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Publications (10 of 29) Show all publications
Nasr, P., Fredrikson, M., Ekstedt, M. & Kechagias, S. (2020). The Amount of Liver Fat Predicts Mortality and Development of Type 2 Diabetes in Non-alcoholic Fatty Liver Disease.. Liver international (Print)
Open this publication in new window or tab >>The Amount of Liver Fat Predicts Mortality and Development of Type 2 Diabetes in Non-alcoholic Fatty Liver Disease.
2020 (English)In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for development of type 2 diabetes mellitus (T2DM). We aimed to evaluate whether conventional histological grading of steatosis and accurate quantification of fat content in liver biopsies using stereological point counting (SPC) can predict mortality and future development of T2DM in NAFLD patients.

METHODS: 129 patients with biopsy proven NAFLD, enrolled between 1988 and 1992, were re-evaluated on two occasions, after 13.7 (±1.5) and 23.2 (±6.8) years. In patients accepting to undergo the procedure, repeat liver biopsies were performed on each follow-up and were evaluated with conventional histopathological methodology and SPC.

RESULTS: Of the 106 patients without T2DM at baseline, 66 (62%) developed T2DM during a mean follow-up of 23.2 (± 6.8) years. Steatosis grade and liver fat measured with SPC independently (adjusted for age, BMI, fibrosis stage) predicted development of T2DM with an aHR of 1.60 per grade and 1.03 for each SPC percentage increase, respectively. Overall mortality and development of T2DM was more common in patients with grade 3 steatosis compared to lower grades of steatosis. Liver fat measured with SPC was significant for overall mortality (aHR 1.04). In patients that underwent repeat biopsy, reduction of liver fat measured with SPC was associated with decreased risk of developing T2DM (aHR 0.91 for each SPC percentage decrease).

CONCLUSION: Steatosis grade and liver fat measured with SPC predict mortality and the risk of developing T2DM in NAFLD. Reduction of liver fat decreases the risk of developing T2DM.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Stereological point count (SPC), hepatic steatosis, quantitative steatosis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-163934 (URN)10.1111/liv.14414 (DOI)32087038 (PubMedID)
Available from: 2020-02-27 Created: 2020-02-27 Last updated: 2020-03-30Bibliographically approved
Rosengren, B., Möller, R., Hellman, J., Jood, K., Ekstedt, M., Särnbland, S., . . . Gummesson, C. (2019). EPA – en modell för att träna och bedöma dagligt läkarjobb [EPA (Entrustable professional activities) - an international approach to define key tasks that a doctor should be able to perform]. Läkartidningen, 116
Open this publication in new window or tab >>EPA – en modell för att träna och bedöma dagligt läkarjobb [EPA (Entrustable professional activities) - an international approach to define key tasks that a doctor should be able to perform]
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2019 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Article, review/survey (Refereed) Published
Abstract [en]

Entrustable Professional Activities (EPAs) define observable key tasks that a doctor should be able to do independently after having completed a certain level of education. Progression is facilitated by frequent assessments of the defined activities, with increased degree of independence. The observations should be supported by constructive feed-forward. EPA is currently used in several countries both in undergraduate and post graduate education. In the context of pending changes in Swedish legislation regarding undergraduate education qualifications ordinance and medical licensing, a Swedish national work group has begun to define Swedish EPA for the future undergraduate education.

Place, publisher, year, edition, pages
Sveriges Läkarförbund, 2019
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:liu:diva-164793 (URN)31192435 (PubMedID)
Note

EPA (entrustable professional activities) avser aktiviteter som ingår i en läkares dagliga arbete och som läkaren ska klara med en definierad grad av självständighet första dagen som legitimerad läkare.

En modell för att träna och bedöma sådana aktiviteter kan säkerställa att studenter klarar av det faktiska arbete som ska utföras första dagen efter legitimation, och den tydliggör också progressionen mot uppsatta mål under hela läkarutbildningen.

Modellen används internationellt på både grund- och specialistutbildningsnivå.

Läkarutbildningarna i Sverige arbetar tillsammans med att utforma en nationell modell för att träna och bedöma EPA under grundutbildningen.

Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2020-04-01
Wiggins, S., Abrandt Dahlgren, M., Ekstedt, M., Hammar Chiriac, E., Larsson Torstensdotter, G. & Törnqvist, T. (2018). Being a professional, or just being a student? A discursive analysis of video-recorded interprofessional learning tutorials in a medical faculty. In: : . Paper presented at NU2018, 9-11 oktober 2018, Västerås, Sweden. Västerås
Open this publication in new window or tab >>Being a professional, or just being a student? A discursive analysis of video-recorded interprofessional learning tutorials in a medical faculty
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2018 (English)Conference paper, Oral presentation only (Other academic)
Place, publisher, year, edition, pages
Västerås: , 2018
National Category
Educational Sciences
Identifiers
urn:nbn:se:liu:diva-152174 (URN)
Conference
NU2018, 9-11 oktober 2018, Västerås, Sweden
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2018-10-31
Wiggins, S., Abrandt Dahlgren, M., Ekstedt, M., Hammar Chiriac, E., Larsson Torstensdotter, G. & Törnqvist, T. (2018). On doing ‘being a student amongst other kinds of students’: Managing academic identities in an interprofessional tutorial group. In: : . Paper presented at 5th International Conference on Conversation Analysis (ICCA),15 July 2018, Loughborough University, UK.
Open this publication in new window or tab >>On doing ‘being a student amongst other kinds of students’: Managing academic identities in an interprofessional tutorial group
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2018 (English)Conference paper, Oral presentation only (Other academic)
National Category
Psychology Pedagogy
Identifiers
urn:nbn:se:liu:diva-152177 (URN)
Conference
5th International Conference on Conversation Analysis (ICCA),15 July 2018, Loughborough University, UK
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2018-10-31
Dulai, P. S., Singh, S., Patel, J., Soni, M., Prokop, L. J., Younossi, Z., . . . Loomba, R. (2017). Increased risk of mortality by fibrosis stage in non-alcoholic fatty liver disease: Systematic Review and Meta-analysis.. Hepatology, 65(5), 1557-1565
Open this publication in new window or tab >>Increased risk of mortality by fibrosis stage in non-alcoholic fatty liver disease: Systematic Review and Meta-analysis.
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2017 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 65, no 5, p. 1557-1565Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Liver fibrosis is the most important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Quantitative risk of mortality by fibrosis stage has not been systematically evaluated. We aimed to quantify the fibrosis stage-specific risk of all-cause and liver-related mortality in NAFLD.

METHODS: Through a systematic review and meta-analysis, we identified 5 adult NAFLD cohort studies reporting fibrosis stage specific mortality (0-4). Using fibrosis stage 0 as a reference population, fibrosis stage-specific mortality rate ratios (MRR) with 95% confidence intervals (CI), for all-cause and liver-related mortality, were estimated. The study is reported according to the PRISMA statement.

RESULTS: 1,495 NAFLD patients with 17,452 patient years of follow-up were included. Compared to NAFLD patients with no fibrosis (stage 0), NAFLD patients with fibrosis were at an increased risk for all-cause mortality and this risk increased with increase in the stage of fibrosis: stage 1, MRR, 1.58 (95% CI 1.19-2.11); stage 2, MRR, 2.52 (95% CI 1.85-3.42); stage 3, MRR, 3.48 (95% CI 2.51-4.83), and stage 4, MRR, 6.40 (95% CI 4.11-9.95). The results were more pronounced as the risk of liver-related mortality increased exponentially with increase in the stage of fibrosis: stage 1, MRR, 1.41 (95% CI 0.17-11.95); stage 2, MRR, 9.57 (95% CI 1.67-54.93); stage 3, MRR, 16.69 (95% CI 2.92-95.36); and stage 4, MRR, 42.30 (95% CI 3.51-510.34).

LIMITATIONS: Inability to adjust for co-morbid conditions or demographics known to impact fibrosis progression in NAFLD, and the inclusion of patients with simple steatosis and NASH without fibrosis in the reference comparison group.

CONCLUSION: The risk of liver-related mortality increases exponentially with increase in fibrosis stage. These data have important implications in assessing utility of each stage and benefits of regression of fibrosis from one stage to another. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-134875 (URN)10.1002/hep.29085 (DOI)000399459800011 ()28130788 (PubMedID)
Note

Funding agencies: American Gastroenterological Association Foundation [K23-DK090303, R01-DK106419-01]; National Institute of Diabetes and Digestive and Kidney Diseases [5T32DK007202]; National Institute of Environmental Health Sciences of the National Institutes of Health 

Available from: 2017-02-28 Created: 2017-02-28 Last updated: 2018-04-18
Nasr, P., Hilliges, A., Thorelius, L., Kechagias, S. & Ekstedt, M. (2016). Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease. Scandinavian Journal of Gastroenterology, 51(9), 1126-1132
Open this publication in new window or tab >>Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 9, p. 1126-1132Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The gold standard for diagnosing fibrosis stage in non-alcoholic fatty liver disease (NAFLD) is liver biopsy. The aim of this study was to determine whether contrast-enhanced ultrasonography (CEUS) with transit time measurements could be a non-invasive alternative for differentiating none or mild from severe fibrosis in NAFLD patients. Various serum markers and clinical variables were also evaluated.

MATERIALS AND METHODS: Fifty-eight patients with NAFLD underwent CEUS prior to liver biopsy. All patients were also evaluated according to the Göteborg University Cirrhosis Index (GUCI), the AST-Platelet Ratio Index (APRI), the NAFLD fibrosis score, and the FIB-4 and BARD score.

RESULTS: The hepatic vein arrival time (HV) was shorter in patients with severe fibrosis (25.9 ± 4.8 vs 29.5 ± 4.7 s, p = 0.023), and the difference between the hepatic and portal vein (ΔHV-PV) was shorter (2.3 ± 2.8 vs 6.4 ± 2.8 s, p < 0.0001) while the difference in arrival time between the portal vein and hepatic artery (ΔPV-HA) arrival time was significantly longer (6.0 ± 2.2 vs 3.6 ± 1.6 s, p < 0.0001). The area under receiver operating characteristics curve values for HV, ΔHV-PV and ΔPV-HA to separate none or mild from severe fibrosis was 0.71, 0.83 and 0.84, respectively. The corresponding figures for GUCI, APRI, NAFLD fibrosis score, FIB-4 and BARD score were 0.93, 0.92, 0.86, 0.90 and 0.77, respectively.

CONCLUSIONS: CEUS and non-invasive scoring systems could exclude severe fibrosis in NAFLD patients.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Contrast-enhanced ultrasonography, fibrosis, fibrosis scores, non-alcoholic fatty liver disease
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-129954 (URN)10.3109/00365521.2016.1172336 (DOI)000381406800018 ()27161854 (PubMedID)
Note

Funding agencies: Research Council of Southeast Sweden [F2004-303]; ALF Grants, Region Ostergotland

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2017-11-28Bibliographically approved
Hagström, H., Nasr, P., Bottai, M., Ekstedt, M., Kechagias, S., Hultcrantz, R. & Stål, P. (2016). Elevated serum ferritin is associated with increased mortality in non-alcoholic fatty liver disease after 16 years of follow-up. Liver international (Print), 36(11), 1688-1695
Open this publication in new window or tab >>Elevated serum ferritin is associated with increased mortality in non-alcoholic fatty liver disease after 16 years of follow-up
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2016 (English)In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 36, no 11, p. 1688-1695Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: High levels of ferritin in patients with non-alcoholic fatty liver disease (NAFLD) are associated with significant fibrosis and higher NAFLD activity score (NAS). It is unclear if this association has an impact on mortality. We investigated if high levels of ferritin, with or without iron overload, were associated with an increased mortality in NAFLD.

METHODS: We included 222 patients between 1979 and 2009 with biopsy-proven NAFLD and available serum ferritin concentrations. The cohort was divided into "high" (n = 89) and "normal" (n = 133) ferritin values, using a cut-point of 350 μg/L in males, and 150 μg/L in females, and stratified upon iron overload status. Data on mortality was obtained from a national, population based register. Poisson regression was used to estimate hazard ratios for mortality. The estimates were adjusted for age at biopsy, sex, smoking, BMI, diabetes, hypertension, cardiovascular disease and fibrosis stage at the time of biopsy.

RESULTS: The median follow-up time was 15.6 years (range: 0.5-34.2). Patients with high ferritin had more advanced fibrosis and higher NAS than patients with normal ferritin (p < 0.05). Fifteen years after diagnosis, and after adjusting for confounders, the high-ferritin group showed an increasingly higher mortality that was statistically significant (Hazard ratio = 1.10 per year, 95% Confidence interval 1.01-1.21, p < 0.05). There was no difference in mortality between patients with different iron overload patterns.

CONCLUSIONS: High levels of ferritin are associated with a long-term increased risk of death. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
ferritin;fibrosis, long-term outcome, mortality, NAFLD activity score, non-alcoholic fatty liver disease
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-129955 (URN)10.1111/liv.13144 (DOI)000385863400016 ()27064133 (PubMedID)
Note

Funding agencies:Stockholm County Council (ALF projects from the Swedish Society of Medicine [20140329, 20150403]; Ruth and Richard Julins Foundation; Medical Research Council of Southeast Sweden [311151]; ALF grants, Region Ostergotland, Sweden

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2017-11-28Bibliographically approved
Ekstedt, M., Hagström, H., Nasr, P., Fredrikson, M., Stal, P., Kechagias, S. & Hultcrantz, R. (2016). Nonalcoholic Fatty Liver Disease Activity Score and Mortality: Imperfect But Not Insignificant REPLY [Letter to the editor]. Hepatology, 64(1), 310-311
Open this publication in new window or tab >>Nonalcoholic Fatty Liver Disease Activity Score and Mortality: Imperfect But Not Insignificant REPLY
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2016 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 64, no 1, p. 310-311Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-124403 (URN)10.1002/hep.28314 (DOI)000379233400041 ()26517017 (PubMedID)
Available from: 2016-01-28 Created: 2016-01-28 Last updated: 2017-11-30
Johansson, J., Sahin, C., Pestoff, R., Ignatova, S., Forsberg, P., Edsjö, A., . . . Stenmark Askmalm, M. (2015). A Novel SMAD4 Mutation Causing Severe Juvenile Polyposis Syndrome with Protein Losing Enteropathy, Immunodeficiency, and Hereditary Haemorrhagic Telangiectasia.. Case Reports in Gastrointestinal Medicine, 2015, 1-5, Article ID 140616.
Open this publication in new window or tab >>A Novel SMAD4 Mutation Causing Severe Juvenile Polyposis Syndrome with Protein Losing Enteropathy, Immunodeficiency, and Hereditary Haemorrhagic Telangiectasia.
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2015 (English)In: Case Reports in Gastrointestinal Medicine, ISSN 2090-6528, E-ISSN 2090-6536, Vol. 2015, p. 1-5, article id 140616Article in journal (Refereed) Published
Abstract [en]

Juvenile polyposis syndrome (JPS) is a rare genetic disorder characterized by juvenile polyps of the gastrointestinal tract. We present a new pathogenic mutation of the SMAD4 gene and illustrate the need for a multidisciplinary health care approach to facilitate the correct diagnosis. The patient, a 47-year-old Caucasian woman, was diagnosed with anaemia at the age of 12. During the following 30 years, she developed numerous gastrointestinal polyps. The patient underwent several operations, and suffered chronic abdominal pain, malnutrition, and multiple infections. Screening of the SMAD4 gene revealed a novel, disease-causing mutation. In 2012, the patient suffered hypoalbuminemia and a large polyp in the small bowel was found. Gamma globulin was given but the patient responded with fever and influenza-like symptoms and refused more treatment. The patient underwent surgery in 2014 and made an uneventful recovery. At follow-up two months later albumin was 38 g/L and IgG was 6.9 g/L. Accurate diagnosis is essential for medical care. For patients with complex symptomatology, often with rare diseases, this is best provided by multidisciplinary teams including representatives from clinical genetics. Patients with a SMAD4 mutation should be followed up both for JPS and haemorrhagic hereditary telangiectasia and may develop protein loosing enteropathy and immunodeficiency.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-115933 (URN)10.1155/2015/140616 (DOI)25705527 (PubMedID)
Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2017-12-04
Lindh Falk, A., Dahlberg, J., Ekstedt, M., Heslyk, A., Whiss, P. & Abrandt Dahlgren, M. (2015). Creating spaces for interprofessional learning: Strategic revision of a common IPL curriculum in undergraduate programs. In: Andre Vyt, Majda Pahor, Tiina Tervaskanto-Maentausta (Ed.), Interprofessional Education in Europe: Policy and Practice: (pp. 49-66). Antwerpen: Garant Publishers Limited
Open this publication in new window or tab >>Creating spaces for interprofessional learning: Strategic revision of a common IPL curriculum in undergraduate programs
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2015 (English)In: Interprofessional Education in Europe: Policy and Practice / [ed] Andre Vyt, Majda Pahor, Tiina Tervaskanto-Maentausta, Antwerpen: Garant Publishers Limited , 2015, p. 49-66Chapter in book (Refereed)
Place, publisher, year, edition, pages
Antwerpen: Garant Publishers Limited, 2015
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:liu:diva-125288 (URN)9789044133349 (ISBN)
Available from: 2016-02-19 Created: 2016-02-19 Last updated: 2016-11-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5590-8601

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