Prevalence and identification of fatty liver (FL) risk markers in local Pakis...Syeda Masoom Fatima
1) The study aimed to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and identify risk markers in the local Pakistani population.
2) Physical data and biochemical profiles were collected from 1366 patients visiting hospitals in Rawalpindi and Islamabad using standardized criteria to diagnose fatty liver disease.
3) Preliminary results found a high prevalence of metabolic syndrome risk factors like obesity, high blood pressure, and diabetes, which are predictors of fatty liver. Further analysis of the data aims to understand the prevalence and risk markers of NAFLD in Pakistan.
Abstract— Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent worldwide, affecting up to 30% of the global population. NAFLD is closely associated with obesity and type 2 diabetes. While initially characterized by excess fat accumulation in the liver (steatosis), some patients can progress to develop more severe non-alcoholic steatohepatitis (NASH) and liver fibrosis. Accurate staging of fibrosis is important for predicting outcomes but liver biopsy is invasive and not always practical. Non-invasive tests (NITs) using blood tests or imaging can help stratify patients' risk of advanced fibrosis as an alternative to biopsy. Lifestyle modifications addressing diet and exercise are recommended for managing NAFL
This document discusses the growing epidemic of non-alcoholic fatty liver disease (NAFLD) in India. It provides background on NAFLD and highlights several studies that estimate the prevalence of NAFLD in India ranges from 8.7% to 32% based on ultrasound and biopsy data. The risk of NAFLD is increased in Indians due to high rates of obesity, diabetes, and the metabolic syndrome. Left untreated, NAFLD can progress to cirrhosis of the liver, creating a serious future health burden. Increased public health education is needed to raise awareness of obesity risks and promote healthy lifestyles.
This document provides an overview of current treatment and updates on non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). It begins with definitions of NAFLD and NASH. It then discusses the prevalence of NAFLD globally and in Asian countries. Risk factors and the pathogenesis involving the gut microbiota and a potential role in lean NASH are reviewed. Current methods for diagnosis including laboratory tests, imaging, serum biomarkers, and liver biopsy are summarized. Current treatment options including lifestyle modifications, metformin, pioglitazone, and vitamin E are mentioned. Several newer potential treatment approaches are also listed. The role of transient elastography in management is
This document provides guidance on indications and limitations of bariatric interventions in severely obese children and adolescents with and without nonalcoholic steatohepatitis (NASH). It finds that bariatric surgery can decrease steatosis, inflammation, and fibrosis in NASH, but uncomplicated NAFLD is not an indication. Roux-en-Y gastric bypass is considered safe and effective for adolescents with extreme obesity if long-term follow-up is provided, while laparoscopic adjustable gastric banding is still investigational. More research is needed on other procedures and temporary devices in pediatrics. NASH with significant fibrosis, type 2 diabetes, moderate-to-severe sleep apnea, and pseudot
Non Alcoholic Fatty Liver Disease: A New Urban Epidemic.KETAN VAGHOLKAR
This document discusses non-alcoholic fatty liver disease (NAFLD), which has become very common in urban populations. NAFLD ranges from simple fatty liver to non-alcoholic steatohepatitis (NASH), which is characterized by fatty changes, inflammation, and fibrosis that can progress to cirrhosis. The main causes are obesity, insulin resistance, and dyslipidemia. Weight loss and improving insulin sensitivity through diet and exercise are the primary treatment approaches. Medications like vitamin E, pioglitazone, and metformin may also provide benefits, but more research is still needed on medical therapies for NAFLD.
Prevalence and identification of fatty liver (FL) risk markers in local Pakis...Syeda Masoom Fatima
1) The study aimed to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and identify risk markers in the local Pakistani population.
2) Physical data and biochemical profiles were collected from 1366 patients visiting hospitals in Rawalpindi and Islamabad using standardized criteria to diagnose fatty liver disease.
3) Preliminary results found a high prevalence of metabolic syndrome risk factors like obesity, high blood pressure, and diabetes, which are predictors of fatty liver. Further analysis of the data aims to understand the prevalence and risk markers of NAFLD in Pakistan.
Abstract— Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent worldwide, affecting up to 30% of the global population. NAFLD is closely associated with obesity and type 2 diabetes. While initially characterized by excess fat accumulation in the liver (steatosis), some patients can progress to develop more severe non-alcoholic steatohepatitis (NASH) and liver fibrosis. Accurate staging of fibrosis is important for predicting outcomes but liver biopsy is invasive and not always practical. Non-invasive tests (NITs) using blood tests or imaging can help stratify patients' risk of advanced fibrosis as an alternative to biopsy. Lifestyle modifications addressing diet and exercise are recommended for managing NAFL
This document discusses the growing epidemic of non-alcoholic fatty liver disease (NAFLD) in India. It provides background on NAFLD and highlights several studies that estimate the prevalence of NAFLD in India ranges from 8.7% to 32% based on ultrasound and biopsy data. The risk of NAFLD is increased in Indians due to high rates of obesity, diabetes, and the metabolic syndrome. Left untreated, NAFLD can progress to cirrhosis of the liver, creating a serious future health burden. Increased public health education is needed to raise awareness of obesity risks and promote healthy lifestyles.
This document provides an overview of current treatment and updates on non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). It begins with definitions of NAFLD and NASH. It then discusses the prevalence of NAFLD globally and in Asian countries. Risk factors and the pathogenesis involving the gut microbiota and a potential role in lean NASH are reviewed. Current methods for diagnosis including laboratory tests, imaging, serum biomarkers, and liver biopsy are summarized. Current treatment options including lifestyle modifications, metformin, pioglitazone, and vitamin E are mentioned. Several newer potential treatment approaches are also listed. The role of transient elastography in management is
This document provides guidance on indications and limitations of bariatric interventions in severely obese children and adolescents with and without nonalcoholic steatohepatitis (NASH). It finds that bariatric surgery can decrease steatosis, inflammation, and fibrosis in NASH, but uncomplicated NAFLD is not an indication. Roux-en-Y gastric bypass is considered safe and effective for adolescents with extreme obesity if long-term follow-up is provided, while laparoscopic adjustable gastric banding is still investigational. More research is needed on other procedures and temporary devices in pediatrics. NASH with significant fibrosis, type 2 diabetes, moderate-to-severe sleep apnea, and pseudot
Non Alcoholic Fatty Liver Disease: A New Urban Epidemic.KETAN VAGHOLKAR
This document discusses non-alcoholic fatty liver disease (NAFLD), which has become very common in urban populations. NAFLD ranges from simple fatty liver to non-alcoholic steatohepatitis (NASH), which is characterized by fatty changes, inflammation, and fibrosis that can progress to cirrhosis. The main causes are obesity, insulin resistance, and dyslipidemia. Weight loss and improving insulin sensitivity through diet and exercise are the primary treatment approaches. Medications like vitamin E, pioglitazone, and metformin may also provide benefits, but more research is still needed on medical therapies for NAFLD.
Core Components of the Metabolic Syndrome in Nonalcohlic Fatty Liver DiseaseIOSR Journals
This study examined the association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) in Bangladeshi patients. The study included 67 patients diagnosed with NAFLD and 50 healthy controls matched for age and BMI. Results found that NAFLD patients had higher levels of insulin resistance, triglycerides, and central obesity compared to controls. However, no significant association was found between MetS and NAFLD when defined by common diagnostic criteria. Individual components of MetS like dyslipidemia, central obesity, and high postprandial glucose were significantly associated with NAFLD on logistic regression analysis. The study concludes that while various MetS components are linked to NAFLD in
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
This document discusses identifying and managing advanced fibrosis due to nonalcoholic steatohepatitis (NASH). It begins by outlining the impact of advanced fibrosis, including increased risk of liver-related morbidity and mortality as well as potential for rapid progression to cirrhosis in some patients. It then examines challenges with biopsy as the reference standard for identification given sampling error and limitations. Non-invasive tests are presented as an alternative, with sequential use of two tests recommended. The document concludes by emphasizing the importance of identifying advanced fibrosis patients to prevent cirrhosis and complications.
This document provides guidelines for the management of acute pancreatitis (AP). It summarizes key recommendations regarding the diagnosis, etiology, risk stratification, and management of AP. The diagnosis of AP is usually established by abdominal pain and elevated serum amylase and/or lipase levels. Contrast-enhanced CT or MRI is only recommended if the diagnosis is unclear or the patient fails to improve. Patients should be stratified based on the presence of organ failure or systemic inflammatory response syndrome and those with organ failure admitted to intensive care. Aggressive intravenous hydration within the first 24 hours and assessment of fluid status is important. Guidelines are also provided for managing gallstone pancreatitis, infectious complications, and interventions.
From Unknown to UN_Charlotte Block_10.14.11CORE Group
This document discusses non-communicable diseases (NCDs) such as diabetes, cancer, heart disease and respiratory diseases. It notes that NCDs cause 63% of deaths globally and that risk factors like tobacco use, unhealthy diet and physical inactivity can be addressed through policy changes. It also highlights Project HOPE's work in countries like Mexico, India and China to train healthcare workers in diabetes care, educate patients and communities, and establish diabetes education programs.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Utility of Homoeopathy in Cases of Nephrolithiasis with Counstitutional Approachijtsrd
Nephrolithiasis also known as renal calculi is a frequent urinary tract condition. Most patients with renal calculi experience recurrent nephrolithiasis. Recurrence rates are estimated at about 10 per year. Most of the people seek for the allopathic treatment for acute cases. The treatment course in the case of renal calculi is flush therapy through I.V. fluids , Lithotripsy or surgical aid etc. these methods are generally painful, harmful and sometime risky for the patients compare to the homoeopathic mode of treatment. Homoeopathic system of medicine manages such case quickly, mildly, gently and permanently without consuming much time. So, this study was conducted to confirm the role of homoeopathy in cases of nephrolithiasis with constitutional approach. Dr. Sheela Dandge | Dr. Janki Bhanvadia "Utility of Homoeopathy in Cases of Nephrolithiasis with Counstitutional Approach" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49642.pdf Paper URL: https://www.ijtsrd.com/medicine/urology/49642/utility-of-homoeopathy-in-cases-of-nephrolithiasis-with-counstitutional-approach/dr-sheela-dandge
1) Fatty liver, measured using CT scans, was present in 17% of participants.
2) Fatty liver was associated with higher risk of diabetes, metabolic syndrome, hypertension, and insulin resistance even after accounting for other measures of obesity like BMI and visceral fat.
3) Fatty liver was also linked to dyslipidemia (higher triglycerides and lower HDL) and dysglycemia (impaired fasting glucose) independent of other fat depots.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Global recommendations on physical activity for healthhome
The document discusses the importance and public health significance of physical activity. It notes that physical inactivity is now the fourth leading risk factor for global mortality. It outlines WHO mandates to support countries in developing national physical activity guidelines and policies to promote physical activity. There is a need for global physical activity recommendations to address links between activity levels and prevention of non-communicable diseases. The recommendations will provide guidance to policy-makers on developing physical activity guidelines and policies at regional and national levels.
The document discusses healthy eating patterns for chronic kidney disease (CKD). It notes that healthy eating patterns with adequate fruits and vegetables and limited alcohol and sodium may delay CKD progression and improve survival. The U.S. Dietary Guidelines recommend a diet including vegetables, fruits, whole grains, low-fat dairy, and protein sources like seafood, nuts, and legumes, while limiting saturated fat, added sugars, and sodium. For people with CKD, such a diet can help reduce risks from the disease.
Chronic Kidney Disease (CKD) is defined as abnormalities of kidney structure or function present for more than three months. It affects over 26 million Americans and is a major public health issue. The leading causes are diabetes and hypertension. As CKD progresses, kidney function declines and complications increase like anemia and bone disease. Cardiovascular disease risk also rises substantially. Inflammation, lipid abnormalities, and genetic factors can all contribute to CKD progression if not properly managed.
Running head:RESEARCH PROPOSAL 1
RESEARCH PROPOSAL 5
Research Proposal on Security and Privacy of Health Data
Name
Institutional Affiliation
Research Proposal on Security and Privacy of Health Data
Summary of the Research
The health sector is important because it ensures the health of the populace. Over the years, there has been digitization of health data with the aim of enabling faster efficient and effective delivery of healthcare services. Digitization of health care enables faster retrieval of health records hence facilitates faster and informed healthcare decisions (Nass, Levit & Gostin, 2009). Due to the importance of digitization of healthcare data, big healthcare data emerged; it changed the way data was previously managed (Abouelmehdi, Beni-Hessane & Khaloufi, 2018). The availability of big healthcare data comes with privacy and security challenges that must be solved. In cognizance of the challenges, the research focuses on identifying mechanisms used in ensuring the security and the limitations of available solutions and how they can be improved amidst increasing amount of healthcare data.
Outline of the Research
The Introduction to the Research
· Overview of healthcare data
· Justification of the research
· Research objectives
· Research questions
Review of Literature
· The differences between privacy and security of health data
· Data protection laws in relation to health
· Privacy and security concerns of health data
· Technologies use in privacy and security of health data
i. Authentication
ii. De-identification
iii. Encryption
iv. Data masking
v. Access control
vi. Monitoring and auditing
· Challenges of existing technologies
Methodology
· Sample selection
· Methods of data collection,
i. Online surveys
ii. Oral interviews
· Data analysis
i. Thematic analysis
Research Findings and Discussion
Recommendations
· Ways of improving the limitations of existing technologies
Conclusion
· The available opportunities for preserving the privacy and the security of health data
Limitations of the Study
· Considerations for future research
References
Abouelmehdi, K ., Beni-Hessane, A and Khaloufi, H (2018). Big Healthcare Data: Preserving Security and Privacy. Journal of Big Data, 5(1), pp. 15-28.
Nass, S. J., Levit, L.A and Gostin, L. O (eds.) (2009). Beyond The HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. Washington DC: National Academies Press.
DQ-1
Non-alcoholic fatty liver diseases (NAFLD).
NAFLD is a spectrum of hepatic disorders not associated with excessive alcohol intake, ranging from steatosis to cirrhosis and hepatocellular carcinoma, with hepatic cell inflammation and injury thought to result from the accumulation of triglycerides in the liver (Ball.
Sarcopenic obesity is a chronic condition, which is due to progressively aging populations, the increasing incidence of obesity, and lifestyle changes. The increasing prevalence of sarcopenic obesity in elderly has augmented interest in identifying the most effective treatment. This article aims at highlighting potential pathways to muscle impairment in obese individuals, the consequences that joint obesity and muscle impairment may have on health and disability, recent progress in management with attention on lifestyle management and pharmacologic therapy involved in reversing sarcopenic obesity. Recent findings: It has been suggested that a number of disorders affecting metabolism, physical capacity, and quality of life may be attributed to sarcopenic obesity. Excess dietary intake, physical inactivity, low-grade inflammation, insulin resistance and hormonal changes may lead to the development of sarcopenic obesity. Weight loss and exercise independently reverse sarcopenic obesity. Optimum protein intake appears to have beneficial effects on net muscle protein accretion in older adults. Myostatin inhibition causes favourable changes in body composition. Testosterone and growth hormone offer improvements in body composition but the benefits must be weighed against potential risks of therapy. GHRH-analog therapy is effective but further studies are needed in older adults. Summary: Lifestyle changes involving both diet-induced weight loss and regular exercise appear to be the optimal treatment for sarcopenic obesity. It is also advisable to maintain adequate protein intake. Ongoing studies will determine whether pharmacologic therapy such as myostatin inhibitors or GHRH-analogs have a role in the treatment of sarcopenic obesity.
Validation of an Off-the-Shelf, Diet-Induced NASH Mouse Model using Digital Whole Slide Scanning of Liver Tissue and Artificial Intelligence-Enabled, Quantitative Histopathological Analysis
Effect of obesity and metabolic status on the chronic kidney disease shahab alizadeh
Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine combined effects of body mass index (BMI) and metabolic status on CKD risk.
ABDOMINAL OBESITY AND ITS ASSOCIATED RISK FACTORS - AN UPDATEindexPub
Background: India has a serious Abdominal Obesity (AO) concern with a frequency of 24.8%, particularly among metropolitan especially in women. Generalised obesity (GO) & AO, both of which are associated with greater rates of mortality & morbidity. In India, AO is more prevalent than GO (24.5%), & it has been associated to a number of health hazards, including the metabolic syndrome, insulin resistance, & cardiovascular diseases (CVD), high blood pressure & PCOS.
Radiology has historically been a leader in digital transformation in healthcare through the introduction of technologies like PACS and teleradiology. Radiology is now at another crossroads with new digital imaging technologies and there is potential for it to evolve into an integrated diagnostic service. Recent decades have seen the adoption of many new digital imaging modalities and pictures were initially printed but as technology improved, radiology has converted to a filmless digital environment. There is now significant interest in machine learning and artificial intelligence to help analyze medical images and aid radiologists.
1) Non-alcoholic fatty liver disease (NAFLD) affects approximately 25% of the global population and up to 30% of people in developed countries. NAFLD can progress to non-alcoholic steatohepatitis (NASH) in 10-30% of cases.
2) Liver biopsy is currently the reference standard for diagnosing and staging liver fibrosis but has limitations including being invasive and having sampling variability.
3) Shearwave elastography is a non-invasive method for assessing liver fibrosis by using ultrasound pulses to generate and measure shear wave propagation speeds, which are directly related to tissue stiffness. Faster shear wave speeds indicate more severe fibrosis.
Contenu connexe
Similaire à A Comprehensive Fatty Liver Program .pptx
Core Components of the Metabolic Syndrome in Nonalcohlic Fatty Liver DiseaseIOSR Journals
This study examined the association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) in Bangladeshi patients. The study included 67 patients diagnosed with NAFLD and 50 healthy controls matched for age and BMI. Results found that NAFLD patients had higher levels of insulin resistance, triglycerides, and central obesity compared to controls. However, no significant association was found between MetS and NAFLD when defined by common diagnostic criteria. Individual components of MetS like dyslipidemia, central obesity, and high postprandial glucose were significantly associated with NAFLD on logistic regression analysis. The study concludes that while various MetS components are linked to NAFLD in
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
This document discusses identifying and managing advanced fibrosis due to nonalcoholic steatohepatitis (NASH). It begins by outlining the impact of advanced fibrosis, including increased risk of liver-related morbidity and mortality as well as potential for rapid progression to cirrhosis in some patients. It then examines challenges with biopsy as the reference standard for identification given sampling error and limitations. Non-invasive tests are presented as an alternative, with sequential use of two tests recommended. The document concludes by emphasizing the importance of identifying advanced fibrosis patients to prevent cirrhosis and complications.
This document provides guidelines for the management of acute pancreatitis (AP). It summarizes key recommendations regarding the diagnosis, etiology, risk stratification, and management of AP. The diagnosis of AP is usually established by abdominal pain and elevated serum amylase and/or lipase levels. Contrast-enhanced CT or MRI is only recommended if the diagnosis is unclear or the patient fails to improve. Patients should be stratified based on the presence of organ failure or systemic inflammatory response syndrome and those with organ failure admitted to intensive care. Aggressive intravenous hydration within the first 24 hours and assessment of fluid status is important. Guidelines are also provided for managing gallstone pancreatitis, infectious complications, and interventions.
From Unknown to UN_Charlotte Block_10.14.11CORE Group
This document discusses non-communicable diseases (NCDs) such as diabetes, cancer, heart disease and respiratory diseases. It notes that NCDs cause 63% of deaths globally and that risk factors like tobacco use, unhealthy diet and physical inactivity can be addressed through policy changes. It also highlights Project HOPE's work in countries like Mexico, India and China to train healthcare workers in diabetes care, educate patients and communities, and establish diabetes education programs.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Utility of Homoeopathy in Cases of Nephrolithiasis with Counstitutional Approachijtsrd
Nephrolithiasis also known as renal calculi is a frequent urinary tract condition. Most patients with renal calculi experience recurrent nephrolithiasis. Recurrence rates are estimated at about 10 per year. Most of the people seek for the allopathic treatment for acute cases. The treatment course in the case of renal calculi is flush therapy through I.V. fluids , Lithotripsy or surgical aid etc. these methods are generally painful, harmful and sometime risky for the patients compare to the homoeopathic mode of treatment. Homoeopathic system of medicine manages such case quickly, mildly, gently and permanently without consuming much time. So, this study was conducted to confirm the role of homoeopathy in cases of nephrolithiasis with constitutional approach. Dr. Sheela Dandge | Dr. Janki Bhanvadia "Utility of Homoeopathy in Cases of Nephrolithiasis with Counstitutional Approach" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49642.pdf Paper URL: https://www.ijtsrd.com/medicine/urology/49642/utility-of-homoeopathy-in-cases-of-nephrolithiasis-with-counstitutional-approach/dr-sheela-dandge
1) Fatty liver, measured using CT scans, was present in 17% of participants.
2) Fatty liver was associated with higher risk of diabetes, metabolic syndrome, hypertension, and insulin resistance even after accounting for other measures of obesity like BMI and visceral fat.
3) Fatty liver was also linked to dyslipidemia (higher triglycerides and lower HDL) and dysglycemia (impaired fasting glucose) independent of other fat depots.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Global recommendations on physical activity for healthhome
The document discusses the importance and public health significance of physical activity. It notes that physical inactivity is now the fourth leading risk factor for global mortality. It outlines WHO mandates to support countries in developing national physical activity guidelines and policies to promote physical activity. There is a need for global physical activity recommendations to address links between activity levels and prevention of non-communicable diseases. The recommendations will provide guidance to policy-makers on developing physical activity guidelines and policies at regional and national levels.
The document discusses healthy eating patterns for chronic kidney disease (CKD). It notes that healthy eating patterns with adequate fruits and vegetables and limited alcohol and sodium may delay CKD progression and improve survival. The U.S. Dietary Guidelines recommend a diet including vegetables, fruits, whole grains, low-fat dairy, and protein sources like seafood, nuts, and legumes, while limiting saturated fat, added sugars, and sodium. For people with CKD, such a diet can help reduce risks from the disease.
Chronic Kidney Disease (CKD) is defined as abnormalities of kidney structure or function present for more than three months. It affects over 26 million Americans and is a major public health issue. The leading causes are diabetes and hypertension. As CKD progresses, kidney function declines and complications increase like anemia and bone disease. Cardiovascular disease risk also rises substantially. Inflammation, lipid abnormalities, and genetic factors can all contribute to CKD progression if not properly managed.
Running head:RESEARCH PROPOSAL 1
RESEARCH PROPOSAL 5
Research Proposal on Security and Privacy of Health Data
Name
Institutional Affiliation
Research Proposal on Security and Privacy of Health Data
Summary of the Research
The health sector is important because it ensures the health of the populace. Over the years, there has been digitization of health data with the aim of enabling faster efficient and effective delivery of healthcare services. Digitization of health care enables faster retrieval of health records hence facilitates faster and informed healthcare decisions (Nass, Levit & Gostin, 2009). Due to the importance of digitization of healthcare data, big healthcare data emerged; it changed the way data was previously managed (Abouelmehdi, Beni-Hessane & Khaloufi, 2018). The availability of big healthcare data comes with privacy and security challenges that must be solved. In cognizance of the challenges, the research focuses on identifying mechanisms used in ensuring the security and the limitations of available solutions and how they can be improved amidst increasing amount of healthcare data.
Outline of the Research
The Introduction to the Research
· Overview of healthcare data
· Justification of the research
· Research objectives
· Research questions
Review of Literature
· The differences between privacy and security of health data
· Data protection laws in relation to health
· Privacy and security concerns of health data
· Technologies use in privacy and security of health data
i. Authentication
ii. De-identification
iii. Encryption
iv. Data masking
v. Access control
vi. Monitoring and auditing
· Challenges of existing technologies
Methodology
· Sample selection
· Methods of data collection,
i. Online surveys
ii. Oral interviews
· Data analysis
i. Thematic analysis
Research Findings and Discussion
Recommendations
· Ways of improving the limitations of existing technologies
Conclusion
· The available opportunities for preserving the privacy and the security of health data
Limitations of the Study
· Considerations for future research
References
Abouelmehdi, K ., Beni-Hessane, A and Khaloufi, H (2018). Big Healthcare Data: Preserving Security and Privacy. Journal of Big Data, 5(1), pp. 15-28.
Nass, S. J., Levit, L.A and Gostin, L. O (eds.) (2009). Beyond The HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. Washington DC: National Academies Press.
DQ-1
Non-alcoholic fatty liver diseases (NAFLD).
NAFLD is a spectrum of hepatic disorders not associated with excessive alcohol intake, ranging from steatosis to cirrhosis and hepatocellular carcinoma, with hepatic cell inflammation and injury thought to result from the accumulation of triglycerides in the liver (Ball.
Sarcopenic obesity is a chronic condition, which is due to progressively aging populations, the increasing incidence of obesity, and lifestyle changes. The increasing prevalence of sarcopenic obesity in elderly has augmented interest in identifying the most effective treatment. This article aims at highlighting potential pathways to muscle impairment in obese individuals, the consequences that joint obesity and muscle impairment may have on health and disability, recent progress in management with attention on lifestyle management and pharmacologic therapy involved in reversing sarcopenic obesity. Recent findings: It has been suggested that a number of disorders affecting metabolism, physical capacity, and quality of life may be attributed to sarcopenic obesity. Excess dietary intake, physical inactivity, low-grade inflammation, insulin resistance and hormonal changes may lead to the development of sarcopenic obesity. Weight loss and exercise independently reverse sarcopenic obesity. Optimum protein intake appears to have beneficial effects on net muscle protein accretion in older adults. Myostatin inhibition causes favourable changes in body composition. Testosterone and growth hormone offer improvements in body composition but the benefits must be weighed against potential risks of therapy. GHRH-analog therapy is effective but further studies are needed in older adults. Summary: Lifestyle changes involving both diet-induced weight loss and regular exercise appear to be the optimal treatment for sarcopenic obesity. It is also advisable to maintain adequate protein intake. Ongoing studies will determine whether pharmacologic therapy such as myostatin inhibitors or GHRH-analogs have a role in the treatment of sarcopenic obesity.
Validation of an Off-the-Shelf, Diet-Induced NASH Mouse Model using Digital Whole Slide Scanning of Liver Tissue and Artificial Intelligence-Enabled, Quantitative Histopathological Analysis
Effect of obesity and metabolic status on the chronic kidney disease shahab alizadeh
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ABDOMINAL OBESITY AND ITS ASSOCIATED RISK FACTORS - AN UPDATEindexPub
Background: India has a serious Abdominal Obesity (AO) concern with a frequency of 24.8%, particularly among metropolitan especially in women. Generalised obesity (GO) & AO, both of which are associated with greater rates of mortality & morbidity. In India, AO is more prevalent than GO (24.5%), & it has been associated to a number of health hazards, including the metabolic syndrome, insulin resistance, & cardiovascular diseases (CVD), high blood pressure & PCOS.
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Radiology has historically been a leader in digital transformation in healthcare through the introduction of technologies like PACS and teleradiology. Radiology is now at another crossroads with new digital imaging technologies and there is potential for it to evolve into an integrated diagnostic service. Recent decades have seen the adoption of many new digital imaging modalities and pictures were initially printed but as technology improved, radiology has converted to a filmless digital environment. There is now significant interest in machine learning and artificial intelligence to help analyze medical images and aid radiologists.
1) Non-alcoholic fatty liver disease (NAFLD) affects approximately 25% of the global population and up to 30% of people in developed countries. NAFLD can progress to non-alcoholic steatohepatitis (NASH) in 10-30% of cases.
2) Liver biopsy is currently the reference standard for diagnosing and staging liver fibrosis but has limitations including being invasive and having sampling variability.
3) Shearwave elastography is a non-invasive method for assessing liver fibrosis by using ultrasound pulses to generate and measure shear wave propagation speeds, which are directly related to tissue stiffness. Faster shear wave speeds indicate more severe fibrosis.
MR Elastography is an MRI-based technique for measuring liver stiffness by analyzing shear wave propagation through the liver. It was developed in 2006 at Mayo Clinic as a painless and less expensive alternative to liver biopsy for diagnosing liver fibrosis. The technique uses active drivers to generate shear waves that are imaged using MRI phase contrast sequences. Stiffness maps are generated and the mean liver stiffness measurement is reported. MRE provides a reliable assessment of liver fibrosis and is more accurate than transient elastography. Image quality must be ensured by reviewing the magnitude, phase, and wave images to check for proper wave propagation and avoid artifacts.
This document discusses quantitative imaging techniques for the liver, including MRI proton density fat fraction (MRI-PDFF) and magnetic resonance spectroscopy proton density fat fraction (MRS-PDFF). A study was conducted to compare liver fat quantification values obtained from MRI-PDFF and MRS-PDFF in 64 male participants before and after a clinical intervention. The results found a strong positive correlation between the differences in MRI-PDFF and MRS-PDFF values after the intervention. Both techniques showed a decrease in the number of participants with grade 1 non-alcoholic fatty liver disease after the intervention according to Brunt's scale.
This document discusses quantitative imaging techniques for the liver, including volumetry, tumor volume measurement, liver surface nodularity scoring, CT texture analysis, MR elastography, and MRI methods for quantifying liver fat, iron, and function. It provides details on technical aspects of various quantitative methods and their clinical applications in assessing liver disease severity and monitoring treatment response. Quantitative imaging is shown to provide objective biomarkers for various liver conditions and has high accuracy in detecting fibrosis and cirrhosis.
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4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
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1. Dr Manoj K S, MD RD, DNB RD , DMRD .
Pioneer Metro Scans ,Trivandrum ,KIMS HEALTH ,Trivandrum
Insights from a single centre
A Comprehensive Fatty Liver
Program
3. World Stats
The Numbers
NAFLD is the most common chronic liver disease in the U.S.,
affecting roughly 25% of adults.
Most people with NAFLD have a fatty liver without
inflammation. However, 20% of people with NAFLD develop
NASH—liver inflammation that can seriously harm the organ.
It is estimated that over 115 million adults around the world are
impacted by NASH.About 5% of the US population, or about 15
million Americans, develops NASH .
Nonalcoholic fatty liver disease (NAFLD) is
a leading cause of liver disease
worldwide. It affects 25% of the global
adult population, with a range of 13.5% in
Africa and 31.8% in the Middle East
By 2030, the number of people in China with NASH is
expected to reach 48.26 million.
In Europe, Spain had 1.8 million cases in 2016, with the
number expected to increase 49% by 2030. German
cases of NASH stood at 3.33 million in 2016 and are
projected to climb 43% by 2030.
5. Aetiology
NASH -Progress
NAFLD is an overarching term that includes all disease grades and stages and
refers to a population in which ≥ 5% of hepatocytes display macrovesicular
steatosis in the absence of a readily identified alternative cause of steatosis (eg,
medications, starvation, monogenic disorders) in individuals who drink little or no
alcohol (defined as < 20 g/d for women and <30 g/d for men).
The spectrum of disease includes NAFL, characterized by macrovesicular hepatic
steatosis that may be accompanied by mild inflammation, and NASH, which is
additionally characterized by the presence of inflammation and cellular injury
(ballooning), with or without fibrosis, and finally cirrhosis, which is characterized by
bands of fibrous septa leading to the formation of cirrhotic nodules, in which the earlier
features of NASH may no longer be fully appreciated on a liver biopsy.
7. The NAFLD nomenclature is changing.
Consensus Nomenclature
7
Hepatic steatosis is defined as intracellular fat accumulation in the liver that constitutes at
least 5% of liver weight. Prolonged hepatic lipid storage may lead to liver metabolic
dysfunction, inflammation, and advanced forms of fatty liver disease
10. Abnormal LFT No significant alcohol consumption
History & Examination Exclude drug induced liver injury
Exclude other aetiologies of liver
disease
Non Invasive Liver Tests Blood tests (raised GGT,AST,WST
Ultrasound confirmation of liver
steatosis
Investigate severity of liver fibrosis Enhanced liver fibrosis (ELF)
Magnetic resonance elastography
(MRE)
VCTE, SWE ,ARFI
Fibrosis-4 ( FIB-4) ,Fibrotest,AST
Platelet
ratio (APRI)
Liver Biopsy (NAS, SAF,NASH CRN NAFLD activity
score Score )
NASH
NAFLD
IMAGING
A simplified
Algorithm for
NASH diagnosis
11. NASH Clinical Research Network histological scoring system
NITs have emerged as
valuable tools for
predicting adverse liver
related outcomes -hitherto
an important function of
liver biopsies
Liver biopsies for grading
and staging of NASH are not
consistently performed in
clinical practice and should
be reserved for specific
clinical scenarios
AASLD Practice Guidelines on
the clinical assessment and
management of NAFLD
Hepatology 2023;77:1797-1835
13. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease
Fasiha Kanwal Jay H. Shubrook Leon A. Adams Hashem B. El-Serag Kenneth Cusi
Published:September 20, 2021DOI:https://doi.org/10.1053/j.gastro.2021.07.049
14. > 50 Crore Indians have
Fatty Liver disease
> 50 Crore Indians are
Obese
India has a 40.3% obesity
prevalence rate. This rate varies
by region, with the south having
the highest rate at 46.51% and
the east having the lowest at
32.96%. Obesity is also higher
among women than men, and in
urban areas than rural areas
19. Sarcopenia ,Total Abdominal Muscle mass (TAM)
Risk scoring with all the above data
Mobile App and Online Data
VAT/SAT quantification
Additional Steps
20. Package -1
1. Questionnaire for preparing personal advise on Diet,
Exercise etc
2. Labs, Physical measurements
3. Ultrasound and Shearwave Elastography
4. Biomarkers
5. Risk scoring with all the above data
Visceral adipose tissue (VAT/SCAT)
6. Biomarkers
7. Risk scoring with all the above data
Package - 2
1. Questionnaire for preparing personal advise on
Diet, Exercise etc
2. Labs, Physical measurements
3. Ultrasound and Shearwave
4. MRI Fat quantification
5. Biomarkers
6. Risk scoring with all the above data
Visceral adipose tissue and Subcutaneous
adipose tissue
Package-3
1. Questionnaire for preparing personal advise on Diet, Exercise etc
2. Labs, Physical measurements
3. Ultrasound and Shearwave Elastography
4. MRI Fat quantification and MR Elastography
5. Visceral adipose tissue and Subcutaneous adipose tissue (VAT/SCAT)
6. Biomarkers
7. Risk scoring with all the above data
FATTY LIVER PROGRAM - PACKAGES
Package - 4
1. Questionnaire for preparing personal advise on Diet, Exercise
etc.
2. Labs, Physical measurements
3. Ultrasound and Shearwave Elastography
4. MRI Fat quantification and MR Elastography
5. Visceral adipose tissue and Subcutaneous adipose tissue
(VAT/SCAT)
6. Sarcopenia. Total abdominal muscle (TAM)
7. Biomarkers
8. Risk scoring with all the above data
9. Physician consultation
10. Apps
11. DEXA -whole body muscle / fat estimation
22. Comprehensive Fatty Liver Program
Patient Questionnaire
Beverages and Supplements:
What kind of beverages do you prefer to drink mostly?
Do you take any vitamin/mineral/nutritional supplements?
Do you take snacks in between meals?
Do you add sugar to meals?
Exercise and Physical Activity:
Do you exercise/practice any specific program?
Which physical exercise do you practice, and for how many hours
each time?
What are your personal barriers to exercise?
Are you able to carry out self-care activities yourself, or do you
feel sick?
Do you walk for at least 30 minutes daily/sometimes/never?
What household activities do you do at home?
What are your leisure activities?
If working, does your work require any physical activities?
How many days did you engage in moderate physical activities
like gardening in the past week?
Dietary Habits:
How many times a week do you eat bakery products?
How many times a week do you eat out?
What type of eating places do you frequently visit?
Do you skip meals? If yes, which one do you usually
skip?
What do you prefer to eat for dinner?
Do you control your diet as part of any ritual?
What food types are included in your diet
(vegetables, fruits, chicken, other meats)?
23. Habits and Lifestyle:
Do you smoke? If yes, how many cigarettes per day?
Do you drink alcohol? If yes, how often and how many drinks on
average?
How many hours do you sleep each night?
Do you snore loudly while sleeping?
Do you have any sleep disorders?
Do you feel drowsy during the daytime?
Medical History:
Do you have hypertension?
Do you have Diabetes mellitus?
Any history of dyslipidemia now?
Have you checked your cholesterol level
recently? Was it normal?
Have you ever had hepatitis?
Did you have any cardiovascular diseases
like heart attack or stroke?
Did you have any history of liver diseases?
Do you intake any medication/drug on a
regular basis?
Do you have a history of acanthosis
nigricans?
Have you ever had obesity problems?
Do you have a past history of any
metabolic syndrome such as
high blood pressure, high blood sugar,
excess body fat around the
waist, and abnormal cholesterol levels?
Family History:
Do any of your relatives suffer from diabetes mellitus?
Do any of your close relatives have hypertension?
Do any of your close relatives have cholesterol issues?
Do any of your relatives have cardiovascular diseases?
Do any of your close relatives suffer from any liver disease?
24. Through a Tablet the
Questionnaire
can be administered
Printed
Questionnaire
can be used
The
Questionnaire
can be administered
in person with trained staff
28. Fatty Liver - Special Lab
Tests
Homocysteine
High sensitive C-reactive protein (hsCRP)
Apolipoprotein A-I
Apolipoprotein B
Lp(a)-lipoprotein
Tumour necrosis factor-alfa (TNF-α)
Adiponectin l
Cytokeratin-18 (CK-18) fragment
Type IV collagen 7S domain
Hyaluronic acid (HA)
Fasting C-peptide
32. Total fat area TAT
Visceral Fat area VAT
Subcutanous fat area SAT
CT/MR BASED VAT/SAT/TAT
33. Grade 0: PDFF less than 6.4%
Grade 1 PDFF equal to or greater than 6.4% and less than 16.3%
Grade 2 PDFF equal to or greater than 16.3% and less than 21.7%
Grade 3 PDFF equal to or greater than 21.7%
MR FAT QUANTIFICATION
34. MR Elastographic Stiffness Stage of Fibrosis
Less than 2.5 Normal
2.5–2.9 Normal or chronic inflammation
2.9–3.5 Stage 1–2
3.5 - 4.0 Stage 2-3
4.0 - 5.0 Stage 3-4
More than 5.0 Stage 4
MR ELASTOGRAPHY
47. PDFF Calculation Method
• Placement of one large single-section ROI in
the anterior, posterior, medial, and lateral
segments of the liver, avoiding bigger vessels
and bile ducts, has been proposed as an
acceptable alternative
Radiology: Volume 301: Number 2—November 2021 n radiology.rsna.org
MR FAT QUANTIFICATION
48.
49.
50. Sequence
Name TR TE TI FOV THICKNESS FREQUENCY PHASE NEX BANDWIDTH Scan Time Min
Ideal IQ-MR
PDFF Axial 6.5 3 42 10 160 160 1 111.1 01:00
T2 SSFSE
Coronal 1000 1.9 38 4 352 224 1 125 03:30
Prep scan 3 plane Localiser 02:00
Patient In-
Out time 03: 00
Total 09: 30
MR Fat quantification Sequences
10 MINUTE MRI : MR PDFF & MR ELASTOGRAPHY
51. MR PDFF Fat quantification -
Segment wise analysis
ROIs Placed in various segments and tabulated to find out average
52. Segment VII Segment VIII Segment V Segment VI
Segment II Segment III Segment IV Segment I
Right lobe Left lobe
Total Average
MR PDFF Fat quantification -
Segment wise analysis
Segment wise analysis helps to find out the regional variability , relatively spared areas etc
53. SLD Grading
Fatty liver was graded with PDFF according to the following
criteria:
Grade 0: PDFF less than 6.4%,
Grade 1: PDFF equal to or greater than 6.4% and less than 16.3%,
Grade 2: PDFF equal to or greater than 16.3% and less than 21.7%
Grade 3: PDFF equal to or greater than 21.7%
Ref : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632805/
54. RESULTS
In more than 95 % subjects , the study could be completed in less than 10 minutes .
SLD
Grade I in 26 =54.1%
Grade II in 12 = 25%
Grade III in 10 = 20.8%
Two patients excluded after study since features of CLD noted
Higher number of patients with SLD Grade III observed , may be due to the clinical stetting -need not
reflect actual prevalence in population .
56. LAI LIVER ATTENUATION INDEX
A non-contrast enhanced or plain CT scan
(NECT) diagnoses and quantifies HS based
on the attenuation values of spleen and liver
in HU.
This is called the liver attenuation index
(LAI).
LAI of above +5 indicates a normal liver,
while a LAI of 0 to −5 is indicative of 10–30%
steatosis .
NECT is more accurate than other CT
modalities. However, increased copper, iron,
or glycogen content, edema and inflammation
may lead to false-negative results
62. NAFLD FIBROSIS SCORE (NFS)
NAFLD fibrosis score (NFS), is a composite score of age, hyperglycemia, body mass index, platelet
count, albumin, and aspartate aminotransferase and alanine aminotransferase (AST/ ALT) ratio and
was found to independently identify NAFLD patients with and without advanced fibrosis at initial
NAFLD diagnosis
NAFLD fibrosis score = -1.675 + 0.037 × age (year) + 0.094 × BMI (kg/m2) + 1.13 × IFG/diabetes
(yes = 1, no = 0) + 0.99 × AST/ALT ratio - 0.013 × platelet count (×109/L) - 0.66 × albumin (g/dL)[9].
People who have a NAFLD fibrosis score above 0.676 are the most likely to have advanced liver
fibrosis. If you have a score below -1.455, you're unlikely to have advanced liver fibrosis. The scores
in between are considered indeterminate
64. FATTY LIVER INDEX (FLI)
The fatty liver index (FLI), which is an algorithm based on waist circumference, body mass
index (BMI), triglyceride, and gamma-
glutamyl-transferase (GGT), was initially developed to detect fatty liver in Western countries
FLI was calculated using the following formula:
FLI = [e(0.953 × ln(triglycerides) + 0.139 × BMI + 0.718 × ln(γGTP) + 0.053 × WC − 15.745)]/ [1 +
e(0.953 ×ln(triglycerides) +0.139 × BMI + 0.718 × ln(γGTP) + 0.053 × WC − 15.745)] × 100.
Repeated evaluations of NAFLD status based on FLI measurements could help physicians identify higher-risk groups in terms of mortality, MI, and
stroke. The association between FLI worsening or improvement and outcomes also suggests clinical benefits of the prevention and treatment of
NAFLD.
65. FIBROSIS 4 SCORE (FIB-4 )
The Fibrosis 4 score is a non-invasive scoring system based on several laboratory tests
(AST/ALT/Platelets) that help to non- invasively estimate the amount of scarring in the liver. This
score has been studied in liver disease due to Hepatitis C and NASH.
FIB-4 below 1.30 is considered as low-risk for advanced fibrosis; a value of FIB-4 over 2.67
is considered as high-risk for advanced fibrosis; and FIB-4 values between 1.30 and 2.67
are considered as intermediate-risk of advanced fibrosis for ages 36-64. For ages > 64 the cut-
off for low-risk goes to < 2.
http://gihep.com/calculators/hepatology/fibrosis-4-score/
https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver- fibrosis
66. APRI SCORE
APRI has been previously validated as an efficient score to predict liver fibrosis in viral hepatitis patients
with a cut-off of 0.5 for fibrosis and 1.5 for cirrhosis.
APRI score interpretation:
Significant fibrosis: APRI threshold of 0.7 (77% sensitive and
72% specific)
Severe fibrosis: APRI threshold of 1.0 (61% sensitive and 64%
specific)
Cirrhosis: APRI threshold of 1.0 (76% sensitive and 72%
specific).
67. APRI SCORE
There are no universal cut-off values for the APRI score, as it is not
sufficiently sensitive to rule out significant diseases (especially with
midrange values). The lower the APRI score (<0.5), the greater the
negative predictive value, and ability to rule out cirrhosis.
The higher the value (>1.5) the greater the positive predictive value and ability to rule in cirrhosis
https://www.mdcalc.com/calc/3094/ast-platelet-ratio-index-apri
https://www.omnicalculator.com/health/apri
77. Magnetic resonance-based
biomarkers in nonalcoholic fatty
liver disease and nonalcoholic
steatohepatitis
Cyrielle Caussy, Lars Johansson
Endocrinol Diab Metab. 2020;3:e00134.
| 1 of 9 https://doi.org/10.1002/edm2.134
80. Diagnostic accuracy of elastography and magnetic
resonance imaging in patients with NAFLD
• The following index tests were assessed in this
review: VCTE (FibroScan®, Echosens, Paris,
France), pSWE (Virtual Touch Quantification
(VTQ); Siemens Healthineers, Erlangen,
Germany), 2DSWE (Aixplorer®; SuperSonic
Imagine, Aix-enProvence, France), MRE
(Resoundant, Rochester, USA), cT1 measured
using LMS (Perspectum, Oxford, UK), DWI, and
deMIL
81. Diagnostic accuracy of elastography and magnetic
resonance imaging in patients with NAFLD
• In conclusion, in patients with NAFLD where liver stiffness can
be measured successfully, VCTE, MRE, pSWE and 2DSWE have
a good diagnostic accuracy for the assessment of fibrosis, but
only MRE and pSWE meet the minimum acceptable criteria of
at least 80% sensitivity and specificity for the diagnosis of
advanced fibrosis. These promising results however, are likely
tobe overestimates of the true diagnostic accuracy as
intention-todiagnose analyses and validation of pre-specified
cut-offs are lacking from the literature. Future studies, like the
LITMUS Imaging Study being conducted in Europe and the USA
currently, should also evaluate the newer 2DSWE and MRI
techniques, and provide data on head-to-head comparisons of
the various techniques
87. TECHNIQUES BASED ON CALCULATION OF
THE ATTENUATION COEFFICIENT
CAP
Controlled attenuation parameter
2-D attenuation imaging (ATI)
Attenuation coefficient (ATT)
US-guided attenuation parameter
(UGAP)
US-derived fat fraction (UDFF)
Fibroscan system (Echosens, Paris,
France)
Aplio i800 systems (Canon Medical
Systems, Japan)
Aloka-Arietta systems (Fujifilm)
LOGIQ E9 series (General Electric,
USA)
Acuson S3000 or Sequoia US platform
(Siemens Healthineers)
104. Shearwave Elastography holds the key
MRI Fat Quantification/MRE is the best
Fatty Liver Program can be introduced in any hospital /institution
Followup is essential
A Diet/Exercise/Relaxation program should be
an integral part
USG having SWE and utilising Serum Biomarkers
105. Acknowledgements
IMA Trivandrum Branch
IMA National Conference Org Committee
Dr Sreejith N Kumar
Dr N.Sulphi
Dr Vijayakrishnan
Dr Althaf Ali
Pioneer Metro Scans ,Tvm
KIMS Health Tvm
Thank You ALL