EFFICACY OF COMPREHENSIVE TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH PREDIABETES

OBJECTIVE

The aim: To evaluate the effectiveness of the proposed treatment recommendations, which included lifestyle changes, as well as the treatment with ursode¬oxycholic acid, rosuvastatin, and omega-3 PUFA, on the severity of cytolytic and cholestatic syndromes in patients with NAFLD and prediabetes.

PATIENTS AND METHODS

Materials and methods: Fifty-five patients with confirmed prediabetes and concomitant NAFLD underwent a comprehensive clinical examination and were treated with rosuvastatin 10 mg/d, omega-3 PUFA at a dose of 1000 mg/d and ursodeoxycholic acid at a dose of 10 mg/kg/d.

RESULTS

Results: The data obtained after 12 months of proposed treatment revealed a statistically significant improvement of indicators of cytolytic syndrome in patients with prediabetes and NAFLD. There was no significant difference between mean values of ALT and AST of treated patients and the corresponding indicators of apparently healthy persons, which confirms the effectiveness of the recommended treatment.

CONCLUSION

Conclusions: Proposed therapy which included recommendations for lifestyle changes and treatment with ursodeoxycholic acid, rosuvastatin and omega-3 PUFA significantly improved hepatic steatosis and cytolytic syndrome in patients with prediabetes and NAFLD.

Molecular Genetics of Keratinization Disorders - What's New About Ichthyosis

The heritable forms of keratinization disorders, including various forms of ichthyosis and keratodermas, comprise a phenotypically heterogeneous group of diseases which can be divided into syndromic and non-syndromic forms. In the non-syndromic forms, the clinical manifestations are limited to the cutaneous structures while the syndromic ones are associated with a spectrum of extracutaneous manifestations. The inheritance in different families can be autosomal dominant, autosomal recessive or either X-linked dominant or recessive. Currently at least 67 distinct genes have been associated with different forms of ichthyosis. These genes can be grouped on the basis of their physiological involvement, including genes encoding structural components of epidermis, those involved in epidermal lipid metabolism, or those critical for cell-cell adhesion, and keratinocyte differentiation. This overview highlights some of the recent progress made in understanding the molecular genetics of keratinization disorders, and presents selected, recently characterized cases as representative of different forms of heritable ichthyosis.

CORRECTION OF AUTONOMIC AND COGNITIVE DISTURBANCES IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

OBJECTIVE

The aim: To explore the features of the congnitive (CD) and neurovegetative dysfunctions (NVD) of patients with different forms of non-alcoholic fatty liver disease NAFLD (nonalcoholicfatty hepatosis (NAFH) and non-alcoholic steatohepatitis (NASH)) and type 2 diabetes mellitus (T2DM), as well as their dynamics against the background of complex therapy using armadin (2-ethyl-6-methyl-3-hydroxypyridine succinate).

PATIENTS AND METHODS

Materials and methods: 50 patients with NAFLD (24 patients with NAFH and 26 patients with NASH) and T2DM were examined. Dysfunction of central and vegetative nervous system was carried out with the help of neuro-psychometric testing.

RESULTS

Results: The analysis of the conducted research before treatments indicates the NVD in the surveyed patients. Cognitive dysfunctions (mostly mild and moderate) was revealed in all of our patients in both groups. The most pronounced disturbances before treatments were determined in the areas of attention and concentration, memory, less pronounced - visually constructive area, especially among patients with NASH and T2DM. Stressful situations have a pronounced impact on the lives of these patients, but they are not critical enough to any issues. Patients of Group 2 before treatments had the lowest level of resistance to stress. They found a slight vulnerability even from minor impacts.

CONCLUSION

Conclusions: In patients with NAFLD and T2DM, congnitive and neurovegetative dysfunctions were found, according to neuro-psychometric testing. Complex therapy using 2-ethyl-6-methyl-3-hydroxypyridine succinate is an effective and safe method for the correction of congnitive and neurovegetative dysfunctions in patients with NAFLD and T2DM.

Arginine/citrulline cycle changes in diet-induced rat model of non-alcoholic fatty liver disease

OBJECTIVE

The aim: to study the Arginine / Citrulline-cycle features on a diet-induced rat model of non-alcoholic fatty liver disease (NAFLD).

PATIENTS AND METHODS

Materials and methods: The studies were carried out on 20 white non-linear adult rats, including 10 (50%) males, 10 (50%) females, weighing 160-220 g. NAFLD was modeled by a 9-week fast food diet. The level of arginine and citrulline, and the arginase activity were investigated in the animals' liver homogenates and in the blood. The morphological analysis of liver tissues changes was done.

RESULTS

Results: NAFLD modeling using a 9-week fast food diet resulted in maximum weight gain in male rats (р<0.05). Female rats had 3 times more accumulation of intra-abdominal fat than male rats in the main group (р<0.05). Histopathologic liver examination confirmed NAFLD development in rats on a fast food diet during 9 weeks (р<0.05). NAFLD led to an increment of arginine level in the blood and liver homogenate in the main group compared to controls (р<0.05). NAFLD development was accompanied by a decrease in arginase activity and citrulline level in the blood and liver homogenate compared to control (р<0.05).

CONCLUSION

Conclusions: The experimental rat model of NAFLD showed the Arginine / Citrulline cycle disorders, that were characterized by an increased arginine level, a decreased arginase activity and citrulline concentration in the blood and liver tissues.

Comorbidity severity index as a new tool for assessment of co-existing diseases in patients with non-alcoholic fatty liver disease at the carbohydrate metabolism disorder background and concomitant subclinical hypothyroidism

OBJECTIVE

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common disease which is characterized by comorbidity. However, no comorbidity index for its assessment has been described yet. The aim of this study was to develop a new index for evaluation of comorbidity in patients with NAFLD.

PATIENTS AND METHODS

Materials and methods: 226 patients with NAFLD and associated carbohydrate metabolism disorders were examined. Besides, 60 persons with subclinical hypothyroidism, 30 patients with type 2 diabetes mellitus (T2-DM) and 30 NAFLD patients were examined. 30 healthy persons formed the control group. Clinical diagnoses were based on the laboratory tests and liver sonography. A new index of comorbidity has been used. Calculation of comorbidity severity index (ComSI) includes the possible presence of NAFLD, thyroid disorders, abdominal obesity, dyslipidemia, anemia, chronic complications of T2-DM, aggravated anamnesis.

RESULTS

Results: The contradiction in the calculation of the well-known comorbidity indices values (CIRS - Cumulative illness rating scale, CCI - Charlson's comorbidity index, Kaplan-Feinstein index) was shown. So, their limited suitability for using in patients with carbohydrate metabolism disorders who have NAFLD was detected. According to our results an increasing of patients' age is associated with the increasing of concomitant diseases number and with deteriorating of the patients' general condition, which is reflected in an increasing of the ComSI value. The increasing of concomitant diseases number is associated not only with the higher ComSI, but also with the number of persons with a severe comorbidity according the ComSI value. Instead, the persons without comorbidity (groups 6, 7, 8) were marked as the patients with mild or moderate disease according the ComSI.

CONCLUSION

Conclusions:The new ComSI index can be used to evaluate the severity of comorbidity in patients with NAFLD.