Acute liver failure: Management update and prognosis.

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.

The analytic hierarchy process in decisionmaking for caprine health programmes.

The purpose of this study was to apply the analytic hierarchy process (AHP) to assist decision-making when planning animal health programmes, by assigning priorities to issues of concern to producers in Chile's main goat production region. This process allows a multi-criteria approach to problems, by analysing and ranking them in a hierarchical structure. Industry experts have highlighted the following animal health and disease control criteria: acceptance by breeders of disease control measures; impact of specific diseases on regional animal trade; the cost and efficacy of control measures; a decrease in flock production; and the impact of caprine diseases on human public health. Using these criteria in the AHP, the study found that the most important impacts were on human public health and on the animal trade. The disease priorities were tuberculosis, brucellosis and echinococcosis/hydatidosis, due mainlyto their zoonotic impact. The analytic hierarchy process proved useful when several criteria were involved in public health issues.

Bedside glucose monitoring: in compliance with regulatory standards.

When accurately performed, bedside glucose monitoring (BGM) is a prompt, reliable, and cost-effective method of managing patients who require a high degree of glucose control. However, regulatory agencies have criticized the quality-control deficiencies of most existing BGM programs. A new generation of multi-user reflectance meters enables the various regulatory directives to be more easily satisfied. These meters provide computer-assisted quality control analysis and facilitate operator feedback for each control test. New York State Department of Health regulations state that the ultimate responsibility for BGM belongs to the chemistry laboratory director. We believe that nursing personnel should retain their patient care prerogative to perform glucose monitoring. Implementation of our successful BGM program required the collaboration of nursing, medical, laboratory, and administrative personnel. These departments combined theoretical and practical expertise with material and financial management. During the first 5 months of operation, our program has shown a steady increase from 78% to 89% of control tests performed correctly. This model can be used by other hospitals to achieve a successful BGM program.

Hepato-splenic distribution of 99Tcm-phytate and hepato-enteric distribution of 99Tcm-DISIDA in mice with carbon tetrachloride-induced acute liver damage.

The hepato-enteric distribution of 99Tcm-labelled DISIDA and the hepato-splenic distribution of 99Tcm-labelled phytate were studied in controls and in mice with carbon tetrachloride-induced acute liver damage. The test group animals showed a diminished excretion of DISIDA to intestine with retention of this tracer in the liver and an increased splenic uptake of phytate. No changes in the hepatic uptake of phytate were found. The joint evaluation of both tracers in the study of diffuse liver disease is discussed.

[Methodological aspects related to the determination of the relative renal function using 99mTC MAG3]. / Aspectos metodológicos relacionados con la determinación de la función renal relativa usando 99mTc MAG3.

UNLABELLED: The aim of the study was to evaluate three different methods for calculating the split renal function in patients with only one functioning kidney, keeping in mind that the split function should be zero on the side of the non-functioning kidney. PATIENTS: We retrospectively selected 28 99mTc MAG3 renograms performed in children, 12 with unilateral nephrectomy, 4 with unilateral agenesis and 12 with a non-functioning kidney. METHODS: A renal and perirenal region of interest (ROI) were delineated around the functioning kidney. The ROIs around the empty kidney were drawn symmetrically to the contralateral side. The split renal function was calculated using three different methods, the integral method, the slope method and the Patlak-Rutland algorithm. RESULTS: For the whole group of 28 kidneys as well as for the three categories of patients, the three methods provided a split function on the side of the non-functioning kidney close to the zero value, regardless of whether the empty kidney was the left or the right one. CONCLUSION: We recommend the use of the integral method for the whole range of split renal function with 99mTc MAG3. No significant improvement was obtained by means of the more sophisticated Patlak-Rutland method.

[Renal size in children with normal renal 99mTc-DMSA scan: building a nomogram with scintigraphic length]. / Tamaño renal en niños con gammagrafía renal Tc99m-DMSA normal: construcción de un nomograma con longitudes cintigráficas.

AIM: The aim of this study was to evaluate renal size in children with normal 99mTc-DMSA scans and to compare it with the published ultrasonographic values. MATERIAL AND METHODS: Renal length of DMSA normal scans obtained from 253 children with history of urinary tract infection was measured. Regression analysis and length/age curves were done. Scintigraphic values were compared with published normal ultrasonographic length. RESULTS: Regression algorithm for the whole group of patients was length (cm) = 6.1727 age (yr)0,1535. In the first year of life the equation was length (cm) = 0.1524 age (month) + 4.568, and in 1-16 yr children it was length (cm) = 0.2644 age (yr) + 6.319. There were no significant differences between both genders or in regards to reference ultrasonographic data. CONCLUSION: Both renal 99mTc-DMSA scintigraphy and ultrasonography are useful tools for estimating renal size in children according age.

The phase angle of the electrical impedance is a predictor of long-term survival in dialysis patients.

INTRODUCTION: Protein-energy malnutrition is a risk factor for mortality in dialysis patients; however, its clinical assessment has not been well defined. Electrical bioimpedance (EBI) is a non-invasive and objective procedure, which is increasingly being used for this assessment. OBJECTIVE: The aim of this study is to analyse the relationship between the phase angle determined by EBI at a frequency of 50kHz (AF50) and other nutritional parameters, and prospectively evaluate its ability as a marker for long-term mortality. PATIENTS AND METHODS: We included 164 patients (127 on haemodialysis and 37 on peritoneal dialysis) who underwent an EBI analysis while simultaneously determining inflammation and nutrition parameters. The Charlson comorbidity index was then calculated. RESULTS: In the linear correlation analysis, we found that the AF50 had a direct association with lean mass, intracellular water, extracellular water and interdialytic weight gain, while having an inverse association with age and fat mass. Patients with AF50 >8º had a better nutritional status, were younger and had significantly longer survival at the six-year follow-up. Among the patients studied, both the AF50 and the other body composition parameters were better in peritoneal dialysis than in haemodialysis, but these differences may be attributable to the fact that the first patients were younger. In the multivariate analysis, only the AF50 <8º and comorbidity adjusted for age persisted as independent risk factors for mortality. CONCLUSIONS: We conclude that AF50 has a good correlation with nutritional parameters and is a good marker of survival in dialysis patients. Nevertheless, intervention studies are needed to demonstrate if the improvement in EBI parameters is associated with better survival.

El ángulo de fase de la impedancia eléctrica es un predictor de supervivencia a largo plazo en pacientes en diálisis / The phase angle of the electrical impedance is a predictor of long-term survival in dialysis patients

Introducción: La malnutrición calórico-proteica es un factor de riesgo de mortalidad en pacientes en diálisis, sin embargo, su valoración clínica no ha sido bien definida. La bioimpedancia eléctrica (BIE) es un procedimiento no invasivo y objetivo, cada vez más empleado en su valoración. Objetivo: El objetivo de este estudio es analizar la relación entre el ángulo de fase determinado por BIE a una frecuencia de 50 kHz (AF50) con otros parámetros de nutrición y valorar prospectivamente su capacidad como marcador pronóstico de mortalidad a largo plazo. Pacientes y métodos: Incluimos a 164 pacientes, 127 en hemodiálisis y 37 en diálisis peritoneal, a los que se les realiza un análisis de BIE al tiempo que se solicitan parámetros de inflamación y nutrición y se calcula el índice de comorbilidad de Charlson. Resultados: En el análisis de correlación lineal, encontramos que el AF50 tiene una asociación directa con la masa magra, con el agua intracelular, con el agua extracelular y con la ganancia de peso interdiálisis, mientras que se asocia de forma inversa con la edad, con la masa grasa y con el log PCR. Los pacientes con AF50 >8o presentan un mejor estado nutricional, son más jóvenes y tienen una supervivencia significativamente mejor a los seis años de seguimiento. Entre los pacientes (..) (AU)

Introduction: Protein-energy malnutrition is a risk factor for mortality in dialysis patients; however, its clinical assessment has not been well defined. Electrical bioimpedance (EBI) is a non-invasive and objective procedure, which is increasingly being used for this assessment. Objective: The aim of this study is to analyse the relationship between the phase angle determined by EBI at a frequency of 50kHz (AF50) and other nutritional parameters, and prospectively evaluate its ability as a marker for long-term mortality. Patients and methods: We included 164 patients (127 on haemodialysis and 37 on peritoneal dialysis) who underwent an EBI analysis while simultaneously determining inflammation and nutrition parameters. The Charlson comorbidity index was then calculated. Results: In the linear correlation analysis, we found that the AF50 had a direct association with lean mass, intracellular water, extracellular water and interdialytic weight gain, while having an inverse association with age and fat mass. Patients with AF50 >8o had a better nutritional status, were younger and had significantly longer survival at the six-year follow-up. Among the patients studied, both the AF50 and the other body composition parameters were better in peritoneal dialysis than in haemodialysis, but these differences may be attributable to the fact that the first patients were younger. In the multivariate analysis, only the AF50 <8o and comorbidity adjusted for age persisted as independent risk factors for mortality. Conclusions: We conclude that AF50 has a good correlation with nutritional parameters and is a good marker of survival in dialysis patients. Nevertheless, intervention studies are needed to demonstrate if the improvement in EBI parameters is associated with better survival (..) (AU)

[Correlation between four-hour creatinine clearance and 51Cr-EDTA test]. / Correlación entre clearance de creatinina de 4 horas y la prueba de 51Cr-EDTA.

BACKGROUND: Creatinine clearance as a measure of glomerular filtration rate has several sources of error such as tubular creatinine secretion or faulty urine collections. On the other hand 51Cr-EDTA test is reliable and accurate, except in patients with edema, in whom the radioisotope equilibrium is retarded after injection. AIM: To validate a 4-hours creatinine clearance correlating it with 51Cr-EDTA test. METHODS: In 59 non insulin dependent diabetic patients without diabetic nephropathy, glomerular filtration rate was measured using one 50 microCi injection of 51Cr-EDTA and collecting blood samples for radioactivity measurement at 10, 30, 120 and 240 min. Simultaneously, creatinine clearance was measured using a 4 hours urine collection. RESULTS: The general correlation coefficient between both methods was 0.85 (p < 0.001). For glomerular filtration rates below 95 ml/min, the correlation coefficient was 0.8 (p < 0.001), for values between 95 and 127 ml/min, the correlation was 0.51 (p < 0.001) and for values over 127 ml/min the correlation was 0.8 (p < 0.001). The regression equation obtained was y = 1,2x + 13 where y was the glomerular filtration rate measured with 51Cr-EDTA and x the same value measured with creatinine clearance. CONCLUSIONS: The four hours creatinine clearance is a reliable method to estimate glomerular filtration rate.

Aspectos metodológicos relacionados con la determinación de la función renal relativa usando 99mTc MAG3 / Methodological aspects related to the determination of the relative renal function using 99mTc MAG3

El propósito de este trabajo fue evaluar tres métodos distintos de cálculo de función renal relativa (FRR) en pacientes con un solo riñón funcionante, teniendo en cuenta que en el lado del riñón 'no funcionante' la función debiera ser cero. Pacientes: Seleccionamos retrospectivamente 28 renogramas 99mTc MAG3 realizados en niños: 12 con nefrectomía unilateral, 4 con agenesia unilateral, y 12 con un riñón 'no funcionante'. Método: Se dibujó un área de interés (ROI) renal, y otra de sustracción de fondo perirrenal, para cada riñón funcionante. Las ROI para el riñón 'no funcionante' se dibujaron simétricamente al lado contralateral. La FRR fue calculada usando 3 métodos: Integral, de las Pendientes y Patlak-Rutland. Resultados: Tanto para el grupo total de riñones como para cada uno de los tres subgrupos de pacientes, los tres métodos dieron resultados cercanos a cero al lado del riñón 'no funcionante', estuviera éste al lado izquierdo o derecho. Conclusión: Recomendamos el uso del método integral para el cálculo de amplios rangos de FRR con 99mTc MAG3.Ninguna mejoría significativa fue obtenida por medio del más sofisticado método de Patlak-Rutland (AU)

Tamaño renal en niños con gammagrafía renal Tc99m-DMSA normal: construcción de un nomograma con longitudes cintigráficas / Renal size in children with normal renal 99m tc-dmsa scan: building a nomogram with scintigraphic length

Objetivo. El objetivo de este estudio fue evaluar el tamaño renal en gammagrafías Tc99m-DMSA normales en niños, y compararla con los valores ultrasonográficos publicados. Material y método. Se midió la longitud renal en gammagrafías DMSA normales de 253 niños con antecedentes de infección urinaria. Se confeccionaron curvas longitud renal/edad y se efectuó análisis de regresión. Los valores cintigráficos se compararon con las longitudes normales ecográficas publicados. Resultados. La ecuación de regresión para el grupo total de pacientes fue Longitud (cm) = 6,1727 edad (años) 0,1535. En el primer año de vida ésta fue Longitud (cm) = 0,1524 edad (meses) + 4,568, y en niños de 1-16 años Longitud (cm) = 0,2644 edad (años) + 6,319. No se encontró diferencias significativas entre sexos, ni con las longitudes de referencia ecográficas. Conclusión. Tanto la gammagrafía renal Tc99m-DMSA como la ecografía son instrumentos útiles para estimar el tamaño renal de acuerdo a la edad en niños (AU)