Hepatic osteodystrophy is a common and frequently untreated complication, manifested as osteoporosis or osteopenia, encountered in the evolution of chronic liver diseases. This article provides a narrative review of hepatic osteodystrophy. The aim is to revise the prevalence, pathophysiology, diagnosis and management of hepatic osteodystrophy. We searched medical literature via PubMed, Google Scholar, Wiley, Science Direct, and Springer Link using respective keywords to obtain data on low bone mineral density connected to chronic liver diseases. Many studies have reported an increased prevalence of osteoporosis/osteopenia in patients with chronic liver diseases. The pathogenesis is multifactorial, involving genetic factors, vitamin deficiencies, proinflammatory cytokines, hypogonadism, hyperbilirubinemia, antiviral therapy, corticosteroid drugs, and lifestyle factors. The management of patients should include individualized assessment for fracture risk factors and bone mineral density. Vitamin D and calcium supplementation should be recommended in all patients with chronic liver diseases and osteoporosis. Bisphosphonates are the most efficient drugs used in the treatment of hepatic osteodystrophy. In the future, it is necessary to define better the management and specific treatment of hepatic osteodystrophy for prevention of fragility fractures and to improve the patient quality of life.
Aims: We aimed to quantify global and regional body composition changes in chronic hepatitis C (CHC) patients, compare them to healthy controls and identify possible association between body composition changes and CHC. To our knowledge, this study is the first one comparing CHC patients to controls with regard to soft tissue body composition changes. Methods: We assessed 60 CHC patients and 60 healthy controls by Dual Energy X-Ray Absorptiometry. Soft tissue and bone body composition parameters were compared between the groups (using the Mann-Whitney test). These parameters were correlated (using Spearman’s rank correlation coefficient – rho) with independent variables (age, gender, body mass index – BMI, cigarette smoking, time since CHC diagnosis, viral load, fibrosis grade, type of treatment, time of treatment) for the entire CHC group and also for subgroups according to gender. Results: Total fat mass, trunk fat mass and percent body fat were lower in CHC patients as compared to controls. Several risk factors were associated with the reduced fat mass: low BMI, cigarette smoking and peginterferon alpha 2a plus ribavirin treatment. Peginterferon alpha 2a and ribavirin treatment negatively correlated with lean body parameters, especially in CHC males group. Bone mineral density (BMD) was lower as compared to controls and was correlated with low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin treatment. Conclusions: Patients with CHC have an acquired type of lipodystrophy (particularly in the trunk region), and also a reduced BMD as compared with controls. A low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin therapy were associatd with a low fat mass and low BMD. Abbreviations: BMD: bone mineral density; BMI: body mass index; CHC: chronic hepatitis C; DXA: Dual Energy X ray Absorptiometry; FM: fat mass; FMR: fat mass ratio; HCADS: hepatitis C associated dysmetabolic syndrome; HCV: hepatitis C virus; HO: hepatic osteodystrophy; LS: lumbar spine; LM: lean mass; PBF: percent body fat.
Heart disease in children can be congenital or acquired. Most congenital heart malformations have specific hemodynamics, producing either volume overload, pressure overload or both, that will finally determine myocardial cell damage, with complications like heart failure and sometime severe pulmonary hypertension. The understanding and management of pediatric patients with heart disease is mandatory in order to have the ability to influence the outcome. Cardiovascular biomarkers play a vital role in adult cardiology, influencing both the diagnosis and the prognostic, however there is still a gap in the pediatric field. We decided to study the relevance of cardiac biomarkers as: NT proBNP, Troponin T and hs-CRP, in the diagnosis and follow up of the pediatric patients with heart disease admitted for severe acute/chronic symptomes or patology, hoping that in future, cardiac biomarkers will be current used in the assessment of children with heart disease.
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