RESUMO
Gastric varices (GV) have different physiology and clinical characteristics compared to oesophageal varices (OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.
RESUMO
Hepatorenal syndrome (HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality. A new definition has been recently recommended by the International Club of Ascites, according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value. Moreover, new data on urinary biomarkers has been recently published. In this sense, the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm. Treatment with terlipressin and albumin is the current standard of care. Recent data show that terlipressin in intravenous continuous infusion is better tolerated than intravenous boluses and has the same efficacy. Terlipressin is effective in reversing HRS in only 40%-50% of patients. Serum bilirubin and creatinine levels along with the increase in blood pressure and the presence of systemic inflammatory response syndrome have been identified as predictors of response. Clearly, there is a need for further research in novel treatments. Other treatments have been assessed such as noradrenaline, dopamine, transjugular intrahepatic portosystemic shunt, renal and liver replacement therapy, etc. Among all of them, liver transplant is the only curative option and should be considered in all patients. HRS can be prevented with volume expansion with albumin during spontaneous bacterial peritonitis and after post large volume paracentesis, and with antibiotic prophylaxis in patients with advanced cirrhosis and low proteins in the ascitic fluid. This manuscript reviews the recent advances in the diagnosis and management of this life-threatening condition.
RESUMO
Santiago Quiotepec, one of the oldest communities of the Tehuacán-Cuicatlán Valley (México), has a great tradition using medicinal plants. The aim of this study was to make an inventory of the medicinal species used by the inhabitants of Santiago Quiotepec and evaluate the antibacterial activity. An ethnobotanical study of medicinal plants was carried out, 60 informants mentioned that 66 species of plants are being used in the treatment of different diseases. Fifteen species were selected to evaluate the antibacterial activity in possible bacterial originated diseases treatment. The lowest values were presented in the hexane extract of Plumbago pulchella, with a MIC of 0.25 mg/mL over Staphylococcus aureus and S. epidermidis as well as the hexanic extract of Echinopterys eglandulosa showed a MIC of 0.25 mg/mL over Pseudomona aeruginosa.
Santiago Quiotepec es una de las comunidades más antiguas del valle de Tehuacán-Cuicatlán (México), y tiene una gran tradición en el uso de plantas medicinales. El objetivo de este estudio fue realizar un inventario de las especies medicinales utilizadas por los habitantes de Santiago Quiotepec y evaluar la actividad antibacteriana. Se realizó un estudio etnobotánico de plantas medicinales, 60 informantes mencionaron 66 especies de plantas utilizadas en el tratamiento de diferentes enfermedades. Quince especies utilizadas en la comunidad para tratar enfermedades de posible origen bacteriano fueron seleccionadas para evaluar la actividad antibacteriana. Los valores más bajos se presentaron en el extracto hexánico de Plumbago pulchella, con una CMI de 0.25 mg/ml sobre Staphylococcus aureus y S. epidermidis, así como el extracto hexánico de Echinopterys eglandulosa mostró una CMI de 0.25 mg/mL sobre Pseudomona aeruginosa.