The global increase in the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), which affects more than one-third of the general population and up to 70% of individuals with type 2 diabetes or obesity, is a critical public health challenge. Given that liver steatosis is often asymptomatic until the advanced stages of disease, early detection is essential to prevent its progression to fibrosis, cirrhosis and, ultimately, hepatocellular carcinoma. However, liver biopsy, the gold-standard diagnostic method, is invasive, costly, and unsuitable for large-scale screening. As a result, noninvasive tests have emerged as practical alternatives, particularly in primary care settings, where early identification is most feasible. The present study explored current perspectives of noninvasive liver disease screening tools and their implementation in primary care. Serum-based indices, along with imaging techniques, have demonstrated promise in identifying patients with advanced fibrosis. Novel biomarkers, including the enhanced liver fibrosis test and Pro-C3, as well as emerging artificial intelligence-assisted diagnostic platforms, yield improved accuracy and risk stratification potential. Despite accumulating evidence supporting the clinical utility and cost-effectiveness of noninvasive tests, several barriers hinder their routine use in primary care settings, which include limited funding, lack of standardized guidelines, insufficient clinician training, and disparities in access to diagnostic tools. The implementation of structured stepwise screening models has demonstrated improved diagnostic efficiency and reduced unnecessary referrals. Future research should emphasize the integration of artificial intelligence, portable diagnostic devices, and personalized risk models to enhance early detection. Ensuring widespread adoption requires coordinated efforts in policy development, provider education, and health-system investment. Noninvasive screening tools offer a feasible and cost-effective pathway for the early detection of MASLD in primary care; however, their successful implementation depends on addressing logistical, educational, and systemic barriers.
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Background Many studies have assessed the risk factors for adverse drug reactions (ADRs) in elderly patients. However, most of these studies have focused on risk factors for ADRs, not serious ADRs (s-ADRs). s-ADRs are commonly found in hospitalized patients. s-ADRs warrant imminent but thorough investigations, given their critical impact on patient health. Therefore, this retrospective study aimed to assess the associated risk factors for s-ADRs in elderly hospitalized patients.
Methods In-patients aged >65 years having ADRs during hospitalization at a university hospital in Korea between 2010 and 2012 were included. Medical professionals spontaneously reported ADRs using an electronic submission system at the study hospital. Further, all descriptions of ADRs were characterized and categorized through the screening of electronic medical records. We compared the characteristics of patients having s-ADRs with those of patients not having s-ADRs.
Results There were 353 cases of ADRs, 67 of which were s-ADRs. Patients taking more than eight concomitant drugs showed the highest odds ratio (OR, 11.99; 95% confidence interval [CI], 3.42–42.03). The ratio of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was also significantly related to s-ADRs (OR, 2.78; 95% CI, 1.33–5.81). The use of antibiotics (OR, 2.39; 95% CI, 1.13–5.02) and antineoplastics (OR, 4.17; 95% CI, 1.09–15.94) were significant risk factors.
Conclusion Our findings highlight the importance of polypharmacy. Liver function tests (AST/ALT ratio) must be monitored carefully within high-risk groups for ADRs.
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