Peripheral artery disease and all-cause and cardiovascular mortality in patients with NAFLD.

PURPOSE: Cardiovascular disease (CVD) is the first cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and risk stratification is recommended by current guidelines. The aim of this study is to assess the prevalence of peripheral arterial disease (PAD) in patients with NAFLD and its association with all-cause and cardiovascular disease (CVD) mortality. METHODS: 9145 participants 40 years or older attended a mobile examination center visit in the 1999-2004 cycles of the National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial index (ABI) < 0.90 in either of the legs and mortality data through December 2015 were obtained from the National Death Index. NAFLD was defined by a fatty liver index ≥ 60 in the absence of other liver conditions, leading to a final sample of 3094 subjects. RESULTS: The overall prevalence of PAD was 5.9% (95% CI 5.0-6.9). Over a median follow-up of 13 years, 876 participants died, 208 of cardiovascular causes. Incidence rates of all-cause mortality (for 1000 person-years) were 20.2 (95% CI 18.7-21.7) and 70.0 (95% CI 60.1-81.6) for participants without and with PAD, respectively. Multivariable-adjusted Cox proportional hazard models showed that PAD was associated with a higher risk of all-cause (1.8, 95% CI 1.4-2.4) and cardiovascular mortality (HR 2.5, 95% CI 1.5-4.3) after adjustment for potential confounders including prevalent CVD. CONCLUSION: Current guidelines strongly encourage the screening of CVD in patients with NAFLD and the use of the simple and inexpensive measurement of ABI in routine clinical practice may find indication.

Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy.

PURPOSE: The purpose of this study was to evaluate the impact of pre-existing diabetes on in-hospital mortality in patients admitted for Coronavirus Disease 2019 (COVID-19). METHODS: This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes on in-hospital mortality after adjustment for potential confounding variables. RESULTS: Mean age of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male and 69 (18.5%) had diabetes. The most common comorbid conditions were hypertension (237 [64.8%]), cardiovascular disease (140 [37.7%]) and malignant neoplasms (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age (Relative Risk [RR] 1.06 [1.04-1. 09] per year), diabetes (RR 1.56 [1.05-2.02]), chronic obstructive pulmonary disease (RR 1.82 [1.13-2.35]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality. CONCLUSION: In this retrospective single-center study, diabetes was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.

Impact of using different biomarkers of liver fibrosis on hepatologic referral of individuals with severe obesity and NAFLD.

PURPOSE: The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals. METHODS: This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis. RESULTS: Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910). CONCLUSION: Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.

[Analysis of a proposal for changing the educational paradigm in bacteriology and virology. Facultad de Ciencias Médicas, Universidad Nacional de Córdoba]. / Análisis de una propuesta para el cambio de paradigma educacional en bacteriología y virología médicas, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba.

The productive character of the scientific thought points out a methodological means that include the demand of the students' job about the information and not his mere reception and reproduction. It is essential to give the students the opportunity of discovering the cognitive processes used in the production of the scientific knowledge. In this work, we present the result of the starting of a workshop dynamic in a basic subject, the students' answers, and the analysis of the subject. In the Chair of Medical Bacteriology and Virology of the School of Medical Sciences, the National University of Córdoba, 1700 students attended classes in 1997. The subject was developed with the activities that worked the same contents from two different learning conceptions: (I) workshop activity, non obligatory, constructive, and (II) theorico-practical activity, obligatory and traditional. Two voluntary and anonymous interviews were done about the valuation that the student gave to these two activities and their basis, one in the middle and the other at the end of the course. 90.55% classified the traditional activity as positive, and 9.45% as negative. Regarding the workshop activity, the 60.5% classified it as positive and the 39.5% as negative. The same developed content with two activities made possible the analysis of the impact that the two different methodologies produced on the students. The student's answer to the traditional activity was better than the workshop activity (p < 0.001). The differences in the student's acceptance between the two option revealed the major difficulty of an alternative methodological strategy in the current educational model.

Análisis de una propuesta para el cambio de paradigma educacional en bacteriología y virología médicas, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba. / [Analysis of a proposal for changing the educational paradigm in bacteriology and virology. Facultad de Ciencias Médicas, Universidad Nacional de Córdoba]

The productive character of the scientific thought points out a methodological means that include the demand of the students job about the information and not his mere reception and reproduction. It is essential to give the students the opportunity of discovering the cognitive processes used in the production of the scientific knowledge. In this work, we present the result of the starting of a workshop dynamic in a basic subject, the students answers, and the analysis of the subject. In the Chair of Medical Bacteriology and Virology of the School of Medical Sciences, the National University of Córdoba, 1700 students attended classes in 1997. The subject was developed with the activities that worked the same contents from two different learning conceptions: (I) workshop activity, non obligatory, constructive, and (II) theorico-practical activity, obligatory and traditional. Two voluntary and anonymous interviews were done about the valuation that the student gave to these two activities and their basis, one in the middle and the other at the end of the course. 90.55

classified the traditional activity as positive, and 9.45

as negative. Regarding the workshop activity, the 60.5

classified it as positive and the 39.5

as negative. The same developed content with two activities made possible the analysis of the impact that the two different methodologies produced on the students. The students answer to the traditional activity was better than the workshop activity (p < 0.001). The differences in the students acceptance between the two option revealed the major difficulty of an alternative methodological strategy in the current educational model.