Department Of Internal Medicine Research Articles

Mitigating overuse of antinuclear antibody (ANA) testing through educational intervention: a study in internal medicine and neurology departments

Introduction/objectivesOveruse of antinuclear antibody (ANA) tests leads to increased costs, false positives, and unnecessary treatments. This study evaluated ANA overuse in internal medicine and neurology departments and assessed the impact of an educational intervention.MethodThis quality improvement educational intervention study examined ANA test overuse in five internal medicine departments and one neurology department at a university-affiliated medical center. The educational intervention included a session focusing on ANA testing appropriateness. Outcome measures comprised the ANA/new patient ratio (APR) and the percentage of positive ANA test results. Outcomes were compared between the pre- and post-intervention periods (both 6 months).ResultsThe intervention took place in December 2021. The APR decreased from 43% in the pre-educational intervention period to 27% in the post-intervention period in the neurology department (odds ratio [OR] 0.49, confidence interval [95% CI] 0.37–0.63, P < 0.0001) and from 2.6% to 2.2% in the internal medicine departments (OR 0.89, 95% CI 0.73–1.10, P = 0.28). The percentage of positive ANA tests increased from 43% pre-intervention to 53% in the post-intervention period (OR 1.49, 95% CI 0.90–2.46, P = 0.12) in the neurology department and from 48% to 59% (OR 1.56, 95% CI 0.99–2.44, P = 0.0543) in the internal medicine departments.ConclusionA simple educational intervention reduced unnecessary ANA testing in the neurology department but not in internal medicine departments, improving patient selection and potential cost savings. The results underscore the importance of targeted education to promote evidence-based behavior among healthcare professionals. Further research with longer follow-up is needed to assess the sustainability of these improvements.Key Points• This study presents a quality improvement intervention to prevent the overuse of ANA testing in non-rheumatologist physicians.• A straightforward educational intervention effectively reduced unnecessary ANA testing and improved patient selection, following the Choosing Wisely campaign.• This educational intervention can be adapted and applied in various clinical settings to address the overuse of diagnostic tests, benefiting a wide range of healthcare professionals.

Colorectal cancer and associated genetic, lifestyle, cigarette, nargileh-hookah use and alcohol consumption risk factors: a comprehensive case-control study.

This study aimed to investigate the causes and risk factors of colorectal cancer (CRC) in a Turkish population, focusing on various modifiable and non-modifiable risk factors. A hospital-based case-control design was employed to compare individuals with CRC (cases) to individuals without CRC (controls). Male and female participants were recruited from the surgery, internal medicine, and out-patient departments. The study encompassed socio-demographic data, clinical information, radiological diagnoses, and biochemical measurements. Univariable and multivariable logistic regressions were used to determine associated risk factors of CRC. The study included 704 individuals with CRC and 704 controls. Significant socio-demographic disparities were observed between the groups, with over 30% of the cases having lower levels of education and income compared to the controls. Lifestyle factors such as obesity, higher rates of smoking (cigarettes and hookah) and alcohol consumption were more prevalent among cases than controls. Further significant associations were identified with intestinal inflammation, obesity, processed food consumption, and symptoms such as abdominal pain, cramps, diarrhea, constipation, blood in stool, bloating, irritable bowel syndrome, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Diet analysis revealed that individuals with CRC consumed more red meat, processed and fast foods along with less pulses and vegetables. Genetic predispositions and exposure to chemicals also correlated strongly with increased CRC risk. Multivariable regression analysis identified, nausea/vomiting, constipation, intestinal disease, genetics factor, hookah-nargileh use, history of any cancer, family history of bowel cancer, constipation, cigarette smoking, stress, milk-yogurt consumption, obesity and red meat consumption as significant determinants for CRC. CRC risk is influenced by dietary, lifestyle, and genetic factors. Awareness of hereditary risk and participation in screening are crucial. Lifestyle changes, such as avoiding smoking, hookah, and alcohol use, and adopting a healthy diet, are essential for prevention.

Obesity and overweight are common among hospitalized patients and are associated with specific causes of admission to an internal medicine department: a cross-sectional study.

Data on the prevalence of obesity among hospitalized patients are limited. Our objective was to capture the rates of overweight and obesity among people admitted to an internal medicine department and to explore a potential association between body mass index (BMI) and causes of hospitalization. Demographic and anthropometric parameters and cause of admission were recorded in all patients admitted to our department over a 30-day period. One hundred and eighteen patients with a mean age of 71.84years and a mean BMI of 26.85kg/m2 were included in the analysis. Among study participants, 53.25% were living with overweight and obesity. Patients admitted for hepatobiliary disease had a higher BMI compared to those admitted for other diseases of the gastrointestinal tract (P < 0.001). More than half of patients admitted to an internal medicine department live with obesity or overweight, the specific reasons for admission being associated with a higher BMI.

Profiling cytokines in peritoneal effluent through a targeted multiplex cytokine panel provides novel insight into the localized proinflammatory processes in patients undergoing peritoneal dialysis.

The number of relevant markers indicating local intraperitoneal inflammation in patients undergoing peritoneal dialysis (PD) is limited. Therefore, this study aimed to evaluate the compatibility of peritoneal effluent (PE) for proteomic analysis and assess its potential utility in immunoprofiling studies. This pilot study included six PD patients from the Peritoneal Dialysis Center, Department of Nephrology, Transplantology, and Internal Medicine in Szczecin, Poland. All patients were clinically stable, with no signs of infections or malignancy at the time of study. PE samples were collected during routine surveillance visits at the Peritoneal Dialysis Center. Proteomic analysis of the samples was conducted using the Olink® (Olink Proteomics AB, Uppsala, Sweden) Target 48 Cytokine panel. PE samples were successfully analyzed, with 28 out of 45 proteins found within the limit of quantitation (LOQ) and 32 out of 45 proteins detected above the limit of detection (LOD). No significant interference from the matrix was observed in the assay. Biomarkers associated with low-grade inflammation showed varied levels, and the observed patterns were comparable across all patients. This study suggests that utilizing a cytokine panel with relative quantification is a promising method for PE immunoprofiling.

12353 Differential Gene Expression And Pathway Analysis In Growth Hormone Secreting Pituitary Tumors According To Granulation Pattern

Abstract Disclosure: H. Shin: None. Differential gene expression and pathway analysis in growth hormone-secreting pituitary tumors according to granulation pattern. Hye Ju Shin [1], Kyung Won Kim[2], Chan Woo Kang[2], Eun Jig Lee[2], Cheol Ryong Ku[2]. [1]Department of Clinical Drug Discovery &amp; Development, Yonsei University College of Medicine, Seoul, Republic of Korea, [2]Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea Objective: The purpose of this research is to explain clinical variations in patients with acromegaly by exploring gene expression differences according to granulation patterns in growth hormone (GH)-secreting pituitary tumors. Materials &amp; methods: Transcriptome analysis was conducted on 6 normal pituitary tissues and 15 GH-secreting pituitary tumors, including 9 densely granulated somatotroph tumors (DGSTs) and 6 sparsely granulated somatotroph tumors (SGSTs). Results: The median age at diagnosis was 50 years, with a predominance of female patients (60%). We identified 3111 differentially expressed genes (DEGs) in tumors compared to normal pituitaries, with 1117 DEGs unique to a specific granulation within tumors. SGST showed enriched the pathways involved in neuronal development (axon development, axonogenesis, axon guidance, synapse and presynapse organization, gliogenesis, glial cell differentiation, nerve development, synaptic membrane adhesion, semaphorin-plexin signaling pathway involved in neuron projection guidance) and acute inflammatory response. No pathways were significantly downregulated in SGST compared with those in DGST. Three signaling pathways (JAK-STAT, phosphatidylinositol 3-kinase, and MAP cascade) and three neuronal development processes (generation of neurons, nerve development, and neurogenesis) were significantly enriched in both GO and GSEA analysis. The PPI networks constructed with the up- and downregulated DEGs consisted of 128 and 132 PPI pairs, respectively. There were 10 hub proteins, top highly connected DEGs: ANLN, TLE3, TLE2, DMD, ADRA1A, RBFOX1, MMP2, LMO1, RUNX1T1, and NPPA. Conclusion: The results indicate that granulation-specific gene expression may underpin diverse clinical characteristics in acromegaly. Overall, this study emphasizes the potential for further investigation into these transcriptomic variations and their roles in disease pathology, particularly the involvement of genes linked to neuronal development, inflammatory response, and JAK-STAT signaling in SGST. Presentation: 6/3/2024

12480 REMS Technology For The Bone Health Assessment After Hormonal Therapy In Transgender Subjects

Abstract Disclosure: F.A. Lombardi*: None. A. Russo: None. P. Pisani*: None. C. Stomaci*: None. F. Conversano*: None. R. Franchini*: None. M. Di Paola*: None. V. Racanelli*: None. S. Casciaro: None. Introduction: Sex steroid hormones play crucial roles in bone metabolism and the musculoskeletal system. These hormones interact with specific nuclear receptors, such as estrogen and androgen receptors, which are expressed in bone tissue. This interaction regulates the ongoing process of bone remodeling and induces positive effects on bone health.In this regard, it is crucial to examine the long-term impact of gender affirming hormone therapy (GAHT) on bone metabolism. Radiofrequency Echographic Multi-spectrometry (REMS) is a radiation-free technology for assessing bone mineral density (BMD) and fracture risk prediction by the analysis of the reference axial sites: lumbar spine (LS) and femoral neck (FN). REMS has been widely validated in comparison with Dual Energy X-ray Absorptiometry (DXA), showing good accuracy and precision (&amp;gt;90%), thereby representing a valid technology to monitor bone health status (BHS) in a short-term period. In this context, the goal of this preliminary clinical study was to track the bone health of transgender subjects for one year after starting treatment, using REMS, in order to comprehend the effects of GAHT on BHS. Methods: 7 transgender patients were recruited at Endocrinology Unit of Internal Medicine Department of Santa Chiara Hospital Trento (Italy). Among them were 4 individuals assigned male at birth (AMAB) undergoing therapy with oestradiol valerate 2 g/day and cyproterone acetate 25 mg/day, as well as 3 individuals assigned female at birth (AFAB) undergoing therapy with testosterone 25 mg/day. Before starting GAHT, patients underwent LS-DXA scan, followed by monitoring of BHS by REMS technology after 12 months from the start of treatment. Results: The results show an increase of T-score values in AMAB (-0,3 ± 0,3 REMS vs -1,8 ± 1,8 DXA) after estrogen treatment starting, and no effect on bone in AFAB subjects after GAHT (0.5 ± 0.4 REMS vs 0.9 ± 0.4 DXA); this is due to:-the protective effect of estrogen therapy in AMAB subjects against bone loss;-the combined effect of the decrease of estrogen together with the increase of testosterone in AFAB ones. Conclusions In summary, these initial findings indicate that REMS could be appropriate for monitoring the bone health status of these individuals, confirming the anticipated beneficial effects of estrogen therapy on bone loss in AMAB individuals. The limitation of the study is the lack of REMS data at the beginning of the treatment, but the possibility of carrying out the technique in subsequent evaluation times will allow us to evaluate the change in bone mass during hormonal reaffirmation therapy and compare it with the progress of the measurements obtained with DXA data ones. Presentation: 6/2/2024

Special Issue on Informatics Education A Longitudinal Graduate Medical Education Curriculum in Clinical Informatics: Function, Structure, and Evaluation.

There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education (ACGME) and the body of undergraduate medical education (UGME) for implementation of informatics curricula. This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform United States (US) Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution. The curriculum aligns with the core content for the subspecialty of clinical informatics (CI) and is led by a multidisciplinary team with both informatics and clinical expertise. This educational pathway has a low direct cost and is a practical example of the academic learning health system (aLHS) in action. The pathway is housed within an internal medicine department at a large tertiary academic medical center. The curriculum has yielded 13 graduates from both internal medicine (11, 85%) and pediatrics (2, 15%) whose projects have spanned acute and ambulatory care and multiple specialties. Projects have included Clinical Decision Support (CDS) tools, of which some will be leveraged as substrate in applications seeking extramural funding. Graduates have gone on to CI board certification and fellowship, as well as several other specialties, creating a distributed network of clinicians with specialized experience in applied CI. An informatics curriculum at the GME level may increase matriculation to CI fellowship and more broadly increase development of the CI workforce through building a cadre of physicians with HIT expertise across specialties without formal CI board certification. We offer an example of a longitudinal pathway which is rooted in aLHS principles. The pathway requires a dedicated multidisciplinary team and departmental and IT leadership support.

Assessment of renal response in Tunisian patients with proliferative lupus nephritis under three different induction immunosuppressive agents: A prognostic retrospective study.

The aim of our study was to evaluate the renal response (RR) of three immunosuppressive protocols in the induction treatment of proliferative lupus nephritis (PLN) in a Tunisian population. We performed a retrospective prognostic cohort study in the Internal Medicine Department of the Habib Thameur University Hospital in Tunis from January 2000 to December 2023, and included kidney biopsy proven proliferative lupus nephritis patients. Three induction treatments were compared: High CYP regimen: glucocorticoids (GC) + IV cyclophosphamide (CYP) in monthly pulses of 0.7g/m2 for 6 months; Low CYP regimen: GC + IV CYP in biweekly pulses of 500mg for 3 months; and MMF regimen: GC + oral MMF 1.5g twice daily for 6 months. The primary endpoint was the incidence of RR (complete and partial remission) at one year post-diagnosis. The additional outcomes were end-stage kidney disease (ESKD), severe adverse events (AEs) and death. Our study included 78 PLN patients (High CYP: 17, Low CYP: 40, MMF: 21). The study found that 94.1% of patients receiving High CYP achieved the primary endpoint, RR, compared to 67.5% of those receiving Low CYP and 61.9% in the MMF group. For the additional outcomes, there were 3 cases of ESKD, all in the Low CYP group, 5 cases of death (4 in the Low CYP group and 1 in the MMF group), and 20 cases of severe AEs, all of which were severe infections (5 in the High CYP group, 12 in the Low CYP group, and 3 in the MMF group). Multivariate analysis showed that the High CYP regimen was more associated with RR than the MMF regimen, with an adjusted OR of 9.846 (95% CI: 1.087-98.210); p = 0.042. Multivariate analysis did not show statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR. As an induction treatment for PLN, the High CYP regimen was strongly associated with a higher rate of RR than the MMF regimen. There were no statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

Nursing Records Regarding Decision-Making in Cancer Supportive Care: A Retrospective Study in Japan.

This study was performed to examine the content of decision-making support and patient responses, as documented in the nursing records of individuals with cancer. These patients had received outpatient treatment at hospitals that met government requirements for providing specialized cancer care. Nursing records from the electronic medical record system (in the subjective, objective, assessment, and plan [SOAP] format), along with data from interviews, were extracted for patients receiving outpatient care at the Department of Internal Medicine and Palliative Care and the Department of Breast Oncology. Data analysis involved simple tabulation and text mining, utilizing KH Coder version 3.beta.07d. The study included 42 patients from palliative care internal medicine and 60 from breast oncology, with mean ages of 70.5 ± 12.2 and 55.8 ± 12.2 years, respectively. Decisions most frequently regarded palliative care unit admission (25 cases) and genetic testing (24 cases). The assessment category covered keywords including (1) "pain," "treatment," "future," "recuperation," and "home," as terms related to palliative care and internal medicine, as well as (2) "treatment," "relief," and "genetics" as terms related to breast oncology. The plan category incorporated keywords such as (1) "treatment," "relaxation," and "visit" and (2) "explanation," "confirmation," and "conveyance." Nurses appear crucial in evaluating patients' symptoms and treatment paths during the decision-making support process, helping them make informed choices about future treatments, care settings, and genetic testing. However, when patients cannot make a decision solely based on the information provided, clinicians must address complex psychological concepts such as disease progression and the potential genetic impact on their children. Further detailed observational studies of nurses' responses to patients' psychological reactions are warranted.

The Prevalence and Impact of Migraine Among Physicians in Saudi Arabia: A Cross-Sectional Study.

Background Migraine is a primary headache disorder and one of the most common causes of disability worldwide. Prior reports showed a higher prevalence of migraine among physicians. We conducted this study to estimate the prevalence of migraine among physicians in Saudi Arabia, as well as its impact on quality of life. Methods A cross-sectional study was conducted using a validated online questionnaire that was distributed among physicians in various medical and surgical specialties in Saudi Arabia from January to June 2023. The inclusion criteria involved physicians in all specialties, who worked in governmental or private hospitals in Saudi Arabia. Employed or healthcare workers other than physicians were excluded. To measure the impact of headache on a person's quality of life, the Migraine Disability Assessment (MIDAS) test was applied. Statistical analysis of the study was conducted using the Statistical Package for the Social Sciences (SPSS) Version 24 (IBM Corp., Armonk, NY). Results We had 387 respondents, of whom 362 fulfilled the inclusion criteria. The mean age was 33.02 ± 9.07 years, and genders were distributed equally. Most physicians worked in departments of internal medicine, family medicine, general practice, and general surgery. The prevalence of migraine was recorded in 17.1% (62 patients) of all the included participants, with a female predominance. MIDAS revealed a total mean score of 16.823±14.149. The severity grades were classified as moderate (37.1%), severe (35.5%), or little to no (21.0%). Stress and light were cited as the top factors that trigger or worsen migraine, while sleep, rest, and quiet and darknesswere cited as the top relieving factors. The average number of headache attacks (month) was 6.823. Most patients with migraine were board residents (27.4%), living in the western region (53.2%), and working in a governmental hospital (38.7%). Conclusion Migraine is a common disorder among physicians in Saudi Arabia, with significant moderate-to-severe disability. Stress is identified as a major trigger. Proper awareness, stress management programs, and therapeutic intervention may mitigate the untoward consequences of migraine.

Circadian pattern of blood pressure in patients with stable COPD

ObjectiveTo describe the circadian blood pressure (BP) pattern in stable COPD patients. MethodsWe included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser). ResultsWe included 43 patients (5 women, mean age 69.5 ± 9.5 years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, p = 0.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, p = 0.009). ConclusionsHypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.

Sofosbuvir, Velpatasvir and Voxilaprevir for Treatment of Chronic Hepatitis C Virus Patients Non-Responder to Previous Sofosbuvir-Daclatasvir Therapy

Abstract Background Egypt is one of the countries with a high HCV burden; the percentage of HCV antibody positivity is 4.61 % of Egyptian general population. The advent of oral direct-acting antivirals (DAAs), as a treatment for chronic hepatitis C (CHC), has revolutionized the field with obvious safety and efficacy privileges. Despite the high rates of SVR achieved with DAAs, HCV is not eliminated from a considerable proportion of patients (1-15%). So, a new problem has emerged which is the need for re-treatment of patients who couldn’t be cured with DAAs in the first instance. Aim of the Work to evaluate the efficacy of sofosbuvir, velpatasvir, voxilaprevir for previously DAA-(Sofosbuvir–Daclatasvir)-treated Egyptian patients who failed to achieve SVR after their treatment. Patients and Methods This study was performed in Ahmed Maher Teaching Hospital, Cairo, Egypt, Internal Medicine Department. The study included 139 patients with chronic hepatitis C Non- responder to Previous Sofosbuvir-Daclatasvir Therapy. Patients enrolled in the study were prospectively evaluated as outpatients by the study staff at 4, 8, 12 weeks and at 12 weeks post-treatment. All the patients were subjected to history taking, clinical examination, complete biochemical and virological studies. Results The overall treatment outcome: there was a statistically highly significant difference in PCR before treatment (100%+ve) and after treatment (97.1%-ve) 3 month after treatment. Throughout the study, most of the patients were responders (97.1% achieved SVR 12). Conclusion Rescue therapy with SOF/VEL/VOX is safe and highly effective, for treatment of chronic hepatitis C virus patients non-responder to previous Sofosbuvir-Daclatasvir therapy achieving SVR12 rates 97.1%.

Nonalcoholic Fatty Liver Disease among Diabetic Patients on Oral Hypoglycemic versus Insulin

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a group of clinicopathologic diseases defined by lipid buildup in the liver parenchyma in people with no history of heavy alcohol consumption. Steatosis alone appears to be benign within this spectrum, but non-alcoholic steatohepatitis (NASH), marked by ballooning degeneration and sinusoidal/pericellular fibrosis, can be progressive. Aim of the Work to detect the prevalence of non-alcoholic fatty liver disease among diabetic patients on oral hypoglycemic versus insulin. Patients and Methods this cross-sectional study was conducted in Internal medicine Department, Ain Shams hospitals in 6 months from April till October 2022 on Diabetic Patients on Oral Hypoglycemic or Insulin. All patients were divided into two groups: Group A: Diabetic patients on Oral Hypoglycemic drugs. Group B: Diabetic patients on Insulin. Results There was no statistically significant difference between the studied groups as regard baseline data (Age, sex, BMI and hypertension). There was statistically significant difference between the studied groups as regard fast blood glucose and non-significant difference as regard HBA1C. There was no statistically significant difference between the studied groups as regard CRP. Conclusion the prevalence of non-alcoholic fatty liver disease (NAFLD) in diabetic patients on hypoglycemic group was less than in patient taking insulin

Study of the Relationship between Insulin Resistance and Risk of Developing Depression and Anxiety Disorders

Abstract Background Studies have suggested that diabetes increases the risk of incident depression and anxiety. Also, it can contribute to a more severe course of depression and anxiety with different mechanisms. Moreover, Insulin resistance is an essential component in development of diabetes in diabetic patients. Yet, no sufficient studies revealed the relationship between insulin resistance and depression and anxiety. Hence, this is important to prevent, early detect, treat, and identify factors affecting their incidence, as this affects prognosis and insulin resistant individuals’ quality of life. Aim of the Work To study the relationship between insulin resistance and risk of developing depression and anxiety disorders. Patients and Methods This is a case control study conducted on patients from diabetes and Internal medicine clinics and department of Ain Shams University Hospitals. This present study aimed at analyzing the data of 60 participants divided into 3 groups. Group 1has 20 Insulin resistant diabetic patients. Group 2 has 20 Insulin resistant non diabetic patients. Group 3 has 20 Non insulin resistant non diabetic normal subjects, over two months period from December 2022 to March 2023. They were subjected to clinical examination and laboratory work up including (HbA1c, HOMA IR, lipid profile), then they were screened by PHQ and GAD. Results A total of 60 participants who are composed of 56.6% females, 70% non workers, 78% married, 30% smokers and 62% with BMI more than 25. As regards psychiatric assessment, PHQ assessment shows a total of 34 participants having depression representing (56.67%), while GAD assessment shows 28 subjects having anxiety disorder (46.67%). As regard the comparison between the 3 groups the HOMA IR values are higher in group 1 and 2, while, HbA1c values are more in group 1 which show a statistical significance with p value &amp;lt;0.001 each. As regards, psychiatric assessment of the participants, 75% of group 1, 60% of group 2 and only 35% of group 3 suffer from depression scored by PHQ. This shows a statistically significant correlation between DM, IR and depression (p value = 0.036) Furthermore, 65% of group 1, 55% of group 2 and only 20% of group 3 suffer from scored by GAD. This shows a statistically significant correlation between DM, IR and anxiety (p value = 0.011) Conclusion Depression shows significant correlation with HbA1c value and Anxiety shows significant correlation with HOMA IR value. Hence, psychiatric evaluation can’t be ignored in any case with insulin resistance or diabetes. Detecting factors which affect the prevalence of such complications will help in preventing them in the future. So, further research to establish management protocols to reduce these complications is needed.

Serum Galectin 3 Level as a Non-Invasive Biomarker of MAFLD Severity

Abstract Background Metabolic dysfunction-associated fatty liver disease (MAFLD) has become one of the most relevant forms of chronic liver disease worldwide due to the progressively increased in obesity rate. It is increasingly clear that subjects with MAFLD and especially those with significant fibrosis are at greatest risk of mortality and adverse clinical outcomes. Aim of the Work The present study was to evaluate the association of galactin-3 with the degree of steatosis and fibrosis in obese patients with MAFLD. Patients and Methods This case-control study was performed on 60 Egyptian patients who have MAFLD. Patients with MAFLD were divided into 3 subgroups according to the severity by the degree of fibrosis and steatosis (mild, moderate and severe). An age and gender matched control group comprised of 30 healthy volunteers were recruited as control group. They were recruited and assessed for eligibility from the Internal Medicine, Hepatology and Gastroenterology Department and Outpatient Clinic at Ain Shams University Hospital. Results Regarding the anthropometric measurements, the present study indicated the presence of a statistically significant increase in the mean SBP, DBP, BMI and WC among MAFLD group compared with the control group. Among the cases group, there was a statistically significant increase in the SBP, DBP, BMI and WC among the moderate and severe cases compared with the mild cases. Regarding the calculated scores of the studied groups, the present study revealed a statistically significant increase in fibrosis scores fibrosis-4 score (FIB-4), Aspartate aminotransferase -to-Platelet Ratio Index (APRI) score and NAFLD Fibrosis score (NFS), and among the cases compared with the control groups (P value&amp;lt;0.001). Among the cases group, there was a statistically significant increase in FIB-4 score, APRI and NFS score among the severe cases compared with moderate and mild cases (P value&amp;lt;0.001). Regarding the Correlation analysis, serum galactin-3 showed that there was a statistically significant positive correlation with BMI, WC, AST, ALT, total bilirubin, PT, PTT, creatinine, urea, FBS, HbA1c HOMA-IR, LDL, T-cholesterol, TGs, CRP, FIB-4, APRI, NFS, and scores of fibrosis and steatosis by TE. there was a statistically significant negative correlation with PLT, HDL, and albumin. The present study revealed a statistically significant increase in serum galactin-3 level among the cases compared with the control group. Among the cases group, there was a statistically significant increase in serum galactin-3 level among severe cases compared with moderate and mild cases. Regarding the diagnostic performance of serum galectin-3 for prediction of severity of MAFLD among obese patients, the present study revealed that the AUC value (the AUC for serum galactin-3 was. 0989 with the best cutoff value ≥ 9.88 with sensitivity = 96.7% and specificity = 93.3% and accuracy 95.6%). Regarding the diagnostic performance of serum galectin-3 for prediction of mild steatosis in MAFLD patients, the present study revealed that the (AUC value was. 0966 with the best cutoff value ≥ 9.15 with sensitivity = 95% and specificity = 93.3% and accuracy 94%). Regarding the diagnostic performance of serum galectin-3 in predicting severe steatosis in patients, the present study revealed that the (AUC value was 1.0 with the best cutoff value ≥ 17.74 with sensitivity = 100% and specificity = 100% and accuracy 100 %). Conclusion Serum galactin-3 is elevated in patients with MAFLD with a tendency toward high levels in cases with severe steatosis. Galactin-3 is positively correlated with deterioration of parameters indicating liver function. Galactin-3 had the best sensitivity = 96.7% and specificity = 93.3% at a cutoff value ≥ 9.88 for predecting MAFLD among obese patients.

Association between Chronic Kidney Disease and Non-Alcoholic Fatty Liver Disease: A Cross Sectional Study

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a growing health problem that poses a significant burden as it is currently the most prevalent form of chronic liver disease, affecting an estimated 25% of the worldwide population. Aim of the Work to evaluate the role of plasma LCN2 levels in the diagnosis and prognosis of patients with non-alcoholic fatty liver disease. Patients and Methods Our case-control study was conducted on 102 Egyptian subjects between the ages of 18 and 70, recruited from the Internal Medicine and Hepatology Department and Clinics at Ain Shams University Hospital during the period from March 2023 to August 2023, and divided them into two groups. Group I: 51 Egyptian patients diagnosed with NAFLD (61% males; 39% females). Group II: 51 Egyptian healthy controls (51% males; 49% females) Results In this study, LCN2 levels were significantly higher in cases than in the control group (p &amp;lt; 0.001), with a mean of 1893.214 ±1002.852 in the cases and a mean of 466.020 ± 397.699 in the controls. This suggests the use of LCN2 as a possible diagnostic marker of NAFLD. The mean LCN2 levels in this study also significantly increased as the grade of fatty liver increased from I to III (p &amp;lt; 0.001). This in turn proposes the use of LCN2 as a prognostic marker for NAFLD progression. LCN2 also significantly correlated with the fatty liver index and NAFLD Fibrosis scoring systems, but not with Fib-4. It showed an excellent diagnostic performance in this study with an area under ROC of 0.906, an 84% sensitivity, a 90% specificity, 89.6% PPV and 85.2% NPV for the prediction of NAFLD patients. Conclusion Lipocalin-2 performs as a diagnostic marker for non-alcoholic liver disease, and a possible prognostic test that may be used to follow up the degree of steatosis. Other studies should be done on a larger size of participants to determine the prevalence of LCN2 in Egyptian population as well as other populations. Other studies should also be expanded to include NAFLD with degrees of fibrosis, and more quantitative imaging tools could be used to compare LCN2 levels with the NAFLD stage. The levels of LCN2 can be also measured in cohort studies before and after treatment of NAFLD to evaluate its sensitivity to the response of treatment.

1PNPLA3 and Neutophil Lymphocyte Ratio as a Genetic and Inflammatory Predictors of Histopathological Severity by Liver Biopsy in Nonalcoholic Fatty Liver Disease

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver condition characterized by fat accumulation in the liver, which can lead to inflammation and scarring, resulting in irreversible liver damage. NAFLD is often associated with other metabolic comorbidities and is considered the hepatic manifestation of metabolic syndrome. In addition to liver-related morbidity and mortality, NAFLD is also associated with cardiovascular disease (CVD). Aim of the Work The aim of the study is to determine the relation between genetic and inflammatory markers in one side to the degree of histopathological changes by liver biopsy in patients with NAFLD on the other side. Patients and Methods This study was conducted on 20 patients who were candidate for bariatric surgery with fatty liver in abdominal ultrasonography and from donors for liver transplantation from internal medicine and surgical department in Ain Shams University hospitals and 10 healthy persons who were donors for liver transplantation as control group. Results The study found that neutrophil lymphocyte ratio (N/L ratio) and mean platelet volume (MPV) were significantly different between NAFLD patients and the control group. Additionally, the distribution of the PNPLA3 gene variant (rs738409 C/G) was significantly different between NAFLD patients and the control group, with most NAFLD patients having the homozygous GG variant. The study also found a significant difference between the PNPLA3 gene variant and steatosis percentage in NAFLD patients. However, there was no significant difference between the PNPLA3 gene variant and other clinical markers, including hepatic cell ballooning, fibrosis, glycemic status, liver enzymes, lipid profile, N/L ratio, or MPV. Conclusion NAFLD is more common in subjects with Homozygous GG variant of PNPLA3 gene. NAFLD patients with Homozygous GG variant of PNPLA3 gene are more prone to high grade of steatosis. Liver cell ballooning and liver fibrosis have no relation with different variants of PNPLA3 gene. Neutrophil to lymphocyte ratio (N/L ratio) and mean platlet volume (MPV) are good inflammatory markers to detect NAFLD.

Frequency of Silent Lacunar Cerebral Infarction in Patients with Type 2 Diabetes Mellitus

Abstract Background Diabetes mellitus type II causes different stroke subtypes, particularly lacunar stroke. Most cerebral lacunar infarctions do not cause a neurological deficit. So, they are called “clinically silent”. Objectives We aimed to study the frequency of silent lacunar cerebral infarctions in patients with Type II diabetes mellitus and to identify patients’ demographic, laboratory, and imaging characteristics. Patients and Methods This Cross-sectional study was conducted at the Internal Medicine Department of Ain Shams University Hospital, and included 92 patients diagnosed with type II diabetes mellitus according to the American diabetes association’s 2021 criteria. Participants underwent comprehensive physical and neurological examinations to detect the presence of any subtle neurological signs, as well as HbA1c and lipid profiles. Brain imaging, with the Philips Achieva 3 Tesla MRI scanner, was utilized to detect silent cerebral lacunar infarctions. Results Silent cerebral lacunar infarctions were detected in 92.4 % of patients (85/92 patients) predominately in the Corona radiata, Centrum semi-oval, and subcortical areas including the Basal ganglia, Pons, and Thalamus. Conclusion Asymptomatic patients with Type II diabetes mellitus could have vascular cerebral changes without neurological symptoms. Brain MRI scanning can be recommended as a routine investigation in neurologically asymptomatic type 2 diabetic patients who have a mean age of 56.8± 7.86 years old, and duration of illness above 10 years, especially males, regardless of HbA1c and lipid profile levels, to detect early vascular ischemic changes.

Impact and Incidence of Food Allergy in Patients with Irritable Bowel Syndrome

Abstract Background Irritable bowel syndrome (IBS) is a multifactorial gastrointestinal disorder affecting 5.2–22% of the population. It is not a single disease, but a name given to a group of gastrointestinal symptoms that commonly present together. Aim and Objectives The study aimed to evaluate the impact and the incidence of food allergy in patients with IBS. Subjects and Methods This was a prospective cohort study conducted at The Gastroenterology and Hepatology Clinic, or the inpatient Internal Medicine Department, at the Faculty of Medicine, Ain Shams University. Result the mean age was 34.8± 5.2, 30% were male while 70% were female. 38% were rural while 62% were urban. In Multivariate correlation regression, there were strong significant correlations between Food Allergy and age, sex, Family history, Smoking and IBS- D. Conclusion The observation that the administration of a monoclonal antibody against IgE resulted in almost complete resolution of this patient’s IBS symptoms suggests that this immunoglobulin plays a part in the pathogenesis of IBS, in at least a subset of patients. Consequently, in patients with atopy and IBS, targeting this abnormality might have therapeutic potential, particularly in those individuals not responding to conventional IBS therapies. There is some evidence that sodium cromoglycate has an effect in patients with atopic IBS, especially in those who have positive skin prick tests to food antigens.

Thyroid Nodules and Insulin Resistance in Type 2 Diabetes Patients

Abstract Background Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. DM can result from deterioration in function and//or a loss of mass in pancreatic tissue. The disease burden of DM is expected to increase in the next few years and decades. The Atlas of the International DM Federation estimated that 537 million adults (20–79 years) were living with DM in 2022, and this number could increase to 643 million by 2030 and 781 million by 2045 Aim of the Work To find out the association between Insulin resistance and thyroid nodules in T2DM. Patients and Methods This study was a Case-control study that was conducted to find association between insulin resistance and thyroid nodules in T2DM cases. The present study was carried out on 80 patients attending Ain Shams University internal medicine department and endocrinology outpatient clinic during the period from August 2021 to May 2023. Results Therefore, the aim of the current work is to find out the assosciation between insulin resistance and thyroid nodules in T2DM. Our study showed that fasting insulin and HOMI-IR were significantly higher in diabetic patients with nodules than in diabetic patients without nodules (P = 0.029 &amp; P = 0.001 respectively). Our study also showed that fasting insulin and HOMI-IR were predictive risk factors for thyroid nodules. Moreover, our results revealed that fasting insulin &amp; IR were positively correlated with thyroid nodule volume and size. Our study showed that there was a significant increase in the mean of FT4 levels in diabetic patients with thyroid nodules (when compared to diabetic patients without thyroid nodules (P = 0.043). Yet, no significant correlation was found between Thyroid nodule volume, Thyroid nodule size, and IR with FT4. The binary logistic regression analysis showed that FT4 was a risk factors for thyroid nodule in the T2DM patients. Furthermore, the results showed that there was a significant increase in the mean of TPO levels in diabetic patients with thyroid nodules when compared to diabetic patients without thyroid nodules (P = 0.038). The binary logistic regression analysis showed that TPO was risk factor for thyroid nodule in the T2DM patients. There was a significant increase in the mean value of fasting blood glucose level in diabetic groups with thyroid nodules when compared to those without thyroid nodules (P &amp;lt; 0.001). Pearson's correlation test also showed significant positive correlation between thyroid nodule size and fasting blood glucose (r = 0.400, P = 0.010) as well as fasting blood insulin (r = 0.440, P = 0.005). The binary logistic regression analysis showed that FBG, PPGL were risk factors for thyroid nodule in the T2DM patients. Conclusion Our research demonstrates that IR is strong risk factors for thyroid nodule occurrence but its prevalence in diabetic cases is not evaluated in our study. So, it is of great clinical significance to perform thyroid Ultrasonography on patients with T2DM. The independent correlates of TNs were multifactorial, and there existed differences in different physiological states