Diabetes mellitus and renal involvement in chronic viral liver disease

HYPOTHESIS

Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues.

OBJECTIVES

Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement.

METHODS AND RESULTS

We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus.

DISCUSSION

Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.

Wireless Capsule Endoscopy in Correlation with Software Application in Gastrointestinal Diseases

Wireless capsule endoscopy is one of the most recent investigation techniques of gastrointestinal pathology. Unlike conventional upper and lower endoscopy, it has the advantages of being a noninvasive and painless procedure. One of the capsule endoscopy disadvantages is represented by the necessary time to analyze the video frames obtained. Software applications proposed in this purpose could offer support in the images evaluation. Different algorithms have been described in the literature, but further research is needed to establish the practical value of computer vision tools in gastroenterology.

Neuroophthalmological examination in children with AIDS

Evaluation of HIV disease status includes physical examination (anthropomorphic measurements, neurological assessment, etc.) and laboratory examination. Consideration should be given to changes from baseline values, age adjusted normal values and the rapidity of changes. Here we compare results of neuroophthalmologic assessment with Western Blo (WB) profiles in cerebrospinal fluids (CSF) of 54 children with AIDS. Children were classified by Denver Developmental Screening Test (DDST) administration in encephalopathy positive (n = 44) and encephalopathy negative (n = 10) groups. Neuroophthalmological examination which included nine items with good test-retest reliability showed that two of them (nystagmus on following and visual memory impairment) appeared early in the encephalopathy free group and correlated with the loss of some gag band in Western Blot (lower gag score). No correlation was however, found with respect to p24 antigen level in cerebrospinal fluid, a marker which reflects CNS viral load.