Consulta hepatología pediátrica pretrasplante: importancia de la misma en el programa de trasplante hepático pediátrico / Check pretransplant pediatric hepatology: importance of it in the pediatric liver transplant program

Introducción: La consulta pediátrica pretrasplante es fundamental en un programa de trasplante hepático, allí se evalúan diferentes aspectos como, la indicación del trasplante, el estadio de la enfermedad, comorbilidades asociadas y nos permite corregir las mismas ya que estas influirán en la sobrevida postrasplante. El objetivo fue conocer las características de la población pediátrica evaluada como posibles candidatos a trasplante. Pacientes y Métodos: Se realizó estudio retrospectivo. Se incluyeron todos los pacientes pediátricos que fueron referidos para valoración como posibles candidatos a trasplante hepático desde 2005 al 2010. Resultados: Se estudiaron 152 pacientes, 65 (43%) del sexo masculino y 87 (57%) del sexo femenino, con edad promedio de 6,16 + 5,24 años. Al momento del estudio 61 pacientes no tenían indicación de trasplante, 35 se encontraban en evaluación, 28 se trasplantaron, 21 fallecieron y 7 fueron referidos. Las indicaciones de trasplante fueron: disminución de la síntesis hepática 20, síndrome hepatopulmonar 2, hemorragia digestiva 3, síndrome hepatorrenal 2 y un fallo hepático subagudo. De los pacientes trasplantados 16 presentaban algún grado de desnutrición previa, 3 presentaban ascitis, 7 habían presentado hemorragias digestivas, 6 presentaban infecciones (urinarias, respiratorias y absceso dentarios), 24 tenían patologías odontológicas. Los 28 pacientes tenían esquema de inmunización incompleto durante la evaluación. Todos estos problemas fueron tratados previo al trasplante. Conclusión: La consulta pediátrica de hígado pretrasplante es de suma importancia ya que en ella se identifican los pacientes con indicación de trasplante además de valorar de forma integral al paciente, lo que nos permite conocer aquellas morbilidades asociadas a la enfermedad hepática terminal y resolverlas previo al trasplante, mejorando su posterior sobrevida.

Introduction: Pediatric liver pre-transplantation consultation is very important in a liver transplant program, there different aspects are assessed, such as the indication the transplant, disease stage, associated comorbidities and it allows us to correct them as they will affect the survival after transplantation. The objective was to determine the characteristics of the pediatric population evaluated as potential transplant candidates. Patients And Methods: A retrospective study was performed. All pediatric patients who were referred for evaluation as potential candidates for liver transplantation from 2005 to 2010 were included. RESULTS: 152 patients were studied, 65 (43%) were males and 87 (57%) females, mean age 6.16 ± 5.24 years. At the time of the study 61 patients had no indication for transplant, 35 were been evaluated, 28 were transplanted, 21 died and 7 were referred. The indications for transplantation were: decreased hepatic synthesis 20, hepatopulmonary syndrome 2, gastrointestinal bleeding 3, hepatorenal syndrome 2 and one subacute liver failure. Of the transplanted patients 16 had some degree of previous malnutrition, 3 had ascites, 7 had presented gastrointestinal bleeding, 6 had infections (urinary, respiratory and dental abscess), and 24 had dental pathologies. The 28 patients had an incomplete immunization schedule during the evaluation. All these problems were treated prior to transplantation. Conclusion: the pediatric liver pretransplantation consultation is of most importance since in it we identify patients with indication for transplantation; in addition, we can completely asses the patient allowing us to recognize morbidities associated with the end stage liver disease and resolve them before transplantation, improving subsequent survival.

The bradykinin type 2 receptor BE1 polymorphism and ethnicity influence systolic blood pressure and vascular resistance.

We examined the effect of -58 C/T and BE1 +9/-9 polymorphisms in the bradykinin B2 receptor gene on forearm vascular resistance (FVR) before and during intrabrachial artery infusion of the B2 receptor-, endothelium-dependent agonist bradykinin and the endothelium-independent agonist sodium nitroprusside in 228 normotensive subjects. In 166 white Americans, systolic blood pressure (SBP) and pulse pressure were highest in the BE1 +9/+9 group (118+/-2 and 51+/-2 mm Hg, respectively; P<0.05 versus -9/-9 for either), intermediate in the +9/-9 group (114+/-1 and 49+/-1 mm Hg, P<0.05 versus -9/-9 for pulse pressure), and lowest in the -9/-9 group (110+/-2 and 44+/-2 mm Hg). In 62 black Americans, FVR was 25% higher in the BE1 +9/+9 group compared with the BE1 +9/-9 and -9/-9 groups at baseline (P=0.038) or during bradykinin (P=0.03). Increased SBP or vascular resistance may contribute to increased left ventricular mass reported previously in individuals with the BE1+9/+9 genotype.

Antibodies to dietary antigen in serum from patients with sickle cell anemia.

The levels of antibodies of the IgG, IgA and IgM isotypes reacting against ovoalbumin (OVA), gliadin (GL) and cow's milk proteins (CMP), were determined by ELISA in sera from a group of adult patients with sickle cell anemia (SCA) bearing homozygous Ss hemoglobinopathy and from matched health donors. Only patients with steady-state disease were included in the study. Increased amounts of IgG and IgA reacting with OVA, GL and CMP were observed in the group of patients as compared with the controls. In contrast, the levels of IgM antibodies against each of the three dietary antigens were similar in patients and controls. Increased levels of IgG and IgA antibodies against dietary antigens in SCA may result from enhanced permeability of the gut mucosa to macromolecules of dietary origin as a consequence of microinfarctions, chronic polyclonal B cell activation and/or diminished inhibitory control of antibody synthesis.

Levels of tumor necrosis factor alpha/cachectin (TNF alpha) in sera from patients with sickle cell disease.

Serum levels of tumor necrosis factor alpha/cachectin (TNF alpha) were studied in a group of adult patients with sickle cell disease (SCD), which include 31 patients with homozygous SS hemoglobinopathy and 10 patients bearing double heterozygous SC hemoglobinopathy and in their matched normal controls. All patients tested did not show any form of crisis for at least 4 weeks prior to the extraction of the sample. The amount of TNF alpha in serum was quantitated by means of an immunoenzymatic assay with a lower limit of detection of 25 pg/ml. The percentage of sera with detectable levels of TNF alpha was significantly increased in SCD patients as compared with the normal controls. Mean TNF alpha values in individuals with detectable levels of the cytokine were also significantly higher in the whole group of SCD patients and in patients bearing either SS or SC hemoglobinopathies than in the control group. An inverse correlation was observed between the percentages of Hb F and the levels of TNF alpha found in the sera from the patients.

[Relation of fat consumption to colorectal cancer mortality in a Venezuelan population]. / Relación entre el consumo de grasas y la mortalidad por cáncer colorrectal en la población venezolana.

Epidemiologic and experimental studies have pointed to an association between fat intake and colorectal carcinogenesis. In the present work we have studied the correlation between fat intake and mortality caused by colorectal cancer in the venezuelan population. For this purpose, we have calculated the correlation coefficients between the ingestion of total fat, visible fat (vegetable oil, margarine, butter, mayonnaise) as well as non-visible fat (that contained in other foods) and the mortality rate by colorectal cancer with data from nine venezuelan states and geographical regions. The highest lipid consumption and mortality rates were observed in the more developed states. There was a positive and significant correlation between total as well as visible fat consumption and colorectal cancer mortality (r = 0.756 p < 0.02, and r = 0.958, p < 0.001; respectively). In contrast, there was no significant correlation between the consumption of non visible fats and colorectal mortality (r = 0.543, p < 0.05). More than 80% of the visible fats ingested in Venezuela are constituted by vegetable oil and margarine, which contain a high proportion of polyunsaturated fatty acids. Based on the above, is possible to infer that colorectal carcinogenesis in Venezuela is associated to the uptake of unsaturated fat, and that measures leading to the prevention of this disease should be based on the reduction in the consumption of total and unsaturated lipids.