Evaluation of rapid colistin susceptibility directly from positive blood cultures using a flow cytometry assay.

Accurate assessment of colistin susceptibility is crucial with the increasing number of multidrug-resistant Gram-negative bacteria and simultaneously increasing colistin resistance. Both EUCAST and CLSI recommend broth microdilution (BMD) to determine colistin susceptibility, however it is cumbersome and growth-dependent. In this study, a rapid flow cytometry method (FASTinovⓇ) to determine colistin susceptibility directly from positive blood cultures (BCs) was evaluated. BCs were spiked with 204 Gram-negative bacilli (137 Enterobacterales, 35 Pseudomonas spp. and 32 Acinetobacter baumannii) at a concentration of 2 × 103 cells/bottle, inoculated with human donor blood and incubated until flagged positive. As quality control strains, two susceptible (Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853) and two resistant (colistin-resistant mcr-1-positive E. coli NCTC 13846 and Serratia marcescens ATCC 14756) were used. Bacteria were extracted according to assay instructions and were incubated for 1 h at 37 °C with 2 and 4 mg/L colistin and a fluorescent dye, previously optimised. Cells were analysed on CytoFLEX (Beckman Coulter) and AccuriTM C6 Plus (BD Biosciences) flow cytometers. Colistin susceptibility results were automatically provided by BioFAST software (FASTinovⓇ) and compared with those obtained with standard BMD. Overall categorical agreement between this new flow cytometry method and BMD was 99.0%. No very major errors were detected as well as no discrepancies between both flow cytometers. Here we describe a rapid and accurate assay for colistin susceptibility directly from positive BCs with a turnaround time of 2 h versus 48 h required for BMD. This method represents an accurate alternative to standard BMD.

Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease.

AIM: This cross-sectional study evaluated liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), and compared the characteristics of metabolically healthy obese (MHO) with metabolically unhealthy obese (MUHO) patients. METHODS: The study was nested within a randomized clinical trial (RCT) and included obese patients with NAFLD, as determined by liver ultrasonography. Fibrosis was assessed by transient elastography, and AST-to-platelet ratio index (APRI) and NAFLD score. Patients were compared according to obesity phenotype using various accepted criteria. RESULTS: The RCT included 1024 patients with NAFLD, of whom 428 (41.7%) were included in the present study. The prevalence of MHO ranged from 1.2% to 63%, depending on the criteria used. According to various criteria for metabolic health, obese patients had less liver fibrosis. MHO patients, as defined by all criteria, showed a significantly lower prevalence of advanced liver fibrosis (F3-F4) than MUHO on transient elastography (16.5% vs. 28%, respectively; P≤0.05). CONCLUSION: MUHO patients are at higher risk of liver fibrosis and, therefore, the identification of obese patients with 'healthy' characteristics is imperative as their entire clinical work-ups are likely to differ.

Revisão sistemática de pesquisas sobre eficácia coletiva docente / Systematic review on researches about collective teacher efficacy

A eficácia coletiva docente é a percepção compartilhada pelos professores sobre a capacidade do corpodocentede organizar e executar ações necessárias a um efeito positivo no desempenho acadêmico dosalunos. Este artigo tem o objetivo de construir um panorama das pesquisas sobre eficácia coletiva deprofessores, analisando seus principais resultados. Para tanto, foram realizadas buscas de artigospublicados entre 2000 e 201 3, na base de dados Portal de Periódicos Capes. Os resultados indicam que aeficácia coletiva de professores está diretamente relacionada ao desempenho acadêmico dos alunos.Notou-se ainda que outras variáveis podem influenciar as crenças coletivas, tais como a autoeficácia e asituação socioeconômicada escola(AU)

Variáveis agronômicas e químicas e degradabilidade ruminal da cana-de-açúcar / Agronomic and chemical variables and sugarcane ruminal degradability

Objetivou-se avaliar a variabilidade do valor nutritivo entre cultivares de cana-de-açúcar, estimar a correlação entre digestibilidade e produtividade da planta e definir características químicas e agronômicas mais correlacionadas ao valor nutritivo. Vinte cultivares de cana-de-açúcar foram cultivados em delineamento em blocos ao acaso, com quatro repetições, em Campos, RJ, Brasil. As plantas foram colhidas com Brix superior a 18 por cento, a partir de 370 dias do corte da segunda soca. Características agronômicas e químicas e as degradabilidades ruminais in situ da FDN e da MS foram avaliadas. A produtividade foi 21,2±5,7t de MS/ha, e a degradabilidade ruminal da MS (DEG MS) foi 57,1±2,6 por cento do incubado (média±DP). A degradabilidade ruminal da FDN foi 19,8±2,42 por cento do incubado. Nenhuma variável avaliada foi correlacionada à degradabilidade da FDN (P>0,10). Obter cultivares que conciliam alta produtividade com alta DEG MS é viável, pois a correlação tanto fenotípica quanto genética entre esses caracteres foi pequena. A h2 para a DEG MS foi superior a 85 por cento. Variáveis indiretamente correlacionadas à DEG MS tiveram menor h2 que o desta variável. Canas com baixo conteúdo de fibra, com colmos curtos e com alta relação entre colmos e folhas, foram mais digestíveis...

The objective was to evaluate the variability of nutritive value among sugarcane cultivars, to estimate the correlation between plant digestibility and productivity, and to define agronomical and chemical traits most correlated with nutritive value. Twenty sugarcane cultivars were cultivated in a completely randomized block design with four replicates in Campos, RJ, Brazil. Plants were harvested when the Brix was superior to 18 percent, starting at 370 days after the second ratoon cut. Agronomical and chemical traits and the ruminal NDF and DM in situ degradability were evaluated. Productivity was 21.2±5.7t of DM/ha and ruminal DM degradability (DM DEG) was 57.1±2.6 percent of incubated (mean±SD). Ruminal NDF degradability was 19.8±2.42 percent of incubated, and none of the variables evaluated were correlated to the NDF degradability (P>0.10). Obtaining cultivars that conciliate high productivity to high digestibility is feasible, since the phenotypic and the genetic correlation between these traits were low. The estimated h2 for the DM DEG was superior to 85 percent. Variables indirectly correlated to the digestibility had smaller h2 than the one for this variable. Sugarcane with low fiber content, short stalk length and high stalk to leaves ratio were more digestible...

Mitochondrial complex I protein differs among residual feed intake phenotype in beef cattle.

Four experiments were performed to determine if residual feed intake (RFI) was related to mitochondrial complex I (CI) protein. For Exp. 1, crossbred Angus steers (initial BW 270 ± 2.0 kg) were fed for a total of 170 d (n = 72). For Exp. 2, crossbred Braunvieh steers (initial BW 280 ± 3.0 kg) were fed for a total of 150 d (n = 50). For Exp. 3, crossbred Braunvieh heifers (initial BW 260 ± 3.0 kg) were fed for a total of 160 d (n = 40). For Exp. 4, crossbred Angus steers (initial BW 290 ± 3.0 kg) were fed for a total of 160 d (n = 40). All cattle in all experiments were fed the same diet. The variable RFI was calculated as the difference between predicted and actual DMI. Predicted DMI was calculated from regressing intake on ADG and metabolic body weight. Blood was collected, lymphocytes were isolated, and antibody used to capture CI. For Exp. 1, 2, and 3, CI quantity was measured using an ELISA commercial kit (Mitosciences, OR). For Exp. 4, CI subunits were separated by gel electrophoresis and bands were analyzed for differences in concentration (absorbance) among RFI phenotypes. For all 4 experiments, there was a significant difference (P < 0.05) between RFI and DMI but no difference (P > 0.05) was reported for ADG and metabolic midweight. For Exp. 1, 2, and 3, CI concentration in mitochondria was greater (P < 0.05) for low RFI compared with other treatments. For Exp. 4, animals with low RFI had a trend (P = 0.07) for greater concentration of Band I (protein S1) than high RFI. Correlation between RFI and Band I was -0.72 (P = 0.04). We concluded that mitochondrial function was at least in part responsible for differences among animals in metabolic efficiency.

Effect of dietary crude glycerol level on ruminal fermentation in continuous culture and growth performance of beef calves.

Continuous culture and in vivo experiments were conducted to measure changes in ruminal fermentation and animal performance when crude glycerol was added to diets. For the continuous culture experiment (n = 6), diets consisted of 4 levels of crude glycerol (0, 5, 10, and 20%) that replaced corn grain. Dry matter and OM digestibility decreased linearly (P < 0.05) when crude glycerol increased in the diet, and no effect (P = 0.20 and 0.65, respectively) was observed for CP and NDF digestibility. Total VFA concentration and ammonia did not change (P > 0.05) due to crude glycerol level. Microbial efficiency increased quadratically (P = 0.012) as crude glycerol increased, whereas microbial N flow did not differ (P = 0.36) among treatments. As crude glycerol increased in the diet, crude glycerol digestibility decreased (P < 0.05). Seventy-two crossbred steer calves (250 ± 2.0 kg) were assigned to 4 treatments: 0, 5, 10, and 20% crude glycerol that replaced corn grain. Animals were fed for a total of 150 d. No differences (P = 0.08) between treatments were measured for DMI. Average daily gain and GF responded quadratically (P < 0.05), with 10% crude glycerol resulting in the greatest values. In the second in vivo experiment, 100 crossbred steer calves (300 ± 2.0 kg) were assigned to 5 treatments: 0, 5, 10, 12.5, or 15% crude glycerol replaced corn grain. Calves were fed for a total of 135 d. No significant differences (P > 0.05) were measured in growth performance. For Exp. 3, one hundred heifer calves (270 ± 2.0 kg) were assigned to 4 treatments: 0, 5, 10, or 20% crude glycerol that replaced hay. No differences (P > 0.05) were measured in animal performance. We concluded that crude glycerol addition to a diet did not negatively affect ruminal fermentation, and addition of up to 20% in concentrate and hay-based diets should not affect performance or carcass characteristics.

Juice of Bryophyllum pinnatum (Lam.) inhibits oxytocin-induced increase of the intracellular calcium concentration in human myometrial cells.

The use of preparations from Bryophyllum pinnatum in tocolysis is supported by both clinical (retrospective comparative studies) and experimental (using uterus strips) evidence. We studied here the effect of B. pinnatum juice on the response of cultured human myometrial cells to stimulation by oxytocin, a hormone known to be involved in the control of uterine contractions by increasing the intracellular free calcium concentration ([Ca2+]i). In this work, [Ca2+]i was measured online during stimulation of human myometrial cells (hTERT-C3 and M11) with oxytocin, which had been pre-incubated in the absence or in the presence of B. pinnatum juice. Since no functional voltage-gated Ca2+ channels could be detected in these myometrial cells, the effect of B. pinnatum juice was as well studied in SH-SY5Y neuroblastoma cells, which are known to have such channels and can be depolarised with KCl. B. pinnatum juice prevented the oxytocin-induced increase in [Ca2+]i in hTERT-C3 human myometrial cells in a dose-dependent manner, achieving a ca. 80% inhibition at a 2% concentration. Comparable results were obtained with M11 human primary myometrial cells. In hTERT-C3 cells, prevention of the oxytocin-induced increase in [Ca2+]i was independent of the extracellular Ca2+ concentration and of voltage-dependent Ca2+-channels. B. pinnatum juice delayed, but did not prevent the depolarization-induced increase in [Ca2+]i in SH-SY5Y cells. Taken together, the data suggest a specific and concentration-dependent effect of B. pinnatum juice on the oxytocin signalling pathway, which seems to corroborate its use in tocolysis. Such a specific mechanism would explain the rare and minor side-effects in tocolysis with B. pinnatum as well as its high therapeutic index.

Comparison of dairy beef genetics and dietary roughage levels.

The objectives of these trials were to investigate the performance of Jersey steers in relation to Holsteins under current management practices when fed diets differing in energy density and subsequent effects on carcass characteristics. In experiment 1, twelve Jersey and 12 Holstein steers were offered dietary treatments with differing roughage levels. Roughage levels investigated on a dry matter basis were 55% reduced to 25% versus 25% followed by 12.5% (HIGH and LOW, respectively) with all animals receiving the same finishing diet containing 6.5% roughage. Holstein steers were heavier than Jerseys at the initiation of the trial (228 vs. 116 kg). A diet response was observed for gain efficiency during the first period in which LOW was greater than HIGH. Holstein steers had higher dry matter intakes and rates of gain than Jerseys. However, gain efficiency was better for Jersey steers during the first and last periods. Carcass traits were influenced by breed but not diet. Holsteins had heavier hot carcass weights, greater dressing percentages, more backfat, and larger longissimus muscle area, whereas marbling scores were similar to Jerseys. The increased efficiency of Jersey steers and significant reduction in carcass value due to light carcass weights suggested that Jersey steers should be fed to heavier live weights. Experiment 2 utilized 85 steers to investigate continuous feeding of a low-roughage, high-concentrate diet versus a phase-feeding strategy. Jersey (n = 40) and Holstein (n = 45) steers were assigned to a diet containing 20% corn silage on a dry matter basis (HEN) or a phase-feeding program (PHASE) in which corn silage was reduced from 60 to 40% followed by the same diet as HEN. Initial body weights were similar for dietary treatments but differed by breed. A diet response was observed for live weight at the end of the first and second period, first period average daily gain (ADG), overall ADG, and days on feed with HEN having higher ADG than PHASE and fewer days on feed. Breed affected all body weight and gain variables with Holsteins being heavier and gaining more rapidly than Jersey steers. Jersey carcasses were lighter, had the highest percentage trim loss, least amount of backfat, and lowest numerical yield grade. Holstein steers had a greater propensity for gain, whereas the Jersey steers were equally or more efficient. These findings suggest that phase feeding Jersey steers higher-roughage diets has minimal effect on carcass traits.

Changes in the clonal nature and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus isolates associated with spread of the EMRSA-15 clone in a tertiary care Portuguese hospital.

Two hundred eighty methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates recovered from a tertiary care hospital in Oporto, Portugal, between 2003 and 2005 were studied by a combination of molecular typing techniques in order to investigate the genetic backgrounds associated with the changes in the resistance phenotypes observed since 2001 and compare them to those previously found in the hospital. All MRSA isolates were grouped into resistance profiles for a panel of seven antibiotics and characterized by pulsed-field gel electrophoresis (PFGE) and SCCmec (staphylococcal cassette chromosome mec) typing. Representative isolates of PFGE types were further studied by spa typing and multilocus sequence typing. Our findings clearly document that the increasing isolation of nonmultiresistant MRSA strains was associated with the decline (from 69% in 1996 to 2000 to 12% in 2003 to 2005) and massive replacement of the multiresistant Brazilian clone (ST239-IIIA) by the epidemic EMRSA-15 clone (ST22-IV), in which resistance to antibiotics other than beta-lactams is very rare, as the major clone (80% of isolates). The Iberian clone (ST247-IA), a major clone in 1992 to 1993, was represented in the present study by just one isolate. Two other pandemic MRSA clones were detected, as sporadic isolates, for the first time in our hospital: the New York/Japan (ST5-II) and the EMRSA-16 (ST36-II) clones. Furthermore, the pattern of susceptibility of MRSA isolates both to gentamicin and to trimethoprim-sulfamethoxazole was shown to be an excellent phenotypic marker for the discrimination of the EMRSA-15 clone from other nonmultiresistant MRSA clones present in our hospital.

Supplemental choline for prevention and alleviation of fatty liver in dairy cattle.

Two experiments were conducted to evaluate if supplementing rumen-protected choline (RPC; Reashure, Balchem Encapsulates, Slate Hill, NY) could prevent or alleviate fatty liver in dairy cattle. The first experiment evaluated the effect of supplementing RPC on hepatic triacylglycerol (TAG) accumulation during fatty liver induction. Twenty-four dry cows between 45 to 60 d prepartum were paired by body weight (BW) and body condition score (BCS) and randomly assigned to control or supplementation with 15 g of choline as RPC/d. From d 0 to 6, before treatment application, all cows were fed 1.4 kg/d of concentrate and forage ad libitum. Samples of blood and liver, obtained during the pretreatment period, were used for covariate adjustment of blood metabolites and liver composition data. During fatty liver induction (d 7 to 17), cows were fed 1.4 kg/d of concentrate with or without supplementation with RPC, and forage intake was restricted, so cows consumed 30% of the total energy requirements for pregnancy and maintenance. Supplementation with RPC during fatty liver induction did not affect plasma glucose and plasma beta-hydroxybutyrate (BHBA) concentration but did decrease plasma nonesterified fatty acid (NEFA; 703 vs. 562 microEq/L, SE = 40) and liver TAG accumulation (16.7 vs. 9.3 microg/microg of DNA, SE = 2.0). In the second experiment, we evaluated the effect of supplementing RPC on the clearance of liver TAG when cows were fed ad libitum after the induction of fatty liver by feed restriction. Twenty-eight cows between 45 and 60 d prepartum were paired according to BCS and BW and assigned to treatments. Fatty liver was induced by feeding 1.4 kg/d of concentrate (without RPC) and restricting forage intake, so cows consumed 30% of maintenance and pregnancy energy requirements for 10 d. From d 11 to 16, after feed restriction, cows were fed forage ad libitum and 1.4 kg/d of concentrate with or without RPC. Treatments were not applied during fatty liver induction; however, following feed restriction, liver for cows assigned to control and RPC treatments contained 6.8 and 12.7 microg of TAG/microg of DNA, respectively. Measurements obtained before treatment served as covariates for statistical analysis. During the depletion phase, plasma glucose, BHBA, and NEFA were not affected by treatment. Liver TAG, expressed as covariate adjusted means, was 6.0 and 4.9 microg/microg of DNA (SE = 0.4) on d 13, and 5.0 and 1.5 microg/microg of DNA (SE = 0.9) on d 16 for control and RPC, respectively. Rumen-protected choline can prevent and possibly alleviate fatty liver induced by feed restriction.

From point to areal rainfall: linking the different approaches for the frequency characterisation of rainfalls in urban areas.

In urban water design and management, many hydrologic problems involve the frequency characterisation of rainfalls. Hydrologists are commonly asked to evaluate rainfall intensities for given recurrence frequencies or to indicate how rare an observed event is by estimating its return period. This study aims to improve the characterisation of rainfall hazard over a city by linking point to areal rainfall frequency analysis. We use a stochastic rainfall field generator based on the turning-bands method directly to assess areal rainfall distributions and to illustrate the link between different approaches. The simulating algorithm is applied to rainfall data from the city of Marseilles. The frequency analysis of simulated fields provides the elements to deal with the notions of return period and severity of observed storm events. The study concludes on the importance of a unified approach to assess rainfall better.

Effectiveness of arm supports during typing for adults with neurological disorders.

Four computer-typing accommodations were evaluated to determine if arm supports would enhance typing performance and/or comfort of adults with neurological disorders. Each of 12 adults (6 females and 6 males) participated in 7-min typing tasks under the following conditions: 1) without arm support, 2) Ergo Rest arm support, 3) custom arm support in fixed mode, and 4) custom arm support with movable mode. The objective dependent variables were speed, errors, and type of errors. The subjective dependent measures were reported body part discomfort, and arm support ratings. The data were found to be nonparametric in nature. Therefore, nonparametric techniques were employed to analyze the data. Only one of the objective dependent measures were statistically significant; Type of error (additional key). This result may be attributed to the wide range of disability manifestations among participants. Subjective dependent measures were found to be statistically significant, leading to the conclusion that typing with an arm support was more comfortable and easier than without an arm support.

Risk factors for gallstone disease in Mexicans are similar to those found in Mexican-Americans.

According to epidemiological studies, gallstone disease is a very common disease in Mexican-Americans and Mexicans. However, the major risk factors for cholelithiasis in Mexicans have not been identified. We designed a case-control study in a group of Mexican subjects with and without gallstone disease confirmed by ultrasound. These subjects were prospectively studied over a three-year period. Clinical and epidemiological data were collected by means of a questionnaire. A total of 1500 subjects were included in this study: 1000 with and 500 without gallstone disease. The major risk factor in both men and women was body mass index [odds ratio (OR) 1.64 and 1.96, respectively; P < 0.008 and 0.001]. In addition, parity was an important factor in women (OR 2.17, P < 0.001), whereas age was associated with gallstone disease in men (OR 1.43, P < 0.001). We found that body mass index, parity, and age were the principal risk factors for gallstone disease in this group of Mexican subjects. These results are similar to those found in Mexican-American populations.

[Multicenter study of isolated micro-organisms resistant to antimicrobials in 10 Portuguese hospitals in 1994]. / Estudo multicêntrico de microrganismos isolados e de resistência aos antimicrobianos em dez hospitais Portugueses em 1994.

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.

[Vegetable protein diets with or without non-absorbable antibiotics for the treatment of chronic portal systemic encephalopathy]. / Son necesarios los antibioticos inabsorbibles en pacientes con encefalopatía hepática manejados con dieta de proteínas vegetales?

Five patients with mild chronic portal systemic encephalopathy (PSE) were studied. The study was designed in a double cross over fashion in which each patient received during period I a 40 g vegetable protein diet as single treatment. During period II three g/day of oral kanamycin were added and then new periods of single vegetable protein diet (period III) and vegetable protein diet plus kanamycin (period IV) were introduced (identical to periods I and II respectively). Each period lasted two weeks. Several biweekly assessements-tests were determined including: mental state, asterixis grade, electroencephalograms, number connection tests, figure connection tests, blood ammonia levels and stool counts of total aerobes/anaerobes per g/feces were done. During the study none of the patients developed acute encephalopathy. In any case it was detected a significant improvement of the PSE parameters assessed with the addition of oral kanamycin. Fecal counts were very similar during the various periods of the study. We conclude that in mild portal systemic encephalopathy controlled with vegetable protein diet, the addition of non absorbable antibiotics is not mandatory for the management of these patients and may represent a potential risk of serious side effects. At the beginning of treatment vegetable protein diet should be administered and only in case of failure, antibiotics are to be indicated.

Corticoesteroides e higado. Metabolismo e indicaciones en padecimientos hepaticos. / Corticosteroids and the liver. Metabolism and indications in hepatic diseases

Los corticoesteroides son medicamentos de muy frecuente prescripcion clinica, entre los corticoesteroides, prednisona y prednisolona son los mas frecuentemente usados en el tratamiento de enfermedades hepaticas. Las concentraciones sericas, asi como la equivalencia farmacologica de prednisona y prednisolona se han estudiado recientemente gracias al empleo del radioinmunoensayo, que permite detectar cantidades muy pequenas de esteroides en sangre.Prednisona se absorbe rapidamente y se convierte en el higado a prednisolona que es su 11 Beta derivado, biologicamente activo. Las concentraciones sericas de prednisolona, despues de administrar prednisona por via oral o por via intravenosa son muy semejantes, tanto en sujetos sanos como en pacientes con hepatitis cronica activa. Cuando se ingiere prednisona simultaneamente con alimento, se observa un retraso en la aparicion de prednisolona, pero no se modifica el resto de parametros farmacodinamicos. La administracion de antiacidos reduce hasta en un 45% los niveles de prednisolona despues de la ingestion de prednisona. En pacientes con hepatitis viral aguda, hepatitis cronica persistente, hepatitis alcoholica o cirrosis biliar primaria, no se ha demostrado que los corticoides produzcan un efecto benefico. En pacientes con hepatitis cronica activa los corticoesteroides inducen respuesta terapeutica hasta en el 70-80% de los casos