scholarly journals Prevalence of Elevated Liver Stiffness Among Potential Candidates for Bariatric Surgery in the United States

2022 ◽  
Author(s):  
Stefano Ciardullo ◽  
Mattia Pizzi ◽  
Pietro Pizzi ◽  
Alice Oltolini ◽  
Emanuele Muraca ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
The United States ◽  
Cross Sectional Study ◽  
Metabolic Dysfunction ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Using Data

Abstract Purpose Obesity represents a well-known risk factor for metabolic-dysfunction associated fatty liver disease (MAFLD) and its progression towards cirrhosis. The aim of this study is to estimate the proportion of potential candidates to a bariatric surgery intervention that has an elevated liver stiffness on vibration-controlled transient elastography (VCTE). Materials and Methods This is a cross-sectional study performed using data obtained during the 2017–2018 cycle of the National Health and Nutrition Examination Survey. Potential candidates for a bariatric surgery intervention from the general US population were identified by applying criteria from international guidelines. All included participants were evaluated by VCTE. A controlled attenuation parameter (CAP) value ≥ 288 dB/m was considered indicative of steatosis while liver stiffness measurement (LSM) was considered elevated if ≥ 9.7 kPa. Multivariable logistic regression models were fitted to identify independent predictors of both outcomes. Results A total of 434 participants were included (mean age 42.9 ± 0.6 years; 54.4% women). Among them, 76.7% (95% CI 71.7–81.0) had steatosis, while 23.1% (95% CI 17.8–29.3) had an elevated LSM. Male sex, older age, γ-glutamyltranspeptidase levels, and body mass index (BMI) were independent predictors of steatosis, while BMI was the only independent predictor of elevated LSM. Non-Hispanic black participants were protected from both outcomes, while other ethnicities were not. Conclusion The prevalence of elevated LSM is high in potential candidates for a bariatric surgery intervention. Accurate screening for occult advanced liver disease might be indicated in this patient population. Graphical abstract

The influence of prescriber and patient gender on the prescription of benzodiazepines: results from the Florida Medicaid Dataset

CNS Spectrums ◽  
2021 ◽  
pp. 1-5
Author(s):  
Leanna M. W. Lui ◽  
Yena Lee ◽  
Orly Lipsitz ◽  
Nelson B. Rodrigues ◽  
Hartej Gill ◽  
...  
Keyword(s):  
The United States ◽  
Sociodemographic Factors ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Assistance Program ◽  
Patient Gender ◽  
Prescription Rates ◽  
Male Patients ◽  
Using Data ◽  
Main Effects

Abstract Background Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription. Methods Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety. Results Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively. Conclusions Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.

scholarly journals Association between circulating alpha-1 antitrypsin polymers and lung and liver disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexa Núñez ◽  
Irene Belmonte ◽  
Elena Miranda ◽  
Miriam Barrecheguren ◽  
Georgina Farago ◽  
...  
Keyword(s):  
Liver Disease ◽  
Genetic Diseases ◽  
Sandwich Elisa ◽  
Liver Stiffness ◽  
Cross Sectional Study ◽  
Control Group ◽  
Cross Sectional ◽  
Impaired Lung Function ◽  
Alpha 1 Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin

Abstract Background Alpha-1 antitrypsin deficiency (AATD) is considered one of the most common genetic diseases and is characterised by the misfolding and polymerisation of the alpha-1 antitrypsin (AAT) protein within hepatocytes. The relevance of circulating polymers (CP) of AAT in the pathogenesis of lung and liver disease is not completely understood. Therefore, the main objective of our study was to determine whether there is an association between the levels of CP of AAT and the severity of lung and liver disease. Method This was a cross-sectional study in patients with different phenotypes of AATD and controls. To quantify CP, a sandwich ELISA was performed using the 2C1 monoclonal antibody against AAT polymers. Sociodemographic data, clinical characteristics, and liver and lung parameters were collected. Results A cohort of 70 patients was recruited: 32 Pi*ZZ (11 on augmentation therapy); 29 Z-heterozygous; 9 with other genotypes. CP were compared with a control group of 47 individuals (35 Pi*MM and 12 Pi*MS). ZZ patients had the highest concentrations of CP (p < 0.001) followed by Z heterozygous. The control group and patients with Pi*SS and Pi*SI had the lowest CP concentrations. Pi*ZZ also had higher levels of liver stiffness measurements (LSM) than the remaining AATD patients. Among patients with one or two Z alleles, two patients with lung and liver impairment showed the highest concentrations of CP (47.5 µg/mL), followed by those with only liver abnormality (n = 6, CP = 34 µg/mL), only lung (n = 18, CP = 26.5 µg/mL) and no abnormalities (n = 23, CP = 14.3 µg/mL). Differences were highly significant (p = 0.004). Conclusions Non-augmented Pi*ZZ and Z-patients with impaired lung function and increased liver stiffness presented higher levels of CP than other clinical phenotypes. Therefore, CP may help to identify patients more at risk of developing lung and liver disease and may provide some insight into the mechanisms of disease.

scholarly journals A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anjali Kumar ◽  
Dana Cernigliaro ◽  
Mary E. Northridge ◽  
Yinxiang Wu ◽  
Andrea B. Troxel ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Cross Sectional Study ◽  
Caries Experience ◽  
Cross Sectional ◽  
Silver Diamine Fluoride ◽  
Fluoride Treatment ◽  
Logistic Regression Models ◽  
Health Related ◽  
The Relationship

Abstract Background Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists. Methods A caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest. Results Overall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9–14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere. Conclusions Caregiver acceptance of SDF treatment is high; child’s age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

scholarly journals Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e2867
Author(s):  
Mihály Sulyok ◽  
Tamás Ferenci ◽  
Mihály Makara ◽  
Gábor Horváth ◽  
János Szlávik ◽  
...  
Keyword(s):  
Hepatic Fibrosis ◽  
Bayesian Model Averaging ◽  
Hepatitis Virus ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Model Averaging ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Cross Sectional

BackgroundLiver disease has become an important cause of morbidity and mortality even in those HIV-infected individuals who are devoid of hepatitis virus co-infection. The aim of this study was to evaluate the degree of hepatic fibrosis and the role of associated factors using liver stiffness measurement in HIV mono-infected patients without significant alcohol intake.MethodsWe performed a cross-sectional study of 101 HIV mono-infected patients recruited prospectively from March 1, 2014 to October 30, 2014 at the Center for HIV, St István and St László Hospital, Budapest, Hungary. To determine hepatic fibrosis, liver stiffness was measured with transient elastography. Demographic, immunologic and other clinical parameters were collected to establish a multivariate model. Bayesian Model Averaging (BMA) was performed to identify predictors of liver stiffness.ResultsLiver stiffness ranged from 3.0–34.3 kPa, with a median value of 5.1 kPa (IQR 1.7). BMA provided a very high support for age (Posterior Effect Probability-PEP: 84.5%), moderate for BMI (PEP: 49.3%), CD4/8 ratio (PEP: 44.2%) and lipodystrophy (PEP: 44.0%). For all remaining variables, the model rather provides evidence against their effect. These results overall suggest that age and BMI have a positive association with LS, while CD4/8 ratio and lipodystrophy are negatively associated.DiscussionOur findings shed light on the possible importance of ageing, overweight and HIV-induced immune dysregulation in the development of liver fibrosis in the HIV-infected population. Nonetheless, further controlled studies are warranted to clarify causal relations.

scholarly journals Prevalence of Significant and Advanced Hepatic Fibrosis in Metabolic Dysfunction Associated Fatty Liver Disease (MAFLD)

2021 ◽  
Author(s):  
Mimi Kim ◽  
Eileen Laurel Yoon ◽  
Seon Cho ◽  
Chul-min Lee ◽  
Bo Kyeong Kang ◽  
...  
Keyword(s):  
Liver Disease ◽  
General Population ◽  
Fatty Liver ◽  
Hepatic Fibrosis ◽  
Fatty Liver Disease ◽  
Cross Sectional Study ◽  
Health Check ◽  
Metabolic Dysfunction ◽  
Advanced Fibrosis ◽  
Cross Sectional

Abstract Background: There are several reports on the prevalence of metabolic dysfunction associated fatty liver disease (MAFLD) in the general population. But the fibrosis burden of MAFLD in general population is largely unknown. We aimed to evaluate the prevalence of significant and advanced fibrosis associated with MAFLD in a health check-up cohort.Materials and methods: Participants who underwent magnetic resonance elastography (MRE) at nationwide thirteen health check-up centers were included in this cross-sectional study. Fatty liver was evaluated using ultrasonography. Significant (≥F2) and advanced (≥F3) hepatic fibrosis were defined by MRE thresholds of 3.0 kPa (range: 2.99–3.65 kPa) and 3.6 kPa (range: 3.4–3.9 kPa), respectively. The sex- and age-standardized prevalence of MAFLD and hepatic fibrosis were estimated.Results: Total 6,775 health check-up adults included analysis. The sex- and age-standardized prevalence of MAFLD was 33.9%. Prevalence of MAFLD was higher in males than in females, and increased with age. The prevalence of diabetes in MAFLD was 13.3%, and 73.6% of subjects with diabetes had MAFLD. The sex- and age-standardized prevalence of significant (≥F2) and advanced hepatic fibrosis (≥F3) was 9.7% (range: 3.0–9.8%) and 3.0% (range: 2.6–4.6%), respectively, in MAFLD subjects. The prevalence of advanced hepatic fibrosis in diabetic with MAFLD 9.5% (range: 7.5–12.7%).Conclusion: The sex- and age-standardized prevalence of advanced fibrosis was 3.0% (range: 2.6–4.6%) in subjects with MAFLD, respectively.

scholarly journals Liver stiffness by transient elastography accompanies illness severity in COVID-19

2020 ◽  
Vol 7 (1) ◽  
pp. e000445
Author(s):  
Maria Effenberger ◽  
Christoph Grander ◽  
Gernot Fritsche ◽  
Rosa Bellmann-Weiler ◽  
Frank Hartig ◽  
...  
Keyword(s):  
Liver Damage ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Gastrointestinal Symptoms ◽  
Severity Of Illness ◽  
Cross Sectional Study ◽  
Illness Severity ◽  
University Hospital ◽  
Cross Sectional ◽  
Severe Liver Damage

ObjectiveSevere liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19.DesignWe investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness.Results12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death.ConclusionTransient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.

scholarly journals Dysregulation of the Immune System in HIV/HCV-Coinfected Patients According to Liver Stiffness Status

Cells ◽  
2018 ◽  
Vol 7 (11) ◽  
pp. 196 ◽  
Author(s):  
Pilar Garcia-Broncano ◽  
Luz Medrano ◽  
Juan Berenguer ◽  
Juan González-García ◽  
Mª Jiménez-Sousa ◽  
...  
Keyword(s):  
Transient Elastography ◽  
Liver Stiffness ◽  
Cross Sectional Study ◽  
T Cell Subsets ◽  
Cross Sectional ◽  
Plasma Cytokine ◽  
Advanced Cirrhosis ◽  
Healthy Donors ◽  
Tnf Α ◽  
Cytokine Levels

Background: Advanced cirrhosis is related to alterations in immunity. We aimed to evaluate the levels of peripheral CD4+ T cells (Tregs) and plasma cytokine in patients coinfected with human immunodeficiency virus and hepatitis C virus (HIV/HCV) according to liver fibrosis stages [evaluated as liver stiffness measure (LSM)] and their linear relationship. Methods: We performed a cross-sectional study on 238 HIV/HCV-coinfected patients (119 had <12.5 kPa, 73 had 12.5–25 kPa, and 46 had >25 kPa). Peripheral T-cell subsets were phenotyped by flow cytometry, plasma biomarkers were assessed by multiplex immunoassays, and LSM was assessed by transient elastography. Results: We found HIV/HCV-coinfected patients had higher values of CD4+ Tregs (p < 0.001), memory Tregs (p ≤ 0.001), and plasma cytokine levels [IFN-γ (p ≤ 0.05) and IL-10 (p ≤ 0.01)] compared with healthy donors and HIV-monoinfected patients. In the multivariate analysis, higher LSM values were associated with reduced levels of IL-10 (adjusted arithmetic mean ratio (aAMR) = 0.83; p = 0.019), IL-2 (aAMR = 0.78; p = 0.017), TNF-α (aAMR = 0.67; p < 0.001), and IL-17A (aAMR = 0.75; p = 0.006). When we focus on HIV/HCV-coinfected patients analyzed by LSM strata, patients with ≥25 kPa had lower values of IL-2 (aAMR = 0.66; p = 0.021), TNF-α (aAMR = 0.565; p = 0.003), and IL-17A (aAMR = 0.58; p = 0.003) than patients with <12.5 kPa. Conclusion: HIV/HCV-coinfected patients showed an immunosuppressive profile compared to healthy controls and HIV-monoinfected patients. Additionally, HIV/HCV-coinfected patients with advanced cirrhosis (LSM ≥ 25 kPa) had the lowest plasma values of cytokines related to Th1 (IL-2 and TNF-α) and Th17 (IL-17A) response.

scholarly journals Moderators of the association between discrimination and alcohol consumption: findings from a representative sample of Brazilian university students

2015 ◽  
Vol 37 (2) ◽  
pp. 72-81 ◽  
Author(s):  
Isabela Zeni Coelho ◽  
João Luiz Bastos ◽  
Roger Keller Celeste
Keyword(s):  
Alcohol Consumption ◽  
Undergraduate Students ◽  
Representative Sample ◽  
Common Mental Disorders ◽  
The United States ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
First Year Students ◽  
Logistic Regression Models ◽  
University Life

Introduction: Few studies about discrimination and patterns of alcohol consumption among youth populations have been conducted outside the United States addressing different types of discriminatory experiences, in addition to racially motivated events. This study investigated moderators of the association between discrimination attributed to single and multiple reasons and patterns of alcohol consumption.Methods: This cross-sectional study enrolled a representative sample (n = 1,264) of undergraduate students from Florianópolis, southern Brazil, in 2013. Analyses included adjustment of associations for covariates in ordinal logistic regression models and the examination of effect modification by common mental disorders, year of study and age.Results: Discrimination was reported by 65.8% of the students, and alcohol consumption, by 80.0%. Over half of the students reported being discriminated against for two or more reasons. The odds of alcohol-related problems were higher among lastyear students that reported discrimination (odds ratio [OR] = 1.9, 95% confidence interval [95%CI] 1.0-3.4) or multiple reasons for being discriminated against (OR = 2.3, 95%CI 1.3- 4.3), when compared to first-year students that did not report discrimination. For the whole sample, there were no associations between discrimination, discrimination attributed to multiple reasons and patterns of alcohol consumption (OR = 1.0, 95%CI 0.8-1.4; and OR = 0.9, 95%CI 0.5-1.6).Conclusions: The effects of discrimination on the patterns of alcohol consumption are seen at a critical period in university life, specifically during the completion of undergraduate studies.

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