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Belcaro G, Cox DM, Cesarone MR, Gizzi G, Pellegrini L, Scipione C, Scipione V, Dugall M, Hu S, Corsi M, Feragalli B, Cotellese R. Effects of Robuvit® on the progression of non-alcoholic fatty liver disease. Minerva Gastroenterol (Torino) 2022; 68:434-441. [PMID: 36507829 DOI: 10.23736/s2724-5985.22.03201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of Robuvit® in preventing the progression of chronic hepatitis (CH) in non-alcoholic fatty liver disease (NAFLD) which encompasses the entire spectrum of fatty liver disease, from isolated steatosis to non-alcoholic steatohepatitis (NASH). METHODS One group of patients followed the Standard management (SM) and were assigned as controls while the supplementation group followed the SM and additionally took 2 Robuvit® capsules daily for 3 months (200 mg/day). RESULTS 34 subjects with NAFLD were included in the study. The two groups completing 90 days were comparable at baseline with 18 being supplemented with Robuvit® and 16 in the control group. The tolerability was very good, and no side effects were observed with the supplement. Fasting glucose levels were significantly lower after 3 months with Robuvit® (P<0.05) compared to controls. The increased serum aspartate aminotransferase levels (AST), considered the key metabolic value in these patients, decreased significantly with Robuvit® (P<0.05) compared to controls. Serum alanine aminotransferase levels (ALT) also decreased significantly with the supplement compared to controls (P<0.05). Platelet count and albumin levels improved significantly with Robuvit® (P<0.05) in comparison to standard management. No other significant changes were observed. The APRI score (the AST/platelet ratio index) was also decreased with the supplementation compared to controls (P<0.05). A high APRI score provides an estimate of the possibility of the liver to develop fibrosis and eventually cirrhosis. After Robuvit® supplementation, the ultrasound characterization showed a significant decrease in the size of the liver in association with a lower echogenicity, which represents less fibrotic changes due to collagen accumulation. CONCLUSIONS Robuvit® improved liver function in NAFLD and prevented progression to liver fibrosis by improving hepatic metabolism in a relatively short period of time. Numerous people are affected by NAFLD, many of them with subclinical symptoms. But to date, there are no specific, definite treatment options. Prolonged evaluations of Robuvit® in a larger group of subjects is suggested.
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Affiliation(s)
- Gianni Belcaro
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy -
| | - David M Cox
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - M Rosaria Cesarone
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Giuseppe Gizzi
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Luciano Pellegrini
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Claudia Scipione
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Valeria Scipione
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Mark Dugall
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Shu Hu
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | - Marcello Corsi
- Irvine3 Labs, San Valentino Vascular Screening Project and IA-PSS (International Agency for Pharma-Standard Supplements) Pescara, Italy
| | | | - Roberto Cotellese
- Dept.SMO-Biotec, Chieti University, Italy.,Outpatients Vascular Surgery, School of General Surgery, Ch-Pe University, Pescara, Italy
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Preveden T, Vereš B, Ružić M, Pete M, Luzza F, Pellicano R, Abenavoli L. Noninvasive assessment of liver fibrosis in chronic hepatitis C virus patients compared to liver biopsy: the experience of tertiary level hospital in Serbia. Minerva Med 2019; 111:197-202. [PMID: 31081313 DOI: 10.23736/s0026-4806.19.06109-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection, that is defined by active carriage of HCV RNA in the blood, is represents one of the major public health problems worldwide. In Serbia, the prevalence of anti-HCV positive persons in the general population, is estimated on average 1.13%. METHODS The aim of our study was to evaluate the ability of noninvasive scores in order to define the degree of liver fibrosis, and to assess the effect of host and viral factors on fibrosis in chronic HCV patients. In a retrospective analysis a total of 814 patients with chronic HCV infection were included. Liver fibrosis scores were calculated, and in particular AST/ALT Score APRI, Forns Index, and FIB-4 score, and all of them compared with histological classification. RESULTS We found that noninvasive biochemical scores of fibrosis, have a good performance especially to distinguish mild and moderate fibrosis to advanced fibrosis. In particular, we found that FIB-4 score is a useful screening tool to accurately exclude patients with advanced disease. CONCLUSIONS Noninvasive liver fibrosis scores are efficient tools in the management and follow-up of HCV patients in clinical practice.
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Affiliation(s)
- Tomislav Preveden
- Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Benjamin Vereš
- Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia
| | - Maja Ružić
- Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Maria Pete
- Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Francesco Luzza
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy -
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Tag-Adeen M, Alsenbesy M, Ghweil AA, Abd Elrazek MAH, Elgohary EA, Sallam MM, Ismael A, Nawara A. Liver stiffness measurement and spleen diameter as predictors for the presence of esophageal varices in chronic hepatitis C patients. Medicine (Baltimore) 2017; 96:e8621. [PMID: 29145280 PMCID: PMC5704825 DOI: 10.1097/md.0000000000008621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although it is an invasive and unpleasant procedure, esophagogastroduodenoscopy (EGD) is still the gold standard for esophageal varices (EV) detection. The aim of this study was to investigate liver stiffness measurement (LSM) and spleen diameter as simple noninvasive tools for EV prediction in chronic hepatitis C patients (CHC).A total of 123 Egyptian patients with CHC have been included and were classified based on screening EGD result into 2 groups; group A (without EV) and group B (with EV). Group (B) was subclassified according to EV grade into 4 subgroups: (B1, grade I), (B2, grade II), (B3, grade III), and (B4, grade IV). LSM was taken for each patient on the next day by an independent Fibroscan operator and correlated to the EGD result. Demographic, clinical, and biochemical data were recorded and analyzed using advanced data-mining computational technology.Mean LSM was 9.94 ± 6 kPa for group A and 33.32 ± 14 kPa for group B, whereas it was 21.22 ± 3, 25.72 ± 6, 33.82 ± 8, and 46.1 ± 15 kPa for subgroups B1, B2, B3, and B4, respectively. Mean spleen diameter was 11.09 ± 1.7 cm for group A and 16.58 ± 1.6 cm for group B. However, LSM ≥17 kPa was the only independent factor for EV prediction; splenic longitudinal span ≥15 cm was a complementary predictor when LSM was <17 kPa. The overall accuracy was 98.33 ± 3.33, Mikro = 98.26%.LSM ≥17 kPa and spleen diameter ≥15 cm is a simple noninvasive algorithm that could be used for prediction of EV and discrimination among its different grades.
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Affiliation(s)
- Mohammed Tag-Adeen
- Department of Internal Medicine, Qena School of Medicine, South Valley University, Qena
| | - Mohamed Alsenbesy
- Department of Internal Medicine, Qena School of Medicine, South Valley University, Qena
| | - Ali Abdelrahman Ghweil
- Department of Tropical Medicine and Gastroenterology, Qena School of Medicine, South Valley University, Qena
| | | | - Elsayed A. Elgohary
- Department of Internal Medicine, Zagazig School of Medicine, Zagazig University, As-Sharqia, Egypt
| | - Mohammad M. Sallam
- Department of Internal Medicine, Zagazig School of Medicine, Zagazig University, As-Sharqia, Egypt
| | - Ali Ismael
- Department of Internal Medicine, Zagazig School of Medicine, Zagazig University, As-Sharqia, Egypt
| | - Abdallah Nawara
- Department of Internal Medicine, Zagazig School of Medicine, Zagazig University, As-Sharqia, Egypt
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Sereno L, Mesquita F, Kato M, Jacka D, Nguyen TTV, Nguyen TN. Epidemiology, responses, and way forward: the silent epidemic of viral hepatitis and HIV coinfection in Vietnam. ACTA ACUST UNITED AC 2012; 11:311-20. [PMID: 22828983 DOI: 10.1177/1545109712453939] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Viral hepatitis is a disease of great concern to public health that is now met by a favorable momentum to combat the global epidemic. This article is intended to highlight the importance of viral hepatitis in the Vietnam population as well in the group of people living with HIV/AIDS (PLWHA). We reviewed available data on epidemiology and response on hepatitis B virus (HBV) and hepatitis C virus (HCV) and HIV coinfection in Vietnam. The hepatitis B surface antigen (HBsAg) prevalence in the general population ranged from 5.7% to 24.7%. The anti-HCV prevalence ranged from 0.38% to 4.3% in the general population, while among people who inject drugs (PWIDs) it ranged from 31% to 97.2%. The HBV prevalence among PLWHA is similar to the general population, while HCV/HIV coinfection is concentrated in some groups. Anti-HCV prevalence among HIV-infected PWIDs can be as high as 98.5%. Developing policies for diagnosis and treatment of chronic HBV and HCV infections are critical priorities in order to prevent clinical progression to cirrhosis and liver cancer.
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Affiliation(s)
- Leandro Sereno
- 1World Health Organization Vietnam Country Office, Hanoi, Vietnam
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Liver stiffness using transient elastography is applicable to canines for hepatic disease models. PLoS One 2012; 7:e41557. [PMID: 22911813 PMCID: PMC3401107 DOI: 10.1371/journal.pone.0041557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 06/22/2012] [Indexed: 01/27/2023] Open
Abstract
Background The objectives of this study were to evaluate the best position and best exploration probe for determining liver stiffness (LS) in dogs using transient liver elastography (TE). Thirteen dogs were used in the study. Methodology/Principal Findings Morphometric measurements taken were thoracic circumference, weight and height. Elastographic measurements were taken in 4 anatomical positions using two different probes: medium (M) and small (S). The exploration was considered correct when the success rate was above 60% and the interquartile range of the measurements did not exceed 30%. The best measurements were obtained in the middle of the 6th–9th intercostal spaces, with the dog in the left lateral position and using probe M for preference in adults and probe S mandatory for animals <2 years. The correlation between probes was 99%. Intra-observer variability showed an intra-class correlation of 97.6%. Conclusions/Significance TE is a technique that is reproducible in dogs.
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Abstract
A reliable, noninvasive marker to help clinicians evaluate hepatic fibrosis is urgently needed. The liver biopsy, an imperfect gold standard, has recognized limitations including sampling error and interobserver variability. Hepatic elastography (HE) is a novel sonographic method for assessing liver stiffness and has excellent accuracy in making the diagnosis of minimal fibrosis and cirrhosis. Several conditions intrinsic to the pathology of the liver compromise the positive predictive value of HE for fibrosis alone including acute hepatitis, obstructive cholestasis, and passive congestion. Technical considerations that hinder the performance of elastography include an advanced body mass index, the presence of ascites and narrow intercostal spaces. Despite these limitations, elastography has a role in staging fibrosis, prognosis of disease outcome, surveillance, and treatment decisions. HE is now being used in lieu of liver biopsy to investigate the natural history of chronic liver diseases. Additional studies are required to better define the appropriate role of HE in clinical practice.
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Interobserver concordance in the assessment of liver fibrosis in HIV/HCV-coinfected patients using transient elastometry. Eur J Gastroenterol Hepatol 2010; 22:801-7. [PMID: 19773664 DOI: 10.1097/meg.0b013e328331a5d0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Although the reproducibility of transient elastometry (TE) in hepatitis C virus (HCV)-monoinfected patients seems to be high, this may not be the case in HIV/HCV-coinfected patients because of different degrees of steatosis and/or inflammation. This study was aimed to determine the interobserver concordance of TE measurements in HIV/HCV-coinfected patients. METHODS A total of 188 patients were evaluated in a cross-sectional, prospective study in two hospitals. The interobserver variability of TE results and the rate of unequal classification of significant fibrosis (cutoff value = 7.2 kPa) and cirrhosis (cutoff value = 14.6 kPa) for two observers were evaluated. RESULTS The values of liver stiffness (LS) for two observers highly correlated [intraclass correlation index = 0.976; 95% confidence interval (CI): 0.968-0.982]. The kappa indexes for the concordance of patient classification were 0.60 for significant fibrosis and 0.89 for cirrhosis. Using two cutoff points to diagnose or rule out significant fibrosis (LS >or=9 kPa or <6 kPa) yielded a kappa index of 0.96, but 46% of patients were not classified. Covariables that influenced the interobserver agreement were a high interquartile range in the determination (adjusted odd ratio: 0.189; 95% CI: 0.087-0.411; P = 0.001) and elevated levels of triglycerides (adjusted odd ratio: 1.004; 95% CI: 1.000-1.008; P = 0.031). CONCLUSION TE measurement is an observer-independent method to evaluate LS in HIV/HCV coinfected patients. The concordance of the classification of mild-to-severe fibrosis is good and for the diagnosis of cirrhosis is excellent. Lower interquartile ranges and triglyceride levels lead to a higher interobserver agreement.
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