Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B.

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B. / Asociación Mexicana de Hepatología A.C. Guía Clínica de Hepatitis B.

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

[Thickening of the colon and terminal ileum documented with computer tomography and its correlation with colonoscopic findings at a third-level hospital]. / Engrosamiento colónico y de íleon terminal documentado por tomografía computarizada y su correlación con hallazgos colonoscópicos en un hospital de tercer nivel.

BACKGROUND: Tomographic finding of thickening of colon and terminal ileum and its correlation with colonoscopic findings has been poorly studied. Various radiographic patterns of intestinal thickening suggestive of benign disease have been described, but they cannot completely rule out malignancy. OBJECTIVE: To determine if a relationship exists between colonic wall or terminal ileum thickening documented by computed tomography with abnormal colonoscopic findings and colon cancer. METHODS: Retrospective study of radiology database of a tertiary hospital identifying patients with report of thickening of terminal ileum or colon and have colonoscopy performed. It was investigated the performance of endoscopic biopsies and histopathological outcome. RESULTS: We included 24 patients. The main site of colonic thickening on CT was sigmoid in 8 (33.3%) cases. The most common colonoscopic finding was colorectal tumor probably malignant in 7 (29.2%) patients, but adenocarcinoma was reported in 8 (33.3%) patients. There was a statistically significant relationship between colonic thickening and colorectal cancer (p < 0.001) but no statistically significant association was found between thickening and sigmoid colon cancer. There was statistical significant correlation between weight loss, melena, anemia, constipation, diarrhea, and hematochezia with diagnosis of cancer (p < 0.01). CONCLUSIONS: The finding of thickening of colon documented by computed tomography is significantly associated with the presence of colorectal carcinoma. Additional colonoscopy must always be performed in an attempt to elucidate the origin of this thickening.

[Descriptive analysis of 41 patients with a pyogenic hepatic abscess]. / Análisis descriptivo de 41 pacientes con absceso hepático piógeno.

OBJECTIVE: To identify the clinical, laboratory and imaging characteristics of 41 patients with a pyogenic hepatic abscess. RESEARCH DESIGN: Retrospective, descriptive. SETTING: Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. STUDY UNITS: 41 patients with a pyogenic hepatic abscess. MAIN MEASUREMENTS: The measurement of the following variables was carried out: previous background, period of evolution, symptoms, signs, laboratory studies, imaging, treatment, complications and evolution. RESULTS: 41 patients were evaluated. The average age of the group was 52.5 years (SD = 14.3) and 30 (73%) were male. The most frequent associated disease was diabetes mellitus which was found in 15 patients (37%). The most frequent clinic data were: fever in 38 patients (93%), chills in 26 (63%) and pain in the upper right quadrant in 25 (61%). The most common source of the formation of the abscess was of biliary origin in six patients (15%) and the serum amoeba test was positive in 10% of the cases. The localization of the abscess in our series was as follows: 33 cases (81%) were from the right lobe, five (12%) from the left lobe, three (7%) from both lobes and 87% were solitary. The germ found more frequently was E. coli in five patients (15%). As for the treatment, puncture by computed tomography was carried out in 25 patients (61%), four patients had a surgery and the rest were treated only with antibiotics. Regarding mortality, only one patient died (2%) due to a septic shock. CONCLUSIONS: An association with diabetes mellitus was identified and the most frequent origin was biliary, these data have already been reported in other studies. On the other hand, mortality and morbidity rates in our study were low.

[Physiopathology of nephropathy studied with contrast media]. / Fisiopatología de la nefropatía por medio de contraste.

For the technological advances in diagnostic and therapeutic procedures, the use of intravenous contrast media in the hospital is more and more frequent. It can produce acute renal failure secondary to its nephrotoxicity known as contrast media nephropathy. This review describes the pathophysiologic mechanisms of contrast media injury, including cytotoxicity caused by hyperosmoloarity of contrast media, the hemodynamic factors and the role of the renin-angiotensin system, prostaglandins, oxygen free radicals, endothelin-1, adenosine, nitric oxide and others. The understanding of this information is of vital importance for the development of prophylactic strategies for contrast media nephropathy.

[Pathogenesis of myasthenia gravis]. / Patogénesis de la miastenia gravis.

Myasthenia gravis is a neuromuscular, autoimmune, and acquired disturbance characterized by weakness and fatigue of skeletal muscles. During the past two decades, remarkable progress has been made in the understanding of myasthenia gravis, and the new knowledge has been applied directly to the clinical diagnosis and treatment of this formerly severe disease. Myasthenia gravis is undoubtedly the most thoroughly understood of all human autoimmune diseases and has served as a model for the elucidation of mechanisms underlying other autoimmune disorders. In this review we mention the most important physiopathological aspects and its application in the clinic practice.

[Hyperhomocysteinaemia: physiopathology and medical implications]. / Hiperhomocistinemia: fisiopatología e implicaciones médicas.

Homocysteine is an intermediate aminoacid result of the conversion of methionine to cysteine. Homocystinuria or the hyperhomocysteinaemia are the most frequently related disorders of this aminoacid, being the former an autosomic recessive alteration, whereas the latter is conditioned by multiple factors, being the most important the genetic and nutritional factors. In the last years this alteration has regained special interest because of its increasing role in the thrombotic pathologies and the identification that hyperhomocysteinaemia represents an independent risk factor for the accelerated atherogenesis of multiple diseases. In this review physiopathological aspects and clinical implications of hyperhomocysteinaemia are mentioned as well as its diagnoses and treatment.