Diabetes Dyslipidemia Research Articles

The serum γ-Glutamyltransferase Level is Associated with the Development of Hypertension in Alcohol Infrequent Drinkers but not in Frequent Drinkers.

Background The controversy persists regarding whether the serum level of γ-glutamyltransferase (GGT), a marker of liver damage, is associated with hypertension irrespective of alcohol intake. Methods We investigated the relationship between the GGT level and new-onset hypertension during a 10-year follow-up period in Japanese individuals who underwent annual health examinations (n=28,990). After excluding subjects without systolic blood pressure and GGT data and those with hypertension at baseline, a total of 18,618 subjects (men/women: 11,262/7,356, mean age: 44 years) were enrolled. Results During the follow-up period, 2,753 men (24.4%) and 837 women (11.4%) developed hypertension. When the subjects were divided by quartiles of GGT at baseline (Q1-Q4), multivariable Cox proportional hazard model analyses after adjustment for age, sex, systolic blood pressure, body mass index, levels of uric acid, estimated glomerular filtration rate, family history of hypertension, habits of current smoking and alcohol drinking, and diagnosis of diabetes mellitus and dyslipidemia showed that hazard risks (HRs) for the development of hypertension were significantly higher in the Q2, Q3, and Q4 groups than in the Q1 group. A significant interaction was observed between alcohol drinking habits and the GGT level at baseline for the development of hypertension (p=0.022), and adjusted HRs were similarly significant in alcohol infrequent drinkers (≤5 days/week). However, the GGT level was not significantly associated with the development of hypertension in frequent alcohol drinkers (≥6 days/week). Conclusions A high GGT level is an independent predictor of new-onset hypertension in infrequent alcohol drinkers but not in frequent drinkers.

Management of Bilateral Significant Carotid Artery Stenosis in an Asymptomatic Patient with Extensive Coronary Artery Disease and Significant Risk Factors

Abstract Introduction Atherosclerosis is defined by the inflammatory process of the blood vessels driven by multiple cardiovascular risk factors. The involvement of at least two vascular territories significantly impacts prognosis and quality of life. Case Presentation Herein, we present the case of a middle-aged male patient, a former smoker, known with multiple cardiovascular risk factors: hypertension, uncontrolled type 2 diabetes mellitus, dyslipidemia, and history of multivessel coronary artery disease complex managed (subsequent serial percutaneous coronary interventions and optimal medical regimen). The patient was admitted for dyspnea on moderate exertion and mild vertigo. A resting electrocardiogram depicted sinus rhythm and sequelae of an inferior myocardial infarction. Advanced echocardiography revealed impaired myocardial contractility (hypo-contractility of the inferior wall). Carotid Doppler ultrasound examination reported bilateral sub-occlusive stenosis, later confirmed by computed tomography angiography. Afterward, a bilateral staged carotid endarterectomy, along with the best medical treatment, was provided. Conclusion In an asymptomatic patient with well-established cardiovascular risk factors and a documented history of severe coronary atherosclerosis, it is crucial to assess the extent of the atherosclerotic burden and implement appropriate medical management.

Long-Term Non-skeletal Complications in Patients with Thyroid Cancer and Hypoparathyroidism Post-total Thyroidectomy.

Thyroid cancer (TC) is a prevalent endocrine malignancy with rising incidence attributed to advancements in diagnostic technology. Despite its generally favorable prognosis, post-surgical complications, including hypoparathyroidism, can cause long-term health challenges. This study evaluated the risk of non-skeletal complications in TC patients with hypoparathyroidism. A retrospective cohort study was conducted using the National Health Insurance Service-National Sample Cohort (2002-2019), including TC patients diagnosed between 2006 and 2019. Participants were categorized into TC with hypoparathyroidism (TC with hypoP), TC without hypoparathyroidism (TC without hypoP), and matched controls. Propensity score matching and Cox proportional-hazards models evaluated the incidence and risk of non-skeletal complications, including diabetes mellitus, dyslipidemia, cardiovascular and renal outcomes, and cataracts. This study included 430 and 850 patients in the TC with hypoP and TC without hypoP groups, respectively, and their matched controls. The TC with hypoP group showed significantly higher risks of diabetes mellitus (HR 1.31, 95% CI: 1.01-1.68), dyslipidemia (HR 1.29, 95% CI: 1.06-1.57), urinary stones (HR 1.61, 95% CI: 1.00-2.57), and cataracts (HR 1.50, 95% CI: 1.15-1.95), compared to controls (all P<0.05). Hypertension risk was higher in the TC with hypoP group versus the TC without hypoP group (HR 1.39, 95% CI: 1.00-1.93, P=0.048). Women had higher urinary stone risk, while cataract risk increased in patients aged over 50. TC patients with hypoparathyroidism are at an increased risk for specific non-skeletal complications, particularly older adults and women. These findings underscore the need for targeted monitoring and management strategies in this population. Further prospective studies are warranted to validate these associations and elucidate the underlying mechanisms.

Factors Influencing Post-Thrombolytic ST-Segment Resolution in STEMI Patients: A Cross-Sectional Study from Tertiary Care Hospitals

Objectives: This study aimed to evaluate the effectiveness of post-thrombolytic ST-segment resolution in patients with ST-elevation myocardial infarction (STEMI) and to identify factors associated with the resolution outcomes. Methodology: A cross-sectional study was conducted at Mardan Medical Complex and Bacha Khan Medical Complex Swabi. Electrocardiogram (ECG) of STEMI patients were reviewed to assess the resolution of ST-segment elevation after thrombolytic therapy. Complete resolution was defined as a ≥70% reduction in ST-segment elevation, partial resolution as a reduction between 30% and 70%, and failed resolution as a &lt;30% reduction. Data were entered and analyzed using SPSS. Results: A total of 222 STEMI patients were included in the study, with 61.3% being male. The mean age of the participants was 57.9±10.8 years. After thrombolytic therapy, 27.5% of patients achieved complete ST-segment resolution, while 51.8% had partial resolution. The resolution of ST-segment elevation was significantly associated with a history of hypertension, but no significant association was found with diabetes mellitus, dyslipidemia, or renal disease. Conclusion: The rate of complete ST-segment resolution following thrombolytic therapy in STEMI patients was relatively low compared to partial resolution. Hypertension was significantly associated with the degree of ST-segment resolution, while diabetes mellitus, dyslipidemia, and renal disease did not significantly impact the resolution of ST-segment elevation in STEMI patients.

Evaluation of Biochemical Parameters in Type 2 Diabetes Mellitus Patients with Non-Alcoholic Fatty Liver Disease at a Tertiary Care Hospital in Bhopal

Background: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide and can progress to fibrosis and cirrhosis. NAFLD is increasingly prevalent, particularly in individuals with central obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, and metabolic syndrome. Objective: To assess biochemical parameters in patients with T2DM and NAFLD at a tertiary care hospital in Bhopal. Methods: This study was conducted in the Department of Biochemistry at L.N. Medical College and J.K. Hospital, involving 70 subjects diagnosed with T2DM and NAFLD. NAFLD severity was classified into three grades (1–3) based on abdominal ultrasonography findings. Biochemical parameters analyzed included HbA1c, serum cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Results: Among 70 participants, those with NAFLD Grade 3 had the highest total cholesterol levels (Mean TC = 266 mg/dL). Grade 3 participants (n=17) exhibited elevated triglyceride levels (Mean TG = 246 mg/dL), while Grade 2 participants (n=25) had increased LDL levels. Grade 1 participants had the lowest HDL levels (Mean HDL = 35 mg/dL). Dyslipidemia, characterized by elevated triglycerides or LDL with reduced HDL, was the most common abnormality. Total cholesterol, LDL, and HDL levels were significantly associated with NAFLD severity, whereas triglyceride variations across NAFLD grades were not statistically significant. Conclusion: This study highlights the importance of recognizing fatty liver as a component of metabolic syndrome in individuals with diabetes mellitus. Regular monitoring of lipid profiles in T2DM patients with NAFLD is essential for early intervention and management.

Bilateral nevus of Ota in association with nevus flammeus: a case report.

Nevus of Ota and nevus flammeus are distinct congenital pigmentary and vascular anomalies, respectively, with different etiologies and clinical implications. While both conditions can present unilaterally, their bilateral coexistence is rare. We report a 39-year-old Filipino female with a medical history of type 2 diabetes mellitus and dyslipidemia who presented to the dermatology clinic with concerns over a newly appearing benign nevus on the sole of her hand. Incidentally, dermatological examination revealed two significant congenital pigmentary lesions: bilateral nevus of Ota and a widespread port-wine stain. The nevus of Ota manifested as well-defined blue-gray macules and patches symmetrically distributed across her face, involving both nasal nostrils and conjunctiva. The nevus flammeus, a congenital vascular malformation, extended over both arms, the upper back, and the chest, presenting as a well-demarcated reddish-purple discoloration. These lesions had been present since birth, remained asymptomatic, and had never been previously evaluated. No systemic involvement was detected, and laboratory investigations were unremarkable. The diagnosis was made clinically. As the patient was not interested in treating the nevi, no treatment was planned. This case highlights the importance of obtaining a detailed family history in all similar cases to aid in understanding the genetic basis of these conditions and their potential coexistence with other congenital dermal anomalies.

Antidiabetic, Antidyslipidemic, Hepatoprotective Effects and Histopathological Analysis of Aqueous Extract of Tamarindus Indica (Fabaceae) on Streptozotocin Induced Diabetic Rats

Aims: Diabetes is global public health concerns, imposing a heavy global burden on public health as well as socio-economic development. This study investigated the antidiabetic, antidyslipidemic and hepatoprotective effects of the aqueous leaves extract of Tamarindus indica. Methodology: The present study was designed to investigate the anti-hyperglycemic, antidyslipidemic and hepatoprotective effects of the fixed dose of linagliptin [5mg/kg body weight (BW)] and Tamarindus Indica [200mg/kg body weight] for four week treatment on streptozotocin [45 mg/kg (BW)] induced diabetic rats. Results: In streptozotocin induced diabetic rats, there was a significant decrease in blood glucose level from (20.04±0.480 mmol/L to 18.94± 0.397 mmol/L). After daily treatment for four weeks, Tamarindus indica reduced blood glucose level (19.8±0.265 mmol/L to 7.94± 0.214 mmol/L). In case of dyslipidemic effect, Tamarindus indica reduced total cholesterol (197.06±0.542 mg/dl), triglyceride (134.18 ±0.309 mg/dl) and LDL-cholesterol (86.18 ±0.307 mg/dl) levels significantly and increased HDL-cholesterol level (30.24 ±0.406 mg/dl) in comparison with diabetic control group. Liver dysfuction parameter significantly decresed SGPT (33.76 ±0.206 U/L) and SGOT (44.46 ±0.607 U/L) compared to diabetic control group was observed.Our findings show that tamarind extracts improve biochemical markers and restore normal histological architecture in treated groups. Conclusion: The results of the present study suggest that, the fixed dose of Tamarindus indica leaves exhibits significant antidiabetic, antidyslipidemic, hepatoprotective properties, enhancing the potential effect for liver health as an adjunct in dietary management of these metabolic disorders. So aqueous leaves extract of Tamarindus indica might be efficacious in patients with diabetic dyslipidemia. It showed safer, synergistic and promising hypoglycemic properties and reduced dose level of oral hypoglycemic agents, while giving better glycemic control.

Cardiovascular risk and cardiac involvement in idiopathic inflammatory myopathies: insights from a cross-sectional Swedish single-centre study

Objective We aimed to investigate the cardiovascular profile, including risk factors and cardiovascular abnormalities, in patients with idiopathic inflammatory myopathies (IIMs). Method In this cross-sectional study, 109 IIM patients and 20 age- and gender-matched healthy controls were enrolled and underwent electrocardiographic and transthoracic echocardiographic examinations. We analysed blood levels of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP), assessed IIM disease-specific features, and evaluated the medical history of cardiovascular risk factors. IIM patients were stratified into two groups: those with previous cardiac involvement and those without. Results IIM patients had a higher body mass index (BMI) and a greater prevalence of diabetes mellitus and dyslipidaemia than healthy controls (p = 0.023, p = 0.024, and p = 0.042, respectively). They also showed significantly higher rates of arrhythmia, cardiac axis deviation, negative T-waves, and suspected pulmonary hypertension, along with elevated NT-proBNP levels (p = 0.041, p = 0.004, p = 0.041, p = 0.012, and p = 0.034, respectively). A significantly higher proportion (p = 0.037) of immune-mediated necrotizing myopathy (IMNM) subtype (50%) was found among IIM with previous cardiac involvement compared to those without (20%). cTnI levels were significantly higher in IIM with cardiac involvement than in IIM without cardiac involvement (p = 0.009). Conclusions Cardiovascular complications in patients with IIM may result from an increased prevalence of traditional cardiovascular risk factors, such as higher BMI, diabetes mellitus, and dyslipidaemia, and/or from direct cardiac involvement, such as previous myocarditis. Cardiac involvement in IIM is notably associated with the IMNM subtype.

Severity and Risk Factors Associated with Premature Coronary Artery Disease in Patients Under the Age of 50 in Saudi Population: A Retrospective Study.

Background and Objectives: The average age of presentation of coronary artery disease (CAD) is one decade younger in the Saudi population relative to other patients worldwide. It is imperative to investigate the prevalence of premature coronary artery disease (PCAD) risk factors in Saudi Arabia's younger population in order to prevent the incidence of cardiovascular diseases in the future. Thus, the present study aimed to evaluate the severity and identify the risk factors associated with PCAD in patients under the age of 50 at King Saud University Medical City (KSUMC), Saudi Arabia. Methods: This observational retrospective study was conducted between June 2022 and June 2023 at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 718 participants were included in the study. The patients, confirmed by electrocardiographic and/or angiographic findings of coronary artery disease, were divided into three age groups: group 1 (<40 years), group 2 (40-45 years), and group 3 (45-50 years). The severity of vessel occlusions was evaluated using the Gensini scoring system. Electrocardiographic findings, sociodemographic variables, and risk factors were also taken into consideration. Results: The mean age of patients in group 1 was 35.2 ± 4.5 years, in group 2 was 43.0 ± 1.3 years, and in group 3 was 48.4 ± 1.4 years. Patients in group 2 had a significantly higher BMI (31.3 ± 10.5) compared to patients in group 3 (29.4 ± 5.3; p = 0.015). Nearly 55% of patients under 40 years had 2 or 3 vessel occlusions according to the vessel score. The percentage of patients with inferior ST elevation was significantly higher in group 1 (<40 years, 11.2%) compared to groups 2 (40-45 years, 10.1%) and 3 (45-50 years, 6.0%; p = 0.001). Non-specific ST-T changes were more common in group 1 (31.4%) and group 2 (32.0%) compared to group 3 (28.4%). Although not statistically significant, left main artery occlusion tended to be higher in group 3 (8.6%) compared to groups 1 (4.6%) and 2 (4.5%; p = 0.229). Hyperlipidemia levels were significantly higher in patients with a Gensini score > 39 compared to those with a Gensini score < 39 (47.9% vs. 37.5%, respectively; p = 0.05). The prevalence of smoking was about 54% in group 1, followed by type 2 diabetes mellitus, dyslipidemia, and hypertension (37%, 36%, and 33%, respectively). Conclusions: This study suggested that PCAD Saudi patients below 40 years of age had a higher percentage of inferior ST elevation compared to older patients, while non-specific ST-T changes were significantly higher in older patients. Astonishingly, more than 50% of patients in all groups had two or three vessel occlusions. There was a high prevalence of modifiable risk factors, such as smoking, in younger patients, whereas hyperlipidemia was a risk factor for PCAD in all age groups. In addition, hyperlipidemia was highly correlated with severe vessel occlusion according to the Gensini score. Therefore, early preventive measures should be taken into consideration to reduce the future burden of cardiovascular complications in this population.

IBC Oxford University Oral Abstract 35 - Long-term effects of one anastomosis gastric bypass on liver histopathology in NAFLD cases: a prospective study

Abstract Background Weight reduction can effectively improve non-alcoholic fatty liver disease (NAFLD), which is a constant companion of severe obesity. This study aimed to determine the effect of one anastomosis gastric bypass (OAGB) on pathological liver changes in severely obese cases with NAFLD. Methods The present prospective research comprised 67 subjects with morbid obesity scheduled for OAGB during the period from February 2015 to August 2018. Clinical, biological, and histologic data were evaluated pre- and 15 months postoperatively. Results Fifteen months after surgery, a considerable reduction was noted in the grades of fat deposition, liver cell ballooning, and lobular inflammatory changes, in addition to the total NAS score. Fifteen months after surgery, non-alcoholic steatohepatitis (NASH) disappeared in 42% of the patients. A significant regression of fibrosis stage occurred after surgery in 79.1% of patients (P &amp;lt; 0.001). After surgery, patients had substantial reductions in aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, HbA1c, total cholesterol, and Low-density lipoprotein (P &amp;lt; 0.001, for all comparisons). Diabetes mellitus, hypertension, and dyslipidemia resolved in 54%, 59%, and 69% of the patients, respectively. Conclusion OAGB resolved NASH in nearly 42% of patients and reduced the histological features of NAFLD 15 months after surgery. Bariatric procedures might be adopted as a therapeutic modality in severely obese cases with NAFLD after the failure of lifestyle modifications.

Role of OCT in Assessing Vasa Vasorum in Chronic Coronary Syndrome: Insights from Long-Term Follow-Up.

Background/Objectives: The aim of this study was to analyze the presence of vasa vasorum in optical coherence tomography (OCT) among patients undergoing coronary angiogram for chronic coronary syndrome with intermediate-grade coronary stenoses in relation to long-term follow-up. Methods: This prospective, observational, single-center study enrolled patients with chronic coronary syndrome and intermediate-grade coronary stenosis. OCT was used to assess the presence of vasa vasorum, type of plaque, mean lumen area, fibrous cap thickness (FCT), and minimal lumen diameter. Patients were divided into two groups based on the presence of vasa vasorum. Results: Overall, 97 patients were enrolled, of whom 82.5% were male. Lesions with vasa vasorum were found in 76 patients. Comorbidities such as diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease did not differ significantly between groups. Among patients with vasa vasorum, there were higher serum creatinine levels (1.03 ± 0.24 vs. 0.87 ± 0.22, p = 0.009). OCT showed that minimal lumen diameter differed between groups (2.26 ± 0.38 mm vs. 2.57 ± 0.57 mm p = 0.026) for the vasa vasorum group and no vasa vasorum, respectively, however minimal lumen area was similar in both groups (3.88 ± 1.76 mm2 vs. 4.01 ± 2.00 mm2, p = 0.731, for vasa vasorum and no vasa vasorum, respectively). Furthermore, the presence of vasa vasorum seemed to have no significant correlation with cardiovascular events in the 2-year, 5-year, and 10-year follow-up. Conclusions: The presence of lesions with vasa vasorum was not shown to be linked to any unfavorable patients' outcomes. Among men, coronary atherosclerotic plaques were more likely to contain OCT-visualized vasa vasorum.

IBC Oxford University Poster Abstract 27 - Is distalization a good option for insufficient weight loss or weight regain after Roux-en-Y gastric bypass? The initial experience of a differentiated center

Abstract Introduction Bariatric surgery is recognized as the most effective long-term treatment for clinically severe obesity, leading to sustained weight loss. Among the common bariatric procedures, the laparoscopic Roux-en-Y gastric bypass (RYGB) is frequently performed and is known for its significant weight loss results and its ability to reduce obesity-related comorbidities in many patients. However, 10% to 40% of patients may experience insufficient weight loss (IWL) or weight regain (WR), along with the persistence or recurrence of comorbidities after 5 to 7 years, presenting a major challenge for bariatric surgeons. The distalisation of RYGB, a revisional malabsorptive procedure, can potentially address these issues but comes with its own complications. Methods We reviewed all distalisations of RYGB performed at our hospital between 2019 and 2023. During this period, a total of 2117 RYGB surgeries were performed. The primary outcomes assessed were weight loss progress and changes in comorbidities. Secondary outcomes included early postoperative complications and the need for surgical revisions. Results A total of 13 distalisations of RYGB type I (BPL distalisation) were performed, all on female patients with a median age of 49 years. The median BMI was 50.7 kg/m2 at the initial bypass and 41.2 kg/m2 before the distalisation. The median interval between the two surgeries were 103 months. In all the cases, the common limb length was more than 2.5 m and there was a median length of 2.32 m of the biliopancreatic limb. Total weight loss was 27.7% at 6 months, 30% at 1 year (n = 9), 25.2% at 1.5 years (n = 7), and 24.1% at 2 years (n = 6). Among the four patients with hypertension before the revisional surgery, there was one patient with remission at 6 months post-surgery, while the others continued to have hypertension. There were no cases of diabetes mellitus, dyslipidaemia, or sleep apnoea syndrome prior to the surgery. However, one patient developed diabetes mellitus 6 months post-surgery. The average surgery duration was 107 minutes, and patients were discharged after 2 days. There were no complications, and no surgical revisions were required. The median follow-up time was 23 months. Discussion Our hospital’s experience with distalisation procedures demonstrates that this surgery is both safe and effective, leading to significant BMI reduction without malnutrition. Furthermore, the initial surgery was highly effective in reducing comorbidities, as most patients had remission of these conditions following gastric bypass. Conclusions The limited number of cases hinders our ability to draw definitive conclusions. Increasing the number of cases will be crucial for obtaining more reliable results.

Glycaemicparameters, Dyslipidaemia and Thyroid Hormone: An exploratory study of their interrelationship in Type 2 Diabetes Mellitus patients

Background: Diabetes mellitus and thyroid disorders may coexist and impacting each other. The thyroid gland function (hypo- and hyper-function) may affect the metabolism of carbohydrates. Both conditions have an impact on the lipid profile since insulin resistance or insufficiency alters important enzymes and pathways involved in lipid metabolism. Lipid abnormalities are common in diabetes mellitus. The purpose of this study is to determine how diabetes mellitus, hypothyroidism, and dyslipidaemia are related. Method: The study included 300 participants, 150 of whom were healthy controls and 150 of whom had diabetes mellitus and hypothyroidism. 150 people with diabetes were further divided into 75 people who had dyslipidemia and 75 people who did not. Serum lipid profiles and blood sugar levels were measured using the Mindray BS240 analyzer. Triiodothyronine [T3], thyroxine [T4], and thyroid stimulating hormone [TSH] were measured using chemiluminescence immunoassay. Result: The study found that female subjects with diabetes had a higher prevalence of dyslipidaemia. The TSH differences between the study and control groups were more significant (OR 3.147, P Value0.001*). Notable were the T4 (OR 1.734, P Value0.001*) and T3 (OR 2.031, P Value0.001*), mean differences as well. Higher levels of FBS, PPBS, and RBS were observed. The lipid profile total cholesterol (OR 3.120, P Value0.001*), triglycerides (OR 1.592, P Value0.001*), HDL (OR 2.173, P Value0.001*), LDL (OR 2.110, P Value0.001*), and VLDL (OR 2.194, P Value0.001*) is also significant compared to controls. Conclusion: This study shows that T2DM significantly affect thyroid function especially in female. It is crucial to take thyroid function into account in diabetic patients because changes in thyroid hormone levels may be caused by insulin resistance and altered glucagon levels.The results suggest a significant association between hypothyroidism and diabetes with dyslipidaemia.

The Management of Cardiometabolic Risk in MAFLD: Therapeutic Strategies to Modulate Deranged Metabolism and Cholesterol Levels.

Background and Objectives: Fatty Liver Disease is a major health problem worldwide. We can distinguish liver steatosis as non-associated or associated with chronic/acute alcohol consumption. These two entities share similar stages ranging from hepatic fat storage (namely, steatosis) to inflammation, necrosis, and fibrosis until hepatocellular carcinoma (HCC). Over time, "Metabolic Associated Fatty Liver Disease" (MAFLD) has replaced nonalcoholic fatty liver disease (NAFLD) nomenclature and has included cardiometabolic criteria in these patients definition. Thus, obesity, type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia are MAFLD features and are of the metabolic syndrome. Importantly, there is not a specific treatment for MAFLD, but there are therapeutic strategies that act on metabolic dysfunction related to MAFLD. They can reduce the progression of liver fibrosis and its complications. Materials and Methods: For all these reasons, we conducted a narrative review of the literature, and we focused on metabolic dysfunction related to MAFLD, with a special regard for cholesterol metabolism. Results: MAFLD is a recently redefined condition that better describes the metabolism derangement responsible for fatty liver disease. This distinguishes MAFLD from NAFLD. In fact, the diagnostic criteria for MAFLD require the presence of liver steatosis together with at least one of the following: obesity, T2DM, or evidence of metabolic disorder such as hypertriglyceridemia, low high-density lipoprotein cholesterol, or hypertension. As a result, MAFLD is closely linked to an increased cardiometabolic risk. Current therapeutic approaches can be used to reduce this risk, focusing on lifestyle interventions and pharmacological strategies. Several treatments in patients diagnosed with MAFLD are mainly cholesterol-lowering remedies. Among these, Pro-protein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) show the most promising efficacy profile but data on liver fibrosis are lacking. Agonists of GLP-1 receptor, Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and Dipeptidyl Peptidase-4 inhibitors (DPP-4i) have a " multi-hit " action allowing their use also in diabetic patients with MAFLD. Conclusions: Lifestyle modifications, some nutraceuticals, statins, incretins, and PCSK9i have changed the natural course and significantly improved the cardiometabolic outcomes of MAFLD. Emerging cholesterol-lowering drugs, such as Bempedoic acid, can overcome low compliance to statins' use and their controversial effect on liver fibrosis. Finally, medications targeting insulin resistance allow for strategic interventions of the convoluted pathophysiology of MAFLD in multiple steps, with the potential to reduce liver steatosis, inflammation, and necrosis and, sometimes even to reverse liver fibrosis.

Single point insulin sensitivity estimator index is associated with predominance of atherogenic small, dense low-density lipoprotein cholesterol particles in Korean obese adults: a retrospective study.

Insulin resistance (IR) influences lipid metabolism, particularly small dense low-density lipoprotein cholesterol (sdLDL-C), a key feature of diabetic dyslipidemia and a predictor of cardiovascular disease. The single-point insulin sensitivity estimator (SPISE) index is an effective tool for assessing IR. This study explored the relationship between the SPISE index and average low-density lipoprotein cholesterol (LDL-C) particle size in obese Korean adults. Cardiovascular risk was assessed in 161 obese individuals. The participants were divided into three groups based on SPISE index tertiles. Steiger's Z test was used to assess the differences in correlation coefficients among various IR indices and average LDL-C particle size. Multivariate linear regression models were used to determine the independent association between the SPISE index and average LDL-C particle size. Receiver operating characteristic (ROC) curves established the SPISE index cut-off for sdLDL-C particle dominance. The SPISE index was positively correlated with mean LDL-C particle size after adjusting for confounders. It demonstrated a stronger independent association with average LDL-C particle size (r=0.679, P<0.001) than with fasting insulin, the homeostatic model assessment for IR, and the quantitative insulin sensitivity check index (P<0.001 for all). ROC analysis identified an optimal SPISE index cutoff for sdLDL-C predominance of 4.955, with an area under the curve of 0.745. Our findings indicate a direct correlation between the SPISE index and average LDL-C particle size, suggesting that the SPISE index may complement labor-intensive IR indices and sdLDL-C measurement techniques for estimating IR-induced sdLDL-C predominance.

Prevalence of Obesity and Dyslipidemia in Maturity Onset Diabetes of the Young Patients

Prevalence of Obesity and Dyslipidemia in Maturity Onset Diabetes of the Young Patients

Characteristics of Overlap Syndrome in a Large Cohort of Brazilian Patients With Systemic Sclerosis: A Retrospective Analysis.

Systemic sclerosis (SSc) often presents alongside other connective tissue disorders, termed "overlap syndrome (OS)." This study aimed to characterize patients with SSc with OS compared to those without OS in a tertiary university hospital in Brazil. A retrospective analysis of demographic, clinical, and laboratory data from 787 SSc patients was performed using electronic medical records. Patients were classified based on the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc and additional criteria for systemic lupus erythematosus (SLE), idiopathic inflammatory myopathy (IIM), Sjögren disease (SjD), and rheumatoid arthritis (RA). Statistical analysis, including univariate and multivariate methods, identified factors associated with OS. Ninety-one patients (11.6%) had OS, mainly with SLE (29.7%), SjD (26.4%), RA (24.2%), or IIM (19.8%). Patients with OS were younger, with an earlier age at onset (P = 0.004) and at diagnosis (P = 0.003). They presented a higher prevalence of limited SSc (P trend = 0.06), musculoskeletal symptoms (P < 0.001), neoplasia (P = 0.03), and sicca symptoms (P < 0.001); and were associated with a lower frequency of pulmonary hypertension (P = 0.048) and comorbidities such as diabetes mellitus (P = 0.02) and dyslipidemia (P = 0.02). A higher prevalence of anti-Ro (P = 0.007) and a lower prevalence of anti-Scl70 (P = 0.003) were also observed. Patients with OS were more frequently prescribed glucocorticoids (GCs; P < 0.001), methotrexate (P = 0.01), and leflunomide (P = 0.001). Multivariate analysis identified limited SSc (odds ratio [OR] 3.1), neoplasia (OR 3.4), and use of GCs (OR 8.2) and leflunomide (OR 5.5) with OS. No worse prognosis was observed. Overall, Brazilian patients with SSc with OS have distinct clinical characteristics but do not have a worse prognosis compared to those without OS.

Leveraging free-text diagnoses to identify patients with diabetes mellitus, obesity or dyslipidaemia - a cross-sectional study in a large Swiss primary care database.

Electronic medical records (EMRs) in general practice provide various methods for identifying patients with specific diagnoses. While several studies have focused on case identification via structured EMR components, diagnoses in general practice are frequently documented as unstructured free-text entries, making their use for research challenging. Furthermore, diagnoses may remain undocumented even when evidence of the underlying disease exists within structured EMR data. This study aimed to quantify the extent to which free-text diagnoses contribute to identifying additional cases of diabetes mellitus, obesity and dyslipidaemia (target diseases) and assess the cases missed when relying exclusively on free-text entries. This cross-sectional study utilised EMR data from all consultations up to 2019 for 6,000 patients across 10 general practices in Switzerland. Diagnoses documented in a free-text entry field for diagnoses were manually coded for target diseases. Cases were defined as patients with a corresponding coded free-text diagnosis or meeting predefined criteria in structured EMR components (medication data or clinical and laboratory parameters). For each target disease, prevalence was calculated along with the proportion of cases identified exclusively via free-text diagnoses and the proportion missed when using free-text diagnoses alone. The prevalence estimates for diabetes mellitus, obesity and dyslipidaemia were 8.8%, 16.2% and 38.9%, respectively. Few cases relied exclusively on free-text diagnoses for identification, but a substantial proportion of cases were missed when relying solely on free-text diagnoses, particularly for obesity (19.5% exclusively identified; 50.7% missed) and dyslipidaemia (8.7% exclusively identified; 53.3% missed). Free-text diagnoses were of limited utility for case identification of diabetes mellitus, obesity or dyslipidaemia, suggesting that manual coding of free-text diagnoses may not always be justified. Relying solely on free-text diagnoses for case identification is not recommended, as substantial proportions of cases may remain undetected, leading to biased prevalence estimates.

Prevalence and Risk Factors of Knee Osteoarthritis: A Cross-Sectional Study in Palembang, Indonesia

Osteoarthritis (OA) is a prevalent degenerative joint disease causing pain, disability, and decreased quality of life. This study aimed to investigate the prevalence and risk factors associated with knee OA in Palembang, Indonesia. A cross-sectional study was conducted using secondary data from medical records of patients diagnosed with knee OA at Dr. Mohammad Hoesin General Hospital in Palembang during 2023. Patients aged ≥ 55 years with primary knee OA were included, while those with secondary knee OA or cerebrovascular disease were excluded. Data on sociodemographics, clinical characteristics, and comorbidities were collected. Univariate analysis and correlation tests were performed to assess the association between risk factors and knee OA. A total of 133 patients with knee OA were included. The majority were female (82%), aged 55-65 years (51.1%), and housewives (48.1%). Bilateral knee involvement was observed in 73.7% of patients. Overweight (35.3%) was the most common BMI category. Hypertension was the most prevalent comorbidity (61.7%), followed by diabetes mellitus (19.5%) and dyslipidemia (19.5%). Correlation analysis showed a significant positive correlation between knee OA and age, female gender, and BMI. In conclusion, knee OA in Palembang is more prevalent in middle-aged women, particularly housewives. Overweight and hypertension are significant risk factors associated with knee OA. These findings underscore the need for targeted preventive strategies and public health interventions to address these modifiable risk factors.

Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular risk factors (data from Russian epidemiological studies)

Aim. To study the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with cardiovascular risk factors (RFs).Material and methods. The database from the ESSE-RF2 and ESSE-RF3 epidemiological studies was used, including data from surveys of population aged 35-64 years in 18 Russian regions (n=21204). To assess the prevalence of NAFLD, the fatty liver index (FLI) was used. Statistical analysis was performed using the statistical programming language and the R environment (version 3.6.1) with open-source code. The significance level for all tested hypotheses was p≤0,05.Results. Standardized prevalence rates of FLI ≥60 in the ESSE-RF3 study are slightly higher than in the ESSE-RF2 study (39,2% vs 42,3%, respectively). Multivariate analysis adjusted for sex, age, region, settlement type, and education showed significant associations of FLI ≥60 with hypertension, type 2 diabetes, hyperuricemia, lipid metabolism disorders, elevated high-sensitivity C-reactive protein levels, and cerebrovascular accident in men and women.Conclusion. Multivariate analysis confirmed the closest association of NAFLD with hypertension, type 2 diabetes mellitus, metabolic disorders, nonspecific inflammation, dyslipidemia, and cerebrovascular accident in men and women.