Ramadani, Atip
Preferred name
Ramadani, Atip
Official Name
Ramadani, Atip
Main Affiliation
Email
atip.ramadani@medf.ukim.edu.mk
7 results
Now showing 1 - 7 of 7
- Some of the metrics are blocked by yourconsent settings
Item type:Publication, MODEL FOR END-STAGE LIVER DISEASE (MELD) IN STRATIFIACATION OF IN HOSPITAL PATIENTS WITH TERMINAL LIVER DISEASE(2012); ; ; Syardelova KINTRODUCTION: Liver cirrhosis is end stage of liver disease where liver transplantation is the only curative treatment. MELD score system is relatively newer system (the last ten years) used as assesment tool for liver disease severity as well as for creating of liver transplantation priority lists. In the contrary of already used system - Child-Turcotte-Pugh, where posibility for subjective assesment of variables as ascites and encephalopathy is existing, this system avoids such posibility. MELD includes another very important variable – renal function assesment as serious prognostic factor. Well-defined formula calculating natural logarithms of bilrubin, creatinin and international normalized ratio (INR) of prothrombin time determined MELD-'s set of points. The aim of this study is to stratify in hospital patients in Clinic of Gastroenterohepatology, Skopje with terminal liver disease using MELD scoring system and easy recognize the real need for transplantation in these patients. MATERIAL AND METHODS: This retrospective study is analyzing medical discharge summary among 192 patients hospitalized at our clinic in the period from 01.01.2011 to 31.12.2011 with diagnosis of liver cirrhosis, who have all the necessary parameters available to calculate the MELD score (patients with the same diagnosis without the necessary parameters were excluded from the study). Patients were aged between 20 and 90 years (average age 55.7 years) with predominance of males (147 males and 45 females). They were analyzed in accordance to cirrhosis etiology, indication for hospitalization, MELD score and the risk of lethal outcome. Descriptive statistics to analyze data was used. RESULTS: Total of 192 patients are analyzed, 76.6% are male, while 23.4% are women. From the etiological point of view the alcohol as cause of cirrhosis dominates in 73 patients (38%), followed by HBV infection in 49 patients (25.5%), undefined etiology has in 24 patients (12.5%), mixed etiology of ethyl and viral origin of hepatitis B in 11 patients (6%), HCV infection in 9 patients (4.7%), immunogenic etiology in 8 patients (4.1%), portal vein thrombosis in 4 patients (2.1%), secondary biliary cirrhosis in 4 patients (2.1%), alcohol and HCV infection in 3 patients (1.5%), mixed HBV and HCV infection in 2 patients (1%), primary biliary cirrhosis in 2 patients (1%), Wilson disease in 2 patients (1%) and nonalcoholic steatohepatitis as a cause of cirrhosis in 1 patient (0.5%). The most common reason for hospitalization is variceal bleeding in 51 patients (26.6%), followed by refractory ascites in 35 patients (18.2%), jaundice in 31 patients (16.1%), portal encephalopathy in 29 patients (15.1%), diagnostic differentiation (liver biopsy) in 28 patients (14.6%), and hepato-renal syndrome in 14 patients (7.3%). In accordance to the MELD score, patients are divided into 5 groups regarding to calculated percentage of three month mortality. Average MELD score for all 192 patients is 15. Under this scoring system 4 patients (2.1%) belong to the group with highest risk (71.3% is the rate of mortality within three months), 14 patients (7.3%) in group having 52.6% mortality rate within three months, 31 patients (16%) belong to a group with 19.6% mortality rate, and the remaining patients in the group with 6% mortality rate (69 patients - 36%) and the group with the lowest mortality of 1.9% (74 patients - 39.5%). The outcome of 20 from 192 patients analyzed was lethal. The reason for this outcome was hepato-renal syndrome in 11 patients (55%), variceal bleeding in 7 patients (35%) and in 2 patients (10%) hepatic coma. DISCUSSION: Liver cirrhosis as an indication for hospitalization is often seen in our daily practice. Especially common reason for hospitalization is the occurrence of complications of cirrhosis (variceal bleeding, refractory ascites, jaundice, portal encephalopathy or hepato-renal syndrome), which caused lethal outcome in some patients. According to our analysis, a significant percentage of patients (39/192 or 25.4%) with MELD score> 20, belong to the group with high short-term risk of lethal outcome (3 months mortality rate). Those patients in developed countries would find themselves on a priority list for liver transplantation. Our commitment (such as internal disease specialists and surgeons) should be to enable these patients equal access to treatment as in those patients with terminal liver failure in developed countries. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Therapeutic endoscopic modalities for acute non-variceal upper gastrointestinal bleeding(2012); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, IMPLEMENTATION OF SHEAR WAVE ELASTOGRAPHY AS A NEWMETHOD IN THE CLINIC OF GASTROENTEROHEPATOLOGY – SKOPJE(SHMSHM/AAMD, 2022-04); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Results of conservative treatment of benign strictures of the esophagus with bougienage: cross sectional study representing first experiences in Republic of Macedonia(2016); ; BACKGROUND: Benign esophageal strictures are complications that result from various causes. They can be structurally categorized into two groups: simple and complex. Treatment is similar in most of cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions can vary and there is no strong consensus in the literature regarding this fact. OBJECTIVE: To analyze, the first 3 year experience of Digestive Endoscopy Unit of the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia, in treating benign esophageal strictures, since the Savary-Gilliard technique of ‘bougienage’ was introduced for the first time in Republic of Macedonia, at our Institution in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response. METHODS: One hundred and forty seven dilations were analyzed during a period from 20-th December 2013, until March 2016 were analyzed in 56 patients. RESULTS: The caustic strictures were the most prevalent, occurring in 12 (48%) of patients, followed by peptic stenosis presenting 28% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best answered on treatment and need fewer dilatation sessions per patient. CONCLUSION: caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long stretch. Peptic stenosis is the second one cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage, irrespective of type and extent of esophageal stenosis is safe and grateful procedure. KEY WORDS: esophageal stenosis, bouginage. INTRODUCTION: Benign esophageal strictures are complications that result from various causes, like gastroesophageal reflux disease, accidental or deliberate ingestion of corrosive substances, congenital rings and esophageal membranes, radiation therapy, eosinophilic esophagitis etc. They can be structurally categorized into two groups: simple and complex (1). Simple strictures are symmetric or concentric, usually short with a diameter of 12 mm or more or easily allow passage of a diagnostic upper endoscope. Complex strictures have one or more of the following features: asymmetry, diameter <12 mm or inability to pass an endoscope. Regardless of the cause, dysphagia as symptom is a main indication for dilation of benign strictures (2). Treatment is similar in most of cases that require dilatation and means use of three general types of dilators that are currently in use. These are: (1) mercury or tungsten-filled bougies (Maloney or Hurst), (2) wire-guided polyvinyl dilators (Savary-Gilliard or American type), and (3) ‘‘through-the-scope’’ balloon dilators. The technic using Maloney/Hurst or Savary-Gilliard dilators is known well as ‘bougienage’. The degree of dilation within a session should be based on the severity of the stricture. The “rule of 3” has been accepted and applied to bougie dilation of esophageal strictures (3). Specifically, the initial dilator chosen, should be based on the estimated stricture diameter. Serial increases in diameter are then performed. However, despite the last ASGE guideline on esophageal dilatation from 2006 (4), the therapeutic response, optimal timing of treatment and interval between dilatation sessions can vary and there is no strong consensus in the literature regarding this fact. Dilatation of esophageal strictures in Republic of Macedonia and University Clinic of Gastroenterohepatology is not new. The use of olive dilators was introduced at our Clinic few decades ago. The University Clinic of otorhinolaryngology has long experience using mercury or tungsten-filled bougies (Maloney/Hurst), meaning the same for the Clinic of Pediatric Surgery. In this retrospective study, we present the first 3 year experience of Digestive Endoscopy Unit of the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia, in treating benign esophageal strictures, since the Savary-Gilliard technique of ‘bougienage’ was introduced for the first time in Republic of Macedonia, at our Institution in December 2013. METHOD: All dilations, independently of their type and origin, were analyzed, during a period from December 20-th, 2013, until March 2016. The dilations performed out of technic of bouginage were excluded. The dilations were performed in an in-hospital setting, with one to two week intervals between sessions. All of the interventions were conducted by three experienced endoscopysts covering the whole number of 25 patients (16, 7 and 2 patients per operator, respectively). The procedure was performed with the patient fasting for at least 12 hours, under conscious sedation using midazolam and continuous pulse-oximetry and post procedural temperature and blood pressure monitoring. Although, routine antibiotic coverage is not recommended mandatory before procedure (4), we used ceftriaxone 2g i.v. for prophylaxes of septic events. We used a flexible metal guide wire, introduced through the stricture under endoscopic vision and X-ray control, on which were passed the Savary-Gilliard type bougies [Safe Guide TM, Over the Guidewire Esophageal Dilators with 16 sizes: 15 FR to 60 FR - in 3 FR increments - equivalent values in mm – from 5 to 20 mm (Medovations inc., 102 East Keefe Avenue, Milwaukee, wi53212 USA]. The initial diameter of the candle is individualized according to the degree of stenosis displayed. Data were collected according to the cause, type and extent of stenosis. According type, the strictures were classified as simple and complex. The extent was used to classify them as short - up to 3 cm, medium - between 3 and 7 cm, and long - when more than 7 cm in length. These variables were correlated with the number of dilations. The influence of etiology in the extent of stenosis was also analyzed. The ultimate goal of treatment was absence or marked reduction of dysphagia. STATISTICAL ANALYSIS: For statistical analysis of data Pearson contingency coefficient test was used (by analyzing the influence of sex on the extent of stenosis) and ANOVA (analysis of variance of the influence of the extent and etiology on the number of dilations). The level of significance was expressed as P <0.05. RESULTS: One hundred and forty seven dilations were analyzed during a period from 20-th December 2013, until March 2016. Thirty one dilations were excluded, concerning the cases where balloon dilation technic was used. In other words 116 dilations, performed by using technic of bouginage in 25 patients (10 women and 15 men with a mean age of 52,4 years, ranging from 1-82 years), during a period of more than 3 years, were analyzed. The caustic stricture was the most prevalent cause, occurring in 12 (48%) of patients, followed by peptic stenosis presenting 28% of patients. Regarding the extent of stenosis, all individuals were evaluated of the total 25 patients included, and it was observed that 64% (16/25) had short nips, these representing the majority of peptic stenosis (6 of 16 patients). Long length stenoses were exclusively present in patients whose origin was caustic. The recurrence rate in the last, despite the high number of sessions needed to provide positive effect, was low. Forty for % of 9 patients were free from symptoms following the finish of therapy. Peptic were predominantly short stenosis - in 6 of 25 patients analyzed for extent (24%). The opposite occurred in the caustic stenosis that have predominantly long changes (7 of 12 patients with corrosive injury analyzed for extent - 58,3%). Stenoses due to esophageal surgery were also short (2 of 2 patients - 100%). Caustic injuries were those that needed more sessions, on average 6,6 dilations per patient (maximum 21 sessions in one patient), a statistically significant difference in relation to other causes (P <0.0005). However, analyzing separately the postoperative cases, peptic and all other types between each other, there was no significant difference between the average number of dilations (P = 0.175667). Nips long segment strictures required on average 7.9 interventions per patient, while narrowing short extension stenosis, required about 2.8 dilations per patient (P <0.00001). In 116 dilations performed, there were no perforations. There was minor bleeding in all patients, but not more than usual and no mortality was registered in this series. DISCUSSION: The causal diagnosis of stenosis may be set at 80% of cases, using only the anamnesis. A barium swallow does much to define the degree of stenosis, location, determine the complexity and choose the type of dilator to be used, and usually is used as the initial examination. Upper endoscopy is essential, because it evaluates the mucosa of the affected region, excluding malignant causes and enables the performance of biopsies to be done even when the etiologic diagnosis is evident. Corrosive agents when ingested accidentally (in children mostly) or intentionally (adults in suicide attempts) can cause esophageal strictures, which bring the higher risk of perforation and more expressed rate of recurrence after dilation compared to other types (5, 6). Endoscopic examination in the acute phase may indicate the prognosis. Tiryaki et al. (7) observed a better therapeutic response when dilation was initiated in the acute phase, seven days after ingestion of corrosive. In this study we started bouginage in caustic cases at least 3 months after the accident, and the success rate was pretty high - 44% without additional need for treatment, and most of the others with de novo symptoms 6 months after initial session. The affected segment extension is also a prognostic factor. In this series, we observe that the more extensive was the stenosis; the needed number of dilations was greater. After the disappearance of the symptoms, the need for retreatment was usually in the period of 3-6 months in the first year. Temir et al. (8) defend the opinion that implementation of new dilations should only be done when reappearance of dysphagia is registered. An estimated 7% to 23% of patients with longstanding gastroesophageal reflux disease (GERD) evolve with esophageal stenosis (9). As shown in this study, they are generally annular stenosis (shorter than <3 cm), typically located on the distal segment of the esophagus. This type of stenosis responds very well to dilation therapy with successful rate greater than 80% (5). The therapy with proton pump inhibitors (PPIs) in full dose and anti-reflux measures should always be carried out. Patients undergoing esophageal surgery, especially esophagectomies and even hernia repair surgeries, may develop stenosis, either due to developing local ischemia, use of "stapler" technic or by the scar processing. The success rate of endoscopic dilations in these patients is around 75% to 92%, usually requiring about three to five sessions for resolution of symptoms (13). In this sample, it was found that two patients with postoperative stenosis required on average 3 sessions for good response. According to our opinion it is safe and recommended to start the expansion immediately after appearance of dysphagia, which is opposite to other experts recommendations, taking cut of value of 2 weeks after surgery as relevant one. In addition, the ideal period is not still determined (13). It is known that only 24 hours of use of a nasogastric tube, it can be seen intraepithelial and sub mucosal edema and hemorrhage of the esophagus and if the probe remains in situ for more than 5 days, hyperemia as well as presence of ulcerations can be detected. This occurs either by direct local irritation by the probe, as well as a result of facilitation of gastroesophageal reflux. There was no patient in this series presented with stenosis resulting from the use of nasogastric tube. Radiotherapy may cause stenosis by direct damage to DNA and producing free radicals which stimulate cell death. The incidence is around 25% to 67% in the irradiated patient to primary tumor and from 1% to 20% for irradiation of tumors arising from adjacent organs (breast, lung, thyroid) (13). In this study, the post-radiotherapy stenosis was uncommon, occurring in only 3 patients (12%) who required on average 1 dilation session to achieve therapeutic response. Eosinophilic esophagitis, predominant entity in children, in which there is chronic inflammation of the esophagus, characterized by infiltration of more than 20-24 eosinophils per high-power field, detected by histopathology, is still underdiagnosed cause in adults with esophageal stenosis. The treatment includes endoscopic dilation, removal of the triggering factor (usually airborne allergens and food allergens) and topical steroids. In the present study we assessed only one patient with this diagnosis, requiring, one expansion sessions adjacent to topical steroid therapy, for dysphagia remission. Esophagitis caused by ingestion of drugs in pill form is because infrequent stenosis. Medications such as tetracycline, nonsteroidal antiinflammatory drugs, potassium chloride and bondronates can cause stenosis by direct injury to the mucosa due to prolonged contact, decreased motor activity and decreased esophageal clearance. This study can’t confirm the use of drugs to cause stenosis. Membranes and rings are causes of stenoses that respond very well to endoscopic dilatation. In the case of Schatzki’s rings, 68% of patients remain without dysphagia for a period of 1 year after the first expansion, but many need new dilations throughout life (10). In the present study evaluated one patient with Schatzki ring, shows good response to endoscopic treatment. Length of stricture best correlates with its cause, and it was found that according to the causes, strictures have their own behavior. Thus, caustic strictures are generally long, opposite to peptic strictures that are short. When comparing the number of dilations undertaken with the cause and extent of the stenosis, it has been found that short lesions or annular, such as peptic and postoperative can be treated by the smaller number of dilations. Already caustic stenoses, usually long, required quite a large number of sessions. The decision on the type of dilator to be used depends on the availability of the material and experience of each service and it’s endoscopysts. In our service where this study was conducted, we used Savary-Gilliard dilatators, consisting of flexible polyvinyl material, and progressed through the stenosis, guided by the passage of a guide wire. The use of fluoroscopy during the procedure, which has been released in the last period in most other services, can be useful in cases of tortuous and complex strictures and provides greater security to the procedure, allowing full control of the dilator and guidewire positioning and minimizing the risk of perforation. Thus the complication rate is lower, we suppose. There is no consensus on the follow-up of these patients. Moura et al. (11) suggest that the expansion should be weekly at 1 month, biweekly in 2 of 21 in 21 days in 3 and 4 months and monthly in 5, 6 and 7 months. The patient would then be instructed to return if still recounting the symptoms or if there was return of dysphagia, being considered the case as refractory if these complaints occurred in less than 3 months after the last expansion. Some authors (12) recommended that the patient must be kept in expansion program at short intervals (weekly or biweekly) at the start of therapy until the ultimate goal is reached, the absence of dysphagia; others (13) , however, argue the progression to higher candle (45Fr or more), even if the patient is already asymptomatic (14). In our study in most cases, the patients were kept under one to two weekly dlation programm until the absence of dysphagia. Most of the patients didn’t need to reach the maximum size of dilators (60Fr – 20mm) for absence of symptoms. Immediate and postponed complications, after dilation occur in 0.5% to 1.2% (2, 21) and excess bleeding may occur in less than 0.5% of the cases (15) and bacteremia 20% - 45%. In this study, there were no cases of perforation and bacteriemia, proving that the procedure is very safe. The use of corticosteroid (triamcinolone) at the site of stenosis or intralesional (in tears after expansion) is used in some centers because it is believed that by inhibiting the synthesis of collagen, can reduce the number of sessions (16, 17, 18). No patient in this study underwent intralesional corticosteroid injections. CONCLUSION: In this study, caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long stretch. Peptic stenosis is the second one cause of benign esophageal strictures and responded well to endoscopic therapy in accordance with the literature. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage, irrespective of type and extent of esophageal stenosis is safe and grateful procedure, especially in the setting of lack of referent thoracic surgery. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Standard and contrast-enhanced doppler sonography in assessment of the vascular pattern in hepatocellular carcinoma(2012); ; ; AIM: Analysis of the type of vascularity in hepatocellular carcinoma (HCC) with various Doppler techniques and evaluation of the possibility of differentiating hepatocellular carcinoma in relation to the vascular pattern from other focal liver lesions. MATERIAL AND METHODS: Standard and contrast enhanced color and power Doppler using contrast medium Levovist was performed in 34 cases of subsequently histopathologically proven hepatocellular carcinoma. The type of vascular pattern was assessed according to the classification of Tanaka and Kubbota. Doppler characteristics of different Doppler methods aimed to allow sonographic diagnosis in different liver lesions. RESULTS: Highly significant difference (p <0.01) was established in vascular patterns between Doppler methods in the analysis of HCC lesions. Power Doppler and contrast-enhanced Doppler methods were superior to color Doppler in detection of the vascular pattern in HCC. Contrast-enhanced power Doppler was superior to standard. With standard and contrast-enhanced Doppler analysis of HCC lesions dominating vascular patterns were: basket pattern (BP), vessel in tumor (VT) and BP + VT. Crostabulation with Wilcoxon test showd highly statistically significant differences (p <0.01) in the sonographically diagnosed HCC lesions between standard and contrast-enhanced color and power Doppler. The difference between sonographical diagnoses in contrast-enhanced color and power Doppler was statistically significant (p <0.05), while in the other comparisons between different methods the difference was not statistically significant (p> 0.05). CONCLUSION: Doppler methods (standard and contrast-enhanced) are useful, safe, easyly applicable modalities for assessing the type and degree of vascularity in hepatocellular carcinoma, and contrast-enhanced Doppler techniques show higher diagnostic value in differentiation of HCC lesions. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Metabolic and thyroid abnormalities in patients with chronic Hepatitis C – single centre experience(2012); ; ; ; HCV appears to induce insulin resistance and is a risk factor for the development of diabetes mellitus. The IR represents an independent factor for progression of liver fibrosis in patients with chronic hepatitis C. The combination of pegylated interferon alpha (PEG-IFN) and ribavirin (RBV) is the current standard of care for chronic hepatitis C. The thyroid function abnormality is more frequent finding in HCV infected subjects comparing the general population. Moreover, autoimmune thyroid disorders have been widely reported as adverse effect of interferon therapy of chronic hepatitis C (CHC). AIM OF THE STUDY: 1. To determine the relation between HCV and IR and the effect of antiviral therapy to IR. 2. To assess the frequency of thyroid abnormalities in patients with CHC before and after the combined antiviral therapy. MATERIAL AND METHOD: 98 pts with chronic hepatitis C were enrolled in the study. Pretreatment investigations included biochemical, virological and histological evaluation, as well as BMI and IR. The degree of insulin resistance was measured according to the homeostasis model assessment for insulin resistance: HOMA-IR=(FPGLxFIL)/22.5, where FPGL is the fasting insulin level measured in micromoles per liter and FIL is fasting insulin level measured in microIU/ml. The thyroid function was defined with free tiroxin level and TSH. Liver auto antibodies were tested in all cases, and antithyroid antibodies in pts who developed thyroid abnormality. Clinical, biochemical and virological parameters were determined at baseline, during the therapy (w.4, 12, 24/48) and 24 weeks after the end of therapy. RESULTS: Male: female ratio was 57:41. Age distribution was between 19 and 59 years. HCV genotype distribution was the following: HCV g.1 38, g.3 60. BMI (kg/m2) was in normal range in 75%, whereas in 25% was >29. Average range of fasting glucose was 5.5mmol/L (3.8-6.5), and average insulin level 12.9 (2.0-25microIU/ml). Histological activity index according Knodell was in range 2-12. Liver steatosis was found in 12 cases (3 of them had moderate to severe steatosis involving more than 30% of hepatocytes). The thyroid disorders were found in 11pts (11.2%). In 9 of them thyreosuppressive drugs were introduced. One patient firstly developed thyreotoxicosis and thyreosuppressive treatment was started. Follow-up of the patient showed transition to hypothyreotic state and modification of therapy was necessary. The patient had very high level of antithyroid antibodies. One single case had regular follow-up, whithout indication for thyreosubstitution. 10 pts successfully finished the scheduled antiviral treatment. Post-treatment follow-up has shown slight improvement of IR, but the thyroid substitution treatment was ongoing after the end of therapy. CONCLUSION: Insulin resistance in HCV positive subjects is related to HCV infection. The antiviral treatment and sustained virological response has beneficial effect on this parameter. The thyroid function abnormality might be induced by interferon therapy, but the presence of antithyroid antibodies suggests preexisting autoimmune phenomenon, additionaly stimulated by antiviral therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Role and Significance of Non-invasive Methods, with a Particular Focus on Shear Wave Elastography in Hepatic Fibrosis Staging(Scientific Foundation SPIROSKI, 2022-04-14); ; ; ; Shear Wave Elastography (SWE) represents a new, non-invasive method, used in the diagnosis of diffuse liver diseases. The method has been widely used instead of liver biopsy - an invasive procedure with potential major risk complications. Compared to liver biopsy, SWE provides an examination of larger areas of the liver, thus providing better staging of hepatic fibrosis. 30 patients were included in the study on basis of previous clinical, biochemical, and ultrasound findings indicating a presence of a chronic liver lesion. Patients were divided into three groups: 6 patients with steatosis, 13 patients with viral hepatitis, and 11 patients with liver cirrhosis. Liver damage biochemical markers, serum markers of liver fibrosis, and SWE were determined in all patients. Statistical analysis revealed a positive correlation between SWE results, and the values of biochemical markers of the hepatic lesion, as well as serum markers of liver fibrosis.