Bleaching efficacy of at home 16% carbamide peroxide. A long-term clinical follow-up study.

OBJECTIVE: To assess the whitening efficacy of a 16% carbamide peroxidase (CP) gel after 42 months of clinical follow-up. MATERIALS AND METHODS: A retrospective clinical study was carried out involving 95 participants. CP 16% was applied for 90 minutes a day for 4 weeks using individualized trays. Tooth color was assessed using spectrophotometry at baseline, 1 week after the end of treatment, and every 6 months until completing 42 months of follow-up. Color parameters were compared using analysis of variance for repeated measures. The analysis by teeth groups was performed using two-way ANOVA. RESULTS: The mean baseline L* was 81.7 ± 5.2 versus 83.6 ± 8.8 after 42 months (P<.01). L* showed a decrease of 2.3 after 30 months. The values corresponding to a* before treatment were 0.4 ± 1.1 versus -1.0 ± 1.0 after 42 months (P<.01). The initial values corresponding to b* were 23.4 ± 3.3 versus 15.8 ± 1.3 after 42 months (P<.01). Values of ΔE00 and ΔE, at the end of the treatment were 4.6 ± 1.2 and 7.8 ± 1.8, respectively. Teeth groups remained stable after 42 months of follow-up. CONCLUSIONS: The home application of 16% CP gel for 90 minutes a day for 4 weeks using individualized trays resulted in whitening that remained stable over the 42 months of follow-up. CLINICAL SIGNIFICANCE: Treatment with 16% CP is an effective and safe tooth whitening procedure, and the color obtained remains stable over the long term.

Identification, characterization, and molecular docking of immunomodulatory oligopeptides from bioavailable hempseed protein hydrolysates.

Promoting dietary patterns in which the content of vegetables is higher than the current consumption of them is one of the strategies to achieve a sustainable food system while promoting health in humans. Hemp (Cannabis sativa L.) protein contains bioactive peptides that can be released via enzymatic hydrolysis. These peptides must reach the target organ in order to potentially exert bioactivity and regulate specific metabolic pathways. The peptides contained in two bioavailable hempseed protein hydrolysates (bioHPHs) showing anti-inflammatory activity were identified using a transwell system employing CACO-2 cell culture as absorption model and subjected to in silico analysis to select 10 unique peptides. These sequences were chemically synthetized to verify their activity in primary human monocytes (assessing gene expression of IL-1ß, IL-6, TNF-α, IL-4, IL-10, and TLR4), in addition to evaluate the interaction with TRL4/MD2 by molecular docking. Six peptides (DDNPRRF, SRRFHLA, RNIFKGF, VREPVFSF, QADIFNPR and SAERGFLY) showed high immunomodulatory activity in in vitro and the mechanisms of interaction with TLR4/MD2 were described. Bioavailable anti-inflammatory hempseed-derived peptides were identified, and their activity verified, suggesting the health benefits that the ingestion of HPHs could exert in humans. These findings open new opportunities for developing nutritional strategies with hemp as a dietary source of biopeptides to prevent the development and progression of inflammatory-related diseases.

Identification of the Bioavailable Peptidome of Chia Protein Hydrolysate and the In Silico Evaluation of Its Antioxidant and ACE Inhibitory Potential.

The incorporation of novel, functional, and sustainable foods in human diets is increasing because of their beneficial effects and environmental-friendly nature. Chia (Salvia hispanica L.) has proved to be a suitable source of bioactive peptides via enzymatic hydrolysis. These peptides could be responsible for modulating several physiological processes if able to reach the target organ. The bioavailable peptides contained in a hydrolysate obtained with Alcalase, as functional foods, were identified using a transwell system with Caco-2 cell culture as the absorption model. Furthermore, 20 unique peptides with a molecular weight lower than 1000 Da and the higher statistical significance of the peptide-precursor spectrum match (-10 log P) were assessed by in silico tools to suggest which peptides could be those exerting the demonstrated bioactivity. From the characterized peptides, considering the molecular features and the results obtained, the peptides AGDAHWTY, VDAHPIKAM, PNYHPNPR, and ALPPGAVHW are anticipated to be contributing to the antioxidant and/or ACE inhibitor activity of the chia protein hydrolysates.

Evidence of Immunomodulatory Food-Protein Derived Peptides in Human Nutritional Interventions: Review on the Outcomes and Potential Limitations.

The immune system is somehow related to all the metabolic pathways, in a bidirectional way, and the nutritional interventions affecting these pathways might have a relevant impact on the inflammatory status of the individuals. Food-derived peptides have been demonstrated to exert several bioactivities by in vitro or animal studies. Their potential to be used as functional food is promising, considering the simplicity of their production and the high value of the products obtained. However, the number of human studies performed until now to demonstrate effects in vivo is still scarce. Several factors must be taken into consideration to carry out a high-quality human study to demonstrate immunomodulatory-promoting properties of a test item. This review aims to summarize the recent human studies published in which the purpose was to demonstrate bioactivity of protein hydrolysates, highlighting the main results and the limitations that can restrict the relevance of the studies. Results collected are promising, although in some studies, physiological changes could not be observed. When responses were observed, they sometimes did not refer to relevant parameters and the immunomodulatory properties could not be clearly established with the current evidence. Well-designed clinical trials are needed in order to evaluate the role of protein hydrolysates in immunonutrition.

Kiwicha (Amaranthus caudatus L.) protein hydrolysates reduce intestinal inflammation by modulating the NLRP3 inflammasome pathway.

The increase in the world population along with new policies aimed at a more sustainable world has led to the need of searching for new food sources, which are environmentally friendly, implying healthy and nutritious diets. This study explored the biological activity of two kiwicha (Amaranthus caudatus L.) protein hydrolysates obtained with the aid of Bioprotease LA-660 regarding their anti-inflammatory response at the intestinal level, employing the CACO-2 cell line. The results obtained showed that the in vitro administration of these hydrolysates decreased the expression of proinflammatory cytokines, increased the expression of anti-inflammatory cytokines, and decreased the gene expression of the major components of inflammasomes in the intestinal CACO-2 cell model. To the best of our knowledge, this is the first study involving the evaluation of the anti-inflammatory activity of kiwicha hydrolysates at the intestinal level, employing the CACO-2 cell model and its ultrastructural characterization using scanning electron microscopy. We conclude that the Amaranthus caudatus hydrolysates are a valuable source of active peptides that take part as functional ingredients in food and nutraceutical preparations.

Antioxidant and Anti-Inflammatory Properties of Bioavailable Protein Hydrolysates from Lupin-Derived Agri-Waste.

Agri-food industries generate several by-products, including protein-rich materials currently treated as waste. Lupine species could be a sustainable alternative source of protein compared to other crops such as soybean or chickpea. Protein hydrolysates contain bioactive peptides that may act positively in disease prevention or treatment. Inflammatory responses and oxidative stress underlie many chronic pathologies and natural treatment approaches have gained attention as an alternative to synthetic pharmaceuticals. Recent studies have shown that lupin protein hydrolysates (LPHs) could be an important source of biopeptides, especially since they demonstrate anti-inflammatory properties. However, due to their possible degradation by digestive and brush-border enzymes, it is not clear whether these peptides can resist intestinal absorption and reach the bloodstream, where they may exert their biological effects. In this work, the in vitro cellular uptake/transport and the anti-inflammatory and antioxidant properties of LPH were investigated in a co-culture system with intestinal epithelial Caco-2 cells and THP-1-derived macrophages. The results indicate that the LPH crosses the human intestinal Caco-2 monolayer and exerts anti-inflammatory activity in macrophages located in the basement area by decreasing mRNA levels and the production of pro-inflammatory cytokines. A remarkable reduction in nitric oxide and ROS in the cell-based system by peptides from LPH was also demonstrated. Our preliminary results point to underexplored protein hydrolysates from food production industries as a novel, natural source of high-value-added biopeptides.

Effects of variation in forest fragment habitat on black howler monkey demography in the unprotected landscape around Palenque National Park, Mexico.

Habitat loss and fragmentation are leading threats to biodiversity today, and primates are particularly vulnerable to anthropogenic habitat disturbance. However, few studies have examined how differential effects of variation in forest fragment characteristics on males and females in a primate population may affect demography and population persistence. We quantified the effects of variation in forest fragment characteristics on the within-fragment demography of black howler monkeys (Alouatta pigra) in forest fragments around Palenque National Park, Mexico, and how these effects differed between adult males and females. We quantified forest loss in the landscape between 2000 and 2017, and used a redundancy analysis to examine the effects of 15 variables quantifying fragment dimensions, forest composition and physical structure, and isolation on fragment population size and density, the proportion of adult males and females in the fragment population, and the mean number of adult males and females per group in 34 fragments (N = 393 monkeys). We hypothesized that (i) population size is positively correlated with fragment area, while population density is negatively correlated, and (ii) the composition of fragment populations results from differential effects of fragment variables on adult males and females. Forest cover decreased by 23.3% from 2000 to 2017. Our results showed a significant effect of fragment variables on population demography in fragments, accounting for 0.69 of the variance in the demographic response variables. Population size increased with fragment area and connectivity, while density decreased. Larger, less isolated fragments with better connectivity, characteristics indicative of abundant secondary growth, and those with more diverse vegetation but lower Simpson's evenness indices tended to have more adult females per group and a higher proportion of adult females in the population. In contrast, fragments that were largely similar in characteristics of forest composition and structure, but that were more isolated from nearby fragments, had more adult males per group and a higher proportion of adult males. These results may stem from black howler females preferentially remaining in natal groups and fragments when possible, and dispersing shorter distances when they disperse, while males may be more likely to disperse between fragments, traveling longer distances through the matrix to more isolated fragments. These differential effects on males and females have important conservation implications: if females are more abundant in larger, less isolated fragments, while males are more abundant in more isolated fragments, then to effectively conserve this population, both landscape connectivity and fragment areas should be maintained and increased.

[Propionic acidemia: clinical diagnosis vs newborn screening]. / Acidemia propionica: diagnostico clinico vs. cribado neonatal.

Propionic acidemia is a rare metabolic disease (prevalence 1/100,000) that can be early detected with the newborn metabolic screening within the first 72 hours of life. It can have a severe neonatal presentation, a late intermittent onset or a chronic and progressive course. The treatment in the crisis consists in inverting the catabolism by pausing the protein intake and giving intravenous non-protein calories. Mortality depends mainly on acute episodes of decompensation, while evolution and prognosis associate a high rate of neurological sequelae and cognitive deficiencies. We present the case of an 11-day-old female newborn with failure to thrive, lethargy, metabolic acidosis and hyperammonemia that, because of a failed newborn screening process, could not be early diagnosed. In spite of the existence of early detection with the newborn metabolic screening, it is very important to keep a high suspicion in cases that suggest metabolic disorders.

La acidemia propiónica es una rara enfermedad metabólica (prevalencia: 1/100 000), cuya detección puede hacerse de forma precoz mediante el cribado neonatal en las primeras 72 horas de vida. Puede tener una presentación neonatal grave, tardía intermitente o crónica progresiva. El tratamiento de las crisis consiste en la inversión del catabolismo que detiene la ingesta proteica con aporte intravenoso de calorías no proteicas. La mortalidad depende, fundamentalmente, de los episodios de descompensación aguda, mientras que la evolución asocia una alta tasa de secuelas neurológicas y déficits cognitivos. Se presenta el caso de una recién nacida de 11 días de vida con clínica de estancamiento ponderal, letargia, acidosis metabólica e hiperamonemia, que, debido a una falla en el proceso de cribado, no se benefició del diagnóstico precoz. A pesar de la ya existente detección por cribado, es vital mantener un alto índice de sospecha en casos sugestivos de metabolopatías.

Hemp (Cannabis sativa L.) Protein Hydrolysates Promote Anti-Inflammatory Response in Primary Human Monocytes.

Hemp seeds have a wide variety of chemical compounds which present biological activity. Specifically, the focus on proteins and bioactive peptides are increasing as alternative sources of nutraceutical uses. In the literature, hemp protein products (HPPs) have reported antioxidant and anti-inflammatory properties. This study aimed to determine the inflammation-related modulatory effects of HPPs on lipopolysaccharide (LPS)-activated primary human monocytes. CD14+ cells were immunomagnetically isolated from buffy coats and the anti-inflammatory activity of hemp protein isolate (HPI) and hydrolysates (HPHs) was evaluated on LPS-stimulated human primary monocytes. The specific markers of inflammation, polarization, and chemoattraction were measured by RT-qPCR and ELISA assays. Our results showed that HPPs decreased the pro-inflammatory mediators (TNFα, IL-1ß, and IL-6) and increased the anti-inflammatory mediators (IL-10 and IL-4). In addition, M1 polarization marker gene expression (CCR7 and iNOS) was downregulated by HPPs and, M2 polarization marker gene expression (CD200R and MRC1) was upregulated. Finally, the mRNA expression of chemotaxis genes (CCR2 and CCL2) was downregulated by HPPs. In conclusion, this study suggests that HPPs may improve chronic inflammatory states and promote regenerative processes by reprogramming monocytes toward M2 polarization phenotype.

Evaluation of Anti-Inflammatory and Atheroprotective Properties of Wheat Gluten Protein Hydrolysates in Primary Human Monocytes.

Bioactive protein hydrolysates have been identified in several sources as possible agents in the prevention and treatment of many diseases. A wheat gluten (WG) concentrate was hydrolyzed by Alcalase under specific conditions. The resulting hydrolysates were evaluated by in vitro cell-free experiments leading to the identification of one bioactive WG protein hydrolysate (WGPH), which was used at 50 and 100 µg/mL on primary human monocytes. Reactive oxygen species (ROS) and nitrite levels and RT-qPCR and ELISA techniques were used to analyze the functional activity of WGPH. Our results showed that WGPH hydrolyzed in 45 min (WGPH45A) down-regulated gene expression of Interleukin (IL)-1ß, IL-6, IL-17, and Interferon gamma (IFNγ) and reduced cytokine release in lipopolysaccharide (LPS)-stimulated monocytes. In addition, WGPH45A down-regulated gene-related to atherosclerotic onset. Our results suggest that WGPH45A has a potent anti-inflammatory and atheroprotective properties, reducing the expression of gene-related inflammation and atherosclerosis that could be instrumental in maintaining cardiovascular homeostasis.

Neuroprotective protein hydrolysates from hemp (Cannabis sativa L.) seeds.

Hemp (Cannabis sativa L.) seeds are well known for their potential use as a source of nutrients, fiber, and bioactive compounds. A hemp protein isolate, prepared from defatted hemp flour, was hydrolyzed by alcalase and flavourzyme under specific conditions. The resulting hydrolysates were evaluated for the selection of potentially bioactive hemp protein hydrolysates (HPHs) owing to their DPPH scavenging and ferric reducing antioxidant power activity. In vitro cell-free experiments led to the identification of two bioactive HPHs, HPH20A and HPH60A + 15AF, which were used at 50 and 100 µg mL-1 on BV-2 microglial cells in order to evaluate the anti-neuroinflammatory activities. Our results showed that HPH20A and HPH60A + 15AF down-regulated TNF-α, IL-1ß, and IL-6 mRNA transcriptional levels in LPS-stimulated BV-2 microglial cells. In addition, HPH20A and HPH60A + 15AF up-regulated the gene expression of anti-inflammatory cytokine IL-10. This study suggests for the first time that HPHs may improve the neuroinflammatory and inflammatory states, supporting the nutraceutical value of hemp seeds.

Acidemia propiónica: diagnóstico clínico vs. cribado neonatal / Propionic acidemia: clinical diagnosis vs newborn screening

La acidemia propiónica es una rara enfermedad metabólica (prevalencia: 1/100 000), cuya detección puede hacerse de forma precoz mediante el cribado neonatal en las primeras 72 horas de vida. Puede tener una presentación neonatal grave, tardía intermitente o crónica progresiva. El tratamiento de las crisis consiste en la inversión del catabolismo que detiene la ingesta proteica con aporte intravenoso de calorías no proteicas. La mortalidad depende, fundamentalmente, de los episodios de descompensación aguda, mientras que la evolución asocia una alta tasa de secuelas neurológicas y déficits cognitivos.Se presenta el caso de una recién nacida de 11 días de vida con clínica de estancamiento ponderal, letargia, acidosis metabólica e hiperamonemia, que, debido a una falla en el proceso de cribado, no se benefició del diagnóstico precoz.A pesar de la ya existente detección por cribado, es vital mantener un alto índice de sospecha en casos sugestivos de metabolopatías.

Propionic acidemia is a rare metabolic disease (prevalence 1/100,000) that can be early detected with the newborn metabolic screening within the first 72 hours of life. It can have a severe neonatal presentation, a late intermittent onset or a chronic and progressive course. The treatment in the crisis consists in inverting the catabolism by pausing the protein intake and giving intravenous non-protein calories. Mortality depends mainly on acute episodes of decompensation, while evolution and prognosis associate a high rate of neurological sequelae and cognitive deficiencies.We present the case of an 11-day-old female newborn with failure to thrive, lethargy, metabolic acidosis and hyperammonemia that, because of a failed newborn screening process, could not be early diagnosed.In spite of the existence of early detection with the newborn metabolic screening, it is very important to keep a high suspicion in cases that suggest metabolic disorders.

A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis.

BACKGROUND: Candida esophagitis remains an important cause of morbidity in patients with advanced human immunodeficiency virus (HIV) infection. Fluconazole is widely regarded as the treatment of choice for this condition. METHODS: The efficacy and safety of caspofungin were compared with fluconazole in adult patients with Candida esophagitis in a double-blind randomized trial. Eligible patients had symptoms compatible with esophagitis, endoscopic demonstration of mucosal plaques, and microscopic demonstration of Candida from the esophageal lesions. Patients were randomly assigned to receive caspofungin (50 mg) or fluconazole (200 mg) intravenously once daily for 7 to 21 days. The primary endpoint was the combined response of symptom resolution and significant endoscopic improvement 5 to 7 days after discontinuation of treatment. Data were analyzed with a modified intention-to-treat analysis, which excluded 2 ineligible patients. RESULTS: Most patients (154/177; 87%) had HIV infection, with a median CD4 count of 30 cells/mm(3). Candida albicans was the predominant isolate. Favorable response rates were achieved in 66 (81%) of the 81 patients in the caspofungin arm and in 80 (85%) of the 94 patients in the fluconazole arm (difference = -4%; 95% confidence interval: -15% to +8%). Symptoms had resolved in >50% of patients in both groups by the fifth day of treatment. No patient in the caspofungin group developed a serious drug-related adverse event; therapy was only discontinued in 1 patient (receiving fluconazole) due to a drug-related adverse experience. Four weeks after stopping study drug, symptoms had recurred in 18 (28%) of 64 patients given caspofungin and in 12 (17%) of 72 patients given fluconazole (P = 0.19). CONCLUSIONS: In this study, caspofungin appeared to be as efficacious and generally as well tolerated as fluconazole in patients with advanced HIV infection and documented Candida esophagitis.

Beta-like hippocampal network activity is differentially affected by amyloid beta peptides.

Alzheimer disease (AD) patients show alterations in both neuronal network oscillations and the cognitive processes associated to them. Related to this clinical observation, it has been found that amyloid beta protein (Abeta) differentially affects some hippocampal network activities, reducing theta and gamma oscillations, without affecting sharp waves and ripples. Beta-like oscillations is another cognitive-related network activity that can be evoked in hippocampal slices by several experimental manipulations, including bath application of kainate and increasing extracellular potassium. Here, we tested whether or not different Abeta peptides differentially affect beta-like oscillatory patterns. We specifically tested the effects of fresh dissolved Abeta(25-35) and oligomerized Abeta(1-42) and found that kainate-induced oscillatory network activity was affected, in a slightly concentration dependent-manner, by both fresh dissolved (mostly monomeric) Abeta(25-35) and oligomeric Abeta(1-42). In contrast, potassium-induced oscillatory activity, which is reduced by oligomeric Abeta(1-42), is not affected by monomeric Abeta(25-35) at any of the concentrations tested. Our results support the idea that different amyloid peptides might alter specific cellular mechanisms related to the generation of specific neuronal network activities, instead of a generalized inhibitory effect of Abeta peptides on neuronal network function.

Conductas sexuales asociadas a preeclampsia severa en pacientes del Servicio de Obstetricia del Hospital de Apoyo María Auxiliadora / Pre-eclampsia associated sexual behaviors in hospitalized patients with severe pre-eclampsia at the Obstetrics Department of Hospital de Apoyo María Auxiliadora

Objetivos: determinar las conductas sexuales asociadas a preeclampsia severa en pacientes hospitalizadas. Material y Métodos: se realizó una encuesta a 41 pacientes con preeclampsia severa para obtener datos con respecto a edad de primera gestación y de primera relación sexual (RS), número de parejas sexuales, hijos con parejas diferentes, frecuencia de coito, duración de RS previa al embarazo, exposición a semen y tiempo de cohabitación con la pareja. Resultados: Se encontró una edad promedio de 19 años para la primera gestación y de 17 para la primera RS, el 63% refirió más de 1 pareja sexual. El 15% presentaba relaciones sexuales durante menos de 6 meses antes del embarazo y el 90% y 22% presentaba exposición a semen según método anticonceptivo usado y sexo oral respectivamente. Conclusiones: las conductas sexuales asociadas con preeclampsia severa, estuvieron presentes en nuestra población con variable correlación a los hallazgos de otros estudios.

Objectives: to determine the presence of pre-eclampsia-associated sexual behaviors in our environment.Material and Methods: Forty-one patients were surveyed in order to obtain the results for age of first pregnancy and first sexual intercourse, number of sexual partners, children with different partners, sexual intercourse frequency, duration of sexual relationship, semen exposure and partner cohabitation period. Results: a mean age of 19 years-old was found for the first pregnancy and of 17 for the first sexual intercourse, 63% had more than 1 total sexual partners. Sexual relationship shorter than 6 months was present in 15% or the surveyed and semen exposure according to contraceptive methods and oral sex was of 90% and 22% respectively. Conclusions: sexual behaviors associated with pre-eclampsia were found in our population with a variable co-relation to the findings of other studies.

Las pruebas intradermicas de evaluacion de competencia celular: estudio comparativo entre antigenos clasicos y otros antigenos / Cellular competence evaluation intradermic tests: comparative study between clasic and other antigens

Se presenta un estudio comparativo en la respuesta de hipersensibilidad demorada frente a 4 antigenos universalmente recomendados. Tuberculina (TU), Candidina (CA), Streptokinasa/Streptodornasa (SK/SD) y virus de parotiditis (PA) con otros antigenos de uso menos comun tal como Antigeno-Respiratorio-Mixto (ARM) y lisado de Staphylococcus Aureus 80/81 (LS). De igual manera se estudio la respuesta al Dinitroclorobenceno (DNCB). La poblacion probada fue de 49 personas normales con edades entre 18-23 anos. Los resultados mostraron que la reactividad para ARM es de 91,8%, para LS 91,8%, para Parotiditis 6,1%. Los estudios con DNCB permiten aconsejar su uso solo en casos muy especiales. El trabajo presentado sugiere una normalizacion en la lectura y el uso de 4 antigenos con la mas alta frecuencia de positividad dentro del grupo probado asi: ARM,LS,CA y TU

Hepatitis fulminante en la Sierra Nevada: una forma de superinfección del virus delta con el virus de la hepatitis B / Fulminant hepatitis in La Sierra Nevada: a type of Delta superinfection with hepatitis B virus

Durante septiembre de 1980 a octubre de 1983, se realizó un estudio seroepidemiológico para hepatitis A y B, en 258 personas en una ciudad (Santa Marta) población de 250.000 y tres pequeños municipios (Santa Rosalía, Julio Zawady y Aracataca), poblaciones de 768.800 y 5.000 habitantes respectivamente. La presencia de hepatitis A se encontró en un 77 a 93 por ciento (IgG Hepatitis A). Hbs Ag o Anti-Hbs Ag en 30.5 por ciento de la población en dos municipios (Santa Rosalía y Julio Zawady), en 2,5 por ciento en el municipio de Aracataca y 48.5 por ciento en la ciudad de Santa Marta. La presencia del agente Delta (Anti-Delta en el suero) se determinó también en estas mismas poblaciones, encontrándose ausente en la ciudad y uno de los municipios (Aracataca), en contraste con una prevalencia de 13,7 por ciento y 22 por ciento en Julio Zawady y Santa Rosalía (P:0.0001). Se escluyeron por historia clínica, antecedentes de drogadicción, transfusiones, o prácticas homosexuales, como mecanismos de transmisión de los virus B y delta. En veinte pacientes con diagnóstico histopatológico de hepatitis fulminante y en quienes se descartaron otras etiologías se demostró la presencia serológica de los virus de la hepatitis B y Delta. De estos veinte, diez provenían de Julio Zawady y los otros diez de Santa Rosalía. La evolución clínica de esta enfermedad fue indistinguible de otras causas de falla hepática aguda. La mortalidad de estas formas fulminantes de hepatitis alcanzaron hasta un 65 por ciento. Los corticoides no modificaron el curso de esta enfermedad. La población joven mostró mayor compromiso y peor diagnóstico (P: 0.033). La hepatitis fulminante de la Sierra Nevada de Santa Marta es el resultado de la superinfección con el virus Delta sobre la infección virus B. La aparición simultánea de casos intrafamiliares sugiere una relación importante entre los grupos comprometidos, aunque la forma exacta de transmisión permanece aún desconocida