All Publications

  • Peri-Complication Diagnosis of Nonalcoholic Fatty Liver Disease: A US Population-Based Retrospective Analysis. Digestive diseases (Basel, Switzerland) Manikat, R., Tran, S., Kam, L. Y., Dronamraju, D., Cheung, R., Nguyen, M. H. 2025: 1-11

    Abstract

    Screening guidelines for nonalcoholic fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), remain controversial, though early diagnosis can faciliate intervention and prevention.A retrospective analysis of adult patients within the Merative™ Marketscan® Databases (1/2007-12/2021) with a diagnosis of MASLD, a liver complication (defined as HCC, cirrhosis with or without evidence of portal hypertension such as varices, ascites, and hepatic encephalopathy or liver transplant), and ≥12 months of insurance coverage prior to the first liver complication.We analyzed 143,310 patients meeting inclusion criteria. The majority (95,843, 66.8%, p < 0.001) had a pericomplication diagnosis of MASLD. Compared to patients without delayed diagnosis, those with a pericomplication diagnosis were older (57.6 ± 14.5 vs. 53.8 ± 12.5), more likely to have used tobacco (18.7% vs. 12.6%) and illicit drugs (2.3% vs. 1.4%), metabolic diseases, and higher mean Charlson Comorbidity Index (CCI, 3.0 ± 3.0 vs. 1.9 ± 2.3), all p < 0.0001. On multivariable logistic regression adjusted for age, sex, and CCI, a first visit with gastroenterology (odds ratio [OR] 0.32, 95% CI 0.31-0.32, p < 0.001), or a specialist seeing patients with metabolic disease (cardiology, endocrinology, or nephrology) (OR 0.44, 95% CI 0.43-0.45, p < 0.001) more than 12 months prior to a complication was associated with significantly lower odds of delayed diagnosis of MASLD.Diagnosis of MASLD in real-world patients is severely delayed, with 2 in 3 patients diagnosed either after or within 6 months from a liver complication. Patients followed longitudinally by medical providers in gastroenterology and other metabolic specialties had a substantially lower risk of an early complication.

    View details for DOI 10.1159/000547392

    View details for PubMedID 40659005

  • Bariatric Surgery Reduced Long-Term Mortality in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease and Cirrhosis. Clinical and molecular hepatology Rouillard, N. A., Barnett, S. D., Zhang, X., Kam, L., Manikat, R., Cheung, R., Nguyen, M. H. 2024

    Abstract

    Objective: With the obesity pandemic, metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease and a leading cause of end-stage liver disease and liver-related deaths in the U.S.A. Therefore, we aimed to compare the long-term outcomes of patients with MASLD and cirrhosis with and without bariatric surgery.Design: Patients were retrospectively identified from the California Department of Healthcare Access and Information database, 2005 to 2019, for a population-based cohort study. Propensity score matching (PSM) was used to balance background risks between patients with cirrhosis who underwent bariatric surgery and those who did not. Overall, liver-related, and non-liver-related mortality were analyzed.Results: Of 91,708 eligible patients with MASLD and cirrhosis, PSM yielded 2,107 patients who underwent bariatric surgery and 8,428 non-bariatric controls. Compared to matched controls, patients who underwent bariatric surgery had lower 5-year overall (24.9% vs. 37.1%; P < 0.0001), liver-related (3.3% vs. 14%; P < 0.0001), and non-liver-related mortality (22.3% vs. 26.9%; P = 0.046). In multivariable analysis, bariatric surgery was associated with decreased overall mortality (adjusted hazard ratio [aHR] = 0.63; P < 0.0001), liver-related (aHR = 0.24; P < 0.0001), and non-liver-related (aHR = 0.81; P = 0.0026) mortality. However, only laparoscopic surgeries were associated with lower overall mortality (aHR = 0.39; P < 0.0001) whereas open surgeries were associated with higher overall mortality (aHR = 1.24; P = 0.022).Conclusion: Patients with MASLD and cirrhosis who underwent bariatric surgery, specifically laparoscopic approaches, had significantly lower mortality risk than non-surgical counterparts.

    View details for DOI 10.3350/cmh.2024.0564

    View details for PubMedID 39541951

  • Current epidemiology of chronic liver disease. Gastroenterology report Manikat, R., Ahmed, A., Kim, D. 2024; 12: goae069

    Abstract

    Chronic liver disease presents a significant global health burden, characterized by several etiologies, including metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease (ALD), chronic hepatitis B virus infection, and chronic hepatitis C virus infection. This review explored current epidemiological trends and projections for each etiology, looking into their respective burdens and challenges. MASLD, formerly known as nonalcoholic fatty liver disease, is the most prevalent cause of chronic liver disease, and its global incidence and prevalence are steadily rising. ALD, fueled by increased alcohol consumption, is also on the rise, with concerning implications for future mortality rates. Chronic hepatitis B and C infections remain major public health concerns, particularly in specific regions of the world, necessitating concerted efforts for screening and treatment. The coronavirus disease 2019 (COVID-19) pandemic has impacted the epidemiology of chronic liver disease, exacerbating mortality rates and disrupting healthcare services. Mental health issues arising from the pandemic further complicate the treatment of chronic liver disease, making comprehensive healthcare strategies essential. Despite advancements in treatment, chronic liver disease continues to impose a substantial economic burden, emphasizing the importance of preventive measures and early intervention. In conclusion, ongoing surveillance and research efforts are crucial for understanding and addressing the evolving landscape of chronic liver disease. Comprehensive strategies that encompass prevention, screening, and treatment of its different etiologies are essential for mitigating its impact and improving patient outcomes.

    View details for DOI 10.1093/gastro/goae069

    View details for PubMedID 38915345

    View details for PubMedCentralID PMC11194530

  • Editorial: Using machine learning to predict significant fibrosis in metabolic dysfunction-associated steatotic liver disease. Alimentary pharmacology & therapeutics Manikat, R., Ahmed, A., Kim, D. 2024; 59 (7): 893-895

    View details for DOI 10.1111/apt.17902

    View details for PubMedID 38462684

  • Editorial: Updated epidemiology of steatotic liver disease in people with HIV in the United States. Alimentary pharmacology & therapeutics Manikat, R., Kim, S. U., Ahmed, A., Kim, D. 2024; 59 (6): 789-790

    View details for DOI 10.1111/apt.17871

    View details for PubMedID 38401138

  • Up-to-date global epidemiology of nonalcoholic fatty liver disease. Hepatobiliary surgery and nutrition Manikat, R., Ahmed, A., Kim, D. 2023; 12 (6): 956-959

    View details for DOI 10.21037/hbsn-23-548

    View details for PubMedID 38115930

    View details for PubMedCentralID PMC10727827

  • Up-to-date global epidemiology of nonalcoholic fatty liver disease HEPATOBILIARY SURGERY AND NUTRITION Manikat, R., Ahmed, A., Kim, D. 2023

    View details for DOI 10.21037/hbsn-23-548

    View details for Web of Science ID 001104296700001

  • DIAGNOSIS IS DELAYED: PERICOMPLICATION DIAGNOSIS OF NONALCOHOLIC FATTY LIVER DISEASE Manikat, R., Tran, S., Kam, L., Dronamraju, D., Cheung, R. C., Nguyen, M. H. LIPPINCOTT WILLIAMS & WILKINS. 2023: S945-S946

    View details for Web of Science ID 001094865402130

  • Patients Receiving Simultaneous Liver-Kidney Transplant Have Improved In-Hospital Outcomes Compared to Patients in the Safety Net Pathway Manikat, R., Achalu, S., Bhargava, M., Kwong, A., Cheng, X., Chung, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: S1153

    View details for Web of Science ID 001091849303222

  • LIVER VOLUME PREDICTS MORTALITY IN ALCOHOL ASSOCIATED LIVER DISEASE Manikat, R., Wu, W., Kwo, P., Kothary, N., Chaudhari, A., Kwong, A. J. LIPPINCOTT WILLIAMS & WILKINS. 2023: S1622-S1623

    View details for Web of Science ID 001094865404050

  • PREDICTORS OF RENAL RECOVERY AND SURVIVAL OUTCOMES IN LIVER TRANSPLANT RECIPIENTS MEETING SLK ELIGIBILITY CRITERIA Manikat, R., Kwong, A. J., Cheng, X., Chow, B., Bhargava, M., Achalu, S., Pham, T., Kim, W., Kwo, P. LIPPINCOTT WILLIAMS & WILKINS. 2023: S240-S241

    View details for Web of Science ID 001094865400234

  • The Impact of Alcohol Consumption and Addiction on Liver Transplantation Programs in the COVID-19 Era. Hepatic medicine : evidence and research Manikat, R., Ahmed, A., Kim, D. 2023; 15: 141-149

    Abstract

    The coronavirus disease 2019 (COVID-19) pandemic has caused significant shifts in alcohol consumption patterns in the United States, with potential long-term implications for liver transplantation (LT) programs. Alcohol consumption has increased, particularly in women, leading to a rise in alcohol-related liver disease (ALD) and alcohol use disorder. Psychological distress associated with the pandemic may further exacerbate alcohol addiction. ALD is now the most common indication for LT, with higher disease severity and complex clinical presentations, demanding a fundamental transformation in LT programs. Multidisciplinary cooperation among medical specialists, telemedicine, and remote healthcare are essential strategies to address these challenges. However, barriers to telemedicine and costs must be overcome. Curbing alcohol consumption at the societal level and bolstering mental health programs to mitigate healthcare workforce moral injury are recommended to optimize patient care in the post-COVID-19 era. Adequate planning and compassionate management of finite resources will be crucial for the successful continuation of LT programs amidst the concerning trends in alcohol consumption and addiction.

    View details for DOI 10.2147/HMER.S384070

    View details for PubMedID 37794854

    View details for PubMedCentralID PMC10546995

  • Medical Misnomers are Murky: Time to Memorialize and Rename. The American journal of medicine Manikat, R., Chopra, S. 2023

    Abstract

    Misnomers have dogged medical practice seemingly since its inception. They may arise out of initial misunderstanding of the underlying disease process, a fanciful personification of the disease itself, or simple confusion encountered early in the disease's discovery. Misnomers are not harmless. By increasing unneeded complexity, they add to challenges in medical education without increasing understanding. Practicing clinicians may experience difficulties in communicating with patients. For example, a diagnosis of "ringworm" may be made but the patient may not understand why an antiparasitic is not being prescribed, requiring an explanation that it is a dermatophytic condition and not a parasitic one. While no randomized controlled trial can be conducted, misnomers can arguably create unconscious bias in clinician minds about the underlying pathophysiology of different conditions. We aim to end the cycle of misinformation by pointing out some common misnomers and encouraging alternate names that are more accurate, either novel or already in use. We invite the reader to send us more examples from their field.

    View details for DOI 10.1016/j.amjmed.2023.08.021

    View details for PubMedID 37742852

  • Letter: rising incidence and poor survival in patients with nonviral HCC-better HCC surveillance and treatment for alcohol-associated and non-alcohol fatty liver diseases are needed. Alimentary pharmacology & therapeutics Manikat, R., Nguyen, M. H. 2023; 57 (3): 361-362

    View details for DOI 10.1111/apt.17334

    View details for PubMedID 36641791

  • NAFLD and Non-Liver Comorbidities. Clinical and molecular hepatology Manikat, R., Nguyen, M. H. 2023

    View details for DOI 10.3350/cmh.2022.0442

    View details for PubMedID 36603574

  • Cutaneous larva migrans JOURNAL OF GLOBAL INFECTIOUS DISEASES Manikat, R., Kannangara, S. 2017; 9 (3): 125

    View details for DOI 10.4103/jgid.jgid_171_16

    View details for Web of Science ID 000407812300009

    View details for PubMedID 28878527

    View details for PubMedCentralID PMC5572199

  • Palpitations as a presenting feature of multisystem sarcoidosis JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES Manikat, R., Gilson, J., Krishnamurthy, M., Khalighi, K. 2017; 7 (3): 190-193

    Abstract

    Introduction: Sarcoidosis is described as a systemic condition characterized by non-caseating granulomas in multiple organs. In this report, we present an unusual manifestation of cardiac sarcoidosis and review management strategies. Case presentation: A 29-year-old African-American man presented with weight loss, fatigue, dyspnea, palpitations, night sweats, painless left eye redness and bilateral leg pain over the course of three months. His physical exam revealed left conjunctival congestion and bilateral crackles on auscultation. Computerized tomography of the chest showed severe parenchymal disease with bilateral fibrotic bands. Bronchoscopy and transbronchial biopsy revealed noncaseating granulomas and multinucleated giant cells, confirming sarcoidosis. Non-sustained ventricular tachycardia developed. Cardiac MRI showed myocardial delayed gadolinium enhancement. He responded to methotrexate and steroid therapy. An implantable cardioverter-defibrillator was placed. Discussion: Although cardiac sarcoidosis manifests in only 5% of sarcoidosis, autopsy reports indicate subclinical cardiac involvement in up to 30%. There are no established criteria for diagnosis of cardiac sarcoidosis. Conclusion: Early recognition and diagnosis of cardiac sarcoidosis is challenging but vital due to unpredictability and high risk for malignant cardiac involvement. Newer diagnostic imaging modalities have further aided in earlier identification and prevention of sudden cardiac death.

    View details for DOI 10.1080/20009666.2017.1333879

    View details for Web of Science ID 000405898000011

    View details for PubMedID 28808515

    View details for PubMedCentralID PMC5538218

  • SPONTANEOUS CORONARY ARTERY DISSECTION: A CASE REPORT AND BRIEF REVIEW OF LITERATURE Manikat, R., Elmi, F. KARGER. 2017: 173

    View details for Web of Science ID 000405743600160

https://orcid.org/0000-0002-7348-8081