A prospective cohort study of the use of the fatty liver index and Fibroscan to determine the prevalence of fatty liver disease in an Irish population

OBJECTIVES

Rates of nonalcoholic fatty liver disease (NAFLD) are increasing worldwide. The fatty liver index (FLI) is a noninvasive predictor of NAFLD. This prospective cohort study used the FLI to estimate the prevalence of NAFLD in patients attending an Irish Acute Medical Unit (AMU), and assessed the degree of fibrosis in this group using Fibroscan.

METHODS

Patients attending the AMU over a 3-month period were invited to participate. Patients with excess alcohol consumption or pre-existing liver disease were excluded. Using established FLI cut-offs, 414 participants were grouped into low (FLI ≤ 30), medium (30 < FLI ≤ 60) and high (FLI > 60) risk of NAFLD. High-risk patients were offered review including liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) score.

RESULTS

A total of 134 patients were at low-risk, 96 at medium-risk and 184 at high-risk of NAFLD. Male sex (P < 0.0001) and increasing age (P < 0.0001) were associated with higher risk. Of the 120 high-risk patients who attended follow up, 13 participants had LSM > 7 kPa. Higher FLI scores were associated with higher CAP scores (P < 0.0001) but did not predict higher LSMs. Fasting glucose and HbA1c were found to be associated with higher LSM.

CONCLUSION

About 44.4% of patients presenting to the AMU were at high risk of NAFLD according to the FLI. Only 10.8% of the high-risk group, and 3% of all those recruited had a LSM > 7 kPa suggesting development of fibrosis.

Symptoms to script: delays in tuberculosis treatment in the west of Ireland

BACKGROUND

The first pillar of the End-TB Strategy is "early diagnosis and prompt treatment". Nevertheless, long delays in starting tuberculosis (TB) treatment are reported. We aimed to describe the demographics and clinical features of TB in the west of Ireland and better understand the delays in treatment.

METHODS

We conducted a retrospective chart review of all patients diagnosed with active TB who attended the Galway University Hospital (GUH) TB clinic from 2014 to 2018.

RESULTS

Eighty-five patients were diagnosed with TB and attended our clinic. Ten (12%) patients were receiving immunosuppressive therapy, 8 (9%) had drug resistance, and 41 (48%) had extra-pulmonary disease. Patients with extra-pulmonary disease had a longer length of stay before treatment (11 vs. 4 days; p = 0.006). Patients older than 55 had a longer length of stay before (16 vs. 5 days, p = 0.0001) and during (36 vs. 11 days, p = 0.004) treatment and were readmitted more frequently than younger patients. A total of 36% of patients were born outside Ireland. Non-Irish patients were younger (mean age 35 vs 48; p = 0.004) and more frequently had drug resistance (19% vs. 4%, p = 0.02). The median time from symptom onset to hospital presentation was 76 days (IQR 35-146 days) and the median time from first hospital presentation to TB treatment was 11 days (IQR 5-51 days).

CONCLUSION

TB patients experienced long symptom durations in the community prior to presentation. Many TB patients experienced delays in diagnosis and treatment following presentation. Both pre-hospital and in-hospital delays need to be addressed in order to 'End-TB'.

High prevalence of fibromyalgia in patients with HFE-related hereditary hemochromatosis

OBJECTIVES

Subjects with HFE-related hereditary hemochromatosis (HH) may present with arthralgias, fatigue, and stiffness, yet little is known on the presence of fibromyalgia syndrome (FMS) in these subjects. We determined the prevalence of FMS in a cohort of subjects with HH and evaluated its relationship to subject demographics, disease status, and quality of life.

METHODS

In a cross-sectional study we collected data on 395 consecutive subjects diagnosed with HH who were attending a tertiary referral Hepatology outpatient clinic at Galway University Hospital, Ireland (between October 2009 and June 2010). Subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability. Univariate logistic regression was applied to determine risk factors independently associated with prevalent FMS in these subjects.

RESULTS

Three hundred ninety-five subjects met the inclusion criteria. Mean age was 43 years (range, 21 to 59 y) and 260 (66%) were males. One hundred seventy (43%) of the subjects were diagnosed with FMS. Among those with fibromyalgia fatigue and ≥ 11 tender points were present in all of the subjects, widespread pain in 150 (88%), depression in 70 (41%), and arthralgia/joint stiffness in 70 (41%). In subjects with FMS 33% reported some functional impairment (HAQ-DI>0), with 10% reporting moderate-severe functional impairment (HAQ-DI ≥ 1.5).

CONCLUSIONS

This study reveals a high prevalence of FMS (43%) among subjects with HFE-related hemochromatosis. Prospective studies are needed to better understand the risk factors for FMS in such patients.