Biophysical investigation of liposome systems decorated with bioconjugated copolymers in the presence of amantadine.

Liposome-based technologies derived from lipids and polymers (e.g., PEGylated liposomes) have been recognized because of their applications in nanomedicine. However, since such systems represent myriad challenges and may promote immune responses, investigation of new biomaterials is mandatory. Here, we report on a biophysical investigation of liposomes decorated with bioconjugated copolymers in the presence (or absence) of amantadine (an antiviral medication). First, copolymers of poly(N,N-dimethylacrylamide-co-fluoresceinacrylate-co-acrylic acid-N-succinimide ester)-block-poly(N-isopropylacrylamide) (PDMA-b-PNIPAM) containing a fluorescence label were biofunctionalized with short peptides that resemble the sequence of the loops 220 and 130 of the binding receptor of the hemagglutinin (HA) protein of the influenza A virus. Then, the bioconjugated copolymers were self-assembled along with liposomes composed of 1,2 dimyristoyl-sn-glycero-3-phosphocholine, sphingomyelin, and cholesterol (MSC). These biohybrid systems, with and without amantadine, were systematically characterized using differential scanning calorimetry (DSC), dynamic light scattering (DLS), and cryogenic transmission electron microscopy (cryoTEM). Finally, the systems were tested in an in vitro study to evaluate cytotoxicity and direct immunofluorescence in Madin Darbin Canine Kidney (MDCK) cells. The biohybrid systems displayed long-term stability, thermo-responsiveness, hydrophilic-hydrophobic features, and fluorescence properties and were presumable endowed with cell targeting properties intrinsically integrated into the amino acid sequences of the utilized peptides, which indeed turn them into promising nanodevices for biomedical applications.

Preventive Detection of Driver Drowsiness from EEG Signals using Fuzzy Expert Systems / Detección Preventiva de la Somnolencia del Conductor a partir de Señales EEG Mediante Sistemas Expertos Difusos

Abstract Currently, the percentage of traffic accidents has increased, and according to statistics, this percentage will continue to increase every year, so it is necessary to develop new technologies to prevent this kind of accidents. This paper presents a drowsiness detection system based on electroencephalogram (EEG) signals using a pair of channels (Fp1 and Fp2) applied to drivers before entering their vehicles. First, this model detects the relationship between the area under the curve (AUC) of alpha brain waves, an effective parameter for detecting drowsiness. Then, the extracted information is passed to a fuzzy expert system (FES) that classifies the subject's state as "alert" or "sleepy"; the criterion used was a threshold and training with subjective levels. The proposed system was compared with neural network models, such as support vector machine (SVM), K nearest neighbors (KNN), and random forest (RF). Measurements of one hundred and twenty minutes were performed on each of the ten drivers for two days to test the system. The tests confirm that this system is suitable for preventive measures and that the fuzzy system is superior to traditional neural network methods.

Resumen Actualmente, el porcentaje de accidentes de tráfico ha aumentado, y según las estadísticas, este porcentaje seguirá aumentando cada año, por lo que es necesario desarrollar nuevas tecnologías para prevenir este tipo de accidentes. Este trabajo presenta un sistema de detección de somnolencia basado en señales de electroencefalograma (EEG) utilizando un par de canales (Fp1 y Fp2) aplicado a los conductores antes de entrar en sus vehículos. En primer lugar, este modelo detecta la relación entre el área bajo la curva (AUC) de las ondas cerebrales alfa, un parámetro eficaz para detectar la somnolencia. A continuación, la información extraída se pasa a un sistema experto difuso (FES) que clasifica el estado del sujeto como "alerta" o "somnoliento"; el criterio utilizado fue un umbral y el entrenamiento con niveles subjetivos. El sistema propuesto se comparó con modelos de redes neuronales, como la máquina de vectores de soporte (SVM), K vecinos más cercanos (KNN) y el bosque aleatorio (RF). Se realizaron mediciones de ciento veinte minutos en cada uno de los diez conductores durante dos días para probar el sistema. Las pruebas confirman que este sistema es adecuado para las medidas preventivas y que el sistema difuso es superior a los métodos tradicionales de redes neuronales.

Stereotactic body radiation therapy for kidney cancer. Where do we stand?

At present, surgery is still the gold standard for the local treatment of renal cancer. Nonetheless, in several clinical scenarios, stereotactic body radiation therapy (SBRT) also known as stereotactic ablative body radiotherapy (SABR) is emerging as a highly effective ablative technique in fragile patients and those with significant comorbidities, as well as in cases where percutaneous therapy (cryoablation or radiofrequency) is not viable. However, considering the intrinsic radioresistance of renal tumors, the optimal treatment schemes have not been established. In oligometastatic patients, it has been reported that the control of the oligometastases can be a potentially curable approach. Being a technique than can be administered exclusively or in combination with systemic therapy, treatment individualization based on patient characteristics is key. Another scenario under investigation is oligoprogression, where SBRT offers the possibility of delaying further lines of systemic therapy by eliminating subclones of resistant tumor with ablative doses, with the additional opportunity of stimulating the immune system (immunomodulatory role). In this review, we have conducted an analysis of recently published studies that test the role of this technique in different clinical scenarios of this disease. We have found promising results that make SBRT a potent therapeutic approach with low toxicity. We also comment on ongoing studies that will generate the necessary evidence needed for the implementation of this technique in our daily clinical practice.

An International Consensus on the Design of Prospective Clinical-Translational Trials in Spatially Fractionated Radiation Therapy for Advanced Gynecologic Cancer.

Despite the unexpectedly high tumor responses and limited treatment-related toxicities observed with SFRT, prospective multi-institutional clinical trials of SFRT are still lacking. High variability of SFRT technologies and methods, unfamiliar complex dose and prescription concepts for heterogeneous dose and uncertainty regarding systemic therapies present major obstacles towards clinical trial development. To address these challenges, the consensus guideline reported here aimed at facilitating trial development and feasibility through a priori harmonization of treatment approach and the full range of clinical trial design parameters for SFRT trials in gynecologic cancer. Gynecologic cancers were evaluated for the status of SFRT pilot experience. A multi-disciplinary SFRT expert panel for gynecologic cancer was established to develop the consensus through formal panel review/discussions, appropriateness rank voting and public comment solicitation/review. The trial design parameters included eligibility/exclusions, endpoints, SFRT technology/technique, dose/dosimetric parameters, systemic therapies, patient evaluations, and embedded translational science. Cervical cancer was determined as the most suitable gynecologic tumor for an SFRT trial. Consensus emphasized standardization of SFRT dosimetry/physics parameters, biologic dose modeling, and specimen collection for translational/biological endpoints, which may be uniquely feasible in cervical cancer. Incorporation of brachytherapy into the SFRT regimen requires additional pre-trial pilot investigations. Specific consensus recommendations are presented and discussed.

Approaches to the Mechanical Properties of Threaded Studs Welded to RHS Columns.

The use of Rectangular Hollow Sections (RHS) as columns in steel construction includes important advantages like higher mechanical strength and fire resistance. However, the practical demountable bolted joints between beams and columns are not easy to execute, due to impossibility of access to the inner part of the tube. The use of threaded studs welded to the face of the tube and bolted to the beam by means of angle cleats is one of the cheaper and most efficient solutions to obtain beam-column joints with a semi-rigid behavior, as is usually sought in building structures. Nevertheless, it is important to point out that the stud-diameter and the stud-class selection may affect the mechanical properties of the welded parts of the joint. In this paper, 8MnSi7 (with a commercial designation K800) and 4.8 threaded studs were welded to RHS steel tubes and mechanical properties on the weld, the Heat Affected Zones (HAZ), and the base metal were obtained in two different ways: through a correlation with the Vickers hardness and by means of the Small Punch Test (SPT). A study of the microstructure and tensile tests on the threaded studs and in the columns was also carried out. The research involved different types of stud qualities, tube wall thicknesses, and stud diameters. The work presented in this paper proved that in most cases, the welded joint between these studs and the RHS steel tubes present a reasonable static behavior that fulfils the requirements for the beam-column joints under static loading.

Ca2+-mediated enhancement of anesthetic diffusion across phospholipid multilamellar systems.

Although sharing common properties with other divalent cations, calcium ions induce fine-tuned electrostatic effects essential in many biological processes. Not only related with protein structure or ion channels, calcium is also determinant for other biomolecules such as lipids or even drugs. Cellular membranes are the first interaction barriers for drugs. Depending on their hydrophilic, hydrophobic or amphipathic properties, they have to overcome such barriers to permeate and diffuse through inner lipid bilayers, cells or even tissues. In this context, the role of calcium in the permeation of cationic amphiphilic drugs (CADs) through lipid membranes is not well understood. We combine differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR) to investigate the effect of Ca2+ on the interlamellar diffusion kinetics of the local anesthetic tetracaine (TTC) in multilamellar artificial membrane systems. Our DSC results show the interesting phenomenon that TTC diffusion can be modified in two different ways in the presence of Ca2+. Furthermore, TTC diffusion exhibits a thermal-dependent membrane interaction in the presence of Ca2+. The FTIR results suggest the presence of ion-dipole interactions between Ca2+ and the carbonyl group of TTC, leading us to hypothesize that Ca2+ destabilizes the hydration shell of TTC, which in turn diffuses deeper into the multilamellar lipid structures. Our results demonstrate the relevance of the Ca2+ ion in the drug permeation and diffusion through lipid bilayers.

Leveraging the Coffee Ring Effect for a Defect-Free Electroformation of Giant Unilamellar Vesicles.

We took advantage of the microflow hydrodynamics in the evaporation of sessile droplets to increase the height uniformity of thin lipid films for the subsequent electroformation of defect-free giant unilamellar vesicles (GUV). By serially casting progressively larger liposome suspension droplets on the same spot of an indium-tin-oxide (ITO) electrode, we managed to leverage the coffee ring effect (CRE) in the evaporation of each droplet to generate a smeared multilayer film of uniform thickness. This multidroplet technique of lipid film formation outperformed the traditional single-droplet deposition, improving the final quality of electroformed GUV samples. The proposed film formation technique constitutes a solvent-free method that results in a dramatic reduction (∼20×) in the appearance of undesirable structures like nonspherical (NSV), multilamellar (MLV), and multivesicular (MVV) vesicles.

Comportamiento del cáncer colorrectal diagnosticado por colonoscopia en el Hospital Militar "Mario Muñoz Monroy". Matanzas / Behavior of the colorectal cancer diagnosed by colonoscopy in the hospital military "Mario Muñoz Monroy". Matanzas

RESUMEN Introducción: el cáncer colorrectal constituye un serio problema de salud por su alta incidencia. Es una entidad que afecta significativamente a la humanidad y conlleva a una alta mortalidad. Objetivo: determinar el comportamiento de los pacientes con cáncer colorrectal diagnosticado por colonoscopia en el Hospital Militar "Mario Muñoz", Matanzas. Materiales y Métodos: se realizó un estudio observacional, descriptivo y prospectivo en pacientes con sangre oculta en heces fecales y diagnóstico colonoscópico de cáncer colorrectal, desde enero del 2015 a noviembre del 2018. El universo quedó conformado por 135 pacientes que cumplieron con los criterios de selección. Se estudiaron variables como: grupo etario, sexo, factores de riesgo, síntomas y signos, localización y estadio. Se utilizó una planilla de recolección de datos. Se emplearon métodos de estadística descriptiva y los resultados fueron presentados en tablas. Resultados: en 722 colonoscopias realizadas a pacientes con sangre oculta positiva, en el 18.7 % se diagnosticó cáncer colorrectal. Predominó el grupo etario de 61-70 años con un 30.4 % de los pacientes y el sexo masculino (41.4%). Los factores de riesgos más frecuentes) fueron: dieta inadecuada (46.6%), sedentarismo (25.2%) y enfermedad inflamatoria intestinal (29.6%). Los síntomas más frecuentes fueron: diarrea (45.9%), dolor abdominal (31.1%) y dispepsia (25.2%). La localización que predominó fue el recto (24.4%), seguido del colon ascendente (22.2%). Predominaron los pacientes en un estadio II con 42.2%. Conclusiones: el cáncer colorrectal se presentó con mayor frecuencia en pacientes de la 6ta década de vida tal como se reporta en la literatura, asociado a malos hábitos dietéticos e inadecuado modo y estilo de vida que pueden ser modificados a través de estrategias educativas que garanticen la salud de la población (AU).

SUMMARY Introduction: Colorectal cancer [cancer colorectal (CCR) in Spanish] is a serious health problem due to its high incidence. It is an entity affecting the human kind and producing a high mortality. Objective: to determine the behavior of the colorectal cancer diagnosed by colonoscopy in the Military Hospital "Mario Muñoz", Matanzas. Material and methods: a prospective, descriptive, observational study was carried out in patients with hidden blood in fecal feces and colonoscopic diagnosis of colorectal cancer from January 2015 to November 2018. The universe was formed by 135 patients who fulfilled the selection criteria. The studied variables were age group, gender, risk factors, symptoms, locations and stage. A form was used for collecting data. Methods of descriptive statistics were used and the results are showed in charts. Results: In 722 colonoscopies carried out to patients with positive hidden blood, 18.7 % was diagnosed as colorectal cancer. The 61-70 years-old age group (30.4 %) and male gender (41.4 %) predominated. The most frequent risk factors were improper diet (46.6 %), sedentary life style (25.2 %), and inflammatory intestinal disease (29.6 %). The most frequent symptoms were diarrhea (45.9 %), abdominal pain (31.1 %) and dyspepsia (25.2 %). The predominant location was the rectum (24.4 %), followed by ascending colon (22.2 %). Stage II patients predominated, with 42.2 %. Conclusions: colorectal cancer appeared more frequently in patients in their sixth decade of life as it is reported in the literature, associated to bad dietary habits and to an inadequate style and way of life that could be modified through educative strategies warranting the population's health (AU).

Dehydration/Rehydration Cycles for Mixing Phospholipids without the Use of Organic Solvents.

An environmentally friendly and straightforward dehydration/rehydration method for glycerophospholipid mixing that avoids the use of organic solvents, cosolvents, or additives was developed. We prepared binary mixtures of zwitterionic and anionic glycerophospholipids using only deionized water in the entire mixing process. The resulting lipid films were subsequently reconstituted in vesicular form and compared to controls using differential scanning calorimetry. The calorimetric scans revealed no significant differences between mixing methods for any of the studied cases. These findings suggest that the developed dehydration/rehydration procedure creates a sample with equivalent compositional uniformity than the conventional solvent evaporation technique.

Improved outcome of treating locally advanced lung cancer with the use of Lattice Radiotherapy (LRT): A case report.

The Lattice Radiotherapy (LRT) technique is mainly based on the GRID technology with the improved feature of the 3D treatment delivery. A 72 year old male presented with left shoulder pain due to a 6 cm pulmonary mass in the left upper lobe (LUL) histologically proven Non-Small Cell Lung Cancer (NSCLC) stage IIIA. In July 2011 he was treated in our center with LRT followed by conventional fractionated Volumetric Modulated Arc Therapy (VMAT) combined with chemotherapy. Clinical and imaging follow up of 6 years demonstrated continued improvement and the patient is currently with no evidence of disease (NED). This outstanding result obtained in our first lung cancer patient treated with this approach corroborates its potential in the treatment of locally advanced lung cancer. In a period of 7 years we have treated more than 30 patients with LRT for different diagnosis and sites; 12 of them NSCLC patients, with markedly improved local control and minimal toxicity.

The Influence of the Heat-Affected Zone Mechanical Properties on the Behaviour of the Welding in Transverse Plate-to-Tube Joints.

Eurocode 3 establishes the component method to analytically characterize the structural joints between beam and columns. When one of the members involved in the joint is a hollow section (i.e., a tube) there is a lack of information for the specific components present in the joint. There are two different ways to bridge the gap: experimental testing on the actual beam column joints involving tubular sections; or numerical modelization, typically by means of finite element analysis. For this second option, it is necessary to know the actual mechanical properties of the material. As long as the joint implies a welding process, there is a concern related to how the mechanical properties in the heat-affected zone (HAZ) influence the behavior of the joint. In this work, some coupons were extracted from the HAZ of the beam-column joint. The coupons were tested and the results were implemented in the numerical model of the joint, in an attempt to bring it closer to the experimental results of the tested joints.

Simplified Models for the Material Characterization of Cold-Formed RHS.

It is well known that the cold-forming process used to manufacture tubes causes an increase in both the yielding stress and the ultimate strength of the corner material in rectangular steel hollow sections. This may have a significant effect on the resistance of any structure built with those profiles. However, the mentioned material hardening can be difficult to take into account in the calculations for member design or to evaluate the connection resistance through the design formulation or when using numerical simulation models. As an attempt to face the above-mentioned problem, the present paper presents a comparison among simplified approaches that consider homogeneous material properties for the whole section. It has been carried out by comparing the results obtained from the finite element modelling of stub column tests in which the material properties based on the flat faces were considered for the whole profile.

Hernia paraesofágica con vólvulo gástrico / Paraesophageal hernia with gastric volvulus

La hernia hiatal tipo IV es la más rara. Se puede reparar por vía abdominal o torácica y por la cirugía laparoscópica mínimo invasiva. Paciente de 67 años de edad, de sexo femenino, que presentaba desde hace más menos 5 meses cuadros de vómitos postprandiales inmediatos con repercusión en el estado nutricional, llega con deshidratación ligera al servicio de urgencias, se realiza panendoscopia digestiva superior de urgencia diagnosticándose una hernia paraesofágica con el estómago intratorácico, se complementó el estudio con una serie esófago-gastroduodenal corroborando el diagnóstico de vólvulo gástrico órgano-axial. Se discute el caso en colectivo y se decide su corrección quirúrgica por vía laparoscópica con evolución satisfactoria(AU)

The hiatal hernia type IV is the weirdest. It can be treated abdominal or thooracic via using lowest invasive laparoscopic surgery. 67 years old patient, famela, who was suffring from postprandial vomiting, affecting her nutritional condition.Patient gets to emergency suffering from light dehydration. An upper digestive panendoscopy is done.Diagnosis: Paraesophageal hernia in intrathoracic stomach the medical examinationwas complemented with a esophagus - gastorduodenal study, assuring the gastric volvulus axial- organ diagnosis. The case is analyzed by medical team and patient was treather surgically through laparoscopic surgery. Patient improved satisfactorily(AU)

Local failure after primary radiotherapy in lung cancer: Is there a role for SBRT?

AIM: Our purpose is to construe the role of stereotactic body radiation therapy (SBRT) in the management of lung cancer from our early experience with SBRT for salvage treatment in patients with recurrent lung cancer after initial radiation therapy. BACKGROUND: Locoregional recurrences are a frequent challenge in patients treated with radio-chemotherapy for locally advanced NSCLC. Conventional external beam radiation therapy (EBRT) is rarely given as salvage treatment because of the risk of toxicity. There is a paucity of published studies evaluating the role of SBRT in this clinical setting. MATERIALS AND METHODS: Between 2008 and present, 10 patients with biopsy proven non-small cell lung cancer (NSCLC) underwent 14 radiosurgical procedures for salvage therapy after failing initial radiation treatment. Patients' age ranged from 54 to 88 years with a median of 74 years in 6 males and 4 females. Intervals from initial radiation treatment to salvage SBRT were 3-33 months with a median of 13 months. SBRT treatments were delivered using Intensity Modulated Volumetric Arc Therapy (VMAT). All patients received concomitant chemotherapy. RESULTS: Overall survival after salvage radiosurgery ranged from 6 to 41 months (mean 20 months, median 18 months). Four of the ten patients are alive with disease locally controlled. Of the remaining 6 patients, 4 had distant progression of disease with brain metastases and one had both brain and lung metastases. The other patient had a regional failure. Toxicities were found in three of the ten (30%) patients with grade I pneumonitis. CONCLUSION: In our early experience, salvage SBRT is an effective modality of treating patients who failed after conventional irradiation, achieving excellent results in terms of local control with acceptable toxicity. Further prospective studies are needed to determine optimal fractionation schemes.

The Use of Lattice Radiation Therapy (LRT) in the Treatment of Bulky Tumors: A Case Report of a Large Metastatic Mixed Mullerian Ovarian Tumor.

The objective of this teaching case is to report the excellent results of using lattice radiation therapy (LTR) for the treatment of a large metastasis from ovarian carcinosarcoma. This new technical concept extrapolates the traditional spatially fractionated radiation therapy (GRID) technique to advanced three-dimensional (3D) high-dose radiation therapy using modern instrumentation in radiation oncology. We report a case of a 61-year-old female with a large metastatic mass from ovarian carcinosarcoma treated by this procedure with excellent clinical and image-based follow-up results for more than four years.

The influence of non polar and polar molecules in mouse motile cells membranes and pure lipid bilayers.

We report an experimental study of mouse sperm motility that shows chief aspects characteristic of neurons: the anesthetic (produced by tetracaine) and excitatory (produced by either caffeine or calcium) effects and their antagonic action. While tetracaine inhibits sperm motility and caffeine has an excitatory action, the combination of these two substances balance the effects, producing a motility quite similar to that of control cells. We also study the effects of these agents (anesthetic and excitatory) on the melting points of pure lipid liposomes constituted by 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and dipalmitoyl phosphatidic acid (DPPA). Tetracaine induces a large fluidization of the membrane, shifting the liposomes melting transition temperature to much lower values. The effect of caffeine is null, but its addition to tetracaine-doped liposomes greatly screen the fluidization effect. A high calcium concentration stiffens pure lipid membranes and strongly reduces the effect of tetracaine. Molecular Dynamics Simulations are performed to further understand our experimental findings at the molecular level. We find a strong correlation between the effect of antagonic molecules that could explain how the mechanical properties suitable for normal cell functioning are affected and recovered.

White-nosed coatis (Nasua narica) are a potential reservoir of Trypanosoma cruzi and other potentially zoonotic pathogens in Monteverde, Costa Rica.

We studied white-nosed coatis (Nasua narica) in Monteverde, Costa Rica to evaluate their potential as a reservoir for the vector-borne zoonotic parasite Trypanosoma cruzi and other selected microorganisms. We live-trapped 20 coatis in July and August 2011 and tested them for T. cruzi by blood smear, molecular analysis of blood, culture of blood and anal gland secretions, and serology. Seven coatis (35%) were polymerase-chain-reaction-positive for T. cruzi and one coati was also culture positive. We did not detect T. cruzi in anal gland secretions. All coatis were positive for Mycoplasma and Babesia, but were negative for Baylisascaris, Anaplasma, Candidatus Neoehrlichia lotoris, Ehrlichia, Bartonella, and several apicomplexan parasites. The possible pathogenicity of T. cruzi, Babesia, and Mycoplasma in coatis and their transmission potential to humans and domestic animals warrants further investigation.

Caracterización clínica de pacientes con cirrosis hepática en el Hospital Militar Docente Dr. Mario Muñoz, de Matanzas / Clinical characterization of patients with liver cirrhosis in the Teaching Military Hospital Dr. Mario Muñoz, Matanzas

Introducción: la cirrosis hepática se caracteriza por una fase asintomática o compensada, seguida de una rápida progresión por el desarrollo de complicaciones o descompensada, lo que determina diferentes estadios evolutivos. Objetivo: caracterizar los pacientes cirróticos atendidos en el Servicio de Gastroenterología del Hospital Militar Docente Dr. Mario Muñoz Monroy, en el período comprendido entre enero de 2009 a diciembre de 2010. Métodos: se realizó un estudio descriptivo transversal. Se tuvieron en cuenta variables clínicas necesarias para clasificar los pacientes según las etapas contempladas en el consenso de Baveno IV. Se aplicaron procedimientos de la estadística descriptiva. Resultados: se estudiaron 41 pacientes, con predominio de masculinos (82,9 %), con edad promedio de 51,9 ± 9,2 años. La astenia fue el principal motivo de consulta en la fase compensada; los pacientes presentaron una enfermedad compensada en su gran mayoría, de acuerdo al estadio clínico de la enfermedad según criterios de Baveno IV Consenso Metodológico sobre Diagnóstico y Tratamiento de la Hipertensión Portal (56,1 %). Conclusiones: con la aplicación de los criterios del consenso de Baveno IV se logra la adecuada clasificación clínica del paciente cirrótico que permite una terapéutica oportuna en beneficio de estos.

Introduction: liver cirrhosis is characterized by an asymptomatic or compensated stage, followed by a fast progression for the development of complications or decompensated stage, determining different evolutionary stages. Objective: characterizing cirrhotic patients attended at the Gastroenterology Service of the Teaching Military Hospital Dr. Mario Muñoz Monroy, in the period from January 2009 to December 2010. Methods: We carried out a crossed descriptive study, taking into account clinical variables necessary to classify the patients according to the stages contemplated at Baveno IV Consensus. The procedures of the descriptive statistics were applied. Results: 41 patients were studied, with a predomination of the male ones (82,9 %), average age 51,9 ± 9,2 years. Asthenia was the main reason of the consultation in the compensated stage. Most of the patients presented the compensated disease taking into account the clinical stage of the disease according to Baveno VI Methodological Consensus on Diagnostic and Treatment of the Portal Hypertension (56,1 %). Conclusions: with the application of the Baveno IV consensus criteria we arrived to the adequate clinical classification of the cirrhotic patients allowing an opportune therapeutic on behalf of them.