Risk factors associated with nonalcoholic fatty liver disease evaluated by elastography in patients with type 2 diabetes

ABSTRACT Objective: There is controversy about the indication for nonalcoholic fatty liver disease (NAFLD) screening in patients with type 2 diabetes mellitus (T2D). The present study aims to contribute to NAFLD surveillance in patients with T2D, assessing the association of clinical and biological variables with hepatic stiffness and steatosis. Subjects and methods: A cross-sectional design was used, with data collection from electronic medical records, including adults with T2D who underwent transient elastography (TE) between June 2018 and December 2019. Liver stiffness and steatosis were evaluated using TE and controlled attenuation parameter (CAP), respectively, with cutoff points > 8 kpa for increased stiffness and > 275 dBm for steatosis. The relationship between clinical variables and elastography results were evaluated by bivariate correlation and multivariate analysis, using SPSS 27. Seventy-nine patients (n = 79) met the inclusion and exclusion criteria. Results: Advanced fibrosis and hepatic steatosis were detected in 17,7% and in 21,5% of the patients, respectively. There was a direct and significant correlation between CAP and BMI, waist circumference, HbA1c, triglycerides levels, and insulin doses and an inverse correlation with HDL. The waist circumference, low levels of HDL cholesterol and the insulin dose maintained a significant association with CAP values in multivariate analysis. Elastography values showed an inverse correlation with HDL and a direct correlation with BMI and insulin dose. The association was only maintained for the insulin dose in multivariate analysis. Conclusion: Our results suggest that clinical factors such as insulin dose, waist circumference, and HDL cholesterol levels could identify T2D patients more likely to present NAFLD.

Creating and Validating Educational Material for Patients Undergoing Orthognathic Surgery

PURPOSE: To create and validate educational material for patients undergoing orthognathic surgery. METHODS: The design included five phases: (a) a review of the literature regarding surgical complications; (b) gathering information on the needs of patients through blogs and virtual communities; (c) evaluating patient perceptions of the post-operative period through a focus group; (d) obtaining information through specialists using the Delphi technique and validation by judges; and (e) validation by patients in terms of understanding the exhibited material. RESULTS: The first three phases of the study and the first round of the Delphi technique assisted in generating the perioperative patient booklet. The following rounds of the Delphi technique introduced modifications to improve the material, with the judges agreeing on the final material to be validated by patients. CONCLUSION: Creating a booklet involves more than simply writing summarized ideas on a paper and handing it to the patient. One must understand the population, involve the relevant professionals, and obtain high-quality graphic aids for this type of educational material.