The aim of this study was to evaluate the diagnostic accuracy of bedside lung ultrasound and chest radiography (CXR) in patients with suspected pneumonia compared with CT scan and final diagnosis at ...discharge. Design A prospective clinical study.
Lung ultrasound and CXR were performed in sequence in adult patients admitted to the emergency department (ED) for suspected pneumonia. A chest CT scan was performed during hospital stay when clinically indicated.
120 patients entered the study. A discharge diagnosis of pneumonia was confirmed in 81 (67.5%). The first CXR was positive in 54/81 patients (sensitivity 67%; 95% CI 56.4% to 76.9%) and negative in 33/39 (specificity 85%; 95% CI 73.3% to 95.9%), whereas lung ultrasound was positive in 80/81 (sensitivity 98%; 95% CI 93.3% to 99.9%) and negative in 37/39 (specificity 95%; 95% CI 82.7% to 99.4%). A CT scan was performed in 30 patients (26 of which were positive for pneumonia); in this subgroup the first CXR was diagnostic for pneumonia in 18/26 cases (sensitivity 69%), whereas ultrasound was positive in 25/26 (sensitivity 96%). The feasibility of ultrasound was 100% and the examination was always performed in less than 5 min.
Bedside chest ultrasound is a reliable tool for the diagnosis of pneumonia in the ED, probably being superior to CXR in this setting. It is likely that its wider use will allow a faster diagnosis, conducive to a more appropriate and timely therapy.
Background
Real-time tissue elastography (RTE), acoustic radiation force impulse (ARFI) imaging, and transient elastography (TE) are new technologies that are used for liver stiffness evaluation. The ...aim of this study was to compare these methods in the same population and to determine their diagnostic accuracy in the prediction of liver fibrosis.
Methods
Forty-five consecutive, previously biopsied, patients with chronic liver disease and 27 normal subjects underwent TE, RTE, and ARFI on the right liver lobe. Correlation coefficients between measurements, Metavir fibrosis stage, and histological necro-inflammatory activity (adjusted for fibrosis stage) were evaluated via Spearman’s rank order correlation coefficients. Areas under the receiver operating characteristic curve (AUROCs) were calculated to predict each fibrosis stage.
Results
Failure or inconsistent results occurred in 12.5% of the attempts at TE, but in none of the attempts at RTE and ARFI. The three methods showed high correlation with fibrosis and poor correlation with necro-inflammatory activity. TE and ARFI exhibited high diagnostic accuracy (AUROCs ≥0.9) in diagnosing cirrhosis (F4 Metavir). All three methods presented fair (AUROCs >0.7) to good (AUROCs >0.8) diagnostic accuracy in diagnosing fibrosis (F1–4 Metavir) and significant fibrosis (F2–4 Metavir), with TE showing the best performance (AUROCs were 0.878 for fibrosis and 0.897 for significant fibrosis).
Conclusions
TE and ARFI provide high diagnostic accuracy in the diagnosis of cirrhosis. When feasible, TE may perform better than RTE and ARFI in predicting fibrosis and significant fibrosis, but larger studies are needed.
Ever since the launch of the multilateral framework at the end of the 1980s,
EU-GCC relations have experienced many ups and downs, although a marked
downward trend has most recently kicked in. Within ...the context of new regional
circumstances following the outbreak of the Arab uprisings, EU-GCC relations
run the risk of becoming totally irrelevant. This is due to growing polarization
within the GCC itself and the emergence of (so far competing) EU-Iran relations,
despite still existing obstacles. Taking stock of what has been achieved and of
the strategic motivations to work together on a number of dossiers is of utmost
importance to be able to re-lanuch EU-GCC relations on more solid grounds.
Practical relevance:
Ciclosporin (CsA) is a systemic immuno-modulatory drug widely used to treat immune-mediated diseases in humans and veterinary species. CsA was registered for use in cats in the ...USA and Europe in 2011, and is indicated for the treatment of chronic allergic dermatitis at a recommended daily dose of 7 mg/kg PO.
Audience:
This review will be of interest to all veterinarians working with cats, given the wide range of potential applications of CsA and its safety profile. Although the drug is currently only licensed to treat chronic allergic dermatitis in cats, a small number of reports describe its use in non-dermatological conditions.
Evidence base:
This article reviews the mechanism of action, pharmacokinetics, drug interactions, adverse effects and clinical use of CsA, both for the licensed indication and for off-label use in the feline patient. Information presented has been summarised from the existing literature on CsA, with specific interest in studies carried out in cats. For its licensed indication, chronic allergic dermatitis, evidence provided includes randomised, placebo or prednisolone-controlled studies (EBM grade I) and prospective or retrospective open trials.
•This systematic review and meta-analysis of 103 studies comprising 948 217 patients found that NAFLD is associated with a significantly higher risk of HCC as compared to no NAFLD.•In addition, NAFLD ...nonsignificantly increased the risk of HCC-related mortality but not of recurrence or overall mortality.•Given the higher risk of HCC in patients with NAFLD, general health interventions and screening should be implemented for high-risk cases (eg, those with steatohepatitis and fibrosis).
Hepatic steatosis of nonalcoholic etiology (nonalcoholic fatty liver disease; NAFLD) is an emergent condition that may lead to hepatic cirrhosis and finally to liver cancer. We evaluate the risk of developing hepatocellular carcinoma (HCC) and quantify the prognosis in terms of recurrence (DFS) as well as HCC-specific and overall survival (CSS and OS) of patients with and without NAFLD.
We searched published articles that evaluated the risk and outcomes of HCC in patients with steatosis/steatohepatitis from inception to July 2021 were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Prospective cohort, case-control, or retrospective studies were selected that were published in English and provided incidence and survival rates of HCC patients with NAFLD. A random-effects model was created to estimate the pooled effect size. The primary outcome of interest was HCC incidence. The secondary endpoints were DFS, CSS, and OS.
In total, 948 217 patients with NAFLD were analyzed, from n = 103 observational studies. NAFLD significantly increased the risk of HCC (HR = 1.88 95% CI, 1.46-2.42; P < .01 but not risk of recurrence (HR = 0.99 95% CI, 0.85-1.15; P = .9) or overall mortality (HR = 1.04 95% CI, 0.88-1.24; P = 0.64). Conversely, NAFLD increased HCC-related mortality risk (HR = 2.16 95% CI, 0.85-5.5; P = .1). Risk of HCC was increased in Western countries but not in Asian countries.
Patients with NAFLD have an increased risk of HCC as compared to patients without NAFLD. NAFLD also increases liver cancer (HCC) mortality. These results justify applying general measures to patients with proven NAFLD and monitoring patients with NASH and fibrosis.
Background
There is a lack of studies comparing topical antiseptics to systemic antibiotics in the treatment of canine superficial pyoderma.
Hypothesis/Objectives
To compare the efficacy of topical ...chlorhexidine with systemic amoxicillin–clavulanic acid for the treatment of canine superficial pyoderma.
Animals
A randomized controlled trial was conducted in dogs with superficial pyoderma. Group T (n = 31) was treated topically with 4% chlorhexidine digluconate shampoo (twice weekly) and solution (once daily) for 4 weeks. Group S (n = 20) was treated orally with amoxicillin–clavulanic acid (25 mg/kg) twice daily for 4 weeks.
Methods
Bacterial culture and susceptibility testing were performed on clinical specimens collected before treatment. Severity of lesions and number of intracellular bacteria were evaluated using four‐point scales to calculate a total pyoderma score for each dog. Pruritus was assessed by owners using a visual analog scale (range 0–10). Scores were analysed for statistical differences between groups T and S.
Results
Staphylococcus pseudintermedius was isolated from 48 dogs, including eight meticillin‐resistant strains (MRSP). Although the number of dogs was small, no significant differences in pyoderma and pruritus scores were observed between groups throughout the study except for day 1, when group S had a significantly higher total score than group T (P = 0.03). Treatment with chlorhexidine products resulted in resolution of clinical signs in all dogs including those infected with MRSP.
Conclusion and clinical importance
Topical therapy with chlorhexidine digluconate products may be as effective as systemic therapy with amoxicillin–clavulanic acid. This finding supports the current recommendations to use topical antiseptics alone for the management of superficial pyoderma.
Résumé
Contexte
Il existe un manque d’études comparant les antiseptiques topiques aux antibiotiques systémiques dans le traitement de la pyodermite superficielle canine.
Hypothèses/Objectifs
Comparer l'efficacité de chlorhexidine topique avec l'amoxicilline acide clavulanique pour le traitement de pyodermite superficielle canine.
Sujets
Une étude contrôlée randomisée a été menée chez des chiens atteints de pyodermite superficielle. Le groupe T (n = 31) a été traité avec un shampooing de digluconate de chlorhexidine à 4% (deux fois par semaine) et une solution (une fois par jour) pendant quatre semaines. Le groupe S (n = 20) a reçu oralement de l'amoxicilline acide clavulanique (25 mg/kg) deux fois par jour pendant quatre semaines.
Méthodes
Une culture bactérienne et un antibiogramme ont été réalisés sur des échantillons prélevés avant le traitement. La sévérité des lésions et le nombre de bactéries intracellulaires ont été évalués à l'aide d'une échelle en quatre points pour calculer un score total de pyodermite pour chaque chien. Le prurit a été évalué par les propriétaires à l'aide d'une échelle visuelle analogue (rang 0‐10). Les scores ont été analyses pour différences statistiques entre les groups T et S.
Résultats
Staphylococcus pseudintermedius a été isolé pour 48 chiens, dont huit MRSP (meticllin resistant Staphylococcus pseudintermedius). Bien que le nombre de chiens soit petit, aucune différence significative dans les scores de pyodermite ou de prurit n'a été observée entre les groupes au cours de l’étude à l'exception du jour 1, le groupe S avait alors un score total significativement plus élevé que le groupe T (P = 0.03). Le traitement à la chlorhexidine a résulté en une résolution clinique pour tous les chiens y compris ceux infectés par MRSP.
Conclusions et importance clinique
Un traitement topique au digluconate de chlorhexidine peut être aussi efficace qu'un traitement systémique avec de l'amoxicilline acide clavulanique. Ces données supportent les recommandations actuelles d'utiliser les antiseptiques topiques seuls dans la gestion de la pyodermite superficielle.
Resumen
Introducción
hay una carencia de estudios comparando los tratamientos antisépticos tópicos con los antibióticos sistémicos en el tratamiento de la pioderma superficial canina.
Hipótesis/Objetivos
comparar la eficacia la clorhexidina tópica con el ácido clavulánico‐amoxicilina para el tratamiento de pioderma superficial canina.
Animales
se realizó una prueba controlada al azar en perros con pioderma superficial. El grupo T (n = 31) se trató tópicamente con un cuatro por ciento de digluconato de clorhexidina en forma de shampoo (dos veces por semana) y en solución (una vez al día) durante cuatro semanas. El grupo S (n = 20) fue tratado por vía oral con amoxiclina‐ácido clavulánico (25 mg/kg) dos veces al día durante cuatro semanas.
Métodos
se realizaron cultivos bacterianos y pruebas de susceptibilidad en los especímenes clínicos recogidos antes del tratamiento. La severidad de las lesiones y el número de bacterias intracelulares se evaluó utilizando una escala de cuatro puntos para calcular un valor total de pioderma para cada perro. El prurito fue evaluado por los propietarios utilizando una escala visual análoga (rango de cero a 10). Los valores se analizaron para detectar diferencias estadísticas entre los grupos T y S.
Resultados
se aisló Staphylococcus pseudintermedius de 28 perros, incluyendo ocho con Staphylococcus pseudintermedius resitente a meticilina (MRSP). Aunque el número de perros fue pequeño, no hubo diferencias significativas en los valores de pioderma y prurito observadas entre los grupos a lo largo del estudio salvo en el día uno, cuando el grupo S tuvo un valor total significativamente más alto que el grupo T (P = 0,03). El tratamiento con productos de clorhexidina resultó en la resolución de los signos clínicos en todos los perros incluyendo aquellos afectados con en MRSP.
Conclusiones e importancia clínica
el tratamiento tópico con digluconato de clorhexidina puede ser tan efectivo como la terapia sistémica con ácido clavulánico‐amoxicilina. Este hallazgo apoya las recomendaciones más recientes del uso de antisétpticos tópicos en solitario para el manejo de la pioderma superficial.
Zusammenfassung
Hintergrund
Es fehlen Studien, die topische Antiseptika mit systemischen Antibiotika bei der Behandlung der oberflächlichen Pyodermie des Hundes vergleichen.
Hypothese/Ziele
Ein Vergleich der Wirksamkeit von topischem Chlorhexidin mit systemischer Amoxicillin‐Clavulansäure zur Behandlung einer oberflächlichen Pyodermie des Hundes.
Tiere
Eine randomisierte kontrollierte Studie wurde bei Hunden mit einer oberflächlichen Pyodermie durchgeführt. Gruppe T (n = 31) wurde topisch mit 4%igem Chlorhexidin Diglukonat Shampoo (zweimal wöchentlich) und Lösung (einmal täglich) vier Wochen lang behandelt. Gruppe S (n = 20) wurde mit Amoxicillin‐Clavulansäure per os (25 mg/kg) zweimal täglich vier Wochen lang behandelt.
Methoden
Es wurde eine Bakterienkultur und ein Antibiogramm an klinischen Proben, die vor der Behandlung entnommen wurden, durchgeführt. Der Schweregrad der Veränderungen und die Anzahl der intrazellulären Bakterien wurden mittels Vier‐Punkte‐Skala untersucht, um einen Totalwert für die Pyodermie eines jeden Hundes zu kalkulieren. Der Juckreiz wurde von den BesitzerInnen mittels Visueller Analog Skala (Breite 0‐10) beurteilt. Die Werte wurden auf statistische Differenzen hin zwischen den Gruppen T und S analysiert.
Ergebnisse
Es wurde Staphylococcus pseudintermedius von 48 Hunden isoliert, dabei inkludiert waren acht Methicillin‐resistente Staphylococcus pseudintermedius (MRSP). Obwohl die Anzahl der Hunde gering war, wurden während der ganzen Studie keine signifikanten Unterschiede zwischen der Pyodermie und den Juckreizwerten zwischen den Gruppen beobachtet, außer am Tag 1, wo die Gruppe S einen signifikant höheren Wert als Gruppe T (P = 0,03) aufwies. Die Behandlung mit Chlorhexidin Produkten brachte bei allen Hunden, auch jenen mit MRSP Infektion eine Resolution der klinischen Symptome.
Schlussfolgerungen und klinische Bedeutung
Eine topische Behandlung mit Chlorhexidin Diglukonat Produkten kann ebenso effektiv sein, wie eine systemische Behandlung mit Amoxicillin‐Clavulansäure. Dieses Ergebnis bestärkt die momentanen Empfehlungen topische Antiseptika alleine zur Behandlung einer oberflächlichen Pyodermie zu verwenden.
Background ‐There is a lack of studies comparing topical antiseptics to systemic antibiotics in the treatment of canine superficial pyoderma. Hypothesis/Objectives ‐ To compare the efficacy of topical chlorhexidine with systemic amoxicillin–clavulanic acid for treatment of canine superficial pyoderma. Conclusion and clinical importance ‐ Topical therapy with chlorhexidine digluconate products may be as effective as systemic therapy with amoxicillin–clavulanic acid. This finding supports the current recommendations to use topical antiseptics alone for management of superficial pyoderma.
Background
Oclacitinib is a Janus kinase inhibitor that decreases pruritus and lesions in allergic dogs. In cats, it is able to inhibit interleukin‐31‐induced pruritus; no information is available on ...its clinical effectiveness.
Hypothesis/Objectives
To evaluate the efficacy, ease of administration and tolerability of oclacitinib in feline nonflea‐, nonfood‐induced hypersensitivity dermatitis.
Methods
Cats >12 months of age and >3 kg body weight with a diagnosis of nonflea‐, nonfood‐induced hypersensitivity dermatitis were treated with oclacitinib, 0.4–0.6 mg/kg orally (p.o.) twice daily for 2 weeks, then once daily for an additional 14 days. Clinical lesions were evaluated with the Scoring Feline Allergic Dermatitis (SCORFAD) system and pruritus was evaluated with a 10‐cm‐long visual analog scale (VAS) before and at the end of the study. Owners assessed global efficacy, ease of administration and tolerability with a four‐point scale.
Results
Twelve cats were treated with a mean initial oclacitinib dose of 0.47 mg/kg p.o. twice daily. There was good improvement in SCORFAD and VAS pruritus scores in five of 12 cases, while the other cats were unchanged, deteriorated or dropped out due to treatment failure. Owners scored global efficacy as good/excellent in four of 12 cases and ease of administration and tolerability as good/excellent in 10 of 12.
Conclusions and clinical importance
Oclacitinib at 0.4–0.6 mg/kg p.o. may be an effective and safe drug for some cats with nonflea‐, nonfood‐induced hypersensitivity dermatitis. Further studies are needed to identify the most effective dose range for this species.
Résumé
Contexte
L'oclacitinib est un inhibiteur Janus kinase qui diminue le prurit et les lésions chez les chiens allergiques. Chez le chat, il peut inhiber le prurit induit par l'interleukine‐31; aucune information n'est disponible sur son efficacité clinique.
Hypothèses/Objectifs
Evaluer l'efficacité, la facilité d'administration et la tolérance de l'oclacitinib sur les dermatites par hypersensibilité non liées aux puces et non liées à l'alimentation.
Méthodes
Les chats de plus de 12 mois et de plus de 3 kg avec un diagnostic de dermatite par hypersensibilité non liée aux puces et non liée à l'alimentation ont été traités par l'oclacitinib per os à 0.4–0.6 mg/kg deux fois par jour pendant 2 semaines, puis une fois par jour 14 jours supplémentaires. Les lésions cliniques ont été évaluées par SCORFAD (Scoring Feline Allergic Dermatitis) et le prurit a été évalué par une échelle visuelle analogue (VAS) avant et à la fin de l’étude. Les propriétaires ont évalués l'efficacité globale, la facilité d'administration et la tolérance à l'aide d'une échelle à quatre points.
Résultats
Douze chats ont été traités avec une dose initiale moyenne d'oclacitinib de 0.47 mg/kg p.o deux fois par jour. Il y a eu une bonne amélioration du SCORFAD et des scores de prurit pour cinq des 12 cas alors que les autres chats restaient inchangés, s'aggravaient ou sortaient de l’étude à cause de l’échec du traitement. Les propriétaires ont notés l'efficacité globale comme bonne/excellente pour quatre des 12 cas et la facilité d'administration et la tolérance comme bonne à excellente pour 10 cas sur 12.
Conclusions et importance clinique
L'oclacitinib à 0.4–0.6 mg/kg p.o peut être efficace et sure pour des chats présentant une dermatite par hypersensibilité non liée aux puces ou à l'alimentation. D'autres études sont nécessaires pour identifier la dose la plus efficace dans cette espèce.
Resumen
Introducción
Ocalcitinib es un inhibidor de la quinasa Janus que disminuye el prurito y las lesiones en perros alérgicos. En gatos es capaz de inhibir el prurito inducido por interleuquina 31; no hay información disponible de su efectividad clínica.
Hipótesis/Objetivos
evaluar la eficacia, facilidad de administración y tolerabilidad de oclacitinib en dermatitis por hipersensibilidad felina no inducida por pulgas ni alimentaria.
Métodos
gatos mayores de 12 meses de edad y de más de tres kilos de peso con un diagnóstico de dermatitis de hipersensibilidad no inducida por pulgas ni por alergias alimentarias fueron tratados con oclacitinib, 0,4 a 0,6 mg/kg por vía oral (p.o.) dos veces al día durante dos semanas, y después una vez al día durante 14 días más. Las lesiones clínica se evaluaron mediante el sistema de evaluación de la dermatitis alérgica felina (SCORFAD) y el prurito se evaluó con una escala análoga visual de 10 cm de longitud (VAS) antes y al final del estudio. Los propietarios evaluaron la eficacia global, la facilidad de administración y tolerabilidad en una escala de cuatro puntos.
Resultados
12 gatos fueron tratados con una dosis inicial media de oclacitinib de 0,47 mg/kg por vía oral dos veces al día. Hubo mejora en SCORFAD y los valores de prurito VAS en cinco de los 12 casos, mientras que en los otros gatos no hubo cambios, deterioraron, o se sacaron del estudio debido a fallo en el tratamiento. Los propietarios valoraron la eficacia global como buena/excelente en cuatro de los 12 casos, y la facilidad de administración y tolerabilidad como buena/excelente en 10 de 12 casos.
Conclusiones e importancia clínica
oclacitinib de 0,4 a 0,6 mg/kg por vía oral puede ser efectivo y seguro como tratamiento en algunos gatos con dermatitis por hipersensibilidad no inducida por pulgas ni por alergia alimentaria. Se necesitan más estudios paréntesis para identificar el rango de dosis más efectivas en esta especie.
Zusammenfassung
Hintergrund
Oclacitinib ist ein Janus Kinase Inhibitor, der Juckreiz und Hautveränderungen bei allergischen Hunden vermindert. Bei Katzen kann es Interleukin‐31‐induzierten Juckreiz verhindern; es gibt keinerlei Information bezüglich seiner klinischen Wirksamkeit.
Hypothese/Ziele
Eine Evaluierung der Wirksamkeit, der Leichtigkeit der Anwendung und der Toleranz von Oclacitinib bei weder durch den Floh noch durch Futter induzierter Hypersensibilitätsdermatitis.
Methoden
Katzen von > 12 Monaten Lebensalter und > 3kg Körpergewicht mit der Diagnose einer Hypersensibilitätsdermatitis, die nicht durch Floh oder Futter ausgelöst war, wurden mit Oclacitinib bei einer Dosis von 0,4‐0,6mg/kg per os (p.o.) zweimal täglich für 2 Wochen, dann einmal täglich für weitere 14 Tage behandelt. Die klinischen Läsionen wurden mittels Scoring Feline Allergic Dermatitis (SCORFAD) System, der Juckreiz mittels einer 10‐cm‐langen Visual Analogskala (VAS) vor und nach Ende der Studie beurteilt. Die BesitzerInnen beurteilten die allgemeine Wirksamkeit, die Leichtigkeit der Verabreichung und die Toleranz anhand einer vier‐Punkte Skala.
Ergebnisse
Zwölf Katzen wurden mit einer durchschnittlichen Oclacitinib Dosis von 0,47 mg/kg p.o. zweimal täglich behandelt. Es bestand eine gute Verbesserung des SCORFAD und der VAS Juckreizwerte bei fünf der 12 Fälle, während die anderen Katzen unverändert blieben, sich verschlechterten oder aufgrund eines Therapieversagens aus der Studie ausfielen. Die BesitzerInnen bewerteten die allgemeine Wirksamkeit bei vier der 12 Fälle als gut/exzellent und die Einfachheit der Anwendung und die Toleranz als gut/exzellent bei 10 der 12 Katzen.
Schlussfolgerungen und klinische Bedeutung
Oclacitinib bei einer Dosierung von 0,4‐0,6 mg/kg p.o. könnte ein effektives und sicheres Medikament sein für einige Katzen mit einer nicht durch Flöhe und Futter ausgelösten Hypersensibilitätsdermatitis sein. Es sind weitere Studien nötig, um die wirksamste Dosisbreite für diese Spezies herauszufinden.
Avian nests are fundamental structures in avian reproduction and face strong selective forces. Climatic conditions are likely to have shaped the evolution of specific nest traits, but evidence is ...scarce at a macroevolutionary level. The Thraupidae family (commonly known as tanagers) is an ideal clade to understand the link between nest architecture and climate because it presents wide variation in nest traits. To understand whether climatic variables have played a role in the diversification of nest traits among species in this family, we measured nests from 49 species using museum collections. We observed that dome‐nesting species are present in dryer and hotter environments, in line with previous findings suggesting that domed nests are a specialisation for arid conditions. We also found evidence that nests with thicker walls are present in locations with lower precipitation and that solar radiation can influence the shape of domed nests; birds tend to build shorter and narrower domes in areas with high levels of solar radiation. Open nest architecture is also potentially influenced by wind speed, with longer and deeper nests in areas characterised by strong winds. Our results support the hypothesis that different climatic variables can drive the evolution of specific aspects of nest architecture and contribute to the diversity of nest shapes we currently observe. However, climatic variables account only for a small fraction of the observed structural variation, leaving a significant portion still unexplained.
Bird nests play a crucial role in the survival and fitness of eggs, nestlings, and incubating parents, but the role of climate variables on the evolution and diversity of avian nest traits is still largely unknown. Previous studies have focused on (i) single species and few environmental variables or (ii) multiple species and general nest morphology. In our study, we explore the relationship between several climatic variables and specific nest traits in a family of birds, Thraupidae (commonly known as tanagers). Thraupidae represents an ideal clade for our study as species belonging to this family vary considerably in their nest architecture. We found evidence that nests with thicker walls are present in locations with lower precipitation and that solar radiation can influence the shape of domed nests; birds tend to build shorter and narrower nests in areas with high levels of solar radiation. Open nest architecture is also potentially influenced by wind speed, with longer and deeper nests in areas characterized by strong winds.
Transient elastography （TE） is a new non invasive tool for measuring liver stiffness, which is correlated to the histologic stage of liver fibrosis. Several studies in chronic liver disease （CLD） ...have determined a good accuracy of TE in predicting significant fibrosis and an optimal accuracy in predicting cirrhosis. Normal liver stiffness ranges between 3.3-7.8 KPa and using a cut off of 7.1 KPa, significant fibrosis and cirrhosis can be excluded with a very high negative predictive value （NPV）. Positive predictive value （PPV） for the diagnosis of cirrhosis is lower using just a single scan but increases to 90% if high stiffness values are confirmed by a second independent scan. However the presence of fatty liver and metabolic syndrome slightly increases the readings and may reduce the accuracy of the test. it is uncertain if this increase is related to the presence of steatofibrosis or if it is caused by steatosis itself. TE can be used in screening patients attending the liver clinics to identify those with significant fibrosis or cirrhosis and may be particularly useful in discriminating HBV inactive carriers from chronic hepatitis B patients. TE, however, is not reliable in predicting the presence of esophageal varices in cirrhotics. Another potential indication for TE is the systematic screening of populations at high risk for CLD, such as intravenous drug users and alcoholics, but further studies are needed to determine its diagnostic accuracy in these settings.
In the North African context, Morocco is a clear example of democratic backsliding. Since popular protests broke out in 2011, institutional reforms were implemented under the leadership of the ...monarchy, leading the Moroccan polity to change without altering its defining features. The previous decade had indeed seen Morocco trailing a thin line between social moderation and repression and between political openings and counter-revolution. Between 2011 and 2022 the process of democratic backsliding accelerated, thus turning Morocco into a 'hybrid regime'. By tracing continuities and changes in the past decade mainly at the political and institutional levels, this article explores the pattern of democratic backsliding undertaken by Morocco by empirically contextualising it within the deterioration of the main features of citizenship understood according to the categorisation introduced by Marshall and Bottomore (1987) that distinguishes between civic, political and social rights. To explain this pattern, the article argues that external factors linked to the deterioration of the regional context (the conflict with Algeria over the Western Sahara and the spill-over of Libyan instability) as well as the rising tensions with the European Union (EU) have not only underpinned Morocco's geopolitical reorientation but also sustained its domestic crisis of (unfinished) democratisation.
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