Inflammatory capacity of exosomes released in the early stages of acute pancreatitis predicts the severity of the disease.

As acute pancreatitis progresses to the severe form, a life-threatening systemic inflammation is triggered. Although the mechanisms involved in this process are not yet well understood, it has been proposed that circulating exosomes may be involved in the progression of inflammation from the pancreas to distant organs. Here, the inflammatory capacity and protein profile of plasma exosomes obtained during the first 24 h of hospitalization of patients diagnosed with acute pancreatitis were characterized and compared with the final severity of the disease. We found that the final severity of the disease strongly correlates with the inflammatory capacity of exosomes in the early stages of acute pancreatitis. Exosomes isolated from patients with mild pancreatitis had no effect on macrophages, while exosomes isolated from patients with severe pancreatitis triggered NFκB activation, TNFα and IL1ß expression, and free radical generation. To delve deeper into the mechanism involved, we performed a proteomic analysis of the different exosomes that allowed us to identify different groups of proteins whose concentration was also correlated with the clinical classification of pancreatitis. In particular, an increase in the amount of S100A8 and S100A9 carried by exosomes of severe pancreatitis suggests that the mechanism of action of exosomes is mediated by the effect of these proteins on NADPH oxidase. This enzyme is activated by S100A8/S100A9, thus generating free radicals and promoting an inflammatory response. Along these lines, we observed that inhibition of this enzyme abolished all the pro-inflammatory effects of exosomes from severe pancreatitis. All this suggests that the systemic effects, and therefore the final severity of acute pancreatitis, are determined by the content of circulating exosomes generated in the early hours of the process. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Hemorragia digestiva grave secundaria a esofagitis por virus del herpes simple y citomegalovirus / Severe gastrointestinal bleeding due to synchronous herpes simplex virus and cytomegalovirus esophagitis

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COVID-19 and liver disease: An update. / Actualización en COVID-19 y enfermedad hepática.

The SARS-CoV-2 pandemic has proven to be a serious challenge for the Spanish healthcare system. The impact of the virus on the liver is not well known, but in patients with chronic liver disease, mostly in advanced stages, it can critically compromise survival and trigger decompensation. Treatment in this subpopulation is complex due to the potential hepatotoxicity of some of the medicinal products used. Moreover, the pandemic has also negatively impacted patients with liver disease who have not contracted COVID-19, since the reallocation of human and material resources to the care of patients with the virus has resulted in a decrease in the treatment, diagnosis and follow-up of patients with liver disease, which will surely have negative consequences in the near future. Efficient reorganization of hepatology units is a priority to minimise the impact of the pandemic on a population as vulnerable as liver disease patients.

Validación clínica del test Endofaster(R) como método diagnóstico rápido de la infección por Helicobacter pylori / No disponible

INTRODUCCIÓN: el objetivo fue evaluar la exactitud diagnóstica de Endofaster(R) para la detección de Helicobacter pylori. MÉTODOS: se realizó estudio histológico de biopsias gástricas (patrón oro) y aspirado del jugo gástrico para análisis por Endofaster(R) (negativo si la concentración de amonio fue < 57 ppm, positivo si > 67 ppm y débilmente positivo entre 57-67). RESULTADOS: ochenta y seis pacientes fueron incluidos y Endofaster(R) fue positivo en el 33,7%, débilmente positivo en el 11,6% y negativo en el 54,7%. Las biopsias fueron positivas en el 38,4%. Se alcanzó una precisión del 81,4% y Kappa = 0.57. CONCLUSIONES: Endofaster(R) permitiría un diagnóstico rápido de la infección con una buena precisión diagnóstica (AUROC = 0.81)

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Clinical validation of Endofaster® for a rapid diagnosis of Helicobacter pylori infection.

BACKGROUND: this study aimed to evaluate the diagnostic accuracy of the Endofaster® for the detection of Helicobacter pylori. METHODS: during upper gastrointestinal endoscopy, gastric juice was aspirated to perform an analysis using the Endofaster®. This test was considered as positive when the ammonium concentration was > 67 ppm, negative when < 57 ppm and weakly positive between 57 and 67. Biopsy specimens were also taken as the gold standard. RESULTS: among the 86 patients enrolled in the study, the Endofaster® result was positive in 23.7%, negative in 54.7% and weakly positive in 11.6%, whereas infection was detected via histology in 38.4% of patients. The accuracy was 81.4%, with a Kappa value of 0.57. CONCLUSIONS: the Endofaster® could be useful to perform a rapid diagnosis of Helicobacter pylori infection (area under the curve = 0.81).

Actualización en COVID-19 y enfermedad hepática / COVID-19 and liver disease: An update

La pandemia producida por SARS-CoV-2 ha supuesto uno de los mayores desafíos del sistema sanitario español. El impacto del virus sobre el hígado no es bien conocido, pero en pacientes con enfermedades hepáticas crónicas, especialmente en estadios avanzados, puede comprometer de forma crítica la supervivencia y desencadenar descompensaciones. El tratamiento en esta subpoblación es complejo por la potencial hepatotoxicidad de algunos fármacos empleados. Más allá, la pandemia también ha impactado negativamente sobre aquellos con enfermedades hepáticas que no han adquirido la enfermedad, ya que la redistribución de los recursos humanos y materiales hacia la atención de pacientes con COVID-19 ha provocado una merma en su tratamiento, diagnóstico y seguimiento que, a buen seguro, tendrá consecuencias negativas en el futuro. La reorganización eficiente de las unidades de Hepatología es una necesidad de primer orden para aminorar el impacto de la pandemia sobre una población tan vulnerable como los pacientes con hepatopatía

The SARS-CoV-2 pandemic has proven to be a serious challenge for the Spanish healthcare system. The impact of the virus on the liver is not well known, but in patients with chronic liver disease, mostly in advanced stages, it can critically compromise survival and trigger decompensation. Treatment in this subpopulation is complex due to the potential hepatotoxicity of some of the medicinal products used. Moreover, the pandemic has also negatively impacted patients with liver disease who have not contracted COVID-19, since the reallocation of human and material resources to the care of patients with the virus has resulted in a decrease in the treatment, diagnosis and follow-up of patients with liver disease, which will surely have negative consequences in the near future. Efficient reorganization of hepatology units is a priority to minimise the impact of the pandemic on a population as vulnerable as liver disease patients

Hepatic angiosarcoma in a patient with liver cirrhosis / Angiosarcoma hepático en un paciente con cirrosis hepática

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Amoebic liver abscess / Absceso hepático amebiano

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Acute gastric volvulus / Vólvulo gástrico agudo

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Gallstone-related disease in the elderly: is there room for improvement?

BACKGROUND AND AIM: Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed. METHODS: We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified. RESULTS: A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21-25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01). CONCLUSIONS: Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.

Tratamiento de la hepatitis crónica B antígeno e positiva con antivirales orales: experiencia y resultados en la práctica clínica / HBeAg-positive chronic hepatitis B treatment with oral antiviral agents: Experience and results in clinical practice

INTRODUCCIÓN: La globalización y los movimientos migratorios hacen que la hepatitis crónica B Age+ (HCBe+) cobre cada día mayor relevancia en nuestro entorno. Objetivo Analizar las características epidemiológicas, evolución y respuesta al tratamiento con antivirales orales (AO) de los pacientes con HCBe+.Material y métodosSe analizaron 436 casos de infección crónica por el virus de la hepatitis B atendidos en el Hospital Universitario Ramón y Cajal desde 1990 hasta junio del 2012.ResultadosSesenta y cinco (14,9%) presentaban HCBe+. Siete pacientes en fase de tolerancia inmune no fueron tratados; los 58 restantes, sí. Fueron excluidos 4: 2 hepatitis agudas graves, una coinfección por VHC y otro por virus Delta. De los 54 restantes, 19 recibieron interferón con o sin AO y 35 solo Dos tratados durante menos de un mes no fueron incluidos en el análisis. Este se realizó finalmente en 33 pacientes. Duración media del tratamiento: 46,81 meses (6-138). Lamivudina fue el fármaco más prescrito (39,39%), seguida de tenofovir (24,24%) y entecavir (21,21%). Edad media: 42,08 ± 14 años; varones 75,75% (25/33). El 57,57% (19/33) seroconvirtió el antígeno e y el 27,27% (9/33) eliminó el antígeno de superficie. No se objetivó la reaparición de este último tras un seguimiento medio de 35,6 meses. Resistencias: 8 casos en 7 pacientes, 7 a lamivudina y uno a adefovir. CONCLUSIONES: El 15% de las HCB en nuestro medio son e+. El tratamiento con AO logra una elevada tasa de seroconversión (57,57%) y un considerable porcentaje de pérdida del antígeno de superficie (27,27%)

INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B isbecoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08 ± 14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%)

[HBeAg-positive chronic hepatitis B treatment with oral antiviral agents: experience and results in clinical practice]. / Tratamiento de la hepatitis crónica B antígeno e positiva con antivirales orales: experiencia y resultados en la práctica clínica.

INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B is becoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08±14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%).