Pancreatic and Hepatic Injury in COVID-19: A Worse Prognosis in NAFLD Patients?

The novel disease produced by SARS-CoV-2 mainly harms the respiratory tract, but it has shown the capacity to affect multiple organs. Epidemiologic evidence supports the relationship between Coronavirus Disease 2019 (COVID-19) and pancreatic and hepatic injury development, identified by alterations in these organ function markers. In this regard, it is important to ascertain how the current prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) might affect COVID-19 evolution and complications. Although it is not clear how SARS-CoV-2 affects both the pancreas and the liver, a multiplicity of potential pathophysiological mechanisms seem to be implicated; among them, a direct viral-induced injury to the organ involving liver and pancreas ACE2 expression. Additionally, immune system dysregulation, coagulopathies, and drugs used to treat the disease could be key for developing complications associated with the patient's clinical decline. This review aims to provide an overview of the available epidemiologic evidence regarding developing liver and pancreatic alterations in patients with COVID-19, as well as the possible role that NAFLD/NASH might play in the pathophysiological mechanisms underlying some of the complications associated with COVID-19. This review employed a comprehensive search on PubMed using relevant keywords and filters. From the initial 126 articles, those aligning with the research target were selected and evaluated for their methodologies, findings, and conclusions. It sheds light on the potential pathophysiological mechanisms underlying this relationship. As a result, it emphasises the importance of monitoring pancreatic and hepatic function in individuals affected by COVID-19.

Exploring Phytotherapeutic Alternatives for Obesity, Insulin Resistance and Diabetes Mellitus.

At present, the pathologic spectrum of obesity-insulin resistance (IR)-diabetes mellitus (DM) represents not only a pressing matter in public health but also a paramount object of study in biomedical research, as they constitute major risk factors for cardiovascular disease (CVD), and other chronic non-communicable diseases (NCD). Phytotherapy, the use of medicinal herbs (MH) with treatment purposes, offers a wide array of opportunities for innovation in the management of these disorders; mainly as pharmacological research on small molecules accumulates. Several MH has displayed varied mechanisms of action relevant to the pathogenesis of obesity, IR and DM, including immunological and endocrine modulation, reduction of inflammation and oxidative stress (OS), regulation of appetite, thermogenesis and energy homeostasis, sensitisation to insulin function and potentiation of insulin release, among many others. However, the clinical correlates of these molecular phenomena remain relatively uncertain, with only a handful of MH boasting convincing clinical evidence in this regard. This review comprises an exploration of currently available preclinical and clinical research on the role of MH in the management of obesity, IR, and DM.

Phytotherapy for Cardiovascular Disease: A Bench-to-Bedside Approach.

At present, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and global trends suggest that this panorama will persist or worsen in the near future. Thus, optimization of treatment strategies and the introduction of novel therapeutic alternatives for CVD represent key objectives in contemporary biomedical research. In recent years, phytotherapy-defined as the therapeutic use of whole or minimally modified plant components-has ignited large scientific interest, with a resurgence of abundant investigation on a wide array of medicinal herbs (MH) for CVD and other conditions. Numerous MH have been observed to intervene in the pathophysiology of CVD via a myriad of molecular mechanisms, including antiinflammatory, anti-oxidant, and other beneficial properties, which translate into the amelioration of three essential aspects of the pathogenesis of CVD: Dyslipidemia, atherosclerosis, and hypertension. Although the preclinical data in this scenario is very rich, the true clinical impact of MH and their purported mechanisms of action is less clear, as large-scale robust research in this regard is in relatively early stages and faces important methodological challenges. This review offers a comprehensive look at the most prominent preclinical and clinical evidence currently available concerning the use of MH in the treatment of CVD from a bench-to-bedside approach.

Clinical Practice Guidelines for Rare Diseases: The Orphanet Database.

Clinical practice guidelines (CPGs) for rare diseases (RDs) are scarce, may be difficult to identify through Internet searches and may vary in quality depending on the source and methodology used. In order to contribute to the improvement of the diagnosis, treatment and care of patients, Orphanet (www.orpha.net) has set up a procedure for the selection, quality evaluation and dissemination of CPGs, with the aim to provide easy access to relevant, accurate and specific recommendations for the management of RDs. This article provides an analysis of selected CPGs by medical domain coverage, prevalence of diseases, languages and type of producer, and addresses the variability in CPG quality and availability. CPGs are identified via bibliographic databases, websites of research networks, expert centres or medical societies. They are assessed according to quality criteria derived from the Appraisal of Guidelines, REsearch and Evaluation (AGREE II) Instrument. Only open access CPGs and documents for which permission from the copyright holders has been obtained are disseminated on the Orphanet website. From January 2012 to July 2015, 277 CPGs were disseminated, representing coverage of 1,122 groups of diseases, diseases or subtypes in the Orphanet database. No language restriction is applied, and so far 10 languages are represented, with a predominance of CPGs in English, French and German (92% of all CPGs). A large proportion of diseases with identified CPGs belong to rare oncologic, neurologic, hematologic diseases or developmental anomalies. The Orphanet project on CPG collection, evaluation and dissemination is a continuous process, with regular addition of new guidelines, and updates. CPGs meeting the quality criteria are integrated to the Orphanet database of rare diseases, together with other types of textual information and the appropriate services for patients, researchers and healthcare professionals in 40 countries.

Quiste tirogloso con granuloma de colesterol en una escolar simulando carcinoma de tiroides

Objetivo: Presentar el caso de una escolar con quiste tirogloso y granuloma de colesterol, hallazgo inusual que simuló clínica e imagenológicamente un carcinoma de tiroides. Esta asociación es infrecuente y hay pocos casos reportados. Caso clínico: Escolar femenina de 11 años, quién consultó por presentar disfagia y tumoración en región anterolateral izquierda del cuello, de 3x3 cm, de consistencia dura, dolorosa a la palpación, sin signos de flogosis. Ultrasonido de cuello evidenció conducto tirogloso permeable en la línea media con presencia de nódulo hipoecoico, de bordes bien definidos, sin calcificaciones que medía 1,8 x 0,9 cm. Se extirpó la tumoración que medía 3x2, 5x0, 8cm. y se observó cavidad quística de 0,8 cm. de diámetro mayor que contenía material de aspecto gelatinoso. Por debajo de éste, se observó nódulo bien circunscrito de 1,5 cm. de diámetro mayor, constituido por tejido firme de color blanco-amarillento. El estudio histopatológico reveló un quiste revestido por epitelio cilíndrico y respuesta inflamatoria linfohistiocitaria, con células gigantes tipo “cuerpo extraño” alrededor de hendiduras; que correspondían a d dd epósito de colesterol. Conclusión: Se presenta este caso por su rareza y porque puede confundirse clínica e imagenológicamente con una neoplasia maligna. Asimismo, pudiera corresponder al primer caso reportado en nuestro país.

Objective: We report the case of a 11 year- old girl with thyroglossal cyst and cholesterol granuloma, an unusual finding that clinically simulates thyroid carcinoma. This association is unusual and there are few reported cases worldwide. Case report: An 11-year-old girl consulted for dysphagia and a 3 x 3 cm hard mass. The mass was painful on palpation and was located in the anterolateral neck left. It was phlogosis-free. A neck ultrasound showed a 1.8 x 0.9 cm permeable midline thyroglossal conduct with a hypoechoic nodule with well-defined edges but without calcifications. A 3 x 2,5 x 0, 8cm tumor was removed. A 0.8 cm cystic cavity that contained gelatinous material was observed. Below that cavity, a well-circumscribed nodule was observed. It measured 1.5 cm and was made up of firm yellowish tissue. The histopathology examination revealed a cyst lined with columnar epithelium and inflammatory linfohistiocitic response with foreign body type giant cells around cracks that corresponded to a cholesterol deposit. Conclusion: We present this case because it is very unusual and because it can be clinically and radiologically mistaken for a malignant tumor. It could be the first case ever reported in Venezuela.

[Phenotypic and genotypic characterization of twelve rhizobial isolates from different regions of Venezuela]. / Caracterización fenotípica y genotípica de doce rizobios aislados de diversas regiones geográficas de Venezuela.

Rhizobial taxonomy and systematics have progressed substantially, nevertheless, few studies have been developed on venezuelan species. This study evaluated the phenotypic and genetic variation between 12 venezuelan indigenous rhizobial isolates and 10 international referential strains, by phenotypical traits and DNA molecular markers. In this regard, a PCR-RFLP of the 16S rDNA gene, the presence of large plasmids, metabolic assays in solid media, salinity resistance, pH and temperature growth conditions, and intrinsic antibiotic resistance were assayed. In reference to the phenotypic attributes, we recognized three main groups: A group I, which comprised all the strains metabolizing between 67.5%-90% of the C and N sources. They were also acid-tolerant, as well as acid producers, capable of growing at 40 degrees C and in high salinity conditions (2-2.5% NaCl). With regard to the antibiotic sensitivity, this group was susceptible to a 30% of the antibiotic assayed. Strains belonging to Group II exhibited a lower salt tolerance (0.1-1.5%NaCl), as well as a lower acid tolerance, since they grew well at pH values equal or higher than 5.0. This group appeared to be resistant to all of the antibiotics assayed and only metabolized between 52.5%-82.5% of the C and N sources. Group III was represented by a single bacterial strain: it has a extremely low salt tolerance (0.1% NaCl). This strain grew at a pH equal or higher than 5.6, was susceptible to 50% of the antibiotics assayed and metabolized 72% of the C and N sources. On the basis of a PCR- RFLP of the 16S rDNA, three groups were also obtained. Members of the group A showed a close resemblance to Rhizobium tropici CIAT 899 and Sinorhizobium americanum CFN-EI 156, while Group B was closely related to Bradyrhizobium spp. Group C, was also represented by only one isolate. The Trebol isolate, was the only one strain able to form nodules and does not appear to be related to any of the referential rhizobial strains, suggesting a possible symbiotic horizontal gene transfer. Finally, in this work, there are evidences of a genetic diversity in the venezuelan rhizobial strains. A different geographical origin is perhaps an important factor affecting the diversity of the indigenous rhizobia in this study.

Caracterización fenotípica y genotípica de doce rizobios aislados de diversas regiones geográficas de Venezuela

Phenotypic and genotypic characterization of twelve rhizobial isolates from different regions of Venezuela. Rhizobial taxonomy and systematics have progressed substantially, nevertheless, few studies have been developed on venezuelan species. This study evaluated the phenotypic and genetic variation between 12 venezuelan indigenous rhizobial isolates and 10 international referential strains, by phenotypical traits and DNA molecular markers. In this regard, a PCR-RFLP of the 16S rDNA gene, the presence of large plasmids, metabolic assays in solid media, salinity resistance, pH and temperature growth conditions, and intrinsic antibiotic resistance were assayed. In reference to the phenotypic attributes, we recognized three main groups: A group I, which comprised all the strains metabolizing between 67.5%-90% of the C and N sources. They were also acid-tolerant, as well as acid producers, capable of growing at 40ºC and in high salinity conditions (2-2.5% NaCl). With regard to the antibiotic sensitivity, this group was susceptible to a 30% of the antibiotic assayed. Strains belonging to Group II exhibited a lower salt tolerance (0.1-1.5%NaCl), as well as a lower acid tolerance, since they grew well at pH values equal or higher than 5.0. This group appeared to be resistant to all of the antibiotics assayed and only metabolized between 52.5%-82.5% of the C and N sources. Group III was represented by a single bacterial strain: it has a extremely low salt tolerance (0.1% NaCl). This strain grew at a pH equal or higher than 5.6, was susceptible to 50% of the antibiotics assayed and metabolized 72% of the C and N sources. On the basis of a PCR- RFLP of the 16S rDNA, three groups were also obtained. Members of the group A showed a close resemblance to Rhizobium tropici CIAT 899 and Sinorhizobium americanum CFN-EI 156, while Group B was closely related to Bradyrhizobium spp. Group C, was also represented by only one isolate. The Trebol isolate, was the only one strain able to form nodules and does not appear to be related to any of the referential rhizobial strains, suggesting a possible symbiotic horizontal gene transfer. Finally, in this work, there are evidences of a genetic diversity in the venezuelan rhizobial strains. A different geographical origin is perhaps an important factor affecting the diversity of the indigenous rhizobia in this study. Rev. Biol. Trop. 59 (3): 1017-1036. Epub 2011 September 01.

Rasgos fenotípicos y marcadores moleculares de ADN se utilizaron para investigar la variación fenotípica y genética entre 12 aislados rizobianos venezolanos y 10 cepas de referencia internacionales. Para ello, se realizó un PCR-RFLP del gen rDNA 16S, la presencia de plásmidos grandes, análisis metabólicos en medios sólidos, resistencia a la salinidad, condiciones del crecimiento a diferentes pH y temperaturas y la resistencia intrínseca a antibióticos. En referencia a las cualidades fenotípicas, se diferenciaron tres grupos principales, un grupo I que abarcó a todas aquellas cepas que metabolizaban entre 67.5% y 90% de las fuentes de C y de N. También eran tolerantes a la acidez y productoras de ácido, capaces de crecer a 40ºC y a altas condiciones de salinidad (NaCl 2-2.5%). Con respecto a la sensibilidad a antibióticos, este grupo era susceptible a un 30% de los antibióticos empleados. Las cepas que pertenecen al grupo II exhibieron una tolerancia salina más baja (0.1- 1.5%NaCl), así como una menor tolerancia a la acidez, puesto que crecieron bien en valores de pH iguales o mayores a 5.0. Este grupo era resistente a todos los antibióticos probados y metabolizaban solamente entre 52.5%-82.5% de las fuentes de C y de N. Una sola cepa bacteriana representó al grupo III, con una baja tolerancia salina (0.1% NaCl). Este aislado creció a un pH mayor o igual a 5.6, era susceptible a 50% de los antibióticos probados y metabolizó el 72% de las fuentes de C y de N. Al tener como base el PCR-RFLP del 16S rDNA, se diferenciaron también tres grupos. Los miembros del grupo A demostraron una estrecha relación con Rhizobium tropici CiAT 899 y Sinorhizobium americanum CFN-Ei156, mientras que el grupo B está estrechamente vinculado a Bradyrhizobium spp. El grupo C, está representado por solo un aislado. El aislado Trebol, fue la única cepa capaz de formar nódulos y no aparece relacionado con ninguna cepa de referencia, y sugiere una transferencia horizontal de genes simbióticos. Finalmente, en este trabajo se evidencia una diversidad genética en las cepas rizobianas venezolanas. El origen geográfico diverso de estas cepas, quizás sea un factor importante que influencie la diversidad de los rizobios indígenas utilizados en este estudio.

Comparación de la actividad antiviral de polifenoles presentes en las frutas: mora (rubus fruticosus B), grapefruit (citrus paradisi M) y fresa (fragaria vesca L) / Comparation of antiviral activity of poluphenoles present in the fruits: blackberry (rubus fruticosus B) grapefruit (citrus paradici M) and strawberry (fragaria vesca L)

Una variada actividad farmacológica de citrus paradasi M, rubus fructicosus B y fragaria vesca L ha sido reportada, relacionada principalmente a la pesencia de polifenoles y sus cualidades como antioxidantes y barredores de radicales libres. La extracción acuosa de las frutas se sometió a separaciones cromatográficas en columnas de silicagel, seguidas por cromatografía de papel. La actividad antiviral fue reconocida mediante la aplicación de las fracciones a bacteriófagos de pseudomonas aeruginosa 10116-195; luego del periodo de contacto, la mezcla fue añadida a las bacterias huésped e incubados a 37°C por 24 y 72 horas. El modelo empleado, es comparable con modelos de virosis humanas. Los experimentos se realizaron con la adición de solución sulfato ferroso para evaluar si la actividad es potenciada por éste. En presencia de sulfato ferroso se encontró que los extractos crudos de las frutas inhibieron al fago a 24 y 72 horas, y todas las fracciones fueron activas a 72 horas. Las fracciones 5 de la mora y 2 de la grapefruit exhibieron actividad a las 72 horas en ausencia sulfato ferroso. Los ensayos se realizaron por cuadruplicado y los controles mostraron los resultados esperados. La inactivación del fago por las fracciones en presencia de sulfato ferroso, probablemente es debida a la producción de radicales libres.

Comparación de la actividad anti-inflamatoria de los polifenoles presentes en las frutas: mora (rubus fructicosus B) fresa (fragaria vesca L) y grapefruit (citrus paradasi M) / Comparation of the polyphenoles anti-inflamatory activity present in the fruits: blackberry (rubus fruticosus B) strawberry (fragaria vesca L) and grapefruit (citrus paradasi M)

La actividad antiflamatoria de muchas plantas se ha relacionado con la propiedad antioxidante de sus polifenoles. Con el objeto de determinar la actividad antiflamatoria de polifenoles presentes en la mora (Rubus fructicosus B), la fresa (fragaria vesca L.) y el grapefruit (citrus paradasi M) se aplicaron técnicas cromatográficas utilizando silicagel como adsorbente para separar estos compuestos de los extractos acuosos de cada una de las frutas. Las fracciones fueron reconocidas para cromatografía de papel. La actividad antiflamatoria de las fracciones fue evaluada por la inhibición de la enzima hialuronidasa, enzima involucrada en procesos inflamatorios. Se encontró que todas las fracciones de la mora, el extracto crudo y dos fracciones de la fresa (F1 y F5) y tres grapefruit (G1,G3 y G5) mostraron un efecto inhibitorio sobre la enzima. Las fracciones M2 y M6 de la mora y las dos de la fresa inhibieron la hialuronidasa en un porcentaje superior o igual al de la aspirina. Los extractos crudos de la mora y del grapefruit no afectaron la actividad de la hialuronidasa.