Prediction of Liver Steatosis and Fibrosis Based on Clinical Variables Using a Large National Survey Database.

Background: Vibration-controlled transient elastography (VCTA) and controlled attenuation parameter (CAP) are used more frequently to diagnose liver fibrosis and steatosis among nonalcoholic fatty liver disease patients. However, limited robust data are available on the clinical variables strongly related to these disorders and who needs to be referred for screening. Methods: We used the National Health and Nutritional Examination Survey 2017-2018 database to identify the clinical predictors strongly related to liver steatosis and advanced fibrosis. Baseline comparisons among these groups were made based on widely accepted cutoffs. Linear and logistic regressions were performed to identify the associations between the clinical variables and liver steatosis and fibrosis. We used adaptive lasso regression, gradient-boosted model, and decision trees to determine clinical variables strongly related to these outcomes. A Naïve Byes classifier and decision trees were used to calculate the predicted probabilities of liver steatosis and fibrosis. Results: 32% of our population had evidence of liver steatosis using 294 dB/m as a cutoff. An increase in age, serum triglyceride, and body mass index were associated with a statistically significant increase in liver steatosis; in contrast, females had statistically significantly lower values for liver steatosis by 15 points in the multivariable linear regression model. Serum LDL, smoking, and systolic and diastolic blood pressure are poorly associated with liver steatosis in the adaptive lasso regression. On the other hand, sex, tobacco use, metabolic energy expenditure, and serum triglyceride are the least associated with liver fibrosis based on decision tree analysis and a gradient-boosted model. In decision trees, people with a body mass index above 30 and HbA1c above 5.7 have a 72% likelihood of liver steatosis compared to 14% for people with a body mass index below 30. On the other hand, people with a body mass index above 41 have a 38% likelihood of liver fibrosis. Conclusion: Body mass index, hemoglobin A1c, serum triglyceride level, sex, and age could provide a good prediction for liver steatosis, while body mass index, blood pressure, platelet counts, hemoglobin A1c, serum LDL, or HDL are highly associated with liver fibrosis and should be used as an initial screening tool prior referral for VCTE/CAP.

Mini-mental state examination (MMSE) scores in elderly Jordanian population.

Background: The Mini-Mental State Examination (MMSE) is a simple informative and validated screening test of cognitive functions. No data of MMSE scores has been published about elderly Jordanian population. Objective: To study the MMSE scores in the elderly Jordanian population (defined as age of 50 years or more). Methods: This was a cross sectional study. A 250 healthy elderly Jordanians were interviewed and tested for their MMSE score. Their scores were analyzed and the effect of age, gender, education, marital status, diabetes mellitus (DM), hypertension (HTN), smoking, dyslipidemia, heart disease (HD), and family history of dementia (FHD) on the score was studied. Results: MMSE scores of 236 elderly subjects, aged 63±8.4 years (range 50-86 years) were analyzed. There were 111 (47%) males. There was a direct correlation between MMSE score and education level. People with a higher education (college) had the highest scores in comparison with people who are illiterates or have a high school level. The score correlated negatively with age (Pearson correlation r = -0.23, p = 0.00). Other studied variables did not correlate with score on multivariate analysis. Conclusion: Jordanians ≥50 years old with no previous brain disease scored 26.7 ± 3.2. Education was the most important determining factor of this score. the score showed also a negative correlation with age. We suggest that in this population a cut off score of 24 for those with high education beyond high school and 21 for those with up to high school education and it is not appropriate for illiterate.

Medico-legal importance of necrotizing fasciitis.

Despite the rarity of necrotizing fasciitis (NF), it is a relatively common cause of death in many lawsuits. Families seek financial compensation or legal charges against those they believe to be involved in the death, usually physicians who did not identify the infection soon enough. This paper explores six cases in forensic pathology practice where NF posed a unique medico-legal dilemma.