Liver-spleen axis dysfunction in COVID-19

Coronavirus disease 2019(COVID-19),caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is an acute infectious disease that spreads mainly through the respiratory route.Besides interstitial pneumonia,a number of other clinical manifestations were noticed in COVID-19 patients.In particular,liver and spleen dysfunctions have been described both as complications of COVID-19 and as potential predisposing factors for severe COVID-19.Liver damage is rather common in COVID-19 patients,and it is most likely multifactorial,caused by the direct insult of SARS-CoV-2 to the liver by the cytokine storm triggered by the virus,by the use of hepatotoxic drugs,and as a consequence of hypoxia.Although generally mild,liver impairment has been found to be associated with a higher rate of intensive care unit admission.A higher mortality rate was reported among chronic liver disease patients.Instead,spleen impairment in patients with COVID-19 has been poorly described.The main anatomical changes are the architectural derangement of the B cell compartment,white pulp atrophy,and reduction or absence of lymphoid follicles,while,from a functional point of view,the IgM memory B cell pool is markedly depleted.The outcome of COVID-19 in asplenic or hyposplenic patients is yet to be defined.In this review,we will summarise the current knowledge regarding the impact of SARS-CoV-2 on the liver and spleen function,as well as the outcome of patients with a pre-existent liver disease or defective spleen function.

Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients

BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different.Resilience may in turn influence the perception of stigma.Patients with inflammatory bowel disease(IBD)are susceptible to stigma,although data are very limited.AIM To validate an Italian translation of the IBD perceived stigma scale(PSS)in relation to patients’resilience.METHODS Consecutive IBD outpatients were prospectively enrolled(December 2018-September 2019)in an Italian,tertiary referral,IBD center.Clinical and demographic data were collected.Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale,respectively.The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality.Higher scores represent greater perceived stigma and resilience.Multivariable analysis for factors associated with greater stigma was computed.RESULTS Overall,126 IBD patients(mean age 46.1±16.9)were enrolled.The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied,with optimal data completeness.There was no ceiling effect,whilst floor effect was present(7.1%).The discriminant validity and the internal consistency reliability were good(Cronbach alpha=0.87).The overall internal consistency was 95%,and the test-retest reliability was excellent 0.996.The median PSS score was 0.45(0.20-0.85).Resilience negatively correlated with perceived stigma(Spearman’s correlation=-0.18,95%confidence intervals:-0.42-0.08,P=0.03).CONCLUSION We herein validated the Italian translation of the PSS scale,also demonstrating that resilience negatively impacts perceived stigma.