#NAFLD has effects on other conditions including DM, CVD, CKD etc due to increased hyperinsulinemia, insulin resistance, proinflammatory factors etc
How do we screen for #NAFLD and find the ones with fibrosis? A lot will be missed if just checking transaminases. FIB-4 and NFS is a better screening tool
Promising performance in using biomarkers to diagnose/screen for fibrosis. ELF with high sensitivity but low specificity to exclude fibrosis
Now on to imaging modalities -- Liver ultrasound Pros: High availability, low cost
• Cons: Not quantitative, low diagnostic accuracy for steatosis (20-30%)
VCTE -- Pros: easy to be trained and simple to use, large supporting literature, not time-consuming and
available at point-of-care
Cons: device is expensive (although testing affordable); less accurate in cases of mild fibrosis
MRE most accurate of imaging modalities to measure liver fibrosis but expensive and time consuming. LIver biopsy is still the gold standard but high cost
New AACE guideline algorithm for screening for advanced fibrosis related NAFLD
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Let's hear The Evidence For and Against Combination #Thyroid Hormone therapy by Dr. Bianco #AACE2022#Endotwitter. This conversation is controversial here are some of the main slides
Patient's on Lt4 reporting a lot of residual symptoms in energy, cognition
Normal physiology the majority of thyroid hormone production is T4 (16:1 T4:T3) and gets converted peripherally to T3 (5mcg made in thyroid, 25mcg made peripherally)
Now to talk about Phosphatonins and #phosphorus metabolism/bone disease by Dr. Kumar moderated by @sfeirjad...I'm ready to learn since admittedly I know little of this #AACE2022#Endotwitter#bone
Why bother about phosphorus? Well it plays many roles in cellular signaling and maintenance of membrane structure of #bone. Low concentrations associated with rhabdo, decreased cardiac function and bone dysfunction (#osteomalacia, #rickets). low and high phos causes bone disease
High Phos Concentrations are Associated with CV Disease and Excess Mortality in CRF and decreasing levels reduces CV mortality
Look how far we have come in #diabetes technology and there is still a lot more to go #AACE2022. #CGM technology has been a game changer and the accuracy continues to improve with each generation
So what's new in the pipeline for #diabetes technology? Let me tell you starting with #dexcom G7. It will be smaller with a better MARD, better warm up and ALL-IN-ONE applicator and transmitter! Just pending FDA review #AACE2022#endotwitter#medtwitter
NAFLD is a spectrum that includes NASH. First rule out secondary causes.
Difference between NAFL and NASH? NAFL is just the accumulation of fat w/o ballooning or much inflamation. NASH has hepatocyte changes from ballooning and inflammation. IIt is staged also based on fibrosis (F0-F4)