Anti-osteoporotic treatments in the era of non-alcoholic fatty liver disease: friend or foe.

Over the last years non-alcoholic fatty liver disease (NAFLD) has grown into the most common chronic liver disease globally, affecting 17-38% of the general population and 50-75% of patients with obesity and/or type 2 diabetes mellitus (T2DM). NAFLD encompasses a spectrum of chronic liver diseases, ranging from simple steatosis (non-alcoholic fatty liver, NAFL) and non-alcoholic steatohepatitis (NASH; or metabolic dysfunction-associated steatohepatitis, MASH) to fibrosis and cirrhosis with liver failure or/and hepatocellular carcinoma. Due to its increasing prevalence and associated morbidity and mortality, the disease-related and broader socioeconomic burden of NAFLD is substantial. Of note, currently there is no globally approved pharmacotherapy for NAFLD. Similar to NAFLD, osteoporosis constitutes also a silent disease, until an osteoporotic fracture occurs, which poses a markedly significant disease and socioeconomic burden. Increasing emerging data have recently highlighted links between NAFLD and osteoporosis, linking the pathogenesis of NAFLD with the process of bone remodeling. However, clinical studies are still limited demonstrating this associative relationship, while more evidence is needed towards discovering potential causative links. Since these two chronic diseases frequently co-exist, there are data suggesting that anti-osteoporosis treatments may affect NAFLD progression by impacting on its pathogenetic mechanisms. In the present review, we present on overview of the current understanding of the liver-bone cross talk and summarize the experimental and clinical evidence correlating NAFLD and osteoporosis, focusing on the possible effects of anti-osteoporotic drugs on NAFLD.

Placental Mesenchymal Dysplasia: Ultrasound Characteristics and Diagnostic Pitfalls.

Placental mesenchymal dysplasia (PMD) is a rare, benign developmental anomaly with a reported prevalence of 0.02% (Arizawa and Nakayama, 2002). It is characterized by placentomegaly with multiple cystic lesions of the stem villi and vascular anomalies (Pawoo and Heller, 2014). Early detection of PMD has been described during routine prenatal ultrasound (Vaisbuch et al., 2009). The sonographic characteristics of PMD include increased placental thickness and multiple cystic areas within the placenta with either an absence of blood flow or with low venous Doppler signals (Vaisbuch et al., 2009). The differential diagnosis of multicystic placental lesions with the presence of a live fetus include partial molar pregnancy, multiple hematomas, chorioangioma Beckwith-Wiedemann syndrome and PMD. Chorioangiomas are well circumscribed masses within the placenta and they are characterized by the presence of a single feeding vessel with the same pulse rate as the umbilical cord (Zalel et al., 2002). Invasive prenatal testing is required for the exclusion of partial molar pregnancy and Beckwith-Wiedemann Syndrome (Vaisbuch et al., 2009). Definitive diagnosis of PMD is based on the pathologic examination of the placenta. Histology reveals aneurysm or dilated blood vessels that may be thrombosed. The stem villi are edematous and enlarged with thick-walled vessels, without trophoblastic proliferation (Pawoo and Heller, 2014). This case report highlights the significance of the early detection of PMD, illustrates the pitfalls in differential diagnosis and provides valuable insights regarding PMD management in a clinical setting.

Immunizations during pregnancy: How, when and why.

Maternal immunization during pregnancy provide protection for the mother and the fetus against certain pathogens. Immunizations during pregnancy are divided to routine immunizations recommended for all pregnant women, immunizations for certain medical indications and vaccines that are potentially harmful during pregnancy and should be avoided. We conducted a comprehensive review of the literature regarding immunizations during pregnancy. The search terms used were immunization, vaccine, pregnancy, influenza, pertussis, safety and efficacy. We gathered all available guidelines on vaccination during pregnancy. Generally, vaccines are allowed during pregnancy when the benefits outweigh the risks. Tdap and inactivated flu vaccines are routinely recommended during pregnancy. Vaccines containing live attenuated viruses are contraindicated during pregnancy. These are LAIV influenza, MMR, Varicella, Zoster, BCG and smallpox pre-exposure. All other vaccines are given when medically indicated and the possible benefits outweigh the risks. Obstetricians and gynecologists should be familiar with the indications of vaccination during pregnancy. Vaccination coverage of pregnant women with routinely recommended vaccines has increased but further efforts are needed. Our aim is to review vaccination practices during pregnancy, demonstrate the benefits and dangers of different vaccines, evaluate their effectiveness and define the proper timing of vaccination.