Interest of hepatic steatosis index (HSI) in screening for metabolic steatopathy in patients with type 2 diabetes.

INTRODUCTION: metabolic steatopathy or non-alcoholic fatty liver disease (NAFLD) is frequently associated with type 2 diabetes mellitus (T2DM) with an increased risk of progression to advanced fibrosis. The purpose of our study was to determine the interest of hepatic steatosis index (HSI) in the detection of hepatic steatosis in patients with type 2 diabetes in order to establish an appropriate screening program of this disease in our population. METHODS: cross-sectional study involving 281 type 2 diabetics hospitalized in the Department of Endocrinology in collaboration with the Hepato-gastroenterology Department at the University Hospital Ibn Rochd Casablanca between January 2018 and June 2018. Anthropometric variables studied were, biological, hepatic steatosis index (HSI) and liver ultrasound. The HSI score of> 36 predicted the presence of fatty liver. The HSI score (fatty liver index) was calculated for all patients using the following formula: 8 × (ALT / AST) + BMI + 2 (if type 2 diabetes) + 2 (if female). Statistical analysis was performed with SPSS Version 19 software. The sensitivity and the specificity of the HSI score were calculated by 2x2 contingency table. The area under the receiver operating characteristic curve (AUROC) was also analyzed. RESULTS: average age of patients was 54.15 ± 13.14 years with a female predominance (76.9% of cases), and a sex ratio of 3.32. Mean duration of diabetes of 10.5 ± 8.03 years with an average glycated hemoglobin of 10.23 ± 1.96%. BMI was 29.53 ± 4.55 kg/m2, the average waist circumference was 99.51 ± 10.98 cm. 39.1% of patients were hypertensive, 58% were dyslipidemic. Abnormalities in transaminases were found in 6% of patients. Prevalence of NAFLD was 45.2% based on the HSI score > 36. This prevalence is consistent with the findings made by the liver ultrasound (47.7% of cases). Hepatic steatosis was significantly correlated with dyslipidemia (P=0.006), overweight (P=0.00015), obesity (P=0.001) and hypertriglyceridemia (P=0.0003). The sensitivity of HSI was 89.55%, negative predictive value (NPV) was 90.91%, specificity was 95.24%, and positive predictive value (PPV) was 94.49%. AUROC for HSI was at 0.979 (95% CI, 0.962-0.997). CONCLUSION: hepatic steatosis is common among our patients; it is correlated with dyslipidemia, obesity and hypertriglyceridemia.

[An ileo-caecal foreign body mimicking a Crohn disease: case report]. / Corps étranger iléo-caecal mimant une maladie de Crohn: rapport de cas.

Foreign-body ingestion is a common cause of admission to the Division of Gastroenterology. However foreign-body lodged in the ileocecal region is very rare. This study aims to report the exceptional case of a patient with a foreign body lodged in the ileocecal region revealed by sub-occlusive syndromes. The study involved a patient aged 22 years with no particular past medical history, presenting with König's syndrome evolving in a context of alteration of the general state. Anatomopathological examination of surgical ileocecal specimen performed after inconclusive endoscopy, histologic examination of the biopsies and scannography, showed ileocecal thickening due to infammatory response to a foreign body. In the absence of anamnestic data, ileocecal foreign body poses a real problem of differential diagnosis including inflammatory, infectious and tumoral diseases of the ileocecal junction. The presence of a foreign body may be revealed by occlusive complications or perforations, hence the essential role of imaging. Endoscopy always plays a central diagnostic and therapeutic role in the management of ingested foreign bodies, thus reducing surgical morbidity (although it is sometimes unavoidable). Anatomopathological study shows foreign body granuloma. Cases of foreign body lodged in the ileocecal region have been rarely reported. Now they should be suspected in patients with any symptom, including ileocecal junction disorders, in order to avoid side effects and complications due to heavy treatments.