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Dijagnoza bolesti nealkoholne masne jetre (engl. non-alcoholic fatty liver disease, NAFLD) počinje već na temelju kliničkih obilježja bolesnika. Tipičan rizični profil predstavlja bolesnik s prekomjernom tjelesnom težinom, pogotovo ako su tome pridruženi šećerna bolest tipa 2, arterijska hipertenzija i/ili hiperlipidemija, uz uvjet isključene rizične konzumacije alkohola. Postojanje masne jetre najčešće se utvrđuje ultrazvukom na kojem je jetra svjetlija (ehogenija) u odnosu na korteks bubrega. Ultrazvukom se ne može prepoznati blaže oblike steatoze kada je < 20 – 30 % hepatocita masno transformirano. Elastografskim metodama može se kvantificirati stupanj steatoze i stadij fibroze. Stadij fibroze je najznačajniji prognostički čimbenik, dok je značaj upalne aktivnosti dvojben, a stupanj steatoze ne utječe bitno na ishod bolesti jetre. Za neinvazivnu procjenu steatoze i fibroze koriste se i biokemijski testovi, od najjednostavnijih dobivenih iz rutinskih laboratorijskih nalaza do složenih koji uključuju cirkulirajuće makromolekule i komponente izvanstaničnoga matriksa. Neinvazivne metode su pouzdane za isključivanje ciroze, no imaju relativno skromnu pozitivnu prediktivnu vrijednost, jer često precjenjuju stadij fibroze i ne daju informaciju o aktivnosti upale. Objektivniju dijagnozu ovih histoloških komponenti i time pouzdanu prognostičku informaciju pruža biopsija jetre. Obradu bolesnika s NAFLD-om treba započeti na primarnoj razini zdravstvene zaštite jednostavnim biokemijskim testom (npr. FIB-4) kojim se isključuje značajna fibroza. U slučaju povišenih vrijednosti potreban je potvrdni test (najbolje elastografija). Ako taj nalaz isključi značajnu fibrozu, bolesnik ostaje u skrbi obiteljskoga liječnika, a u slučaju teške fibroze/ciroze bolesnik se nastavlja liječiti kod specijaliste. Na ovaj način za 80 % se smanjuje upućivanje bolesnika specijalisti, te za pet puta poboljšava otkrivanje značajne fibroze/ciroze., Diagnosing non-alcoholic fatty liver disease (NAFLD) begins with analysing patient’s clinical features. The typical risk profile includes an overweight patient with comorbidities such as type 2 diabetes mellitus, arterial hypertension and/or hyperlipidaemia, excluding harmful alcohol consumption. Ultrasonography is the most widely used diagnostic tool for detecting fatty liver, which has higher echogenicity, i.e. is lighter in colour, compared to renal cortex. However, ultrasound cannot detect mild steatosis where < 20 – 30% of hepatocytes have been infiltrated by fat. Elastographic methods are used for grading steatosis and staging fibrosis. Liver fibrosis stage is the most significant prognostic indicator. On the other hand, the relevance of inflammatory activity is questionable and the degree of steatosis has no significant impact on the outcome of the disease. Steatosis and fibrosis can be evaluated using non-invasive biochemical tests, ranging from simple routine laboratory tests to more complex tests that include circulating macromolecules and components of extracellular matrix. Non-invasive methods provide reliable results for the exclusion of cirrhosis; however, their positive predictive value is relatively modest, as they often over-estimate the fibrosis stage and provide no information on inflammatory activity. Liver biopsy provides a more objective diagnosis of the histological features and, as a result, a more reliable prognosis. The workup of NAFLD patients should start at the primary healthcare level, with simple biochemical tests such as FIB-4, which excludes significant fibrosis. Elevated results need to be additionally confirmed by another test, most preferably elastography. If this test excludes significant fibrosis, the patient remains under the care of a primary care physician, and if it detects severe fibrosis/cirrhosis, the patient is referred to specialist treatment. This pathway has resulted in an 80 % decrease in referrals to a specialist and a 5-fold improvement in the detection of significant fibrosis/cirrhosis.

COVID-19 je infektivna bolest koja se nakon pojave (prosinac 2019., Wuhan, Kina) tijekom sljedeća 3 mjeseca proširila na sve kontinente i izazvala pandemiju s kojom je čovječanstvo prvi put suočeno. S obzirom na to da bolesnici imaju pretežito respiratornu simptomatologiju često s razvojem intersticijske upale pluća te da se radi o visoko kontagioznoj bolesti, nameće se potreba brze, pouzdane i sigurne dijagnostike plućnih komplikacija ove bolesti. U COVID-19 bolesnika ciljani ultrazvuk pluća je superioran u odnosu na klasičnu Rtg snimku srca i pluća te se u dijagnostičkoj pouzdanosti približio MSCT-u toraksa. Razlog tomu je činjenica da su upalni infiltrati lokalizirani prvenstveno bazalno i periferno gdje su dostupni UZV pregledu. Najčešće zahvaćene regije su 5 i 6 obostrano, a u nalazu dominiraju multiple B linije u 2 i više regija u kombinaciji s pojedinačnim B linijama. U ožujku 2020. osnovan je Primarni respiracijsko-intenzivistički centar u KB Dubrava (PRIC KBD) s ciljem zbrinjavanja COVID-19 bolesnika s umjerenom do teškom kliničkom slikom i znacima respiracijske insuficijencije. Za dijagnostiku i praćenje bolesnika, uz Rtg snimku srca i pluća te MSCT toraksa, korišten je ciljani UZV pluća. Osim dobre korelacije s kliničkom slikom i stupnjem respiracijske insuficijencije, ciljani UZV pluća pokazao se korisnim zbog kratke izloženosti aerosolu tijekom pretrage, a bez potrebe za mobilizacijom bolesnika ili korištenjem mobilnog Rtg uređaja. Postao je suverena zamjena za stetoskop uz mogućnost pridržavanja svih mjera za prevenciju širenja aerosola: mobilni uređaj bez kabela, mogućnost dezinfekcije pa čak i korištenje samo jednog uređaja po bolesniku u intenzivističkom centru, čime je postao važna dijagnostička metoda kod COVID-19 pozitivnih bolesnika., COVID-19 is an infectious disease which surfaced in December 2019 (Wuhan, China) and swept across all the continents in a matter of 3 months, triggering a pandemic faced by humanity for the first time. Given the predominance of respiratory symptoms in patients, often accompanied by the development of interstitial pneumonia, and the fact that it is a highly contagious disease, it called for a prompt, reliable and safe diagnosis of pulmonary complications of the disease. In COVID-19 patients, focused lung ultrasound is superior to the classical heart or chest X-ray, and in terms of diagnostic reliability, is almost up to par to an MSCT of the thorax. This is due to the fact that inflammatory infiltrates are localized primarily basally and peripherally where they are accessible to ultrasound examinations. Regions 5 and 6 (both sides) are most commonly affected, and medical reports show a predominance of multiple B lines in 2 or more regions in combination with individual B lines. In March 2020, the Primary Respiratory Intensive Care Center at Clinical Hospital Dubrava (PRIC KBD) was founded to treat COVID-19 patients with a moderate to severe clinical picture and signs of respiratory failure. In addition to an X-ray of the heart and lungs and MSCT of the thorax, patients were diagnosed and monitored using focused lung ultrasound. Besides a good correlation with the clinical picture and degree of respiratory failure, focused lung ultrasound has shown to be favorable due to short aerosol exposure during screening, without the need to mobilize patients or use a mobile X-ray device. It has become an unrivalled replacement for the stethoscope, capable of adhering to all measures to prevent the spread of aerosols: a cordless mobile device, disinfectable, with even the ability to use only one device per patient in the intensive care unit, rendering it an important diagnostic tool in COVID-19 positive patients.