Introduction: Hepatitis D virus (HDV) infection remains a significant global health challenge due to its severity and high risk of progression to cirrhosis and hepatocellular carcinoma (HCC). Bulevirtide, a novel HDV entry inhibitor, has shown promise in managing chronic hepatitis D by blocking viral entry into hepatocytes. This study evaluated the efficacy and safety of bulevirtide in reducing HDV RNA levels and improving liver function in a real-life cohort of Italian patients with HDV infection. Methods: This multicenter prospective trial enrolled 108 consecutive patients with chronic HDV infection, from June 2023 to June 2024, who received 2 mg/day of bulevirtide in combination with a nucleoside/nucleotide analogue for hepatitis B virus (HBV) infection. Patients with any stage of liver fibrosis or compensated cirrhosis were included. Data collected included demographic and clinical characteristics, liver function tests, HDV RNA levels, and adverse events at baseline and 6 months. Results: The virological response was achieved in 54.6% of patients (n = 59), with 36 demonstrating undetectable HDV RNA levels. Among responders, ALT levels decreased significantly from 67.0 U/mL [IQR 44.0–116.3] to 31.5 U/mL [IQR 24.0–36.5, p = 0.001], and AST levels from 66.0 U/mL [IQR 46.5–91.0] to 32.5 U/mL [IQR 28.0–38.0, p = 0.021]. Median HDV RNA dropped from 29,800 IU/mL [IQR 3100–375,000] to 0 IU/mL [IQR 0–291, p < 0.001]. No significant predictors of response emerged. Mild adverse events, including pruritus (5.6%) and injection-site reactions (1.9%) and flu-like syndrome (0.9) were reported, with no treatment discontinuation. Conclusions: Bulevirtide effectively reduces HDV RNA levels and improves liver function with a favorable safety profile, offering a promising therapeutic option for chronic hepatitis D. Further large-scale studies are needed to confirm these findings and explore long-term outcomes.

Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.

Insulin resistance (IR) in type 1 diabetes mellitus (T1D) has significant cardiovascular and metabolic implications. Hypovitaminosis D has been linked to IR in various populations; however, its relationship with insulin sensitivity in T1D remains unclear. This review aimed to investigate the association between hypovitaminosis D and IR in individuals with T1D. Vitamin D may enhance glucose metabolism by protecting pancreatic β-cells, and therefore, insulin secretion. Animal studies and clinical trials have suggested that vitamin D supplementation improves β-cell survival and can slow disease progression when initiated soon after T1D diagnosis. Nevertheless, its impact on insulin secretion in established T1D is limited because of significant β-cell loss at diagnosis. Moreover, vitamin D can improve insulin sensitivity by attenuating renin-angiotensin system activity, enhancing insulin receptor expression, activating metabolic pathways such as peroxisome proliferator-activated receptor delta, and reducing inflammation by downregulating proinflammatory cytokines associated with IR. Studies have demonstrated an inverse relationship between serum 25-hydroxyvitamin D (25[OH]D) levels and IR in T1D, with higher vitamin D levels being associated with reduced IR odds across various age groups. However, factors such as the body mass index may influence this relationship, particularly in younger populations, indicating complex interactions. Despite preliminary evidence, the link between hypovitaminosis D and IR in T1D remains underexplored. The evidence reviewed in this work underscores the need for further research to clarify this relationship and explore the detailed mechanisms involved.

Patients on renal replacement therapy are typically subject to several dietary restrictions; however, this approach has been questioned in recent years, with some suggesting that the Mediterranean diet might be beneficial. Data on the adherence to this diet and factors that influence it are scarce. We conducted a web survey among individuals on renal replacement therapy (dialysis or kidney transplant, KT) using the MEDI-LITE questionnaire to assess adherence to the Mediterranean diet and dietary habits in this population. Adherence to the Mediterranean diet was generally low, and significantly lower among participants on dialysis versus KT recipients (19.4% vs. 44.7%, p < 0.001). Being on dialysis, adopting fluid restrictions, and having a basic level of education were predictors of low adherence to the Mediterranean diet. Consumption of foods typically included in the Mediterranean diet, including fruit, legumes, fish, and vegetables, was generally low, particularly among those on dialysis. There is a need for strategies to improve both the adherence to and the quality of the diet among individuals on renal replacement therapy. This should be a shared responsibility between registered dietitians, physicians, and the patient.

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently overlaps with hepatitis C virus (HCV) infection, yet the recently proposed combinatorial MASLD (cMASLD) classification remains poorly characterized in this setting. This study aimed to evaluate the prevalence, metabolic profile, and virological determinants of cMASLD in an Italian cohort of HCV-infected patients. Methods: We conducted a cross-sectional study on 169 HCV-infected patients evaluated at two referral Centers in Southern Italy (between 2020 and 2024). All subjects underwent transient elastography, and cMASLD was diagnosed according to international guidelines. Group comparisons were performed using ANOVA or Kruskal-Wallis tests with appropriate post-hoc analyses, categorical variables by Chi-square or Fisher’s exact test, and multivariate logistic regression to identify factors independently associated with cMASLD (p<0.05). Results: Among 169 patients, n=52 (31%) fulfilled cMASLD criteria, n=14 (8%) had HCV with liver steatosis, and n=103 (61%) had HCV infection alone. Compared with other groups, cMASLD patients showed higher body mass index (28±8 kg/m²; p<0.001), larger waist circumference (p<0.001), increased controlled attenuation parameter (298±41 dB/m; p<0.001), and higher fasting insulin (p=0.029). HCV RNA levels were significantly elevated in the cMASLD group (p=0.014). Multivariate logistic regression identified HCV RNA as independently associated with cMASLD (OR=1.48; 95%CI: 1.01-2.17; p=0.045). Conclusions: Applying the cMASLD nomenclature emphasizes the need for a multidisciplinary management approach integrating antiviral and metabolic care. This classification provides a more comprehensive understanding of liver injury mechanisms in patients with overlapping metabolic and viral etiologies.