Rajiv Chhabra

Association of Coronary Artery Calcification With Hepatic Steatosis in Asymptomatic Individuals

OBJECTIVE To determine the association of coronary artery calcification with hepatic steatosis in asymptomatic volunteers. PATIENTS AND METHODS The study group comprised 400 asymptomatic volunteers, enrolled from April 1, 2011, to September 30, 2012, without known coronary artery disease who were self-referred for screening noncontrast computed tomography to determine coronary calcium score (CCS). Computed tomographic images were used to determine the presence of hepatic steatosis. An a priori model was created to predict a CCS of 100 Agatston units (AU) or higher on the basis of Framingham risk factors, diabetes mellitus, and metabolic syndrome. Hepatic steatosis was then added to this model. Computation of the odds ratio (OR) for hepatic steatosis predicting a CCS of 100 AU or higher was performed. Finally, the OR for a CCS of 100 AU or higher being associated with hepatic steatosis was calculated. RESULTS When hepatic steatosis was added to traditional coronary risk factors, it was independently associated with a CCS of 100 AU or higher (OR, 2.85). This was greater than the OR of Framingham factors, diabetes mellitus, or metabolic syndrome. A CCS of 100 AU or higher was independently associated with an increased risk for hepatic steatosis (OR, 2.4). This OR was higher than traditional hepatic steatosis risk factors or metabolic syndrome. CONCLUSION Hepatic steatosis is a strong independent predictor of a CCS of 100 AU or higher in asymptomatic patients. It is associated with an increased risk of coronary artery disease beyond that expected from traditional coronary risk factors and/or metabolic syndrome. Additional studies are needed to clarify the role of hepatic steatosis as a possible independent risk factor for the development of coronary artery disease.

NON-ALCOHOLIC FATTY LIVER DISEASE BUT NOT EPICARDIAL FAT IS ASSOCIATED WITH CORONARY ARTERY CALCIFICATION

Epicardial adipose tissue (EAT), thoracic adipose tissue (TAT) and visceral abdominal fat may be predictive of coronary artery disease (CAD). Using a coronary calcium score (CCS) >100, we prospectively examined whether EAT, TAT, and non-alcoholic fatty liver disease (NAFLD) as determined from non-

The Role of Infliximab Biosimilar CT-P13 in Inflammatory Bowel Disease

The advent of targeted biologic therapies for debilitating disorders such as Crohn’s disease (CD) and Ulcerative Colitis (UC) has changed management and significantly improved outcomes. However, biologic agents are expensive, and the introduction of biosimilar medications for the treatment of inflammatory bowel diseases presents a lower-cost alternative. In this review, the mechanism of action, pharmacokinetics, efficacy and adverse effects associated with biosimilar CT-P13 in the treatment of inflammatory bowel disease are discussed.

Evaluation of the Small Bowel and Colon

Currently available endoscopic technologies for small bowel and colon evaluation include traditional endoscopic techniques, deep enteroscopy techniques, and wireless video capsule endoscopy. Wireless video endoscopy can roughly be defined as the use of means other than directly controlled, applied, or introduced electrical devices to obtain imaging data from the gastrointestinal tract to provide a diagnostic and/or treatment modality for a disease. In the world of science fiction, we imagine the ability to diagnose disease via a noninvasive “tricorder” like device (Star Trek, circa 1960s), and then perhaps employ nanotechnology targeted to the abnormality to treat it (Star Trek, circa 1990s). An analogy to this is the development of wireless video surveillance and weapons systems, some of which can be remotely guided for use by law enforcement and the military. A tremendous amount of resources for research and development is required to develop this type of remote wireless technology, which is also still highly dependent on operator training and experience to be effective. In this chapter, we review existing wireless video technologies currently in use in diagnosing and treating gastrointestinal diseases of the small bowel and colon, and those modifications that are currently in the development and planning stages. We also review the means of wireless physiologic assessment of the small bowel (SmartPill) and current and potential future applications of more traditional “wired” endoscopic technologies, including single balloon enteroscopy, double balloon enteroscopy, spiral enteroscopy, and NaviAid.