Nduwimana, Marie-Joy

Alcohol use disorder (AUD) is a preventable non-communicable disease that affects multiple organs and organ systems across all age groups, including the fetus and is a risk factor for developing certain cancers. Furthermore, alcohol intoxication can result in physical trauma to oneself and others, and is a contributing factor in road accidents. Early recognition of AUD is critical for improving diagnosis, management, and outcomes. Accurate diagnosis relies on comprehensive clinical evaluation and patient history. However, denial of AUD, inebriation, and lack of awareness of problems associated with AUD, can prevent early identification of the disease. AUD-associated organ damage manifests in several ways and can be recognized on imaging modalities including ultrasound, CT, and MRI. Detection of these imaging features is useful in raising suspicion of AUD or diagnosing chronic alcohol use. Radiologists should be aware of the manifestations of alcohol's effects across various organ systems and aid in the early detection and treatment of AUD. In this two-part review, the authors present a comprehensive image-based review illustrating the effects of AUD on different organ systems at various stages. This second part focuses on the imaging manifestations in the central nervous system, fetal health, cardiovascular system, and musculoskeletal system. Additionally, a brief overview of secondary imaging manifestations of alcohol use, associated with trauma and cancers, will be presented.

Alcohol use disorder (AUD) is a significant public health challenge, affecting multiple organs and organ systems, and fetal health. Additionally, AUD also significantly contributes to self-harm and road accidents. Beyond its health effects, AUD creates economic and political challenges, including escalating treatment costs and the complex alcohol regulation policies. Despite global impact, AUD remains under-addressed in countries like India due to cultural norms and limited resources. Early recognition of AUD is vital for better outcomes, relying on thorough clinical evaluation and patient history. However, denial, inebriation, or lack of awareness often delays diagnosis. Imaging techniques like ultrasound, CT, and MRI effectively depict AUD-related organ damage and aid in detecting chronic alcohol use. Radiologists play a crucial role in identifying these manifestations, contributing to its early detection and treatment. This review article highlights the imaging of alcohol use related disorders and diseases affecting different organs and organ systems at various stages. The review is presented in two parts: the first focuses on alcohol burden, alcohol metabolism and toxicity, and imaging findings of AUD-related abdominal diseases and disorders.

Abstract Disclosure: A. Al Nofal: None. K. Benkhadra: None. M. Nduwimana: None. A. Mohammad: None. A. Abbas: None. Z. Wang: None. M. Murad: None. Background: Hybrid closed-loop (HCL) systems for automated insulin delivery are increasingly used in diabetes management. However, their safety and efficacy in pregnant women with pre-existing type 1 diabetes remain uncertain. Aim: To assess the safety and effectiveness of HCL systems in pregnant women with pre-existing type 1 diabetes compared to current standard of care. Methods: A comprehensive search of several databases was conducted from inception to January 3rd, 2024. Pairs of independent reviewers screened abstracts. Abstracts included by at least one reviewer were reviewed in full text by a pair of independent reviewers. The DerSimonian and Laird random effects model with the Hartung-Knapp-Sidik-Jonkman method was used to pool effect sizes across the included studies. Results: Five randomized controlled trials (RCTs) with 274 pregnant women with type I diabetes met the inclusion criteria. Our meta-analysis showed no significant difference between HCL and standard of care regarding overall time in range (TIR), time above range (TAR), and time below range (TBR). However, overnight, women using HCL showed significantly higher TIR (mean difference: 10.18%, CI 7.42-12.94%) and lower TBR (mean difference: -0.67%, CI -0.91 to -0.43%) compared to those using standard care. Additionally, there were no significant differences between HCL and standard of care in term of LGA, SGA, neonatal hypoglycemia, and maternal severe hypoglycemia or hyperglycemia. Conclusion: HCL systems for management of pre-existing type I diabetes during pregnancy are associated with similar outcomes without increased risk of complications when compared to standard of care. This is derived from limited number of RCTs with low risk of bias but significant imprecision, which warrant low confidence. Presentation: Sunday, July 13, 2025

Abstract Context Women with preexisting diabetes mellitus (PDM) are at increased risk of pregnancy-related complications. Objective To summarize the available supporting evidence for the Endocrine Society guidelines about management of PDM in pregnancy. Data Sources MEDLINE, EMBASE, Scopus, and other sources through February 2025. Study Selection Studies were selected by pairs of independent reviewers. Data Extraction Data were extracted by pairs of independent reviewers. Data Synthesis We included 17 studies. Meta-analysis showed no significant difference between hybrid closed-loop insulin pump (HCL) and standard of care regarding time in range (TIR), time above range (TAR), and time below range (TBR). HCL had better overnight TIR and TBR. For women with type 2 diabetes mellitus (T2DM), intermittent use of continuous glucose monitoring (CGM) was not associated with a significant change in the risk of large for gestational age (LGA) neonates (2 randomized controlled trials [RCTs], 102 patients). Adding metformin to insulin was associated with a lower risk of LGA (2 RCTs, 1126 patients). Three retrospective studies (1724 patients) suggested increased neonatal complications when delivery was induced before 39 weeks of gestation (particularly before 38 weeks) in women with preexisting type 1 (T1DM) and T2DM, although this evidence was subject to likely confounding. One retrospective study showed no increase in neonatal complications with periconceptional exposure to glucagon-like peptide-1 receptor agonists. We could not identify comparative studies assessing a screening question about the possibility of pregnancy or a carbohydrate restrictive diet. Conclusion This systematic review addresses various aspects of managing PDM in pregnancy and will support the development of the Endocrine Society guidelines.