Underlying Mechanisms and Treatment of Hypertension in Glomerular Diseases.

PURPOSE OF REVIEW: This review aims to explore the underlying mechanisms that lead to hypertension in glomerular diseases and the advancements in treatment strategies and to provide clinicians with valuable insights into the pathophysiological mechanisms and evidence-based therapeutic approaches for managing hypertension in patients with glomerular diseases. RECENT FINDINGS: In recent years, there have been remarkable advancements in our understanding of the immune and non-immune mechanisms that are involved in the pathogenesis of hypertension in glomerular diseases. Furthermore, this review will encompass the latest data on management strategies, including RAAS inhibition, endothelin receptor blockers, SGLT2 inhibitors, and immune-based therapies. Hypertension (HTN) and cardiovascular diseases are leading causes of mortality in glomerular diseases. The latter are intricately related with hypertension and share common pathophysiological mechanisms. Hypertension in glomerular disease represents a complex and multifaceted interplay between kidney dysfunction, immune-mediated, and non-immune-mediated pathology. Understanding the complex mechanisms involved in this relationship has evolved significantly over the years, shedding light on the pathophysiological processes underlying the development and progression of glomerular disease-associated HTN, and is crucial for developing effective therapeutic strategies and improving patients' outcomes.

Terahertz photodiode integration with multi-octave-bandwidth dielectric rod waveguide probe.

Photonic integrated circuits play a vital role in enabling terahertz (THz) applications that require multi-octave bandwidth. Prior research has been limited in bandwidth due to rectangular waveguide (WRs) interconnects, which can only support single octave at low loss. To overcome this fundamental limitation, we exploit the ultra-wideband (UWB) near-field coupling between planar waveguides and silicon (Si)-based subwavelength dielectric rod waveguides (DRWs) to interconnect THz bandwidth uni-traveling-carrier photodiodes (UTC-PDs) at 0.08-1.03 THz. In a proof-of-concept experiment, the on-chip integrated UTC-PDs demonstrate a UWB operation from 0.1 THz to 0.4 THz. Furthermore, by employing Si DRWs as probes, multi-octave device-under-test characterization of UTC-PDs integrated with UWB transition is enabled with only one DRW probe. The proposed UWB interconnect technology is distinct from previously used WR-based ground-signal-ground probes or quasi-optical free-space coupling since it can provide multi-octave bandwidth and enable on-chip THz circuit integration.

Polarimetric imaging for the detection of synthetic models of SARS-CoV-2: A proof of concept.

Objective: To conduct a proof-of-concept study of the detection of two synthetic models of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using polarimetric imaging. Approach: Two SARS-CoV-2 models were prepared as engineered lentiviruses pseudotyped with the G protein of the vesicular stomatitis virus, and with the characteristic Spike protein of SARS-CoV-2. Samples were prepared in two biofluids (saline solution and artificial saliva), in four concentrations, and deposited as 5-µL droplets on a supporting plate. The angles of maximal degree of linear polarization (DLP) of light diffusely scattered from dry residues were determined using Mueller polarimetry from87 samples at 405 nm and 514 nm. A polarimetric camera was used for imaging several samples under 380-420 nm illumination at angles similar to those of maximal DLP. Per-pixel image analysis included quantification and combination of polarization feature descriptors in 475 samples. Main results: The angles (from sample surface) of maximal DLP were 3° for 405 nm and 6° for 514 nm. Similar viral particles that differed only in the characteristic spike protein of the SARS-CoV-2, their corresponding negative controls, fluids, and the sample holder were discerned at 10-degree and 15-degree configurations. Significance: Polarimetric imaging in the visible spectrum may help improve fast, non-contact detection and identification of viral particles, and/or other microbes such as tuberculosis, in multiple dry fluid samples simultaneously, particularly when combined with other imaging modalities. Further analysis including realistic concentrations of real SARS-CoV-2 viral particles in relevant human fluids is required. Polarimetric imaging under visible light may contribute to a fast, cost-effective screening of SARS-CoV-2 and other pathogens when combined with other imaging modalities.

Influence of Topography and Composition of Commercial Titanium Dental Implants on Cell Adhesion of Human Gingiva-Derived Mesenchymal Stem Cells: An In Vitro Study.

The topography and composition of dental implant surfaces directly impact mesenchymal cell adhesion, proliferation, and differentiation, crucial aspects of achieving osseointegration. However, cell adhesion to biomaterials is considered a key step that drives cell proliferation and differentiation. The aim of this study was to characterize characterize the topography and composition of commercial titanium dental implants manufactured with different surface treatments (two sandblasted/acid-etched (SLA) (INNO Implants, Busan, Republic of Korea; BioHorizonsTM, Oceanside, CA, USA) and two calcium phosphate (CaP) treated (Biounite®, Berazategui, Argentina; Zimmer Biomet, Inc., Warsaw, IN, USA)) and to investigate their influence on the process of cell adhesion in vitro. A smooth surface implant (Zimmer Biomet, Inc.) was used as a control. For that, high-resolution methodologies such as scanning electron microscopy (SEM), X-ray dispersive spectroscopy (EDX), laser scanning confocal microscopy (LSCM), and atomic force microscopy (AFM) were employed. Protein adsorption and retromolar gingival mesenchymal stem cells (GMSCs) adhesion to the implant surfaces were evaluated after 48 h. The adherent cells were examined by SEM and LSCM for morphologic and quantitative analyses. ANOVA and Tukey tests (α = 0.05) were employed to determine statistical significance. SEM revealed that INNO, BioHorizonsTM, and Zimmer implants have an irregular surface, whereas Biounite® has a regular topography consisting of an ordered pattern. EDX confirmed a calcium and phosphate layer on the Biounite® and Zimmer surfaces, and AFM exhibited different roughness parameters. Protein adsorption and cell adhesion were detected on all the implant surfaces studied. However, the Biounite® implant with CaP and regular topography showed the highest protein adsorption capacity and density of adherent GMSCs. Although the Zimmer implant also had a CaP treatment, protein and cell adhesion levels were lower than those observed with Biounite®. Our findings indicated that the surface regularity of the implants is a more determinant factor in the cell adhesion process than the CaP treatment. A regular, nanostructured, hydrophilic, and moderately rough topography generates a higher protein adsorption capacity and thus promotes more efficient cell adhesion.

Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis: A systematic review of randomized controlled trials.

Early enteral nutrition through a feeding tube is essential for the management of severe acute pancreatitis (SAP). Nasojejunal tube nutrition has been preferred on the assumption that it provided pancreatic rest in comparison to the nasogastric tube. However, nasojejunal tube placement is complex, may delay feeding initiation and can increase hospital costs. Our aim was to compare the efficacy and safety of enteral feeding with a nasogastric tube versus nasojejunal tube in patients with SAP. We searched four databases (PubMed, Web of Science, Scopus, and Embase) until December 1, 2022. We included randomized controlled trials (RCTs) comparing enteral feeding by nasogastric and nasojejunal tubes in patients with SAP. Primary outcome was all-cause mortality. Secondary outcomes were organ failure, infection, complications, surgical intervention, duration of tube feeding and length of hospital stay. Risk of bias assessment was completed independently by two investigators using the Cochrane RoB 2.0 tool. We performed random effects model meta-analyses using the inverse variance method. Effect measures were reported as relative risks (RR) and their 95% CIs for dichotomous outcomes and mean differences (MD) and their 95% CIs for continuous outcomes. We included four RCTs involving 192 patients with SAP. The mean ages ranged between 36 and 62 years old. There was no significant difference in all-cause mortality between the nasogastric and nasojejunal feeding arms (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). There were no significant differences in all secondary outcomes between feeding arms. There were three RCTs with some concerns of bias, in the randomization process. In conclusion, in patients with SAP, enteral feeding delivered by nasogastric tube was as efficacious and safe as nasojejunal tube. Further randomized controlled trials with more participants and better design are needed to confirm these findings.

Generation and persistence of S1 IgG and neutralizing antibodies in post-COVID-19 patients.

BACKGROUND: Antibody-mediated immune response plays an important role in protection against reinfection. In the case of SARS-CoV-2 infection, the maximum duration of antibody response is still unknown. In this work, the generation of neutralizing  antibodies (NAbs) and IgG antibodies against the S1 subunit (S1 IgG ) of SARS-CoV-2 and their possible duration were determined through decay models. METHODS: 132 participants with SARS-CoV-2 infection were classified according to the severity of the disease. Seroconversion and persistence of S1 IgG antibodies and NAbs were determined by ELISA, samples were taken at two different times post-infection and duration of those antibodies was estimated using Linear Mixed Models (LMMs). RESULTS: The highest amount of S1 IgGs antibodies was associated with age (41 years or older), greater severity of COVID-19 and male gender. NAbs production was associated with the same variables, except for age. The percentage of NAbs decay is higher in the asymptomatic group (P = 0.033), while in S1 IgG antibodies decay, no statistical difference was found between the 4 severity groups. An exponential decay model was built by using a LMM and similarly, two dispersion regions where constructed. The duration of S1 IgG antibodies was 744 days (668-781) for first region and 744 days (453-1231) for the second. Regarding NAbs, an adaptative LMM was used to model a logistic function, determining a duration of 267 days (215-347). CONCLUSION: Humoral immunity to SARS-CoV-2 infection depends on the severity of the disease, gender and age. This immune response could be long-lasting as for other coronaviruses.

Time-Slotted Spreading Factor Hopping for Mitigating Blind Spots in LoRa-Based Networks.

It has been demonstrated that LoRa-based wide area networks (WANs) can cover extended areas under harsh propagation conditions. Traditional LoRaWAN solutions based on single-hop access face important drawbacks related to the presence of blind spots. This paper aims to tackle blind spots and performance issues by using a relaying approach. Many researchers investigating multi-hop solutions consider a fixed spreading factor (SF). This simplifies synchronization and association processes, but does not take advantage of the orthogonality between the virtual channels (i.e., frequency, SF) that help to mitigate blind spots. This paper proposes a time-slotted spreading factor hopping (TSSFH) mechanism that combines virtual channels and time slots into a frame structure. Pseudo-random scheduling is used inside blind spots, which simplifies the end-devices' communication process and network organization. The results show how collisions decrease inside blind spots when more communication opportunities become available as more relaying nodes can be listening in different cells (i.e., frequency, SF-offset, time-offset). This has a direct impact on the collision-free packet delivery ratio (PDR) metric, which improves when more listening windows are opened, at the expense of faster battery depletion.

Oil bioremediation in soils contaminated with oil spills in tropical environments.

Bioremediation techniques like bioaugmentation and/or biostimulation are an economical and environmentally friendly procedure which emerged as the most advantageous methodology for treatment of contaminated sites by oil spills pollutants. This research uses a tropical soil contaminated with oil based drilling fluids (OBMs) and drill cuttings were evaluating at laboratory scale. Seven treatments were implemented separately: (C) control; (A) natural attenuation; (B) compost (Bs) nutrients; (BsT) nutrients and tween 80; (BsTL) nutrients, tween 80, leonardite, and (BL) nutrients, tween 80, leonardite and d-limonene. For three months, changes in Total Petroleum Hydrocarbons (TPH) soil microbial counts and activity were monitored as indicators of biodegradation. In order to evaluate the efficiency of treatments in the microcosm experiments. After 90 days of incubation hydrocarbon biodegradation is 76.2% (C), 28.6% (A), 76.2% (B), 66.7% (Bs), 83.3% (BsT), 69% (BsTL) and 88.1% (BL), respectively. Scanning electron microscopy (SEM) of OBMs evidenced absence of heavy metals. Biodiversity analysis showed a decrease in bacterial diversity and a rise in tolerant genus of hydrocarbons such as Nocardiodes, Streptomyces, Dietzia and Advenella. The co-substrate and stimulants had synergistic effect on the biological degradation of hydrocarbons. This research suggests that the implementation of bioaugmentation and biostimulation methods will be used a larger scale in contaminated sites.

Postoperative Abdominal Bulge and Hernia Rates in Patients Undergoing Abdominally Based Autologous Breast Reconstruction: Systematic Review and Meta-Analysis.

ABSTRACT: Bulge and hernia may occur after abdominally based breast reconstruction. The purpose of this study is to provide an estimate of the effects that the type of flap used for breast reconstruction (ie, transverse rectus abdominis muscle [TRAM] vs muscle-sparing [MS]-2 TRAM vs DIEP) has on the postoperative development of both abdominal bulge and abdominal hernia, taking into consideration the method of donor site closure (ie, with mesh vs without mesh), based on the available literature. Twenty-eight studies met the inclusion criteria and were included in the systematic review. From these, 9 studies were comparative and suitable for meta-analysis. The results showed that, for unilateral breast reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flap without mesh, MS-2 TRAM flap with mesh, and DIEP flap without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flap without mesh, and TRAM flap with mesh, whereas for bilateral reconstructions, there was no statistically significant difference in hernia/bulge rates in the following techniques: MS-2 TRAM flaps with mesh and DIEP flaps without mesh, and they showed significantly lower hernia/bulge rates compared with TRAM flaps without mesh, TRAM flaps with mesh, and MS-2 TRAM flaps without mesh.

Methanogens and Iron-Reducing Bacteria: the Overlooked Members of Mercury-Methylating Microbial Communities in Boreal Lakes.

Methylmercury is a potent human neurotoxin which biomagnifies in aquatic food webs. Although anaerobic microorganisms containing the hgcA gene potentially mediate the formation of methylmercury in natural environments, the diversity of these mercury-methylating microbial communities remains largely unexplored. Previous studies have implicated sulfate-reducing bacteria as the main mercury methylators in aquatic ecosystems. In the present study, we characterized the diversity of mercury-methylating microbial communities of boreal lake sediments using high-throughput sequencing of 16S rRNA and hgcA genes. Our results show that in the lake sediments, Methanomicrobiales and Geobacteraceae also represent abundant members of the mercury-methylating communities. In fact, incubation experiments with a mercury isotopic tracer and molybdate revealed that only between 38% and 45% of mercury methylation was attributed to sulfate reduction. These results suggest that methanogens and iron-reducing bacteria may contribute to more than half of the mercury methylation in boreal lakes.IMPORTANCE Despite the global awareness that mercury, and methylmercury in particular, is a neurotoxin to which millions of people continue to be exposed, there are sizable gaps in the understanding of the processes and organisms involved in methylmercury formation in aquatic ecosystems. In the present study, we shed light on the diversity of the microorganisms responsible for methylmercury formation in boreal lake sediments. All the microorganisms identified are associated with the processing of organic matter in aquatic systems. Moreover, our results show that the well-known mercury-methylating sulfate-reducing bacteria constituted only a minor portion of the potential mercury methylators. In contrast, methanogens and iron-reducing bacteria were important contributors to methylmercury formation, highlighting their role in mercury cycling in the environment.

Long-term anesthetic protocol in rats: feasibility in electrophysiology studies in visual prosthesis.

Electrical stimulation of excitable cells provides therapeutic benefits for a variety of medical conditions, including restoration of partial vision to those blinded via some types of retinal degeneration. To improve visual percepts elicited by the current technology, researchers are conducting acute electrophysiology experiments, mainly in cats. However, the rat can provide a model of a range of retinal diseases and possesses a sufficiently large eye to be used in this field. This article presents a long-term anesthetic protocol to enable electrophysiology experiments to further the development of visual prostheses. Six Long-Evans rats (aged between 14 and 16 weeks) were included in this study. Surgical anesthesia was maintained for more than 15 h by combining constant intravenous infusion of ketamine (24.0-34.5 mg/kg/h), xylazine (0.9-1.2 mg/kg/h), and inhaled isoflurane in oxygen (<0.5%). Overall heart rate, respiratory rate, and body temperature remained between 187-233 beats/min, 45-58 breaths/min, and 36-38 °C, respectively. Neural responses to 200-ms light pulses were recorded from the superior colliculus using a 32-channel neural probe at the beginning and before termination of the experiment. Robust responses were recorded from distinct functional types of retinal pathways. In addition, a platinum electrode was implanted in the retrobulbar space. The retina was electrically stimulated, and the activation threshold was determined to be 5.24 ± 0.24 µC/cm2 . This protocol may be used not only in the field of visual prosthesis research, but in other research areas requiring longer term acute experiments.

Risk factors associated with gastric cancer in Mexico: education, breakfast and chili.

BACKGROUND AND AIM: the aim of the study was to use a validated questionnaire to identify factors associated with the development of gastric cancer (GC) in the Mexican population. METHODS: the study included cases and controls that were paired by sex and ± 10 years of age at diagnosis. In relation to cases, 46 patients with a confirmed histopathological diagnosis of adenocarcinoma-type GC, as reported in the hospital records, were selected, and 46 blood bank donors from the same hospital were included as controls. The previously validated Questionnaire to Find Factors Associated with Gastric Cancer (QUFA-GC©) was used to collect data. Odds ratio (OR) and 95% confidence interval (IC) were estimated via univariate analysis (paired OR). Multivariate analysis was performed by logistic regression. A decision tree was constructed using the J48 algorithm. RESULTS: an association was found by univariate analysis between GC risk and a lack of formal education, having smoked for ≥ 10 years, eating rapidly, consuming very hot food and drinks, a non-suitable breakfast within two hours of waking, pickled food and capsaicin. In contrast, a protective association against GC was found with taking recreational exercise and consuming fresh fruit and vegetables. No association was found between the development of GC and having an income that reflected poverty, using a refrigerator, perception of the omission of breakfast and time period of alcoholism. In the final multivariate analysis model, having no formal education (OR = 17.47, 95% CI = 5.17-76.69), consuming a non-suitable breakfast within two hours of waking (OR = 8.99, 95% CI = 2.85-35.50) and the consumption of capsaicin ˃ 29.9 mg capsaicin per day (OR = 3.77, 95% CI = 1.21-13.11) were factors associated with GC. CONCLUSIONS: an association was found by multivariate analysis between the presence of GC and education, type of breakfast and the consumption of capsaicin. These variables are susceptible to intervention and can be identified via the QUFA-GC

[Validation of an ammonia breath test for the diagnosis of Helicobacter pylori infection in patients with dyspepsia at Hospital Cayetano Heredia]. / Validación de una prueba de amonio en aliento para el diagnóstico de la infección por Helicobacter pylori en pacientes del Hospital Cayetano Heredia.

Objetive: To determine the diagnostic validity of an ammonia breath test for Helicobacter pylori infection in patients who undergo an upper gastrointestinal endoscopy at Hospital Cayetano Heredia. MATERIAL AND METHODS: From April to December 2014, 155 patients were evaluated with the ammonia breath test and compared with a histological evaluation of the gastric biopsies as the gold standard. Data were evaluated using Microsoft Excel and STATA 14 to build a ROC curve. RESULTS: The patients were predominantly female (71%), with a median age of 53 years (18-84) and a Helicobacter pylori prevalence of 51.6%. The ammonia breath test, when compared to the gastric biopsy has a 70% sensitivity, 36% specificity, 53.8% positive predictive value, 36% negative predictive value, 1.15 positive likelihood ratio and 0.75 negative likelihood ratio. According to the ROC curve, there is not an optimal cut off value and the area under the curve was 0.5517. CONCLUSIONS: The ammonia breath test evaluated on this study does not have diagnostic accuracy and is not recommended as a diagnostic tool for Helicobacter pylori infection.

[Fulminating ischemic hepatitis induced by severe cardiac dysfunction: case report]. / Hepatitis isquémica fulminante inducida por disfunción cardiaca severa: reporte de caso.

Ischemic Hepatitis is an uncommon entity in daily clinical practice with a prevalence of 0.16 to 0.5% among patients admitted to a critical care unit, associated with an approximate 60% mortality rate. This liver disease is characterized by a rapid and marked increase (more than 20 times the normal value) of the level of transaminases secondary to a severe and persistent hepatic hypoperfusion caused by multiple etiologies, which may be transient when the triggering cause is timely identified and appropiately treated. The case of an elderly adult patient with a clinical, epidemiological and biochemical profile compatible with ischemic hepatitis secondary to severe cardiac dysfunction is presented below.

[Autoimmune pancreatitis type 1: a case report]. / Pancreatitis autoinmune tipo 1: reporte de caso.

Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis.

[Duodenal melanoma: a case report and review of the literature]. / Melanoma duodenal: reporte de caso y revisión de la literatura.

We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions.

[Gastric hemangioma as a cause of upper gastrointestinal bleeding]. / Hemangioma gástrico como causa de hemorragia digestiva alta.

Gastric hemangioma as a cause of upper gastrointestinal bleeding (UGIB) is a rare event. We present the case of an 83 years old male with a history of abdominal pain, vomiting and melena, along with an 8 Kg weight loss. The upper gastrointestinal endoscopy showed an elevated, ulcerated lesion in the gastric antrum with a visible vessel, for which he receives endoscopic therapy. In the abdominal computed tomography, a contrast enhancing, well-circumscribed mass attached to the gastric wall is observed. Due to the persistence of the UGIB, the patient suffers hemodynamic decompensation and undergoes exploratory laparotomy, where a vascularized mass is found. The pathology report informs a gastric cavernous hemangioma.

[Validation of the rapid urease test for the detection of Helicobacter pylori in a Peruvian hospital]. / Validación del test rápido de la ureasa para la detección del Helicobacter pylori en el Hospital Nacional Cayetano Heredia, Lima, Perú.

OBJECTIVE: To validate a rapid urease test (RUT) in Cayetano Heredia Hospital (HCH) in Lima, Peru. MATERIALS AND METHODS: This is a prospective observational study that included 181 patients over 18 years old with dyspeptic symptoms. All of them underwent upper gastrointestinal endoscopy at the Department of Gastroenterology at HCH. They had not received, during the last four weeks, proton pump inhibitors (PPIs), bismuth or antibiotics. Two biopsies of antrum were taken, one to perform the TRU (Sensibacter pylori test®) and the other one for pathology, in order to determine by both methods the presence of H. pylori infection. TRU's results were compared with pathology ́s (gold standard). RESULTS: 181 patients, average age 52.8±13.5 years, were evaluated. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) at 20 minutes were 86.8%, 98.5%, 81.5% and 99% and at 24 hours 97.3%, 99.5%, 95.7% y 99.1% respectively. CONCLUSION: The rapid urease test is a reliable, accessible and easy to apply test for the diagnosis of H. pylori infection.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis.

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

[Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report]. / Porfiria cutánea tarda como manifestación extrahepática de hepatitis Ccrónica: reporte de un caso.

The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.