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Background: Non-alcoholic fatty liver disease (NAFLD) has become the predominant chronic liver disease globally in recent years, mostly due to the rise in obesity and metabolic syndrome (MS). Non-high-density lipoprotein cholesterol (non-HDL-c) and the ratio of non-HDL-c to HDL-c are emerging as significant indicators for cardiovascular disease risk, especially in patients with metabolic disorders. Method: This observational and record-based study focuses on lipid profile estimations using routine fasting samples billed during March 2022. All samples processed on the Vitros 5.1 FS for lipid profile between March 1st and March 31st, 2022, were included. The study variables were fasting total cholesterol (TC), fasting HDL, fasting LDL, and fasting triglycerides (TG). Inclusion criteria included all samples assayed, while exclusion criteria excluded hemolyzed samples and non-fasting samples. Blood samples, approximately 3ml, were collected after an overnight fasting period of 8-12 hours. Lipid profile estimations were conducted using the Vitros 5.1 FS, employing dry chemistry methods. Result: Descriptive statistics showed that the mean total cholesterol (TC) was 196.68 mg/dL, HDL was 43.16 mg/dL, and non-HDL was 153.52 mg/dL. The CHOL/HDL ratio had a mean of 4.77. A strong positive correlation (r = 0.815, p = 0.001) was observed between non-HDL cholesterol and the CHOL/HDL ratio. Conclusion: The study concludes that lipid profiles should include both non-HDL cholesterol and the cholesterol to HDL ratio. These parameters, when considered alone and in combination, provide a more accurate marker for predicting cardiovascular risk and are highly associated. [ABSTRACT FROM AUTHOR]

Introduction: Treating primary hypothyroidism with appropriate weight-based dosing is usually straightforward. When supraphysiologic doses of thyroxine are required, it is important to know the reason behind the increased requirement. When compliance with medication is assured and when there are no drug interactions resulting in increased thyroxine requirements, a levothyroxine absorption test (LT4AT) could be performed to diagnose the coexistence of malabsorption. Materials and Methods: This was a single-center, retrospective chart review. Patients who had undergone LT4AT between 2018 and 2020 with a complete evaluation and follow-up records were reviewed. LT4AT and further evaluation (if necessary) were standardized, and details until the last review were obtained. Results: In all, 11 patients had complete records and follow-up details. The median age (range) of the cohort was 24 years (19 to 46), and the duration of hypothyroidism was 8 years (4 to 24). Seven had low absorption (<60%) in LT4AT of which two each had celiac disease and Helicobacter pylori infection; one had autoimmune gastritis, and in two the reasons of malabsorption was not known. The median follow-up duration was 13 months. Nine of 11 (81%) achieved euthyroid state with/without thyroxine dose reduction on follow-up. Conclusion: A high proportion of patients requiring supraphysiological doses of levothyroxine had occult malabsorptive states, some of which were curable. Even in those with pseudo-malabsorption, LT4AT helped in reinforcing compliance and thereby thyroxine dose reduction. [ABSTRACT FROM AUTHOR]

Background: Ventral hernia repair (VHR) is one of the most common general surgery procedures among older adults but is often deferred due to a higher risk of complications. This study compares postoperative quality of life (QOL) and complications between frail and non-frail patients undergoing elective VHR. We hypothesized that frail patients would have higher complication rates and smaller gains in quality of life compared to non-frail patients., Study Design: Patients 65 years of age and older, undergoing elective VHR between 2018 and 2022 were selected from the ACHQC (Abdominal Core Health Quality Collaborative) and grouped based on frailty scores obtained using the Modified Frailty Index (mFI-5). Logistic regression adjusting for hernia characteristics (size, recurrent, parastomal, incisional) were performed for 30-day outcomes including surgical site infections (SSI), surgical site occurrences (SSO), surgical site infections/occurrences requiring procedural intervention (SSOPI), and readmission. Multivariable analyses controlling for patient and procedure characteristics were performed comparing QOL scores (HerQLes scale, 0-100) at baseline, 30 days, 6 months and 1 year postoperatively., Results: A total of 4888 patients were included, 29.17% non-frail, 47.87% frail, and 22.95% severely frail. On adjusted analysis, severely frail patients had higher odds of SSO (most commonly seroma formation) but no evidence of a difference in SSI, SSOPI, readmission or mortality. Severely frail patients had lower median QOL scores at baseline (48.3/100, IQR 26.1-71.7, p ​= ​0.001) but reported higher QOL scores at both 30-days (68.3/100, IQR 41.7-88.3, p ​= ​0.01) and 6-months (86.7/100, IQR 65.0-93.3, p ​= ​0.005)., Conclusion: Severely frail patients reported similar increases in QOL and similar complications to their not frail counterparts. Our results demonstrate that appropriately selected older patients, even those who are severely frail, may benefit from elective VHR in the appropriate clinical circumstance., Competing Interests: Declaration of competing interest This research, through Dr. Collins, was supported by the National Institutes of HealthNational Institute of Aging (NIA) [grant number R03AG074072]. Dr. Benjamin Poulose has received research support from the Bard-Davol and Advanced Medical Solutions. He received consulting fees from Ethicon and receives salary support from the ACHQC as the ACHQC Director of Quality and Outcomes. ACHQC Foundation is supported by Bard-Davol, Allergan, Medtronic, W.L. Gore, Ethicon, and TelaBio. Dr. Benjamin Poulose received salary support from ACHQC and research grant support from BD Interventional and Advanced Medical Solutions. Dr. Alison Whalen, Savanah Renshaw, Molly Olson, and Sahana Holla have no conflicts of interest or financial ties to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Ventral hernia repair is a common elective general surgery procedure among older patients, a population at greater risk of complications. Prior research has demonstrated improved quality of life in this population despite increased risk of complications. This study sought to assess the relationship between post-ventral hernia repair quality of life and patient frailty. We hypothesized that frail patients would report smaller gains in quality of life compared to the non-frail group., Methods: The Abdominal Core Health Quality Collaborative was used to identify a cohort of patients 65 years of age or older undergoing elective ventral hernia repair from 2018 to 2022. Patients were categorized based on their modified frailty index scores as not frail/prefrail, frail, and severely frail. Quality of life was assessed using a patient-reported 12-item scale preoperatively, 30 days, 6 months, and 1 year postoperatively., Results: A total of 3,479 patients were included: 30.93% non-frail, 47.17% frail, and 21.90% severely frail. Severely frail patients had lower quality of life scores at baseline (P = .001) but reported higher quality of life at both 30 days (1.24 points higher, 95% confidence interval (-1.51, 2.52), P = .010) and 6 months (0.92 points higher, 95% confidence interval (-2.29, 4.13), P = .005). Severely frail patients had higher rates of surgical site complications (P < .001) but no difference in 30-day readmissions., Conclusion: Our results found that frail patients reported the greatest increase in quality of life 1 year from baseline, showing that they, when selected appropriately, can gain equal benefits and have similar surgical outcomes as their non-frail counterparts., (Copyright © 2024 Elsevier Inc. All rights reserved.)