Deaconess Clinic

Abstract Disclosure: H. Ayesh: None. K.D. Niswender: None. B.G. Carranza Leon: None. Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) poses a growing global health threat. The surge in NAFLD, often linked to metabolic disorders such as diabetes and obesity, underscores the urgency for effective screening methods. Traditional approaches rely on indicators that involve elevated BMI and/or liver function tests to identify individuals at risk of NAFLD. The Triglyceride-Glucose Index (TyG Index), calculated as ln(Fasting Triglycerides × Fasting Glucose/2), may be a promising NAFLD risk prediction tool. Our study aims to investigate the correlation between the TyG Index and NAFLD in the normal BMI population, utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods: A total of 1130 subjects with a normal Body Mass Index (BMI) (18.5 - 24.9) were selected from the NHANES study. The primary goal was to explore the correlation between hepatic steatosis and the Triglyceride-Glucose (TyG) index. The study population was categorized into TyG quartiles. Regression analysis was conducted while controlling for confounding variables such as BMI, Hemoglobin A1c, and age. Hepatic steatosis was evaluated using the Fibroscan technique, with the Median Controlled Attenuation Parameter (CAP) as the quantitative indicator. Results/Discussion: The study found a significant correlation between steatosis and the Triglyceride-Glucose Index (TyG), with an odds ratio of 3.75, a P-value < 0.001 between the lowest and highest quartile, and a confidence interval of 2.385 to 5.99. This correlation increased across higher quartiles (2-1, 3-1, 4-1) with odds ratios of 1.34, 1.91, and 3.75, revealing a dose-response relationship with higher TyG. These findings remained significant after adjusting for BMI and hemoglobin A1c, key NAFLD risk factors. The TyG index is valuable for identifying high-risk NAFLD patients, especially those with a normal BMI. Unlike other calculators like Fatty Liver Index and Hepatic Steatosis Index, TyG does not rely on BMI. The study unveiled a racial difference in the correlation between TyG and NAFLD, with a weaker TyG-NAFLD association in African Americans and a stronger one in Asians. This discovery emphasizes the need for future large-scale studies to explore potential genetic components and the potential of the TyG index to modulate genetic predisposition to NAFLD. Presentation: 6/2/2024

When redness of the auricle is present, the main differential diagnoses are erysipelas, Ramsay-Hunt syndrome, relapsing polychondritis, and chilblain lupus. The pathogenesis of red ears can be inferred by careful anatomical observation. Making the correct diagnosis is important because the treatment and prognosis vary according to the cause.

High-specificity colorectal cancer screening is desirable to triage patients <50 years for colonoscopy; however, most endorsed colorectal cancer screening tests have not been rigorously evaluated in younger populations. This prospective cross-sectional study determined the specificity of the multitarget stool DNA (mt-sDNA) test in an average-risk screening population of 45 to 49 year-olds. Specificity was the primary outcome and was measured in participants without colorectal cancer or advanced precancerous lesions [APL- advanced adenomas (AA), and sessile serrated lesions ≥10 mm], and in the subgroup of participants with negative colonoscopic findings. APL sensitivity was a secondary outcome. The evaluable cohort included those who completed the study without protocol deviations and had a usable mt-sDNA test. Of 983 enrolled participants, 816 formed the evaluable cohort, with a mean age of 47.8 (SD, 1.5) years; 47.7% were women. No participants had colorectal cancer, 49 had APL, 253 had nonadvanced adenomas (NAA), and 514 had negative colonoscopic findings. mt-sDNA test specificity was 95.2% (95% CI, 93.4-96.6) in participants with NAA or negative findings [96.3% (confidence interval (CI), 94.3%-97.8%)] in those with negative findings, and did not differ by sex (P = 0.75) or race (P = 0.36) in participants with NAA or negative findings. Sensitivity for APL was 32.7% (CI, 19.9-47.5%), with most APL (83.7%) measuring 10-19 mm and none having high-grade dysplasia. The area under the ROC curve for discriminating between APL and lesser findings was 0.72 (CI, 0.64-0.81). mt-sDNA's high specificity would help minimize risk from unnecessary diagnostic procedures in this age group. This study shows that mt-sDNA has high specificity among average-risk 45 to 49-year olds, supporting its use as a noninvasive option for colorectal cancer screening. PREVENTION RELEVANCE: This study shows that mt-sDNA has high specificity among average-risk 45-49 year olds, supporting its use as a non-invasive option for colorectal cancer screening.

Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

Severe acne vulgaris has limited therapeutic options. To evaluate photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL, 80 mg g(-1) ) as the photosensitizer in severe facial acne. A double-blind, randomized, vehicle-controlled multicentre trial in 153 patients (aged 12-35 years) with severe facial acne [Investigator's Global Assessment (IGA) score 4; 25-75 inflammatory lesions with ≤ 3 nodules; 20-100 noninflammatory lesions]. Treatment (four treatments 2 weeks apart) involved incubation with MAL (n = 100) or vehicle cream (n = 53) for 1·5 h under occlusion, then illumination (635-nm red light, total dose 37 J cm(-2) ). IGA assessment and standardized lesion counts were performed before each treatment and 12 weeks after the first treatment. Treatment success was defined as improvement from baseline in IGA by ≥ 2 grades at 12 weeks. Safety assessments were for pain (10-cm visual analogue scale, immediately after illumination), erythema (four-point rating scale) and adverse events. At 12 weeks, PDT using MAL 80 mg g(-1) reduced inflammatory lesions vs. vehicle PDT (mean change -15·6 vs. -7·8, P = 0·006; mean percentage change -37·3% vs. -16·2%, P = 0·003). However, noninflammatory lesions did not decrease significantly (mean change -11·8 vs. -10·7, P = 0·85; mean percentage change -28·6% vs. -24·9%, P = 0·72). Treatment success rates were greater with MAL-PDT 80 mg g(-1) (44% vs. 26%, P = 0·013). Pain was low and manageable by briefly pausing illumination. There was similar pain or erythema with successive treatments. PDT using topical MAL 80 mg g(-1) and red light may offer promise for severe acne vulgaris.

This paper is reflective and deals with how societies view child sexual abuse through different cultural lenses. The deficits we subconsciously hold can impact, not only our personal views, but our teaching and our treatment methodologies. The purpose is to initiate discussion that will encourage more research on this subject. The objective is to enable practitioners to better recognize the psychological trauma accentuated by violence and sexual abuse and thus allow for better designed treatment programs. Central to this exploration is the concept of deficit ideology. The importance of understanding structural, cultural, and perhaps religious differences that shape ideas about child sexual abuse is stressed.

Gamma-glutamyltransferase (γ-GT) is used as a marker of alcohol-related pathology, while γ-GT is recently considered to be an oxidative stress marker. The present study aimed to investigate the correlation between the oxidative status and γ-GT levels, in association with menopausal stages. In total, 252 women, who were subjectively healthy, were divided into three groups: premenopausal, perimenopausal, and postmenopausal. The circulating oxidative status was evaluated by the diacron-reactive oxygen metabolite (d-ROM) test. In addition to serum γ-GT, routine blood investigations, including lipid, glucose, and inflammatory parameters, were performed. The median γ-GT level was 17U/L and the mean d-ROM level was 335 Carr U in all subjects. On multiple regression analysis, independent significant positive correlations were observed between d-ROM and high-sensitivity CRP levels in three groups, while there was a significant positive correlation between d-ROM and γ-GT levels only in the premenopausal group but not in the perimenopausal and postmenopausal groups. The significant relationship between d-ROM and γ-GT at active estrogen stage may indicate a different oxidative stress condition by memopausal stage. The reasons of this relationship should be further explored. A positive relationship between d-ROM and γ-GT levels, both as known as oxidative stress-related markers, could exist in premenopausal women.

Objective of the present study is to determine the estrogenic effect of isoflavone on vaginal epithelia and bone metabolism in early postmenopausal women. Twenty-two postmenopausal women were randomly assigned to either a group that was given isoflavone extract (61.8 mg) for three months or a control group that was given placebo. We measured the L2-4 bone mineral density (BMD) before and 3 months after treatment by dual X-ray absorptiometry (DXA). Blood and urine samples were obtained from the women before and 3 months after treatment. We measured FSH using radioimmunoassay and, urinary pyridinoline and deoxypyridinoline levels by HPLC. For endocrine cytology, vaginal smears were collected before and 3 months after the treatment. Three months after the treatment, the serum FSH levels and the BMD values did not significantly differ between the two groups. Urinary excretion of isoflavone was significantly higher in the group given isoflavone compared with that given placebo (p<0.03). Numbers of parabasal and intermediate types of cells were significantly decreased (58.2 +/- 12.4% to 25.0 +/- 10.7%; p<0.05) and increased (24.1 +/- 8.7% to 63.7 +/- 10.7%; p<0.05), respectively in the isoflavone group, but remained unchanged in the control group. Urinary pyridinoline excretion was significantly decreased (49.6% vs. before, p<0.01 by paired t-test) in the isoflavone group. The intake of 60 mg of isoflavone daily for 3 months produced maturational changes of vaginal epithelia without affecting serum FSH levels, and could possibly slow down bone turnover rates as judged by decreased urinary pyridinoline excretion.