Screening Of Disease In Patients Research Articles

#2343 Fabry disease screening in patients with chronic kidney disease and dialysis at a single medical center in Taiwan

Abstract Background and Aims Chronic Kidney Disease (CKD) poses a significant global health challenge, with diverse contributing factors impacting its progression. Among these, Fabry Disease, a rare lysosomal storage disorder, has emerged as a potential complicating factor. Despite its relevance, the prevalence of Fabry Disease among CKD patients, particularly in Taiwan, remains insufficiently explored. Recognizing and understanding the occurrence of Fabry Disease in CKD populations are crucial for comprehensive patient care and may have implications for treatment strategies. Additionally, investigating the relationship between kidney function and Plasma α-Gal A activity is essential. α-Gal A, the enzyme deficient in Fabry Disease, may experience altered activity levels in the presence of compromised kidney function. Clarifying this connection is pivotal for gaining insights into the intricate interplay between Fabry Disease and CKD. This study aims to achieve three key objectives (1) Determine Fabry Disease Prevalence among CKD Patients in Taiwan.(2) Investigate the Impact of Kidney Function on Plasma α-Gal A Activity.(3) Characterize Gene Mutation Patterns and Demographic Data of Fabry Patients in CKD Population in Taiwan: Method Fabry Disease assessment involved a two-stage process, tailored to the patient's gender. Males underwent a dry blood test measuring α-galactosidase activity; samples below 15% of the adult average were deemed positive. Females were screened based on lyso-Gb3 levels in whole blood; a result exceeding 0.8 ng/ml was considered positive. Positive screenings prompted genomic DNA extraction, and the GLA gene's seven exons and intron 4 segment ([GRCh38/Hg38] chrX:101,399,610-101,399,874) were PCR-amplified. Sanger sequencing identified pathogenic variants. This gender-specific, multi-step approach ensures precision. Defined thresholds and advanced genomic techniques enhance diagnostic accuracy. The method provides a robust means of identifying Fabry Disease, supporting early intervention and personalized treatment. Results Study Recruitment: Initially, 2000 subjects enrolled, but 155 withdrew, yielding a final cohort of 1845 patients for analysis. Screening and Referral: Among 1602 subjects, 26 males (1.6%) were referred for DBS LysoGB3 check-up due to low serum α-Gal A activity. In a cohort of 243 females, 6 individuals (2.4%) underwent GLA genetic sequencing due to elevated lyso-GB3 levels. Clinical Presentation - Male Case: A male with acute stroke symptoms and CKD stage 3b (eGFR 34.5 mL/min/1.73 m²) showed significantly low DBS α-Gal A activity (0.48 μmol/hr) and elevated Plasma LysoGB3 (28.08 ng/ml).GLA genetic sequencing revealed a specific deletion (c.1072-1074delGAG, p. (Glu358 del)) in exon 7, leading to a Fabry disease diagnosis, classifying it as a specific type. The family pedigrees of this male patient are visually represented in Fig. 1, illustrating the genetic relationships within the family. Clinical Presentation - Female Case: A female on hemodialysis for four years, cause unknown, exhibited a DBS LysoGB3 level of 0.5 ng/ml. GLA genetic sequencing identified a nucleotide variation (c.640-801G>A) in intron 4, establishing a diagnosis of Fabry disease with the cardiac variant (301500). Fig. 2 demonstrates the relationship between serum DBS GLA activity and different stages of CKD. Our analysis reveals that in CKD stages 1, 2, 3 (3a and 3b), and 4, the serum GLA activity is significantly higher compared to stage 5. Conclusion The prevalence of Fabry Disease in our cohort was 0.1% (2 out of 1845 individuals), featuring one female with the cardiac variant and one male with the class type. Our investigation unveiled a significant rise in serum GLA activity in CKD stages 1–4 compared to stage 5, suggesting potential implications for early CKD detection. Moreover, serum α-Gal A activity displayed a notable correlation with age, BUN, and eGFR across CKD stages 1–5, questioning its status as a biomarker for advanced CKD and aging in CKD patients. This prompts consideration for a large-scale study to validate this hypothesis.

1406. A Systematic Quality Improvement Initiative to Improve Chagas Disease Screening in Patients with HIV at a Large Safety Net Clinic in Denver

Abstract Background Chagas Disease (CD) is a neglected parasitic disease that affects people living in continental Latin America. Immigrants from these countries or those born to mothers from Latin America are at risk of developing disease. Detection of cases before end-organ damage has occurred is crucial for treatment to be beneficial. Patients with HIV (PWH) may be at high risk of reactivation and death. We sought to screen PWH at risk of CD that receive medical care in the safety net hospital for the Denver area. Methods We identified 325 PWH that receive care in the Denver Health system who self-identified as born in Latin American countries. We ordered serological Trypanosoma cruzi testing for all patients (T cruzi IgG, ELISA, ARUP Laboratories, UT). Providers were educated about the intervention and CD via email (Figure 1). Concurrently, the Denver Health refugee clinic began a process to screen for CD among people at risk who do not have HIV.Figure 1.Chagas disease screening process in patients with HIV in Denver Health, March 2022 - March 2023 Results Between March 2021 and March 2022, a total of 265 patients completed testing (81.5%). 89.8% were male and the mean age was 45.4 years (SD +/- 11.5). Most patients had controlled HIV (mean CD4 624 +/- 303.5 cells/µL, HIV viral load < 30 cps/mL in 92%). Most patients were born in Mexico (80%), followed by El Salvador (5%). Three patients had a positive test, yielding a prevalence of 1.1%. One of these patients had an already confirmed and treated infection. The other 2 patients had uncontrolled HIV with CD4 count < 200 cells and have been lost to follow-up with inability to obtain confirmatory testing. Using a 2.2% prevalence of serologic positivity for CD in Hispanic patients, 90 patients at risk will need to be screened in order to detect a positive patient. Due to increased awareness of CD in our primary care clinics, a parallel 3-fold increase in testing in non-HIV patients was seen in the study period. Conclusion Chagas disease screening in patients at risk can be performed in clinics that provide care for patients with HIV. Obtaining a second confirmatory test is challenging and processes to facilitate blood collection should be implemented to not delay testing. Increased awareness of medical providers leads to increased screening for this disease. Disclosures Edward Gardner, MD, Cepheid: Grant/Research Support|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Grant/Research Support

Frequency of anti-resorptive therapy prescription and skeletal disease screening in patients diagnosed with multiple myeloma.

398 Background: Patients with multiple myeloma (MM) who have evidence of myeloma-related osseous disease should receive anti-resorptive therapy. However, there are often many delays in initiating therapy and some patients are never initiated on treatment despite best practice recommendations. In this study, we examined rates of anti-resorptive therapy for patients with lytic bone lesions seen on imaging and potential barriers for starting therapy. Methods: A retrospective chart review of patients diagnosed with MM between January & November 2022 at our institution was conducted. All patients diagnosed with MM were included in our analysis. Patient demographics and medical information were collected from the electronic medical record. Data was analyzed using descriptive statistics (mean, standard deviation, median, frequency, interquartile range (IQR)) & inferential statistics (t test, chi squared, ANOVA, Kruskal Wallis analyses). A p-value level of < 0.05 was considered significant. Results: Out of a cohort of 68 patients, 39 (57.4%) demonstrated lytic lesions on imaging. 23 (59%) of these patients were prescribed anti-resorptive therapy. The median time from diagnosis of MM to anti-resorptive prescription was 18 days (IQR=188.5) for a bisphosphonate and 57 days (IQR=190) for denosumab. For those who did receive anti-resorptive therapy, median time to prescription by insurance type, in days, was 23.5 for state, 36 for private, 48 for traditional Medicare, 144.5 for Medicaid expansion, and 175 for Medicare advantage (p=0.21). Insurance type, race, and sex were found to be unrelated to the lack of administration of anti-resorptive therapy. Our analysis demonstrates that factors, other than those studied, account for low administration rates of anti-resorptive therapy. Conclusions: There is a critical under-prescription of anti-resorptive therapy for patients with myeloma-related skeletal disease. While not significant, in this limited sample, large variation in time to therapy based on insurance type warrants further investigation in a larger cohort of patients to better understand how it might lead to disparities in care. Although limited to a single institution, our study reveals a prominent gap in the care of newly diagnosed MM patients that may be applicable to many institutions. Ongoing efforts are currently underway to improve the prescription & time to therapy of anti-resorptive agents.[Table: see text]

EP05.01-07 Propective Study: Usefulness of D-Dimer Determination for Thromboembolic Disease Screening in Patients with Metastatic Lung Cancer

EP05.01-07 Propective Study: Usefulness of D-Dimer Determination for Thromboembolic Disease Screening in Patients with Metastatic Lung Cancer

Celiac disease screening in patients with cryptogenic cirrhosis.

We write a letter to the editor commenting the article "Who to screen and how to screen for celiac disease". We discuss the present literature on cirrhosis and celiac disease (CD) and recommend screening and treating CD in individuals with cryptogenic cirrhosis.

Delphi-Based Consensus on Interstitial Lung Disease Screening in Patients with Connective Tissue Diseases (Croatian National-Based Study).

The aim of this study was to develop a Croatian Delphi-based expert consensus for screening interstitial lung disease (ILD) associated with connective tissue disease (CTD). A systematic literature review was conducted on risk factors for the development of ILD, prevalence and incidence of ILD, diagnostic and screening methods for ILD, and prognosis of ILD in idiopathic inflammatory myopathy (IIM), mixed connective tissue disease (MCTD), primary Sjögren's syndrome (pSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) were performed. Based on the evidence found, experts developed questionnaires for screening and monitoring ILD in each CTD, which were provided via an online survey. Following the electronic survey, two screening algorithms were developed based on the consensus opinions. The detection strategy for ILD included high-resolution computed tomography (HRCT) in addition to pulmonary function testing for IIM, MCTD, and SSc. and pulmonary function testing for newly diagnosed pSS, RA and SLE. However, in patients with identified risk factors for ILD HRCT, these tests should also be performed. A screening strategy for early identification of patients with various CTD-ILD was first developed by a multidisciplinary team of rheumatologists, pulmonologists, and radiologists to identify early CTD patients at risk of ILD, a severe extra-articular manifestation of CTD.

Abstract 11770: Cost-Effectiveness Analysis of Coronary Artery Disease Screening in Patients With Breast Cancer

Background: Association of cardiovascular disease with cancer is caused by an increased risk of coronary artery disease (CAD), in part attributable to the association of standard risk factors with both coronary disease and cancer. In addition to these drivers of accelerated plaque formation, treatment used in breast cancer therapy is associated with CAD. Purpose: Cancer patients require an individualised approach for managing CAD and there is an unmet need to define the benefit of CAD screening on outcomes in cancer survivors and the cost-effectiveness of this approach is unknown. Methods: A Markov model was assembled using three states; well, myocardial infarction and death. Base case scenario was a 55 year old female treated for breast cancer, followed up 10 years post treatment. Costs, utilities, and transition probabilities were derived from published literature. Costs are in 2021 AUD$ and calculated from a societal perspective. Costs and utilities were discounted at 3% per annum. Sensitivity analyses were performed on key inputs including transition probabilities of well state and MI, costs of CAD and screening test. Willing-to-pay threshold of AUD$50,000 was selected. Results: Screening cancer survivors for CAD dominated no screening, providing cost savings of $1916 and QALY savings of 5.9 QALYs per-patient. Major determinants were probabilities of MI, death and costs of screening and MI. There was no change in life expectancy. Conclusion: Screening for CAD provided an increase in long-term QALY and reduction in healthcare costs in breast cancer survivors at least 10 years post treatment. ​

Artificial intelligence applications in cardio-oncology: Leveraging high dimensional cardiovascular data.

Growing evidence suggests a wide spectrum of potential cardiovascular complications following cancer therapies, leading to an urgent need for better risk-stratifying and disease screening in patients undergoing oncological treatment. As many cancer patients undergo frequent surveillance through imaging as well as other diagnostic testing, there is a wealth of information that can be utilized to assess one's risk for cardiovascular complications of cancer therapies. Over the past decade, there have been remarkable advances in applying artificial intelligence (AI) to analyze cardiovascular data obtained from electrocardiograms, echocardiograms, computed tomography, and cardiac magnetic resonance imaging to detect early signs or future risk of cardiovascular diseases. Studies have shown AI-guided cardiovascular image analysis can accurately, reliably and inexpensively identify and quantify cardiovascular risk, leading to better detection of at-risk or disease features, which may open preventive and therapeutic opportunities in cardio-oncology. In this perspective, we discuss the potential for the use of AI in analyzing cardiovascular data to identify cancer patients at risk for cardiovascular complications early in treatment which would allow for rapid intervention to prevent adverse cardiovascular outcomes.

Cardiac Magnetic Resonance Imaging-Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing.

BackgroundSome myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented.Methods and ResultsOur myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high‐degree atrioventricular block.ConclusionsCMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.

A study of bone–vascular axis in health and disease

ObjectivesThe aim was to study bone–vascular axis in health and disease.Data sourcesMedline databases (PubMed and MedScape) and all materials available in the internet were searched. The search was performed in September 2021.Study selectionThe initial search presented 120 articles. The number of studies that met the inclusion criteria was 21. The articles included both sexes and patients with bone–vascular disease.Data extractionIf the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest.Data synthesisSignificant data were collected. Then a structured review was performed.FindingIn total, 21 potentially relevant publications were included; it was found that cardiovascular and bone disease are pathophysiologically interrelated.ConclusionsCardiovascular and bone disease are pathophysiologically interrelated, even though a full understanding of the mechanisms underlying this relationship is still lacking. A better understanding of the biological link between the two processes could lead to the development of new compounds that act on both vessels and bone. Meanwhile, it would seem reasonable to consider cardiovascular disease screening in patients with advanced bone demineralization, as well as careful monitoring for signs and symptoms of cardiovascular disease in chronic kidney disease patients.

Abstract 14062: Nation-Wide Screening of Fabry Disease in Patients With Hypertrophic Cardiomyopathy in Czech Republic

Introduction: Fabry disease (FD) is a rare X-linked genetic disorder caused by α-galactosidase A (AGALA) deficiency. While "classic" variant has multisystemic manifestation, the more recently described "later-onset" variant is characterized by predominant cardiac involvement that often mimics hypertrophic cardiomyopathy (HCM). Hypothesis: Routine screening in patients with hypertrophic cardiomyopathy may detect patients with Fabry disease who are not clinically characterized by a typical multi-organ disorder. Methods: Consecutive unrelated patients with HCM were screened for FD in 16 (out of 17) cardiac centers in the Czech Republic covering specialized cardiology care from June 2017 to December 2018. AGALA activity and globotriaosylsphingosine (lyso-Gb 3 ) levels were measured in all subjects using the dry blood spot method. FD was suspected in male patients with AGALA activity <1.2μmol/h/L and in females with either low AGALA activity or lyso-Gb 3 >3.5ng/mL. Positive screening results were confirmed by genetic testing. Results: We evaluated 589 patients (390 males, 66%) with HCM (mean maximal myocardial thickness 19.1±4.3 mm). The average age was 58.4±14.7 years. In total, 17 patients (11 males, 6 females) had a positive screening results and subsequently six of them (4 males and 2 females) had a genetically confirmed pathogenic variant (total prevalence of 1.02 %). Five of these patients were carrying the p.N215S mutation known to cause a typical later-onset cardiac FD. Conclusions: We confirmed the prevalence of FD repeatedly reported in previous screening programs (approximately 1 % irrespective of gender) in a non-selected HCM population in Central Europe. Our findings advocate a routine screening for FD in all adult patients with HCM phenotype including both genders. The dry blood spot method used led to identification of clearly pathogenic variants.

Abstract PS2-32: Incidental malignant findings on pre-admission chest computed tomography scan for coronavirus disease screening in patients with breast cancer or other cancers

Abstract Background: Amidst the coronavirus disease (COVID-19) pandemic, pre-admission chest computed tomography (CT) screening has been performed for all patients (pts) scheduled for cancer surgery to prevent the nosocomial spread of COVID-19 at our cancer center in Tokyo. This strategy was employed owing to a shortage of polymerase chain reaction assay opportunities and the relatively abundant availability of CT scanning in Japan. Notably, a screening CT may reveal incidental findings that are different from the original purpose of the examination. Thus far, there are no reports of incidental malignant findings on CT scans for COVID-19 screening. Methods: This single-institutional retrospective study included pts scheduled for surgery and who underwent pre-admission CT scans for COVID-19 screening between April 26, 2020, and June 12, 2020. Clinical and radiological data of pts were extracted from medical records. Clinical data included age, sex, medical history, and treatment. All CT scans for COVID-19 screening were examined one or two days before surgery and interpreted by two trained radiologists. This study aimed to reveal the ratio of incidental findings related to malignancy. Results: Between April 26, 2020, and June 12, 2020, 863 pts underwent pre-admission CT scans for COVID-19 screening. Median patient age was 58 years (range, 11-91 years), and 511 (59%) of the pts were female. The most common disease was breast cancer (n = 165, 19%), followed by colorectal cancer (n = 108, 13%), gynecological cancer (n = 107, 12%), and other cancers (n = 483, 56%). CT scan revealed radiological findings of pneumonia in 23 pts (2.7%); therefore, surgery was postponed for these pts. Incidental findings were detected in 28 pts (3.2%), including one pneumothorax and 27 findings related to malignancies. The present study included 165 pts (19%) with breast cancer and who were scheduled for curative surgery. Among them, incidental findings related to malignancies were detected in nine pts (5.5%), including small ground-glass pulmonary nodules (GGN) (n=5), pancreatic duct dilatation (n=1), suspected vertebral metastasis (n=2) and suspected liver tumor (n=1). All pts did not undergo breast surgery but underwent additional examinations after surgery. Five pts (2.5%) with GGN needed follow-up. One patient’s pancreatic duct dilatation was diagnosed as benign using ultrasound. One patient with suspected vertebral metastasis was diagnosed with degenerative changes. The other patient was diagnosed with multiple bone metastases by bone scintigraphy, and further treatment was planned. Pre-admission screening CT scan for pts with other cancers was performed in 698 pts (81%). Among them, findings related to malignancies were detected in 18 pts (2.6%), including breast nodules (n=3), lung nodules (n=5), liver metastasis (n=1), progression of metastasis (n=3), mediastinum tumor (n=1), and GGN (n=5). Two of the three pts with breast nodules were diagnosed with invasive breast cancer and planned for breast surgery after the current cancer treatment. Two pts developed new lung metastasis, and the surgical strategy was changed. The progression of known liver or lung metastasis was detected in three pts, which led to the addition of systemic chemotherapy without modification of surgical treatment. One patient had a mediastinum tumor, and an MRI evaluation after surgery revealed an athymic cyst. Five pts were determined to have GGN, and follow-up was required. Conclusion: The proportion of pts for whom pre-admission CT for COVID-19 revealed incidental findings was 3.2%. Incidental breast cancer was found in 0.4% of female pts. GGNs needed follow-up examination in 2.5% of operable breast cancer pts. Physicians and surgeons should be aware of incidental malignant findings in the COVID-19 screening CT scan. Citation Format: Jun Masuda, Akemi Kataoka, Katsunori Oikado, Natsue Uehiro, Yukinori Ozaki, Lina Inagaki, Chieko Kato, Hidemoto Morizono, Toshimi Takano, Takayuki Ueno, Shinji Ohno. Incidental malignant findings on pre-admission chest computed tomography scan for coronavirus disease screening in patients with breast cancer or other cancers [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-32.

Early-Onset Parkinson Disease Screening in Patients From Nigeria.

Introduction: Nigeria is one of the most populated countries in the world; however, there is a scarcity of studies in patients with age-related neurodegenerative diseases, such as Parkinson disease (PD). The aim of this study was to screen patients with PD including a small cohort of early-onset PD (EOPD) cases from Nigeria for PRKN, PINK1, DJ1, SNCA multiplication, and LRRK2 p.G2019S.Methods: We assembled a cohort of 109 Nigerian patients with PD from the four main Nigerian tribes: Yoruba, Igbo, Edo, and Hausa. Fifteen cases [14 from the Yoruba tribe (93.3%)] had EOPD (defined as age-at-onset <50 years). All patients with EOPD were sequenced for the coding regions of PRKN, PINK1, and DJ1. Exon dosage analysis was performed with a multiplex ligation-dependent probe amplification assay, which also included a SNCA probe and LRRK2 p.G2019S. We screened for LRRK2 p.G2019S in the entire PD cohort using a genotyping assay. The PINK1 p.R501Q functional analysis was conducted.Results: In 15 patients with EOPD, 22 variants were observed [PRKN, 9 (40.9%); PINK1, 10 (45.5%); and DJ1, 3 (13.6%)]. Three (13.6%) rare, nonsynonymous variants were identified, but no homozygous or compound heterozygous carriers were found. No exonic rearrangements were present in the three genes, and no carriers of SNCA genomic multiplications or LRRK2 p.G2019S were identified. The PINK1 p.R501Q functional analysis revealed pathogenic loss of function.Conclusion: More studies on age-related neurodegenerative diseases are needed in sub-Saharan African countries, including Nigeria. Population-specific variation may provide insight into the genes involved in PD in the local population but may also contribute to larger studiesperformed in White and Asian populations.

Use of Noncontact Infrared Skin Thermometer for Peripheral Arterial Disease Screening in Patients With and Without Diabetes.

Peripheral arterial disease (PAD) poses a threat of limb amputation and cardiovascular events. However, PAD diagnostic procedure requiring time, cost, and technical skills preclude its application as a screening test in the general population. Although PAD tends to be associated with lower foot skin temperature, none has yet to appreciate its usefulness for diagnosis/screening. We measured foot skin temperatures at the first and fifth metatarsal head and heel areas using noncontact infrared thermometer at the time of ankle brachial pressure index (ABI) measurement and limb arterial ultrasonography in 176 patients (345 legs) in participants. Foot skin temperatures correlated with ABI and showed distinctly lower levels in legs with ultrasound-confirmed arterial stenosis/occlusion and in those with ABI ≤0.90. Receiver operating characteristics analyses revealed that the lowest temperature value of the 3-foot locations had a higher sensitivity than every single location in detecting lower extremity PAD. Diagnostic efficiency for the ABI cutoff of 0.90 showed sensitivity/specificity of 41%/94%, while that for the lowest skin temperature cutoff of 30.8°C showed sensitivity/specificity of 60%/64%. In conclusion, an accurate skin temperature measurement using noncontact handheld infrared skin thermometer could serve as a new, cost-effective screening strategy for earlier diagnosis of PAD.

Advanced fibrosis of non-alcoholic steatohepatitis affects the significance of lipoprotein(a) as a cardiovascular risk factor

Background and aimsLipoprotein(a) [Lp(a)] is an important independent cardiovascular risk factor. However, Lp(a) levels are lower in patients with chronic liver disease than in healthy subjects. Furthermore, Lp(a) levels decrease as residual liver function declines. Although non-alcoholic fatty liver disease (NAFLD), especially advanced non-alcoholic steatohepatitis (NASH), increases the risk of cardiovascular diseases, the relationship between serum Lp(a) level and NASH is unknown. Thus, we examined the relationship between serum Lp(a) levels and biopsy-proved NAFLD and clarified the significance of Lp(a) measurements for cardiovascular disease screening in patients with NAFLD. MethodsA total of 176 patients with NAFLD were enrolled. Comprehensive blood chemistry tests and histological examinations of liver samples were conducted. The relationship between serum Lp(a) levels and NAFLD was analyzed. ResultsSerum Lp(a) levels in advanced fibrosis (stage 3–4) were lower than those in non-advanced fibrosis (stage 0–2) (p < 0.05). After adjustment for age, sex, body mass index, alanine aminotransferase (ALT), creatinine (Cre), HbA1c level, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and the use of lipid-lowering agents, the significant inverse association between advanced fibrosis and serum Lp(a) levels remained (p < 0.01). Although the Lp(a) level was inversely associated with an NAFLD Activity Score (NAS) of 5–8, there was no significant association between Lp(a) levels and NAS adjusted for age, sex, body mass index, ALT, Cre, HbA1c level, HDL-C, LDL-C, TG, and the use of lipid-lowering agents. ConclusionsAdvanced NASH is associated with low serum Lp(a) levels; therefore, Lp(a) levels may not be useful in evaluating cardiovascular risk.

Screening of Fabry Disease in Patients With GI Symptoms

Screening of Fabry Disease in Patients With GI Symptoms

To Study Role of Fibroscan as a Noninvasive Tool for Screening of Liver Disease in Patients on Maintenance Haemodialysis—A Preliminary Data

To Study Role of Fibroscan as a Noninvasive Tool for Screening of Liver Disease in Patients on Maintenance Haemodialysis—A Preliminary Data

Determination of Sensitivity and Specificity of Cardio-Goniometry in Detection of Coronary Artery Disease in Patients with Osteoporosis and Rheumatoid Arthritis

Background: This study aimed to determine the sensitivity and specificity of cardio-goniometry (CGM ) in detection of coronary artery disease in patients with osteoporosis and rheumatoid arthritis that have symptoms of chest pain through angiography or radionuclide myocardial perfusion imaging (MPI). Study Methods and design:100 patients with osteoarthritis and rheumatoid arthritis, according to WHO criteria suspected to have ischemic heart disease enrolled in study. The patients were studied by cardio-goniometry and then the results were compared with angiography or MPI of the same patient (selected as standard diagnosis method). then sensitivity and specificity of cardio-goniometry were calculated. Results: 71 patients underwent to angiography and in 29 patients MPI was done. In first a group 42 patients had Coronary artery disease (CAD). In MPI group 18 patients had CAD in CGM.Seventy-one of these patients underwent angiography for diagnose of ischemic heart disease .29 of them diagnosed as healthy. Of the 100 patients, 29 patients were evaluated previously using MPI to determine ischemic heart disease .11 patients diagnosed as healthy. All 100 patients were examined by cardio-goniometry among which 47 subjects were healthy and the rest subjects had significant and nonsignificant ischemia. Statistical analyses didn’t show significant difference between the results of cardio-goniometry with angiography and myocardial perfusion (p Value &gt;0/05). the results showed the sensitivity and specificity of cardiogoniometry compared rather than angiography and cardiac scan was equal to 0/86 and 0/63. Conclusion: CGM can be suitable for screening of ischemic heart disease in patients with Rheumatoid arthritis and osteoporosis (who cannot do exercise test).

Screening of liver disease in patients with type 2 diabetes mellitus

Screening of liver disease in patients with type 2 diabetes mellitus

Su1434 Celiac Disease Screening in Patients Previously Diagnosed With Infertility. A Prospective Study in Mexican Population

Su1434 Celiac Disease Screening in Patients Previously Diagnosed With Infertility. A Prospective Study in Mexican Population