Dyskurs (post)konwencjonalnej tożsamości wobec merkantylistycznej natury globalizującego się świata

In this article I described the idea of globalization, but I abandoned a strictly scientific analysis and treated the subject more contemplatively. I described not only the process, but also the values (connected with the culture of instant gratification, globalization and the cultural homogenization) and the orientation connected with it (consumerism, commoditization of human life) which shape the surrounding reality as well as ourselves. The question of identity, which is constantly shaping, is significant in this context. It is, just as globalization, fluid, unspecified and ambivalent. I endeavour to prove the hypotheses by adducing sociological, cultural and philosophical classic writers. The very last ones – fairly unexpectedly – become crucial to me and they let me analyse the human nature in postmodern reality holistically

NAFLD and NASH in HCV Infection: Prevalence and Significance in Hepatic and Extrahepatic Manifestations

The aim of this paper is to review and up to date the prevalence of hepatitis C virus (HCV)-associated non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their significance in both accelerating progression of HCV-related liver disease and development of HCV-associated extrahepatic diseases. The reported mean prevalence of HCV-related NAFLD was 55%, whereas NASH was reported in 4%–10% of cases. HCV genotype 3 directly induces fatty liver deposition, namely “viral steatosis” and it is associated with the highest prevalence and degree of severity, whereas, HCV non-3 genotype infection showed lower prevalence of steatosis, which is associated with metabolic factors and insulin resistance. The host’s genetic background predisposes him or her to the development of steatosis. HCV’s impairment of lipid and glucose metabolism causes fatty liver accumulation; this seems to be a viral strategy to optimize its life cycle. Irrespective of insulin resistance, HCV-associated NAFLD, in a degree-dependent manner, contributes towards accelerating the liver fibrosis progression and development of hepatocellular carcinoma by inducing liver inflammation and oxidative stress. Furthermore, NAFLD is associated with the presence of metabolic syndrome, type 2 diabetes, and atherosclerosis. In addition, HCV-related “metabolic steatosis” impairs the response rate to interferon-based treatment, whereas it seems that “viral steatosis” may harm the response rate to new oral direct antiviral agents. In conclusion, a high prevalence of NAFLD occurs in HCV infections, which is, at least in part, induced by the virus, and that NAFLD significantly impacts progression of the liver disease, therapeutic response, and some extrahepatic diseases

Pathogenesis and significance of hepatitis C virus steatosis: An update on survival strategy of a successful pathogen

Hepatitis C virus (HCV) is a successful pathogen on the grounds that it exploits its host's metabolism to build up viral particles; moreover it favours its own survival by inducing chronic disease and the development of specific anatomic changes in the infected organ. Steatosis, therefore, is associated with HCV infection by necessity rather than by chance alone. Approximately 6% of HCV patients have steatohepatitis. Interestingly, HCV steatosis occurs in the setting of multiple metabolic abnormalities (hyperuricemia, reversible hypocholesterolemia, insulin resistance, arterial hypertension and expansion of visceral adipose tissue) collectively referred to as "hepatitis C-associated dysmetabolic syndrome" (HCADS). General, nonalcoholic fatty liver disease (NAFLD)-like, mechanisms of steatogenesis (including increased availability of lipogenic substrates and de novo lipogenesis; decreased oxidation of fatty substrates and export of fatty substrates) are shared by all HCV genotypes. However, genotype 3 seemingly amplifies such steatogenic molecular mechanisms reported to occur in NAFLD via more profound changes in microsomal triglyceride transfer protein; peroxisome proliferator-activated receptor alpha; sterol regulatory element-binding proteins and phosphatase and tensin homologue. HCV steatosis has a remarkable clinical impact in as much as it is an acknowledged risk factor for accelerated fibrogenesis; for impaired treatment response to interferon and ribavirin; and development of hepatocellular carcinoma. Recent data, moreover, suggest that HCV-steatosis contributes to premature atherogenesis via both direct and indirect mechanisms. In conclusion, HCV steatosis fulfills all expected requirements necessary to perpetuate the HCV life cycle. A better understanding of the physiology of HCADS will likely result in a more successful handling of disease with improved antiviral success rates. © 2014 Baishideng Publishing Group Inc. All rights reserved

NAFLD and NASH in HCV Infection: Prevalence and Significance in Hepatic and Extrahepatic Manifestations

The aim of this paper is to review and up to date the prevalence of hepatitis C virus (HCV)-associated non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) and their significance in both accelerating progression of HCV-related liver disease and development of HCV-associated extrahepatic diseases. The reported mean prevalence of HCV-related NAFLD was 55%, whereas NASH was reported in 4%–10% of cases. HCV genotype 3 directly induces fatty liver deposition, namely “viral steatosis” and it is associated with the highest prevalence and degree of severity, whereas, HCV non-3 genotype infection showed lower prevalence of steatosis, which is associated with metabolic factors and insulin resistance. The host’s genetic background predisposes him or her to the development of steatosis. HCV’s impairment of lipid and glucose metabolism causes fatty liver accumulation; this seems to be a viral strategy to optimize its life cycle. Irrespective of insulin resistance, HCV-associated NAFLD, in a degree-dependent manner, contributes towards accelerating the liver fibrosis progression and development of hepatocellular carcinoma by inducing liver inflammation and oxidative stress. Furthermore, NAFLD is associated with the presence of metabolic syndrome, type 2 diabetes, and atherosclerosis. In addition, HCV-related “metabolic steatosis” impairs the response rate to interferon-based treatment, whereas it seems that “viral steatosis” may harm the response rate to new oral direct antiviral agents. In conclusion, a high prevalence of NAFLD occurs in HCV infections, which is, at least in part, induced by the virus, and that NAFLD significantly impacts progression of the liver disease, therapeutic response, and some extrahepatic diseases

Hepatic Steatosis And necro-Inflammatory Activity overestimate Liver Stiffness by Transient Elastography in Staging Liver Fibrosis in Chronic Hepatitis C

Abstract Introduction: Transient Elastography (TE) is a non-invasive method to evaluate liver fibrosis by measuring Liver Stiffness (LS). However, its role in the full management of chronic hepatitis C patients is not completely appraised as well as its limitations are scantly explored. In particular the impact of liver steatosis and necro-inflammatory activity require being more investigated. Thus, this study was aimed to further assess the reliability of TE in evaluating liver fibrosis and the impact of hepatic necro-inflammatory activity and steatosis on the performance of TE. Patients and Methods: Enrolled were 258 consecutive patients with chronic hepatitis C who underwent to liver biopsy. Hepatic fibrosis was scored according to METAVIR, steatosis and necro-inflammatory activity were also scored. LS ranges were defined according to Castéra. Concordance between liver biopsy and TE was evaluated by Kappa index test. The performance of TE was assessed by ROC curves and by calculating AUROC. Factors independently associated with LS were weight up by logistic regression analysis. Results: The data showed a high diagnostic accuracy of TE for severe fibrosis (≥F3) with an AUROC of 0.80 and 0.95 for F3 and F4, respectively, with a high specificity and sensitivity; but a lower efficiency in discriminate F1 from F2. At univariate analysis TE showed a relationship with liver fibrosis (p<0.0001),liver inflammation (p<0.0001) and steatosis (p<0.006).Overall, multivariate analysis showed that factors independently associate with LS were liver fibrosis (p<0.0001) and inflammation (p<0.005), whereas, steatosis (p<0.005) was independently associated with LS in patients with fibrosis lower then F3. Conclusion: Our study confirms that TE is a reliable tool to individuate chronic hepatitis C patients with advanced liver fibrosis or cirrhosis, but it has lesser accuracy for earlier stages of liver fibrosis. Furthermore, high levels of liver necro-inflammatory activity overestimate LS and steatosis induces misevaluation of LS by TE in non-cirrhotic patients

Exploring the effectiveness of the Green Pass Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area.

Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population. In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory “Green pass” (GP) to access workplaces for some categories considered at risk. We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influenceof the introduction by law of the Green Pass (GP) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022. Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the GP.&nbsp; The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom(Adj-OR= 2.45, 95%CIs= 1.51-3.97, p-value: &lt;0.001)but a lower sense of safety (Adj-OR= 0.19, 95%CIs= 0.12-0.29, p-value: &lt;0.001)after vaccine administration. Our findings, in line with the available literature, suggest that the introduction of GP has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy

Development and Rasch Validation of an Observational Assessment Tool of Upper Limb Functional Impairment in Stroke Survivors: Functional Assessment Test for Upper Limb

Objective: To develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evalu-ation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke.Design: Observational, cross-sectional, psychometric study. Setting: Inpatient and outpatient rehabilitation clinic. Participants: A total of 188 post-stroke survivors (mean age 65.217.7 years, 61% men, 48% with ischemic stroke and 66% in the sub-acute phase; N=188). Interventions: Not applicable.Main Outcome Measures: Principal component analysis and Rasch analysis through a Partial Credit Model were used to assess the structure and psychometric properties of the 5 items of the FAST-UL (Hand to Mouth [HtM], Reach to Target, Prono-Supination, Grasp and Release, and Pinch and Release [PaR]).Results: The Cronbach's a equal to 0.96 was indicative of an acceptable internal consistency; the reliability, as measured through the Person Sep-aration Reliability equal to 0.87, was good. The FAST-UL tool was unidimensional. All the FAST-UL items were found to fit well the Rasch mea-surement model. The easiest to perform FAST-UL item was the HtM movement while the most difficult was the PaR movement.Conclusions: The FAST-UL is a quick, easy-to-administer observational assessment tool of upper limb motor impairment in post-stroke survivors with good item-level psychometric properties. Archives of Physical Medicine and Rehabilitation 2023;104:597-604 (c) 2022 by the American Congress of Rehabilitation Medicine

Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief

By blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle contracture). Although the mechanism of action of BoNT-A on p-ROM is far from understood, pain relief may be hypothesized to play a role. To test this hypothesis, a retrospective investigation of p-ROM and pain was conducted in post-stroke patients treated with BoNT-A for upper limb hypertonia. Among 70 stroke patients enrolled in the study, muscle tone (Modified Ashworth Scale), pathological postures, p-ROM, and pain during p-ROM assessment (Numeric Rating Scale, NRS) were investigated in elbow flexors (48 patients) and in finger flexors (64 patients), just before and 3-6 weeks after BoNT-A treatment. Before BoNT-A treatment, pathological postures of elbow flexion were found in all patients but one. A decreased elbow p-ROM was found in 18 patients (38%). Patients with decreased p-ROM had higher pain-NRS scores (5.08 ± 1.96, with a pain score ≥8 in 11% of cases) than patients with normal p-ROM (0.57 ± 1.36) (p < 0.001). Similarly, pathological postures of finger flexion were found in all patients but two. A decreased finger p-ROM was found in 14 patients (22%). Pain was more intense in the 14 patients with decreased p-ROM (8.43 ± 1.74, with a pain score ≥ 8 in 86% of cases) than in the 50 patients with normal p-ROM (0.98 ± 1.89) (p < 0.001). After BoNT-A treatment, muscle tone, pathological postures, and pain decreased in both elbow and finger flexors. In contrast, p-ROM increased only in finger flexors. The study discusses that pain plays a pivotal role in the increase in p-ROM observed after BoNT-A treatment