ABSTRACT
Introduction The purpose of this study was to discern the pattern of alcohol consumption and the severity of alcohol-related liver disease (ARLD) in patients visiting the tertiary care hospital. Methods A cross-sectional study was conducted at Dr. Ziauddin Hospital Clifton campus, Karachi. Patients visiting the liver clinic with disturbed liver enzymes and a history of alcohol intake after excluding other causes were included. A detailed history, routine investigations, insulin level, abdominal ultrasound, and transient elastography were performed. Results A total of 155 patients were included in the study, 98% of whom were men. The median age was 45.93 years (range: 18-78 years). Just over three-fourths of the visiting patients were Muslim (n=119; 76.8%). The median duration of alcohol intake was 5.7 years. All patients admitted to consuming alcohol on an empty stomach before dinner. The most common associated addiction was smoking (n=95; 61.2%). Around two-thirds of patients confessed to binge drinking (n=66; 42.9%). According to the Diagnostic and Statistical Manual of Mental Disorders criteria, 92 patients (59.35%) were alcohol dependent. Hepatic steatosis was positively correlated with the weight of patients (p=0.035). Other factors positively correlated with hepatic steatosis included insulin resistance (p=0.031), elevated uric acid levels (p=0.003), and units of alcohol intake (p=0.054). Significant fibrosis (F3-F4) was present in 73 (47.09%) patients. It was correlated with low platelet count, total bilirubin, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, international normalized ratio, albumin, uric acid, controlled attenuation parameter, and units of alcohol intake with significant p-values. Further multivariant analysis showed liver fibrosis was correlated with cholesterol level with a significant p-value (p=0.045). Conclusion ARLD is mainly a male-dominant disease in our population. Most patients consumed a large volume of highly concentrated alcohol and were alcohol dependent. Insulin resistance was observed in a significant number of patients.
ABSTRACT
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.
ABSTRACT
Mesenteric panniculitis (MP) is a rare condition that encompasses a spectrum of disease processes characterized by degeneration, inflammation, and scarring of the adipose tissue of the mesentery. The etiology of MP remains unknown; although various causes have been suggested and it has been seen to occur independently as well as in association with other disorders. The clinical manifestations of MP vary over a spectrum, and most patients actually experience no discomfort at all. When present, these clinical presentations vary according to the stage of the disease and may include general symptoms like abdominal pain and weight loss or more specific ones such as an abdominal mass, peritoneal irritation, and ascites. CT findings have emerged to be the gold standard in diagnosis, wherein MP is characterized by localized mesenteric thickening and stranding covering the blood vessels with a characteristic 'halo sign', in which the fat around the lymph nodes and blood vessels is spared. Here, we present the case of a 45-year-old male patient who reported to a private hospital in Karachi, Pakistan with non-specific complaints of abdominal pain and vomiting and typical CT and histopathology findings of MP on investigation, as well as abnormally raised alanine transaminase (ALT) levels.
