The emerging issues nowadays are non-alcoholic fatty liver disease (NAFLD) and its advanced stage non-alcoholic steatohepatitis (NASH), which further can be a predisposing factor for chronic liver complications, such as cirrhosis and/or development of hepatocellular carcinoma (HCC). Liver lipotoxicity can influence the accumulation of reactive oxygen species (ROS), so oxidative stress is also crucial for the progression of NASH. Moreover, NASH is in strong connection with metabolic disorders, and supporting evidence shows that insulin resistance (IR) is in a close relation to NAFLD, as it is involved in the progression to NASH and further progression to hepatic fibrosis. The major issue is that, at the moment, NASH treatment is based on lifestyle changes only due to the fact that no approved therapeutic options are available. The development of new therapeutic strategies should be conducted towards the potential NAFLD and NASH treatment by the modulation of IR but also by dietary antioxidants. As it seems, NASH is going to be the leading indication for liver transplantation as a consequence of increased disease prevalence and the lack of approved treatment; thus, an effective solution is needed as soon as possible.
Point-of-Care ultrasound (POCUS) is based on target ultrasound that is performed wherever a patient is being treated, and by a non-radiologist directly involved in the patient’s care. It is used either for quick diagnosis or procedural guidance. Abdominal pain is one of the most common complaints in emergency departments, and POCUS can help in the differentiation of patients who need additional diagnostic tests or hospital treatment, which eventually reduces the overall costs of health care. POCUS has high sensitivity and specificity in abdominal pathology, it can be helpful in the evaluation of biliary, intestinal, and urinary tract, and it is especially used in trauma. Additionally, the gold standard for abdominal aortic aneurysm detection, follow up and screening is precisely this diagnostic procedure. Unfortunately, the quality of ultrasound examination can be affected by the experience of the physician performing it and the patient’s body weight. There is no doubt that POCUS is being increasingly recognized, but all motivated physicians should be provided with dedicated tutors and enough time for learning. This would certainly help to implement this diagnostic method as a routine in emergency and critical care departments, and significantly shorten the time until definitive diagnosis.
The proportion of elderly people in the world population is constantly increasing. With age, the risk of numerous chronic diseases and their complications also rises. Research on the subject of cellular senescence date back to the middle of the last century, and today we know that senescent cells have different morphology, metabolism, phenotypes and many other characteristics. Their main feature is the development of senescence-associated secretory phenotype (SASP), whose pro-inflammatory components affect tissues and organs, and increases the possibility of age-related diseases. The liver is the main metabolic organ of our body, and the results of previous research indicate that its regenerative capacity is greater and that it ages more slowly compared to other organs. With age, liver cells change under the influence of various stressors and the risk of developing chronic liver diseases such as non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), alcoholic steatohepatitis (ASH) and hepatocellular carcinoma (HCC) increases. It has been proven that these diseases progress faster in the elderly population and in some cases lead to end-stage liver disease that requires transplantation. The treatment of elderly people with chronic liver diseases is a challenge and requires an individual approach as well as new research that will reveal other safe and effective therapeutic modalities.
Alcoholic liver disease (ALD) is a consequence of excessive alcohol use. According to many studies, alcohol represents a significant socioeconomic and health risk factor in today’s population. According to data from the World Health Organization, there are about 75 million people who have alcohol disorders, and it is well known that its use leads to serious health problems. ALD is a multimodality spectrum that includes alcoholic fatty liver disease (AFL) and alcoholic steatohepatitis (ASH), consequently leading to liver fibrosis and cirrhosis. In addition, the rapid progression of alcoholic liver disease can lead to alcoholic hepatitis (AH). Alcohol metabolism produces toxic metabolites that lead to tissue and organ damage through an inflammatory cascade that includes numerous cytokines, chemokines, and reactive oxygen species (ROS). In the process of inflammation, mediators are cells of the immune system, but also resident cells of the liver, such as hepatocytes, hepatic stellate cells, and Kupffer cells. These cells are activated by exogenous and endogenous antigens, which are called pathogen and damage-associated molecular patterns (PAMPs, DAMPs). Both are recognized by Toll-like receptors (TLRs), which activation triggers the inflammatory pathways. It has been proven that intestinal dysbiosis and disturbed integrity of the intestinal barrier perform a role in the promotion of inflammatory liver damage. These phenomena are also found in chronic excessive use of alcohol. The intestinal microbiota has an important role in maintaining the homeostasis of the organism, and its role in the treatment of ALD has been widely investigated. Prebiotics, probiotics, postbiotics, and symbiotics represent therapeutic interventions that can have a significant effect on the prevention and treatment of ALD.
A survey on summer squash open field crops was carried out during 2000 and 2001 in order to identify the major viruses infecting these crops in different localities. Plants showed different types of symptoms: mild mosaic, chlorotic spotting, distinctive mosaic, blistering of leaf lamina leaf yellowing, deformation of leaf lamina, knobbed fruits and stunting of plants. The symptoms were very variable but showed the viral nature of the investigated summer squash diseases. The collected samples were tested by bioassay and by two serological methods ELISA and EBIA using cucumber mosaic cucumovirus (CMV), zucchini yellow mosaic potyvirus (ZYMV), watermelon mosaic potyvirus 2 (WMV-2), zucchini yellow flack potyvirus (ZYFV) watermelon mosaic potyvirus 1 (WMV-1), squash mosaic comovirus (SqMV) and cucurbit aphid-borne yellows polerovirus (CABYV) polyclonal antisera. In all tested samples single or mixed infection with ZYMV, CMV and WMV-2 was detected. The most prevalent virus infecting summer squash was ZYMV. This is the first report of ZYMV, the most destructive virus infecting cucurbits, in Yugoslavia. It was also proven that the identified viruses are transmissible by Aphis gossypii in a non-persistent manner, but possible role of seed in virus transmission was not confirmed
Background: This study aimed to calculate the frequency of elevated liver enzymes in hospitalized patients with coronavirus disease 2019 (COVID-19) infection and to test if liver enzyme biochemistry levels on admission could predict the computed tomography (CT) scan severity score of bilateral interstitial pneumonia. Methods: This single-center study comprised of 323 patients including their demographic data, laboratory analyses, and radiological findings. All the information was taken from electronic health records, followed by statistical analysis. Results: Out of 323 patients, 115 of them (35.60%) had aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) over 40 U/L on admission. AST was the best predictor of CT scan severity score of bilateral interstitial pneumonia (R2 = 0.313, Adjusted R2 = 0.299). CT scan severity score in the peak of the infection could be predicted with the value of AST, neutrophils, platelets, and monocytes count (R2 = 0.535, Adjusted R2 = 0.495). Conclusion: AST, neutrophils, platelets, and monocytes count on admission can account for almost half (49.5%) of the variability in CT scan severity score at peak of the disease, predicting the extensiveness of interstitial pneumonia related to COVID-19 infection. Liver enzymes should be closely monitored in order to stratify COVID-19 patients with a higher risk of developing severe forms of the disease and to plan the beforehand step-up treatment.
Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.
It has been a year and a half since the fight against the COVID-19 pandemic started. In today's protocols for the treatment of COVID-19 and the prevention of its complications, corticosteroid therapy and anticoagulant therapy have a crucial part. The goal of this article is to show, based on available data, both the benefits and the disadvantages of corticosteroid and anticoagulant therapy in treating the infection caused by the Sars-CoV-2 virus. At the very onset of the pandemic, an increased frequency of thrombotic events negatively impacting the course and outcome of the disease, was registered. It has been observed that increased values of D-dimer in patients with COVID-19 do not correlate with the presence of venous thrombosis and are not reliable in the detection of deep vein thrombosis and pulmonary thromboembolism. According to the National Protocol for Treating COVID-19 (Version 12), anticoagulant therapy is recommended in hospitalized patients. Due to the risk of different side effects, such as bleeding and heparin-induced thrombocytopenia, a careful use of anticoagulant therapy is necessary, as well as close monitoring of its effects. With respect to corticosteroids, their efficacy in patients with moderate and severe clinical presentation of COVID-19, who are in need of oxygen support, was analyzed. Corticosteroids have proven efficient in decreasing mortality, decreasing the need for mechanical ventilation, decreasing the length of stay in intensive care units, as well as in shortening the length of hospital stay. Assessing the individual benefits and risks before introducing these drugs into the therapy of a patient with confirmed COVID-19 is of vital importance for achieving the desired effects of the therapy.
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