Trasplante hepático en hepatitis alcohólica aguda: ¿debemos decir que no?

Alcohol liver disease is one of the main indications for liver transplantation (LT). Currently, an abstinence period <6 months is required to include a patient with alcohol liver disease on the waiting list, a period that has not been shown to reduce the risk of relapse. Alcoholic hepatitis is characterized by hepatic decompensation secondary to recent, excessive consumption of alcohol, and LT may be the option in a well-selected group of patients who do not respond to medical treatment, but due to established sobriety intervals are excluded, this requires a change in the criteria established by the committees. We propose an evaluation algorithm to consider alcoholic hepatitis unresponsive to medical treatment for LT.

La enfermedad hepática por alcohol es una de las principales indicaciones de trasplante hepático (TH). Actualmente se requiere un período de abstinencia > 6 meses para incluir a un paciente con enfermedad hepática por alcohol en lista de espera de TH, periodo que no ha demostrado disminuir el riesgo de recaída. La hepatitis aguda por alcohol se caracteriza por una descompensación hepática secundaria a un consumo de alcohol excesivo reciente, y el TH puede ser la única opción en un grupo bien seleccionado de pacientes que no responden al tratamiento médico, pero debido a los intervalos de sobriedad establecidos son excluidos, y esto requiere un cambio en los criterios establecidos por los comités. Proponemos un algoritmo de evaluación para considerar para TH la hepatitis aguda por alcohol no respondedora a tratamiento médico.

Bone Disease and Liver Transplantation: A Review.

Liver transplantation is currently the most effective and almost routine treatment for chronic and acute liver diseases. The survival of transplanted patients has increased exponentially, which has led to more knowledge of the long-term complications secondary to the underlying pathology or the various treatments that must be followed. Bone metabolic disease is a chronic complication of liver transplantation that inhibits quality of life. The factors that contribute to the development of bone disease are different according to the various etiologies of liver damage. All patients should be examined for osteoporosis risk factors because the incidence of new fractures in transplant patients is higher during the first year after transplantation, reflecting the greater bone loss during this time. This article outlines a proposal for a treatment algorithm; we propose that pharmacologic therapy in patients post liver transplant should first consider the diagnosis of osteoporosis by bone mineral density, the patient's personal and family history of spine and femoral neck fractures, and the use glucocorticoids (dose and time) until a tool is available that allows the best estimation of the fracture risk in this population of patients.

Tratamiento farmacológico de la diabetes mellitus tipo 2 dirigido a pacientes con sobrepeso y obesidad / Pharmacological treatment of diabetes mellitus type 2 directed to patients with overweight and obesity

Resumen La diabetes mellitus tipo 2 es una enfermedad multifactorial y de carácter crónico que requiere un tratamiento integral a lo largo de la vida del paciente y con necesidad de ajustes constantes de acuerdo con los requerimientos específicos de cada paciente. Se ha identificado que la disminución de peso en pacientes diabéticos puede retrasar la progresión de la enfermedad e incluso retrasar o evitar su aparición. Además de ser un factor benéfico en las metas de tratamiento de los pacientes diabéticos, la disminución del peso puede lograr cambios clínicamente significativos en las concentraciones totales de glucosa sérica, hemoglobina glucosilada (HbA1C) y en las concentraciones de triglicéridos. En la actualidad las recomendaciones basadas en evidencia están dirigidas a la intervención farmacológica, quirúrgica y cambios en el estilo de vida en el manejo de la obesidad como parte del tratamiento integral de los pacientes con diabetes mellitus tipo 2. Los tratamientos farmacológicos tradicionales contra la diabetes mellitus tipo 2 pueden aumentar aún más el peso y esto puede disminuir los beneficios del control glucémico adecuado. Es importante identificar la injerencia de cada grupo de fármacos en el peso.

Abstract Diabetes mellitus type 2 (DM2) is a chronic and multifactorial disease that requires an integral treatment throughout the life of the patient and in need of constant adjustments according to specific requirements of each patient. It is well established that weight loss in diabetic patients may delay the progression of the disease or even delay its onset. In addition to being a beneficial factor in the treatment goals of diabetic patients, weight reduction can achieve clinically significant changes in serum glucose, glycated hemoglobin (HbA1c) and triglyceride levels. Evidence-based recommendations are currently aimed at pharmacological, surgical and lifestyle changes in the management of obesity as part of the comprehensive treatment of patients with diabetes mellitus type 2. Traditional pharmacological treatments for diabetes mellitus type 2 may further increase weight and this may decrease the benefits of adequate glycemic control. It's important to identify the interference of each drug group on weight.

Characterization of anode and anolyte community growth and the impact of impedance in a microbial fuel cell.

BACKGROUND: A laboratory-scale two-chamber microbial fuel cell employing an aerated cathode with no catalyst was inoculated with mixed inoculum and acetate as the carbon source. Electrochemical impedance spectroscopy (EIS) was used to study the behavior of the MFC during initial biofilm (week 1) and maximum power density (week 20). EIS were performed on the anode chamber, biofilm (without anolyte) and anolyte (without biofilm). Nyquist plots of the EIS data were fitted with two equivalent electrical circuits to estimate the contributions of intrinsic resistances to the overall internal MFC impedance at weeks 1 and 20, respectively. RESULTS: The results showed that the system tended to increase power density from 15 ± 3 (week 1) to 100 ± 15 mW/m(2) (week 20) and current density 211 ± 7 (week 1) to 347 ± 29 mA/m(2) (week 20). The Samples were identified by pyrosequencing of the 16S rRNA gene and showed that initial inoculum (week 1) was constituted by Proteobacteria (40%), Bacteroidetes (22%) and Firmicutes (18%). At week 20, Proteobacterial species were predominant (60%) for electricity generation in the anode biofilm, being 51% Rhodopseudomonas palustris. Meanwhile on anolyte, Firmicutes phylum was predominant with Bacillus sp. This study proved that under the experimental conditions used there is an important contribution from the interaction of the biofilm and the anolyte on cell performance. Table 1 presents a summary of the specific influence of each element of the system under study. CONCLUSIONS: The results showed certain members of the bacterial electrode community increased in relative abundance from the initial inoculum. For example, Proteobacterial species are important for electricity generation in the anode biofilms and Firmicutes phylum was predominant on anolyte to transfer electron. R1 is the same in the three systems and no variation is observed over time. The biofilm makes a significant contribution to the charge transfer processes at the electrode (R2 and Cdl) and, consequently, on the performance of the anode chamber. The biofilm can act as a barrier which reduces diffusion of the anolyte towards the electrode, all the while behaving like a porous material. The anolyte and its interaction with the biofilm exert a considerable influence on diffusion processes, given that it presents the highest values for Rd which increased at week 20.

Factores asociados a hemorragia subaracnoidea aneurismática en el Hospital Nacional Edgardo Rebagliati Martins (2009). Estudio Preliminar / Associated with subarachnoid hemorrhage of cerebral aneurysms in patients at Nacional Edgardo Rebagliati Martins (2009). Preliminar study

Objetivo: Identificar factores asociados a la ruptura de aneurismas cerebrales en pacientes del Hospital Nacional Edgardo Rebagliati Martins (HNERM) en el año 2009. Métodos: Estudio analítico de corte transversal. Se analizaron 69 historias clínicas de hospitalización, 51 tuvieron diagnóstico de hemorragia subaracnoidea (HSA) aneurismática y 18 de aneurisma cerebral sin ruptura. La edad, sexo, hipertensión arterial, obesidad, diabetes mellitus tipo 2, hipercolesterolemia, consumo de alcohol, tabaco y café; localización y tamaño del aneurisma fueron evaluados como factores asociados mediante las pruebas de Chi-Cuadrado, t de Student; Odds Ratio (OR). Resultados: La localización más frecuente de los aneurismas fue en la arteria comunicante posterior (37.3%). Se encontraron seis casos de aneurismas múltiples, de estos, un 66.6% culminaron en HSA. Se encontró diferencias significativas entre el sexo femenino (p=0.007, OR=0.09; IC95%: 0.01-0.74), la localización del aneurisma intracraneal (p=0.031, p<0.05) relacionados con el suceso de ruptura de aneurismas cerebrales. Conclusiones: En los pacientes del HNERM, durante el año 2009, la ubicación del aneurisma cerebral y el sexo femenino han sido factores asociados al desarrollo de HSA aneurismática. Los resultados no significativos obtenidos en los demás factores postulados pueden explicarse por una insuficiente recolección de datos en la historia clínica.

Objective: To identify factors associated with the rupture of cerebral aneurysms in patients at Hospital Nacional Edgardo Rebagliati Martins (HNERM) in 2009. Methods: Cross-sectional analytical study. We analyzed medical records of 69 hospitalized, 51 were diagnosed with aneurysmal SAH and 18 unruptured cerebral aneurysm. Age, sex, hypertension, obesity, type 2 diabetes mellitus, hypercholesterolemia, alcohol, snuff and coffee, location and size of the aneurysm were evaluated as factors associated with the Chi-square, Student t, Odds Ratio (OR). Results: The most common location of aneurysms was the posterior communicating artery (37.3%). We found six cases of multiple aneurysms of these, 66.6% resulted in SAH. Significant differences were found between female gender (p=0.007, OR=0.09, CI95% 0.01 to 0.74), the location of intracranial aneurysm (p=0.031, p<0.05) related to the event of rupture of cerebral aneurysms. Conclusions: In patients from the HNERM, in 2009, the location of cerebral aneurysms and female sex were factors associated with development of aneurysmatic SAH. The non significant results obtained in other factors postulates can be explained by insufficient data collection on medical history.