Ultrasounds are acoustic vibrations that are not perceived by the human ear as their frequency is greater than 20,000 Hz. They are artificially generated by the action of the electric current, whose polarity is periodically reversed, on a quartz crystal, subjecting it, by the action of the electromagnetic field created, to successive contractions and expansions. This alternation of movements generates vibrations, which, transmitted to cellular and intercellular structures, cause collisions and generate heat.

We are witnessing the evolution of the diagnostic imaging that is rapidly becoming available to Women’s Health physicians (OB/GYN’s), enabling the use of technology to augment our ability to medically palpate on examination of the patient, to identify conditions which we were unable to appreciate a short time ago.

Liver biopsy continues to be the gold-standard with regards to diagnosis and staging of the majority of liver diseases. Serologic markers certainly have helped in diagnosing various autoimmune and viral-related liver diseases. Furthermore, laboratory testing and imaging studies such as liver elastography have allowed us to non-invasively assess fibrosis. Unfortunately, there are shortcomings with these forms of testing. False positives or laboratory errors will lead to misleading diagnoses. Situations can also arise during which there are diagnostic dilemmas, such as an obese patient with positive autoimmune serology and elevated liver chemistries.

In pharmacologic doses niacin (nicotinic acid) has been used clinically for over six decades for atherogenic dyslipidemia and reduction of cardiovascular event risk. In combination with statin therapy, it effects regression of coronary atherosclerosis. Emerging evidence indicates a new potential use for niacin for the treatment of NAFLD and its complications. Despite this enormous amount of data on niacin, there is confusion and misconceptions about its use of a drug rather than as a vitamin, its formulations, and how it can be used in clinical practice. The purpose of this invited brief communication is to update and summarize this emerging evidence. We comment on how it may be valuable in the context of other drugs-in-development for NAFLD, especially for combination therapy for synergistic efficacy.

Until the early sixties, the concept prevailed that alcoholic liver disease (ALD), also termed alcohol-related liver disease (ARLD), results from malnutrition commonly observed among individuals consuming chronically high amounts of alcohol rather than being causally related to the use of alcoholic beverages. However, the malnutrition concept became a matter of debate because of the clinical observation that humans, even on a normal diet and without signs of underweight or malnutrition