- Email: [email protected]
Expression of Pro-inflammatory Cytokines in Human Metabolic Syndrome
MISCELLANEOUS
Table 1 LSM
CKD DM HTN Jaundice Ascites HBV HCV CAD
<7 7–12 12–21 >21 Total No
40 30 17 18 105
19 17 14 4 54
38 29 32
7 2 2
1 1 6
1 2
1 1 2
9 7 6
99
11
8
3
4
22
to diagnose asymptomatic liver involvement in advanced stage CKD population (Table 1).
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.182
31 PREDICTORS OF ADVANCED FIBROSIS IN NONALCOHOLIC FATTY LIVER DISEASE, CHRONIC HEPTITIS B, CHRONIC HEPATITIS C Rajendra Gunjal ∗ , Aniruddha P. Singh, Gaurav Kapoor, N. Sandeep, Rathan Cyriac, S. Srijaya, Krishnadas Devadas
liver [P = 0.004] and coarse liver [P = 0.002], among CHB patients were older age [P = 0.048], low platelet count [P = 0.002], low serum protein [P = 0.025], USG finding of normal liver [P = 0.004] and coarse liver [P = 0.023], among CHC patients were older age [P = 0.023], increased Bilirubin [P = 0.022], increased SGOT [P = 0.001], low platelet count [P = 0.000], USG findings of normal liver [P = 0.006], fatty liver [P = 0.008] and coarse liver [P = 0.000]. On mulitivariate analysis, factors significantly associated with NAFLD were SGOT [P = 0.016] and coarse ultrasound [P = 0.017], with HBV were normal [P = 0.025] and coarse ultrasound [P = 0.000], low platelet count [P = 0.002], low protein [P = 0.009], with HCV was coarse ultrasound [P = 0.003]. Conclusion: Advanced fibrosis is more common in CHC followed by NAFLD and CHB. Factors predicting advanced fibrosis among NAFLD were SGOT and coarse ultrasound, among CHB were normal and coarse ultrasound, low platelet count, low protein, among CHC was coarse ultrasound.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.183
MISCELLANEOUS
32
Government Medical College, Thiruvananthapuram, India
E-mail address: [email protected] (R. Gunjal). Background and Aim: Transient elastography (TE) using ultrasound offers great promise in providing accurate and reliable information among Non alcoholic fatty liver disease (NAFLD), chronic Hepatitis B (CHB), chronic Hepatitis C (CHC), patients with advanced fibrosis and cirrhosis. The study was done to find out the prevalence and factors associated with advanced fibrosis among NAFLD, CHB, CHC, patients using TE. Methods: All consecutive patients with newly diagnosed NAFLD, CHB, CHC were subjected to anthropometric measurements i.e. Mid-arm circumference (MAC), Triceps skinfold thickness (TST), Waist circumference (WC) and Body Mass Index (BMI). All patients underwent TE and routine investigations like hemogram, liver function test, lipid profile and abdominal ultrasonography. Advanced fibrosis (≥F3/F4) was defined as TE value >11, >9, >9.6 kPa for NAFLD, CHB, CHC respectively. Results: This cross sectional study included 52 patients with NAFLD, 98 with CHB, 71 with CHC. Advanced fibrosis was seen in 50%, 20%, 66.2% patients with NAFLD, CHB, CHC respectively. On univariate analysis, factors significanlty associated with advanced fibrosis among NAFLD patients were older age [P = 0.008], higher BMI [P = 0.029], high SGOT [P = 0.003], USG finding of fatty S102
EXPRESSION OF PRO-INFLAMMATORY CYTOKINES IN HUMAN METABOLIC SYNDROME V. Rakotoarivelo, M. Mayhue, M.F. Langlois 1 , S. Ramanathan ∗,1 Université de Sherbrooke, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
E-mail address: [email protected] (S. Ramanathan). 1 Equal senior authorship. Background and Aim: Obesity is emerging as a major healthcare burden. Excess visceral adiposity is associated with insulin resistance (IR), type 2 diabetes (T2D), atherosclerosis, hypertension and fatty liver disease. Adipose tissue is considered as an endocrine organ in addition to its primary function as a depot where energy is stored in the form of triglycerides for release during starvation, exercise or infections. However, when the adipose tissue is unable to stockage the excessive nutrient influx, insulin resistance develops in a progressive manner. Insulin resistance in the liver results in dysregulated gluconeogenesis and glycogenolysis and increases circulating glucose. Insulin resistance in the muscles and adipose tissues prevents glucose uptake despite the availability © 2017, INASL
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
of insulin. Population studies have linked insulin resistance to systemic low-grade inflammation, as evidenced by increased levels of circulating C-reactive protein. Methods: The expression of pro-inflammatory and anti-inflammatory cytokines and chemokines were analyzed in serum, subcutaneous and visceral adipose tissues of patients with body mass index (BMI) ranging from 17 to 100. Results: Parallel gene and protein expression analysis suggest that some of the inflammatory mediators may be produced in the adipose tissues. Gene expression for IL1B, but not IL6 or TNFA, was increased in obese patients. On the other hand no significant correlation was observed between protein and gene expression. Conclusion: Our results suggest that the profile of chronic inflammation in metabolic syndrome may be more complex than what is suggested.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.184
33
Bone marrow aspiration was normal. His treatment was changed to lenalidomide-based CT. Conclusion: The liver is an uncommon site for extramedullary plasmacytoma (EMP). Ascites is frequent in the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin change) syndrome, but extremely unusual in MM. Extramedullary spread generally predicts poor outcome, though stem cell transplant offers hope for improved survival. With increasing survival in MM thanks to newer CT agents, rare forms of EMP should be kept in mind.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.185
34 PROSPECTIVE EVALUATION OF SCLEROSING CHOLANGITIS IN CHILDREN WITH AUTOIMMUNE LIVER DISEASE Nagendra Kumar, Ujjal Poddar ∗ , Rajanikant Yadav, Surender K. Yachha, Anshu Srivastava E-mail address: [email protected] (U. Poddar).
Ajinkya Sonambekar ∗ , Devendra Desai, Philip Abraham, Anand Joshi, Tarun Gupta, Vatsal Mehta
Background and Aim: Autoimmune liver disease encompass “overlap syndromes” of autoimmune hepatitis (AIH) with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In children only AIH-PSC overlap syndrome also known as ‘autoimmune sclerosing cholangitis’ (ASC) has been recognized. We aimed to study prevalence of ASC by using MRC in children diagnosed as AIH, and to compare the clinical presentation and outcome of children with AIH and ASC, and compare cholangiographic appearance in AIH and in children with cirrhosis due to non-autoimmune, non-biliary etiology. Methods: We prospectively got Magnetic resonance cholangiography (MRC) done in 39 children with AIH and 19 controls with non-autoimmune, non-cholestatic causes of chronic liver disease. Based on MRC, children with definitive changes of sclerosing cholangitis (SC) were considered as ASC. Details of clinical features, laboratory parameters, liver histopathology were analysed. One child was excluded due to poor MRC imaging. Results: The median age of 38 children with AIH was 11.5 (range 3–18) years and 22 (55%) were girls. Majority (74%) were diagnosed as type 1 AIH. MRC was done in 11 children (29%) at the time of diagnosis while in 21 (71%) it was done after a median follow-up of 2.5 (range 0.3–10) years. Abnormal MRC changes were seen in 14/38 (37%) and 8/19 (42%) in children with AIH and controls,
P D Hinduja Hospital and Medical Research Centre, Mumbai City, India
E-mail address: [email protected] (A. Sonambekar). Background and Aim: Liver or peritoneal metastasis in multiple myeloma (MM) is rare. We report two such patients: one had space-occupying lesions (SOL) in the liver and the other had ascites. Case Summary: Case 1: A 47-year-old gentleman was evaluated for progressive weight loss and multiple hypoechoic lesions in the liver. He had a history of MM and had received chemotherapy (CT) earlier. Serum immunofixation electrophoresis suggested monoclonal kappa gammopathy. Biopsy of the liver SOL showed moderately differentiated plasmacytoma. He is planned for salvage CT and stem cell transplant. Case 2: A 57-year-old gentleman had completed 6 cycles of bortezomib-based CT for MM. He was on entecavir for hepatitis B-related compensated liver cirrhosis and now presented with rapidly refilling ascites. Portal and hepatic vein Doppler was normal, and ascites was high protein, high SAAG. Ascitic fluid cytology showed large number of plasma cells and plasma blasts with bizarre forms.
Journal of Clinical and Experimental Hepatology July 2017 Vol. 7 No. S2
S103
MISCELLANEOUS
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
LIVER AND PERITONEAL METASTASIS IN MULTIPLE MYELOMA
Table 1 LSM
CKD DM HTN Jaundice Ascites HBV HCV CAD
<7 7–12 12–21 >21 Total No
40 30 17 18 105
19 17 14 4 54
38 29 32
7 2 2
1 1 6
1 2
1 1 2
9 7 6
99
11
8
3
4
22
to diagnose asymptomatic liver involvement in advanced stage CKD population (Table 1).
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.182
31 PREDICTORS OF ADVANCED FIBROSIS IN NONALCOHOLIC FATTY LIVER DISEASE, CHRONIC HEPTITIS B, CHRONIC HEPATITIS C Rajendra Gunjal ∗ , Aniruddha P. Singh, Gaurav Kapoor, N. Sandeep, Rathan Cyriac, S. Srijaya, Krishnadas Devadas
liver [P = 0.004] and coarse liver [P = 0.002], among CHB patients were older age [P = 0.048], low platelet count [P = 0.002], low serum protein [P = 0.025], USG finding of normal liver [P = 0.004] and coarse liver [P = 0.023], among CHC patients were older age [P = 0.023], increased Bilirubin [P = 0.022], increased SGOT [P = 0.001], low platelet count [P = 0.000], USG findings of normal liver [P = 0.006], fatty liver [P = 0.008] and coarse liver [P = 0.000]. On mulitivariate analysis, factors significantly associated with NAFLD were SGOT [P = 0.016] and coarse ultrasound [P = 0.017], with HBV were normal [P = 0.025] and coarse ultrasound [P = 0.000], low platelet count [P = 0.002], low protein [P = 0.009], with HCV was coarse ultrasound [P = 0.003]. Conclusion: Advanced fibrosis is more common in CHC followed by NAFLD and CHB. Factors predicting advanced fibrosis among NAFLD were SGOT and coarse ultrasound, among CHB were normal and coarse ultrasound, low platelet count, low protein, among CHC was coarse ultrasound.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.183
MISCELLANEOUS
32
Government Medical College, Thiruvananthapuram, India
E-mail address: [email protected] (R. Gunjal). Background and Aim: Transient elastography (TE) using ultrasound offers great promise in providing accurate and reliable information among Non alcoholic fatty liver disease (NAFLD), chronic Hepatitis B (CHB), chronic Hepatitis C (CHC), patients with advanced fibrosis and cirrhosis. The study was done to find out the prevalence and factors associated with advanced fibrosis among NAFLD, CHB, CHC, patients using TE. Methods: All consecutive patients with newly diagnosed NAFLD, CHB, CHC were subjected to anthropometric measurements i.e. Mid-arm circumference (MAC), Triceps skinfold thickness (TST), Waist circumference (WC) and Body Mass Index (BMI). All patients underwent TE and routine investigations like hemogram, liver function test, lipid profile and abdominal ultrasonography. Advanced fibrosis (≥F3/F4) was defined as TE value >11, >9, >9.6 kPa for NAFLD, CHB, CHC respectively. Results: This cross sectional study included 52 patients with NAFLD, 98 with CHB, 71 with CHC. Advanced fibrosis was seen in 50%, 20%, 66.2% patients with NAFLD, CHB, CHC respectively. On univariate analysis, factors significanlty associated with advanced fibrosis among NAFLD patients were older age [P = 0.008], higher BMI [P = 0.029], high SGOT [P = 0.003], USG finding of fatty S102
EXPRESSION OF PRO-INFLAMMATORY CYTOKINES IN HUMAN METABOLIC SYNDROME V. Rakotoarivelo, M. Mayhue, M.F. Langlois 1 , S. Ramanathan ∗,1 Université de Sherbrooke, Centre de Recherche Clinique, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
E-mail address: [email protected] (S. Ramanathan). 1 Equal senior authorship. Background and Aim: Obesity is emerging as a major healthcare burden. Excess visceral adiposity is associated with insulin resistance (IR), type 2 diabetes (T2D), atherosclerosis, hypertension and fatty liver disease. Adipose tissue is considered as an endocrine organ in addition to its primary function as a depot where energy is stored in the form of triglycerides for release during starvation, exercise or infections. However, when the adipose tissue is unable to stockage the excessive nutrient influx, insulin resistance develops in a progressive manner. Insulin resistance in the liver results in dysregulated gluconeogenesis and glycogenolysis and increases circulating glucose. Insulin resistance in the muscles and adipose tissues prevents glucose uptake despite the availability © 2017, INASL
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
of insulin. Population studies have linked insulin resistance to systemic low-grade inflammation, as evidenced by increased levels of circulating C-reactive protein. Methods: The expression of pro-inflammatory and anti-inflammatory cytokines and chemokines were analyzed in serum, subcutaneous and visceral adipose tissues of patients with body mass index (BMI) ranging from 17 to 100. Results: Parallel gene and protein expression analysis suggest that some of the inflammatory mediators may be produced in the adipose tissues. Gene expression for IL1B, but not IL6 or TNFA, was increased in obese patients. On the other hand no significant correlation was observed between protein and gene expression. Conclusion: Our results suggest that the profile of chronic inflammation in metabolic syndrome may be more complex than what is suggested.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.184
33
Bone marrow aspiration was normal. His treatment was changed to lenalidomide-based CT. Conclusion: The liver is an uncommon site for extramedullary plasmacytoma (EMP). Ascites is frequent in the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin change) syndrome, but extremely unusual in MM. Extramedullary spread generally predicts poor outcome, though stem cell transplant offers hope for improved survival. With increasing survival in MM thanks to newer CT agents, rare forms of EMP should be kept in mind.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.185
34 PROSPECTIVE EVALUATION OF SCLEROSING CHOLANGITIS IN CHILDREN WITH AUTOIMMUNE LIVER DISEASE Nagendra Kumar, Ujjal Poddar ∗ , Rajanikant Yadav, Surender K. Yachha, Anshu Srivastava E-mail address: [email protected] (U. Poddar).
Ajinkya Sonambekar ∗ , Devendra Desai, Philip Abraham, Anand Joshi, Tarun Gupta, Vatsal Mehta
Background and Aim: Autoimmune liver disease encompass “overlap syndromes” of autoimmune hepatitis (AIH) with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In children only AIH-PSC overlap syndrome also known as ‘autoimmune sclerosing cholangitis’ (ASC) has been recognized. We aimed to study prevalence of ASC by using MRC in children diagnosed as AIH, and to compare the clinical presentation and outcome of children with AIH and ASC, and compare cholangiographic appearance in AIH and in children with cirrhosis due to non-autoimmune, non-biliary etiology. Methods: We prospectively got Magnetic resonance cholangiography (MRC) done in 39 children with AIH and 19 controls with non-autoimmune, non-cholestatic causes of chronic liver disease. Based on MRC, children with definitive changes of sclerosing cholangitis (SC) were considered as ASC. Details of clinical features, laboratory parameters, liver histopathology were analysed. One child was excluded due to poor MRC imaging. Results: The median age of 38 children with AIH was 11.5 (range 3–18) years and 22 (55%) were girls. Majority (74%) were diagnosed as type 1 AIH. MRC was done in 11 children (29%) at the time of diagnosis while in 21 (71%) it was done after a median follow-up of 2.5 (range 0.3–10) years. Abnormal MRC changes were seen in 14/38 (37%) and 8/19 (42%) in children with AIH and controls,
P D Hinduja Hospital and Medical Research Centre, Mumbai City, India
E-mail address: [email protected] (A. Sonambekar). Background and Aim: Liver or peritoneal metastasis in multiple myeloma (MM) is rare. We report two such patients: one had space-occupying lesions (SOL) in the liver and the other had ascites. Case Summary: Case 1: A 47-year-old gentleman was evaluated for progressive weight loss and multiple hypoechoic lesions in the liver. He had a history of MM and had received chemotherapy (CT) earlier. Serum immunofixation electrophoresis suggested monoclonal kappa gammopathy. Biopsy of the liver SOL showed moderately differentiated plasmacytoma. He is planned for salvage CT and stem cell transplant. Case 2: A 57-year-old gentleman had completed 6 cycles of bortezomib-based CT for MM. He was on entecavir for hepatitis B-related compensated liver cirrhosis and now presented with rapidly refilling ascites. Portal and hepatic vein Doppler was normal, and ascites was high protein, high SAAG. Ascitic fluid cytology showed large number of plasma cells and plasma blasts with bizarre forms.
Journal of Clinical and Experimental Hepatology July 2017 Vol. 7 No. S2
S103
MISCELLANEOUS
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
LIVER AND PERITONEAL METASTASIS IN MULTIPLE MYELOMA