Determination of nonalcoholic fatty liver disease in patients with pre-impaired glucose tolerance

INTRODUCTION: Pre-impaired  glucose  tolerance  (pre-IGT) or  compensated  hyperinsulinemia,  is  defined  as  normal glucose,  and  elevated  insulin  two  hours  after  a  75-gram oral glucose load.  It is characteristic of the early stages of diabetes  mellitus  (DM),  where  beta  cells  compensate  for  insulin resistance by increasing insulin secretion to maintain normoglycemia. With  continuing  beta  cell  failure,  insulin  secretion  eventually  fails,  leading  to  the  progression  to diabetes.    Nonalcoholic  fatty  liver  disease  (NAFLD),  a common feature of insulin resistance, is found in 50-75% and 42-55% of DM and pre-diabetes patients. We determined if NAFLD was present in patients with pre-IGT.METHOD: A study on the determination of NAFLD - diagnosed by liver ultrasound in pre-IGT patients at a university hospital.Descriptive statistics, Chi square test of independence, 2x2 Fischer  Exact  test,  Z  test  of  difference  in  proportion, were used  for  statistical  analysis  with  a  p-value  set  at  0.05?.IBMSPSS ver 21 was used as software.RESULTS:The mean age of 22 patients was 29.95 years, with average BMI of 25.73 kg/m2;77.3% were female.  Average lipid  panels  were  within  optimal  limits;  kidney  and  liver functions were normal.  The mean insulin level was 58.36 uIU/mL. NAFLD was identified in eight of the subjects. CONCLUSION: Although  pre-IGT  is  a  subclinical  phase  in  the  diabetes  spectrum,  36%  already  have  NAFLD.This prevalence  was  lower  compared  to  diabetics  and  pre-diabetics, but higher compared to the general population.There was a noticeable trend of increasing insulin levels with increasing severity of fatty liver.

Clinical practice guidelines on the diagnosis and treatment of gastroesophageal reflux disease (GERD)

In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.