Epstein-Barr Virus Infection Is Associated with Elevated Hepcidin Levels.

EBV and Helicobacter pylori (H. pylori) cause highly prevalent persistent infections as early as in childhood. Both pathogens are associated with gastric carcinogenesis. H. pylori interferes with iron metabolism, enhancing the synthesis of acute-phase proteins hepcidin, C-reactive protein (CRP), and α-1 glycoprotein (AGP), but we do not know whether EBV does the same. In this study, we correlated the EBV antibody levels and the serum levels of hepcidin, CRP, and AGP in 145 children from boarding schools in Mexico City. We found that children IgG positive to EBV antigens (VCA, EBNA1, and EA) presented hepcidin, AGP, and CRP levels higher than uninfected children. Hepcidin and AGP remained high in children solely infected with EBV, while CRP was only significantly high in coinfected children. We observed positive correlations between hepcidin and EBV IgG antibodies (p < 0.5). Using the TCGA gastric cancer database, we also observed an association between EBV and hepcidin upregulation. The TCGA database also allowed us to analyze the two important pathways controlling hepcidin expression, BMP−SMAD and IL-1ß/IL-6. We observed only the IL-1ß/IL-6-dependent inflammatory pathway being significantly associated with EBV infection. We showed here for the first time an association between EBV and enhanced levels of hepcidin. Further studies should consider EBV when evaluating iron metabolism and anemia, and whether in the long run this is an important mechanism of undernourishment and EBV gastric carcinogenesis.

Hepcidin and other indicators of iron status, by alpha-1 acid glycoprotein levels, in a cohort of Mexican infants.

The purpose of this study was to describe the changes in iron status indicators at 6 and 12 months of age, controlling by inflammation by measuring alpha-1 acid glycoprotein (AGP). This longitudinal study included 48 healthy-term singleton infants with birth weight ≥ 2500 g, born in hospitals of the Mexican Institute for Social Security. Complete blood count, ferritin, soluble transferrin receptor (sTfR), hepcidin, and AGP were measured in blood at 6 and 12 months of age. sTfR/ferritin ratio and total body iron (TBI) stores were calculated. Hemoglobin and sTfR/ferritin ratio increased with age, while ferritin and TBI decreased. In infants without inflammation, hepcidin, sTfR, and MVC did not show significant changes from 6 to 12 months of age, while ferritin and TBI decreased. In infants with inflammation, hepcidin, TBI, and ferritin levels increased, while hemoglobin and sTfR/ferritin ratio decreased. MVC and sTfR did not change significantly in the presence or absence of inflammation. Hepcidin concentration correlated positively and significantly with ferritin and TBI stores and showed significant negative correlation with sTfR/ferritin ratio. Our study showed that, in absence of inflammation and ID, during the first year of life, physiological changes occur in hemoglobin and ferritin levels as well as in indicators derived from ferritin and sTfR; in contrast, hepcidin and sTfR did not show significant change. However, hepcidin concentration was lower in infants with ID and was higher when inflammation was present, supporting that infants have a functional hepcidin response to changes in iron stores.

Present and past Helicobacter pylori infection in Mexican school children.

BACKGROUND: In developing countries, more than 50% of children have serological evidence of Helicobacter pylori infection. However, serological tests for H. pylori did not differentiate between active and past infection. The objectives of this study were to estimate the frequency of active and past H. pylori infection utilizing functional urea breath test (UBT) and serological tests and evaluate factors associated with the infection. METHODS: A total of 675 school children, 6-13 years of age, participated. UBT was performed to detect active H. pylori infection. Blood samples were obtained to determine iron status and Immunoglobulin G (IgG) responses to the H. pylori whole-cell and to Cag A antigens by antigen-specific enzyme-linked immunosorbent assays. Weight, height, and sociodemographic characteristics were recorded. RESULTS: A total of 37.9% (95% Confidence Intervals (CI): 34.2-41.6) of school children had active or past H. pylori infection; of them, 73.8% (CI95% 68.4-79.2) were carrying CagA-positive strain, 26.5% (CI95% 23.2-29.8) had active infection, and 11.4% (95%CI: 9.0-13.8) had evidence of past H. pylori infection. School children with iron deficiency and low height for age had higher risk of H. pylori infection: [OR to active or past infection was 2.30 (CI 95% 1.01-5.23) and to active infection it was 2.64 (CI 95% 1.09-6.44)] compared to school children with normal iron status and height for age or with normal iron status but low height for age or with iron deficiency and normal height for age. CONCLUSIONS: The estimated prevalence of infection depends of the test utilized. Frequency of H. pylori infection and carrying CagA-positive strains was high in this population. Malnutrition was associated with active H. pylori infection.

Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis.

AIM: Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis. METHODS: Patients with liver cirrhosis were selected independent of the etiology of the disease. All patients underwent a complete clinical history, and only patients with decompensated hepatic cirrhosis were included. Psychometric tests were applied to evaluate the presence of MHE along with the Chronic Liver Disease Questionnaire. Appetite was measured by verbal and visual analog scales. RESULTS: One hundred and twenty-five patients were included with a median age of 56.0 years. They were classified according to the Child-Pugh index as A, (n = 56), B, (n = 51) and C (n = 18). Prevalence of MHE was 44.0% (n = 55). In patients with MHE, a significant reduction was observed in domains of activity (3.3 [2.0] vs 4.8 [2.8]), fatigue (3.2 [2.0] vs 3.9 [2.3]), systemic symptoms (3.8 [2.0] vs 4.8 [1.7]), emotional function (3.6 [1.9] vs 4.0 [1.9]) and global scoring (3.7 [1.7] vs 4.3 [1.8]) when compared with non-MHE patients (n = 70). Twenty-two percent of the patients with MHE reported little appetite compared with 11% in the non-MHE group. CONCLUSION: The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis.

Effect of supplementation with ferrous sulfate or iron bis-glycinate chelate on ferritin concentration in Mexican schoolchildren: a randomized controlled trial.

BACKGROUND: Iron deficiency is one of the most common nutritional deficiencies worldwide. It is more prevalent when iron requirements are increased during pregnancy and during growth spurts of infancy and adolescence. The last stage in the process of iron depletion is characterized by a decrease in hemoglobin concentration, resulting in iron deficiency anemia. Iron deficiency, even before it is clinically identified as anemia, compromises the immune response, physical capacity for work, and intellectual functions such as attention level. Therefore, interventions addressing iron deficiency should be based on prevention rather than on treatment of anemia. The aim of this study was to compare short- and medium-term effects on ferritin concentration of daily supplementation with ferrous sulfate or iron bis-glycinate chelate in schoolchildren with iron deficiency but without anemia. METHODS: Two hundred schoolchildren from public boarding schools in Mexico City who had low iron stores as assessed by serum ferritin concentration but without anemia were randomly assigned to a daily supplement of 30 mg/day of elemental iron as ferrous sulfate or iron bis-glycinate chelate for 12 weeks. Iron status was evaluated at baseline, one week post-supplementation (short term), and 6 months (medium term) after supplementation. RESULTS: Ferritin concentration increased significantly between baseline and post-supplementation as well as between baseline and 6 months after supplementation. One week post-supplementation no difference was found in ferritin concentration between iron compounds, but 6 months after supplementation ferritin concentration was higher in the group that received bis-glycinate chelate iron. However, there is no difference in the odds for low iron storage between 6 months after supplementation versus the odds after supplementation; nor were these odds different by type of supplement. Hemoglobin concentration did not change significantly in either group after supplementation. CONCLUSIONS: Supplementing with 30 mg/d of elementary iron, either as ferrous sulfate or iron bis-glycinate chelate for 90 days, showed positive effects on increasing ferritin concentration in schoolchildren with low iron stores, and this effect persisted 6 months after supplementation.

Recreational physical activity is inversely associated with asymptomatic gallstones in adult Mexican women.

BACKGROUND AND RATIONALE: Epidemiologic research suggests that physical activity (PA) reduces the risk of chronic diseases including gallstones. OBJECTIVE: This study explores the association between recreational physical activity (RPA) and risk of asymptomatic gallstones (AG) in adult Mexican women. MATERIAL AND METHODS: We performed a cross-sectional analysis of women from the Health Workers Cohort Study. The study population included Mexican women aged 17-94 years, with no history of gallstone (GS) or cholecystectomy. A self-administered questionnaire was used to collect information on weight change, gynecological health history, cholesterol-lowering medications and diuretics, history of diabetes mellitus type 2 (DM2), PA and diet. PA was calculated in minutes/day, minutes/week and Metabolic Equivalents (METs)/week. Gallstone diagnosis was performed using real-time ultrasonography. The association between RPA and risk of AG was evaluated using multivariate logistic regression models. Results. Of the 4,953 women involved in the study, 12.3% were diagnosed with AG. The participants with AG were significantly older, had a higher body mass index, and had a higher prevalence of DM2 than those without AG. The participants with > 30 min/day of RPA had lower odds of AG (OR = 0.80; 95% CI: 0.65-0.97; P = 0.03), regardless of other known risk factors for gallstone disease. Furthermore, we observed an inverse relationship between RPA time and AG risk, especially in women doing more than 150 min a week of RPA (OR = 0.76; 95%CI: 0.61- 0.95; P = 0.02). CONCLUSION: These findings support the hypothesis that RPA may protect against AG, although further prospective investigations are needed to confirm this association.

Natural history of Helicobacter pylori infection in Mexican schoolchildren: incidence and spontaneous clearance.

OBJECTIVES: The aim of the present study was to estimate the incidence and spontaneous clearance rate of Helicobacter pylori infection and the effect of some variables on these outcomes in schoolchildren. METHODS: From May 2005 to December 2010, 718 schoolchildren enrolled in 3 public boarding schools in Mexico City participated in the follow-up. At the beginning of the study and every 6 months thereafter, breath samples were taken to detect H pylori infection; blood samples and anthropometric measurements were taken to evaluate nutritional status. Data on sociodemographic characteristics were collected. RESULTS: The prevalence of H pylori infection was 38%. The incidence rate was 6.36%/year. Schoolchildren with anemia or iron deficiency at the beginning of the study (who received iron supplements) showed a higher infection acquisition rate than those with normal iron nutritional status, hazard ratio (HR) 12.52 (95% confidence interval [CI] 4.01%-39.12%), P < 0.001 and HR 2.05 (95% CI 1.09%-3.87%), P = 0.027, respectively. The spontaneous clearance rate of the infection was 4.74%/year. The spontaneous clearance rate was higher in children who had iron deficiency (who received iron supplements), HR 5.02 (95% CI 1.33%-18.99%), P = 0.017, compared with those with normal nutritional iron status. It was lower in schoolchildren with ≥ 2 siblings compared with schoolchildren with 1 or no siblings, HR 0.23 (95% CI 0.08%-0.63%), P = 0.004. CONCLUSIONS: H pylori infection status is dynamic in schoolchildren. Variables related to health status and infection transmission, such as iron status and number of siblings, are important for the incidence and spontaneous clearance of H pylori infection.

Ovarian morphology and endocrine function in polycystic ovary syndrome.

PURPOSE: To assess the relationship between ovarian morphology, hormonal levels and anthropometrical characteristics in a group of patients with polycystic ovary syndrome (PCOS). METHODS: This prospective, cross-sectional study included 82 patients with diagnosis of PCOS and 21 women with regular menstrual cycles without hyperandrogenism. They were submitted to endovaginal pelvic ultrasound. Anthropometric measures and hormonal levels of LH, FSH, insulin, total testosterone (T), free T, dehydroepiandrosterone and dehydroepiandrosterone sulfate were evaluated. The morphology of polycystic ovary (PCO) was considered when 12 or more follicles, less than 10 mm in diameter, in one or both ovaries, were observed. PCOS patients were divided into two groups: with PCO (n = 51) and without PCO (n = 31). RESULTS: In 51 out of 82 (62%) patients with PCOS, an image of PCO was observed. PCOS Patients with PCO showed a significantly greater body mass index and hip perimeter than PCOS patients without PCO. Higher levels of total T and free T were found in PCOS patients with PCO compared to those without PCO. CONCLUSION: PCOS patients with PCO on ultrasound present greater hyperandrogenism and obesity than PCOS patients without PCO. The presence of PCO appears to indicate a major clinical alteration of PCOS.

Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis.

Minimal hepatic encephalopathy (MHE) corresponds to the earliest stage of hepatic encephalopathy (HE). MHE does not present clinically detectable neurological-psychiatric abnormalities but is characterized by imperceptible neurocognitive alterations detected during routine clinical examination via neuropsychological or psychometrical tests. MHE may affect daily activities and reduce job performance and quality of life. MHE can increase the risk of accidents and may develop into overt encephalopathy, worsening the prognosis of patients with liver cirrhosis. Despite a lack of consensus on the therapeutic indication, interest in finding novel strategies for prevention or reversion has led to numerous clinical trials; their results are the main objective of this review. Many studies address the treatment of MHE, which is mainly based on the strategies and previous management of overt HE. Current alternatives for the management of MHE include measures to maintain nutritional status while avoiding sarcopenia, and manipulation of intestinal microbiota with non-absorbable disaccharides such as lactulose, antibiotics such as rifaximin, and administration of different probiotics. This review analyzes the results of clinical studies that evaluated the effects of different treatments for MHE.

A randomized controlled trial of double versus triple therapy with amantadine for genotype 1 chronic hepatitis C in Latino patients.

BACKGROUND: With only a third of Latinos achieving sustained virologic response (SVR), there is a need for enhanced HCV treatment. Amantadine has been proposed to improve response rates in addition to standard therapy with peginterferon alpha and ribavirin. Our objective is to evaluate whether triple therapy with amantadine improves SVR rates in this special population. METHOD: Treatment-naïve Latino subjects with HCV genotype 1 infection were randomized to receive peginterferon alpha-2a plus weight-based ribavirin for 48 weeks (double therapy) or the same regimen plus amantadine 200 mg daily (triple therapy). The primary endpoint was SVR. Predictors of liver fibrosis using APRI and Forns indices were also evaluated. RESULTS: We enrolled 124 patients with chronic hepatitis C genotype 1. Sixty-three received conventional therapy and 61 patients had triple therapy with amantadine. SVR at week 72 was achieved in 25 patients (39.7%) vs. 26 patients (42.6%) in the double and triple regimen, respectively (p=0.561). After multivariate analysis, advanced fibrosis, obesity, and low pretreatment ALT levels were associated with non-response in both groups (p=0.0234, p=0.0012, p=0.0249, respectively). APRI values delimited an area under the ROC curve (AUROC) of 0.724 and Forns index with AUROC of 0.733. There was no difference between both indices in predicting significant fibrosis (Knodell index: F3-F4). CONCLUSION: Our study demonstrates that the addition of amantadine to standard treatment of chronic HCV does not improve SVR rates in Latino patients with genotype 1. Further research to improve response rates in this special population is needed.

Prevalence of polycystic ovary syndrome and related disorders in mexican women.

BACKGROUND/AIMS: Polycystic ovary syndrome (PCOS) has been found to affect 4-8% of women of reproductive age; however, in Mexican-Americans a prevalence of 12.8% has been reported. This study determines the prevalence of PCOS in a sample of Mexican women. METHODS: This prospective cross-sectional study included 150 female Mexican volunteers aged 20-45 years. Menstrual cycles were recorded and hirsutism was graded. Pelvic ultrasound was performed and androgen levels were measured. PCOS was diagnosed by hyperandrogenism and/or hyperandrogenemia, and oligo-ovulation (NIH 1990 criteria), and also by 2 of 3 findings: oligo-ovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries (PCO) (Rotterdam 2003 criteria), excluding other disorders. RESULTS: Nine of the 150 women were diagnosed with PCOS, a prevalence of 6.0% (95% CI: 1.9-10.1%), according to NIH criteria. The ultrasound morphology added one patient to give ten PCOS patients, a prevalence of 6.6% (95% CI: 2.3-10.9%) according to Rotterdam criteria. All PCOS patients presented oligo-ovulation, 9 had hirsutism and 7 of them had acne. Eight of the 10 PCOS patients had morphologic characteristics of PCO. CONCLUSION: The prevalence of PCOS in Mexican women is approximately 6.0%, similar to other populations, but lower than 12.8% reported in Mexican-American women.

Association between Active H. pylori Infection and Iron Deficiency Assessed by Serum Hepcidin Levels in School-Age Children.

Hepcidin regulates iron metabolism. Its synthesis increases in infection and decreases in iron deficiency. The aim of this study was to evaluate the relationship between H. pylori infection and iron deficiency by levels of hepcidin in children. A total of 350 school-age children participated in this cross-sectional study. Determinations of serum ferritin, hemoglobin, hepcidin, C-reactive protein, and α-1-acid-glycoprotein were done. Active H. pylori infection was performed with a 13C-urea breath test. In schoolchildren without H. pylori infection, hepcidin was lower in those with iron deficiency compared to children with normal iron status (5.5 ng/mL vs. 8.2 ng/mL, p = 0.017); while in schoolchildren with H. pylori infection the levels of hepcidin tended to be higher, regardless of the iron nutritional status. Using multivariate analysis, the association between H. pylori infection and iron deficiency was different by hepcidin levels. The association between H. pylori and iron deficiency was not significant for lower values of hepcidin (Odds Ratio = 0.17; 95% Confidence Interval [CI] 0.02-1.44), while the same association was significant for higher values of hepcidin (OR = 2.84; CI 95% 1.32-6.09). This joint effect is reflected in the adjusted probabilities for iron deficiency: Individuals with H. pylori infection and higher levels of hepcidin had a probability of 0.24 (CI 95% 0.14-0.34) for iron deficiency, and this probability was 0.24 (CI 95% 0.14-0.33) in children without H. pylori infection and lower levels of hepcidin. In children with H. pylori infection and iron deficiency, the hepcidin synthesis is upregulated. The stimulus to the synthesis of hepcidin due to H. pylori infection is greater than the iron deficiency stimulus.

The utility of the 13C-methacetin breath test in predicting the long-term survival of patients with decompensated cirrhosis.

AIM: The 13C-methacetin breath test (13C-MeBT) is a noninvasive tool that allows evaluation of the functional activity of the liver and the prediction of liver cirrhosis. Nevertheless, there is no information on its potential utility to predict long-term survival in patients with liver disease. METHODS: Patients with cirrhosis were selected. All patients underwent a complete clinical assessment, standard biochemical tests, and 13C-MeBT at the beginning of the study. Death was recorded during the three years of follow-up. Survival curves were calculated by the Kaplan-Meier method, and Cox proportional risk models were used to identify predictive factors. The ability to classify the overall risk was assessed by the C statistic. RESULTS: One hundred and twenty-three patients were included. A significant inverse correlation was found between delta over baseline at the 15 min point (DOB15) after ingestion of 13C-methacetin and the Child-Pugh score (r = -0.411, p < 0.001). In multivariate analysis, DOB15 ≤ 4.5‰ was associated with mortality, [HR = 2.58 95% CI (1.17-5.69)]. In conclusion, our results confirm the utility of 13C-MeBT as a simple, noninvasive tool to quantitatively assess the liver's functional reserve and as a potential predictor of long-term survival in patients with decompensated cirrhosis.

Increased insulin levels independent of gestational overweight in women with preeclampsia.

BACKGROUND: The etiology of preeclampsia is unknown. It is controversial whether insulin resistance (IR) is present in preeclamptic patients, and it is unclear if hyperinsulinemia is dependent upon being overweight during pregnancy or on preeclampsia per se. METHODS: We performed a cross-sectional study in 140 pregnant patients and compared serum insulin concentrations. These women, 18-40 years old, were classified into four groups: 1) overweight patients with mild preeclampsia (n = 21), 2) overweight patients without preeclampsia (n = 23), 3) non-overweight patients with mild preeclampsia (n = 48), and 4) non-overweight patients without preeclampsia (n = 48). An oral glucose tolerance test (OGTT) was performed in all patients between 29 and 40 weeks of gestation. Blood samples were taken at 0, 60, 120 and 180 min after 100 g oral glucose to measure serum glucose and insulin levels. RESULTS: Basal and postload OGTT glucose values and basal insulin levels were similar in all groups. However, insulin levels at 60, 120 and 180 min were significantly higher (p = 0.009, p = 0.009, p = 0.046, respectively) in overweight patients with preeclampsia than in those without. Insulin levels at 60 and 180 min were also higher (p = 0.024, p = 0.023, respectively) in non-overweight patients with preeclampsia than in those without. The area under the curve (AUC) for glucose was not significantly different between both groups of overweight patients or between non-overweight patients with or without preeclampsia. In contrast, the AUC of insulin was significantly higher in preeclamptic patients in both overweight (p = 0.004) and non-overweight (p = 0.024) groups than in overweight and non-overweight groups without preeclampsia, respectively. CONCLUSIONS: Increased insulin levels observed in mild preeclamptic patients were independent of overweight-related hyperinsulinemia.

Hepatitis C virus infection and non-Hodgkin's lymphoma: a review and case report of nine patient.

The role of hepatitis C virus (HCV) is well established in the development of chronic hepatitis, cirrhosis and hepatic carcinoma, as well as in mixed type II cryoglobulinemia, membranoproliferative glomerulonephritis(MPGN) and porphyria cutanea tarda (PCT). Increasing evidence has been reported of a close association of HCV infection with autoimmune and hematological processes, mainly cytopenias and lymphoproliferative disorders such as B cell non-Hodgkin's lymphoma. We describe the demographic, clinical and histopathological findings of nine patients from the Mexican population with non-Hodgkin's lymphoma and HCV infection.

[Assessment of high sensitivity C-reactive protein (HS-CRP) as a marker of liver inflammation in patients with metabolic syndrome]. / Evaluación de la proteína C reactiva ultrasensible (PCR-us) como marcador de inflamación hepática en pacientes con síndrome metabólico.

UNLABELLED: C-reactive protein (CRP) plays an important role on inflammatory processes associated to the metabolic syndrome (MS), alike of insulin sensitivity, endothelial dysfunction and fibrinolysis insufficiency. Alanine aminotransferase (ALT) may be a sensible marker for the diagnosis of hepatic damage and has therefore been used as an alternative method for the noninvasive diagnosis of non-alcoholic fatty liver disease (NAFLD), especially in epidemiological studies. At the present time, the possible utility of high sensitivity CRP (hsCRP) as a simple measure to detect the degree of hepatic inflammatory response during the development NAFLD in MS has not been explored. OBJECTIVE: To evaluate the measurement of serologic hsCRP for the identification of hepatic inflammatory response in patients with MS. MATERIAL AND METHODS: Seven hundred and forty persons (526 men and 214 women), mean age 45 +/- 11 years who were asymptomatic and otherwise seeming healthy in whom a medical questionnaire was applied underwent physical examination, laboratory testing, hepatic ultrasound and measurement of hsCRP by the immuno-turbidimetric method. Receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of all possible hsCRP for detecting different degrees of hepatic inflammation (ALT > 44 U/L and ALT > 88 U/L). Patients were stratified according to the presence of metabolic syndrome (MS) and ALT concentration in three groups: Group I, having MS and ALT > 44 U/L (n = 39); Group II, having ALT > 44 U/L without MS (n = 105) and Group III, having ALT < or = 44 U/L without MS (n = 596). RESULTS: The optimal hsCRP cut-off for detecting patients with ALT 44 U/L was 2.5 mg/L (sensibility 66%; specificity 50%) and for detecting patients with ALT > 88 U/L was 2.35 (sensibility 72%; specificity 59%). hsCRP serum concentrations in Group I were significantly higher than in Group II and Group III (p < 0.05) but no difference was found between Group II and Group III (Group I = 6.0 +/- 6.7 mg/L vs. Group II = 2.8 +/- 3.1 mg/L, vs. Group III = 2.9 +/- 4.1 mg/L). ALT concentrations were also significantly higher in Group I than in Group II and Group III, (p < 0.05) and a difference between Group II and Group III (p < 0.05) was also found (Group I = 72 +/- 31 U/L vs. Group II = 64 +/- 29 U/L vs. Group III = 24 +/- 8 U/L). CONCLUSIONS: These results suggest that the measurement of hsCRP for the identification of hepatic inflammatory response in patients with MS with NAFLD is limited because of its low sensibility and specificity observed on identifying different degrees of hepatic inflammation.

[Surgical treatment of hemorroids with rectal mucosal resection using a stapler]. / Mucosectomía rectal con engrapadora para el tratamiento quirúrgico de la enfermedad hemorroidal: estudio prospectivo de 160 pacientes.

OBJECTIVE: To analyze the results of Longo stapled mucosectomy for hemorrhoidal disease in a 1 to 3 years follow up. PATIENTS AND METHODS: Clinical response and complications where analyzed in patients treated for grade II to IV non-complicated hemorrhoidal disease with Longo stapled hemorrhoidectomy. RESULTS: In a 27 months period, 160 patients were treated (105 men and 55 women), mean age was 44.1 years (range: 24 to 72 years), and 110 patients had grade III hemorrhoid disease. Non procedure complications were noted, early complications were detected in 5% of patients and late complications were detected in 10% of patients. In a mean follow-up of 18.8 months, 82.5% of the patients remained asymptomatic and 94.4 of the patients reported a good satisfaction score. A second surgery was required in three patients because of recurrence. CONCLUSION: Longo stapled mucosectomy is a safe treatment for non complicated hemorrhoid disease. In a 18 month follow up most patients were asymptomatic.

Reproducibility and reliability of the 13C-acetate breath test to measure gastric emptying of liquid meal in infants.

OBJECTIVE: This study assessed the noninvasive 13C-acetate breath test (13C-ABT) as a reliable and reproducible method to evaluate gastric emptying in infants METHODS: Gastric emptying was measured simultaneously by scintigraphy and 13C-ABT in 11 infants with clinical symptoms of gastroesophageal reflux to validate the method compared with the gold standard. Gastric emptying was also measured with 13C-ABT in a separate group of 14 healthy infants on 2 consecutive days to evaluate reproducibility of the method. Half-emptying times obtained with scintigraphy and 13C-ABT were correlated with Pearson's analysis. The variability of the half-emptying times obtained on 2 consecutive days was analyzed with paired t test and by the coefficient of variation as proposed by Bland and Altman. RESULTS: The mean emptying times obtained with scintigraphy and 13C-ABT were not different (89 +/- 27 min and 70 +/- 39 min, respectively, P = 0.22). Both methods correlated significantly (r = 0.75, P < 0.05). Half-emptying times measured on 2 consecutive days with 13C-ABT were 69 +/- 31 min and 68 +/- 30 min, respectively (mean difference = 1.4 +/- 12.4 min, P = 0.67). Intraindividual coefficient of variation was 6.3%. CONCLUSIONS: This study supports the 13C-ABT method as a useful tool to evaluate gastric emptying of liquids in healthy infants and in infants with gastroesophageal reflux in the field of research and in clinical evaluations.

Adrenal androgen excess and body mass index in polycystic ovary syndrome.

CONTEXT: Adrenal hyperandrogenism affects approximately 25% of polycystic ovary syndrome (PCOS) patients but its relation to obesity is not totally understood. OBJECTIVE: This study aimed to assess dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels in relation to body mass index (BMI) in PCOS. DESIGN AND SETTING: This was a prospective observational study at an institutional practice at an obstetrics/gynecology hospital. PARTICIPANTS: The study included 136 PCOS patients, 20-35 years old, and 42 age-matched control women. The participants were classified with the BMI cutoff value of 27 kg/m(2) as follows: 1) high-BMI PCOS patients; 2) low-BMI PCOS patients; 3) high-BMI control women; and 4) low-BMI control women. The data were reanalyzed with the BMI cutoff value of 30 kg/m(2) to corroborate the findings in obese and nonobese patients. MAIN OUTCOME MEASURE(S): Blood samples were taken and LH, FSH, insulin, T, androstenedione (A4), DHEA, DHEAS, and glucose levels were determined. Homeostatic model assessment was calculated. Pelvic and abdominal ultrasound for ovarian morphology and adipose tissue, respectively, were performed. RESULTS: Obese PCOS patients presented significantly more insulin resistance than nonobese PCOS patients. The LH levels and LH/FSH ratio were significantly higher in low-BMI than in high-BMI PCOS patients. The A4 and DHEAS levels were significantly higher in nonobese than in obese PCOS patients. A significant correlation between LH and A4 in nonobese PCOS patients was observed. The frequency of hyperandrogenism by increased A4, and DHEA along with DHEAS was significantly higher in low-BMI PCOS patients compared with high-BMI PCOS patients. Some findings observed with the BMI cutoff value of 27 kg/m(2) changed with the cutoff value of 30 kg/m(2). CONCLUSIONS: Low BMI more so than high BMI is associated with increased LH, high A4, DHEA, and DHEAS levels in PCOS patients. The BMI cutoff value of 27 kg/m(2) classified better than 30 kg/m(2) for hormonal and metabolic characteristics.