Interaction of metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease with advanced fibrosis in the death and intubation of patients hospitalized with coronavirus disease 2019.

Patients with pre-existing liver diseases are considered to have an increased risk of morbidity and mortality from any type of infection, including viruses. The aim of this work was to explore the implications of metabolic dysfunction-associated fatty liver disease (MAFLD) and nonalcoholic fatty liver disease (NAFLD) definitions in coronavirus disease 2019 (COVID-19) and to study the interaction between advanced fibrosis (AF) and each of these diseases in the death and intubation of patients hospitalized with COVID-19. We performed a retrospective study with 359 patients hospitalized with confirmed COVID-19 infection in a tertiary referral hospital who were admitted between April and June 2020. A multivariate Cox model was performed regarding the interaction of AF with MAFLD and NAFLD in the mortality and intubation of patients with COVID-19. The death rate was statistically significantly higher in the MAFLD group compared to the control group (55% vs. 38.3%, p = 0.02). No significant difference was seen in the death rate between the NAFLD and control group. The MAFLD (44.09% vs. 20%, p = 0.001) and NAFLD (40.51% vs. 20%, p = 0.01) groups had statistically significantly higher intubation rates than the control group. A statistically significant interaction between NAFLD and AF was associated with an increase in mortality (p = 0.01), while a statistically significant interaction between MAFLD and AF was associated with an increased risk of mortality (p = 0.006) and intubation (p = 0.049). In the case of patients hospitalized with COVID-19, our results indicate that the death rate was higher in the MAFLD group but not the NAFLD group compared to that in the control group. The intubation rates were higher in the NAFLD and MAFLD groups compared to rates in the control group, suggesting that both could be associated with COVID-19 severity. In addition, we found interactions between AF with MAFLD and NAFLD.

Initial Histological Evaluation of a Novel Dura Mater Graft Based on Capsule Granulation Harvested From Subcutaneous Tissue: Experimental Model.

INTRODUCTION: Autografts are useful but unfortunately are limited in big dural defects, in such cases, synthetic implants have been recommended. Extensive evidence in the literature suggests that sometimes synthetic implants had high rates of complications like infections. This paper aims to present a novel dura matter graft based on capsule granulation tissue harvested from subcutaneous space as a dura substitute and its histological findings. MATERIALS AND METHODS: Wistar rats between 240 and 430 grams of both genders were included. First stage procedure introducing silicon spheres in the subcutaneous tissue. Second stage procedure 4 weeks later harvested de capsule granulation tissue that contain them. Then a craniectomy was performed to create a dura mater defect. This defect was reconstructed with the granulation tissue was placed onlay the defect. After another 4 weeks the subjects were euthanized and sent to an external pathology unit for analysis with validated integration scales. RESULTS: A total of 5 subjects were included (3 males and 2 females) with weight between 240 and 430 grams. Only 2 outcome out of 6 scales had significance difference between the samples: adhesions P = 0.011 and integration P = 0.006. CONCLUSIONS: The histological findings shown that capsule granulation graft is a compatible, autologous compatible substitute for dura mater. It has a great potential of full integration and an acceptable grade of adhesions.

Evaluation of Predictive Values of an Automatic Device Measuring Oximetry in Free Flaps.

Free-flap monitoring is challenging to perform in some centers. It requires the availability of trained health care personnel for 24 hours a day and seven days a week. Many methods had been proposed for flap monitoring, and none of them are superior to clinical evaluation. This study aimed to present a murine model to evaluate the accuracy (sensitivity, specificity, and the positive or negative predictive values) of a device. Wistar rats weighing 240-490 g were included for intervention and data collection. A murine model of left inferior epigastric vessel flaps was implemented. Intermittent pedicle clamping was performed to calculate the accuracy of the device that detects flow obstruction. The general variables studied were age, weight, and gender. The sensitivity, specificity, and negative or predictive values were calculated. The results showed a sensitivity of 97%, a specificity of 95% with a positive predictive value of 95%, and negative predictive value of 97%. The sensitivity and specificity showed excellent results within the range of clinical security. We require more data to analyze the multiparameter monitoring to see if it is feasible and cost-effective.