Eggshell calcifications at thyroid ultrasound are connected to the challenging field of thyroid nodules and/or malignancy from a multidisciplinary perspective. Calcifications may be found in malignant and benign tumors; typically, micro-calcifications are identified in the papillary type of cancer, being equivalent to psammoma bodies in the pathological report. The risk of macro- calcifications, however, is more nuanced; recent data suggest a potential connection with a differentiated malignancy as well. Eggshell calcifications, a distinct type of macro-calcification, are generally considered benign findings, especially uninterrupted forms. Yet, the real incidence is not clear, which is why the topic remains open. In this narrative review, we analyzed eggshell calcifications in relationship with cytological diagnosis upon fine needle aspiration and post-thyroidectomy histological report. A PubMed-based search of the English-language papers using several
Bariatric surgery represents one of the most efficient treatments addressing obesity and its associated complications with an increasing trend. Even if the medical benefits for patients are huge, due to weight loss and despite technical improvements in bariatric procedures, it is still associated with diverse types of complications. Most of the complications appear due to nutrient deficiency, as absorption is compromised after surgical anatomy modification. Neurological complications after bariatric surgery are very diverse with an occurrence within days to years after surgery, most frequently in patients with gastrointestinal or surgical complications. Any segment of the nervous system can be affected with distinct types of manifestations ranging from peripheral axonal neuropathy, nerve palsy secondary to compartment syndrome, encephalopathy, and myelopathy, to psychiatric and demyelinating central nervous system diseases. Identifying patients at risk and systematic screening for nutrient deficiency with proper supplementation is essential for preventing neurological complications and lifelong sequelae. In this paper, we present the spectrum of neurological complications reported after bariatric surgery.
Gynecologic cancers are among the most common cancers in women and are a significant cause of mortality in women worldwide. FDG-PET images play a critical role in several areas of oncology and are an essential tool for the diagnosis and staging of gynecologic cancer, providing information about tumor metabolism. Aim: The aim of this study was to investigate the relationship between tumor differentiation, type of malignancy, and glucose metabolism in patients with confirmed gynecologic cancer. Materials and Methods We performed a retrospective review of 60 consecutive patients (ages 31-76) with histopathologically confirmed gynecologic cancer who underwent PET-CT in our department between January 2021 and March 2022. Quantitative data on glucose metabolism were collected using the maximum standardized uptake value normalized by lean body mass (SULmax). We reviewed a total of 60 patients with a mean age of 60±9 years, and a median of 62. Results: 14 patients were diagnosed with cervical cancer, 20 with endometrial cancer, and 26 with ovarian cancer; 13 patients had well- differentiated cancer, 11 had moderately differentiated cancer, and 36 had poorly differentiated cancer. A positive correlation was observed between the measured SULmax and the degree of tumor differentiation, indicating higher glucose uptake in poorly differentiated cancer. When examining the relationship between the type of cancer and SULmax, we found that endometrial cancer exhibited the highest mean SULmax (8.36±6.75), followed by ovarian cancer and cervical cancer. Additionally, we noted that glucose uptake was higher in patients aged over 62 years. Regardless of the tumor differentiation, the findings in endometrial cancer showed the highest mean SUVmax values in all grades of tumor differentiation. Conclusion: Our study showed that glucose consumption correlates not only with the degree of differentiation but also with age and type of tumor, with the highest values in patients older than 62 years with endometrial cancer. Given the correlation between glucose consumption and tumor aggressiveness, this finding may be important for prognostic evaluation of patients with gynecologic malignancies.
Pulmonary hypertension (PH) has gained more and more attention in the last years given the increased mortality and morbidity rate and in particular pulmonary arterial hypertension associated with autoimmune diseases (a specific subgroup of PH), entities with an increasing incidence and prevalence globally. Among these, systemic sclerosis is of particular interest, being the most common among connective tissue diseases (CTDs) with PH as a major complication. Other CTDs such as mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), primary Sjogren's syndrome, and dermatomyositis may also develop PH as a complication of these severe and complex conditions, which can have a major impact on prognosis and quality of life. PH has also been reported in rheumatoid arthritis and ankylosing spondylitis but further studies are necessary. Several studies have shown that the 3-year survival rate for patients with systemic sclerosis-associated with pulmonary hypertension (SSc-PH) is between 31% and 52%, while the 5-year survival rate is below <50%. Therefore, an early and accurate diagnosis as well as subsequent management of PH in these conditions is mandatory, since survival remains suboptimal despite treatment advances. The aim of this article is to provide an overview of different autoimmune diseases associated with PH and to provide an easy reference source on current best practices.
Obesity affects the population worldwide. A hypercaloric diet associated with a sedentary life, stress, and genetic background, triggers various metabolic disorders, such as metabolic syndrome, diabetes mellitus, cancer, cardiovascular diseases, non-alcoholic fatty liver disease, and cognitive impairment. A healthy diet correlated with physical activity, not smoking, and moderate alcohol consumption reduces the risk of developing metabolic diseases. The Mediterranean diet contains antioxidants, fiber, polyunsaturated fats, and compounds with anti-inflammatory, anti-oxidant, anti-cancer, and anti-obesity properties. In a wide variety of species including humans, the reduction of calories between 20-40% significantly improves health, increases longevity, and delays the development of various pathologies. The main aim of this review is to present the comparative effects of the Mediterranean diet versus the hypercaloric diet on insulin sensitivity.
Million people worldwide are affected by the hepatitis C virus (HCV). The highest incidence of illness was between 1945 and 1975. It was also estimated that 70% of those people were not tested for the disease. Most recent treatment concepts are safe, highly effective and have a vital public health influence by achieving a viral constant response in a significant proportion of treated patients. It helps reduce liver fibrosis, liver cancer risk and dissemination. With its increased population incidence, HCV becomes a serious public health problem. This review discusses the current literature in this field in terms of the importance of screening of HCV, follow-up, treatment and includes considerations in specific populations such as patients with cirrhosis, with HIV/HCV co-infection, patients with HBV/HCV co-infection and with renal damage.
Worldwide, adults and childhood obesity are increasing alarmingly, being a major health problem. Obesity is correlated with an increased incidence of various systemic diseases including cancer, heart diseases, and diabetes mellitus type 2. Risk factors for obesity are dysbiosis, genetic, socioeconomic, behavioural and environmental. The gut microbiota has beneficial effects on human health, like host immune system stimulation, being influenced by pH, or nutrient intake. Studies performed on humans and animal models reported differences regarding microbiota at lean and obese individuals. The consumption of probiotics and prebiotics may balance the microbiota with positive effects in obesity. The main aim of this review is to reveal the interaction between dysbiosis and obesity.
Auto-immune rheumatic diseases are characterised by high levels of inflammation that accelerate the development of atherosclerosis, increasing the cardiovascular risk. Direct evaluation of arteries such as of intima media thickness measurement is a simple test that asesses the cerebral and cardiovascular risk. In the initial stages, an increase of the intimal media thickness can be observed. Later on, atherosclerosis (plaques), stenosis and occlusion of the arteries can be identified. Indirect evaluation of the cardiovascular risk can be performed using serological markers - fibrinogen, C reactive protein, estimated sedimentation rate, total cholesterol, low density lipoproteins and high density lipoproteins, homocysteine levels etc. The presence of certain lifestyle factors that increase the risk, such as smoking, sedentarism and associated pathologies such as obesity, diabetes, hypertension were assesed in patients with rheumatoid arthritis. The aim of the study is to prove the relationship between anti-tumor necrosis factor alpha therapy effect on the cardiovascular risk in rheumatoid arthritis patients.
A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.
Laparoscopic sleeve gastrectomy (LSG) is becoming popular between the bariatric procedures. There are few studies available in the literature about LSG impact on esophageal motility, with debatable results. Technically, it modifies the anatomy of the esophago-gastric junction; it can damage the phreno-esophageal ligament and decrease the lower esophageal sphincter pressure that will predispose to reflux. Gastroesophageal reflux disease (GERD) is already common in obese patients due to frequent hiatal hernia, high intraabdominal pressure, increased transient lower esophageal sphincter relaxations (TLESR), altered esophageal motility and poor esophageal clearance. LSG can worsen gastroesophageal reflux disease, but also the weight loss achieved after it and the decrease of acid production in the small gastric pouch will probably reduce the GERD symptoms. Dysphagia and odynophagia were reported after sleeve gastrectomy, but usually associated with anatomical narrowing of the gastric sleeve, caused by esophageal dismotility or secondary to diabetes mellitus, low tiamine level, the use of opioids and non-steroidal anti-inflammatory drugs, even hypothyroidism. In addition to upper GI tract endoscopy, high-resolution esophageal manometry (HRM) should be required for all patients planning to undergo a LSG, and in the follow-up period according to the contractility pattern.
The idea of using mobile hospitals - a fully functional hospital is a system with a high degree of complexity - in case of a pandemic crisis, is not new, but shows how much they are needed. Solutions belonging to the category of mobile architecture are increasingly common, technical and logistic difficulties are solved in more perfect way. This applies mostly to objects with simple layouts and functional relationships, with relatively little technical equipment. In the case of healthcare facilities there are several factors increasing the difficulty: multitude of functional connections, sanitary requirements, technical equipment, and internal infrastructure. The Romanian military and civilian specialists from Bucharest Central Military Emergency University Hospital (SUUMC) showed that is possible to build a hospital as a modular and mobile structure in order to fight COVID 19, but the strategic actions and the effort needed to organize and run mobile hospital far exceeds the expenditure, protocols and specialized M.D.s necessary to run the stationary hospital.
Background and aim: Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir in association with ribavirin was the only interferon-free regimen available in 2015 in Romania for compensated HCV cirrhosis. The aim of our study is to reveal our experience with interferon-free therapy in compensated HCV cirrhosis. Materials and methods: We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for twelve weeks. The HCV infection was diagnosed using clinical, biological, and FibroMax tests. Each patient had follow-up visits at four, eight, twelve and twenty-four weeks after the initiation of the treatment. Results: 44 (49% of) patients were female and 46 (51 % of) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. It was noticed a decreasing of cytolysis, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had a virologic response (VR) at the end of treatment (EOT) and sustained virologic response (SVR) twelve weeks after the last dose administration. Conclusion: The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon-free combination treatment was safe and highly effective in compensated HCV cirrhosis.
Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding. The most common clinical presentation of GAVE is chronic occult bleeding that leads to symptomatic iron deficiency anemia, but some cases could present with acute massive bleeding. Frequently, patients are dependent by iron suplimentation, or in severe cases even blood transfusions. Endoscopic therapy is frequently necessary in acute or chronic blood loss. Over the past several years, treatment for GAVE has continued to evolve as the number of available effective therapeutic interventions has increased. These included: YAG laser, argon plasma coagulation (APC), endoscopic band ligation, cryotherapy and surgical anterectomy. Argon plasma coagulation is the most commonly used technique, but has been associated with several complications like sepsis, post-APC bleeding, gastric outlet obstruction and increased incidence of hyperplastic polyps. Endoscopic band ligation (EBL), a mechanical procedure, has been reported in the past years as an effective salvage therapy for GAVE that is refractory to other approaches, or even as the first line treatment. We present a case of nodular GAVE treated succesfully with endoscopic band ligation after unsuccesufull sessions with argon plasma coagulation.
In the past, finding out the chemical resistance of the barrier materials designated for the production of individual protective equipment ofthe protection forces (policemen, firefighters, soldiers) was based on the need to respond to protection against weapons of mass destruction. Simple chemical methods based on indicating the colorimetric reactions were used. It was necessary to switch to more universal methods due to a change in the security of the environment and the need to focus on toxic industrial materials. The universality is due to using sensitive QCM sensors equipped with a special detection layer and some special carbon electrodes. The paper deals with new methods that are used to determine the chemical resistance of the barrier materials against the permeation of toxic substances, primarily in field conditions. However, they can also be used in stationary chemical laboratory conditions.
Colorectal cancer prevalence is increasing worldwide. Modifiable risk factors are responsible for almost 50 % of cases and this could imply a huge potential of preventability. Among these factors the level of physical activity is of paramount importance. Physical activity has a positive impact on health status in general and it decreases the prevalence of various cancers including colorectal cancer. Physical activity decreases the prevalence of benign colorectal adenomas and it prolongs the disease free interval after surgery in colorectal cancer, thus increasing survival. The mechanisms involved are multiple: decreasing bowel transit time, regulating energy balance, decreasing peripheral insulin resistance, decreasing hyperinsulinism, antiinflamatory effects, increasing vitamin D production.
Gut microbiota is a superorganism involved in homeostasis and in pathogenesis. Microbiota composition is influenced by several factors such as: type of birth (cesarean or natural), role of age, role of diet. Pathological consequences of certain type of diet (especially western type of diet) may, in fact, be mediated by gut microbiota alteration. Also few studies have investigated the issue of gut microbiota composition in patients suffering of colorectal cancer, several reports notice relevant differences. Certain pathogenic bacteria in gut microbiota have been extensively studied in relation to their role in colorectal cancer. Thus, Fusobacterium nucleatum, which is abundant in colorectal cancer patient’s colon, may initiate the progression from adenoma to adenocarcinoma. A suggested pattern of oncogenesis in colorectal cancer may be represented by this: dysbiosis-inflammation-oncogenesis. A metanalysis that has been published in 2006 concluded a protective role of probiotics in colorectal cancer and in colonic adenoma.
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A finite element simulation of the mechanical static features for a modified short hip endoprosthesis was performed. The corkscrew-like femoral stem was modified introducing more turns of the thread. By such an approach it is expected that for some cases the mechanical fixation of the prosthesis to the bone will be improved or the use of the cement for bonding is not necessary. Our scenario was estimated for titanium and stainless steel, and both materials show good safety factors. Mechanical stress is expected to be distributed more uniform in the bone for the new design with more turns of thread.
Introduction: Our objective is to review current international guidelines for Helicobacter Pylori treatment and our department`s experience in this field. Materials and methods: Helicobacter pylori is a Gram-negative, microaerophilic bacterium that can be found mainly in the gastric mucus or on the inner surface of the gastric epithelium, infecting up to 50% of the population. Colonization with this bacterium is not a disease in itself, but can cause chronic gastritis, peptic ulcer, gastric cancer and MALToma. Because of this, infection with H. pylori continues to be a major healthcare burden, especially in less-developed countries. A multitude of non-invasive tests are available for the diagnosis of Helicobacter pylori infection (blood antibody, stool antigen or urea breath test), but the most reliable method of diagnosis is histological examination from two sites after endoscopic biopsy, combined with either a microbial culture or rapid urease test. Treatment of Helicobacter pylori infection is becoming a challenge, as eradication following standard triple therapy is decreasing worldwide due to increased bacterial resistance against antibiotics, which has led to the development of newer therapies such as the sequential treatment in which a PPI and amoxicillin is given for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days, or the quadruple therapy based on a PPI, bismuth subcitrate, metronidazole and tetracycline for 10 days. Results and conclusion: H. pylori infection remains one of the most challenging infectious diseases, causing high morbidity and mortality, mainly because none of the actual antibiotic therapies can provide successful eradication.
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Chronic liver disease is a late stage of progressive hepatic fibrosis. It consists of functional and structural disruptions in most chronic liver diseases. An accurate diagnosis allows us to establish the degree of fibrosis and the stage of the disease, the prognosis of the patient and to predict a treatment response. Despite the fact that liver biopsy is considered a gold standard, non- invasive methods for diagnosing liver fibrosis have gained more and more importance. Whether we talk about serum biomarkers or imagistic methods from transient elastography to 3-D magnetic resonance elastography, the question remains: are these useful or useless? Serum biomarkers represent blood components that can reflect liver histological changes, thus they can monitor the continuous process of fibrosis. These can be subcategorized in direct (that show extracellular matrix turnover) and indirect markers (that reflect disturbances in the hepatic function). However these markers alone are not as accurate in the staging of fibrosis, only help differentiate patients without or with low grade of fibrosis from those with significant fibrosis and cannot be considered alone in the diagnosis of liver fibrosis. Imagistic methods include: ultrasound-based transient elastography, magnetic resonance elastography (MRE), 2D-shear wave elastography, acoustic radiation impulse imaging (ARFI) and cross sectional imaging, the first being the most used. Using a combination of non-invasive tools allows us to diminish the number of patients in need of liver biopsy. However, the patient must always be informed of the advantages and disadvantages of each method and its limitations.
The burden of colorectal cancer (CRC) is increasing all over the world. The prevalence of diabetes mellitus is increasing. It is estimated that diabetes affects 387 million people worldwide. It is predicted that 552 million people worldwide will develop diabetes by 2030. A large pool of data indicate that DM increases by 2 fold the risk of CRC. This is the reason to firmly suggest the inclusion of DM in the criteria for CRC screening as an important measure to decrease the mortality of this ailment.
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Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012 at “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest. Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infra- centimetric tumor size. EUS has a high resolution which allows detection of lesions with very small diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases were demonstrated in 3 patients, one by US and all 3 by MRI. Conclusions: - CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes. - MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with infracentimetric size, and is the imaging test of choice for possible liver metastases. - EUS is the preoperative imaging test of choice.
Introduction: The infection caused by H. pylori appears secondary after a bacterial colonization of the stomach and the initial portion of the small bowel. H. pylori –infected patients can develop gastritis, peptic ulcer, stomach cancer or MALT lymphoma. H. pylori infection is defined by WHO like a type I carcinogen, its role in gastric carcinogenesis being supported by the greatest researchers. Objectives: In this study our purpose was to determine the endoscopic appearances in H. pylori infection quoted in medical literature until now and the frequency of their appearance in our group of interest. Materials and methods: In this study it was made an analytic study in which it was realized a retrospective cohort investigation at the Emergency Central Military and University Hospital “Dr. Carol Davila” Bucharest, gastroenterology branch –endoscopic department between 18.12.2012- 21.08.2013 on 1694 patients between 18 and 92 years old, with the medium age of 55 years old. As a diagnostic method for H. pylori infection we used superior digestive endoscopy during which were taken biopsies and it was made a fast urease test. Results: Regarding the variation of the endoscopic aspects at the population of study, we have found gastritis with all its aspects (which was Sidney classified) in the biggest percentage meaning 59.3% of the cases, followed with a percentage of 18.8% by those without any endoscopic abnormality, and then in 10,33% of the cases we have found peptic ulcer. With a smaller percentage, under 10%, we have found duodenitis at 8.67% of this patients, and finally the most severe lesions represented by gastric cancer and lymphoma were found at 2,7% of the H.pylori infected patients.
Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. AMI may be classified as arterial or venous, non-occlusive or occlusive. The overall prevalence of AMI is 0.1% of all hospital admissions [1]. The exact prevalence of mesenteric venous ischemia (MVT) is not known, because many cases are presumed to be limited in symptomatology and to resolve spontaneously.
Sepsis, severe sepsis and septic shock are some of the most serious affections which threaten the lives of the patients who come to the Emergency Department and which require fast treatment because the more severe the sepsis was, the higher the mortality, up to 50% higher in severe sepsis. That is why, at present, the 2013 Guides of Surviving Sepsis Campaign recommend that the potential source of infection should be confirmed as soon as possible, in the first 6 hours since the patient arrived in the Emergency Unit if possible, moreover the large spectrum antibiotics therapy must be administered in one hour after the severe sepsis or the septic shock were identified. That is why the identification of these patients at risk is very important and this identification can only be made using POCT type devices. This type of devices has the capacity to make precise determinations, in a short time (15-17 minutes), using minimum quantities of integral blood, without using test tubes, sepsis biomarkers and other additional material. The possibility to fast diagnose sepsis, offers the doctors from the Emergency Department, the capacity to fast initiate an antibiotic treatment, to hospitalize the patient and at the same time, it gives them the certainty that they did not miss the sepsis diagnosis, thus avoiding the situation of malpractice. A preliminary study, regarding the sepsis biomarkers, which took place in the Emergency Unit of University Central Emergency Military Hospital, is also presented within this article.
Autoimmune cholangitis defines a spectrum of cholestatic liver diseases that are characterized by inflammation of bile ducts and a reasonable response to immunosuppressive therapy. The two most common diseases associated with this term in the literature are: an overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis and a form of hyper IgG4 syndrome (currently associated with autoimmune pancreatitis). Liver biopsy is mandatory for the diagnosis. There are, whatsoever, in clinical practice, many cases that do not meet current diagnostic criteria but that have a good response to corticosteroid treatment.
Chronic pancreatitis is characterised by progressive and irreversible damage of the pancreatic parenchyma and ductal system, which leads to chronic pain, loss of endocrine and exocrine functions. Clinically, pancreatic exocrine insufficiency becomes apparent only after 90% of the parenchima has been lost. Despite the simple definition, diagnosing chronic pancreatitis remains a challenge, especially for early stage disease. Because pancreatic function tests can be normal until late stages and have significant limitations, there is an incresing interest in the role of imaging techniques for the diagnosis of chronic pancreatitis. In this article we review the utility and accuracy of different imaging methods in the diagnosis of chronic pancreatitis, focusing on the role of advanced imaging (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and endoscopic ultrasound).
Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) either on imaging or on liver histology only after the exclusion of secondary causes of fat accumulation in the liver (e.g. high alcohol drinking, drugs and other medical ailments). Considering the fact that there are many causes of hepatic steatosis, the term NAFLD is reserved for the liver disease that is predominantly associated with obesity and metabolic syndrome. The presence of inflammation and cell injury defines steatohepatitis (NASH) which has the potential to evolve into cirrhosis and hepatocarcinoma, being, therefore, the stage of NAFLD most amenable to treatment. Among the treatments available, the most important are: weight loss, vitamin E and, last but not least, probiotics.
