TCM is rich,and"toxin"is closely related to the occurrence and development of chronic liver disease.Treatment from"toxin"is an important treatment for chronic liver disease.In this article,by summarizing the ancient and modern literature to explain the theory of"toxin",and combined with clinical experience,it concluded that"toxin"has the pathogenic characteristics of strong bias,lingering nature,complex and changeable in chronic liver disease.The authors put forward the view that"toxin leads to disease occurrence and accelerates disease progression",and explored the idea of treating chronic liver disease from"toxin",including tracing the source of toxins,clarifying the nature of toxins,identifying changes of toxins,strengthening the body and eliminating toxins,in order to provide ideas for the clinical treatment of chronic liver disease.
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Non-alcoholic fatty liver disease(NAFLD) has become the main cause of chronic liver disease in children worldwide, and the incidence of NAFLD shows an increasing trend year by year. The risk factors leading to the onset of NAFLD in children are diversified and different from those in adults. At present, most medical institutions still pay little attention to NAFLD in children. This paper summarizes the risk factors and mechanisms for NAFLD in children, including gene polymorphism, maternal and fetal conditions, diet and living habits, environmental exposure, metabolic syndrome, endocrine-related mechanisms and intestinal microecology, in order to provide reference for the prevention and management of childhood NAFLD.
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Background: The relationship between viral infections and host factors holds high hopes for identifying the role of Interferon Lambda 3 (IFNL3) and Interleukin 6 (IL-6) polymorphisms in the development of Chronic Liver Disease (CLD) in patients infected with hepatitis Delta virus (HDV) in the Western Brazilian Amazon. Methods: Cross-sectional study conducted with a cohort of 40 chronic HDV patients, 27 with CLD and 13 without evident liver damage. Biological samples from the participants were analyzed using the polymerase chain reaction (PCR) technique, followed by sequencing by the automated Sanger method. Results: The rs8099917 T allele, from the IFNL3 gene, showed a higher frequency in both groups; however, it was not possible to establish an association with HDV infection [OR = 1.42 (0.42 - 4.75; p = 0.556 (95% CI). For IL-6, the rs1800795 G allele was superior to rs1800795 C. Analyzing both distributions in the studied groups, any association with HDV was absent (p > 0.05). Conclusion: The results suggest that the rs8099917 T/G (IFNL3) and rs1800795 G/C (IL-6) polymorphisms are not associated with the evolution of HDV in the studied population.
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Humans , Hepatitis Delta Virus , Hepatitis D, Chronic , Polymorphism, Single Nucleotide , Brazil/epidemiologyABSTRACT
Decompensated chronic liver disease, is a histopathologically defined condition with a variety of clinical symptoms and complications, some of which are associated with an increased risk of in-hospital mortality. Cirrhosis is predicted to affect 100 (range 25-400) per 100,000 people worldwide, with a male-to-female ratio of one. Patients with ethanol-related cirrhosis have a 5-year death rate ranging from 60-85%. One of the leading causes of cirrhosis is alcoholism. However, it can also be caused by non-alcoholic steatohepatitis (NASH), autoimmune disorders, and viral hepatitis. The decompensated chronic liver disease carries a 9.7 times greater chance of mortality. Cirrhosis is a histologic diagnosis, but a combination of clinical, laboratory, and imaging characteristics can help confirm a cirrhosis diagnosis. For evaluating liver cirrhosis, a liver biopsy continues to be the gold standard. A non-invasive approach to assessing liver cirrhosis is transient elastography (FibroScan). Patients with severe cirrhosis may experience several significant sequelae that complicate their clinical path. These include portal hypertension and related side effects, such as gastroesophageal varices, splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma. In decompensated chronic liver disease, treatment focuses on underlying liver disease, dietary changes, and long-term medical management to control underlying problems. For patients who do not react to other medications, liver transplantation can be an effective long-term therapy option.
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Fever and thrombocytopenia mostly associated with dengue hemorrhagic fever. But on certain condition of fever with thrombocytopenia, we still seek another etiology such as chronic liver disease. How to clarify between thrombocytopenia in dengue and chronic liver disease.
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Background: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D has a central role in developing hepatic deficiency of osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their and their relationship with disease advancement in these patients according to child Pugh-score. Aims and Objectives were study of vitamin D level in patients with different aetiology of chronic liver disease and its correlation with child Pugh score. Methods: This was a cross sectional study conducted over 200 patients after applying inclusion and exclusion criteria in patients with different etiology of chronic liver disease. Results: In our study total (N=200), 152 patients of alcoholic liver disease 41 patients having deficient vitamin D, 79 having insufficient vitamin D level and 32 patients having normal vitamin D level. Patients of chronic liver disease also have negative correlation on vitamin D level with Child Pugh score. In our study it was found that patients having higher Child Pugh score there is more chance of having vitamin D deficiency and insufficiency than the patient’s low Child Pugh score. Conclusions: The prevalence of vitamin d deficiency in patients with CLD was found to be having a significant correlation with increasing CTP score with p value <0.001.
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Background: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D has a central role in developing hepatic deficiency of osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their and their relationship with disease advancement in these patients according to child Pugh-score. Aims and Objectives were study of vitamin D level in patients with different aetiology of chronic liver disease and its correlation with child Pugh score. Methods: This was a cross sectional study conducted over 200 patients after applying inclusion and exclusion criteria in patients with different etiology of chronic liver disease. Results: In our study total (N=200), 152 patients of alcoholic liver disease 41 patients having deficient vitamin D, 79 having insufficient vitamin D level and 32 patients having normal vitamin D level. Patients of chronic liver disease also have negative correlation on vitamin D level with Child Pugh score. In our study it was found that patients having higher Child Pugh score there is more chance of having vitamin D deficiency and insufficiency than the patient’s low Child Pugh score. Conclusions: The prevalence of vitamin d deficiency in patients with CLD was found to be having a significant correlation with increasing CTP score with p value <0.001.
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Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients. Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism. Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class.
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Background: Acute on chronic liver disease is determined by the acute deterioration of liver function over a short period of time. It leads to an increase in morbidity and mortality, hence scores like model for end-stage liver disease (MELD) and chronic liver failure-sequential organ failure (CLIF-C ACLF) are identified to determine prognosis. A comparison would help us in determining which score is better for predicting immediate outcomes. Methods: In this single centre study, patients of both genders, >18 years of age, >48 hours hospital stay with organ failure either ?1, defined as, an increase in serum creatinine by 50% or more (1.5-fold from baseline), hepatic encephalopathy (HE) graded III/IV according to West haven criteria, liver failure, bilirubin ?5 mg/dl, international normalized ratio (INR)??1.5 were enrolled after which relevant lab investigations and imaging was done and MELD and CLIF-C ACLF scores were applied, they were compared and analyzed. Results: Among 50 patients, 62% had grade 2, 36% had grade 3 and only 1 had grade 4 HE. Mean MELD score and CLIF- C ACLF scores were significantly high in patients who expired (both p<0.05), and the mean PaO2/FIO2 ratio was considerably low in patients with mortality (p=0.00). Sensitivity and specificity for CLIF-C ACLF score is much higher (90.9% and 100% respectively, with cut off value of 59), compared to the MELD score (77.3% and 60.7% respectively, with cut-off value of 25.50) Conclusions: CLIF-C ACLF score is a better predictor of mortality and for survival in ACLF than the MELD score in changing the outcome of the patient.
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Patients with advanced chronic liver disease （ACLD） are hospitalized due to hepatitis， acute decompensation or liver failure and its complications， and they often require stratified management due to different severities. The patients with acute－on－chronic liver failure （ACLF） have the highest short－term mortality rate among ACLD patients and should be treated in tertiary hospitals. Although non－ACLF patients tend to have a relatively low mortality rate， they still have the risk of progression to ACLF， and there is a significant increase in mortality rate after progression to ACLF， which requires stratified management. The patients with extremely low progression rates often have favorable clinical outcomes and can be administrated in primary hospitals， while the high－risk population should be closely monitored and timely transferred in case of disease progression. However， currently there is still a lack of accurate predictive models for evaluating the risk of progression to ACLF， and further studies are needed to find new biomarkers or algorithms.
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ABSTRACT BACKGROUND: Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) in the liver of individuals with undetectable hepatitis B virus surface antigen (HBsAg) in the serum. The actual prevalence of OBI and its clinical relevance are not yet fully understood. OBJECTIVE: To evaluate the prevalence of HBV DNA in liver biopsies of HBsAg-negative patients with chronic liver disease of different etiologies in a referral center in Brazil and compare two different HBV DNA amplification protocols to detect HBV. DESIGN AND SETTING: This cross-sectional observational study was conducted at the Liver Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil, between January 2016 and December 2019. METHODS: HBV DNA was investigated in 104 liver biopsy samples from individuals with chronic liver disease of different etiologies, in whom HBsAg was undetectable in serum by nested-polymerase chain reaction (nested-PCR), using two different protocols. RESULTS: OBI, diagnosed by detecting HBV DNA using both protocols, was detected in 6.7% of the 104 individuals investigated. Both protocols showed a good reliability. CONCLUSION: In addition to the differences in the prevalence of HBV infection in different regions, variations in the polymerase chain reaction technique used for HBV DNA amplification may be responsible for the large variations in the prevalence of OBI identified in different studies. There is a need for better standardization of the diagnostic methods used to diagnose this entity.
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Background: Amoebic liver abscesses (ALA) in the presence of Alcoholic liver disease (ALD) constitutes a high-risk group of patients who are prone to complications and may need more aggressive treatment. This study was aimed at evaluating disease course and outcomes in patients of ALA with ALD, in comparison to those without ALD. Material & Methods: This prospective observational study was conducted on 60 consecutive patients of ALA without ALD (Group-I) and 60 consecutive patients of ALA with ALD (Group II). Result: The patients ALA with ALD were older (47.2 ±13.3 years) than those without ALD (34.1±14 years). Mean size of the abscess cavity was significantly larger in patients with ALD (391.2± 208.7 cc in Group I and 594.3 ± 297.9 cc in Group II). In Group I, conservative management was most common (43.3%); while in Group II pigtail catheter insertion was the most frequently used modality of treatment (45%). Complications like empyema (6.6%), acute on chronic liver failure (8.3%) and impending liver failure (23.3%) manifesting as ascites and oedema were seen only in patients in Group II and they also had longer hospital stay. (4.87 days in Group I vs 8.37 in Group II). Conclusion: Patients of ALA with ALD have a more aggressive course of disease and should be managed with a lower threshold for abscess drainage.
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ABSTRACT Background Variceal hemorrhage (VH) is a medical emergency. Prompt endoscopic variceal ligation (EVL) is therapeutic. Terlipressin is used in VH and continued for 2—5 days even after EVL. As hemostasis is primarily achieved by EVL, the benefit of continuing trelipressin after EVL is unknown. Objective To evaluate the efficacy of continuing terlipressin after EVL to prevent re-bleed and mortality. Methods In this pilot study, after EVL 74 patients of VH were randomized into two treatment groups TG2 & TG5, received terlipressin (1 mg IV bolus q 4 hourly) for 2 days and 5 days respectively and one control group (TG0), received 0.9% normal saline (10 mL IV bolus q 4 hourly) and followed up for 8 weeks. Results A total of 9 (12.6%) patients had re-bleed with maximum 4 (5.6%) patients in TG5 group followed by 3 (4.2%) in TG2 and 2 (2.8%) in TG0 groups (P=0.670). The overall mortality was 15 (21.1%) patients, 6 (8.5%) patients in TG0 group, followed by 5 (7.0%) in TG5 and 4 (5.6%) in TG2 group (P=0.691). Adverse drug reactions were significantly higher in treatment groups with maximum 18 (24.32%) patients in TG5, followed by 8 (10.8%) in TG2 and 2 (2.7%) in TG0 groups (P=0.00). Duration of hospital stay was also significantly higher in treatment group, 6.63 (±0.65) days in TG5 followed by 3.64 (±0.57) in TG2 and 2.40 (±0.50) days in TG0 groups (P=0.00). Conclusion The rational for continuing terlipressin after EVL is doubtful as it didn't have any benefit for the prevention of re-bleed or mortality; rather it increased the risk of adverse drug reactions and duration of hospital stay. Further randomized clinical trials are encouraged to generate more evidence in support or against continuing terlipressin after EVL.
RESUMO Contexto A hemorragia varicosa (HV) é emergência médica. A ligadura endoscópica imediata das varizes (LEV) é terapêutica. A terlipressina é usada em HV e contínua por 2—5 dias mesmo após a LEV. Como a hemostasia é alcançada principalmente pela LEV, o benefício do uso contínuo da terlipressina após o evento é desconhecido. Objetivo Avaliar a eficácia da terlipressina contínua após a LEV para evitar o ressangramento e a mortalidade. Métodos Neste estudo piloto, após a LEV, 74 pacientes com HV foram randomizados em dois grupos de tratamento TG2 & TG5, que receberam terlipressina (1 mg EV em bolus a cada 4 horas) durante 2—5 dias, respectivamente, e um grupo controle (TG0), que receberam soro fisiológico normal de 0,9% (10 mL EV em bolus a cada 4 horas) e foram seguidos por 8 semanas. Resultados Um total de 9 (12,6%) pacientes tiveram ressangramento, 4 (5,6%) no grupo TG5, seguidos por 3 (4,2%) no TG2 e 2 (2,8%) no grupo TG0 (P=0,670). A mortalidade geral de pacientes foi de 15 (21,1%), 6 (8,5%) no grupo TG0, seguidos por 5 (7,0%) no TG5 e 4 (5,6%) no TG2 (P=0,691). As reações adversas de medicamentos foram significativamente maiores em grupos de tratamento em 18 (24,32%) pacientes no TG5, seguidos por 8 (10,8%) no TG2 e 2 (2,7%) em grupo TG0 (P=0,00). A duração da internação hospitalar também foi significativamente maior no grupo de tratamento, 6,63 (±0,65) dias no TG5, seguido por 3,64 (±0,57) em TG2 e 2,40 (±0,50) dias em grupos TG0 (P=0,00). Conclusão O uso racional para a continuação da terlipressina após a LEV é duvidoso, pois não teve qualquer benefício para a prevenção de ressangramento ou mortalidade; pelo contrário, aumentou o risco de efeitos adversos e duração da internação hospitalar. Outros ensaios clínicos randomizados são necessários para gerar mais evidências em apoio ou contra a terlipressina contínua após a LEV.
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La historia natural de la enfermedad hepática crónica (EHC) se caracteriza por una fase de cirrosis compensada asintomática seguida de una fase descompensada, que se acompaña de signos clínicos evidentes, de los cuales los más frecuentes son la ascitis, las hemorragias, la encefalopatía y la ictericia. Esta guía actualizada sobre el manejo de pacientes con EHC en la edad pediátrica fue confeccionada con el propósito de mejorar la práctica clínica de estos pacientes complejos y darle herramientas al pediatra de cabecera para un seguimiento adecuado. Para ello, un grupo de expertos subrayó la importancia del inicio temprano del tratamiento etiológico en cualquier grado de enfermedad hepática y ampliaron su labor jerarquizando las complicaciones de la cirrosis: ascitis, hemorragia digestiva, infecciones, malnutrición; aspectos endocrinológicos, neurológicos, oftalmológicos y gastrointestinales; y complicaciones vasculares pulmonares y renales. Se incluyeron, además, aspectos psicosociales, así como el cuidado del adolescente en su transición a la vida adulta.
The natural history of chronic liver disease (CLD) is characterized by a phase of asymptomatic compensated cirrhosis followed by a decompensated phase, accompanied by the development of evident clinical signs, the most frequent being ascites, hemorrhages, encephalopathy and jaundice. This updated guideline on the management of pediatric patients with CLD was developed with the purpose of improving the clinical practice of these complex patients and to provide the pediatrician with tools for an adequate follow-up. To this end, a group of experts, after stressing the importance of early initiation of etiologic treatment in any degree of liver disease, expanded their work to include a hierarchy of complications of cirrhosis: ascites, gastrointestinal bleeding, infections, malnutrition, endocrinological, neurological, ophthalmological, gastrointestinal, pulmonary vascular and renal complications. Psychosocial aspects including the care of the adolescent in their transition to adult life were also included.
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Humans , Child , Adolescent , Adult , Ascites/etiology , Jaundice , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/therapyABSTRACT
The Baveno VII workshop held in October 2021 was featured by the subject of personalized care in portal hypertension. The workshop focused on the following 9 topics including: the relevance and indications for measuring the hepatic venous pressure gradient as a gold standard; the use of non-invasive tools for the diagnosis of compensated advanced chronic liver disease and clinically significant portal hypertension; the impact of etiological and of non-etiological therapies in the course of cirrhosis; the prevention of the first episode of decompensation; the management of the acute bleeding episode; the prevention of further decompensation; as well as the diagnosis and management of splanchnic vein thrombosis and other vascular disorders of the liver. This essay provides a compilation and summary of recommendations regarding the abovementioned topics, and presents the most recent research proceedings and the corresponding consensus to our readers.
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Humans , Consensus , Esophageal and Gastric Varices , Hypertension, Portal/therapy , Liver Cirrhosis/therapy , Portal PressureABSTRACT
Despite recent advances in pediatric chronic cholestatic diseases, the causes and effective therapies remain elusive, and many patients progress to liver failure and need liver transplantation.Malnutrition is a common complication in these patients and is a well-recognized, tremendous challenge for the clinician.The malnutrition and failure to thrive are associated with increased risks of morbidity and mortality, and they also affect the outcomes of liver transplantation, including long-term survival.Malnutrition in children with chronic cholestatic disease is multifactorial and with multiple potential nutritional deficiencies.Supplemental feeding, including medium-chain triglycerides, essential fatty acids, branched-chain amino acids.In order to improve the life expectancy and quality of life of children with chronic liver disease, this paper reviews ways to address the nutritional needs for specific cause of malnutrition in children.
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Background. Chronic liver disease (CLD) is linked to immune system failure, which increases the risk of infections and consequences brought on by COVID-19. Therefore, we aimed to compare hospitalized COVID -19 patients with and without CLD to assess the effect of CLD on the severity of COVID-19 infection. Methods. The study was conducted between April and October 2022 at Zagazig university hospitals. It enrolled 108 subjects admitted at the isolation hospital for COVID-19 illness. The cases were allocated equally into three groups, group (I): Patients without evidence of liver disease. Group (II): patients with chronic hepatitis, and group (III): patients with cirrhotic liver. Result. There were significant correlations between the severity of COVID -19 and the CTP classification of Group III (r=0.5 p=0.05 in child A, r=0.08 p=0.05 in child B, r=0.4 p=0.001in child C). In addition, there were significant correlations between laboratory parameters such as INR (r=0.6, p=0.05), bilirubin (r=0.4, p=0.001), ALT (r= 0.5, p=0.05), and AST (r=0.08, p=0.05) and severity of COVID -19 in studies groups. Conclusion: Those with CLD and cirrhosis had a higher death rate. COVID-19 severity related to the Child-Turcotte-Pugh score (CTP) score.
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Humans , Male , Female , COVID-19 , Liver DiseasesABSTRACT
Introdução: A doença hepática gordurosa não alcoólica (DHGNA) é uma das causas mais comuns de hepatopatia. Devido ao grande risco de progressão para cronicidade, seu rastreamento se faz necessário. A Elastografia por Ressônancia Magnética (MRE) foi estabelecida em diversos estudos como uma técnica acurada para o diagnóstico de fibrose. Objetivos: Descrever a prevalência de esteatose e de fibrose hepática em pacientes com DHGNA submetidos à MRE; estimar o grau de fibrose, correlacionando com a escala METAVIR, e avaliar a fração de gordura por densidade de prótons (PDFF) e os fatores clínicos associados à esteatose e fibrose. Métodos: Estudo transversal, realizado mediante revisão de imagens de MRE, entre janeiro de 2017 e março de 2019, em um hospital da região sul do Brasil. Resultados: Dos 298 pacientes incluídos, a maioria dos pacientes apresentava esteatose leve (41,6%, n=124) ou ausente (30,9%, n=92), enquanto 15,1% (n=45) apresentava esteatose moderada e 12,4% (n=37), acentuada. A maioria dos pacientes (65,8%, n=181) apresentava rigidez hepática dentro da normalidade, 11,6% (n=32) inflamação crônica, 7,6% (n=21) fibrose estágio 1-2, 3,6% (n=10) fibrose estágio 2-3, 4,7% (n=13) fibrose estágio 3-4 e 6,5% (n=18) fibrose estágio 4 ou cirrose. Discussão: Os resultados encontrados nesta amostra reforçam os fatores de risco para o desenvolvimento de DHGNA previamente avaliados. Uma combinação de estratégias não invasivas, incluindo a MRE, poderá selecionar os pacientes com maior probabilidade de agravos. Conclusão: Nesse estudo, a maioria dos pacientes apresentou a forma leve ou ausência de esteatose e rigidez hepática dentro da normalidade. A MRE tem se mostrado uma técnica altamente acurada, não invasiva para estadiamento de fibrose hepática em pacientes com DHGNA, sem influência significativa da idade, sexo, adiposidade e grau de inflamação hepática.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of liver disease. Due to the high risk of progression to chronicity, its tracking is necessary. Magnetic Resonance Elastography (MRE) has been established in several studies as an accurate technique for diagnosing fibrosis. Objectives: To describe the prevalence of steatosis and liver fibrosis in NAFLD patients undergoing MRE; estimate the degree of fibrosis, correlating with the METAVIR scale, and assess the proton density fat-fraction (PDFF). Methods: A cross-sectional study, performed by reviewing MRE images, between January 2017 and March 2019, in a hospital in southern Brazil. Results: Of the 298 patients included, most patients had mild (41.6%, n=124) or absent (30.9%, n=92) steatosis, while 15.1% (n=45) had moderate and 12.4% (n=37) marked steatosis. Most patients (65.8%, n=181) had liver stiffness within the normal range, 11.6% (n=32) chronic inflammation, 7.6% (n=21) stage 1-2 fibrosis, 3.6% (n=10) stage 2-3 fibrosis, 4.7% (n=13) stage 3-4 fibrosis, and 6.5% (n=18) stage 4 fibrosis or cirrhosis. Discussion: The results found in this sample reinforce the risk factors for the development of NAFLD previously evaluated. A combination of non-invasive strategies, including MRE, may select the patients with the greatest likelihood of harm. Conclusions: MRE has been shown to be a highly accurate, non-invasive technique for staging liver fibrosis in NAFLD patients, with no significant influence of age, sex, adiposity, and degree of liver inflammation.
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Background: The molecular epidemiology of HCV and its association with liver diseases in North India is not well understood. Aim: To assess the incidence of HCV infection in blood donors and liver disease patients and the influence of HCV genotype on the severity of the liver disease. Methods: We screened 487 patients with acute viral hepatitis (AVH), 141 patients of fulminant hepatic failure(FHF), 1058 patients of chronic liver disease (CLD) (chronic hepatitis-468, cirrhosis-527, HCC-63), and 3504 voluntary blood donors for anti-HCV. Anti HCV positive patients were further subjected to HCV RNA testing followed by genotyping. Results: HCV infection was observed in 1.6%, 12.94%, 10.64%, 27.13%, 21.25% and 49.2% of blood donors, AVH,FHF, chronic hepatitis, cirrhosis and HCC patients respectively. Conclusion: Genotype 3 was found to be the major genotype. HCV genotype one infection was associated with advanced liver disease.