Research

9 pages, 732 KiB

Open AccessCommunication

Vitamin D Deficiency (VDD) and Benefits of Supplementation in Veterans with IBS-D

by Chandrasekhar Kesavan, Anjali Das, Preeya Goyal, Christian S. Jackson, Donna D. Strong and Richard M. Strong

Diagnostics 2023, 13(17), 2807; https://doi.org/10.3390/diagnostics13172807 - 30 Aug 2023

Viewed by 1179

Abstract

Many veterans deployed to Gulf War areas suffer from persistent chronic diarrhea that is disabling and affects their quality of life. The causes for this condition have eluded investigators until recently and recent literature has shed light on the effect of vitamin D [...] Read more.

Many veterans deployed to Gulf War areas suffer from persistent chronic diarrhea that is disabling and affects their quality of life. The causes for this condition have eluded investigators until recently and recent literature has shed light on the effect of vitamin D on the brain–gut axis. This study focused on determining clinical causes contributing to diarrhea and assessed whether reversing the identified causes, specifically vitamin D deficiency (VDD), could reduce the incidence of diarrhea in Gulf War veterans (GWVs). All patients completed a workup that included serologies (IBD, celiac), routine laboratory tests (CBC, chemistry panels, TSH, T4, CRP), cultures for enteric pathogens (C diff, bacteria, viruses, small intestinal bacterial overgrowth (SIBO)), and upper and lower endoscopies with histology and a trial of cholestyramine to exclude choleretic diarrhea and rifaximin for dysbiosis. A total of 4221 veterans were screened for chronic diarrhea, yielding 105 GWVs, of which 69 GWVs had irritable bowel syndrome with diarrhea (IBS-D). Paired t-tests demonstrated that all GWVs had VDD (t-11.62, df68 and sig(2-tailed) 0.0001) (defined as a vitamin D level less than 30 ng/mL with normal ranges of 30–100 ng/mL) but no positive serologies, inflammatory markers, abnormal endoscopies, cultures, or histology to explain their persistent diarrhea. There was no correlation with age, BMI, or inflammation. Some zip codes had a higher frequency of GWVs with VDD, but the number of deployments had no impact. Treatment with vitamin D supplementation (3000–5000 units), given in the morning, based on weight, reduced the number of bowel movements per day (p < 0.0001) without causing hypercalcemia. We suggest that VDD is important in the etiology of IBS-D in GWVs and that vitamin D supplementation significantly reduces diarrhea. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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10 pages, 1112 KiB

Open AccessArticle

Validation Study of Novel Point-of-Care Tests for Infliximab, Adalimumab and C-Reactive Protein in Capillary Blood and Calprotectin in Faeces in an Ambulatory Inflammatory Bowel Disease Care Setting

by Adriaan Volkers, Mark Löwenberg, Marlou Braad, Yara Abeling, Krisztina Gecse, Nicole Berkers, Nahid Montazeri and Geert D’Haens

Diagnostics 2023, 13(10), 1712; https://doi.org/10.3390/diagnostics13101712 - 12 May 2023

Cited by 2 | Viewed by 1182

Abstract

Background and aims: Point-of-care tests (POCT) allow instant measurement of inflammatory markers and drug concentrations. Here, we studied agreement between a novel POCT device and reference methods of measuring infliximab (IFX) and adalimumab (ADL) serum concentrations and C-reactive protein (CRP) and faecal calprotectin [...] Read more.

Background and aims: Point-of-care tests (POCT) allow instant measurement of inflammatory markers and drug concentrations. Here, we studied agreement between a novel POCT device and reference methods of measuring infliximab (IFX) and adalimumab (ADL) serum concentrations and C-reactive protein (CRP) and faecal calprotectin (FCP) concentrations of patients with inflammatory bowel disease (IBD). Methods: In this single-centre validation study, IBD patients were recruited in which IFX, ADL, CRP and/or FCP tests were required. IFX, ADL and CRP POCT were performed on capillary whole blood (CWB), obtained via finger prick. Additionally, IFX POCT was performed on serum samples. FCP POCT was performed on stool samples. Agreement between POCT and reference methods was tested using Passing–Bablok regression, intra-class correlation coefficients (ICC) and Bland–Altman plots. Results: In total, 285 patients participated. Passing–Bablok regression identified differences between the reference method and IFX CWB POCT (intercept = 1.56), IFX serum POCT (intercept = 0.71, slope = 1.10) and ADL CWB POCT (intercept = 1.44). There were also differences in the Passing–Bablok regressions of CRP (intercept = 0.81, slope = 0.78) and FCP (intercept = 51 and slope = 0.46). Bland–Altman plots demonstrated that IFX and ADL concentrations were slightly higher with the POCT and CRP and FCP were slightly lower with POCT. The ICC demonstrated almost perfect agreement with IFX CWB POCT (ICC = 0.85), IFX serum POCT (ICC = 0.96), ADL CWB POCT (ICC = 0.82) and CRP CWB POCT (ICC = 0.91) and moderate agreement with FCP POCT (ICC = 0.55). Conclusions: IFX and ADL results were slightly higher with this novel rapid and user-friendly POCT, whereas CRP and FCP results were slightly lower compared to the reference methods. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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10 pages, 263 KiB

Open AccessArticle

Interleukin-4 Gene Polymorphisms in Romanian Patients with Inflammatory Bowel Diseases: Association with Disease Risk and Clinical Features

by Elena Mirela Ionescu, Andrei Ovidiu Olteanu, Cristian George Tieranu, Luis Ovidiu Popa, Silvia Ioana Andrei, Carmen Monica Preda, Monica Irina Dutescu, Mihai Bojinca, Ioana Tieranu and Olivia Mihaela Popa

Diagnostics 2023, 13(8), 1465; https://doi.org/10.3390/diagnostics13081465 - 18 Apr 2023

Cited by 1 | Viewed by 1141

Abstract

1. Introduction. Multiple cytokines have been studied for their role in the propagation of the inflammatory process related to inflammatory bowel diseases (IBD), but the role of interleukin-4 remains controversial. The aim of this study was to evaluate the role of two IL-4 [...] Read more.

1. Introduction. Multiple cytokines have been studied for their role in the propagation of the inflammatory process related to inflammatory bowel diseases (IBD), but the role of interleukin-4 remains controversial. The aim of this study was to evaluate the role of two IL-4 gene single nucleotide polymorphisms (SNPs) in disease susceptibility and phenotypic expression. 2. Materials and Methods. A group of 160 patients with IBD (86CD/74UC) and 160 healthy controls were genotyped for IL-4 rs2243250/−590C/T and rs2070874/−34C/T using real-time polymerase chain reaction with TaqMan assay. 3. Results. The analysis of IBD patients and controls revealed a significantly reduced frequency of the minor allele T of both SNPs in CD patients (p = 0.03, OR 0.55 and p = 0.02, OR 0.52) and for the entire IBD group (p = 0.01, OR 0.57 and p = 0.01, OR 0.55). Haplotype analysis identified the most frequent haplotype (rs2243250/rs2070874 CC) associated with a high risk for developing IBD (either UC or CD) (p = 0.003). IBD patients with extraintestinal manifestations had significantly increased frequency of the minor alleles T. We also found an association between the presence of allele C of rs2070874 and response to antiTNF treatment. 4. Conclusions. This is the first study to investigate the IL-4 gene’s relation to IBD susceptibility conducted in Romania. Both SNPs were found to be associated with disease susceptibility and phenotypic features, such as extraintestinal manifestations and response to antiTNF agents. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

14 pages, 1445 KiB

Open AccessArticle

A Statistical Approach to the Diagnosis and Prediction of HCC Using CK19 and Glypican 3 Biomarkers

by Călin Burciu, Roxana Șirli, Renata Bende, Alexandru Popa, Deiana Vuletici, Bogdan Miuțescu, Iulia Rațiu, Alina Popescu, Ioan Sporea and Mirela Dănilă

Diagnostics 2023, 13(7), 1253; https://doi.org/10.3390/diagnostics13071253 - 27 Mar 2023

Cited by 1 | Viewed by 1455

Abstract

Various statistical models predict the probability of developing hepatocellular carcinoma (HCC) in patients with cirrhosis, with GALAD being one of the most extensively studied scores. Biomarkers like alpha-fetoprotein (AFP), AFP-L3, and des-g-carboxyprothrombin (DCP) are widely used alone or in conjunction with ultrasound to [...] Read more.

Various statistical models predict the probability of developing hepatocellular carcinoma (HCC) in patients with cirrhosis, with GALAD being one of the most extensively studied scores. Biomarkers like alpha-fetoprotein (AFP), AFP-L3, and des-g-carboxyprothrombin (DCP) are widely used alone or in conjunction with ultrasound to screen for HCC. Our study aimed to compare the effectiveness of Cytokeratin 19 (CK19) and Glypican-3 (GPC3) as standalone biomarkers and in a statistical model to predict the likelihood of HCC. We conducted a monocentric prospective study involving 154 participants with previously diagnosed liver cirrhosis, divided into two groups: 95 patients with confirmed HCC based on clinical, biological, and imaging features and 59 patients without HCC. We measured the levels of AFP, AFP-L3, DCP, GPC3, and CK19 in both groups. We used univariate and multivariate statistical analyses to evaluate the ability of GPC3 and CK19 to predict the presence of HCC and incorporated them into a statistical model—the GALKA score—which was then compared to the GALAD score. AFP performed better than AFP-F3, DCP, GPC3, and CK19 in predicting the presence of HCC in our cohort. Additionally, GPC3 outperformed CK19. We used multivariate analysis to compute the GALKA score to predict the presence of HCC. Using these predictors, the following score was formulated: 0.005*AFP-L3 + 0.00069*AFP + 0.000066*GPC3 + 0.01*CK19 + 0.235*Serum Albumin—0.277. The optimal cutoff was >0.32 (AUROC = 0.98, sensitivity: 96.8%, specificity: 93%, positive predictive value—95.8%, negative predictive value—94.8%). The GALKA score had a similar predictive value to the GALAD score for the presence of HCC. In conclusion, AFP, AFP-L3, and DCP were the best biomarkers for predicting the likelihood of HCC. Our score performed well overall and was comparable to the GALAD score. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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13 pages, 2956 KiB

Open AccessArticle

Usefulness of the Measurement of Psoas Muscle Volume for Sarcopenia Diagnosis in Patients with Liver Disease

by Takushi Manabe, Chikara Ogawa, Kei Takuma, Mai Nakahara, Kyoko Oura, Tomoko Tadokoro, Koji Fujita, Joji Tani, Mitsushige Shibatoge, Asahiro Morishita, Masatoshi Kudo and Tsutomu Masaki

Diagnostics 2023, 13(7), 1245; https://doi.org/10.3390/diagnostics13071245 - 26 Mar 2023

Cited by 2 | Viewed by 2512

Abstract

Computed tomography (CT) is often used in the diagnosis of sarcopenia. In this study, we validated the assessment of sarcopenia by the psoas muscle volume using versatile software. The study involved a retrospective analysis of data from 190 patients with liver disease who [...] Read more.

Computed tomography (CT) is often used in the diagnosis of sarcopenia. In this study, we validated the assessment of sarcopenia by the psoas muscle volume using versatile software. The study involved a retrospective analysis of data from 190 patients with liver disease who underwent grip-strength testing and abdominal pelvic computed tomography. To assess sarcopenia, SYNAPSE 3D was used to obtain the skeletal muscle index, the psoas muscle index (PMI), and the simple method. We also used the recently proposed PMI cutoff values, for which the usefulness has been evaluated (O-PMI). The cutoff value of the psoas muscle volume index (PMVI) was determined using one of the diagnostic methods as the gold standard. All diagnostic methods showed that patients with sarcopenia had shorter survival, with O-PMI having the highest hazard ratio (HR) (HR, 6.12; 95% confidence interval [CI], 2.6–14.41; p < 0.001). Even when sarcopenia could not be diagnosed by O-PMI, low PMVI was associated with shorter survival (HR, 3.53; 95% CI, 1.34–9.32; p = 0.01). PMVI may be useful in the evaluation of sarcopenia, including the identification of poor overall survival in cases that cannot be diagnosed by O-PMI, which is considered more useful than PMI. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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15 pages, 959 KiB

Open AccessArticle

CD24 Gene Expression as a Risk Factor for Non-Alcoholic Fatty Liver Disease

by Mona A. Amin, Halla M. Ragab, Nabila Abd El Maksoud and Wafaa Abd Elaziz

Diagnostics 2023, 13(5), 984; https://doi.org/10.3390/diagnostics13050984 - 04 Mar 2023

Viewed by 1421

Abstract

In light of increasing NAFLD prevalence, early detection and diagnosis are needed for decision-making in clinical practice and could be helpful in the management of patients with NAFLD. The goal of this study was to evaluate the diagnostic accuracy of CD24 gene expression [...] Read more.

In light of increasing NAFLD prevalence, early detection and diagnosis are needed for decision-making in clinical practice and could be helpful in the management of patients with NAFLD. The goal of this study was to evaluate the diagnostic accuracy of CD24 gene expression as a non-invasive tool to detect hepatic steatosis for diagnosis of NAFLD at early stage. These findings will aid in the creation of a viable diagnostic approach. Methods: This study enrolled eighty individuals divided into two groups; a study group included forty cases with bright liver and a group of healthy subjects with normal liver. Steatosis was quantified by CAP. Fibrosis assessment was performed by FIB-4, NFS, Fast-score, and Fibroscan. Liver enzymes, lipid profile, and CBC were evaluated. Utilizing RNA extracted from whole blood, the CD24 gene expression was detected using real-time PCR technique. Results: It was detected that expression of CD24 was significantly higher in patients with NAFLD than healthy controls. The median fold change was 6.56 higher in NAFLD cases compared to control subjects. Additionally, CD24 expression was higher in cases with fibrosis stage F1 compared to those with fibrosis stage F0, as the mean expression level of CD24 was 7.19 in F0 cases as compared to 8.65 in F1 patients but without significant difference (p = 0.588). ROC curve analysis showed that CD24 ∆CT had significant diagnostic accuracy in the diagnosis of NAFLD (p = 0.034). The optimum cutoff for CD24 was 1.83 for distinguishing patients with NAFLD from healthy control with sensitivity 55% and specificity 74.4%; and an area under the ROC curve (AUROC) of 0.638 (95% CI: 0.514–0.763) was determined. Conclusion: In the present study, CD24 gene expression was up-regulated in fatty liver. Further studies are required to confer its diagnostic and prognostic value in the detection of NAFLD, clarify its role in the progression of hepatocyte steatosis, and to elucidate the mechanism of this biomarker in the progression of disease. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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12 pages, 899 KiB

Open AccessArticle

The Role of Noninvasive ¹³C-Octanoate Breath Test in Assessing the Diagnosis of Nonalcoholic Steatohepatitis

by Carmen Fierbinteanu-Braticevici, Ana-Maria Calin-Necula, Vlad-Teodor Enciu, Loredana Goran, Anca Pantea Stoian, Ioan Ancuta, Octav Viasu and Alexandru Constantin Moldoveanu

Diagnostics 2022, 12(12), 2935; https://doi.org/10.3390/diagnostics12122935 - 24 Nov 2022

Cited by 1 | Viewed by 3629

Abstract

Background: The diagnosis of NASH needs a liver biopsy, an invasive procedure that is not frequently accepted by patients. The aim of our study was to evaluate the efficacy of the ¹³C-Octanoate breath test (OBT) as a non-invasive surrogate marker to differentiate [...] Read more.

Background: The diagnosis of NASH needs a liver biopsy, an invasive procedure that is not frequently accepted by patients. The aim of our study was to evaluate the efficacy of the ¹³C-Octanoate breath test (OBT) as a non-invasive surrogate marker to differentiate patients with NASH from patients with simple steatosis (NAFL). Methods: We performed a prospective study on patients with histologically established non-alcoholic steatohepatitis and no other hepatic disease. Each patient underwent a testing protocol, which included a clinical exam, laboratory blood tests, standard abdominal ultrasound, and a ¹³C-Octanoate breath test. Results: The study group included: 82 patients with steatohepatitis, 64 patients with simple steatosis, and 21 healthy volunteers. The univariate and bivariate analysis identified that significant values were the percent dose recovery (PDR) at 15 min—r = 0.65 (AUROC = 0.902) and cumulative percent dose recovery (cPDR) at 120 min—r = 0.69 (AUROC = 0.899). Discussion: Our study showed that ¹³C-OBT had good efficacy for identifying patients with NASH from those with NAFL (steatosis alone) but not those with NAFL from healthy subjects. Considering all these pathogenic steps in NASH we considered that OBT could have the clinical utility to identify patients at risk for NASH, especially “fast progressors”. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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Review

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20 pages, 1386 KiB

Open AccessReview

Autoimmune Hepatitis: A Diagnostic and Therapeutic Overview

by Lydia A. Mercado, Fernando Gil-Lopez, Razvan M. Chirila and Denise M. Harnois

Diagnostics 2024, 14(4), 382; https://doi.org/10.3390/diagnostics14040382 - 09 Feb 2024

Cited by 1 | Viewed by 1472

Abstract

Autoimmune hepatitis is an immune-mediated inflammatory condition of the liver of undetermined cause that affects both sexes, all ages, races, and ethnicities. Its clinical presentation can be very broad, from having an asymptomatic and silent course to presenting as acute hepatitis, cirrhosis, and [...] Read more.

Autoimmune hepatitis is an immune-mediated inflammatory condition of the liver of undetermined cause that affects both sexes, all ages, races, and ethnicities. Its clinical presentation can be very broad, from having an asymptomatic and silent course to presenting as acute hepatitis, cirrhosis, and acute liver failure potentially requiring liver transplantation. The diagnosis is based on histological abnormalities (interface hepatitis), characteristic clinical and laboratory findings (increased aspartate aminotransferase, alanine aminotransferase, and serum IgG concentration), and the presence of one or more characteristic autoantibodies. The large heterogeneity of these clinical, biochemical, and histological findings can sometimes make a timely and proper diagnosis a difficult task. Treatment seeks to achieve remission of the disease and prevent further progression of liver disease. First-line therapy includes high-dose corticosteroids, which are later tapered to decrease side effects, and azathioprine. In the presence of azathioprine intolerance or a poor response to the standard of care, second-line therapy needs to be considered, including mycophenolate mofetil. AIH remains a diagnostic and therapeutic challenge, and a further understanding of the pathophysiological pathways of the disease and the implementation of randomized controlled trials are needed. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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18 pages, 804 KiB

Open AccessReview

Acute Kidney Injury in Liver Cirrhosis

by Rose Mary Attieh and Hani M. Wadei

Diagnostics 2023, 13(14), 2361; https://doi.org/10.3390/diagnostics13142361 - 13 Jul 2023

Cited by 1 | Viewed by 3489

Abstract

Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival [...] Read more.

Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival with the poorest outcomes observed in those with hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). In recent years, new definitions, and classifications of AKI in cirrhosis have emerged. More knowledge has also become available regarding the benefits and drawbacks of albumin and terlipressin use in these patients. Diagnostic tools such as urinary biomarkers and point-of-care ultrasound (POCUS) became available and they will be used in the near future to differentiate between different causes of AKI and direct management of AKI in these patients. In this update, we will review these new classifications, treatment recommendations, and diagnostic tools for AKI in cirrhotic patients. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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20 pages, 12587 KiB

Open AccessReview

Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma

by Maria Chiara Brunese, Maria Rita Fantozzi, Roberta Fusco, Federica De Muzio, Michela Gabelloni, Ginevra Danti, Alessandra Borgheresi, Pierpaolo Palumbo, Federico Bruno, Nicoletta Gandolfo, Andrea Giovagnoni, Vittorio Miele, Antonio Barile and Vincenza Granata

Diagnostics 2023, 13(8), 1488; https://doi.org/10.3390/diagnostics13081488 - 20 Apr 2023

Cited by 5 | Viewed by 1886

Abstract

Background: This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma. Methods: The PubMed database was searched for papers published in the English language no earlier than October 2022. Results: We found 236 studies, and 37 satisfied our research [...] Read more.

Background: This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma. Methods: The PubMed database was searched for papers published in the English language no earlier than October 2022. Results: We found 236 studies, and 37 satisfied our research criteria. Several studies addressed multidisciplinary topics, especially diagnosis, prognosis, response to therapy, and prediction of staging (TNM) or pathomorphological patterns. In this review, we have covered diagnostic tools developed through machine learning, deep learning, and neural network for the recurrence and prediction of biological characteristics. The majority of the studies were retrospective. Conclusions: It is possible to conclude that many performing models have been developed to make differential diagnosis easier for radiologists to predict recurrence and genomic patterns. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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22 pages, 5420 KiB

Open AccessReview

Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet?

by Anuj Bohra, Abhinav Vasudevan, Numan Kutaiba and Daniel Ross Van Langenberg

Diagnostics 2023, 13(6), 1061; https://doi.org/10.3390/diagnostics13061061 - 10 Mar 2023

Cited by 4 | Viewed by 2025

Abstract

Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography [...] Read more.

Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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13 pages, 619 KiB

Open AccessReview

The Link between NAFLD and Metabolic Syndrome

by Fabiana Radu, Claudia-Gabriela Potcovaru, Teodor Salmen, Petruța Violeta Filip, Corina Pop and Carmen Fierbințeanu-Braticievici

Diagnostics 2023, 13(4), 614; https://doi.org/10.3390/diagnostics13040614 - 07 Feb 2023

Cited by 12 | Viewed by 4609

Abstract

Metabolic syndrome (MetS) is characterized by an association of cardiovascular and diabetes mellitus type 2 risk factors. Although the definition of MetS slightly differs depending on the society that described it, its central diagnostic criteria include impaired fasting glucose, low HDL-cholesterol, elevated triglycerides [...] Read more.

Metabolic syndrome (MetS) is characterized by an association of cardiovascular and diabetes mellitus type 2 risk factors. Although the definition of MetS slightly differs depending on the society that described it, its central diagnostic criteria include impaired fasting glucose, low HDL-cholesterol, elevated triglycerides levels and high blood pressure. Insulin resistance (IR) is believed to be the main cause of MetS and is connected to the level of visceral or intra-abdominal adipose tissue, which could be assessed either by calculating body mass index or by measuring waist circumference. Most recent studies revealed that IR may also be present in non-obese patients, and considered visceral adiposity to be the main effector of MetS’ pathology. Visceral adiposity is strongly linked with hepatic fatty infiltration also known as non-alcoholic fatty liver disease (NAFLD), therefore, the level of fatty acids in the hepatic parenchyma is indirectly linked with MetS, being both a cause and a consequence of this syndrome. Taking into consideration the present pandemic of obesity and its tendency to drift towards a progressively earlier onset due to the Western lifestyle, it leads to an increased NAFLD incidence. Novel therapeutic resources are lifestyle intervention with physical activity, Mediterranean diet, or therapeutic surgical respective metabolic and bariatric surgery or drugs such as SGLT-2i, GLP-1 Ra or vitamin E. NAFLD early diagnosis is important due to its easily available diagnostic tools such as non-invasive tools: clinical and laboratory variables (serum biomarkers): AST to platelet ratio index, fibrosis-4, NAFLD Fibrosis Score, BARD Score, fibro test, enhanced liver fibrosis; imaging-based biomarkers: Controlled attenuation parameter, magnetic resonance imaging proton-density fat fraction, transient elastography (TE) or vibration controlled TE, acoustic radiation force impulse imaging, shear wave elastography, magnetic resonance elastography; and the possibility to prevent its complications, respectively, fibrosis, hepato-cellular carcinoma or liver cirrhosis which can develop into end-stage liver disease. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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7 pages, 1357 KiB

Open AccessInteresting Images

Spontaneous Rupture of Esophageal Diverticulum—A Case Report and Literature Review

by Shengting Dong, Shiliang Xie and Yongxin Zhou

Diagnostics 2023, 13(1), 19; https://doi.org/10.3390/diagnostics13010019 - 21 Dec 2022

Viewed by 1455

Abstract

The spontaneous rupture of the esophageal diverticulum is a rare condition that occurs without any warning signs. Its incidence is low, but the mortality rate is high. This paper reports a case of spontaneous esophageal diverticulum rupture and analyzes it along with 13 [...] Read more.

The spontaneous rupture of the esophageal diverticulum is a rare condition that occurs without any warning signs. Its incidence is low, but the mortality rate is high. This paper reports a case of spontaneous esophageal diverticulum rupture and analyzes it along with 13 other cases to explore its prevention and treatment measures. When patients suffer from chronic swallowing difficulties and chest pain or vomiting that cannot be explained after meals, they should be suspected to have a possible spontaneous rupture of the esophageal diverticulum, which is critical to the patient’s prognosis. Full article

(This article belongs to the Special Issue Gastrointestinal and Liver Diseases: New Advances in Diagnosis and Prognosis)

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