Effects of proprotein convertase subtilisin/kexin type-9 inhibitors on fatty liver

BACKGROUND Many studies have investigated the progression of nonalcoholic fatty liver disease(NAFLD)and its predisposing risk factors,but the conclusions from these studies have been conflicting.More challenging is the fact that no effective treatment is currently available for NAFLD.AIM To determine the effects of proprotein convertase subtilisin/kexin type-9(PCSK9)inhibitors on fatty infiltration of the liver.METHODS This retrospective,chart review-based study was conducted on patients,18-yearold and above,who were currently on PCSK9 inhibitor drug therapy.Patients were excluded from the study according to missing pre-or post-treatment imaging or laboratory values,presence of cirrhosis or rhabdomyolysis,or development of acute liver injury during the PCSK9 inhibitor treatment period;the latter being due to false elevation of liver function markers,alanine aminotransferase(ALT)and aspartate aminotransferase(AST).Radiographic improvement was assessed by a single radiologist,who read both the pre-and post-treatment images to minimize reading bias.Fatty infiltration of the liver was also assessed by changes in ALT and AST,with pre-and post-treatment levels compared by paired t-test(alpha criterion:0.05).RESULTS Of the 29 patients included in the study,8 were male(27.6%)and 21 were female(72.4%).Essential hypertension was present in 25(86.2%)of the patients,diabetes mellitus in 18(62.1%)and obesity in 15(51.7%).In all,patients were on PCSK9 inhibitors for a mean duration of 23.69±11.18 mo until the most recent ALT and AST measures were obtained.Of the 11 patients who received the radiologic diagnosis of hepatic steatosis,8(72.73%)achieved complete radiologic resolution upon use of PCSK9 inhibitors(mean duration of 17.6 mo).On average,the ALT level(IU/L)decreased from 21.83±11.89 at pretreatment to 17.69±8.00 at posttreatment(2-tailed P=0.042)and AST level(IU/L)decreased from 22.48±9.00 pretreatment to 20.59±5.47 post-treatment(2-tailed P=0.201).CONCLUSION PCSK9 inhibitors can slow down or even completely resolve NAFLD.

Splenic injuries secondary to colonoscopy:Rare but serious complication

BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases.Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.AIM To investigate the reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients METHODS A structured search on four databases was done and 45 articles with 68 patients were selected.The reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients were identified and analyzed using SPSS.RESULTS The mean age of the patients was 62.7 years with 64%females.Twenty two percent had a complete splenic rupture with colonoscopy while 63%had subcapsular hematoma,spleen laceration and spleen avulsion.The most common reason for colonoscopy was screening(46%)followed by diagnostic colonoscopy(28%).Eighty seven percent of patients presented with abdominal pain.Patients with spleen rupture mostly required splenectomy(47%),while minor spleen hematomas and lacerations were managed conservatively(38%).Six percent of the patients were managed with proximal splenic artery splenic embolization and 4%were managed with laparoscopic repair.The overall mortality was 10%while 77%had complete recovery.The reason of colonoscopy against presentation specifically,abdominal pain showed no statistical significance P=0.69.The indication of colonoscopy had no significant impact on incidence of splenic injury(P=0.89).Majority of the patients(47%)were managed with splenectomy while the rest were managed conservatively(P=0.04).This association was moderately strong at a cramer’s V test(0.34).The Fisher exact test showed a higher mortality with spleen rupture(P=0.028).CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality.The management of the patients can be individualized based on clinical presentation.