Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Has the Time Come for Cardiologists to Be Hepatologists?

Nonalcoholic fatty liver disease (NAFLD) is prevalent in people with the metabolic syndrome and type 2 diabetes and is present in up to one-third of the general population. Evidence is now accumulating that NAFLD is associated with obesity and diabetes and may serve as a predictor of cardiovascular disease (CVD). The possible mechanisms linking NAFLD and CVD include inflammation and oxidative stress, hyperlipidaemia, insulin resistance, and direct impact of NAFLD on coronary arteries and left ventricular dysfunction. In addition, several studies suggest that NAFLD is associated with high risk of CVD and atherosclerosis such as carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the metabolic syndrome. It is not yet clear how treatment of NAFLD will modulate the risk of CVD. Furthermore, studies are urgently needed to establish (i) the pathophysiology of CVD with NAFLD and (ii) the benefit of early diagnosis and treatment of CVD in patients with NAFLD. In the absence of biochemical markers, it is crucial that screening and surveillance strategies are adopted in clinical practice in the growing number of patients with NAFLD and at risk of developing CVD. Importantly, the current evidence suggest that statins are safe and effective treatment for CVD in individuals with NAFLD

Nonalcoholic fatty liver disease and cardiovascular disease: has the time come for cardiologists to be hepatologists? J Obes. 2012;2012:483135 doi: 10.1155/2012/483135. Epub 2012 Dec 23

Nonalcoholic fatty liver disease (NAFLD) is prevalent in people with the metabolic syndrome and type 2 diabetes and is present in up to one-third of the general population. Evidence is now accumulating that NAFLD is associated with obesity and diabetes and may serve as a predictor of cardiovascular disease (CVD). The possible mechanisms linking NAFLD and CVD include inflammation and oxidative stress, hyperlipidaemia, insulin resistance, and direct impact of NAFLD on coronary arteries and left ventricular dysfunction. In addition, several studies suggest that NAFLD is associated with high risk of CVD and atherosclerosis such as carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the metabolic syndrome. It is not yet clear how treatment of NAFLD will modulate the risk of CVD. Furthermore, studies are urgently needed to establish (i) the pathophysiology of CVD with NAFLD and (ii) the benefit of early diagnosis and treatment of CVD in patients with NAFLD. In the absence of biochemical markers, it is crucial that screening and surveillance strategies are adopted in clinical practice in the growing number of patients with NAFLD and at risk of developing CVD. Importantly, the current evidence suggest that statins are safe and effective treatment for CVD in individuals with NAFLD

Nonalcoholic fatty liver disease and risk of diabetes and cardiovascular disease: What is important for primary care physicians?

Nonalcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in Western World and across the globe. NAFLD prevalence is estimated to be around one-third of the total population. There are no published data that project the future prevalence of NAFLD, but with an increase in epidemic of diabetes and obesity, it is possible to suggest an increase in a number of individuals with NAFLD. NAFLD is associated with insulin resistance and occurs with an increase in cluster of features of metabolic syndrome and type 2 diabetes. Therefore, it is important to exclude the possibility of diabetes in those individuals with evidence of fatty liver. The global diabetes epidemic continues to grow, and it is estimated that the number of people with diabetes will double by year 2030. NAFLD is also a risk factor for an increase in cardiovascular incidence independent of age, sex, low-density lipoprotein-cholesterol, smoking, and cluster of metabolic syndromes. It is expected that NAFLD will be an important challenge for health providers in the near future. Taking all these factors into consideration, we believe that increasing awareness of metabolic and cardiovascular impact of NAFLD among general practitioners and health authorities may decrease the serious consequences of late diagnosis of NAFLD. Importantly, the collaboration between medical specialties is vital in decreasing the impact of the epidemic of NAFLD. The focus of this review is in the role of primary care physician in diagnosis, treatment and prevention of NAFLD and patients education

Frequency of breast cancer among Sudanese patients with breast palpable lumps

Background: Breast cancer mortality is high in Sudan and most patients are detected at later stages of the disease due to the lack of awareness and absence of screening programs. This study aimed to determine the pattern and frequency of breast cancer among patients presenting with palpable breast lumps within one year duration. Settings and Design: As a part of the continuous development in cancer management, this descriptive longitudinal study was conducted in Khartoum, Sudan. Methods and Materials: We obtained information (patient\u2032s personal data) and Fine-Needle Aspiration (FNA) materials, for occurrence of 200 breast lesions in patients. Statistical Analysis Used: Data were analyzed by using a computer SPSS program. Results: The diagnoses of the 200 breast lesions were as follows: 68 (34%) were malignant, 56 cases (28%) were fibroadenoma, 23 cases (11.5%) were fibrocystic change, 22 cases (11%) were inflammatory lesions (including mastitis and abscess formation), 12 cases (6%) were benign cysts and the remaining 19 patients (9.5%) were with lactation changes (8 cases), lipoma (6 cases), gynecomastia (3 cases) and phyllodes tumor (2 cases). Regarding gender, only 6 patients (0.03%) were males of whom 3 (50%) were diagnosed with gynecomastia. Conclusions: The frequency of advanced breast cancer among patients with breast lesions is high, in this subset of patients, which signals the urgency for implementation of breast screening programs

Frequency of breast cancer among Sudanese patients with breast palpable lumps

Background: Breast cancer mortality is high in Sudan and most patients are detected at later stages of the disease due to the lack of awareness and absence of screening programs. This study aimed to determine the pattern and frequency of breast cancer among patients presenting with palpable breast lumps within one year duration. Settings and Design: As a part of the continuous development in cancer management, this descriptive longitudinal study was conducted in Khartoum, Sudan. Methods and Materials: We obtained information (patient′s personal data) and Fine-Needle Aspiration (FNA) materials, for occurrence of 200 breast lesions in patients. Statistical Analysis Used: Data were analyzed by using a computer SPSS program. Results: The diagnoses of the 200 breast lesions were as follows: 68 (34%) were malignant, 56 cases (28%) were fibroadenoma, 23 cases (11.5%) were fibrocystic change, 22 cases (11%) were inflammatory lesions (including mastitis and abscess formation), 12 cases (6%) were benign cysts and the remaining 19 patients (9.5%) were with lactation changes (8 cases), lipoma (6 cases), gynecomastia (3 cases) and phyllodes tumor (2 cases). Regarding gender, only 6 patients (0.03%) were males of whom 3 (50%) were diagnosed with gynecomastia. Conclusions: The frequency of advanced breast cancer among patients with breast lesions is high, in this subset of patients, which signals the urgency for implementation of breast screening programs

An outbreak of cutaneous leishmaniasis among a displaced population in North Sudan: Review of cases

Background: Human cutaneous leishmaniasis (CL) is an endemic disease in many parts of Sudan. Objective: To document an outbreak of CL among internally displaced people (IDP) in north Sudan. Methods: A household survey was conducted in the rural region of New Manasir, at El Damer Locality in north Sudan during the year 2013. All villagers were screened for recent and old skin lesions in addition to other urgent medical problems. Written consent was obtained from each participant before data collection. A pretested, interviewer-administered questionnaire was used to collect the socio-demographic and clinical characteristics of participants. The diagnosis of CL was based on clinical findings and/or identification of the amastigotes on skin smears. Results: Out of the 1,236 individuals enrolled in this survey, 688 were diagnosed as cases of CL, giving an infection rate of 55.7%. Children constituted 244 (35.5%) of infected cases. Majority of skin lesions were found in the Extremities 524 (76.2%). The average duration of skin lesions was 3.6 months (±1.6). Conclusion: This outbreak among IDPs affected a large proportion of inhabitants of the newly established villages in north Sudan. Preventive measures might have help control such outbreaks

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study

Background: Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan. Materials and Methods: Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin. Results: A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin> 7%), in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively. Conclusion: Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications

Prevalence and determinants of undernutrition among children under 5-year-old in rural areas: A cross-sectional survey in North Sudan

Background: Child malnutrition is a major public health problem in developing countries. Therefore, the aim of this study was to estimate the prevalence of undernutrition among children <5 years in River Nile state (RNS) in North Sudan. Subjects and Methods: A cross-sectional household survey was done in four localities in RNS. Using Multistage Cluster sampling, 1635 under 5 years' children had participated. Pretested questionnaire and anthropometric measures were used during data collection. The analysis was done using SPSS software program version 21 and World Health Organization (WHO) Anthro 2005 software. Indices were reported in z-scores and compared with the WHO 2005 reference population to determine the nutritional status of children. Results: Among 1,447 surveyed children, the prevalence of stunting, underweight, and wasting were 42.5%, 32.7%, and 21%, respectively. Stunting was highest among the 48–60 months of age group (82.5%). Boys had poorer indicators of undernutrition in comparison to girls. Geographically stunting was more prevalent in Berber locality. Infectious diseases (gastroenteritis and respiratory symptoms) and incomplete vaccination were significantly associated with wasting (P = 0.007, P = 0.013, and P = 0.008). Poor socioeconomic status (P = 0.043), poorer household sanitation (P = 0.022), large family size, lack of family spacing, and infants weaned suddenly were regarded as risk factors for undernutrition. Conclusion: There was a high prevalence of undernutrition in the 4th and 5th year of life in RNS population, with significant gender imbalance. Our survey highlighted the importance of urgent need to improve child health in this region