Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy.

Patients with cirrhosis may show minimal hepatic encephalopathy (MHE), for which rifaximin is effective. Metabolic syndrome may be associated with cognitive impairment. Our aims were to evaluate the influence of metabolic syndrome features on response to rifaximin for neurological and inflammatory alterations in MHE. A prospective cohort study was conducted in 63 cirrhotic patients and 30 controls from two tertiary centres recruited between 2015 and 2019. Metabolic syndrome was defined according to the Adult Treatment Panel-III. Patients were classified into 31 without and 32 with MHE according to the Psychometric Hepatic Encephalopathy Score (PHES). All participants performed specific psychometric tests, and inflammatory parameters were studied. Patients with MHE received rifaximin (400 mg/8 h). Response was evaluated by PHES at 3 and 6 months. Response according to metabolic syndrome manifestations was compared. The response rate was 66%. Older age (p = 0.012) and all metabolic syndrome diseases (p < 0.05) were associated with non-response, plus an increase in risk as the number of manifestations rose (p < 0.001). Patients with metabolic manifestations exhibited worse processing speed (p = 0.011), working memory (p = 0.005), visual coordination (p = 0.013) and lower proportion of activated CD4+ lymphocytes (p = 0.039) at baseline, as well as worse concentration (p = 0.030), bimanual coordination (p = 0.004) and higher levels of intermediate monocytes (p = 0.026), CX3CL1 (p < 0.05), IL-17 (p = 0.022), AHR (p = 0.010) and IgG (p < 0.05) at 3 and/or 6 months of rifaximin. Patients with clinical signs of metabolic syndrome have poor response to rifaximin for MHE, with a higher proportion of neurological alterations associated with a pro-inflammatory environment.

Patients with Minimal Hepatic Encephalopathy Show Altered Thermal Sensitivity and Autonomic Function.

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.

Épulis congénito gigante: importancia del diagnóstico prenatal / Congenital giant cell epulis: Importance of the prenatal diagnosis

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Inhibition of xanthine oxidase to prevent statin-induced myalgia and rhabdomiolysis.

Although statins remain the cornerstone of lipid-lowering therapy for reducing the burden of atherosclerotic vascular disease, their administration has been associated with muscle-related adverse effects, including myalgia and rhabdomyolysis. Such adverse events are probably due to reduced antioxidant defenses associated with fewer intermediate metabolites in the cholesterol synthesis pathway. We hypothesize that the concomitant inhibition of xanthine oxidase via coadministration of allopurinol with statins could diminish reactive oxygen species (ROS)-related muscle damage, which would have in turn have positive effects on both the incidence of muscle-related adverse events and cardiovascular outcomes. Accordingly, inhibition of xanthine oxidase has been previously shown to be effective for reducing biomarkers of muscle damage following exercise in professional athletes. Because of the widespread statin utilization and increasing trends in their therapeutic use in atherosclerotic vascular diseases, the proposed strategy could have important clinical implications for reducing statin-induced myalgia and rhabdomyolysis.

Methodological considerations to determine the effect of exercise on brain-derived neurotrophic factor levels.

OBJECTIVES: Physical exercise up-regulates brain-derived neurotrophic factor (BDNF) in the brain and blood. However, there is yet no consensus about the adequate blood processing conditions to standardize its assessment. We aimed to find a reliable blood sample processing method to determine changes in BDNF due to exercise. DESIGN AND METHODS: Twelve healthy university students performed an incremental cycling test to exhaustion. At baseline, immediately after exercise, and 30 and 60 min of recovery, venous blood was drawn and processed under different conditions, i.e. whole blood, serum coagulated for 10 min and 24 h, total plasma, and platelet-free plasma. BDNF concentration was measured by ELISA. RESULTS: Exercise increased BDNF in whole blood and in serum coagulated for 24 h when corrected by hemoconcentration. We did not find effects of exercise on BDNF in serum coagulated for 10 min or in plasma samples. Plasma shows heterogeneous BDNF values in response to exercise that are not prevented when platelets are eliminated while homogeneous BDNF levels were found in whole blood or serum coagulated for 24 hour samples. CONCLUSIONS: In exercise studies, BDNF levels should be adjusted by hemoconcentration. Our data highlight the importance of blood sample selection since the differences between each one affect significantly the BDNF factor changes due to exercise.

Blocking the rectus sheath guided by ultrasound in an 8-year-old patient with cystic fibrosis: reporting a case.

Cystic fibrosis (CF) is a severe disease that is transmitted with an autosomal recessive inheritance pattern, and is the commonest disease among Caucasian populations (1/2,500). There are many clinical manifestations that derive from its multiorgan dysfunctions, mainly in the respiratory and digestive tract. In addition, lung disease injury is principally responsible for morbidity and mortality in CF patients. Blocking the rectus sheath, first described by Schleich in 1899, is a loco-regional technique that provides adequate analgesia in those surgical procedures with midline or umbilical incisions.

Hemoglobin point-of-care testing: the HemoCue system.

Besides the use of traditional laboratory resources, the diagnosis of anemia can also be accomplished by assessing hemoglobin (Hb) concentration with point-of-care testing (POCT) devices such as the HemoCue test systems. In several situations, these devices might suitably replace traditional laboratory testing, including several areas of health care where a very rapid Hb measurement might be required to make immediate therapeutic decisions. The use of these devices, however, should fulfill some basic criteria, including economic, clinical, and regulatory issues; appropriate training of the users and knowledge of test requirements, performance, limitations, and potential interferences; the use of venous and arterial sampling, when possible; and a rigorous quality assessment, which should be under the responsibility of laboratory professionals. Because of its optimal performance along with the fact that the HemoCue is probably one of the most commonly used devices worldwide, the aim of this article is to review the literature data about the performance of this test system as compared with laboratory reference testing estimations and according to the biological matrix.

Bocio. Hipo e hipertiroidismo

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados para cada tema (bocio, hipotiroidismo, hipertiroidismo): introducción, definición y clasificación, criterios diagnósticos, valoración incial y seguimiento, tratamiento, interconsulta, criterios de buen control, actuación frente a posibles complicaciones y anexos. También incluye guías de consulta rápida.

Recent progress in prominence seismology.

Prominence seismology is a rapidly developing topic which seeks to infer the internal structure and properties of solar prominences from the study of their oscillations. An extense observational background about oscillations in quiescent solar prominences has been gathered during the last 70 years. These observations point out the existence of two different types of oscillations: flare-induced oscillations (winking filaments) which affect the whole prominence and are of large amplitude and small amplitude oscillations which seem to be of local nature. From the theoretical point of view, few models have been set up to explain the phenomenon of winking filaments while, on the contrary, for small amplitude oscillations a large number of models trying to explain the observed features have been proposed. Here, recent theoretical and observational developments on both types of oscillations are reviewed, and suggestions about future research topics which should provide us with a more in-depth knowledge of solar prominences are made.

Excitation and damping of disturbances in cylindrical coronal loops.

The excitation and damping of transversal coronal loop oscillations is studied using one-and two-dimensional models of line-tied cylindrical loops. By solving the time-dependent magnetohydrodynamic equations it is shown how an initial disturbance generated in the solar corona induces kink mode oscillations. We investigate the effect of the disturbance on a loop with a non-uniform boundary layer. In particular, a strong damping of transversal oscillations due to resonant absorption is found, such as predicted by previous works based on normal mode analysis.

Hepatitis C virus antibodies and other markers of blood-transfusion-transmitted infection in multi-transfused Cuban patients.

BACKGROUND: HCV was initially identified in 1989 when it was found to be the primary causative agent of non-A, non-B hepatitis,a condition associated with high rates of progressive and end-stage liver disease, cirrhosis, and hepatocellular carcinoma. Since then, appreciation of the significant worldwide health impact of HCV infection has grown. HCV infection was identified as a public health problem in Cuba in the 1990s. Despite universal blood donor screening, which was achieved in 1995 using the Cuban immunoassay system UMELISA HCV, the infection is still found in multi-transfused patients. OBJECTIVES: To determine the magnitude of HCV, HBV and HIV-1&2 infections among Cuban blood recipients and to assess the role of potential risk factors. STUDY DESIGN: Cross-sectional study of 318 patients from Havana City, Pinar del Río and Villa Clara, who had been previously treated with 10 or more units of allogenic blood or blood components in at least two different occasions. The patients were evaluated for HCV Ab, HBsAg, anti-HBc Ab, and HIV-1&2 Ab. Data management and statistical analysis were performed using EpiInfo and SSPS software. RESULTS: Prevalence rates were 51.6% for HCV Ab; 5.3% for HBsAg; 45.0% for anti-HBc and 0% for HIV-1&2 Ab. Ten (3.1%) patients were co-infected with HCV and HBV Blood transfusion was not identified as the main risk factor for HCV transmission. The number of blood units received by the patients was not statistically associated with the HCV Ab prevalence. CONCLUSIONS: Infection with HCV was identified more frequently than HBV and HIV among our study population. Patients undergoing hemodialysis were at the highest risk of becoming infected. Medical procedures including surgery, transplantation, invasive odontology, and sharing or reuse of needles and syringes, are associated with higher HCV Ab seroprevalences compared with blood transfusion alone.

[Endothelial adhesion molecules ICAM-1, VCAM-1 and E-selectin in patients with acute coronary syndrome]. / Moléculas de adhesión endoteliales ICAM-1, VCAM-1 y E-selectin en pacientes con síndrome coronario agudo.

INTRODUCTION AND OBJECTIVES: The acute inflammatory response is an important phenomenon in the pathogenesis of myocardial damage during acute coronary syndrome. Endothelial dysfunction has been found in unstable angina and acute myocardial infarction, although the results are controversial. The purpose of this study was to determine the levels of the soluble endothelial adhesion molecules ICAM-1, VCAM-1 and E-selectin, in patients with unstable angina and acute myocardial infarction, compare the results in both groups, and analyze their relation with the degree of myocardial injury. METHODS: Serum concentrations of ICAM-1, VCAM-1, and E-selectin were measured in 37 control subjects and 43 patients (32 with acute myocardial infarction and 11 with unstable angina). Measurements were made at the time of admission and ten days later using commercial enzyme-linked immunoabsorbent assay (ELISA) kits (R&D Systems, UK). RESULTS: There was a significant increase in E-selectin (p < 0.05) in patients with unstable angina at admission and ten days later. In contrast, patients with acute myocardial infarction showed no significant differences in E-selectin compared with the control group at admission or ten days later. A significant increase in VCAM-1 levels was demonstrated in both groups of patients and ICAM-1 levels in acute myocardial infarction, but the concentrations of VCAM-1 and ICAM-1 in both groups of patients at admission and ten days later did not differ significantly. There was no relation between soluble endothelial adhesion molecule levels and the severity of myocardial damage estimated by cardiac enzymes or electrocardiographic changes. CONCLUSION: This study indicates that serum levels of E-selectin, measured at time of admission and ten days later, could be a marker for unstable angina and might be useful in the differential diagnosis with myocardial infarction.

Moléculas de adhesión endoteliales ICAM-1, VCAM-1 y E-selectina en pacientes con síndrome coronario agudo / Endothelial adhesion molecules ICAM-1, VCAM-1 and E-selectin in patients with acute coronary syndrome

Introducción y objetivos. La respuesta inflamatoria aguda es un importante fenómeno en la patogenia del daño miocárdico durante el síndrome coronario agudo, y se ha demostrado la existencia de disfunción endotelial con resultados controvertidos. El propósito de este estudio fue determinar los valores de las moléculas de adhesión endoteliales solubles ICAM-1, VCAM-1 y E-selectina en pacientes con angina inestable e infarto, comparar los resultados en ambos grupos y analizar su relación con el grado de daño miocárdico. Método. Las concentraciones séricas de estas moléculas se estudiaron en 37 controles sanos y 43 pacientes, 32 con infarto de miocardio y 11 con angina inestable, en el momento del diagnóstico y 10 días más tarde, utilizando enzimoinmunoanálisis (ELISA) mediante estuches comerciales (R&D Systems, Reino Unido). Resultados. Se observó un incremento significativo de la E-selectina (p < 0,05) en los pacientes con angina inestable en el momento del diagnóstico y 10 días más tarde. Sin embargo, en los pacientes con infarto de miocardio no se observaron diferencias significativas de las concentraciones de E- selectina en el momento de la admisión y 10 días después, al compararlos con el grupo control. Se demostró un incremento significativo de los valores de VCAM-1 en ambos grupos de pacientes y de los de ICAM-1 en el infarto de miocardio en relación con el grupo control, pero las concentraciones de VCAM-1 e ICAM-1 entre ambos grupos de pacientes en el momento de la admisión y 10 días más tarde no reveló diferencias significativas. No hubo correlación entre los valores de las moléculas de adhesión endoteliales solubles y la severidad del daño miocárdico, estimado por enzimas cardíacas y cambios electrocardiográficos. Conclusión. Este estudio indica que los valores séricos de la E-selectina, medidos en el momento de la admisión y 10 días más tarde, podrían ser un marcador para la angina inestable y en el diagnóstico diferencial con el infarto agudo de miocardio. (AU)

Prevalencia de anticuerpos contra el virus de la hepatitis C en pacientes cubanos con enfermedades hematológicas / Prevalence of antibodies to hepatitis C virus in Cuban patients presenting with hematological diseases

Se estudió la seroprevalencia de anticuerpos contra el virus de hepatitis C (VHC) en 370 pacientes cubanos con enfermedades hematológicas procedentes de 5 provincias (Pinar del Río, Ciudad de La Habana, Sancti Spíritus, Ciego de Avila y Santiago de Cuba), utilizando el sistema ELISA HCVAB de la firma ORTHO DIAGNOSTIC SYSTEMS, Inc. Se detectaron anticuerpos en 54 enfermos, para el 14,5 por ciento de seroprevalencia. La positividad varió desde el 9,8 por ciento en los pacientes con hemopatías malignas, 16,3 por ciento en los casos con anemia depranocítica, hasta el 50 por ciento en los hemofílicos, diferencia que resultó estadísticamente significativa (p<=0,001(. Estos resultados subrayan la necesidad del pesquisaje masivo de los anticuerpos contra VHC en las donaciones de sangre del país para reducir la frecuencia de las hepatitis postransfunsionales causadas por virus C en pacientes hematológicos y otros receptores de sangre

Prevalencia de anticuerpos contra el virus de la hepatitis C en pacientes cubanos con enfermedades hematológicas / Prevalence of antibodies to hepatitis C virus in Cuban patients presenting with heatological diseases

Se estudió la seroprevalencia de anticuerpos contra el virus de hepatitis C (VHC) en 370 pacientes cubanos con enfermedades hematológicas procedentes de 5 provincias (Pinar del Río, Ciudad de La Habana, Sancti Spíritus, Ciego de Avila y Santiago de Cuba), utilizando el sistema ELISA HCVAB de la firma ORTHO DIAGNOSTIC SYSTEMS, Inc. Se detectaron anticuerpos en 54 enfermos, para el 14,5 por ciento de seroprevalencia. La positividad varió desde el 9,8 por ciento en los pacientes con hemopatías malignas, 16,3 por ciento en los casos con anemia depranocítica, hasta el 50 por ciento en los hemofílicos, diferencia que resultó estadísticamente significativa (p<=0,001(. Estos resultados subrayan la necesidad del pesquisaje masivo de los anticuerpos contra VHC en las donaciones de sangre del país para reducir la frecuencia de las hepatitis postransfunsionales causadas por virus C en pacientes hematológicos y otros receptores de sangre (AU)

Presencia de anticuerpos contra citomegalovirus en donantes de sangre / Presence of antibodies against cytomegalovirus in blood donors

Se estudiaron 300 donantes de sangre con un rango de edad de 18 a 55 años. En todos los casos se determinó la presencia de anticuerpos de la clase IgG contra citomegalovirus, de los cuales 97 fueron positivos para el 32,3

Presencia de anticuerpos contra citomegalovirus en donantes de sangre / Presence of antibodies against cytoegalovirus in blood donors

Se estudiaron 300 donantes de sangre con un rango de edad de 18 a 55 años. En todos los casos se determinó la presencia de anticuerpos de la clase IgG contra citomegalovirus, de los cuales 97 fueron positivos para el 32,3