Rationale: The prevalence of malnutrition and the provided nutritional therapy were evaluated in all the patients with SARS-CoV-2 infection (COVID-19) hospitalized in a 3rd level hospital in Italy. Methods: A one-day audit was carried out recording: age, measured or estimated body weight (BW) and height, body mass index (BMI, kg/m 2), 30-day weight loss (WL), comorbidities, serum albumin and Creactive protein (CRP: nv < 0.5 mg/dL), hospital diet (HD) intake, oral nutritional supplements (ONS), enteral (EN) and parenteral nutrition (PN). Modified NRS-2002 tool and GLIM criteria were used for nutritional risk screening and for the diagnosis of malnutrition, respectively. Results: A total of 268 patients was evaluated; intermediate care units (IMCUs, 61%), sub-intensive care units (SICUs, 8%), intensive care units (ICUs, 17%) and rehabilitation units (RUs, 14%): BMI: <18.5, 9% (higher in RUs, p ¼ 0.008) and !30, 13% (higher in ICUs, p ¼ 0.012); WL ! 5%, 52% (higher in ICUs and RUs, p ¼ 0.001); CRP >0.5: 78% (higher in ICUs and lower in RUs, p < 0.001); Nutritional risk and malnutrition were present in 77% (higher in ICUs and RUs, p < 0.001) and 50% (higher in ICUs, p ¼ 0.0792) of the patients, respectively. HD intake 50%, 39% (higher in IMCUs and ICUs, p < 0.001); ONS, EN and PN were prescribed to 6%, 13% and 5%, respectively. Median energy and protein intake/kg BW were 25 kcal and 1.1 g (both lower in ICUs, p < 0.05) respectively. Conclusions: Most of the patients were at nutritional risk, and one-half of them was malnourished. The frequency of nutritional risk, malnutrition, disease/inflammation burden and decrease intake of HD differed among the intensity of care settings, where the patients were managed according to the severity of the disease. The patient energy and protein intake were at the lowest limit or below the recommended amounts, indicating the need for actions to improve the nutritional care practice.

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Nonalcoholic fatty liver disease (NAFLD) is defined by hepatic steatosis in the presence of alcohol intake within safe limits, defined by guidelines of scientific associations (usually 20 g or 2 units/day in women, 30 g or 3 units in men). The diagnosis is usually followed by medical counseling of total abstinence, in order to prevent disease progression. This policy has been challenged by epidemiological studies, suggesting that the risk of liver disease and disease progression is lower in modest drinkers than in total abstainers. We revised the literature on the effects of modest alcohol intake on disease burden. Epidemiological data may suffer from several potential biases (recall bias for retrospective analyses, difficulties in the calculation of g/day), limiting their validity. Prospective data suggest that NAFLD patients with regular alcohol intake, although within the safe thresholds, are at higher risk of liver disease progression, including hepatocellular carcinoma; a detrimental effect of modest alcohol drinking is similarly observed in liver disease of viral etiology. Alcohol intake is also a risk factor for extrahepatic cancers, particularly breast, oral, and pharyngeal cancers, with gender difference and no floor effect, which outweigh the possible beneficial effects on cardiovascular system, also derived from retrospective studies. Finally, the negative effects of the calorie content of alcohol on dietary restriction and weight loss, the pivotal intervention to reduce NAFLD burden, should be considered. In summary, the policy of counseling NAFLD patients for alcohol abstinence should be maintained.Nutrients 2019, 11, 3048 2 of 23 equals mortality in alcohol users) for an average alcohol consumption of approximately 25-30 g in women and 40 g in men [4].All NAFLD studies explicitly report the exclusion of subjects with alcohol intake at risk, defined according to pre-specified criteria, and most clinicians suggest total abstinence from alcohol as therapeutic measure for prevention NAFLD and/or disease progression. More than a decade ago a few epidemiological studies reported an inverse association between moderate alcohol consumption (within presumably safe limits) and the prevalence of NAFLD in the population [5,6], pointing to a favorable effect of moderate alcohol use extending from the cardiovascular system to the setting of metabolic liver disease. This raised a lot of debate on the correct dietary and lifestyle treatment of NAFLD, which has not settled yet. Do we need to counsel our NAFLD patients for total alcohol abstinence to prevent disease progression?This narrative review is intended to summarize the evidence linking moderate alcohol intake with NAFLD, starting from difficulties in the correct assessment of alcohol intake. The conclusions are based on the experience of authors and the general effects of alcohol on the liver and outside the liver, in the hope to generate a common health policy among healthcare professionals. Literature Search

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Developing effective vaccines against Neisseria meningitidis serogroup B has been challenging for several reasons, including the fact that the capsular polysaccharide of N. meningitidis serogroup B is a poor antigen. Therefore, studies have focused on developing vaccines that target capsular protein meningococcal antigens using reverse vaccinology, a technique that predicts likely vaccine candidates using computational analysis of the whole bacterial genome. This has resulted in a multicomponent, recombinant, meningococcal serogroup B vaccine: 4CMenB (Bexsero(®), Novartis Vaccines & Diagnostics, NC, USA), containing four main immunogenic components: two recombinant fusion proteins (Neisseria heparin-binding antigen-GNA1030 and factor H-binding protein-GNA2091); recombinant Neisserial adhesion A; and detergent-treated outer membrane vesicles derived from the meningococcal NZ98/254 strain, where porin A 1.4 is the major immunodominant antigen. In this article, we summarize the available clinical data on 4CMenB in healthy infants, adolescents and adults, and discuss the methods available for assessing vaccine efficacy.

INTRODUZIONE Il coinvolgimento articolare in corso di sclerosi sistemica ( SSc ) è relativamente frequente e si manifesta essenzialmente con la comparsa di tenovaginite a livello di caviglie e polsi. Una vera artrite si rileva meno comunemente. La classica artrite descritta in corso di SSc è tipicamente poliarticolare simil-artrite reumatoide (AR), con assenza del fattore reumatoide, di noduli reumatoidi e di erosioni articolari e si rileva nel 10% dei casi (1). Tuttavia, è importante sottolineare che non sempre è semplice distinguere una "poliartrite sclerodermica" propriamente detta da una sindrome da "overlap" SSc-AR (2-4). L'associazione SSc con AR è di comune riscontro nella letteratura, mentre è certamente rara l'associazione della SSc con l'artrite psoriasica (Aps) (5, 6). Qui si descrive un caso di SSc insorta dopo la comparsa di una artrite psoriasica e si discute del possibile nesso patogenetico tra le due forme morbose. CASO CLINICOLa paziente, di 61 anni, era stata in pieno benessere sino al 1994, epoca in cui era comparsa artrite a carico delle ginocchia, scapolo-omerali, gomiti, caviglie e MCF del II e III dito delle mani bilateralmente, in associazione a classiche lesioni psoriasiche a livello dei gomiti e delle ginocchia. Formulata la diagnosi di "artrite psoriasica" era stata prescritta terapia con methotrexate 5 mg/settimana ed indometacina 50 mg/die con buona risposta clinica, per circa due anni. Successivamente, si era verificata la comparsa di fenomeno di Raynaud alle dita delle mani e progressivo irrigidimento della cute, con perdita di elasticità, alle dita delle mani e al volto. A questo periodo, si può far risalire la comparsa di una dispnea da sforzo, secondaria ad una interstiziopatia polmonare documentata da una TAC HR e dalla compromissione di test spirometrici e DLCO. Inoltre, con la scintigrafia esofagea si potè evidenziare un rallentamento del transito al terzo medio del viscere. Mediante l'esame obiettivo, erano apprezzabili rantoli crepitanti alle basi polmonari, artrite a carico delle MCF, IFP e IFD del II e III dito delle mani bilateralmente, del ginocchio sinistro e l'impotenza funzionale con manovra di Yergason positiva a livello di entrambe le spalle. Erano, inoltre, presenti tenovaginiti dei tendini dei mm. estenAssociazione sclerosi sistemica ed artrite psoriasica: descrizione di un caso clinico Reumatismo, 2001; 53(3):232-234 Reumatismo, 2001; 53(3):232-234 SUMMARY

(CCI). Results: 161 participants were included. Mean age was 66 years (SD 11.5), 58% were male and 81% did not receive preoperative chemotherapy or radiotherapy. LSMM was identified in 69 (43%) participants and prevalence was higher in males (54.8%) compared to females (26.5%). Sarcopenia was detected in 21 (13.2%) participants. LSMM was not associated with postoperative outcomes: CD odds ratio 1.15, 95% CI 0.45, 2.95; CCI incidence rate ratio 0.98, 95% CI 0.30, 3.22; LoS hazard ratio 1.03, 95% CI 0.73, 1.46. Conclusion: Prevalence of sarcopenia and LSMM in people before CRC surgery was lower than expected. In contrast with other studies we found no association between body composition and LoS or short-term complications. Variation between studies in methodological aspects (e.g., definitions and cutpoints, software, timeframes assessed) may contribute to these differences.