Rationale:Although immunomodulatory therapy has been clearly stated as an important landmark in treatment of ulcerative colitis, significantly improving the quality of life for patients with inflammatory bowel disease, there are several aspects to be considered regarding the possible side-effects of anti-TNF alpha agents. In spite of a good safety profile, biologic TNF antagonists may induce paradoxical inflammation, which can manifest as sarcoid-like granulomatosis, consisting of noncaseating granulomas in the affected organs.Patient concerns:We report the case of a 30-year-old male patient, with no personal or familial history of lung disease, with a personal history of ulcerative colitis (UC), under clinical remission following infliximab therapy in maintenance dose, who was admitted for treatment administration, but also for dyspnea, nocturnal sweating, and nonproductive cough.Diagnoses:Based on clinical manifestations, biological landmarks excluding various infections, CT scan, fibrobronchoscopy with bronchoalveolar lavage for culture and immunohistochemical examination, followed by mediastinoscopy with sampling of paratracheal lymph node, which underwent histopathological examination, the patient was diagnosed with drug- induced stage II pulmonary sarcoidosis.Interventions:Since the patient had developed severe allergic reaction after being administered Infliximab at admission, the biological treatment was immediately discontinued. Following the diagnosis of pulmonary sarcoidosis, corticotherapy was initiated.Patient outcomes:After corticotherapy was initiated, the patient had a favorable outcome at 3 months reevaluation, both regarding the course of ulcerative colitis and sarcoidosis.Lessons:Patients under biological therapy using anti-TNF alpha agents must be carefully monitored, in order to early identify potential paradoxical inflammation (such as sarcoidosis) as a side-effect. The drug-related pulmonary disease tends to improve upon withdrawal of the drug, with occasional requirement of steroid treatment. However, a thorough strategy should be assembled in the case of UC relapse in this patient category, with switching to adalimumab or surgical approach as main possibilities.

Non-alcoholic fatty liver disease (NAFLD) has become of major interest worldwide, it is estimated that more than 20% of the general population suffer from liver steatosis. NAFLD is highly associated with metabolic risk factors like type 2 diabetes mellitus, obesity and dyslipidemia, the patients diagnosed with NAFLD should adopt a high fiber low calorie diet, with reduced saturated fat and carbohydrates content, leading to weight loss and improvement of metabolic profile. Our study is aiming to shape the profile of the patient interested in being informed related to food quality and chemical composition and to evaluate the aspects on the food products label which are important for the customer. Between June 2017 and December 2017, 83 patients diagnosed with NASH were included in the study, representing the study group, while 33 subjects, without metabolic syndrome or digestive diseases, selected from patient list belonging to two general practitioners, constituted the control group. Related to the interest of being informed about the chemical composition and nutritional value of the products bought, the study showed a low interest for the provided information on nutritional value. lack of confidence in the provided information and complexity of the information are understandable, the high number of subject reasoning through lack of immediate clinical benefit is surprising. Among the healthy population the willingness to pay attention to this aspect is extremely low.

Background: The assessment of fibrosis in chronic liver diseases using non-invasive methods is an important topic in hepatology. Aim: To compare Shear Wave and Transient elastography and in what the possible measurement biases and discordance factors are concerned. Material and Methods: This study enrolled 139 patients with non-alcoholic fatty liver disease, who underwent assessment of hepatic fibrosis by Shear Wave and Transient elastography. Results: The results obtained by the two methods were correlated in the most cases, but discordance in one or more degrees of fibrosis stage was also found. The multiple correlations analysis regarding the predictors of discordance indicated that a significant influence was exercised by the fibrosis degree, steatosis, BMI and necroinflammatory activity. Conclusions: Shear Wave and Transient elastography appear as comparably reliable methods for assessment of liver fibrosis, but there are possible discrepancies in evaluating fibrosis stage.

Introduction of contrast agents as microbubbles and to improve ultrasound examination techniques has increased the rate of detection and characterization of liver lesions. Contrast-enhanced ultrasonography (CEUS) is a relatively new method of exploring the liver and diagnosing focal liver lesions (FLL). The aim of this study is to determine the efficiency of microbubbles used for CEUS in managing patients detected in conventional ultrasonography with FLL. We examined 84 patients with FLL, detected on conventional ultrasonography (US), during October 2012-September 2015. We performed contrast-enhanced ultrasonography, using sulphur hexafluoride as a contrast agent, and contrast-enhanced MRI to set the diagnosis. For 37 patients (44.1%) CEUS showed a malignity pattern of enhancement (according to the EFSUMB - European Federation of Societies for Ultrasound in Medicine and Biology- Guidelines 2012), while for 54 (64.3%) patients MRI set the diagnosis of malignity. CEUS detected fewer malignant lesions than MRI, in 20.1% of the cases MRI set de diagnosis. We need further studies in order to improve the quality of CEUS images and technique.