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Metabolic puzzle: Exploring liver fibrosis differences in Asian metabolic-associated fatty liver disease subtypes

World Journal of Hepatology 2024年第1期16卷 54-64页

作者： Sabhita Shabir Shaikh fakhar ali qazi-arisar Saba Nafay Sidra Zaheer Hafeezullah Shaikh Zahid Azam National Institute of Liver and GI Diseases Dow University of Health SciencesSindhKarachi 75330Pakistan School of Public Health Dow University of Health SciencesSindhKarachi 75330Pakistan

BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is a liver condition marked by excessive fat buildup in the absence of heavy alcohol *** is primarily linked with metabolic issues like insulin resistance,obesity,and abnormal lipid levels,and is often observed with other conditions such as type 2 diabetes and cardiovascular ***,whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated,especially in the Asian *** To compare the severity of liver fibrosis among different MAFLD *** A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December *** was defined as per the Asian Pacific Association for the Study of the Liver ***-4 index(Fib-4)and nonalcoholic fatty liver disease fibrosis score(NFS)were employed to evaluate liver *** The mean age was 44.84±11 ***-two percent of the patients were *** hundred and seventy-three patients were classified as having MAFLD,of which 110(40.3%)carried a single,129(47.3%)had two,and 34(12.5%)had all three metabolic *** cumulative number of metabolic conditions was related to elevated body mass index,triglyceride(TG)levels,and glycated hemoglobin,lower high-density lipoprotein(HDL)levels,higher liver inflammation(by aspartate aminotransferase andγ-glutamyl transferase),and higher likelihood of fibrosis(by NFS and Fib-4 scores)(P<0.05 for all).The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions(4.1%,25.5%,35.6%,and 44.1%by NFS and 6.1%,10.9%,17%,and 26.5%by Fib-4 for no MAFLD and MAFLD with 1,2,and 3 conditions,respectively).Among MAFLD patients,those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score(P<0.05),while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and a

关键词： Metabolic syndrome Diabetes Fatty liver disease Dyslipidemia Obesity

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Risk factors and outcomes of peptic ulcer bleed in a Pakistani population:A single-center observational study

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第3期15卷 1-9页

作者： Nazish Butt Muhammad Tayyab Usmani Nimrah Mehak Saba Mughal fakhar ali qazi-arisar Ghulam Mohiuddin Gulzar Khan Department of Gastroenterology Jinnah Postgraduate Medical CentreKarachi 75505SindhPakistan National Institute of Liver&GI Diseases Dow University of Health SciencesKarachi 75330SindhPakistan School of Public Health Dow University of Health SciencesKarachi 75330SindhPakistan

BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality *** advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori *** To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani *** This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December *** on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was *** The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting *** patients(73.2%)were discharged within five *** mortality rates at one week and one month were 10.6%and 14.8%,***-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,*** ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed *** use was associated with more FCⅢ***-bleed at 24 h and 7 d was strongly associated with one-week or one-month *** Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.

关键词： Non variceal bleed Mortality Re-bleed Forrest classification Antiplatelets Alternative medicines

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Divergent trajectories of lean vs obese non-alcoholic steatohepatitis patients from listing to post-transplant:A retrospective cohort study

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World Journal of Gastroenterology 2022年第26期28卷 3218-3231页

作者： fakhar ali qazi-arisar Raj Uchila Catherine Chen Cathy Yang Shi-Yi Chen Ravikiran Sindhuvalada Karnam Amirhossein Azhie Wei Xu Zita Galvin Nazia Selzner Leslie Lilly Mamatha Bhat Ajmera Transplant Program Toronto General HospitalUniversity Health NetworkToronto M5G 2N2OntarioCanada Division of Gastroenterology and Hepatology Department of MedicineUniversity of TorontoToronto M5G 2N2OntarioCanada National Institute of Liver and GI Diseases Dow University of Health SciencesKarachi 75330Pakistan Department of Biostatistics Princess Margaret Cancer CenterUniversity Health NetworkToronto M5G 2C1OntarioCanada Division of Biostatistics Dalla Lana School of Public HealthUniversity of TorontoToronto M5G 2C1OntarioCanada

BACKGROUND Non-alcoholic steatohepatitis(NASH)cirrhosis is the second most common indication for liver transplantation(LT).The role of body mass index(BMI)on outcomes of NASH cirrhosis has been *** To compare the longitudinal trajectories of patients with lean vs obese NASH cirrhosis,from listing up to post-transplant,having adjusted their BMI for *** We retrospectively reviewed all adult NASH patients listed for LT in our program from 2012 to ***-Gray Competing Risk analyses and Cox Proportional-Hazard Models were performed to examine the cumulative incidence of transplant and survival outcomes *** Out of 265 NASH cirrhosis listed patients,176 were *** age was 61.0 years;46%were females.111 patients underwent *** robust patients had better waitlist survival[hazard ratio(HR):0.12;95%CI:0.05–0.29,P<0.0001]with higher instantaneous rate of transplant(HR:5.71;95%CI:1.26–25.9,P=0.02).Lean NASH patients had a substantially higher risk of graft loss within 90 d post-LT(1.2%vs 13.8%,P=0.032)and death post-LT(2.4%vs 17.2%,P=0.029).1-3-and 5-year graft survival was poor for lean NASH(78.6%,77.3%and 41.7%vs 98.6%,96%and 85%respectively).Overall patient survival post-LT was significantly worse in lean NASH(HR:0.17;95%CI:0.03–0.86,P=0.0142)with 83%lower instantaneous rate of death in obese *** Although lean NASH is considered to be more benign than obese NASH,our study suggests a paradoxical correlation of lean NASH with waitlist outcomes,and graft and patient survival post-LT.

关键词： Outcomes Frailty Waitlist Liver transplant Survival

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Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients

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World Journal of Hepatology 2018年第12期10卷 944-955页

作者： fakhar ali qazi arisar Shahab Abid Preet Ayoub Shaikh Safia Awan Section of Gastroenterology Department of MedicineFaculty Offices Buildingthe Aga Khan University Hospital

AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) *** this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were *** older than 18 years with decompensation of CLD(i.e., jaundice, ascites,encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay(> 5 d), and early readmission(within 7 d).RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and64.6%(n = 258) were male. Six-week mortality was 13%(n = 52). Prolonged hospital stay and readmission were present in 18%(n = 72) and 7%(n = 28) of patients, respectively. NCDs were found in 47.4%(n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in41%(n = 165), 17.5%(n = 70), and 1.75%(n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease(CKD), low albumin, and high Model for End-Stage Liver Disease(MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventionalMELD score predicted mortality even better than MELD-Na(area under receiver operating characteristic: 0.735 vs 0.686; P ality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.

关键词： Chronic liver disease Mortality Morbidity Prognostic factors Noncommunicable diseases Sepsis

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Rapid Development of Hepatocellular Carcinoma after Eradication of Hepatitis C Virus with Directly Acting Antiviral Treatment

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Open Journal of Gastroenterology 2018年第9期8卷 295-305页

作者： fakhar ali qazi arisar Saeed Hamid Section of Gastroenterology Department of Medicine The Aga Khan University Karachi Pakistan

Hepatitis C is a major risk factor for the development of hepatocellular carcinoma (HCC), arising typically on a background of liver cirrhosis. Treatment of hepatitis C has been revolutionized by the addition of oral direct-acting antivirals (DAAs) with sustained virological response (SVR) rates above 90%. There is a recent concern under debate about the increased risk of early HCC recurrence in patients with chronic hepatitis C who were treated with direct-acting antivirals. Nonetheless, these reports mostly focused on patients who were cirrhotic and were already treated for HCC. We report 4 cases of treatment naive, chronic hepatitis C patients who were treated with DAAs and rapidly developed infiltrative HCC despite achieving SVR. Moreover, in our scenario, one of the patients appeared clinically non-cirrhotic until he developed HCC.

关键词： Direct Acting Antivirals Hepatitis C Hepatocellular Carcinoma Hepatoma

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Partial Splenic Artery Embolization in Cirrhosis Is a Safe and Useful Procedure

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Open Journal of Gastroenterology 2018年第9期8卷 327-336页

作者： fakhar ali qazi arisar Syed Hasnain ali Shah Tanveer Ul Haq Section of Gastroenterology Department of Medicine The Aga Khan University Hospital Karachi Pakistan Section of Interventional Radiology Department of Radiology The Aga Khan University Hospital Karachi Pakistan

Background: Portal Hypertension is a common complication of cirrhosis. It leads to splenomegaly which manifests with features of hypersplenism. This results in leucopenia which increases the likelihood of sepsis and prevents treatment with interferon. Thrombocytopenia increases the risk of bleeding including variceal bleeds which make the anemia worse. This study was done to determine the usefulness and safety of partial splenic artery embolization (PSAE) in portal hypertension due to cirrhosis. Methods: Patients with PSAE were identified by using International Classification of Diseases (ICD)-10 coding from medical records and their charts were reviewed retrospectively. 25 patients underwent splenic artery embolization at The Aga Khan University Hospital Karachi from November 2000 to December 2016. 18 patients who underwent PSAE for disabling hypersplenism caused by cirrhosis were included. Patients who were under 18 year of age, or in whom PSAE were performed for reasons other than cirrhosis and those with missing records/incomplete data were excluded (n = 7). Information was collected regarding demographic details, procedure indications, nature, technique, clinical efficacy, repeat embolization and complications along with laboratory and radiological investigations. Results: Eighteen patients of cirrhosis with a mean age of 43.47 ± 10.926 years, of which 14 were males, underwent PSAE (19 procedures). Indications were severe hypersplenism which precluded treatment with interferon and ribavirin (n = 8) and recurrent Gastro-oesophageal variceal (GOV) bleeds due to advanced Child-Pugh grade and thrombocytopenia (n = 10). Hematological parameters improved significantly following PSAE. Three out of eight patients successfully completed interferon + ribavirin treatment for hepatitis C (HCV) infection post PSAE, and GOV bleeds stopped in eight out of 10 patients. Complications included mild Left upper quadrant (LUQ) abdominal pain n = 9 (47.3%), post-embolization syndrom

关键词： Partial Splenic Artery Embolization Chronic Liver Disease Cirrhosis Hyper-splenism Safety Outcome

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Changes in Serum Lipid Profile among Patients Suffering from Chronic Liver Disease Secondary to Hepatitis C

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Open Journal of Gastroenterology 2016年第11期6卷 333-342页

作者： fakhar ali qazi arisar Shameem Behram Khan Anam Umar Noor ul Saba Shaikh Fizza Choudhry Departement of Medicine Section of Gastroenterology The Aga Khan University Hospital Karachi Pakistan Departement of Medicine Jinnah Postgraduate Medical Centre Karachi Pakistan

Objective: To find out the changes in lipid metabolism among patients suffering from chronic liver disease secondary to hepatitis C. Study Design: Hospital based observational study. Setting: Medical Unit-I, Ward–5, Jinnah Postgraduate Medical Centre, Karachi. Duration: July 2013 to December 2013. Patients and Methods: About 110 patients admitted in Medical Unit-I with a diagnosis of chronic liver disease were included in the study. Patients suffering from DM, HTN, CKD were excluded from the study. Fasting lipid profile was done in all cases. Results and Observations: There were 44 (40%) male and 66 (60%) female patients. Mean age of the patients was 50.18 (±11.7) years. Total cholesterol was decreased in 76 (69.09%) patients. Normal range was present in 34 (30.91%) patients. None of the patient had hypercholesterolemia. Serum triglyceride levels were low in 14 (12.72%) patients, normal in 82 (74.54%), borderline high in 7 (6.36%) and hypertriglyceridemia was seen in 7 (6.36%). HDL-c was below normal in 26 (23.63%) cases, normal in 78 (70.91%), and high in 6 (5.45%). LDL was near optimal/above optimal in only 5 (4.5%) patients. Mean TC/HDL ratio was 2.53 (±1.02). Mean LDL/HDL ratio was 1.23 (±0.73). Mean TC of HCV +ve patients was 130.5 mg/dl as compared to that of HCV –ve patients which was 82.85 mg/dl (P-value: 0.011). Mean TGs of HCV +ve group was 151.5 mg/dl while that of HCV –ve was 79.9 mg/dl (P-value: 0.025). Mean HDL & LDL levels were 43.67 mg/dl and 39.78 mg/dl in HCV group while 34.83 mg/dl & 64.67 mg/dl in the other group with P-value of 0.026 and 0.081 respectively. Conclusion: When it comes to its relationship with lipid metabolism, HCV is a remarkable virus. Its interaction with lipoproteins and its ability to induce massive steatosis are quite unique and idiosyncratic. Despite of causing hepatic steatosis, chronic HCV infection is associated with a paradoxically favorable lipid profile, although its reason cannot be enlightened precisely. There is a n

关键词： Dyslipidemia Hepatitis C Chronic Liver Disease

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