Fibroblast growth factor 21 (FGF21) signaling and genetic factors are involved in non-alcoholic fatty liver disease (NAFLD) pathogenesis. However, these factors have rarely been studied in type 2 diabetes mellitus (T2D) patients from admixed populations such as in those of Brazil. Therefore, we aimed to evaluate rs738409 patanin-like phospholipase domain-containing protein (PNPLA3) and rs499765 FGF21 polymorphisms in T2D, and their association with NAFLD, liver fibrosis, and serum biomarkers (FGF21 and cytokeratin 18 levels). A total of 158 patients were included, and the frequency of NAFLD was 88.6%, which was independently associated with elevated body mass index. Significant liver fibrosis (≥F2) was detected by transient elastography (TE) in 26.8% of NAFLD patients, and was independently associated with obesity, low density lipoprotein, and gamma-glutamyl transferase (GGT). PNPLA3 GG genotype and GGT were independently associated with cirrhosis. PNPLA3 GG genotype patients had higher GGT and AST levels; PNPLA3 GG carriers had higher TE values than CG patients, and FGF21 CG genotype patients showed lower gamma-GT values than CC patients. No differences were found in serum values of FGF21 and CK18 in relation to the presence of NAFLD or liver fibrosis. The proportion of NAFLD patients with liver fibrosis was relevant in the present admixed T2D population, and was associated with PNPLA3 polymorphisms.
Spontaneous peritonitis is a potentially fatal complication of advanced liver disease and the reported incidence reaches up to 30% among in-hospital cirrhotic patients. 1 In most cases, the etiology is bacterial, 2 and fungi are responsible for less than 10%, with a predominance of Candida species. 3 Cryptococcus neoformans is an encapsulated yeast, which is usually responsible for opportunistic infections. Although this fungus mainly infects the respiratory tract and central nervous system, it can affect multiple organ systems in susceptible hosts. Patients with malignancies, long-term use of corticosteroids, solid organ transplantation, sarcoidosis, HIV, immunosuppressive therapy, and cirrhosis may be at increased risk. [3][4][5] The first reports of Cryptococcus neoformans infection in patients with chronic liver disease date from 1967 and its mortality remains high (80%-92%) despite the improvement in treatment. [5][6][7] Cryptococcal infection in cirrhotic subjects most commonly presents as meningitis (39%-48%), peritonitis (19%-45%), and pulmonary disease (18%-37%). 8 Hematogenous spread is a strong predictor of mortality, so early diagnosis and prompt treatment can be lifesaving. This is a report of spontaneous cryptococcal peritonitis in two patients awaiting liver transplantation.
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