Other poster session 18
Track 18
| Sunday, October 29, 2023 |
| 1:30 PM - 1:55 PM |
| Exhibition Hall |
Speaker
Dr Hyejung Lee
Seoul St. Mary’s Hospital, College Of Medicine, The Catholic University Of Korea, Seoul, Korea
HOMA-IR as a Potential Screening Tool for Non-Alcoholic Fatty Liver Disease in Non-Diabetic Adults: Insights from a Korean Population Study
Summary
Background:
NAFLD (Non-Alcoholic Fatty Liver Disease) is a disease that is rapidly increasing in prevalence worldwide and can progress to end-stage liver disease such as liver cirrhosis or HCC (hepatocellular carcinoma). This study evaluated the relationship between NAFLD and Insulin Resistance and aimed to evaluate the accuracy of HOMA-IR for NAFLD in non-diabetic Korean adults and estimate the optimal cut-off value for discriminating NAFLD from non-NAFLD.
Methods:
Subjects
The National Health and Nutrition Examination Survey 2019~2021 raw data were used. Among a total of 22,559 samples, 12,924 people who aged 19 years or older, without diabetes, without high-risk drinking, and without liver disease (hepatitis B, hepatitis C, cirrhosis, HCC) were selected.
Statistical analysis
The chi-square test, logistic regression, and receiver operating characteristic (ROC) curves were conducted to determine the relationship between HOMA-IR and NAFLD, as well as the optimal cut-off value for identifying NAFLD.
Results:
An association between HOMA-IR and NAFLD was found (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.53 to 2.04, p<.001), independently of general characteristics, triglyceride levels, and BMI. The AUROC curve of HOMA-IR for identifying NAFLD was 76.3%. The optimal threshold of HOMA-IR for discriminating NAFLD from non-NAFLD was 1.665.
Conclusion:
HOMA-IR is independently associated with the presence of NAFLD in adults without diabetes, and might potentially be applied in clinical practice as a screening tool. In order to generalize these results, well-designed prospective studies based on a large population sample should be performed in the future.
NAFLD (Non-Alcoholic Fatty Liver Disease) is a disease that is rapidly increasing in prevalence worldwide and can progress to end-stage liver disease such as liver cirrhosis or HCC (hepatocellular carcinoma). This study evaluated the relationship between NAFLD and Insulin Resistance and aimed to evaluate the accuracy of HOMA-IR for NAFLD in non-diabetic Korean adults and estimate the optimal cut-off value for discriminating NAFLD from non-NAFLD.
Methods:
Subjects
The National Health and Nutrition Examination Survey 2019~2021 raw data were used. Among a total of 22,559 samples, 12,924 people who aged 19 years or older, without diabetes, without high-risk drinking, and without liver disease (hepatitis B, hepatitis C, cirrhosis, HCC) were selected.
Statistical analysis
The chi-square test, logistic regression, and receiver operating characteristic (ROC) curves were conducted to determine the relationship between HOMA-IR and NAFLD, as well as the optimal cut-off value for identifying NAFLD.
Results:
An association between HOMA-IR and NAFLD was found (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.53 to 2.04, p<.001), independently of general characteristics, triglyceride levels, and BMI. The AUROC curve of HOMA-IR for identifying NAFLD was 76.3%. The optimal threshold of HOMA-IR for discriminating NAFLD from non-NAFLD was 1.665.
Conclusion:
HOMA-IR is independently associated with the presence of NAFLD in adults without diabetes, and might potentially be applied in clinical practice as a screening tool. In order to generalize these results, well-designed prospective studies based on a large population sample should be performed in the future.
Biography
Dr Lidia Ferrer Luna
Es Castell primary care health centre
Doctor, I am young to have hematuria, what is going on?
Summary
26-year-old man who consulted for episodes of asthenia and hematuria coinciding with the practice of sports and overexertion one year ago. He associates intermittent episodes of colicky pain in the lumbar region radiating to the left flank, similar to renoureteral colic, previously evaluated by urologists who did not observe lithiasis.
Denies use of nephrotoxic drugs or toxic substances. No relevant personal or family history.
Physical examination was normal. Blood analysis without significant findings. Clear urinary sediment hematuria without leukocytes or proteinuria, without dysmorphic red blood cells or blood casts. Sonographically, a decrease in the exit angle of the superior mesenteric artery and dilation of the left renal vein were detected. The patient was referred to the nephrology service.
It is important to make the differential diagnosis with lithiasis, congenital vascular malformations, tumors, infections, parenchyma or urinary tract anomalies, pelvic pain syndromes and alterations of neighboring organs or structures.
Angio-CT was requested to confirm the diagnostic impression of “nutcracker syndrome”.
Treatment depends on the intensity of the bleeding. When there are intermittent bleeding without anemia, conservative treatment will be chosen, especially if they are young patients.
In cases of abdominal pain, gross hematuria with anemia, or the presence of congestive symptoms, interventional treatments with endovascular techniques or open surgery can be considered.
In discussion with patient, conservative management was chosen, with periodic controls and analgesics on demand, without ruling out the indication for endovascular or surgical treatment in the future, depending on the evolution.
.Conclusions:
Nutcracker syndrome is a rare disorder consisting of entrapment of the left renal vein and manifested by pain and / or hematuria in patients of both sexes. In our primary care consultation we must take this syndrome into account after ruling out the most frequent causes of intermittent hematuria in a young patient.
Denies use of nephrotoxic drugs or toxic substances. No relevant personal or family history.
Physical examination was normal. Blood analysis without significant findings. Clear urinary sediment hematuria without leukocytes or proteinuria, without dysmorphic red blood cells or blood casts. Sonographically, a decrease in the exit angle of the superior mesenteric artery and dilation of the left renal vein were detected. The patient was referred to the nephrology service.
It is important to make the differential diagnosis with lithiasis, congenital vascular malformations, tumors, infections, parenchyma or urinary tract anomalies, pelvic pain syndromes and alterations of neighboring organs or structures.
Angio-CT was requested to confirm the diagnostic impression of “nutcracker syndrome”.
Treatment depends on the intensity of the bleeding. When there are intermittent bleeding without anemia, conservative treatment will be chosen, especially if they are young patients.
In cases of abdominal pain, gross hematuria with anemia, or the presence of congestive symptoms, interventional treatments with endovascular techniques or open surgery can be considered.
In discussion with patient, conservative management was chosen, with periodic controls and analgesics on demand, without ruling out the indication for endovascular or surgical treatment in the future, depending on the evolution.
.Conclusions:
Nutcracker syndrome is a rare disorder consisting of entrapment of the left renal vein and manifested by pain and / or hematuria in patients of both sexes. In our primary care consultation we must take this syndrome into account after ruling out the most frequent causes of intermittent hematuria in a young patient.
Takeaways
1. Hematuria 2. Colic pain 3. Compression of the left renal vein
Biography
It is Lidia, born in Biar a beautiful mountain village in the interior of Alicante, on her father's side with Valencian roots. She is a lover of paella, nougat and of course, Fallas and the festivities of Moors and Christians.
She is the youngest of four siblings spread around the world.
She is an inveterate traveler and nature lover. His unfinished business, music
She has been a volleyball player and in general an athlete.
As a child she always loved to "cure" her dolls, so much so that at the end of her basic studies, she went to Valencia to study Medicine at the Catholic University of Valencia. After 6 years, she prepared for a year, the exam to perform the specialty. Finally, she got her place as an internal resident doctor on a beautiful Mediterranean island, Menorca, where she is now in the last year of her residency. She loves her work.
Dr Lidia Ferrer Luna
Es Castell primary care health centre
It's not always what it seems.
Summary
A 79-year-old woman consulted in the emergency room due to two months of evolution of increasing watery diarrhea. In recent days, he explains marked prostration, sporadic vomiting and increased depositional rhythm with evacuation of watery consistency stools practically on an hourly basis, without thermometring fever.
As a history he has type 2 diabetes mellitus with suboptimal poor metabolic control on treatment with empagliflozin and sitagliptin / metformin. Hypertensive, dyslipidemic and obese. Moreover, she has atrial fibrillation being treated with acenocumarol.
Physical examination revealed a state of dehydration. Diffuse discomfort on palpation of the abdomen, without defense. Rest of nondescript exploration
Analytically mild leukocytosis with moderate elevation of acute phase reactants. Acute renal failure with severe metabolic acidosis. Rehydration is started with intravenous fluid, bicarbonate replacement and antibiotic therapy, maintaining hypotension and in a state of anuria.
He was admitted to the ICU, after persistence of hypotension norepinephrine was administered.
In the following hours, evolution to shock (septic + vasoplegia secondary to vasodilator drugs + hypovolemic secondary to dehydration) that requires aggressive fluid replacement and norepinephrine infusion impresses. Acute anuric renal failure persists with metabolic acidosis requiring extrarenal clearance with hemofilter that is suspended after three days.
After recovery, he went to the hospitalization ward where he presented a favorable course, so he was discharged with a diagnosis of diarrhea probably induced by metformin that was complicated by renal failure due to the unfavorable contributory effect of antihypertensive and antidiabetic. It is important to think about the different causes of diarrhea.
Conclusion
Diabetes mellitus is one of the most prevalent diseases worldwide, the main drug used is metformin, being one of the most related to diarrheal stools as an adverse effect. The most serious complication associated with metformin is lactic acidosis.
As a history he has type 2 diabetes mellitus with suboptimal poor metabolic control on treatment with empagliflozin and sitagliptin / metformin. Hypertensive, dyslipidemic and obese. Moreover, she has atrial fibrillation being treated with acenocumarol.
Physical examination revealed a state of dehydration. Diffuse discomfort on palpation of the abdomen, without defense. Rest of nondescript exploration
Analytically mild leukocytosis with moderate elevation of acute phase reactants. Acute renal failure with severe metabolic acidosis. Rehydration is started with intravenous fluid, bicarbonate replacement and antibiotic therapy, maintaining hypotension and in a state of anuria.
He was admitted to the ICU, after persistence of hypotension norepinephrine was administered.
In the following hours, evolution to shock (septic + vasoplegia secondary to vasodilator drugs + hypovolemic secondary to dehydration) that requires aggressive fluid replacement and norepinephrine infusion impresses. Acute anuric renal failure persists with metabolic acidosis requiring extrarenal clearance with hemofilter that is suspended after three days.
After recovery, he went to the hospitalization ward where he presented a favorable course, so he was discharged with a diagnosis of diarrhea probably induced by metformin that was complicated by renal failure due to the unfavorable contributory effect of antihypertensive and antidiabetic. It is important to think about the different causes of diarrhea.
Conclusion
Diabetes mellitus is one of the most prevalent diseases worldwide, the main drug used is metformin, being one of the most related to diarrheal stools as an adverse effect. The most serious complication associated with metformin is lactic acidosis.
Takeaways
1. The most serious complication associated with metformin is lactic acidosis.
2. Make good differential diagnosis of the patient
3. Comprehensive vision of the patient in the face of an ailment.
2. Make good differential diagnosis of the patient
3. Comprehensive vision of the patient in the face of an ailment.
Biography
It is Lidia, born in Biar a beautiful mountain village in the interior of Alicante, on her father's side with Valencian roots. She is a lover of paella, nougat and of course, Fallas and the festivities of Moors and Christians.
She is the youngest of four siblings spread around the world.
She is an inveterate traveler and nature lover. His unfinished business, music
She has been a volleyball player and in general an athlete.
As a child she always loved to "cure" her dolls, so much so that at the end of her basic studies, she went to Valencia to study Medicine at the Catholic University of Valencia. After 6 years, she prepared for a year, the exam to perform the specialty. Finally, she got her place as an internal resident doctor on a beautiful Mediterranean island, Menorca, where she is now in the last year of her residency. She loves her work.
Dr Lidia Ferrer Luna
Es Castell primary care health centre
The importance of making a good differential diagnosis
Summary
A 63-year-old male patient who consults for presenting time evolution pruritic, scaly erythematous lesions of patchy and erratic distribution throughout the body but more marked in the thighs, buttocks and sacral area.
He denies medical-surgical history of interest. Former smoker. Occasional enolic habit.
Interrogating the patient, during the last 2-3 years he has presented similar lesions without peeling that he begins to treat with oral antihistamines and topical corticosteroids with good response after consulting with his doctor. He used this treatment on demand according to the intensity of erythema or pruritus. The injuries never went away, after worsening, he consulted again..
On suspicion of psoriasis is suspected, calcipotriol-betamethasone is prescribed in foam and heliotherapy agreeing to review at 3 weeks. In the review, modest improvement is observed. Blood tests show no significant findings
At 2 months he consults again for persistence of the clinic, so he is referred to Dermatology, who perform biopsy of one of the lesions, objectivating in the pathological anatomy small cells with cerebriform nucleus with epidermotropism.
The patient is diagnosed with mycosis fungoides.
It can be misdiagnosed as contact dermatitis, psoriasis or atopic dermatitis.
There are currently multiple treatments for mycosis fungoides that vary according to the stage of the disease. It is important to individualize therapies. For almost 30 years, photochemotherapy (psoralen and ultraviolet A radiation, PUVA) has been the treatment used for mycosis fungoides.
The patient received skin treatment with PUVA in the hematology unit.
Conclusions
In daily clinical practice, it is of vital importance to make a good differential diagnosis at an early stage, since the delay in diagnosis can lead to systemic commitment of the patient, with alteration of the general condition, severe dermatological compromise and significant weight loss, adding the risk that entails the predisposition to superinfections.
He denies medical-surgical history of interest. Former smoker. Occasional enolic habit.
Interrogating the patient, during the last 2-3 years he has presented similar lesions without peeling that he begins to treat with oral antihistamines and topical corticosteroids with good response after consulting with his doctor. He used this treatment on demand according to the intensity of erythema or pruritus. The injuries never went away, after worsening, he consulted again..
On suspicion of psoriasis is suspected, calcipotriol-betamethasone is prescribed in foam and heliotherapy agreeing to review at 3 weeks. In the review, modest improvement is observed. Blood tests show no significant findings
At 2 months he consults again for persistence of the clinic, so he is referred to Dermatology, who perform biopsy of one of the lesions, objectivating in the pathological anatomy small cells with cerebriform nucleus with epidermotropism.
The patient is diagnosed with mycosis fungoides.
It can be misdiagnosed as contact dermatitis, psoriasis or atopic dermatitis.
There are currently multiple treatments for mycosis fungoides that vary according to the stage of the disease. It is important to individualize therapies. For almost 30 years, photochemotherapy (psoralen and ultraviolet A radiation, PUVA) has been the treatment used for mycosis fungoides.
The patient received skin treatment with PUVA in the hematology unit.
Conclusions
In daily clinical practice, it is of vital importance to make a good differential diagnosis at an early stage, since the delay in diagnosis can lead to systemic commitment of the patient, with alteration of the general condition, severe dermatological compromise and significant weight loss, adding the risk that entails the predisposition to superinfections.
Takeaways
Psoriasis; mycosis fungoides; Cutaneous T-cell lymphoma
Biography
It is Lidia, born in Biar a beautiful mountain village in the interior of Alicante, on her father's side with Valencian roots. She is a lover of paella, nougat and of course, Fallas and the festivities of Moors and Christians.
She is the youngest of four siblings spread around the world.
She is an inveterate traveler and nature lover. His unfinished business, music
She has been a volleyball player and in general an athlete.
As a child she always loved to "cure" her dolls, so much so that at the end of her basic studies, she went to Valencia to study Medicine at the Catholic University of Valencia. After 6 years, she prepared for a year, the exam to perform the specialty. Finally, she got her place as an internal resident doctor on a beautiful Mediterranean island, Menorca, where she is now in the last year of her residency. She loves her work.
