Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease.

BACKGROUND AND AIM: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes. AIM: To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver. METHODS: We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT-PCR in 26 frozen liver samples and the ratio CB2/beta-actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann-Whitney U-test. We considered as significant differences those with a P-value <0.05. RESULTS: Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti-CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/beta-actin ratio of 0.001+/-0.01, steatosis 6.52+/-17.3 (P=0.05 vs normal) and NASH 6.49+/-12.2 (P=0.06 vs normal and P=0.6 vs steatosis). CONCLUSION: CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.

[Variations in serum ferritin and erythrocyte index in the first eight weeks of life in term newborn infants]. / Variaciones en la ferritina sérica e índices eritrocitarios en las primeras ocho semanas de vida en recién nacidos a término.

OBJECTIVE: To describe changes in erythrocyte index during the first 8 weeks of life in neonates in relation to their iron store. MATERIAL AND METHODS: We performed a longitudinal study of a group of healthy term newborn infants, in whom we evaluated erythrocyte index and serum ferritin (SF) values at birth and at weeks 4 and 8 of age. Depending on the comparison made in SF values between birth and 2 months, the infants were divided into two groups: group I (without variation in SF) and group II (with a decrease in SF). RESULTS: A total of 110 neonates were included, with 46 neonates in group I and 64 in group II. No differences in demographic or hematologic data were found, including neonates with anemia or a decrease in hemoglobin values (5.2 vs. 5.5 g/dL). SF decreased to lower values in group II than in group I (215 vs. 194 microg/L, p < 0.001), with a greater number of neonates with low iron stores at 2 months of age (0.15 vs. 0.37, p < 0.01; RR 2.464, 95 % CI: 1.162-5.227). CONCLUSIONS: In healthy term newborn infants, erythrocyte index at birth showed no relation with iron store. SF values at 2 months of age depended on SF concentrations at birth. Decreased hemoglobin and SF values are part of physiological adaptation in the first few months of life.

[Prevention of maternal RhD isoimmunization with anti-D gamma isoimmunization]. / Prevención de la isoinmunización materna al RhD, con gamma-globulina anti-D.

OBJECTIVE: To report our experience in preventing RhD maternal isoimmunization by using anti-D gamma globulin among Rh-negative women. MATERIAL AND METHODS: Between 1982 and 1995, immunologic and hematologic data were collected from all Rh-negative women seen at Mexico's National Perinatology Institute. Women at risk of Rh isoimmunization were given a prophylactic dose of 150 micrograms of anti-D gamma globulin. RESULTS: A total of 4,857 Rh-negative women were seen during the study period (4.85% of the total population of women seen at the Institute), 629 (13.0%) of whom developed RhD isoimmunization; 542 (86.2%) of these women were already isoimmunized when first seen at our Institute. Twenty-two women (3.5%) developed isoimmunization even after receiving a proper dose of anti-D gamma globulin. Prophylaxis was given to 2,605 women (53.6%); 2,039 received a single dose, and 475 two doses. Prophylaxis failed in 22 cases; four were women with multiple pregnancy and 18 developed obstetric pathologic conditions. CONCLUSIONS: The use of anti-D gamma globulin resulted in a reduction of maternal Rh isoimmunization to less than one case per 1,000 women. Failures to prevent isoimmunization were associated to additional obstetric conditions and to lack of adherence to prevention guidelines.

[Changes in plasma values of interleukin 1-beta and TNF-alpha at birth]. / Cambios en los valores plasmáticos de interleucina 1-beta y TNF-alpha al nacimiento.

OBJECTIVE: To describe the changes during the period of transition of the TNF-alpha and IL-1 beta in newborn healthy, under effect of deliver. MATERIAL AND METHODS: They were selected randomly at term newborn, with low perinatal risk. We quantified the plasmatic concentrations of TNF-alpha and IL-1 beta at birth, one hour and 24 hours of life. RESULTS: We included 110 newborn. The concentrations of TNF-alpha and IL-1 beta quantified to the birth, at the time of life and to the 24 hours of life; were of 7.4, 8.7 and 9.3 pg/mL and of 1.1, 1.3 and 0.7 pg/mL, respectively. In the TNF-alpha, was significant difference to the birth (12.9 versus 4.4 pg/mL) and one hour of life (14.7 vs 5.6 pg/mL), with more elevated values in neonates born by vaginal delivery (p < 0.01). There was not the same effect for the IL-1 beta. There was not statistical influence in relation to sex, birth weight when or gestational age. CONCLUSIONS: The TNF-alpha, but not it IL-1 beta, it presented statistical changes associate to the delivery.

[Changes in iron levels in non-anemic women 18-58 years of age]. / Cambios en la reserva de hierro en mujeres no anémicas entre los 18 y 58 años de edad.

The objective was to describe changes in serum ferritin (SF) in women residents in Mexico City. We evaluated prospectively, three groups of non-anemic, non-pregnant women (< 20, 21-40 y 40-58 years old). Sociodemographic variables, hemoglobin (Hb) and erythrocyte index and SF values were registered. We included 252 women in the study. There were no differences in Hb values (15.0, 14.6 and 14.7 g/dL) or erythrocyte index between the three groups of women. We found significative differences (p < 0.001) in mean values of (32 and 34 micrograms/L), for group 1 and 2, with group 3 (SF 54 micrograms/L). In global sample, we observed low SF store, a normal or higher in 76 cases (30.2%), 163 (64.6%) and 13 cases (5.2%), respectively. The women with SF lower than 20 micrograms/L were in proportion 0.54, 0.32 and 0.16. Elevated values in SF were found in a proportion 0.04, 0.18 and 0.13, for groups 1, 2 and 3, with significative differences (p < 0.001). We observed that non-anemic women in Mexico City, showed increase in SF concentrations beginning at 41 years of age, without any major variation in their erythocyte indexes. The prevalence in moderate-severe iron deficiency between 18 to 40 years of years, decreasing progressively.

[Changes in the thrombophilic status in patients with pre-eclampsia]. / Cambios en el estado trombofílico en pacientes con preeclampsia.

The object of this study was to evaluate the changes in fibrinolysis and clotting inhibitors in patients with preeclampsia and to describe the connection between preeclampsia and blood pressure values. Two groups of pregnant women were prospectively studied at delivery: group 1 women without preeclampsia and group 2 patients with preeclampsia. The variables that were registered are: diastolic blood pressure (DBP), systolic blood pressure (SBP), mean blood pressure (MBP), hemoglobin (Hb), platelet count (Plt), lupus like inhibitor, anticardiolipin antibodies (ACA), antinuclear antibodies (ANA), fibronectina, D dimer, protein S (PS), protein C (PC) and vo Willebrand factor (vWF). 62 pregnant women were included. The patients of group 2 presented high values of Hb (p 0.01), fibronectin (p 0.0001), D-dimer (p 0.01) and lower PC (p 0.04). We found an association between fibronectin and higher values of SBP, DBP, MBP and Hb (p 0.0007) versus lower values of VFW and PC (p 0.002). The low values of total PS were associated with high D-dimer and SBP results (p 0.04 and 0.002 respectively). All patients were ACA/ANA negative. In preclampsia there is a increased hemoconcentration and drop in clotting inhibitors (PC), without fibrinolytic compensatory response (lower D-dimer) and remarked vasopressive effect (hig fibronectin). This changes depend on the stratification of blood pressure. Th SBP and MBP values depend on the haemodynamic changes (Hb, fibronectin), while the increase in DBP expresses a non compensated thrombophilic state.

[Neonatal consequences of maternal autoimmune thrombocytopenic purpura]. / Repercusión neonatal de la púrpura trombocitopénica autoinmune materna.

PURPOSE: To describe the clinical characteristics in newborns of mothers with autoimmune thrombocytopenic purpura (ATP), as well as to evaluate the mother's platelet count in the prediction of the neonatal thrombocytopenia. PATIENTS AND METHODS: We included 33 mothers with their 40 newborns, who were classified in four groups: Group I: ten newborns whose mothers suffered of chronic autoimmune thrombocytopenic purpura who during the pregnancy remained in haematologic remission. Group II: nine newborns whose mothers were splenectomized for ATP in the preceding treatment but without symptoms during the actual pregnancy. Group III: eleven newborns whose mothers had chronic ATP and splenectomy, but during the actual pregnancy showed purpuric activity. Group IV: Ten newborns whose mothers had acute ATP during actual gestation with clinical data for bleeding. RESULTS: None of the newborns belonging to the group I presented thrombocytopenia. Mean platelet count at birth was 150 x 10(9)/L in group I, 124 x 10(9)/L u/L in group II, 47 x 10(9)/L in group III and 89 x 10(9)/L in group IV. There were significant differences between the focus groups (p < .01). The mean platelet count in groups III and IV, presented the lower values between days three and fourteen of postnatal age. In these same groups, we observed more morbility related with haemorrhagical activity or infectious complications derived from treatment with steroids. The presence of maternal thrombocytopenia was associated in the 86.7% of the cases with platelet count < 100 x 10(9)/L at the time of birth. CONCLUSION: The maternal background with low probability of fetal or neonatal thrombocytopenia included mothers with inactive ATP and the antecedent of splenectomy. On the contrary, the greatest probability of fetal and neonatal affection happens when the mother presents active chronic ATP and the previous antecedent of being refractory to the treatment with splenectomy or when acute ATP occurred during pregnancy.

[The prevalence of hepatitis B and C in blood donors in a 3rd-level hospital of Mexico City]. / Prevalencia de hepatitis B y C en donadores de sangre en un hospital de tercer nivel de la ciudad de México.

OBJECTIVE: To investigate the prevalence of the hepatitis C virus (HCV) and B virus (HBV) in blood donors attending Médica Sur Hospital. MATERIAL AND METHODS: A total of 9,099 blood donors were tested for hepatitis B and C viruses from 1994 to 1998. A questionnaire was used to collect data and HCV and HBV were detected in serum. We obtained percentages and assessed statistical significance using the chi 2 test. RESULTS: The prevalence of HCV and HBV carriers was 0.47 and 0.11 per cent. The main risk factors were dental procedures (11.6% for HCV and 20%, for HBV), and unsafe sexual practices (20%) for HBV. CONCLUSIONS: These results indicate a low prevalence of HCV and HBV infection in this population.

[Iron storage in infants at 2 and 8 months of age]. / Estudios de la reserva de hierro en el lactante menor a los dos y ocho meses de edad.

For to establish the probability of the early identification of the iron deficient in the infant, we evaluate the correlation between the serum ferritin (SF) values at two and eight months of age. It included 57 infants, 30 cases with SF higher than 20 ng/mL (group I), eight cases with SF between 12-20 ng/mL (group II) and 19 infants with SF lower of 12 ng/mL (group III); the addition of two late groups result in 27 cases with SF lower of 20 ng/mL (group IV). None cases had SF lower 20 ng/mL at two months of age. The correlation between SF values and hemoglobin (Hb) at two and eight months of age, the Hb of the infants deficients had better correlation (0.602 P = 0.006). The SF not had statistic correlation. For to establish if the groups had the same values of SF and Hb at two months on age, the SF values were in the group III vs group I were 154.1 and 274.6 ng/mL (P = 0.004) respectively. This data indicate that the infants that development severe iron deficiency to eight months of age, may predict this quantify the SF at two months of age.

[Usefulness of erythrocyte indices in the study of iron storage in infants]. / Utilidad de los índices eritrocitarios en el estudio de la reserva de hierro del lactante menor.

For establishment correlation between erythrocyte indices and serum ferritin (SF), to identify infants at eighth months of age, with iron normal corporal stores, were studied 112 infants; 40 cases had severe deficient iron stores (SF < 12 ng/mL), 17 cases with "moderate" deficient iron stores (SF 12-20 ng/mL) and 55 infants with normal iron stores. The mean corpuscular hemoglobin (MCH) was altered in the 40.1%, the mean corpuscular volume (MCV) 29.5% and hemoglobin (Hb) 6.2%. In severe deficient iron stores, the MCH, with abnormal values had minor specificity (0.62), that MCV (0.88). With a SF < 20 ng/mL, specificity of the MCV was 0.92. Simultaneous alteration on MCH and MCV had similar specificity (0.92) and predictive positive values. With abnormal values of CMH + MCV or MCV alone, were established high probability for identify infants with normal iron stores.

[Irregular antierythocytic antibodies outside of the ABO system in the perinatal period]. / Anticuerpos irregulares antieritrocitarios fuera del sistema ABO en el periodo perínatal.

Included in this study are the results of the tests done with irregular anti-erythrocytic antibodies outside of the ABO system of women in reproductive stage. In 2,623 cases considered, 279 samples positive for the antibodies were found (10.6%). In 184 cases (65.9%), the antibodies were classified as "immune irregular". The most frequently found antibodies from this group were the anti-D (63.08%), followed by the anti-c (1.07%), the anti-Kell (0.72%), anti-C, anti-E and an anti-Rh system (0.36% for each one). In 52 cases (18.6%) there were irregular "natural" antibodies, predominantly the anti-Lewis (9.68%), followed by anti-P (5.02%), the anti-I (3.2%), an anti-M and an anti-N (0.36% each one). In 43 (15.4%) cases, we were not able to identify the specificity of the antibody found. We include a discussion and a comparison of the frequency of these antibodies in our population. Based on these data, we recommend the clinician to consider the existence and specificity of the irregular anti-erythrocytic antibodies in their obstetric patients, candidates to transfusional therapy, as well as those newborn with hemolytic diseases.

[Growth curves for premature infants during the 1st year of life]. / Curvas de crecimiento del neonato pretérmino durante el primer año de vida.

A 107 newborn premature children were anthropometrically evaluated during the first 12 months of their lives at the Growth Clinic of the National Institute of Perinatology in Mexico City. The study was longitudinal and included variables such as weight, height, cephalic, thoracic, abdominal and bronchial perimeters. The data are show in percentiles of 10, 50 and 90 for each variable. A symmetrical logarithmic behavior throughout the entire curve was seen with each of the six indicators evaluated, whose greatest percentage increase within the growth rate was generally seen during the first semester, decreasing during the second. It was seen that once the child reaches one, the premature infant reaches the full-term child (50 percentile) in weight, height and cephalic perimeter. In addition, the average speed of growth was four times greater for weight, two times greater for height and similar for the cephalic perimeter of the premature child with respect to the full-term infant. We conclude that it is useful to count on specific growth curves for premature children since their speed and rhythm of growth are different than for the full-term child during the first year of life.

[Antierythrocyte antibodies due to ovarian dysgerminoma. A case report]. / Anticuerpos antieritrocitarios por disgerminoma del ovario. Informe de un caso.

The case of a 24-year-old woman with fever, abdominal pain and weight loss, is presented. Right ovarian dysgerminoma was diagnosed; group A blood, negative direct Coombs. The search for free serum antibodies was positive, with specificity: auto anti 1, anti P with activity at 37 degrees C. Hysterectomy, appendectomy, omentectomy and retroperitoneal ganglia biopsy, were performed; the latter one showed metastasis. Blood transfusions were given. Thirty days postoperative, the red cell polyagglutination had disappeared, as well as antibodies.

[Bacterial colonization of the oral cavity in the newborn]. / Colonización bacteriana de la cavidad oral del recién nacido.

To determine the correlation between the bacterial flora of vagina or amniotic fluid of the mother and the oral cavity of the newborn, we made a prospective bacteriologic study in 43 newborns; 18 of them were born by cesarean section and 25 by vaginal delivery. The samples for the study were taken at birth, at 12 and 24 hours of life. In the newborns delivery by cesarean section was not correlation between the microorganism founded in amniotic fluid and neonatal oral cavity. In the neonates obtained by vaginal delivery there was correlation between the microorganisms in the oral cavity and the maternal vaginal flora. The results support the hypothesis that the bacteria colonize the oral cavity at birth comes from the vaginal cavity contamination of the mother.

[Usefulness of C-reactive protein for the diagnosis of neonatal sepsis]. / Utilidad de la proteína C reactiva para el diagnóstico de sepsis neonatal.

With the object to determine the utility of C-reactive protein (CRP) in the diagnosis of neonatal sepsis. We proceeded to create the prospective study of cases and controls of newborn included in the study of neonatal sepsis in the Instituto Nacional de Perinatologia. We measured the seric CRP in samples obtained by capillary punction simultaneously with blood culture and/or CSF culture, for bacterial infection criteria. We included 64 newborn divided in two groups: 42 patients were not infected and 22 cases had positive cultures. The results in the uninfected newborn group of CRP were negative to positive dilutions 1:32; with the newborn infected the CRP had values of 1:32 to 1:2048. The probability to find values equal or major to 1:32 in the infected newborn with positive cultures the CRP have values of sensitivity of 91% and specificity of 93% to get this values. We accept that the CRP could be used systematically for the diagnosis of neonatal sepsis, being a simple procedure and accessible for use in the newborn with sepsis suspicion.

[Determination of C-reactive protein in low-risk newborn infants]. / Determinación de la proteína C reactiva en neonatos de bajo riesgo.

We present the results of the determination of C-reactive protein (CRP) in neonates with low risk of developing infection and without obstetric trauma. In determining the values of CRP we used the technique of latex agglutination. We included 56 neonates determining the changes in the values obtained in samples of cord blood and 24 hours. At birth, in 51 cases, the CRP was negative (0.91), 4 cases were positive at a dilution 1:4 (0.07) and one case at a dilution 1:8 (0.02). At 24 hours, in 47 cases (0.84) the CRP was negative; in 6 cases (0.04), at a dilution 1:8 and one more positive result at a dilution 1:6. There was not difference in the dilutions of the CRP in relation to the moment of sampling. We suggest that the method of latex agglutination is useful in sistemating the application use of CRP in neonates.

[Neurologic follow-up of polycythemic newborn infants]. / Seguimiento neurológico de neonatos policitémicos.

Seventy five newborn infants with neonatal polycythemia diagnosis (venous hematocrit levels greater than 65% were studied). They were born in the Instituto Nacional de Perinatologia and follow through their first year of life searching for neurologic findings. The more frequent signs related to polycythemia in this group were: presence of plethora, respiratory distress, cyanosis and tremors; the associated findings were hypoglycemia, hyperbilirubinemia, necrotizing enterocolitis and meconium aspiratum. Sixty eight of the seventy five neonates developed symptomatology and seven didn't. The eight neonates who developed neurologic transient impairments belonged to the symptomatic group in a 0.11 proportion. We concluded that the number of babies with neurologic findings in our sample was small in comparison with other reference studies; we also found that the exchange transfusion is not a preventive measure for neurologic sequel, but it is useful to diminish the symptomatology caused by polycythemia; besides we don't recommend this procedure in asymptomatic babies because the complication risks as the enterocolitis. We propose a simple treatment scheme.