Normal transaminases in obese patients with metabolic associated steatohepatitis (MASH): a cohort of Peruvian patients.

INTRODUCTION: Metabolic associated steatohepatitis (MASH) is one of the most frequent causes of chronic liver disease. Liver transaminases are important biomarkers to measure liver injury, however, a proportion of patients with MASH may present with normal levels of transaminases. The levels of serum transaminases may not correlate with the severity of histopathological changes. OBJECTIVE: We aimed to identify the frequency of normal transaminases in obese patients with MASH, as well as to describe the clinical, biochemical and histological characteristics in this specific group of patients. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) >30Kg/m2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria. RESULTS: 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.03- 7.96; p<0.01), diagnosis of type 2 diabetes mellitus OR=4.86 (95% CI: 1.97- 11.95; p<0.01) and levels of GGT >50 IU/L OR=7.50 (95% CI: 3.40-16.56; p<0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p<0.01). Differences in the degree of fibrosis were not associated with transaminases levels. CONCLUSION: In conclusion we found that the frequency of normal transaminases was 47.2% in obese patients with MASH. Factors associated with elevation in liver enzymes were being male, diagnosis of diabetes mellitus and elevation in GGT levels. The degree of fibrosis was not associated with elevations in liver transaminases. These findings suggest that transaminases levels alone are not accurate markers to assess liver injury, as they do not necessarily correlate with histological liver damage.

Normal transaminases in obese patients with metabolic associated steatohepatitis (MASH): a cohort of Peruvian patients

Introduction: Metabolic associated steatohepatitis (MASH) is one of the most frequent causes of chronic liver disease. Liver transaminases are important biomarkers to measure liver injury, however, a proportion of patients with MASH may present with normal levels of transaminases. The levels of serum transaminases may not correlate with the severity of histopathological changes. Objective: We aimed to identify the frequency of normal transaminases in obese patients with MASH, as well as to describe the clinical, biochemical and histological characteristics in this specific group of patients. Materials and methods: A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) >30Kg/m2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria. Results: 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.037.96; p50 IU/L OR=7.50 (95% CI: 3.40-16.56; p<0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p<0.01). Differences in the degree of fibrosis were not associated with transaminases levels. Conclusion: In conclusion we found that the frequency of normal transaminases was 47.2% in obese patients with MASH. Factors associated with elevation in liver enzymes were being male, diagnosis of diabetes mellitus and elevation in GGT levels. The degree of fibrosis was not associated with elevations in liver transaminases. These findings suggest that transaminases levels alone are not accurate markers to assess liver injury, as they do not necessarily correlate with histological liver damage.

Introducción: La esteatohepatitis asociada metabólica (MASH) es una de las causas más frecuentes de enfermedad hepática crónica. Las transaminasas hepáticas son biomarcadores importantes para medir el daño hepático; sin embargo, una proporción de pacientes con MASH pueden presentar niveles normales de transaminasas. Los niveles de transaminasas séricas pueden no estar correlacionados con la gravedad de los cambios histopatológicos. Objetivo: Nuestro objetivo fue identificar la frecuencia de transaminasas normales en pacientes obesos con MASH, así como describir las características clínicas, bioquímicas e histológicas en este grupo específico de pacientes. Materiales y métodos: Se realizó un estudio transversal retrospectivo en el servicio de cirugía bariátrica de una clínica privada. Se incluyeron pacientes obesos mayores de 18 años con índice de masa corporal (IMC) >30Kg/m2 y 2 comorbilidades sometidos a cirugía de manga gástrica. Se realizó la medición de los exámenes bioquímicos de laboratorio de rutina. La resistencia a la insulina se calculó mediante el modelo de evaluación de la homeostasis (HOMA-IR). Todos los pacientes se sometieron a biopsias hepáticas antes de la cirugía y el diagnóstico de MASH se basó en los criterios de Brunt. Resultados: Se incluyeron 159 pacientes obesos con MASH, de los cuales el 47,2% tenían transaminasas normales y el 52,8% transaminasas elevadas. Los factores asociados a la alteración de las transaminasas fueron: ser hombre OR=4,02 (IC 95%: 2,03-7,96; p50 UI/L OR=7,50 (IC 95%: 3,40-16,56; p<0,01). Los valores de HOMA-IR y GGT fueron significativamente mayores en el grupo de transaminasas altas (p<0,01). Las diferencias en el grado de fibrosis no se asociaron con los niveles de transaminasas. Conclusión: Encontramos que la frecuencia de transaminasas normales fue del 47,2% en pacientes obesos con MASH. Los factores asociados con la elevación de las enzimas hepáticas fueron el sexo masculino, el diagnóstico de diabetes mellitus y la elevación de los niveles de GGT. El grado de fibrosis no se asoció con elevaciones de las transaminasas hepáticas. Estos hallazgos sugieren que los niveles de transaminasas por sí solos no son marcadores precisos para evaluar el daño hepático, ya que no necesariamente se correlacionan con el daño hepático histológico.

Prunus persica crop management differentially promotes arbuscular mycorrhizal fungi diversity in a tropical agro-ecosystem.

Due to the important role of arbuscular mycorrhizal fungi (AMF) in ecosystem functioning, determination of the effect of management practices on the AMF diversity in agricultural soils is essential for the sustainability of these agro-ecosystems. The objective of this study was to compare the AMF diversity in Prunus persica roots under two types of fertilisation (inorganic, with or without manure) combined with integrated or chemical pest management in a Venezuelan agro-ecosystem. The AM fungal small-subunit (SSU) rRNA genes were subjected to PCR, cloning, sequencing and phylogenetic analyses. Twenty-one different phylotypes were identified: 15 belonged to the genus Glomus, one to Claroideoglomus, two to Paraglomus, one to Acaulospora, one to Scutellospora and one to Archaeospora. The distribution of the AMF community composition differed as a consequence of the treatment effects. The treatment combining organic and inorganic fertilisation with chemical pest control had the highest AMF richness and the treatment combining inorganic fertilisation with chemical pest had the lowest. The real causes and effects of these differences in the AMF community are very difficult to establish, since the crop management regimes tested were composed of several interacting factors. In conclusion, the crop management practices can exert a significant influence on the populations of AMF. The treatment combining organic and inorganic fertilisation with chemical pest control appears to be the most suitable agricultural management strategy with respect to improving the AMF diversity in this crop under tropical conditions, and thus for maintaining the agricultural and environmental sustainability of this agro-ecosystem.

Evidence of differences between the communities of arbuscular mycorrhizal fungi colonizing galls and roots of Prunus persica infected by the root-knot nematode Meloidogyne incognita.

Arbuscular mycorrhizal fungi (AMF) play important roles as plant protection agents, reducing or suppressing nematode colonization. However, it has never been investigated whether the galls produced in roots by nematode infection are colonized by AMF. This study tested whether galls produced by Meloidogyne incognita infection in Prunus persica roots are colonized by AMF. We also determined the changes in AMF composition and biodiversity mediated by infection with this root-knot nematode. DNA from galls and roots of plants infected by M. incognita and from roots of noninfected plants was extracted, amplified, cloned, and sequenced using AMF-specific primers. Phylogenetic analysis using the small-subunit (SSU) ribosomal DNA (rDNA) data set revealed 22 different AMF sequence types (17 Glomus sequence types, 3 Paraglomus sequence types, 1 Scutellospora sequence type, and 1 Acaulospora sequence type). The highest AMF diversity was found in uninfected roots, followed by infected roots and galls. This study indicates that the galls produced in P. persica roots due to infection with M. incognita were colonized extensively by a community of AMF, belonging to the families Paraglomeraceae and Glomeraceae, that was different from the community detected in roots. Although the function of the AMF in the galls is still unknown, we hypothesize that they act as protection agents against opportunistic pathogens.

Efecto de la rotación de cultivos y prácticas de labranza sobre las fracciones de la materia orgánica del suelo / Tillage system and crop rotattion effects on soil organic matter fractions

Las prácticas de labranza y rotación de cultivos pueden modificar la materia orgánica del suelo (MOS). Un estudio conducido por siete años, donde se incluyeron labranza y rotación de cultivos, fue utilizado para evaluar el efecto del manejo de suelo sobre las diferentes fracciones de C y N. El experimento fue localizado en Turén, estado Portuguesa, Venezuela, e incluyó dos sistemas de labranza, labranza convencional (LC) y siembra directa (SD), y dos rotaciones de cultivos, maíz-algodón (MA) y maíz-fríjol (MF). Muestras de suelo fueron colectadas a tres profundidades y se analizó el C (COT) y N orgánico total (NOT), C (MMC) y N (MMN) de la masa microbiana, C y N mineralizable (Cmin y N min), N lábil potencialmente mineralizable (N1) y su tasa de descomposición (kl). Los cambios observados en COT y NOT en respuesta a la labranza y a la rotación de cultivos fueron relacionados con la cantidad y calidad de residuos de planta que regresan al suelo, pero no con su distribución en el perfil del suelo, con excepción de la MO mineralizable. Este estudio demuestra la importancia de la MMC, MMN y de la mineralización de C y N como índices para conocer la dinámica de la MOS en una zona tropical. Por otra parte, el N1 puede ser usado como indicador de la capacidad del suelo de liberar N de la MOS.

[Colestasic toxic hepatitis caused by terbinafine: case report]. / Hepatitis tóxica colestásica por terbinafina: reporte de caso.

Trichophytic onychomycosis of the feet represents an important and serious medical problem. Until recent years, there was not cure for this unpleasant pathology. It is only at the beginning of the 50s, especially at the onset of the antimycotic systemic therapy that a cure is available offering high rate of clinical and mycological therapy. The purpose of this report is to better inform on the undesirable side-effects of antimycotic agents which are currently so largely disseminated. The case of a young patient is presented who was enjoying good health and who after 6 weeks of starting therapy with terbinafine on a doses of 1 pill of 250 mg a day, to treat a trichophytic onychomycosis in both feet, developed severe symptoms of toxic colostatic hepatitis duly corroborated after pertinent testing. Patient had a full recovery after a few months of having interrupted her therapy, apparently without any sequel. The literature in this regard has been revised and a close monitoring of the hepatic function is recommended prior and during treatment with this drug. The need to continue research to find an ideal antimycotic still not found is also recommended.

Hepatitis tóxica colestásica por terbinafina: reporte de caso / Colestasica toxic hepatitis by terbinafine: case report

Las onicomicosis tricofíticas de los pies representan un importante y serio problema médico. Hasta años recientes, no se contaba con una terapia que ofreciera curación para esta desagradable patología. Recién a partir de los años 50, sobre todo con el advenimiento de la terapia sistémica antimicótica, se puede ofrecer un elevado porcentaje de curaciones clínico-micológicas. Con el propósito de contribuir al mejor conocimiento de los efectos indeseables de estos agentes antimicóticos, actualmente tan difundidos, presentamos el caso de una paciente joven y gozando de buena salud que, 6 semanas después de iniciada la terapia con terbinafina oral a dosis terapéuticas, 1 comprimido de 250 mg por día, para tratar una onicomicosis tricofítica universal de ambos pies, desarrolló un cuadro sintomático severo de hepatitis tóxica colestásica, comprobado por las pruebas pertinentes, que, afortunadamente, remitió hasta su recuperación, varios meses después de interrumpida la terapia, sin dejar, aparentemente, secuelas. Se revisa la literatura al respecto y se llama la atención de la necesidad de controlar previamente y durante el tratamiento con esta droga la función hepática y se señala la necesidad de continuar con las investigaciones hasta el hallazgo de un antimicótico ideal, todavía no logrado.

Trichophytic onychomycosis of the feet represents an important and serious medical problem. Until recent years, there was not cure for this unpleasant pathology. It is only at the beginning ofthe 50s, especially at the onset of the antimycotic systemic therapy that a cure is available offering high rate of clinical and mycological therapy. The purpose of this report is to better inform on the undesirable side-effects of antimycotic agents which are currently so largely disseminated. The case of a young patient is presented who was enjoying good health and who after 6 weeks of starting therapy with terbinafine on a dosis of 1 pill of 250 mg a day, to treat a trichophytic onychomycosis in both feet, developed severe symptoms of toxic colostatic hepatitis duly corroborated after pertinent testing. Patient had a full recovery after a few months of having interrupted her therapy, apparently without any sequel. The literature in this regard has been revised and a close monitoring of the hepatic function isrecommended prior and during treatment with this drug. The need to continue research to find an ideal antimycotic still not found is also recommended.