Remission of central fever with morphine post traumatic brain injury.

After a brain injury, raised temperature may be due to a regulated readjustment in the hypothalamic 'set-point' in response to inflammation. The purpose of this report is to mention possible implications related to temperature and homeostasis of morphine treatment in a patient with brain injury. During the month previous to her hospitalization in our city she was treated for fever with paracetamol and metamizol without results. After 31 days with similar results, we changed to morphine IV considering the possibility of treating pain and fever. This option was successful and afterwards we changed to fentanyl patches, keeping fever absent. After 100 days of hospitalization, the patient was discharged to her home.

Fermented Non-Digestible Fraction of Andean Berry (Vaccinium meridionale Swartz) Juice Induces Apoptosis in Colon Adenocarcinoma Cells.

Vaccinium meridionale Swartz, known as Andean berry, has a high content of anthocyanins, phenolic acids, and other flavonoids due to their putative anticancer activity. However, after consumption, the structures and function of these molecules may be altered. The purpose of this study was to evaluate the pro-apoptotic effect of fermented non-digestible fraction (FNDF) of Andean berry juice (ABJ) on colon adenocarcinoma HT29 cells. HT29 cells were treated by FNDF-ABJ obtained by in vitro gastrointestinal fermentation. We determined the proapoptotic capacity by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays, oxidative stress by analyzing superoxide dismutase and catalase activity, lipid peroxidation by measuring 8-iso-prostaglandin F2α, and measured lactate dehydrogenase. Our results show that FNDF-ABJ inhibited cell growth [lethal dose 50(%)=26% v/v]. In addition, FNDF-ABJ increased the number of TUNEL positive cells 2-fold compared with untreated cells without altering the release of lactate dehydrogenase. However, superoxide dismutase activity was reduced in HT29 cells treated with FNDF-ABJ, catalase activity was not affected and 8-iso-prostaglandin F2α levels were increased. These results support that the anti-proliferative effects of FNDF-ABJ on HT29 cells can be explained by apoptotic mechanisms.

Re-expressing Epigenetically Silenced Genes by Inducing DNA Demethylation Through Targeting of Ten-Eleven Translocation 2 to Any Given Genomic Locus.

Epigenetic editing is a novel methodology to modify the epigenetic landscape of any genomic location. As such, the approach might reprogram expression profiles, without altering the DNA sequence. Epigenetic alterations, including promoter hypermethylation, are associated with an increasing number of human diseases. To exploit this situation, epigenetic editing rises as a new alternative to specifically demethylate abnormally hypermethylated regions. Here, we describe a methodology to actively demethylate the hypermethylated ICAM-1 promoter. Reducing DNA methylation in our target region increased the expression of the ICAM-1 gene. As the ICAM-1 gene in our cell lines was highly methylated (up to 80%), this approach proves a robust manner to reduce methylation for hypermethylated regions. Epigenetic editing therefore not only provides an approach to address mechanisms of gene expression regulation, but also adds to the therapeutic toolbox as current inhibitors of epigenetic enzymes are limited by genome-wide effects.

Molecular characterization of occult hepatitis B virus infection in patients with end-stage liver disease in Colombia.

BACKGROUND: Hepatitis B virus (HBV) occult infection (OBI) is a risk factor to be taken into account in transfusion, hemodialysis and organ transplantation. The aim of this study was to identify and characterize at the molecular level OBI cases in patients with end-stage liver disease. METHODS: Sixty-six liver samples were obtained from patients with diagnosis of end-stage liver disease submitted to liver transplantation in Medellin (North West, Colombia). Samples obtained from patients who were negative for the surface antigen of HBV (n = 50) were tested for viral DNA detection by nested PCR for ORFs S, C, and X and confirmed by Southern-Blot. OBI cases were analyzed by sequencing the viral genome to determine the genotype and mutations; additionally, viral genome integration events were examined by the Alu-PCR technique. RESULTS: In five cases out of 50 patients (10%) the criteria for OBI was confirmed. HBV genotype F (subgenotypes F1 and F3), genotype A and genotype D were characterized in liver samples. Three integration events in chromosomes 5q14.1, 16p13 and 20q12 affecting Receptor-type tyrosine-protein phosphatase T, Ras Protein Specific Guanine Nucleotide Releasing Factor 2, and the zinc finger 263 genes were identified in two OBI cases. Sequence analysis of the viral genome of the 5 OBI cases showed several punctual missense and nonsense mutations affecting ORFs S, P, Core and X. CONCLUSIONS: This is the first characterization of OBI in patients with end-stage liver disease in Colombia. The OBI cases were identified in patients with HCV infection or cryptogenic cirrhosis. The integration events (5q14.1, 16p13 and 20q12) described in this study have not been previously reported. Further studies are required to validate the role of mutations and integration events in OBI pathogenesis.

Virus-host interplay in hepatitis B virus infection and epigenetic treatment strategies.

Worldwide, chronic hepatitis B virus (HBV) infection is a major health problem and no cure exists. Importantly, hepatocyte intrusion by HBV particles results in a complex deregulation of both viral and host cellular genetic and epigenetic processes. Among the attempts to develop novel therapeutic approaches against HBV infection, several options targeting the epigenomic regulation of HBV replication are gaining attention. These include the experimental treatment with 'epidrugs'. Moreover, as a targeted approach, the principle of 'epigenetic editing' recently is being exploited to control viral replication. Silencing of HBV by specific rewriting of epigenetic marks might diminish viral replication, viremia, and infectivity, eventually controlling the disease and its complications. Additionally, epigenetic editing can be used as an experimental tool to increase our limited understanding regarding the role of epigenetic modifications in viral infections. Aiming for permanent epigenetic reprogramming of the viral genome without unspecific side effects, this breakthrough may pave the roads for an ambitious technological pursuit: to start designing a curative approach utilizing manipulative molecular therapies for viral infections in vivo.

Evidence of the circulation of hepatitis A virus, subgenotype IA, in environmental samples from Antioquia, Colombia.

INTRODUCTION: Hepatitis A virus (HAV) is an important pathogen, typically transmitted via the faecal-oral route. The epidemiology of the infection is directly related to drinking water access and adequate disposal of sewage water.  OBJECTIVE: To determine the presence and identify the genotype of HAV in environmental samples from eight municipalities and two villages in Antioquia, northwestern Colombia.  MATERIALS AND METHODS: Three serial samplings were done between December, 2012, and April, 2014. Water samples were obtained from drinking water plants prior to treatment, as well as from the main reserve of wastewater in each municipality included in the study. Viral concentrations for the two types of sample sources were determined by filtration/tangential ultrafiltration and polyethyleneglycol plus flocculation with skimmed milk, respectively. Total ARN was subsequently obtained from each sample and the VP3-VP1 region amplified for detection of the viral genome. The genotype was determined by amplification of the VP1-2B region.  RESULTS: The HAV genome was detected in samples from drinking water plants at Puerto Berrío, Frontino and Nutibara, and in wastewater samples from the municipalities of Arboletes, Zaragoza and Venecia. HAV subgenotype IA was identified using phylogenetic analysis.  CONCLUSION: In this study, HAV was identified in 6.6% of the samples from drinking water plants and 13.3% of wastewater samples. This is the first report of HAV subgenotype IA circulating in environmental samples from Antioquia.

Hepatitis E Virus Genotype 3 in Colombia: Survey in Patients with Clinical Diagnosis of Viral Hepatitis.

BACKGROUND: Hepatitis E virus is a major cause of outbreaks as well as sporadic hepatitis cases worldwide. The epidemiology of this enterically transmitted infection differs between developing and developed countries. The aims of this study were to describe HEV infection in Colombian patients and to characterize the genotype. METHODS: A prospective study was carried out on 40 patients aged over 15 with a clinical diagnosis of viral hepatitis, recruited from five primary health units in the city of Medellin, Colombia. Fecal samples obtained from the 40 consecutives cases were analyzed for HEV RNA using nested reverse transcription PCR for both ORF1 and ORF2-3. The amplicons were sequenced for phylogenetic analyses. RESULTS: Nine (22.5%) cases of HEV infection were identified in the study population. Three HEV strains obtained from patients were classified as genotype 3. No significant association was found between cases of Hepatitis E and the variables water drinking source, garbage collection system and contact with pigs. CONCLUSIONS: This is the first prospective study of hepatitis E in Colombian patients. The circulation of the genotype 3 in this population is predictable considering the reports of the region and the identification of this genotype from pigs in the state of Antioquia, of which Medellin is the capital. Further studies are necessary to establish whether zoonotic transmission of HEV is important in Colombia.

Analysis of hepatitis B virus genotypes by restriction fragment length polymorphism.

INTRODUCTION: Ten viral genotypes (A-J) distributed in all continents have been described for hepatitis B virus (HBV). One of the methodologies for determining the viral genotype is the restriction fragment length polymorphism (RFLP) technique, a simple and relatively inexpensive method, albeit with some limitations. OBJECTIVE: The initial objective of the project was to identify the HBV genotypes by RFLP in serum samples obtained from patients and blood donors. However, due to the discrepancies of RFLP patterns it was also necessary to perform phylogenetic genotyping and in silico analysis of HBV sequences. MATERIALS AND METHODS: We obtained 56 serum samples. DNA extraction was followed by PCR amplification of a fragment of HBV ORF S. We analyzed PCR products by RFLP with AlwI, BsrI, CfrI, HpaII and StyI, and we sequenced some. We compared the patterns obtained with those in previous reports. We also performed RFLP analysis in silico since we found differences between the patterns expected and those obtainedResults: We identified genotypes A and F, subgenotype F3, in the samples. This result is in agreement with those of previous studies carried out in Colombia; indeed, subgenotype F3 is the most frequent in the Andean region of the country, while genotype A is the most frequent HBV genotype in the western region (department of Chocó). Based on the in silico analysis of 229 HBV sequences from GenBank and 11 sequences of this study, we identified the RLFP pattern for genotype F, subgenotype F3, and we described some modifications of genotype A RFLP patterns. CONCLUSIONS: We identified the single nucleotide polymorphism pattern for genotype F, subgenotype F3, by in silico analysis and sequencing. Further robust in silico analyses are necessary to validate the RFLP patterns of HBV genotype and subgenotypes.

[Hepatitis E virus infection in patients with clinical diagnosis of viral hepatitis in Colombia]. / Infección por el virus de la hepatitis E en pacientes con diagnóstico clínico de hepatitis viral en Colombia.

INTRODUCTION: Hepatitis E virus (HEV) is an emergent virus of global importance; it is the etiological agent of sporadic cases and outbreaks of hepatitis. The epidemiology of this infection in Colombia is unknown. OBJECTIVE: To determine the seropositivity for hepatitis E virus in Colombia in cases with clinical diagnosis of viral hepatitis. MATERIALS AND METHODS: Serum samples from patients that were sent to the Instituto Nacional de Salud during the period 2005-2010 (group 1) and samples sent to the Laboratorio Departamental de Salud Pública de Antioquia during the 2008-2009 period were included in this study (group 2). Serum samples were analyzed by immunoassay with commercial kits. RESULTS: From the 344 analyzed samples, 8.7% were positive for anti-HEV; the frequency of anti-HEV IgM was 1.74% (6/344) and the frequency of anti-HEV IgG was 7.5% (26/344). A difference in frequency of anti-HEV between group 1 (6.3%) and group 2 (1.3%) was observed. The cases were identified in nine departments of Colombia. CONCLUSIONS: This is the first study of hepatitis E virus infection in patients with diagnosis of hepatitis in Colombia. The frequency of anti-HEV described in this population of patients in Colombia is similar to that described in other Latin American countries like Brazil, Perú and Uruguay. Considering the results of this study, it could be necessary to include hepatitis E virus infection serological markers in the differential diagnosis of viral hepatitis in Colombia.

Analysis of hepatitis B virus genotypes by restriction fragment length polymorphism / Análisis de genotipos del virus de la hepatitis B mediante el análisis de polimorfismos de longitud de fragmentos de restricción

Introduction: Ten viral genotypes (A-J) distributed in all continents have been described for hepatitis B virus (HBV). One of the methodologies for determining the viral genotype is the restriction fragment length polymorphism (RFLP) technique, a simple and relatively inexpensive method, albeit with some limitations. Objective: The initial objective of the project was to identify the HBV genotypes by RFLP in serum samples obtained from patients and blood donors. However, due to the discrepancies of RFLP patterns it was also necessary to perform phylogenetic genotyping and in silico analysis of HBV sequences. Materials and methods: We obtained 56 serum samples. DNA extraction was followed by PCR amplification of a fragment of HBV ORF S. We analyzed PCR products by RFLP with Alw I, Bsr I, Cfr I, Hpa II and Sty I, and we sequenced some. We compared the patterns obtained with those in previous reports. We also performed RFLP analysis in silico since we found differences between the patterns expected and those obtained. Results: We identified genotypes A and F, subgenotype F3, in the samples. This result is in agreement with those of previous studies carried out in Colombia; indeed, subgenotype F3 is the most frequent in the Andean region of the country, while genotype A is the most frequent HBV genotype in the western region (department of Chocó). Based on the in silico analysis of 229 HBV sequences from GenBank and 11 sequences of this study, we identified the RLFP pattern for genotype F, subgenotype F3, and we described some modifications of genotype A RFLP patterns. Conclusions: We identified the single nucleotide polymorphism pattern for genotype F, subgenotype F3, by in silico analysis and sequencing. Further robust in silico analyses are necessary to validate the RFLP patterns of HBV genotype and subgenotypes.

Introducción. Se han descrito diez genotipos (A-J) del virus de la hepatitis B (HBV) que están distribuidos en todos los continentes. Una de las técnicas utilizadas para determinar el genotipo viral es el análisis del polimorfismo de longitud de los fragmentos de restricción, un método simple y económico, pero con algunas limitaciones. Objetivo. El objetivo inicial del estudio fue identificar el genotipo del HBV mediante RFLP en muestras de suero obtenidas de pacientes y donantes de sangre. Sin embargo, por las discrepancias observadas en los patrones de RFLP fue necesario realizar análisis filogenéticos y un análisis in silico de secuencias del HBV. Materiales y métodos. Se obtuvieron 56 muestras de suero. Tras la extracción de ADN, se amplificó un fragmento del ORF S del HBV mediante reacción en cadena de la polimerasa, cuyos productos se analizaron por RFLP con las enzimas Alw I, Bsr I, Cfr I, Hpa II y Sty I, y algunos se secuenciaron. Los patrones obtenidos se compararon con los reportados previamente. Se efectuó un análisis in silico de RFLP en consideración de las diferencias entre los patrones esperados y los observados. Resultados. Se identificaron los genotipos A y F, subgenotipo F3, en las muestras. Este resultado coincide con lo descrito en estudios previos en los que se ha demostrado que el genotipo F, subgenotipo F3, es prevalente en la población de la región andina del país, en tanto que el genotipo A predomina en el occidente (departamento del Chocó). Con base en el análisis in silico de 229 secuencias virales obtenidas del GenBank y las 11 secuencias de este estudio, se caracterizó un nuevo patrón de RFLP específico para el genotipo F, subgenotipo F3, y se describieron algunas modificaciones en el patrón de RFLP del genotipo A, subgenotipo A1. Conclusiones. Se caracterizó el patrón de genotipificación del genotipo F, subgenotipo F3, del HBV mediante RFLP, análisis in silico y secuenciación. Se requieren nuevos análisis in silico con un número mayor de secuencias para validar los patrones de RFLP de los genotipos y subgenotipos del VHB.

Infección oculta por el virus de la hepatitis B en pacientes sometidos a trasplante hepático / Occult Hepatitis B Virus Infection in Liver Transplant Patients

Introducción: la infección oculta por el virus de la hepatitis B (VHB) se caracteriza por la presencia del genoma viral en suero y/o tejido hepático de individuos negativos para el antígeno de superficie HBsAg. La infección oculta se ha asociado con el desarrollo de cirrosis y carcinoma hepatocelular. Objetivo: identificar casos de infección oculta por el VHB en pacientes con diagnóstico de cirrosis y carcinoma hepatocelular, sometidos a trasplante hepático. Materiales y métodos: entre febrero de 2013 y marzo de 2014 fueron obtenidas muestras de explante hepático provenientes de pacientes con diagnóstico de cirrosis y/o carcinoma hepatocelular. Se detectó el genoma del VHB mediante amplificación de tres regiones del genoma viral (S, Core y X). Las muestras positivas se confirmaron por reacción en cadena de la polimerasa (PCR) en tiempo real para la región S. Resultados: se analizaron 15 muestras de tejido hepático, y en dos (13,3%) se detectó el genoma del VHB mediante PCR anidada para la región S y por PCR semianidada para la región X, resultado confirmado por PCR en tiempo real. Estas muestras provenían de pacientes negativos para los marcadores serológicos de infección por el VHB, anti-HBc y anti-HBs. Conclusión: la frecuencia de infección oculta reportada en este estudio es similar a lo reportado en Brasil en muestras de biopsias obtenidas de pacientes con hepatitis crónica. Estudios adicionales son necesarios para estimar la frecuencia de infección oculta por VHB (OBI) en pacientes con hepatopatías terminales en Colombia

Introduction: Occult hepatitis B virus infection is characterized by the presence of the viral genome in serum and/or liver tissue from individuals who test negative for the HBsAg surface antigen. Occult infection has been associated with the development of cirrhosis and hepatocellular carcinoma. Objective: The objective of this study was to identify cases of occult hepatitis B virus infection in patients with cirrhosis and/or hepatocellular carcinoma undergoing liver transplantation. Materials and methods: Between February 2013 and March 2014 hepatic explant samples were obtained from patients with cirrhosis and/or hepatocellular carcinoma. The hepatitis B virus genome was detected by amplification of three regions of the viral genome (S, Core and X). Positive samples were confirmed by real-time PCR for the S region. Results: Fifteen hepatic tissue samples were analyzed. The genome of the hepatitis B virus was detected in two (13.3%) samples by nested PCR for the S region and by semi-nested PCR for region X. The results were confirmed by real-time PCR. These samples came from patients who had tested negative for anti-HBc and anti-HBs serological markers for hepatitis B virus infection. Conclusion: The frequency of occult infection reported in this study is similar to that reported in Brazil in biopsy specimens obtained from patients with chronic hepatitis. Additional studies are needed to estimate the frequency of occult hepatitis B in patients with end-stage liver disease in Colombia

Evidencia de circulación del virus de la hepatitis A, subgenotipo IA, en muestras ambientales en Antioquia, Colombia / Evidence of the circulation of hepatitis A virus, subgenotype IA, in environmental samples from Antioquia, Colombia

Introducción. El virus de la hepatitis A (HAV) es un importante patógeno que se transmite por vía fecal-oral. La epidemiología de la infección está directamente relacionada con el acceso de la población al agua potable y con la infraestructura de alcantarillado. Objetivo. Determinar la presencia del HAV e identificar el genotipo en muestras de agua de abastecimiento y agua residual en ocho municipios, un corregimiento y una vereda del departamento de Antioquia, noroccidente de Colombia. Materiales y métodos. Se hicieron tres muestreos seriados de diciembre de 2012 a abril de 2014 en la fuente principal de abastecimiento de los acueductos y en el principal vertimiento de aguas residuales de cada municipio. Las muestras se concentraron por filtración y ultrafiltración tangencial, y por las técnicas de polietilenglicol y floculación con leche descremada, respectivamente. A partir del ARN total de cada muestra, se amplificaron la región VP3-VP1 para la detección del genoma viral y la región VP1-2B para la genotipificación. Resultados. El genoma del HAV se detectó en las fuentes de agua de abastecimiento de Puerto Berrío, Frontino y Nutibara, y en las muestras de aguas residuales provenientes de los municipios de Arboletes, Zaragoza y Venecia. Mediante el análisis de las secuencias se identificó el subgenotipo IA del virus. Conclusión. Este estudio permitió detectar la presencia del HAV en 6,6 % de las muestras de agua de abastecimiento y en 13,3 % de las muestras de agua residual de los municipios en estudio. Se reporta por primera vez la circulación del subgenotipo IA en muestras ambientales en Antioquia.

Introduction: Hepatitis A virus (HAV) is an important pathogen, typically transmitted via the faecal-oral route. The epidemiology of the infection is directly related to drinking water access and adequate disposal of sewage water. Objective: To determine the presence and identify the genotype of HAV in environmental samples from eight municipalities and two villages in Antioquia, northwestern Colombia. Materials and methods: Three serial samplings were done between December, 2012, and April, 2014. Water samples were obtained from drinking water plants prior to treatment, as well as from the main reserve of wastewater in each municipality included in the study. Viral concentrations for the two types of sample sources were determined by filtration/tangential ultrafiltration and polyethyleneglycol plus flocculation with skimmed milk, respectively. Total ARN was subsequently obtained from each sample and the VP3-VP1 region amplified for detection of the viral genome. The genotype was determined by amplification of the VP1-2B region. Results: The HAV genome was detected in samples from drinking water plants at Puerto Berrío, Frontino and Nutibara, and in wastewater samples from the municipalities of Arboletes, Zaragoza and Venecia. HAV subgenotype IA was identified using phylogenetic analysis. Conclusion: In this study, HAV was identified in 6.6% of the samples from drinking water plants and 13.3% of wastewater samples. This is the first report of HAV subgenotype IA circulating in environmental samples from Antioquia.

Infección por el virus de la hepatitis E en pacientes con diagnóstico clínico de hepatitis viral en Colombia / Hepatitis E virus infection in patients with clinical diagnosis of viral hepatitis in Colombia

Introducción. El virus de la hepatitis E (HEV), agente etiológico de casos esporádicos y epidemias de hepatitis, es un virus emergente de importancia global. En Colombia se desconoce la epidemiología de la infección causada por este virus. Objetivo. Determinar la seropositividad para el virus de la hepatitis E en muestras de suero de pacientes con diagnóstico clínico de hepatitis viral en Colombia. Materiales y métodos. Se estudiaron muestras de pacientes remitidas al Instituto Nacional de Salud en el periodo 2005-2010 provenientes de 15 departamentos de Colombia (grupo 1) y muestras remitidas al Laboratorio Departamental de Salud Pública de Antioquia en el periodo 2008-2009 (grupo 2). Las muestras de suero se analizaron por inmunoensayo con estuches comerciales. Resultados. La frecuencia de seropositividad para el virus de la hepatitis E en las 344 muestras analizadas fue de 8,7 % (30/344); de estas, 1,74 % (6/344) presentó IgM anti-HEV y 7,5 % (26/344), IgG anti-HEV. Se observó una diferencia en el resultado positivo entre el grupo 1 (6,3 %) y el grupo 2 (15,3 %). Los casos provenían de nueve departamentos del país. Conclusiones. Este es el primer estudio de infección por el virus de la hepatitis E en muestras de pacientes con diagnóstico de hepatitis en Colombia. La seropositividad descrita en esta población de pacientes es similar a la descrita en otros países de América Latina, como Brasil, Perú y Uruguay. Teniendo en cuenta estos resultados, se debe considerar la inclusión de los marcadores de la infección por el virus de la hepatitis E en el diagnóstico diferencial de la hepatitis viral en Colombia.

Introduction: Hepatitis E virus (HEV) is an emergent virus of global importance; it is the etiological agent of sporadic cases and outbreaks of hepatitis. The epidemiology of this infection in Colombia is unknown. Objective: To determine the seropositivity for hepatitis E virus in Colombia in cases with clinical diagnosis of viral hepatitis. Materials and methods: Serum samples from patients that were sent to the Instituto Nacional de Salud during the period 2005-2010 (group 1) and samples sent to the Laboratorio Departamental de Salud Pública de Antioquia during the 2008-2009 period were included in this study (group 2). Serum samples were analyzed by immunoassay with commercial kits. Results: From the 344 analyzed samples, 8.7% were positive for anti-HEV; the frequency of anti-HEV IgM was 1.74% (6/344) and the frequency of anti-HEV IgG was 7.5% (26/344). A difference in frequency of anti-HEV between group 1 (6.3%) and group 2 (1.3%) was observed. The cases were identified in nine departments of Colombia. Conclusions: This is the first study of hepatitis E virus infection in patients with diagnosis of hepatitis in Colombia. The frequency of anti-HEV described in this population of patients in Colombia is similar to that described in other Latin American countries like Brazil, Perú and Uruguay. Considering the results of this study, it could be necessary to include hepatitis E virus infection serological markers in the differential diagnosis of viral hepatitis in Colombia.