NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD): A REVIEW OF PATHOPHYSIOLOGY AND CLINICAL MANAGEMENT

<p><i><strong>Introduction: </strong>The harmful effects of non-alcoholic fatty liver disease (NAFLD) are becoming a significant problem for public health due to the rising incidence of diabetes and obesity worldwide. In the Western world, NAFLD is the most prevalent chronic liver disease. Metabolic problems such as central obesity, dyslipidemia, hypertension, hyperglycemia, and recurrent abnormalities in liver function tests are all intimately related to NAFLD. In general, NAFLD is a term used to describe a wide range of liver diseases, including fibrosis, inflammation, and hepatocyte injury. This is typically detected through a liver biopsy and can take a variety of forms, from lesser forms (steatosis) to more severe forms (cirrhosis, advanced fibrosis, non-alcoholic steatohepatitis, and liver failure). A precise diagnosis of NASH and NAFLD is essential since severe fibrosis is the main indicator of morbidity and liver-related death in these patients. The gold standard for diagnosing NAFLD continues to be histologic assessment with liver biopsy. The presence of hepatic steatosis, ballooning, and lobular inflammation with or without fibrosis is required for the diagnosis of NAFLD. Once the diagnosis is made, the pillars of treatment are still weight loss, dietary changes, and the management of the underlying metabolic syndrome. Once a diagnosis is made, the fundamentals of therapy continue to be dietary advice and lifestyle changes, weight loss, and the treatment of the underlying metabolic syndrome, all of which show promise but are challenging to sustain. Guidelines prescribe pioglitazone and vitamin E in some people.</i></p><p><i><strong>Aim of the study: </strong>Clinicians encounter difficulties due to the complexity of NAFLD and related diseases, especially its association with metabolic syndrome. The pathophysiology of NAFLD, risk factors, diagnostic techniques, and conservative and surgical treatment options are all summarised in this review. An overview of NAFLD and available treatments is provided in this review.</i></p><p><i><strong>Methodology: </strong>The present review is a comprehensive research of PUBMED since the year 1995 to 2023</i></p><p><i><strong>Conclusion: </strong>The management of these patients has grown more challenging due to the expanding obesity pandemic and the increased frequency of concomitant disorders, including T2DM and NAFLD. There are several therapy options; however, there isn't much high-quality research that compares them with one another. Prospective studies addressing the remaining uncertainties regarding the relationship between insulin resistance, fatty liver, and fibrosis progression should be made accessible soon, given the rising popularity of bariatric surgery.</i></p><p><i><strong>Keywords: </strong>Non-alcoholic fatty liver disease (NAFLD), obesity, dyslipidemia, hypertension, hyperglycemia, liver failure etc.</i></p&gt

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014–1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality