Psychological distress among hospital caregivers during and after the first wave of COVID-19: Individual factors involved in the severity of symptoms expression

Coronavirus disease 2019 has spread rapidly over the globe and has put an unprecedent psychological pressure on health care workers (HCWs). The present study aimed at quantifying the psychological consequences of the COVID-19 pandemic on HCWs during and after the first wave and identify sociodemographic, situational, and psychological risk/protective factors for symptoms severity. An online survey was sent by e-mail to all nurses and physicians employed by a teaching hospital in Brussels, Belgium. 542 (20,62%) completed the survey. 47%, 55%, 32% and 52% of participants reported posttraumatic stress, anxiety, depression and insomnia symptoms, respectively, during the peak. Two to three months later, posttraumatic symptoms emerged de novo in 54% of HCWs. It persisted in 89% of those presenting severe symptoms initially. Neuroticism was the strongest predictor of posttraumatic stress, anxiety, and insomnia. Work overload was the strongest predictor of depression and second predictor of posttraumatic stress, anxiety, and insomnia. Other significant predictors included being a nurse, the number of past traumatic experiences, avoidant coping style, and expressive suppression of emotion

Fibroscan Reliably Rules Out Advanced Liver Fibrosis and Significant Portal Hypertension in Alcoholic Patients.

To date, there is no consensus on optimal cut-off values and timing of transient elastography (TE, Fibroscan) for fibrosis staging and prediction of portal hypertension in alcoholic liver disease. We evaluated the accuracy of Fibroscan for the diagnosis of fibrosis and clinically significant portal hypertension in alcoholic patients. Heavy drinkers admitted to our standardized alcohol withdrawal program were evaluated by Fibroscan, by transjugular hepatic venous pressure gradient (HVPG) measurement and liver biopsy if significant fibrosis was suspected and by upper gastrointestinal endoscopy. All investigations were performed within 3 days of admission. Patients who had remained abstinent for 2 weeks underwent a second Fibroscan. A total of 118 patients were included. Fibroscan correlated well with histology and HVPG. Negative predictive value of 92% and 93% for ruling out severe fibrosis (≥F3) and cirrhosis, and optimal cut-offs at ≥11.7, ≥15.2, and ≥21.2 kPa for F2, F3, and F4, respectively, were found. In abstinent patients, a mean decrease of 2.7 kPa improved concordance between Fibroscan and histology. A TE value of 30.6 kPa predicted a HVPG>10 mm Hg with 94% specificity and showed a good negative predictive value of 84% for ruling out the presence of varices at endoscopy. Steatosis, alcoholic hepatitis, sinusoidal fibrosis, cholestasis, and high transaminases did not influence TE values. Fibroscan is an accurate non-invasive method for the diagnosis of fibrosis in alcoholic patients. TE values below 11 and 30 kPa likely rule out significant fibrosis and varices, respectively

Fructoholism in adults: the importance of personalised care in metabolic dysfunction-associated fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a quickly expanding welfare disease. It has been associated with unhealthy high-sugar beverages containing fructose. Here we describe the case of a 64-year-old woman who has been followed at the endocrinology consultation for about 20 years, for a metabolic syndrome associating type 2 diabetes. Due to the development of liver test disturbances, the patient was referred to hepatology and the diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD) was made. Interestingly, the patient denied any major consumption of sweetened beverages or other processed food, but on thorough history mentioned an excessive and uncontrollable consumption of fruits. Psychiatric follow-up was then initiated. After a period of six months, the body weight remained stable, but we found a reduction of fruit consumption, a reduction of insulin resistance and a normalisation of liver blood tests and elasticity. We further describe how fructose has specific metabolic pathways that cause liver damage and similarities with alcohol in terms of addictive potential. In conclusion, this case shows the importance of a detailed and personalised care in NAFLD-MAFLD and considering food addiction (also for foods that are considered “healthy”) as a real substance-use disorder and a potential cause of liver disease