Statin treatment in routine clinical practice: Insights from the STATRIP physician survey.

Statins Are Safe for the Treatment of Hypercholesterolemia in Patients With Chronic Liver Disease

To develop and validate a Mandarin version of the Leeds Dyspepsia Questionnaire (M-LDQ) in Asian patients with dyspepsia. The M-LDQ was developed according to standardized methods. The validity, internal consistency, test-retest reliability and responsiveness of the instrument were evaluated in both primary and secondary care patients. A total of 184 patients (mean age 54.0 ± 15.8 years, of whom 59% were women and 72.3% of whom had at least secondary level education) were recruited between August 2012 and March 2013, from both primary (n = 100) and secondary care clinics (n = 84). Both the internal consistency of all components of the M-LDQ (Cronbach's α 0.79) and test-retest reliability (Spearman's correlation coefficient 0.78) were good. The M-LDQ was valid in diagnosing dyspepsia in primary care (area under the receiver operating characteristics curve 0.84) and was able to discriminate between secondary and primary care patients (median cumulative LDQ score 13.0 vs 3.0, P < 0.0001). Among eight patients with organic dyspepsia, the median M-LDQ score reduced significantly from 21.0 (pretreatment) to 9.5 (4 weeks post-treatment) (P < 0.0001). The M-LDQ is a valid and responsive instrument for assessing ethnic Chinese adults with dyspepsia.

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care...

Introduction Colorectal carcinoma is the second most common cause of cancer death in the western world. Alarm features such as weight loss, change in bowel habit, iron deficiency anaemia, rectal bleeding or a palpable abdominal mass have been proposed as the optimal method of identifying patients in primary care who need early assessment and investigations. However, the accuracy of these clinical features in identifying high-risk patients is quite variable. Tumour M2PK is the dimeric isoform of pyruvate kinase, which is upregulated in proliferating tissues. Several studies show good sensitivity and specificity of faecal M2PK for colorectal cancer. There is still a paucity of data for M2PK in identifying high-risk patients in secondary care. Methods To investigate the clinical utility of faecal M2PK in detection of colorectal cancer, colonic polyps or any other significant colonic pathology in routine clinical practice and assess its suitability as a tool for identifying patients referred to secondary care for early lower gastro-intestinal investigations. Patients undergoing colonoscopy or barium enema (routine/urgent/cancer pathway) were recruited from both general gastroenterology and surgical outpatient clinics. Patients returned a stool sample in the specimen container provided. A quantitative analysis by sandwich ELISA using two different monoclonal antibodies to specifically recognise the dimeric form of M2PK was used. A positive test result was defined as >4 kU/l. Data were collected prospectively including demographics, clinical presentation and indication for colonoscopy as well as findings at lower GI investigations. The data were analysed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results 48 patients (60.4% females) were recruited from March to October 2007. The mean age was 59.6±15.1 years, with no significant difference in M2PK levels between males and females. Elevated M2PK levels were found in 43.8% of patients. Abnormal pathology was found in 58.3% of patients. The diagnoses included polyps (n=9), sigmoid colon cancer (n=1), diverticular disease (n=16), collagenous colitis (n=1), and miscellaneous (n=2). Raised stool M2PK was found in 55.6% of patients with polyps. The sensitivity of M2PK for detecting significant colorectal pathology (polyps/cancer) was 50%. Specificity was 57.9% at 4 kU/l, and increased to 84.2% with a modified cut-off of 8 kU/l (sensitivity unchanged). PPV was 23.8% and NPV 81.5% (8 kU/l: 45.5% and 86.5%, respectively). Conclusion In this highly selected cohort of patients referred to secondary care, a modified cut-off of M2PK may act as a useful adjunct in identifying high-risk patients.

To assess the prevalence of elevated liver enzymes in adults with type 1 diabetes mellitus (T1DM) in routine clinical care and the association with cardiovascular risk profile in the Diabetes-Prospective-Documentation (DPV) network in Germany and Austria. This cross sectional observational study from the DPV registry includes data from 45 519 adults with T1DM at 478 centres up to September 2016. Liver enzyme measurements were available in 9226 (29%) patients at 270 centres and were analysed for increased alanine aminotransferase (ALT; men >50 U/L, women >35U/L) and/or aspartate aminotransferase (AST; men >50 U/L, women >35U/L) and/or gamma-glutamyltransferase (GGT; men >60U/L, women >40 U/L). A subgroup analysis in patients for whom 2 or more ALT measurements were available (n = 2335, 25%) and whose ALT was increased at least twice (men >30 U/L, women >19U/L) was performed. Associations with glycaemic control, cardiovascular risk factors and late complications were investigated with multiple regression analyses. Twenty percent (19.8%, n = 1824) had increased liver enzyme(s) on one or more occasions. Increased liver enzymes were associated with worse glycaemic control and higher BMI (both P < .0001), dyslipidemia (OR, 1.75; 95% CI, 1.54-2.0), hypertension (OR, 1.48; 95% CI: 1.31-1.68), myocardial infarction (OR, 1.49; 95% CI, 1.17-1.91) and end stage renal disease (OR, 1.59; 95% CI, 1.17-2.17). ALT was increased twice in 29% and was associated with worse glycaemic control (P < .0001), higher BMI (P < .0001), hypertension (OR, 1.58; 95% CI, 1.26-1.97) and dyslipidemia (OR, 1.89; 95% CI, 1.51-2.37). In this clinical audit in adults with T1DM, elevated liver enzymes on routine assessment were associated with a less favourable cardiovascular risk profile and with poorer glycaemic control.

BackgroundChronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP).Methods and designThis study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral.

Background: Iron and Folic acid are essential micronutrients for reproductive health. Although dietary supplements are common during pregnancy, excessive intake can impair liver and kidney function. Aim: To study the effect of Iron and Folic acid supplements and overdoses on the hematopoietic function, liver functions and renal functions of female mice. Methodology: The animals were raised and provided with appropriate conditions for reproduction in an animal house at the Faculty of Veterinary Medicine, University of Tripoli, until the required number for the experiment was obtained. The doses were given to 36 female mice only, which were divided into 6 groups: the control group and 5 other groups were divided as follows: Group I (control), Group II (Fe 15mg/kg), Group III (FA 8mg/kg), and Group IV (FA 4mg/kg). Group V (Fe with FA 8mg/kg) and Group VI (Fe with FA 4mg/kg). Every other day intraperitoneal injections of Fe were administered, and oral FA supplements were provided daily for a week, mice were monitored and weighed weekly and fed daily for 3 weeks. Liver and kidney enzyme levels were measured, and blood component levels were assessed. Data were analysed using analysis of variance (ANOVA). Results: The effect of treatments on liver and kidney functions was analysed using one-way analysis of variance (ANOVA). The results showed that Iron and Folic acid supplementation had an impact on liver and kidney functions. Liver enzymes in female rats supplemented with Iron showed a significant increase (p &lt; 0.05) compared to female rats supplemented with Folic acid alone or with Iron, which led to a significant increase in liver enzymes and serum creatinine levels, and worsened kidney function. Although liver enzymes increased after supplementing with Iron alone (group II), Folic acid alone (group III), but after treatment with both (group V and VI), the increase in liver enzymes was significantly lower. Conclusion: Excess Iron and Folic acid negatively affect female health, with high Iron doses potentially increase the risk of the liver and kidney. This research highlights the importance of screening of Iron levels before supplementation and raises awareness about the risks of unnecessary Iron intake. KEYWORDS: Folic acid, Iron toxicity, anemia, supplementation, Liver, Kidney.

BACKGROUND: The administration of high-fat and high-glucose in diet followed by a low-dose streptozotocin injection in rats could mimic hyperglycemia, prediabetic, or diabetic conditions in humans. However, whether the rat model may lead to early liver impairment was still unclear. AIM: This study was aimed to investigate the possible changes in liver functions and morphology in the rat model of prediabetes after a short-term administration of a high-fat and high-glucose diet followed by low-dose streptozotocin injection. METHODS: Eighteen male Wistar rats were divided into nine rats in the control group and nine in the prediabetic group. To induce prediabetic rats, high-fat high-glucose in daily diets for 3 weeks continued with once to twice low-dose streptozotocin was given. Rats in control groups were fed with a standard diet for 2 months. Afterward, we analyzed glucose control parameters, liver functions, and liver histology of the rats. RESULTS: High-fat, high-glucose diet combined with a low dose of streptozotocin successfully caused prediabetics in the rats. There was a significant increase in several liver enzymes, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). However, no significant changes were found in the serum lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) levels. The histological changes in the liver confirmed the increase in liver enzymes. CONCLUSION: Short-term administration of high-fat high-glucose in combination with low-dose streptozotocin triggers alterations in liver functions marker and liver morphology.

Excerpt To the Editor:Acute increases (hepatitis-like) in liver enzymes, without clinical evidence of viral hepatitis, have been reported only occasionally and have been termed ischmic hepatitis (1...

Background: Hundreds of thousands around the world die from a disease caused by smoking cigarettes. Cigarette smoking (CS) is considered a worldwide major cause of preventable morbidity and mortality. The main clinical consequences of prolonged exposure to CS are chronic respiratory diseases, increased incidence of a variety of cancers, cigarette smoking had a dangerous effect on the essential biochemical mechanisms on the human body. Objective: This study aimed to assess the liver function in Sudanese male cigarettes smoker to identify the influence of cigarettes smoking on the level of their parameters. Material and methods: The study was designed as case control and include 81 samples, which is divided into case (51 samples) and control group (30 samples). The data collected by the use of questionnaire and blood specimens, and the levels of the parameters is measured by A15 automation spectrophotometer. Then the collected data is analyzed by the use of SPSS. Results: The results of the study showed statistically significant increase in total bilirubin and liver enzymes in case group when compared with control group. The mean of plasma total bilirubin, GOT (AST), GPT (ALT), and ALP levels in case group is (0.663, 26.49, 18.82 and 159.27) and in control group is (0.543, 23.00, 14.30 and 146.63) with p. value (0.001, 0.041, 0.004 and 0.000) respectively. And showed statistically insignificant decrease in total protein and albumin in case group when compared with control group, the means of total protein and albumin in case group is (66.47 and 33.73) and in control group is (68.30 and 34.43) with p. value (0.322 and 0.403) respectively. Conclusion: The study concluded that there was significant increase in liver enzymes (GOT, GPT, and ALP) and total bilirubin in cigarette smoking. And significant decrease in total protein and albumin, in cigarette smoking when compared to nonsmoking.

Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians' routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.

Mycophenolate mofetil (MMF) is a potent immunosuppressive agent used in renal transplantation. Gastrointestinal and hematological side effects are commonly observed, but hepatotoxicity has not been reported. In this study, we assessed MMF-related hepatotoxicity in renal transplant recipients. A total of 124 renal transplantation recipients (RTRs) were evaluated for elevated liver enzymes associated with MMF, and 79 patients were enrolled to the study. Patients used MMF 2 g/day. The patients who had progressive increase in liver enzymes after renal transplantation and their AST, ALT, GGT, ALP, bilirubin levels, hepatitis, cytomegalovirus (CMV), abdominal ultrasonography, duration of hepatotoxicity, and decreased dosage or withdrawal of MMF were recorded. Also, we evaluated their liver enzymes while the patients were on the waiting list. Of the 79 patients, 11 patients (13.9%) had a progressive increase in liver enzymes. The median (min–max) age of the patients with MMF-hepatotoxicity was 29 (19–54) and 72.7% of them were male. None of the patients had hepatitis B or C, CMV infection, or other possible causes for elevated liver enzymes and their abdominal ultrasonography were normal. High liver enzyme levels regressed after the withdrawal (n = 6) or reduce dosage (n = 5) of MMF. The median time of the increase in liver enzymes was 28 (4–70) days and after 50% reduction or withdrawal of MMF, returned to normal values in 16 (4–210) days. The median levels of ALT in waiting list (I), before (II), and after (III) reduction dosage or withdrawal of MMF were 22.0 (3–22), 222.0 (51–508), and 33.0 (21–64) U/L, respectively (p I–II = 0.004, p I–II = 0.013, and p II–III = 0.005). There were no differences for ALP, GGT, total bilirubin, and direct bilirubin levels. Also, the correlation between recovery time of ALT and persistence time of ALT elevation before adjustment of MMF was significant (r = 0.739, p = 0.009). Consequently, after renal transplantation, hepatotoxicity can occur due to a lot of reason including MMF usage. If hepatotoxicity related to MMF is not considered, especially in the early period of renal transplantation, resolution of hepatotoxicity can be required long term.

Background: The Covid-19 pandemic affected primary health care in various ways and general practitioners (GPs) take a key position in caring for patients with persistent Covid-19-related symptoms, also referred to as Long Covid. In this study, GPs’ knowledge, experiences and opinions on Long Covid, as well as the definition being used by GPs is investigated to provide more insight in the care for Long Covid patients in primary care. Methods: An online questionnaire, validated by experts, was distributed to all Belgian GPs through established national GP networks (SGP network, Domus Medica and SSMG) during spring 2022. The survey has 16 (ordinal, open-ended or multiple choice) questions on Long Covid. To characterize GPs, practice and demographic characteristics were collected. A case definition for Long Covid was not included, as there was no widely accepted definition available in general practice at the timing of the study. Descriptive and analytic statistics were performed. Results: A total of 105 GPs responded to the survey. GPs were well distributed across all Belgian regions and practice type. Female GPs represented 58.1% and mean age was 51 years (IQR: 38-63). Most of GPs reported that they did not have sufficient scientific knowledge on Long Covid, they reported lack of availability of reliable information on Long Covid diagnosis and treatment, and felt that accessibility to educational material on Long Covid was limited. For the diagnoses of Long Covid, 60.0% reported that a positive Covid-19 test result is a minimum requirement when speaking about Long Covid complaints. The commonest criteria utilized by GPs for diagnosing Long Covid was the duration of symptoms (from 4 weeks to 5 months) and on the basis of diagnostic criteria by the GP. 58.1% of GPs stated that Long Covid should be considered a chronic disease. The majority (75.2%) of participating GPs reported to have cared for Long Covid patients (independently of practice type, GP’s gender or age). These patients suffered mainly from fatigue (94.9%), concentration/memory problems (74.7%), breathing difficulties (68.0%), impairment in daily functioning (66.7%) and brain fog (46.2%). Most GPs (93.4%) believed that caring for Long Covid patients should follow multidisciplinary approach. Half of them (51.9%) reported to have been following up these patients by themselves or by GP colleagues and 32.9% by multidisciplinary cooperation. Other healthcare professionals involved include pneumologists, physiotherapists, specialists in physical medicine/rehabilitation and neurologists. GPs were consulted biweekly (17.9%), monthly (47.8%) or every few months (19.4%) by these Long Covid patients. Conclusion: In Belgian general practice, similar definitions and diagnostic criteria are used by GPs to identify Long Covid patients. A majority of GPs frequently provide care to Long Covid patients and GPs take a key role in the (multidisciplinary) coordination of care for these patients. However, multidisciplinary care for Long Covid patients is less organized than preferred by GPs at the timing of the study (spring 2022). With the establishment of the ‘care trajectory post-Covid-19’ for Long Covid patients in primary care since July 2022, collaboration between care givers may be stimulated in Belgian primary health care.

Demographic and clinical characteristics of primary and secondary care patients with osteoarthritis of hip and knee are quite similar

Healthcare Use and Costs of Primary and Secondary Care Patients With Prostatitis