Development and validation of a scoring system to predict response to obeticholic acid in primary biliary cholangitis.

BACKGROUND & AIMS: Obeticholic acid (OCA) is the only licensed second-line therapy for primary biliary cholangitis (PBC). With novel therapeutics in advanced development, clinical tools are needed to tailor the treatment algorithm. We aimed to derive and externally validate the OCA response score (ORS) for predicting the response probability of individuals with PBC to OCA. METHODS: We used data from the Italian RECAPITULATE (N 441) and the IBER-PBC (N 244) OCA real-world prospective cohorts to derive/validate a score including widely available variables obtained either pre-treatment (ORS), or also after 6 months of treatment (ORS+). Multivariable Cox's regressions with backward selection were applied to obtain parsimonious predictive models. The predicted outcomes were biochemical response according to POISE (ALP/ULN<1.67 with a reduction of at least 15%, and normal bilirubin), or ALP/ULN<1.67, or NORMAL RANGE criteria (NR: normal ALP, ALT and bilirubin) up to 24 months. RESULTS: Depending on the response criteria, ORS included age, pruritus, cirrhosis, ALP/ULN, ALT/ULN, GGT/ULN and bilirubin. ORS+ also included ALP/ULN and bilirubin after 6 months of OCA therapy. Internally validated c-statistics for ORS were of 0.75, 0.78 and 0.72 for POISE, ALP/ULN<1.67 and NR response, which raised to 0.83, 0.88, 0.81 with ORS+, respectively. The respective performances in validation were of 0.70, 0.72 and 0.71 for ORS, and 0.80, 0.84, 0.78 for ORS+. Results were consistent across groups with mild/severe disease. CONCLUSIONS: We developed and externally validated a scoring system capable to predict OCA response according to different criteria. This tool will enhance a stratified second-line therapy model to streamline standard care and trial delivery in PBC.

Post-treatment LSM rather than change during treatment predicts decompensation in patients with cACLD after HCV cure.

BACKGROUND & AIMS: Baveno VII has defined a clinically significant (i.e., prognostically meaningful) decrease in liver stiffness measurement (LSM) in cACLD as a decrease of ≥20% associated with a final LSM <20 kPa or any decrease to <10 kPa. However, these rules have not yet been validated against direct clinical endpoints. METHODS: We retrospectively analysed patients with cACLD (LSM ≥10 kPa) with paired liver stiffness measurement (LSM) before (BL) and after (FU) HCV cure by interferon-free therapies from 15 European centres. The cumulative incidence of hepatic decompensation was compared according to these criteria, considering hepatocellular carcinoma and non-liver-related death as competing risks. RESULTS: A total of 2,335 patients followed for a median of 6 years were analysed. Median BL-LSM was 16.6 kPa with 37.1% having ≥20 kPa. After HCV cure, FU-LSM decreased to a median of 10.9 kPa (<10 kPa: 1,002 [42.9%], ≥20 kPa: 465 [19.9%]) translating into a median LSM change of -5.3 (-8.8 to -2.4) kPa corresponding to -33.9 (-48.0 to -15.9) %. Patients achieving a clinically significant decrease (65.4%) had a significantly lower risk of hepatic decompensation (subdistribution hazard ratio: 0.12, 95% CI 0.04-0.35, p <0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM <10 kPa (5-year cumulative incidence: 0.3%) compared to a high risk in patients with FU-LSM ≥20 kPa (16.6%). Patients with FU-LSM 10-19.9 kPa (37.4%) also had a low risk of hepatic decompensation (5-year cumulative incidence: 1.7%), and importantly, the risk of hepatic decompensation did not differ between those with/without an LSM decrease of ≥20% (p = 0.550). CONCLUSIONS: FU-LSM is key for risk stratification after HCV cure and should guide clinical decision making. LSM dynamics do not hold significant prognostic information in patients with FU-LSM 10-19.9 kPa, and thus, their consideration is not of sufficient incremental value in the specific context of HCV cure. IMPACT AND IMPLICATIONS: Liver stiffness measurement (LSM) is increasingly applied as a prognostic biomarker and commonly decreases in patients with compensated advanced chronic liver disease achieving HCV cure. Although Baveno VII proposed criteria for a clinically significant decrease, little is known about the prognostic utility of LSM dynamics (changes through antiviral therapy). Interestingly, in those with a post-treatment LSM of 10-19.9 kPa, LSM dynamics did not provide incremental information, arguing against the consideration of LSM dynamics as prognostic criteria. Thus, post-treatment LSM should guide the management of patients with compensated advanced chronic liver disease achieving HCV cure.

First Update to B-Chrom: A Database on B-Chromosomes.

The supernumerary mostly dispensable B chromosomes are nuclear components of about 15% of eukaryotic phyla. For a long time, B chromosomes have been studied, generating an enormous bulk of knowledge, diluted in the vastness of the scientific literature. In order to provide better access to this information, we created B-chrom ( www.bchrom.csic.es ), an online database with comprehensive information on Bs for plants, animals, and fungi. It was released in 2017 and first updated in 2021, by adding 334 entries and 123 new species. Currently, the resource provides information for 2951 species coming from 3292 sources. During this time, the usefulness of this database has been proven by the number of visits (more than 207,000 since its release) and by the scientific community, having been cited in more than 60 publications until present. This chapter explains the database composition and tips on how to use it.

Release 4.0 of the Plant rDNA Database: A Database on Plant Ribosomal DNA Loci Number, Their Position, and Organization: An Information Source for Comparative Cytogenetics.

This paper presents the latest update to the Plant rDNA database (Release 4.0), a valuable resource for researchers in the field of plant cytogenetics. The database provides information on the number, position, and arrangement of ribosomal DNA loci in plants, including angiosperms, gymnosperms, bryophytes, and pteridophytes. The new release includes new data for 820 species coming from additional 173 papers. In the updated version of the Plant rDNA database, 4948 entries comprising 2760 organisms can be found. A brief guide on how to navigate the database and obtain the desired information is also provided. The regular updating of the database is important for ensuring the information it contains is accurate, up-to-date, and useful for the research community. The Plant rDNA database continues to be beneficial for phylogenetic and cytogenetic studies in a wide range of taxa including angiosperms, gymnosperms, and early diverging groups, such as bryophytes and lycophytes.

Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series.

BACKGROUND AND AIMS: Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. AIM: we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. METHODS: One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018-2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. RESULTS: Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. CONCLUSIONS: Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients.

Online Resources Useful for Plant Cytogenetics and Cytogenomics Research.

The advancements in research in the field of plant cytogenetics and genomics in recent decades have led to a significant increase in publications. To simplify access to the widely dispersed data, there has been a rise in the number of online databases, repositories, and analytical tools. This chapter presents a comprehensive overview of these resources, which can be beneficial to researchers in these areas. It includes, among others, databases on chromosome numbers, special chromosomes (such as B chromosomes or sex chromosomes), some of which are taxon-specific; genome sizes, cytogenetics; and online applications and tools for genomic analysis and visualization.

Significant heterogeneity in the diagnosis and long-term management of Wilson disease: Results from a large multicenter Spanish study.

There is uncertainty regarding Wilson's disease (WD) management. OBJECTIVES: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers. METHODS: Data on WD patients followed at 32 Spanish hospitals were collected. RESULTS: 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response. CONCLUSIONS: Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored.

A Model Based on Noninvasive Markers Predicts Very Low Hepatocellular Carcinoma Risk After Viral Response in Hepatitis C Virus-Advanced Fibrosis.

BACKGROUND AND AIMS: Patients with hepatitis C virus (HCV) and advanced fibrosis remain at risk of hepatocellular carcinoma (HCC) after sustained viral response (SVR) and need lifelong surveillance. Because HCC risk is not homogenous and may decrease with fibrosis regression, we aimed to identify patients with low HCC risk based on the prediction of noninvasive markers and its changes after SVR. APPROACH AND RESULTS: This is a multicenter cohort study, including patients with HCV and compensated advanced fibrosis that achieved SVR after direct antivirals. Clinical and transient elastography (TE) data were registered at baseline, 1 year, and 3 years after the end of treatment (EOT). All patients underwent liver ultrasound scan every 6 months. Patients with clinical evaluation 1 year after EOT were eligible. Univariate and multivariate Cox regression analysis were performed, and predictive models were constructed. HCC occurrence rates were evaluated by Kaplan-Meier. Nine hundred and ninety-three patients were eligible (56% male; 44% female; median age 62 years), 35 developed HCC (3.9%), and the median follow-up was 45 months (range 13-53). Baseline liver stiffness measurement (LSM) (HR 1.040; 95% CI 1.017-1.064), serum albumin (HR 0.400; 95% CI 0.174-0.923), 1-year DeltaLSM (HR 0.993; 95% CI 0.987-0.998), and 1-year FIB-4 score (HR 1.095; 95% CI 1.046-1.146) were independent factors associated with HCC. The TE-based HCC risk model predicted 0% of HCC occurrence at 3 years in patients with score 0 (baseline LSM ≤ 17.3 kPa, albumin >4.2 g/dL, and 1-year DeltaLSM > 25.5%) versus 5.2% in patients with score 1-3 (Harrell's C 0.779; log-rank 0.002). An alternative model with FIB-4 similarly predicted HCC risk. CONCLUSIONS: A combination of baseline and dynamic changes in noninvasive markers may help to identify patients with a very low risk of HCC development after SVR.

Alimentación y nutrición en cáncer hematológico: diseño y validación de una infografía psicoeducativa / Feeding and nutrition in hematological cancer: design and validation of a psychoeducational infographic

El cáncer y su tratamiento implican cambios en la dieta y metabolismo que aumentan el riesgo de desarrollar desnutrición, especialmente cuando los pacientes desconocen cómo alimentarse. Aunque se han desarrollado materiales psicoeducativos para favorecer conductas alimentarias saludables, la mayoría son extensos, están dirigidos a pacientes diagnosticados con tumores sólidos o no señalan datos de validación. Con el objetivo de construir y validar un material psicoeducativo breve, orientado a la promoción de conductas alimentarias y nutricionales saludables del paciente oncohematológico adulto, se diseñó y validó la infografía Recomendaciones para la alimentación del paciente oncohematológico. Se empleó la metodología propuesta por la Organización Panamericana de la Salud y por Ziemendorff y Krause en un grupo de jueces expertos (n=18) y otro de pacientes oncohematológicos (n=20). Se obtuvieron acuerdos porcentuales superiores a 80 % y κ>.68 en ambos grupos de validación, por lo tanto, la infografía diseñada es un instrumento conciso, válido y específico que puede ser distribuida entre la población diana

Cancer and its treatment involve changes in diet and metabolism that increase the risk of developing malnutrition, especially when patients do not know how to feed. Although psychoeducational materials have been developed to favor healthy eating behaviors, the majority are extensive, they are aimed at patients diagnosed with solid tumors or do not indicate validation data.In order to create and validate a brief psychoeducational material aimed at promoting healthy eating and nutritional behaviors of the adult oncohematological patient, the infographic Recommendations for feeding the oncohematological patient was designed and validated. The methodology proposed by the Pan American Health Organization and by Ziemendorff and Krause was used in a group of expert judges (n = 18) and another group of oncohematological patients (n = 20). Percent agreements greater than 80% and κ> .68 were obtained in both validation groups, therefore, the designed infographic is a concise, valid and specific instrument that can share out among the target population

Degradation kinetics of carbendazim by Klebsiella oxytoca, Flavobacterium johnsoniae, and Stenotrophomonas maltophilia strains.

The fungicide carbendazim is an ecotoxic pollutant frequently found in water reservoirs. The ability of microorganisms to remove pollutants found in diverse environments, soil, water, or air is well documented. Although microbial communities have many advantages in bioremediation processes, in many cases, those with the desired capabilities may be slow-growing or have low pollutant degradation rates. In these cases, the manipulation of the microbial community through enrichment with specialized microbial strains showing high specific growth rates and high rates and efficiencies of pollutant degradation is desirable. In this work, bacteria of the genera Klebsiella, Flavobacterium, and Stenotrophomonas, isolated from the biofilm attached to the packed zones of a biofilm reactor, were able to grow individually in selective medium containing carbendazim. In the three bacteria studied, the mheI gene encoding the first enzyme involved in the degradation of the fungicide carbendazim was found. Studying the dynamics of growth and carbendazim degradation of the three bacteria, the effect of co-formulants was also evaluated. The pure compound and a commercial formulation of carbendazim were used as substrates. Finally, the study made it possible to define the biokinetic advantages of these strains for amendment of microbial communities.

Upcoming pharmacological developments in chronic hepatitis B: can we glimpse a cure on the horizon?

BACKGROUND: Hepatitis B virus (HBV) chronic infection affects up to 240 million people in the world and it is a common cause of cirrhosis and hepatocellular carcinoma (HCC). HBV covalently closed circular DNA (cccDNA) plays an essential role in HBV persistence and replication. Current pharmacological treatment with nucleos(t)ide analogues (NA) may suppress HBV replication with little or no impact on cccDNA, hence lifelong treatment is required in the vast majority of patients. Clearances of intrahepatic cccDNA and/or HBsAg are critical endpoints for future antiviral therapy in chronic HBV. Recent promising developments targeting different molecular HBV life cycle steps are being pre-clinically tested or have moved forward in early clinical trials. METHODS: We review the current state of the art of these pharmacological developments, mainly focusing on efficacy and safety results, which are expected to lay the ground for future HBV eradication. An inclusive literature search on new treatments of HBV using the following electronic databases: Pubmed/MEDLINE, AMED, CINAHL and the Cochrane Central Register of Controlled Trials. Full-text manuscripts and abstracts published over the last 12 years, from 2005 to March 2011 were reviewed for relevance and reference lists were crosschecked for additional applicable studies regarding new HBV antiviral treatment. RESULTS: HBV entry inhibitors, HBV core inhibitors, HBV cccDNA transcripts RNA interference, HBV cell apoptosis inducers, HBV RNA, viral proteins and DNA knock down agents, HBV release inhibitors, anti-sense nucleosides, exogenous interferon stimulation, interferon response stimulation and HBV therapeutic vaccines were reviewed. CONCLUSION: This review will provide readers with an updated vision of current and foreseeable therapeutic developments in chronic hepatitis B.

Kinetics of carbendazim degradation in a horizontal tubular biofilm reactor.

The fungicide carbendazim is an ecotoxic agent affecting aquatic biota. Due to its suspected hormone-disrupting effects, it is considered a "priority hazard substance" by the Water Framework Directive of the European Commission, and its degradation is of major concern. In this work, a horizontal tubular biofilm reactor (HTBR) operating in plug-flow regime was used to study the kinetics of carbendazim removal by an acclimated microbial consortium. The reactor was operated in steady state continuous culture at eight different carbendazim loading rates. The concentrations of the fungicide were determined at several distances of the HTBR. At the loading rates tested, the highest instantaneous removal rates were observed in the first section of the tubular biofilm reactor. No evidence of inhibition of the catabolic activity of the microbial community was found. Strains of the genera Flectobacillus, Klebsiella, Stenotrophomonas, and Flavobacterium were identified in the biofilm; the last three degrade carbendazim in axenic culture.

Concordancia de la tasa de filtración glomerular con depuración de creatinina en orina de 24 horas, fórmulas de Schwartz y Schwartz actualizada / Concordance of glomerular filtration rate with creatinine clearance in 24-hour urine and Schwartz and Schwartz updated

Resumen: Introducción: Los métodos de referencia para cuantificar la tasa de filtración glomerular (TFG) son poco accesibles en la práctica clínica. Para evaluar la TFG se utilizan fórmulas basadas en la creatinina sérica y/o aclaramiento de creatinina. El objetivo de este estudio fue cuantificar la correlación y concordancia de la TFG con depuración de creatinina en orina de 24 horas (TFG24) y fórmulas de Schwartz y Schwartz actualizada. Métodos: Estudio transversal analítico que incluyó pacientes de 5 a 16.9 años, sanos y con enfermedad renal crónica. Se evaluó la relación lineal entre la TFG24 y ambas fórmulas con el coeficiente de correlación de Pearson (r) y la concordancia con el coeficiente de correlación intraclase (CCI). Resultados: Se estudiaron 134 pacientes, 59.7% de género masculino, la edad promedio fue 10.8 años. La TFG24 promedio fue 140.34 ml/min/1.73 m2; el 34.3% (n = 46) presentaron TFG < 90 ml/min/1.73 m2. Se observó moderada relación lineal entre la TFG24 y las fórmulas de Schwartz (r= 0.63) y Schwartz actualizada (r= 0.65). Hubo buena concordancia entre la TFG24 y fórmula de Schwartz (CCI= 0.77) y de Schwartz actualizada (CCI= 0.77). En pacientes con TFG24 ≥ 90 ml/min/1.73 m2 la fórmula de Schwartz clásica estimó valores mayores de TFG, mientras que Schwartz actualizada subestimó los valores. Conclusiones: Existe moderada correlación y buena concordancia entre la TFG24 y fórmulas de Schwartz y Schwartz actualizada. Con ambas fórmulas la concordancia fue mayor en pacientes con obesidad y menor en mujeres, pacientes con hiperfiltración y con peso normal.

Abstract: Background: Reference methods for the quantification of the glomerular filtration rate (GFR) are difficult to use in clinical practice; formulas for evaluating GFR based on serum creatinine (SCr) and/or creatinine clearance are used. The aim of this study was to quantify the correlation and concordance of GFR with creatinine clearance in 24-hour urine (GFR24) and Schwartz and Schwartz updated formulas. Methods: Cross-sectional study involving healthy pediatric patients and with chronic kidney disease (CKD) from 5 to 16.9 years. Linear correlation between GFR 24 and two formulas was evaluated with the Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC). Results: We studied 134 patients, of which 59.7% were male. Mean age was 10.8 years. The average GFR24 was 140.34 ml/min/1.73 m2; 34.3% (n = 46) had GFR <90 ml/min/1.73 m2. Moderate linear correlation between GFR24 and Schwartz (r= 0.63) and Schwartz updated (r= 0.65) formulas was observed. There was good concordance between the GFR24 and Schwartz (ICC= 0.77) and updated Schwartz (ICC= 0.77) formulas. Schwartz classical formula in patients with GFR24 ≥ 90 ml/min/1.73 m2 estimated higher values, while Schwartz updated underestimated values. Conclusions: There is moderate correlation and good concordance between the GFR24 and Schwartz and Schwartz updated formulas. The concordance was better in patients with obesity and lower in women, patients with hyperfiltration and normal weight.

Non-selective ß-blockers in advanced cirrhosis: a critical review of the effects on overall survival and renal function.

INTRODUCTION: Non-selective ß-blockers (NSBBs) are widely prescribed in patients with cirrhosis for primary and secondary prophylaxis of bleeding oesophageal varices. Furthermore, it has been suggested that the clinical benefits of NSBBs may extend beyond their haemodynamic effects. Recently, a potentially harmful effect has been described in patients with refractory ascites or spontaneous bacterial peritonitis. METHODOLOGY: A comprehensive literature search on ß-blockers and cirrhosis survival using the electronic databases PubMed/MEDLINE, AMED, CINAHL and the Cochrane Central Register of Controlled Trials. Full-text manuscripts published over more than 35 years, from 1980 to April 2016 were reviewed for relevance and reference lists were cross-checked for additional pertinent studies regarding potential NSBB effects, especially focused on those concerned with survival and/or acute kidney injury (AKI). DISCUSSION: The proposed review will be able to provide valuable evidence to help decision making in the use of NSBB for the treatment of advanced cirrhosis and highlights some limitations in existing evidence to direct future research.

[Concordance of glomerular filtration rate with creatinine clearance in 24-hour urine and Schwartz and Schwartz updated]. / Concordancia de la tasa de filtración glomerular con depuración de creatinina en orina de 24 horas, fórmulas de Schwartz y Schwartz actualizada.

BACKGROUND: Reference methods for the quantification of the glomerular filtration rate (GFR) are difficult to use in clinical practice; formulas for evaluating GFR based on serum creatinine (SCr) and/or creatinine clearance are used. The aim of this study was to quantify the correlation and concordance of GFR with creatinine clearance in 24-hour urine (GFR24) and Schwartz and Schwartz updated formulas. METHODS: Cross-sectional study involving healthy pediatric patients and with chronic kidney disease (CKD) from 5 to 16.9 years. Linear correlation between GFR 24 and two formulas was evaluated with the Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC). RESULTS: We studied 134 patients, of which 59.7% were male. Mean age was 10.8 years. The average GFR24 was 140.34ml/min/1.73m2; 34.3% (n=46) had GFR <90ml/min/1.73m2. Moderate linear correlation between GFR24 and Schwartz (r= 0.63) and Schwartz updated (r= 0.65) formulas was observed. There was good concordance between the GFR24 and Schwartz (ICC= 0.77) and updated Schwartz (ICC= 0.77) formulas. Schwartz classical formula in patients with GFR24 ≥ 90ml/min/1.73m2 estimated higher values, while Schwartz updated underestimated values. CONCLUSIONS: There is moderate correlation and good concordance between the GFR24 and Schwartz and Schwartz updated formulas. The concordance was better in patients with obesity and lower in women, patients with hyperfiltration and normal weight.

Labour productivity losses caused by premature death associated with hepatitis C in Spain.

BACKGROUND AND AIMS: Hepatitis C virus (HCV) infection places a huge burden on healthcare systems. There is no study assessing the impact of HCV infection on premature deaths in Spain. The aim of this study was to estimate productivity losses because of premature deaths attributable to hepatitis C occurring in Spain during 2007-2011. MATERIALS AND METHODS: We use data from several sources (Registry of Deaths, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human capital approach and to estimate the flows in labour productivity losses in the period considered. The attributable fraction method was used to estimate the numbers of deaths associated with HCV infection. Two sensitivity analyses were developed to test the robustness of the results. RESULTS: Our model shows total productivity losses attributable to HCV infection of 1054.7 million euros over the period analysed. The trend in productivity losses is decreasing over the period. This result is because of improvements in health outcomes, reflected in the reduction of the number of years of potential productive life lost. Of the total estimated losses, 18.6% were because of hepatitis C, 24.6% because of hepatocellular carcinoma, 30.1% because of cirrhosis, 15.9% because of other liver diseases and 10.7% because of HIV-HCV coinfection. CONCLUSION: The results show that premature mortality attributable to hepatitis C involves significant productivity losses. This highlights the need to extend the analysis to consider other social costs and obtain a more complete picture of the actual economic impact of hepatitis C infection.

Modificaciones de conductas alimentarias, hábitos alimentarios y apetito en lactantes con desnutrición / Changes in eating behavior, habits and appetite of infants with malnutrition

Prácticas de alimentación inadecuadas que impidan al niño obtener la calidad y cantidad de alimentos requeridos, pueden propiciar la aparición de desnutrición en los mismos. Este estudio relacionó las conductas y hábitos alimentarios con el apetito en 97 niños menores de dos años con desnutrición primaria que recibieron atención nutricional ambulatoria en el Centro de Atención Nutricional Infantil Antímano durante el período 2000 - 2010. Para ello, se describió la variable apetito y las correspondientes a las categorías conductas alimentarias y hábitos alimentarios, reportadas en historias dietéticas al ingreso y a 3±2 meses de iniciado el tratamiento nutricional de los niños, aplicándose pruebas estadísticas para determinar cambio y asociación entre dichas variables (test de McNemar, Chi-cuadrado y Fisher). Inicialmente, más de la mitad de los niños tenían conductas y hábitos alimentarios inadecuados, algunos asociados significativamente (p-valor <0,050) con el apetito malo o regular (presencia de elementos distractores; horario, lugar y duración de la comida incorrectos; respuesta del cuidador inapropiada; adecuaciones de proteínas, carbohidratos y folato inadecuadas e introducción incorrecta de alimentos complementarios). Luego de 3±2 meses de iniciado el tratamiento nutricional, se observaron cambios significativos (p-valor <0,050) en las conductas alimentarias, el apetito y algunos hábitos alimentarios (adecuación de calcio; frecuencia de consumo de hortalizas, frutas, grasas y misceláneos; tipo de preparaciones; dilución y cantidad de leche completa o fórmula infantil y número de comidas principales diarias). En conclusión, el tratamiento nutricional en niños con desnutrición primaria, modifica conductas y hábitos alimentarios inadecuados asociados con su apetito regular o malo(AU)

TInadequate feeding practices that restrict the child to obtain the required quality and quantity of food, can promote the occurrence of malnutrition in them. This study related behaviors and eating habits with appetite in 97 children under two years with primary malnutrition receiving outpatient nutritional care in the Centro de Atención Nutricional Infantil Antímano during the period 2000 - 2010. In order to achieve this, the following variables were described: appetite and those into the categories of eating behaviors and eating habits, which were reported in the dietary histories at baseline and at 3±2 months after starting the nutritional treatment of the children. Statistical tests were applied to assess changes and the relationship between such variables (McNemar´s, Chi-squared, and Fisher tests). Initially, more than half of the children had inadequate dietary behaviors and habits, some of them had significant association (p-value <0.050) with the poor or fair appetite (presence of distracting elements; incorrect meal schedule, place and duration; improper caregiver response; inadequate protein, carbohydrate, and folate adequacies and the incorrect introduction of complementary foods). After 3±2 months, significant changes (p-value <0.050) were observed in eating behavior, appetite and some eating habits (calcium adequacy; vegetables, fruit, fat, and miscellaneous consumption frequency; types of preparations; dilution and amount of whole milk or formula and number of main meals per day). In conclusion, the nutritional treatment in children with primary malnutrition changes inadequate eating behaviors and habits associated with their poor or fair appetite(AU)

A9 region in EPHB2 mutation is frequent in tumors with microsatellite instability. Analysis of prognosis.

AIM: The aim of the present study was to determine the relation of EPH tyrosine kinase receptor B2 (EPHB2) A9 region mutation and microsatellite instability (MSI); and to analyze their influence in prognosis of patients with sporadic colorectal cancer (CRC). PATIENTS AND METHODS: A total of 481 patients with CRC were examined. MSI (NCI criteria) and EPHB2 were analyzed using PCR and fragment analysis software. RESULTS: EPHB2 mutation was detected in 3.1% of patients. Mutation of EPHB2 was associated with location and with MSI status. We considered low instability (L-MSI) when only one marker showed instability, high instability (H-MSI) when two or more markers were positive and microsatelllite stable (MSS) when no instability was detected. The stratified analysis of overall survival (OS) and disease-free survival (DFS) in MSI according to EPHB2 status revealed no statistically significant differences. However, the risk of recurrence of H-MSI tumors with EPHB2 mutation carriers was 3.6-times higher than in non-mutation carriers. CONCLUSION: The frequency of EPHB2 mutation is higher in patients with H-MSI than MSS tumors. Promising results were found regarding the prognostic influence of EPHB2 in H-MSI.

Factores dietéticos y su relación con el apetito en niños menores de dos años con desnutrición leve

La desnutrición está condicionada por una serie de factores, entre ellos los dietéticos que comprenden apetito, conductas y hábitos alimentarios, lo que planteó el siguiente objetivo: describir los factores dietéticos y su relación con el apetito en niños menores de dos años con desnutrición leve. El estudio fue correlacional, la muestra quedo constituida por todos los niños menores de dos años (n=168) con diagnóstico de desnutrición leve primaria que asistieron a la consulta del Centro de Atención Nutricional Infantil Antímano, CANIA, durante el período 2000-2008. Los resultados señalaron: consumo de energía y macronutrientes inferior al requerimiento individual, consumo de hierro <85% del requerimiento según Recommended Dietary Allowances (RDA) en más del 50% de la niños; la frecuencia de consumo semanal para vegetales (57%) y misceláneos (66%) fue inadecuada; más del 60% tuvo un consumo inadecuado de fórmulas lácteas y leche completa, 9% recibió lactancia materna exclusiva durante los 6 primeros meses de vida; 64% no tuvo lugar fijo para alimentarse; en la interacción del niño con el cuidador durante las comidas más de la mitad de los niños se mostraron rebeldes y los cuidadores permisivos. La adecuación de proteínas, frecuencia de consumo de vegetales y leche completa, tipo de preparación, identificación de rechazos y preferencias, lugar y duración de las comidas, interacción del niño y del cuidador durante la alimentación tuvieron asociación significativa con el apetito; si se considera este ultimo como una guía y se actúa para modificar los hábitos y conductas inadecuadas se generaría un impacto sobre el apetito del niño que pudiera mejorar su ingesta de alimentos y prevenir la desnutrición.

Dietary factors and their relation to appetite in children under two years with mild malnutrition. Malnutrition is conditioned by a series of factors, among them the dietary factors, which include appetite, eating behaviors and habits. In order to assess these factors, the following objective was pursued: describe the dietary factors and their relation to appetite in children under two years of age with mild malnutrition. A correlational study was conducted. The sample consisted of all children under two years of age (n=168) diagnosed with primary (mild) malnutrition, who attended consultation at the Centro de Atención Nutricional Infantil Antímano, CANIA, during the period 2000 - 2008. The results showed: intake of energy and macronutrients was lower than the individual requirement; iron intake <85% of the requirement, in accordance with the Recommended Dietary Allowances (RDA) in over 50% of the sample; weekly consumption of vegetables (57%) and miscellaneous (66%) was inadequate; inadequate intake of formula and whole milk in more than 60%; 9% were exclusively breastfed during the first six months; 64% lacked a regular eating place; in child-caregiver interaction during mealtimes, more than half of the children showed rebellious behavior and caregivers were permissive. Protein adequacy, vegetable and whole milk consumption frequency, preparation type, identification of refusals and preferences, place and duration of meals, and child-caregiver interaction at mealtimes were significantly associated with appetite; if we consider this last one as a guide and we try to modify inadequate eating behaviors and habits, we will generate an impact over the child appetite that could improve the food consumption and prevent malnutrition.