A NEW ERA IN HEPATIC FIBROSIS EVALUATION: NONINVASIVE INSIGHTS

Hepatic fibrosis is a common consequence of chronic liver diseases and necessitates accurate evaluation for optimal patient management. Traditional liver biopsy, the gold standard for fibrosis assessment, is invasive and can be associated with complications. Lately, considerable progress has been made in developing noninvasive markers for liver fibrosis evaluation.This comprehensive review presents a systematic analysis of the current noninvasive markers for hepatic fibrosis assessment. Serological markers, imaging techniques and novel technologies are thoroughly evaluated for their diagnostic accuracy and clinical applicability.The advantages and limitations of each noninvasive marker are discussed, highlighting their potential to replace or complement liver biopsy. Moreover, challenges and opportunities in standardization, validation, and clinical implementation of these markers are addressed.In conclusion, noninvasive markers play a significant role in hepatic fibrosis evaluation. As reliable alternatives to liver biopsy, these markers have the potential to enhance patient care, streamline disease monitoring, and drive personalized treatment strategies in liver diseases associated with fibrosis. However, further research and validation studies are required to establish their widespread use in routine clinical practice

Adverse effects due to changes in the composition of the intestinal microbiota as result of the administration of antibiotics during the perinatal period

Antibiotic administration commonly induces allergic reactions, dysmicrobism and microbial resistance, but longterm effects due to changes in gut microbiota composition are difficult to assess. This paper aims to identify in the literature adverse effects induced by changes in gut microbiota composition after perinatal administration of antibiotics. Antibiotic administration during pregnancy is a predisposing factor for the development of bronchial asthma, eczema, or allergic rhinitis in children, but does not support the hypothesis as being a risk factor for childhood obesity/overweight. The effect on the newborn’s microbiota of prophylactic administration of antibiotics during caesarean section is controversial. Postnatal treatments with antibiotics frequently causes intestinal dysmicrobism, the most severe form being necrotizing enterocolitis, especially among premature infants, but effects on the changes in body weight are controversial. Early administration of broad-spectrum antibiotics, particularly macrolides and cephalosporins, is strongly associated with the development of bronchial asthma at age 5 years. Recently, altered auditory processing and changes in recognition memory were described in newborn exposed to antibiotics in the absence of infection. More studies are needed to clarify the association between the type of antibiotic, the frequency, respectively period (both prenatal and intrapartum) of administration and long-term effects

A Debate on Surgical and Nonsurgical Approaches for Obstructive Sleep Apnea: A Comprehensive Review

Regular and unobstructed breathing during the night is the prerequisite for an undisturbed and restful sleep. The most prevalent nocturnal breathing disturbance with morbid consequences is obstructive sleep apnea syndrome. The prevalence of obstructive sleep apnea (OSA) is increasing, and a significant number of patients with OSA are undiagnosed. On the other hand, the “obesity epidemic” is a growing concern globally. A sleep test is required to diagnose sleep apnea and to individualize therapy. A multidisciplinary approach is the key to success. This narrative review presents a debate on whether surgery is a friend or a foe in the treatment of sleep apnea. Depending on the type and severity of the apnea, the causal factor, and the presence of obesity and hypercapnia as well as the associated pathologies, the optimal therapeutic method is determined for each individual case. The article concludes that each case is unique, and there is no ideal method. Positive pressure ventilation, although a therapeutic gold standard, has its disadvantages extensively discussed in this paper. Nevertheless, it is necessary prior to any surgical intervention, either for the curative treatment of the causal factor of apnea or for elective surgery for another condition. The anesthetic risks associated with the presence of apnea and obesity should not be neglected and should form the basis for decision making regarding surgical interventions for the treatment of sleep apnea