Background/Aims: Advanced fibrosis (F≥3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods: The diagnostic performance of each noninvasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored <1.3 and >2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored <-1.455 and >0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eightyone patients (17.5%) had biopsy-proven advanced fibrosis (F≥3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (≥1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (≥-1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.

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Background and Aim: Noninvasive scores are developed for the estimation of advanced fibrosis, including parameters in addition to transaminases in non-alcoholic fatty liver disease (NAFLD). In this study, we aimed to investigate the diagnostic performances of Fibrosis-4 (FIB-4) and NAFLD Fibrosis Score (NFS) in the estimation of advanced fibrosis comparing patients with normal and elevated transaminases. Material and Methods: We retrospectively analyzed the prospectively collected data of a total of 407 consecutive patients with biopsy-proven NAFLD. FIB-4 scores of <1.3 and >2.67 or <1.45 and >3.25 indicated a low and high risk for advanced fibrosis, respectively. NFS scores of <-1.455 and >0.676 were used to assess low and high risk for advanced fibrosis, respectiv. Results: FIB-4 cutoffs of <1.3 and <1.45 for low risk of advanced fibrosis had a sensitivity of 70% and 54% in patients with elevated transaminases and 70% and 52% in patients with normal transaminases, respectively. The specificities for the cutoffs of >2.67 and >3.25 were 97% and 98% in patients with elevated transaminases and 99% and 100% in patients with normal transaminases, respectively. Concerning NFS, we found similar results. Conclusion: FIB-4 and NFS showed acceptable diagnostic performance in the exclusion of advanced fibrosis in both populations with normal and elevated transaminases.

Background/aim: The clinical guidelines recommend the use of nonalcoholic fatty liver disease fibrosis score and fibrosis-4 score for estimating the advanced liver fibrosis in nonalcoholic fatty liver disease. However, these scores are used confidently in eliminating advanced fibrosis, rather than detecting it. Therefore, paired combination with liver stiffness measurement by transient elastography is recommended. In this study, we aimed to validate this combined algorithm in our study population. Methods: A total of 139 consecutive biopsy-proven nonalcoholic fatty liver disease patients were enrolled in the study. We calculated the noninvasive scores and performed liver stiffness measurement examination for each patient. Results: The optimal cutoff of liver stiffness measurement for advanced fibrosis was 11.0 kPa (area under curve: 0.856) with a sensitivity of 84% and a specificity of 78%. Using the fibrosis-4 score (< 1.45 for low risk of advanced fibrosis and > 3.25 for high risk of advanced fibrosis) in combination with the liver stiffness measurement cutoffs revealed the best diagnostic performance (< 8.8 kPa for low risk of advanced fibrosis and > 10.9 kPa for high risk of advanced fibrosis). This paired combination had the positive predictive value of 0.735 at a sensitivity of 89% and the negative predictive value of 0.932 at a specificity of 82%. Conclusion: A paired combination of the fibrosis-4 score and liver stiffness measurement (< 8.8 kPa for exclusion of advanced fibrosis and > 10.9 kPa for inclusion of advanced fibrosis) is able to diagnose the patients with advanced fibrosis with the highest diagnostic accuracy.

Background Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. Methods We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. Results Baseline eGFR was under 60 mL/min/1.73m 2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Ageadjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m 2 .

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Background:The association between depression, anxiety, and stress among Arab menopause and postmenopausal women have been explored in detailed.Aim:The objective of this study was to determine the correlation between depression, anxiety, and stress in menopausal and postmenopausal women and shedding more light on a complex relationship.Subjects and Methods:A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian women at the primary health care centers in Qatar. A representative sample of 1468 women aged 45–65 years were approached during July 2012 and May 2014 and 1101 women agreed to participate (75.0%) and responded to the study. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scales 21. Data on body mass index (BMI), clinical and other parameters were used. Univariate, multivariate, and matrix correlation analysis were performed for statistical analysis.Results:A total of 1101 women agreed to participate after informed consent was obtained. The mean age and standard deviation (SD) of the menopausal age were 49.55 (3.12), the mean and SD of postmenopausal age was 58.08 (3.26) (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Furthermore, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure (BP), Vitamin D deficiency, and diseases. Depression and anxiety were more common among postmenopause women. Furthermore, there were no differences between the groups regarding the frequency of certain levels of stress among menopause and postmenopause. The multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were a predictor for depression. Meanwhile, diastolic BP, occupation, and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation, and sheesha smoking habits were considered as the main risk factors associated with stress.Conclusion:A large number of factors were associated with experiencing menopausal and psycho-social problems and which had negative effects on the quality of life among Arabian women. Depression, anxiety, and stress should be considered as important risk factors for osteoporosis.

Background Recent data have reinforced the concept of a reciprocal relationship between COVID-19 and kidney function. However, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. Methods We recruited 336 adult consecutive patients (male 57.1%, mean age 55.0 ±15.9) that were hospitalized with the diagnosis of COVID-19 in the tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. Results Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.1% of the patients. In-hospital mortality was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p:0.005, odds ratio:0.974, CI:0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2. Conclusions On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19; We recommend to determine eGFR in all patients on admission and use it as an additional tool for risk stratification. Close follow-up should be warranted in patients with reduced eGFR.