Communication vs evidence: What hinders the outreach of science during an infodemic? A narrative review.

BACKGROUND: The COVID-19 pandemic is placing significant pressure on national and international health organizations and the measures taken to combat it are having many impacts beyond health. At the same time, misleading communication practices and what has been called an "infodemic" by the World Health Organization have been hampering the uptake of coronavirus-related scientific information. Moreover, public awareness about the dangers of the infodemic remains poor, and misinformation may lead to hazardous behaviours. We therefore analysed factors potentially undermining communication of scientific evidence and proposed strategies to counteract this phenomenon. METHODS: We sought official academic and institutional publications of any type, published in English and analyzed their approaches to communication used during the pandemic. RESULTS: The factors that might undermine appropriate communication include but are not limited to (a) the exponential increase of COVID-19-related publications, often including biases in the peer-review and editorial process; (b) the role of traditional media; (c) politicization of the virus; and (d) the impact of social media. We argue that evidence synthesis and knowledge translation are useful tools to communicate accurate scientific evidence to decision-makers. CONCLUSION: Clear and concise messages in this form can help decision-makers to interpret data correctly, take consequent actions, and avoid being compromised by low-quality or even misleading information.

Bile acids for non-alcoholic fatty liver disease and/or steatohepatitis.

The review is withdrawn on 09.07.2020, as it has not been updated since its first publication in 2007.

Splenomegaly as risk factor of liver cirrhosis. A retrospective cohort study of 2,525 patients who underwent laparoscopy.

The aim of this study was to evaluate the meaning of laparoscopic splenomegaly and its relationship with the severity and evolution of liver cirrhosis. Medical records of 2,525 consecutive patients with chronic liver diseases who underwent laparoscopy and video-guided hepatic biopsy were reviewed. There were 1,610 (63.8%) men and 915 (36.2%) women. All patients underwent gastroscopy to diagnose esophageal varices. The diagnosis of cirrhosis was made in 910 (36.0%) patients, while 620 (24.6%) had hepatic fibrosis, and 995 (39.4%) chronic active hepatitis. Splenomegaly was present in 460 out of 910 patients (50.5%) with cirrhosis. Among the 1,615 patients without cirrhosis, splenomegaly was present in 80 (4.9%), and esophageal varices were present in 70 out of 910 (7.6%) cirrhotic patients. In patients without cirrhosis, esophageal varices were present in 30 out of 1,615 (1.2%) at the time of laparoscopy. Statistical analysis showed significant differences between patients with cirrhosis and without cirrhosis for splenomegaly (χ(2)=717.03, p<0.001) and esophageal varices (χ(2)=50.57, p<0.001). In conclusion, laparoscopic splenomegaly seems to be an important prognostic factor in liver cirrhosis, which represents a risk factor for portal hypertension.

The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups.

Ethnic minorities living in high-income countries usually exhibit a greater risk of developing diabetes along with higher morbidity and mortality rates. We evaluated the effectiveness of interventions to improve glycaemic control in ethnic minority groups. Results of major controlled trials, systematic reviews and meta-analyses were included in the review. Only 1/47 studies addressing diet and exercise interventions reported details on the ethnicity of the studied population. Self-management education was successful if associated with increased self-efficacy; delivered over a longer period; of high intensity; culturally tailored; and when using community educators. Strategies adopted in community-gathering places, family-based, multifaceted, and those tackling the social context were likely to be more effective. A positive relationship was found between social support and self-management behaviour as well as quality of life, but there is little evidence about the impact of organizational changes within health-care services on diabetes control. More research is needed to strengthen the evidence on effective strategies for response to diabetes in ethnic minorities. Also, there is a need to take into account diabetes beliefs and communication difficulties, as well as potential protective factors. Globally, many health-care systems are inadequately equipped to improve diabetes prevention and disease outcomes in these communities.

Perihepatic adipose tissue thickness: a new non-invasive marker of NAFLD?

BACKGROUND AND AIMS: Several non-invasive markers have been proposed to assess liver damage in NAFLD. We measured by ultrasound (US) the perihepatic adipose tissue thickness (PATT), i.e. the thickness of the fat between the abdominal muscular layer and the hepatic surface, in addition to waist circumference, BMI, biochemistry and serum adipokines, to predict the severity of liver damage in NAFLD. METHODS: 63 NAFLD patients and 45 controls were studied. PATT and US steatosis score were assessed in all patients. Histology was obtained in those with an US steatosis score greater or equal to 2. RESULTS: PATT was 13.5 + or - 4.1 mm in NAFLD vs 8.0 + or - 4.1 in controls (p less than 0.001). A PATT value of 11.2 mm seems to represent a cut-off below which NAFLD is unlikely. Test sensitivity, specificity and the area under the ROC curve were 100%, 50% and 75%, respectively, suggesting a good discrimination between patients with non-NASH and those with NASH or borderline NASH. In addition, PATT strongly correlated with waist circumference (p less than 0.001). Both PATT and waist circumference correlated with US steatosis, HOMA-IR, TNF-alpha, IL-6 and leptin. Based on a multiple logistic regression analysis, waist circumferences greater or equal to 110, 113 and 122 cm were associated with a probability over or equal to 50% of abnormal HOMA-IR, TNF-alpha and leptin values, respectively. CONCLUSION: PATT and waist circumference could represent non-invasive markers predicting the severity of liver damage in NAFLD.

Recurrent dermatofibrosarcoma protuberans sixteen years after radical excition. A case report.

We report the case of a young patient with an apparently benign slowly growing lesion which was excised 15 years after its occurrence. However, the histopathological examination revealed a DFSP which necessitated two more surgical procedures for inadequate surgical margins and a skin graft. Notwithstanding these radical operations, the patient presented a local recurrence 16 years later, suggesting that the insidious behavior of the tumour must be taken into account and that patients with DFSP need a life-long follow-up.

Macro-aspartate aminotransferase (macro-AST). A 12-year follow-up study in a young female.

We describe a case of chronic elevation of serum aspartate aminotransferase (AST) activity due to the presence of a macro-enzyme form of AST (macro-AST) in a young female followed up for 12 years. This biochemical abnormality, although generally detected in acute and chronic hepatitis, malignancies and autoimmune disease, was not associated with any particular illness and did not seem to be congenital, as normal AST concentrations were reported in the patient's family members. Moreover, the normal or quasi-normal values of AST associated with peak levels observed in our case suggest that this phenomenon has a fluctuating behaviour rather than persisting for many months or years. In conclusion, we believe that it is important: 1) to reassure the patient with macro-AST, as this condition has a benign evolution and does not require any specific treatment; 2) to keep in mind this biochemical abnormality in all cases of unexplained AST elevation in order to avoid unnecessary invasive diagnostic procedures.

Adrenocortical carcinoma: a 15-year survival after complete resection and repeated resection. A retrospective study in a patient with an expected poor prognosis.

Adrenocortical carcinoma is a rare but aggressive malignancy with metastases being present in 30-40% of cases at the time of diagnosis. A number of prognostic factors have been identified in patients with adrenocortical carcinoma, but criteria predicting survival are not uniform. We report the case of a 58-year-old man with a large, non-functioning and poorly-differentiated adrenocortical carcinoma who, according to current knowledge, was expected to have a short survival. On the contrary, the prompt diagnosis and curative resection of the primary tumour, together with two reoperations for local recurrences, allowed a 15-year survival and a good quality of life. A revision of both clinical and histological prognostic factors is therefore needed in patients with this type of malignancy.

Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications?

Laparoscopy is a relatively safe invasive procedure, but complications can occur, mainly related to Veress needle and trocar insertion. The rate of these complications is generally reported to be low, but the true incidence may be higher because of underreporting. We retrospectively studied the records of 2650 consecutive diagnostic laparoscopies performed by the same operator with the aim of assessing the true incidence and nature of these complications. Major complications occurred in 0.41% of cases and included bladder injury, bowel perforation, hemoperitoneum, and abdominal wall hematoma. Minor complications, including omental and subcutaneous emphysema, occurred in 1.58% of cases. Some of these resolved spontaneously, whereas others required surgical or medical treatment. We believe that all laparoscopic complications should be reported to a registry so that their potential risk can be quantified. Simply reporting complications as major or minor on the basis of the follow-up does not allow laparoscopists to understand their true incidence completely.