Understanding the Relationship between Nonalcoholic Fatty Liver Disease and Thyroid Disease.

The prevalence of hypothyroidism in patients with nonalcoholic fatty liver disease (NAFLD) is high (22.4%). Thyroid hormones (THs) regulate many metabolic activities in the liver by promoting the export and oxidation of lipids, as well as de novo lipogenesis. They also control hepatic insulin sensitivity and suppress hepatic gluconeogenesis. Because of its importance in lipid and carbohydrate metabolism, the involvement of thyroid dysfunction in the pathogenesis of NAFLD seems plausible. The mechanisms implicated in this relationship include high thyroid-stimulating hormone (TSH) levels, low TH levels, and chronic inflammation. The activity of the TH receptor (THR)-ß in response to THs is essential in the pathogenesis of hypothyroidism-induced NAFLD. Therefore, an orally active selective liver THR-ß agonist, Resmetirom (MGL-3196), was developed, and has been shown to reduce liver fat content, and as a secondary end point, to improve nonalcoholic steatohepatitis. The treatment of NAFLD with THR-ß agonists seems quite promising, and other agonists are currently under development and investigation. This review aims to shine a light on the pathophysiological and epidemiological evidence regarding this relationship and the effect that treatment with THs and selective liver THR-ß agonists have on hepatic lipid metabolism.

Understanding the Role of Metabolic Syndrome as a Risk Factor for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) and metabolic syndrome (MetS) have a rising prevalence worldwide. The relationship between these two entities has long been studied and understanding it has become a public health and clinical priority. This association follows, in most patients, the path through non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), cirrhosis and finally HCC. Nonetheless, increasing evidence has been found, that shows MetS as an independent risk factor for the development of HCC. This review brings together the clinical evidence of the relationship between these highly prevalent diseases, with a particular interest in the impact of each component of MetS on HCC; It aims to summarize the complex physiopathological pathways that explain this relationship, and to shed light on the different clinical scenarios of this association, the impact of treating the different components of MetS on the risk of HCC and what is known about screening for HCC in patients with MetS. By doing so, it hopes to improve awareness on this topic.

Diseño y validación de un simulador híbrido de paracentesis / Design and validation of paracentesis hybrid simulator

La enseñanza médica por simulación es un método eficaz para el aprendizaje; mejora la adquisición de competencias, la práctica repetitiva y elimina riesgos para el paciente. Los simuladores de paracentesis existentes, tienen un alto costo y bajo nivel de realismo, por lo que se diseñó y elaboró un simulador híbrido de bajo costo. Se realizó un video representativo de un escenario clínico apropiado, que demuestra la técnica completa de paracentesis. Veinte médicos especialistas observaron el video y realizaron el procedimiento en simulador, posteriormente se aplicó un cuestionario sobre el realismo del simulador, utilidad del video e importancia del procedimiento en la educación médica. Los resultados mostraron que el 85% de los participantes considera que el simulador favoreció la experiencia de aprendizaje. El 90% consideró la apariencia clínica muy adecuada. El 100% opina que la adquisición de la habilidad de paracentesis es relevante en alumnos de pregrado

Medical education by simulation is an effective method for learning; It improves competence acquisition, repetitive practice and eliminates risks for the patient. Existing paracentesis simulators have a high cost and low level of realism, so a low cost simulator was designed and developed. A representative video of a suitable clinical scenario was demonstrated, demonstrating the complete paracentesis technique. 20 medical specialists observed the video and performed the procedure in the simulator, later applied a questionnaire on the realism of the simulator, the utility of the video, and the importance of the procedure in medical education. The results show that 85% of the participants consider the simulator favored the learning experience. 90% considered the clinical appearance to be adequate. 100% believe that the acquisition of paracentesis ability is relevant in undergraduate students