Studies of psychological condition of patients suffering from nonalcoholic fatty liver disease are rather equivocal about the results: while some claim that NAFLD patients suffer from anxiety and depression more than non-NAFLD controls, others do not withstand those findings. Lower cognitive potentials have also been reported, both in patient related and in animal model-based investigations, and correlated with assessed brain tissue changes. We hypothesized that NAFLD, as a condition, affects the brain tissue and, subsequently, the cognitive state. So we compared findings in 40 NAFLD positive and 36 NAFLD negative patients and correlated their brain tissue volumes with the results of Montreal Cognitive Assessment (MoCA) test. Binomial logistic regression verified the influence of NAFLD state leading to lower cognitive potentials: odds ratio 0.096; 95% confidence interval (CI) 0.032–0.289; p < 0.001. Patients with NAFLD had a greater risk to suffer from the cognitive impairment and depression: RR = 3.9; 95% CI 1.815–8.381; p = 0.0005 and RR = 1.65; 95% CI 1.16–2.36; p = 0.006. NAFLD significantly influenced the cognitive deficit and tissue volume reduction and patients suffering from NAFLD had about four times higher risk of having a cognitive impairment.

Obstructive sleep apnea (OSA) is characterized by repetitive complete or partial collapse of the upper airway and reduction of airflow during sleep. It is associated with significantly increased daytime muscle sympathetic nerve activity thought to result from the repetitive intermittent periods of hypoxemia during sleep and brain alterations that are likely to result. Different brain regions are affected by subsequent hypoxia/anoxia. Neurodegenerative processes result in measurable atrophy of cortical gray matter in the temporal lobes and posterior cingulate cortex, as well as in subcortical structures such as the hippocampus, amygdala, and thalamus. This study involved a group of firstly diagnosed, therapy-naive, nonalcoholic fatty liver disease (NAFLD) patients, out of which 144 (96 males and 48 females), aged 34–57 (mean 47.88 ± 6.07), satisfied the recruiting criteria for the study and control groups. All the patients underwent MRI scanning, polysomnography testing, and cognitive evaluation. Cognitively, worse results were obtained in the group with OSA ( p < 0.05 ) and NAFLD ( p = 0.047 ). A significant decrease in volumes of cortical and subcortical structures was revealed ( p < 0.001 ). In conclusion, brain deterioration followed by cognitive impairment is, most likely, the result of intermittent hypoxia and anoxia episodes that initiate the domino process of deteriorating biochemical reactions in the brain.

Introduction. Primary spontaneous pneumothorax is an infrequent condition which requires emergency medical treatment. Nowadays, due to hiking and tourism, many people reach high altitudes in a hypobaric hypoxia environment. These hypoxic conditions can be tolerated if one is exposed to low oxygen pressure, leading to a sequence of physiological responses. Occasionally, hypoxia causes maladaptive responses which leads to different forms of high altitude diseases. Case Report. We report a case of a 49-year-old man, a former professional athlete, passionate about hiking and still physically active. He was admitted to our Emergency Department with short breath and a chest X-ray revealed a large right sided pneumothorax which was successfully treated with tube drainage. Conclusion. Although primary spontaneous pneumothorax is a rare condition, it should be suspected during physical examination. Therefore, physicians should be prepared to recognize it, especially paying attention to all hikers and high-altitude travelers in order to avoid possible risks for high-altitude sickness.