Nonalcoholic Fatty Liver Disease: Could It Be the Next Medical Tsunami?

Nonalcoholic fatty liver disease (NAFLD) is a rapidly increasing cause of chronic liver disease with excess fat deposition in the liver, without an identifiable cause. NAFLD's benign form is called nonalcoholic fatty liver (NAFL), which can progress to nonalcoholic steatohepatitis (NASH) with or without fibrosis. Over time, NASH can progress to cirrhosis and eventually hepatocellular carcinoma (HCC) or progress to HCC without cirrhosis. Its incidence and prevalence are increasing to epidemic proportions, making it the most common cause of chronic liver disease in the western world. This review article attempts to understand the epidemiology, pathophysiology, evaluation, and management, and, most importantly, to generate awareness of this disease process.

Constipation Misperception: Could It Be Familial Adenomatosis Polyposis?

Colorectal cancer is the second leading cause of cancer deaths in the United States. Familial adenomatosis polyposis (FAP) is a rare cause of colorectal cancer. The United States Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years. While age is the most important risk factor, we need to consider the family history of colorectal cancer. FAP is a rare cause of colorectal cancer, leading to high morbidity and mortality if undetected and undiagnosed. It is easy to overlook the family history in a busy primary care clinic with limited patient encounter times. Clinicians mustn't forget this important piece of information as it can give leads for further patient evaluation. We present a case report of a 21-year-old male who presented to our clinic to establish primary care and with vague abdominal complaints. Still, the concerning family history of early onset colon cancer in his half-sister raised red flags and directed us to further evaluate. Further evaluation revealed our patient, in fact, had FAP.

Fitting the Pieces of the Puzzle Together: A Case of Median Arcuate Ligament Syndrome.

Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is one of the many rare vascular compression syndromes attributed to celiac trunk compression by the median arcuate ligament of the diaphragm, with presentations ranging from completely asymptomatic to myriad gastrointestinal symptoms, including chronic abdominal pain (CAP), post-prandial pain, nausea and vomiting, anorexia, early satiety, and subsequently weight loss. We present a case of a 50-year-old female presenting with ongoing multiple chronic gastrointestinal symptoms, later attributed to the marked narrowing of her celiac axis secondary by the median arcuate ligament.

Double Whammy: A Case of Concurrent Alcohol Use and Hereditary Hemochromatosis Leading to Avascular Necrosis of the Femur.

Avascular necrosis (AVN) of the femur is due to damage to the vasculature of the bone and can include a multitude of causes including medications, alcohol intake, hemoglobinopathies, thrombophilias, and connective tissue disorders, among others. Hereditary hemochromatosis is not a common cause of AVN but should be considered prior to labeling such cases as idiopathic. If a patient has symptoms of persistent hip pain and plain radiography has been unremarkable, one should proceed with magnetic resonance imaging (MRI) of the affected joint due to its sensitivity in detecting osteonecrosis. We present a case report of a 54-year-old male patient with a significant history of alcohol intake and a diagnosis of hereditary hemochromatosis who presented with persistent left hip pain and further imaging revealed the presence of osteonecrosis of the femur.

Food Insecurity and Diabetes: The Role of Federally Qualified Health Centers as Pillars of Community Health.

Food insecurity is a complex public health problem affecting millions of people globally. It leads to negative health outcomes in the afflicted population and the society at large. There is a self-perpetuating vicious cycle between food insecurity and chronic health conditions like diabetes. It is important for healthcare professionals to be aware of its existence, to be able to recognize it, and to work with their patients to find solutions for it. Simultaneously, the providers should advocate for their patients and make program administrators, policymakers, and legislatures aware of this crisis. During the current coronavirus disease 2019 (COVID-19) pandemic, when economies have been badly affected and many people have lost their jobs, this subject has arguably assumed much greater importance. In this article, we discuss the magnitude of the problem, its relation to diabetes mellitus, and the role that a Federally Qualified Health Center (FQHC) can play in mitigating this problem.

Cognitive Assessment of Geriatric Patients in Primary Care Settings.

Cognitive decline is a common issue seen in older adults in the primary care setting. Assessment of cognitive decline in primary care includes a detailed history, physical examination, labs, imaging, and a formal cognitive assessment. Various tools are available for cognitive assessments. However, a short screening tool is more practical for cognitive evaluation. A decline in cognition should be correlated with the broader clinical picture, and a detailed cognitive assessment should be performed. This article focuses on some of the cognitive assessment tools used in clinical settings to assess cognition.

Clinician Beware, Giant Ovarian Cysts are Elusive and Rare.

Giant ovarian cysts, which are described in the literature as measuring more than 10 cms in size in their largest diameter, are rare in occurrence. With the availability of multiple imaging modalities and routine physical examinations, it has become even rarer to find such cases. Ovarian serous cystadenomas, which are benign tumors arising from the ovarian epithelium, represent the most common type. We present a case of a 58-year-old female who came to establish primary care in our clinic. She reported ongoing symptoms of constipation, abdominal discomfort, bloating, as well as intermittent postmenopausal bleeding for the past few months. The patient reported taking over-the-counter medications for her predominant gastrointestinal symptoms with no improvement at all. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) of the pelvis revealed the presence of giant bilateral ovarian masses measuring more than 17 X 10cms each. Further testing revealed highly elevated levels of tumor markers cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4). The patient subsequently underwent total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Her histopathology report revealed the presence of bilateral benign cystadenomas. From a primary care physician's perspective, this case highlights the importance of possible rare pathologies that can present with symptoms of a completely unrelated organ system. Even with the rarity of these cases, a clinician may encounter such a case in their everyday practice. Patients can endorse a plethora of vague complaints, often masquerading other entities seen commonly in the clinic.

Bone graft substitutes for spine fusion: A brief review.

Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins (recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.