Accuracy of Transient Elastography in Assessing Fibrosis at Diagnosis in Naïve Patients With Primary Biliary Cholangitis: A Dual Cut-Off Approach.

BACKGROUND AND AIMS: Liver fibrosis holds a relevant prognostic meaning in primary biliary cholangitis (PBC). Noninvasive fibrosis evaluation using vibration-controlled transient elastography (VCTE) is routinely performed. However, there is limited evidence on its accuracy at diagnosis in PBC. We aimed to estimate the diagnostic accuracy of VCTE in assessing advanced fibrosis (AF) at disease presentation in PBC. APPROACH AND RESULTS: We collected data from 167 consecutive treatment-naïve PBC patients who underwent liver biopsy (LB) at diagnosis at six Italian centers. VCTE examinations were completed within 12 weeks of LB. Biopsies were scored by two blinded expert pathologists, according to the Ludwig system. Diagnostic accuracy was estimated using the area under the receiver operating characteristic curves (AUROCs) for AF (Ludwig stage ≥III). Effects of biochemical and clinical parameters on liver stiffness measurement (LSM) were appraised. The derivation cohort consisted of 126 patients with valid LSM and LB; VCTE identified patients with AF with an AUROC of 0.89. LSM cutoffs ≤6.5 and >11.0 kPa enabled to exclude and confirm, respectively, AF (negative predictive value [NPV] = 0.94; positive predictive value [PPV] = 0.89; error rate = 5.6%). These values were externally validated in an independent cohort of 91 PBC patients (NPV = 0.93; PPV = 0.89; error rate = 8.6%). Multivariable analysis found that the only parameter affecting LSM was fibrosis stage. No association was found with BMI and liver biochemistry. CONCLUSIONS: In a multicenter study of treatment-naïve PBC patients, we identified two cutoffs (LSM ≤6.5 and >11.0 kPa) able to discriminate at diagnosis the absence or presence, respectively, of AF in PBC patients, with external validation. In patients with LSM between these two cutoffs, VCTE is not reliable and liver biopsy should be evaluated for accurate disease staging. BMI and liver biochemistry did not affect LSMs.

Asymptomatic SARS-CoV-2 infections in pregnant patients in an Italian city during the complete lockdown.

Data from both New York and London report a high prevalence of the asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant patients admitted for delivery, raising questions on the possible correlated dangers (ie, contacts with healthcare workers; the possible creation of an intrahospital outbreak at birth; and conflicting evidence on vertical transmission). For this study, results from SARS-CoV-2 screening via nasopharyngeal swab from maternity wards of the four hospitals of Genoa, Italy, were collected during a month of complete lockdown from 1 April to 30 April 2020. Out of 333 tested women, only 9 were symptomatic. Only one symptomatic patient (0.3%) and six asymptomatic ones (1.8%) tested positive. Out of the six positive asymptomatic patients, five were from the most disadvantaged neighborhood of the city (assessed by postal code). In conclusion, even if Italy was badly affected by coronavirus disease 2019 in the studied month, the reported prevalence of SARS-CoV-2 infections in asymptomatic pregnant patients at term was lower than the ones reported in the literature.

High rates of 30-day mortality in patients with cirrhosis and COVID-19.

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities, but its impact on patients with cirrhosis is currently unknown. Herein, we aimed to evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis. METHODS: In this multicentre retrospective study, patients with cirrhosis and a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 1st and 31th March 2020. Clinical and biochemical data at diagnosis of COVID-19 and at the last outpatient visit were obtained through review of medical records. RESULTS: Fifty patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled (age 67 years, 70% men, 38% virus-related, 52% previously compensated cirrhosis). At diagnosis, 64% of patients presented fever, 42% shortness of breath/polypnea, 22% encephalopathy, 96% needed hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin. Serum albumin significantly decreased, while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis compared to last available data. The proportion of patients with a model for end-stage liver disease (MELD) score ≥15 increased from 13% to 26% (p = 0.037), acute-on-chronic liver failure and de novo acute liver injury occurred in 14 (28%) and 10 patients, respectively. Seventeen patients died after a median of 10 (4-13) days from COVID-19 diagnosis, with a 30-day-mortality rate of 34%. The severity of lung and liver (according to CLIF-C, CLIF-OF and MELD scores) diseases independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections. CONCLUSION: COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis. LAY SUMMARY: Coronavirus disease 2019 (COVID-19) poses a major health threat to healthy individuals and those with comorbidities. Herein, we assessed its impact on patients with cirrhosis. Infection with COVID-19 was associated with liver function deterioration and elevated mortality in patients with cirrhosis.

Lens Factor Choice in IOL Power Calculation after Laser Refractive Surgery: The Right Constant for Advanced Lens Measurement Approach (ALMA).

Background/Objectives: To evaluate the advanced lens measurement approach (ALMA) formula accuracy using different lens constants available on the user group for laser interference biometry (ULIB) and IOL Con platforms. Methods: In this retrospective, comparative, case-series study, 150 eyes of 160 patients with previous myopic Photorefractive Keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), who underwent uneventful cataract surgery and IOL implantation, were examined. The ALMA formula was evaluated to calculate the refractive prediction error (PE), analysing four different categories of lens constants: both nominal and optimized A-Constant for SRKT, which are available on the ULIB and IOL Con platforms. An additional analysis was carried out in this study, evaluating if a decreased ULIB optimized constant (DUOC) with different fixed factors (-1.2 -1.3 -1.4 -1.5) could improve refractive outcomes. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of prediction error were measured as the main outcomes. Results: Comparing the lens factors available on ULIB and IOL Con platforms, the ALMA formula reported a lower MedAE and higher percentages of eyes with a refractive PE within 1.0 D using ULIB nominal constants (all p < 0.05). Using DUOC (-1.3), and there was a statistically significant improvement of both MedAE and of the percentages of eyes with PE within ±0.50 D with the ALMA method compared to nominal ULIB constants (all p < 0.05). Conclusions: The impact of different lens factors in the IOL power calculation after myopic LRS should be carefully evaluated. The ALMA formula, in the absence of optimized constants by zeroing the mean error, should be used by subtracting 1.3 from the optimized ULIB constants available on the IOL Con website. This finding suggests further studies to test which of these constants could work better with the other post-refractive surgery formulas.

Impact of Brightness on Choroidal Vascularity Index.

The use of choroidal vascularization to diagnose and follow-up ocular and systemic pathologies has been consolidated in recent research. Unfortunately, the choroidal parameters can be different depending on the lighting settings of optical coherence tomography (OCT) images. The purpose of this study was to examine whether the brightness of OCT images could influence the measurements of choroidal parameters obtained by processing and analyzing scientific images with the ImageJ program. In this observational, prospective, non-randomized study, 148 eyes of 74 patients with a mean age of 30.7 ± 8.5 years (ranging from 23 to 61 years) were assessed. All patients underwent a complete ophthalmological examination including slit lamp, fundus oculi, ocular biometry, corneal tomography and spectral domain (SD) OCT evaluations of the foveal region in the enhanced depth imaging (EDI) mode. OCT images at two different brightness levels were obtained. The total choroidal area (TCA), choroidal vascularity index (CVI), stromal choroidal area (SCA) and luminal choroidal area (LCA) at both lower and higher brightness levels were measured. To avoid the bias of operator-dependent error, the lower and higher brightness TCAs were obtained using two methods: the manual tracking mode and fixed area. At the two different brightness levels, LCA, SCA and CVI measurements showed statistically significant changes (p < 0.05), whereas the TCA differences were not statistically significant (p > 0.05). According to the results of this study, highlighting that brightness could affect LCA, SCA and CVI parameters, care should be taken during OCT image acquisition.

Changes in the size of rectovaginal endometriotic nodules infiltrating the rectum during hormonal therapies.

PURPOSE: To evaluate the changes in the volume of rectovaginal endometriotic nodules infiltrating the rectum during 12-month treatment with hormonal therapies. MATERIALS AND METHODS: This prospective, non-randomized, self-controlled clinical trial included patients with rectovaginal endometriotic nodules infiltrating at least the muscularis propria of the rectum, who received one of the following therapies: norethisterone acetate, triptorelin and tibolone, norethisterone acetate and letrozole, desogestrel, sequential oral contraceptive pill. The volume of the nodules was determined by virtual organ computer-aided analysis (VOCAL, GE Healthcare, USA) at baseline and after 6 and 12 months of treatment. RESULTS: Eighty-three women (90.2 %) completed the 12-month treatment. When compared with baseline values, the volume of the nodules decreased at 6-month (p < 0.001) and 12-month treatment (p < 0.001). After 12-month treatment, the volume of the nodules decreased in all study groups. The volume of the nodules decreased during therapy in 68 women (73.9 %) and increased in 11 women (12.0 %). CONCLUSION: 12-month administration of hormonal therapies reduces the volume of rectovaginal endometriotic nodules infiltrating the rectum in the majority of cases.

The Effect of Fluid Challenge Test on Optic Nerve Sheath Diameter.

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Choroidal involvement in Mediterranean fever.

Standardized measurements are needed to obtain reliable data, therefore the aim of this letter is to clarify some points.

Choroidal Thickness Measurements in the Case of Diabetic Macular Edema. Comment on Amjad et al. Choroidal Thickness in Different Patterns of Diabetic Macular Edema. J. Clin. Med. 2022, 11, 6169.

We read with great interest the article by Amjad R. et al. on "Choroidal Thickness in Different Patterns of Diabetic Macular Edema" [...].

Risk stratification in primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) is a chronic liver disorder commonly affecting young patients and associated with uncertain prognosis and elevated risk of end-stage liver disease and hepatobiliary cancer. Rate of progression in PSC is heterogeneous and accurately predicting the disease course is of paramount importance to clinical practice and interventional trial design. So far, efforts have brought to the development of models looking at short-to-middle-term outcome using composite models including clinical, laboratory, radiological and histological parameters with limited performance. In the era of whole genome sequencing and digital innovation, the time is ripe for the development of stratified medicine in PSC. Efforts should be directed toward developing well-phenotyped cohorts of patients with longitudinal follow-up across sustained periods of time, application of novel image-processing technology, and biomarker discovery using multiomics platforms.

Does Subretinal Fluid Influence Choroidal Thickness (ChT) and Structure in Preeclampsia with Serous Retinal Detachment? Comment on Fukui et al. Changes in Choroidal Thickness and Structure in Preeclampsia with Serous Retinal Detachment. J. Clin. Med. 2023, 12, 609.

We read with great interest the article by Fukui A et al. concerning the "Changes in Choroidal Thickness (ChT) and Structure in Preeclampsia with Serous Retinal Detachment" [...].

The Correlation between Retinal and Choroidal Thickness with Age-Related White Matter Hyperintensities in Progressive Supranuclear Palsy.

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease. Recently, several retinal layers in PSP compared to healthy controls. were found to be thinner. However, no studies evaluating the correlation between retinal layers and cerebral white matter changes, nor eventual choroidal changes in PSP, have been conducted so far. The goals of the present study were to explore potential differences in choroidal structure between PSP and healthy controls, and to describe the relationship between retinal layers' thickness and volume, using spectral-domain optical coherence tomography (SD-OCT) and age-related white matter change scores (ARWMC) using magnetic resonance imaging (MRI) of the brain. Choroidal structures of 26 PSP patients and 26 healthy controls using standard SD-OCT with an enhanced depth imaging (EDI) approach were analyzed; then, retinal the structures of 16 of these PSP patients using standard SD-OCT were examined; finally, the same patients underwent brain MRI, and their cerebral white matter changes were calculated. Non-statistically significant differences between PSP patients' and healthy controls' choroidal structure were found. On the contrary, PSP patients' inner retinal layers (INR), retinal pigmented epithelium (RPE) and all retinal layers' thicknesses in the macular region were found to be significantly correlated with ARWMC, independently from age and axial length (AL). PSP patients' neurological alterations go hand in hand with retinal ones, independently from age and axial length. Our results suggest a mutual relationship between cerebral and retinal structure pathological alterations. On the other hand, no significant differences in the choroidal evaluation compared to healthy controls have been found.

Risk factors and prevention of choking.

Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances).  The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%)  and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.

The importance of promoting oral health in schools: a pilot study.

Promotion of oral health has an essential role in the maintenance of teeth in adults. However, health education must start from an early age, in order to monitor the child's growth and prevent pathologies. Schools are in charge of the overall education of children and of guidance to parents but could also be engaged in the promotion of oral health, supported and counseled by pediatricians and dentists. The purpose of this pilot study is to evaluate whether school age children could be taught, successfully, basic oral sciences and dental hygiene, by a professional, during school hours. In this pilot study, an anonymized test was administered to 45 children of age between 8 and 10, both before and after an interactive lecture on oral health, to assess the effectiveness of the lesson and acquisition by the children of knowledge on oral health. After the presentation, the majority of the children were able to answer correctly to the questionnaire that was given to them (test, retest) which was related to dental anatomy and pathology (number of teeth, cavities, halitosis), and dental hygiene tools and practices (brushes, floss, mouth wash, tongue scrapers). The children seemed to be receptive to learning while in school, and a specific educational session of dental hygiene and oral health seems to be the right approach to ensure children can identify dental hygiene tools and use them appropriately.

Optic Nerve Changes Detected with Ocular Ultrasonography during Different Surgical Procedures: A Narrative Review.

Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of neurological and non-neurological conditions. Considering the latter, increases in intracranial pressure have also been described during several surgical procedures. Ocular ultrasonography might be utilized to identify intracranial pressure increases by evaluating optic nerve sheath diameter variations. The aim of this review is to provide a wide overview on the use of the optic nerve ultrasound evaluation to detect intracranial pressure changes during surgical procedures, also discussing the pitfalls of the B-scan technique, the most widely used for such a purpose. PubMed medical database, Web of Science and Scopus were used to carry out this review. The present review showed that ocular ultrasonography could be considered a valuable diagnostic tool in the surgical setting to indirectly assess intracranial pressure. However, the use of the B-scan ultrasound should always be coupled with the standardized A-scan technique for a more accurate, precise and trustworthy ultrasound assessment.

The Influence of SARS-CoV-2 Pandemic on TMJ Disorders, OSAS and BMI.

The pandemic of the 21st century had a significant influence on the lives of the world population in a negative way. This situation determined a change of lifestyle; it caused the necessity of social isolation for a great number of people. In fact, people tended to avoid crowded environments, social events, to reduce medical checks and sports activities, favoring sedentary life because of fear of the virus. This social attitude brought a high level of stress that worsened many health conditions. This study has the aim of evaluating the possible influence of the pandemic on temporomandibular joint (TMJ) disorders, obstructive sleep apnea syndrome (OSAS) and body mass index (BMI). An anonymized survey, available in two languages (Italian and English), was given to 208 patients from different private dental practices. In this questionnaire, the patients shared experiences about their life during the pandemic. The article highlighted that during this health emergency, there was an increase in body weight in the considered sample. This brought a worsening of OSAS in 65% of patients with a previous diagnosis. Eventually, an increase in TMJ disorders and orofacial pain was reported.