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BACKGROUND: There is limited data on the community prevalence of non-alcoholic fatty liver disease (NAFLD). The present study evaluated the prevalence of NAFLD in a large number of healthy male blood donors of urban north India. METHODOLOGY: In a prospective study performed over 18 months, voluntary blood donors fulfilling the requisite blood donation criteria and consenting to participate in the study were evaluated. The study received the approval of the institute's ethics committee. Diagnosis of NAFLD was made by excluding significant alcohol intake, ultrasound showing hepatic steatosis, and exclusion of transfusion associated infections. Subjects were also evaluated for various metabolic risk factors and the presence of metabolic syndrome. RESULTS: Of 1388 subjects who consented for participation, 386 did not come for evaluation. Three females, nine (0.9%) HBsAg-positive, and four (0.4%) anti-HCV positive subjects were excluded. Of the 986 males evaluated with hepatobiliary ultrasound, 543(55.1%) had fatty liver on ultrasonography [15 (1.5%) alcoholic fatty liver and 528 (53.5%) NAFLD]. Among those with NAFLD, 469 (88.8%), 54 (10.2%), and 5 (0.9%) had mild, moderate, and severe hepatic steatosis, respectively. Subjects with NAFLD, when compared to those without NAFLD, had significantly higher age, BMI, waist circumference, blood pressure, total cholesterol and triglycerides, low-density lipoprotein, and fasting plasma glucose. Multivariate regression analysis demonstrated age, BMI, waist circumference, systolic blood pressure, total cholesterol, and number of metabolic syndrome criteria as independent predictors of NAFLD. CONCLUSIONS: Urban Indian healthy male blood donors have a high prevalence of NAFLD.
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BACKGROUND: The normal range for Aspartate and Alanine Aminotransferases (AST and ALT) levels (<40 IU/L) were set in 1950s. Recent data from certain countries suggest lower levels of AST and ALT. Aim of the study was to redefine the normal values of aminotransferases in healthy Indian adults. METHODOLOGY: In a cross sectional prospective study, 1002 blood donors were evaluated to isolate a healthy cohort. Four and 9 subjects positive for HBsAg and anti-Hepatitis C Virus (HCV) respectively and three females were excluded. 986 male subjects were evaluated for levels of serum aminotransferases. RESULTS: Of total 986 subjects (Group I), 543 (55.1%) had fatty liver on ultrasound [15 (1.5%) alcoholic fatty liver and 528 (53.5%) Nonalcoholic Fatty Liver Disease (NAFLD)]. Median AST and ALT in total group (Group I) were 27.69 (Interquartile Range (IQR) 22.33-37.04) and 34.19 IU/L (IQR 23.12-54.87) and in NAFLD (Group II) were 35.67 (IQR -27.49-47.43) and 50.36 (IQR 37.70-76.58) IU/L. Of remaining 443 subjects without fatty liver, 288 had one or more components of metabolic syndrome. Out of 155 patients with no fatty liver and no component of metabolic syndrome (Group III), 103 subjects had normal Body Mass Index (BMI) and normal cholesterol and Low Density Lipoprotein (LDL) (Group IIIB). Median AST and ALT in Group IIIB were 22.56 (IQR 20.23-26.91) and 21.36 (IQR 17.49-27.21) U/L respectively with a 95th percentile of 34.28 and 36.57 U/L for AST and ALT, respectively. CONCLUSION: Levels of AST and ALT in healthy men are lower than the conventional values in India.
RESUMO
BACKGROUND & OBJECTIVES: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 10 [8] autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. METHODS: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). RESULTS: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 10 [8] (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. INTERPRETATION & CONCLUSIONS: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.
