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Background: Emerging evidence suggests that patients with metabolic (dysfunction) associated fatty liver disease (MAFLD) are prone to severe forms of coronavirus disease (COVID-19), especially those with underlying liver fibrosis. The aim of our study is to assess the association of an increased FIB-4 score with COVID-19 disease prognosis. Methods: We performed a prospective study on hospitalized patients with known type II diabetes mellitus (T2DM) and confirmed COVID-19, with imaging evidence of liver steatosis within the last year or known diagnosis of MAFLD. All individuals were screened for liver fibrosis with a FIB-4 index. We evaluated the link between FIB-4 and disease prognosis. Results: Of 138 participants, 91.3% had MAFLD and 21.5% patients had a high risk of fibrosis. In the latter group of patients, the number of severe forms of disease, the hospital stay length, the rate of ICU admissions and the number of deaths reported registered a statistically significant increase. The independent predictors for developing severe forms of COVID-19 were obesity (odds ratio (OR), 3.24; 95% confidence interval (CI), p = 0.003), higher values of ferritin (OR-1.9; 95% CI, 1.17–8.29, p = 0.031) and of FIB-4 ≥ 3.25 (OR-4.89; 95% CI, 1.34–12.3, p = 0.02). Conclusions: Patients with high scores of FIB-4 have poor clinical outcomes and liver fibrosis may have a relevant prognostic role. Although the link between liver fibrosis and the prognosis of COVD-19 needs to be evaluated in further studies, screening for liver fibrosis with FIB-4 index, particularly in patients at risk, such as those with T2DM, will make a huge contribution to patient risk stratification.

In the global context of COVID-19 outbreak, scientific efforts have been directed to investigate the risk factors associated with the development of severe illness. Emerging evidence linked the metabolic syndrome to more severe forms of the disease. The majority of the patients with these risk factors develop hepatic injury, particularly those previously diagnosed with nonalcoholic fatty liver disease (NAFLD). NAFLD is the most common cause of chronic liver disease, affecting a quarter of the population worldwide. While type II diabetes mellitus is linked to a higher severity of COVID-19, it has not been established whether patients with metabolic-associated fatty liver disease are prone to worse outcomes. To have a closer look at the consequences of this association, we have systematically searched the latest updates and studies to assess the connection between NAFLD and the severity of COVID-19, as well as the treatment considerations. Rezumat În contextul pandemiei COVID-19, eforturile cercetătorilor au fost îndreptate spre a identifica factorii de risc asociați cu progresia severă a bolii. Studii recente scot în evidență legătura sindromului metabolic cu formele grave de COVID-19. O proporție mare din pacienții cu tulburări metabolice au dezvoltat afectare hepatică, în special cei diagnosticați anterior cu boala ficatului gras non-alcoolic (FGNA), patologie ce afectează peste un sfert din populația lumii. În timp ce diabetul zaharat tip II este cunoscut ca fiind factor de risc pentru evoluția severă a COVID-19, nu este încă stabilit dacă pacienții cu FGNA asociat cu sindromul metabolic au un prognostic nefast. Scopul acestei lucrări este de a analiza asocierea dintre FGNA și evoluția COVID-19, precum și posibilele implicații terapeutice, axându-se pe cele mai recente actualizări și cercetări din domeniu.

Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD)-related severe liver fibrosis is associated with a higher risk of progressing to decompensated cirrhosis and hepatic failure and developing NAFLD-related hepatocellular carcinoma (HCC), particularly in populations with diabetes. Our pilot study aims to evaluate the performances of various noninvasive methods in predicting liver fibrosis in a population of patients with diabetes and to establish a new scoring system for the prediction of severe fibrosis (>F3). Materials and Methods: A total of 175 patients with diabetes were enrolled for liver fibrosis evaluation. Using the degree of agreement (concordance) between a noninvasive score based on serum biomarkers (NAFLD fibrosis score) and point shear-wave elastography (pSWE) as the reference method, we generated receiver operating characteristic (ROC) curves and performed a multivariate analysis to predict severe liver fibrosis. Results: In our population of patients with diabetes, gamma-glutamyltransferase (GGT), age, body mass index (BMI), the homeostatic model assessment of insulin resistance (HOMA-IR), and glycosylated hemoglobin (HbA1C) were significant predictors for the diagnosis of the F3/F4 group (area under the ROC: 0.767, 0.743, 0.757, 0.772, and 0.7, respectively; p < 0.005 for all). Moreover, the combined composite score (the sum of GGT, age, BMI, HOMA index, and HbA1C) had the highest diagnostic performance at a cut-off value of 3 (AUROC—0.899; p < 0001). The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 91.20%, 79%, 79%, and 89%, respectively, and 89% of patients were correctly classified as having severe liver fibrosis. In contrast with the Fibrosis 4 (FIB-4) score and the AST-to-platelet ratio index (APRI), the composite score had the best accuracy in discriminating advanced fibrosis. Conclusions: The proposed composite score had a reliable and acceptable diagnostic accuracy in identifying patients with diabetes at risk of having severe fibrosis using readily available laboratory and clinical data.

The aim was to assess the frequency, risk factors and consequences of falls in elderly and the rate of reporting their occurrence to health professionals. Materials and methods: This is a cross-sectional study of 182 patients admitted to the National Institute of Geriatrics and Gerontology during December 2014 -April 2015. Data was obtained from the medical records and by asking the patients to fill in a questionnaire. Results: 46.15% patients reported no fall during the previous year; 40.11% reported 1 fall; 17.34% were frequent fallers. We found a positive correlation between age and falls frequency (R=0.420. p=0.0001).There were significant associations between prevalent falls and: vestibular syndromes (p=0.001), postural hypotension (p=0.021), stroke (p=0.034) and foot deformities (p=0.048). The most important consequences were: pain (79.59%), limitations of the activities of daily life (46.94%), fear of falling (24.49%). Conclusions: Environmental hazards, vestibular syndromes, postural hypotension, vertigo, dizziness were the leading risk factor for falls in this study.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects up to one third of the adult population of industrialized countries. The pathophysiological spectrum includes the following entities that are clinically and histologically distinct: hepatic steatosis and steatohepatitis; their subsequent evolution can lead to cirrhosis and hepatocellular carcinoma.The increase of the prevalence of NAFLD during the last decade is caused by the epidemiological and pathophysiological association with type II diabetes and obesity, NAFLD being present in about 70-80% of patients with type II diabetes mellitus. It has long been thought that the relationship between type II diabetes mellitus and NAFLD is unidirectional, fatty liver being secondary to insulin resistance and type II diabetes mellitus, but recent studies show that hepatic steatosis may precede insulin resistance and diabetes mellitus, thus demonstrating abidirectional causal relationship between these two disorders. Weight loss through diet andexercise is effective in preventing and treating NAFLD in diabetic patients; also, drugs that causeweight loss need to be evaluated. Both anti-diabetic medication and statins play an important vrole in the prevention and treatment of NAFLD.

Introduction. Sarcopenia is a common complication and a frequently encountered feature in liver cirrhosis. Also, sarcopenia is a strong prognosis factor and a predictor of mortality in patients with advanced liver disease. However, in clinical practice, there are no well-established criteria for the diagnosis of this common complication of cirrhosis, the mechanisms which are involved are poorly understood and the possible therapeutic options are still undergoing randomized clinical trials.Materials and methods. To summarize the actual understanding of sarcopenia in cirrhosis, a literature search was performed using PubMed, MedLine, and Web of Science, to find articles related to definition, physiopathology, and treatment of sarcopenia of these patients.Results. A number of 30 papers that were suitable for this review were found. Most of them concluded that sarcopenia is a strong predictor of mortality, has a higher risk of hepatic encephalopathy and an increased health related cost in cirrhotic patients. The factors involved in this condition are far more complex than malnutrition and reduced protein intake, and include metabolic switch to the use of amino acids and fats to produce glucose. According to actual guidelines, beside moderate physical exercise and BCAA intake, therapeutic intervention with testosterone and ammonia-lowering therapies might have the potential to reverse sarcopenia in cirrhosis.Conclusion. Improved understanding of factors such as underlying nutritional imbalances, amount of oral protein intake, dose, type and duration of supplementation and the compliance of physical exercise, should be the focus of further research with randomized controlled trials.