Lys656Asn polymorphism of leptin receptor, leptin levels and insulin resistance in patients with non alcoholic fatty liver disease.

BACKGROUND: Some studies have pointed to a role of leptin and insulin resistance in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of Lys656Asn polymorphism LEPR gene on the histological changes, insulin resistance and leptin levels in overweight patients. MATERIAL AND METHODS: A population of 76 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of LEPR gene Lys656Asn was studied. RESULTS: Nineteen patients (25%) had the genotype Lys656Asn and 4 patients genotype Asn656Asn (mutant type group) and 53 patients (69.7%) Lys656Lys (wild type group). Body mass index, weight, fat mass, waist circumference, waist to hip ratio, glucose levels and HOMA-IR were higher in mutant than wild type group. LEPR polymorphism is in any way related with liver lesions. The multivariate analysis adjusted by age, sex, BMI and genotype showed an independently association of lobular inflammation 4.19 (CI95%: 1.37-12.77), portal inflammation 1.97 (CI95%: 1.05-3.74) and steatosis 9.23 (CI95%: 1.47-57.83) with HOMA. Liver steatosis was associated with leptin levels (1.09 (CI95%: 1.06-1.18)), too. CONCLUSION: Lys656Asn polymorphism of LEPR gene is associated with obesity parameters, insulin resistance and glucose levels in patients with NAFLD. In logistic regression analysis, only insulin resistance was associated with portal inflammation), lobular inflammation and steatosis; liver steatosis was related with leptin levels, too.

Humoral and cellular immune memory response 12 years following single dose vaccination against hepatitis A in Argentinian children.

Infants' universal hepatitis A virus (HAV) single-dose vaccination has been highly effective for controlling HAV infection in Argentina, and in other Latin-American countries that adopted that strategy. Although antibodies wane over time, this has not been associated with HAV outbreaks or breakthrough infections, suggesting a relevant role for memory immunity. This study assessed long term humoral and cellular immune memory response after an average of 12 years follow-up of HAV single-dose vaccination. We selected 81 HAV-single dose vaccinated individuals from a 2015 study, including 54 with unprotective (UAL) and 27 with protective antibody levels (PAL) against HAV. Humoral memory response was assessed by measuring anti-HAV antibody titers at admission in both groups, and 30 days after a booster dose in the UAL group. Flow cytometry analysis of peripheral blood mononuclear cell samples stimulated with HAV antigen was performed in 47/81 individuals (21 with PAL, 26 with UAL) to identify activated CD4 + memory T cells or CD8 + memory T cells. The results showed that 48/52 (92%) individuals from UAL group who completed follow up reached protective levels after booster dose. In the PAL group, anti-HAV Abs waned in 2/27 (7%) individuals lacking seroprotection, while in 25/27 (93%) Abs remained >10 mUI/mL. HAV-specific memory CD4 + T cells were detected in 25/47 (53.2%) subjects while HAV-specific memory CD8 + T cells were observed in 16/47 (34.04%) individuals. HAV-specific memory CD4+ and CD8+ T cell responses were detected in 11/21 (52.4%) and in 9/21 (42.9%) subjects with PAL and in 14/26 (53.8%) and in 7/26 (26.9%) individuals with UAL, showing that the presence of memory T-cells was independent of the level or presence of anti-HAV antibodies. Long-term immunity demonstrated in the present work, including or not antibody persistence, suggests that individuals with waned Ab titers may still be protected and supports the single-dose HAV strategy.

Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients.

BACKGROUND: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. METHODS: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. RESULTS: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). CONCLUSION: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.

ANTECEDENTES: La estratificación de la gravedad de una infección se basa actualmente en la puntuación SOFA (Sequential Organ Failure Assessment), que es difícil de calcular fuera de la unidad de cuidados intensivos. Los biomarcadores podrían ayudar a estratificar la gravedad de la infección en pacientes quirúrgicos. MÉTODOS: Se compararon las concentraciones de 10 biomarcadores que denotan disfunción endotelial, 22 que indican granulopoyesis de emergencia y 6 que expresan la degranulación de neutrófilos en tres grupos de pacientes de tres hospitales españoles (100 con infección, 95 con sepsis y 57 con shock séptico) en las primeras doce horas después del diagnóstico. RESULTADOS: Siete biomarcadores que expresan disfunción endotelial (proadrenomedulina, sindecan-1, trombomodulina, angiopoyetina-2, endocan-1, molécula de adhesión endotelial 1 y E-selectina) mostraron una fuerte asociación con la sepsis en comparación con la infección aislada. La proadrenomedulina presentó el valor más alto de la razón de oportunidades (odds ratio, OR) en el análisis multivariable (OR 11,53, i.c. del 95% 4,15-32,08, P = 0,006) y la mejor área bajo la curva para detectar sepsis (AUC 0,86, i.c. del 95% 0,80-0,91, P < 0,001). En la comparación entre sepsis y shock séptico, los biomarcadores que mostraron la asociación más estrecha con el shock séptico fueron dos biomarcadores de degranulación de neutrófilos (proteinasa-3 y lipocalina-2) (OR 8,09, i.c. del 9% 1,34-48,91, P = 0,028; OR 6.62, i.c. del 95% 2,47-17,77, P = 0,002), pero la lipocalina-2 presentó la mejor AUC (0,81, i.c. del 95% 0,73-0,90, P < 0,001). CONCLUSIÓN: la proadrenomedulina y la lipocalina-2 podrían representar alternativas a la puntuación SOFA para detectar sepsis y shock séptico en pacientes quirúrgicos con infección.

Influence of visfatin on histopathological changes of non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common liver disease. The aim of the present study was to explore the relation of visfatin with underlying histopathological changes of NAFLD patients. SUBJECTS: A population of 55 NAFLD patients was analyzed in a cross-sectional study. A liver biopsy was realized. Weight, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and visfatin levels were measured. A bioimpedance was performed. RESULTS AND CONCLUSIONS: The mean age was 42.8 +/- 11.2 years, the mean BMI was 33.1 +/- 10.2 with 37 males (67.3%) and 18 females (32.7%). Probabilities to have; portal inflammation increased 1.11 (CI95%:1.03-1.50) with each increment of 1 ng/ml of visfatin concentration, high grade of steatosis increased 1.25 (CI 95%:1.06-1.61) with each unit of insulin concentrations, fibrosis increased 1.12 (CI 95%:1.02-1.43) with each unit of fat mass and lobulillar inflammation increased 13.4 (CI 95%:1.3-147) with each unit of HOMA-IR. Portal inflammation frequencies were different between groups (low visfatin group 13.07 < ng/ml: 37.5% versus high visfatin group 13.07 > ng/ml: 62.5%; P < 0.05). In conclusion, several histopathological changes in liver biopsies could be explained by insulin concentrations, HOMA-IR, and fat mass amount. Moreover, visfatin plasma concentrations could predict the presence of portal inflammation in NAFLD patients.

Palliative care and end-of-life care for polypathological patients. / Cuidados paliativos y atención al final de la vida en los pacientes pluripatológicos.

Patients with advanced chronic diseases receive fragmented care, which entails high resource consumption and a poor quality of life. Uncertainty in the prognosis and scarce investigation into the importance of symptomatic control in this patient group hinders a proper therapeutic approach. Palliative care teams optimise the use of resources through comprehensive patient care, the optimization of the patient's environment, communication, the preparation of early care plans and the creation of coordinated healthcare circuits, which improve the quality of the patient's care in advanced stages of the disease. In the end-of-life phase, the therapeutic approach is focused on symptomatic control, selecting treatments according to the cause, comorbidities and the patient's wishes. To control refractory symptoms, palliative sedation is considered an indispensable option.

Liver infiltrating mononuclear cells in children with type 1 autoimmune hepatitis.

OBJECTIVE: To investigate infiltrating cells in the liver of children with type 1 autoimmune hepatitis (AH-1). METHODS: liver biopsies from 24 untreated AH-1 patients (14 children, 10 adults), five patients with hepatitis C virus related chronic hepatitis (HCV), and 10 control liver specimens (CL) were processed for immunohistochemical cell characterisation. RESULTS: Two different cell distribution patterns were detected in the liver of patients with AH-1: (1) CD4(+) and CD20(+) cells were found in the central areas of the portal tracts (portal distribution); (2) CD8(+) cells were observed at the periphery of the portal space (periportal distribution). Some cell subsets, like CD56, CD57, Fas-L, and Bak, showed a non-defined distribution pattern. The presence of two well defined patterns of cell distribution was not observed in HCV and CL (CD4(+), CD20(+), and CD8(+) cells were uniformly distributed in the portal space). In AH-1 and CL, the NK markers CD56 and CD57 were found scattered throughout the liver parenchyma. However, in HCV biopsies, CD56(+) cells were also clearly increased in both the portal and the periportal areas. Biopsies of AH-1 and HCV patients showed a uniform distribution of Fas-L and Bak in the portal and periportal areas, with Bak staining also detected in the hepatic parenchyma. CONCLUSIONS: Despite clinical and genetic differences, there was a similar distribution of liver infiltrating mononuclear cells in children and adults with AH-1. These results raise the possibility of reclassifying cryptogenic chronic hepatitis by immunohistochemical analysis of infiltrating liver cells.

Economic analysis of the single-dose immunization strategy against hepatitis A in Argentina.

BACKGROUND: Vaccination against hepatitis A (HA) was carried out only as part of a limited outbreak control strategy in Argentina until June 2005, when universal immunization in infants was introduced into the national immunization calendar. A single-dose strategy was chosen instead of the standard two-dose schedule used elsewhere. This study aimed to estimate preventive, medical, and non-medical costs related to HA and to compare these costs in the periods before and after mass vaccination. METHODS: A retrospective analysis estimated treatment costs of HA and unspecified hepatitis cases reported to the National Health Surveillance System from 2000 to 2010. Costs related to immunization, fulminant hepatitis (FH), liver transplantation, and death were projected as well. Using a social perspective and a healthcare system perspective, costs in two 5-year periods were compared: 2000-2004 versus 2006-2010. Finally, we evaluated the impact of different discount rates, FH risk, and exclusion of unspecified hepatitis cases in the sensitivity analysis. RESULTS: Total HA and unspecified hepatitis cases decreased from 157,871 in 2000-2004 to 17,784 in 2006-2010. Medical and non-medical costs decreased from US$11,811,600 and US$30,118,222 to US$1,252,694 and US$4,995,895 in those periods, respectively. Immunization costs increased from US$6,506,711 to US$40,912,132. Total preventive, medical, and non-medical costs decreased from US$48,436,534 to US$47,160,721, representing a 2.6% reduction in total costs between the two periods. When a healthcare system perspective was considered or unspecified hepatitis cases were excluded, total costs were 130.2% and 30.8% higher in 2006-2010 than in the previous period, respectively. CONCLUSION: After implementation of the universal single-dose vaccination against HA in infants in Argentina, an impressive decline was observed in HA cases, with a decrease in medical and non-medical costs in the first 5 years. The single-dose strategy, which is simpler and less expensive than the standard two-dose scheme, can be a good alternative for future vaccination policies in other countries where HA is endemic.

[Acute myocardial infarct and thyrotoxicosis. A report of a new case]. / Infarto agudo de miocardio y tirotoxicosis. Presentación de un nuevo caso.

The presence of an acute myocardial infarction in a premenopausal woman without any known coronary artery disease risk factors, rules out other non atherosclerotic causes of coronary lesion. Hyperthyroidism and ischemic heart disease are well related clinically, but for pathophysiological reasons, still under discussion. Here, we present the case of a young woman with typical heart disease symptoms and an absence of initial electrocardiographic alterations, who is diagnosed as having a transmural myocardial infarction. The later anamnesis and the laboratory results allowed a hyperthyroidism diagnosis to be made. What follows is a selection of some of the limited contributions to AMI literature dealing with hyperthyroidism, as well as the possible mechanisms described up to now.

[Miliary dissemination with pulmonary involvement secondary to intravesical immunotherapy with Calmette-Guérin bacillus]. / Diseminación miliar con afectación pulmonar secundaria a inmunoterapia intravesical con bacilo de Calmette-Guérin.

We describe the case of a 67-years-old man who underwent transurethral resection and immunotherapy with Calmette-Guérin bacillus solution (CGB) for superficial transitional carcinoma of the bladder. After a series of intravesical irrigations with CGB, the patient developed fever, asthenia and persistent anorexia and was hospitalized. After testing he was diagnosed of miliary tuberculosis due to CGB and died in spite of tuberculostatic therapy. Hematogenous dissemination, a rare but serious complication of vesical irrigation with CGB, is thought to be more common than previously suspected. It should be suspected in all patients receiving CGB when a compatible clinical picture presents. An understanding of this complication and early establishment of specific treatment is the only wat to improve prognosis.

[Permanent endoprostatic prostheses in patient with obstruction caused by benign hyperplasia of the prostate]. / Prótesis endoprostáticas permanentes en pacientes con obstrucción por hiperplasia benigna de próstata.

Presentation of the results obtained using the intraprostatic prosthesis UroLume in 78 patients wit BPH obstruction, 69 of which presented high surgical risk (ASA IV). Mean age was 79.8 years (r: 62-93). All patients carried urethral catheters, except 4 (5.1%) who had a provisional metal coil that required replacement. Prosthesis were implanted successfully in 72 cases (93.3%). The most significant exclusion criterion was an excessive length of prostate urethra. Mean follow-up was 15.3 months (r: 3-38). Mean maximum flow at 1 year after implant was 12.7 mL/sec; mean symptoms score (I-PSS score) was 6.2 points and in most prosthesis, epithelization had taken place. Three patients required implant of another prosthesis, either during the same surgical procedure (1 case) or later due to retention or dysuria (2 cases). Due to acute urine retention (AUR) during the immediate postoperative, resection of the middle lobe was performed in one case while a second case required late resection of intraluminal hyperplastic tissue. Three patients (4.1%) had haematuria that forced hospital admission some months after the implant, and three cases (4.1%) required removal of the prosthesis; at patient's request (1 case), due to calcification (1 case) and for stress incontinence (1 case). After a follow-up of over three years, it can be concluded that the UroLume prosthesis is an effective alternative to TUR in patients at high surgical risk.

[HCV and HBV prevalence in hemodialyzed pediatric patients. Multicenter study]. / Prevalencia de HCV y HBV en pacientes pediátricos hemodializados. Estudio multicéntrico.

Hemodialized pediatric patients are a risk population for the hepatitis B and C virus infection. The aim of this paper was to study the serum prevalence of HBV and HCV infection in hemodialized children. We study 61 pediatric patients at hemodialisis, 12 on renal transplant, range between 2 and 20 years old (mean: 12.9 years), 23 male and 38 female. The specific anti-HCV IgC were measured by enzyme immunoassay (ELISA Abbott) and confirmed by LIA-TEK (Organon). The anti-HBV were measured by ELISA Abbott and transaminases by cinetic method (ASAT: 29 UI/L and ALT: 33 UI/L). The 19.7% of studied children were HCV (+) and 29.5% were HBV (+), 38.9% of them were HbsAg (+) and 50% anti-HBs (+). The HCV and HBV infection was more elevated in relation to the transfusion number and the hemodilisis time. The elevation of ALT/ASAT activity isn't a right infection index for HCV and HBV in this children.

[Hepatitis A virus infection in children in Argentina: a pilot study]. / Infección por virus de hepatitis A (HAV) en niños en Argentina. Ensáyo piloto.

UNLABELLED: The severity and/or the prognostic of infections with the hepatitis A virus (HAV) is related to the age at which the infection occurs. Since transmission of the virus occurs by the fecal-oral route, the prevalence and age-relate incidence of infection is determined by the adequacy of sanitation hygienic measures and the socio economic level of exposed populations. Thus, the disease is having an increasing impact in developing countries with improving sanitary standards whereas inhabitants of industrialized countries are particularly at risk while visiting under-developed countries. We have established a cooperative group for the serologic study of children range between six months to ten years old, without sintomatology of acute hepatitis. The patients live in Buenos Aires, San Justo, Trelew, Rosario and Tucumán cities. We studied 3699 children. The specific Ab-antiHAV IgG were measured by enzyme immunoassay with commercial available kits (Organon and-or Abbott). The variable of study were age, sex and water quality. RESULTS: 45.19% were of San Justo, 26.15% of Rosario, 13% of Buenos Aires, 8.37% of Trelew and 7.29% of Tucumán. We observed the highest of possibility percentage (%POS) in Tucumán (81.4%), followed by San Justo (57.8%), Rosario (46.5%), Trelew (41.99%) and Buenos Aires (29.4%). In all the cities the lowest %POS was found in children under three years old. Between three and six years old the results were variable and an increase in %POS was observed related to the growth. The global %POS was 51.56%. CONCLUSIONS: This study confirms Argentina as a high endemic country for HAV infection. A global vaccination program is the only strategy that has the potential to prevent recurrent epidemics of hepatitis A and its erradication.

[Surgery in superficial skin lesions (II of III). Procedure: technique preparation]. / Cirugía en lesiones dérmicas superficiales (II de III). Procedimiento: preparación de la técnica.

The authors make a detailed presentation about the steps to follow to ensure the patient is comfortable and that the execution of this technique is correct. The authors review the most important aspects, including asepsis and anesthesia, to prepare a wound for suturing and to make preparations for surgery. They also provide a brief description of the necessary surgical instruments and their characteristics.

[Surgery of superficial skin injuries (I of III). Nursing approach]. / Cirugía en lesiones dérmicas superficiales (I de III). Actuación de enfermería.

Among the procedures in minor surgery, to suture wounds is a technique which nursing professional frequently perform as part of their normal work load, especially those nurses who work in Primary Health Care Centers and Emergency Wards. This article in the first in a series of three articles which enables the reader to review his/her knowledge about how to repair superficial skin lesions. After citing the legal aspects, the authors shall review each step in this procedure. We will check to see if the indication for suture is correct, evaluating a wound adequately. Afterwards, we review the procedure to clean the wound and to apply an anti-tetanus prophylaxis. We will mention how to adequately select the technique, the suture material and the instrument to be used. We will show the manner to use to avoid complications derived from an inadequate technique and we will continue with the follow up procedure for cicatrisation after first treatment, which includes informing the patient and a precocious treatment of complications, assuring the patient's welfare and the defense of his/her rights at all times; all of which will make possible an intervention which guarantees quality and is satisfactory to both the patient and the nursing professional who employs it.

[Surgery in superficial skin lesions (III of III). Procedure: carrying out the technique]. / Cirugía en lesiones dérmicas superficiales (III de III) Procedimiento: realización de la técnica.

This third article closes a series about surgery in superficial skin lesions. The authors describe how to perform the technique of suture, both continuous and discontinuous suture, as well as the technique of knotting. The authors also describe the follow up procedures for treating a lesion, how to inform a patient about this procedure and the removal of the suture. At the end of this article, the authors include a bibliography for the entire series.

Influence of G1359A polimorphysm of the cannabinoid receptor gene (CNR1) on insulin resistance and adipokines in patients with non alcoholic fatty liver disease.

BACKGROUND: Considering the evidence that endogenous cannabinoid system plays a role in metabolic aspects of body weight and metabolic syndrome components such as non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of this polymorphism on insulin resistance, liver histological changes, anthropometric parameters and adipocytokines in patients with NAFLD. MATERIAL AND METHODS: A population of 71 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of G1359A polymorphism of CB1 receptor gene CB1 receptor was studied. Forty one patients (36.9%) had the genotype G1359G (wild type group) and twenty nine (26.1%) patients G1359A or A1359A (mutant type group). RESULTS: Twenty four 24 patients (32,3%) had a Brunt grade > 4 and 12 patients (17%) had a significative fibrosis (F > = 2). HOMA values were higher in wild type group than mutant type group. Adiponectin and visfatin levels were higher in mutant type group. Moreover, TNF-alpha and resistin levels were higher in wild type group than mutant type group. Patients with mutant genotype showed less frequently elevated levels of AST. AST > 40 UI/L was detected in 28.5% of patients in the mutant vs. 53% of patients with wild genotype, p < 0.05. Patients with mutant type group presented a percentage of Brunt grade > = 4 less frequently than patients with wild type group (28.5%vs 7.1%). CONCLUSION: A variant of the polymorphism G1359A CBR1 is associated with lower levels of HOMA, TNF-alpha, resistin and higher levels of adiponectin than patients with the wild variant of this polymorphism. Besides, patients with A allele variant shown lower Brunt grade in liver biopsy.

Mycobacterium africanum, an emerging disease in high-income countries?

BACKGROUND: Mycobacterium africanum is a cause of tuberculosis (TB) that has mainly been described in Africa, but immigration and travel patterns have contributed to the spread of the disease to other countries. METHODS: We retrospectively reviewed TB cases due to M. africanum during 2000-2010 in seven Spanish hospitals. Selected clinical charts were reviewed using a predefined protocol that included demographical, clinical and microbiological data and outcome. RESULTS: Although 57 cases were diagnosed, only 36 clinical charts were available for review: 82.8% were men and the mean age was 31.6 years (range 12-81). Forty-four cases were from Africa, 1 from the Philippines, 1 from India, and 4 from Spain, while the country of origin was unknown in 7 cases. The most frequent site of infection was the lung (58.3%). Four cases (6.9%) were resistant to at least one first-line anti-tuberculosis drug. CONCLUSIONS: Disease due to M. africanum in industrialised countries is mainly associated with immigration from endemic areas, although some cases also occur among native-born populations.

Role of -55CT polymorphism of UCP3 gene on non alcoholic fatty liver disease and insulin resistance in patients with obesity.

BACKGROUND AND AIMS: Some studies have pointed to a role of UCP3 in the regulation of biochemical and fat parameters in overweight patients. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene (rs1800849) on histological changes and insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS: A population of 39 patients with NAFLD was recruited in a cross sectional study. The inclusion criterion was the presence of biopsy-proven NAFLD. A biochemical analysis of serum (lipid profile, and adipocytokines) was measured. An anthropometric analysis was assessed, too. Genotype of UCP3 gene -55CT was studied. RESULTS: Nine patients (23%) had the genotype 55CC (mutant type group) and 30 patients (77%) 55CT (wild type group).TT genotype was not detected. Insulin levels and HOMA were higher in mutant type group (insulin: 17.7 +/- 10.9 mUI/L vs 11.9 +/- 4.7 mUI/L/; p < 0.05) and (HOMA: 3.2 +/- 1.8 vs 4.5 +/- 2.8; p < 0.05). Adiponectin levels were lower in mutants type group (36.5 +/- 28.1 ug/ml vs 21.5 +/- 18.6 ug/ml:p < 0.05). Moderate-severe inflammation and moderate-severe steatosis were more frequent in mutant type group, with higher levels of insulin and lower levels of adiponectin than mild stages. CONCLUSION: -55CT genotype is associated with high insulin resistance and low adiponectin levels than -55CC genotype. Patients with -55CT genotype have more frequently moderate-severe steatosis and inflammation than -55CC genotype.