Efectividad y seguridad de las emulsiones de pescado en la colestasis asociada a nutrición parenteral en neonatos

El daño hepático asociado a Nutrición Parenteral es una complicación letal en pacientes con nutrición parenteral prolongada. Su etiología no es clara aún, y se cree que las emulsiones lipídicas tradicionales con en base aceite de soya pueden contribuir a su génesis. Recientemente la modificación del contenido de ácidos grasos de las emulsiones lipídicas tradicionalmente de ácidos grasos omega-6 a ricas en omega-3 se postula como terapia prometedora en niños con PNALD. Se realizó una búsqueda sistemática de la literatura en Cochrane y Pubmed, se seleccionaron ensayos clínicos controlados y estudios de cohorte prospectiva. Se utilizó le metodología SIGN para la calificación de los estudios y evaluación del grado de recomendación basada en la evidencia. El meta-análisis que se llevó a cabo incluyó dos artículos de cohorte prospectiva del grupo de Boston para la variable principal de desenlace considerada: tiempo de reverso de la colestasis. Los pacientes que recibieron emulsiones de lípidos de pescado experimentaron regresión de la colestasis significativamente más rápido que los que recibieron emulsiones de soya (HR=10.3, IC 95%:3.7,29,0, efectos fijos), menor mortalidad y menor necesidad de trasplante hepático. Su utilización no se asocia con deficiencia de ácidos grasos, hipertrigliceridemia, coagulopatía o retraso en el crecimiento. Se evidencio una correlación entre la disminución de los niveles de triglicéridos y aumento de los niveles de albúmina, sugiriendo un beneficio nutricional en los pacientes bajo infusiones de lípidos de pescado.

Perfil acido-base de pacientes con cirrosis descompensada por hemorragia digestiva alta en el departamento de emergencias: serie de casos

Introducción: La hemorragia digestiva (HVDA) es la principal causa de descompensación en pacientes con cirrosis. Caracterizar el estado ácido-base de estos pacientes sería útil para reflejar la severidad del sangrado e identificar pacientes con alto riesgo de complicación. Objetivo: Describir el estado ácido-base de los pacientes que consultaron a urgencias con cirrosis descompensada por HVDA y posteriormente fueron manejados en la unidad de cuidado intensivo (UCI) o fallecieron. Métodos: Se realizó el análisis del estado ácido-base a 10 pacientes con estas características, utilizando tres métodos distintos. Resultados: El perfil ácido-base encontrado fue: acidosis metabólica por iones no medidos, acidosis láctica, alcalosis por hipoalbuminemia y anión gap elevado en la mayoría de pacientes. Conclusiones: La teoría de Henderson-Hasselbach no fue suficiente para identificar pacientes con alto riesgo, debería implementarse concomitantemente el análisis anión gap, base déficit y el método físico–químico, para entender los fenómenos acido base de estos pacientes.

Factores que influyen en la actividad de trasplantes en Colombia año 2013. Desde la perspectiva de pacientes renales y de expertos en trasplante de riñón, hígado y corazón

Antecedentes: Se encuentran datos oficiales sobre trasplante de órganos en Colombia desde 2005 del Instituto Nacional de Salud y desde 2008 para riñón por la Cuenta de Alto Costo. Los datos no ofrecen explicación del número de inscritos en lista de espera para trasplante renal, al comparar con otros países: Colombia 4,68% vs. Argentina 27,58% o Estados Unidos 21,73%. Por otra parte no existen datos acerca de factores que influyen en el seguimiento pos-trasplante y no se tienen de sobrevida del receptor y del injerto. Metodología: Investigación de metodología mixta cuantitativa y cualitativa a partir de la información disponible en los informes oficiales y teniendo como fuente primaria pacientes y expertos en el cuidado de paciente antes y después del trasplante. Resultados: Los factores para acceder o no a lista de espera y seguimiento más mencionados son sistema de salud, aspectos éticos en cuanto remisión y autorización. Emerge como categoría la necesidad de un sistema de vigilancia en trasplantes. En la parte cuantitativa se trasplantan más personas si viven en una ciudad con grupo de trasplante 17,6 vs. 8,05%, si pertenecen al régimen contributivo O.R 3,37 p<0,00001, si no tienen diabetes O.R 3,22 p<0,0001 ni hipertensión arterial O.R 2,42 p<0,0001. No se encontró diferencia en cuanto a género O.R 1,01 p 0,57. Conclusiones: Se proponen ajustes al sistema de salud, de la normatividad, de la educación de la promoción de la donación y trasplante en todos los niveles del público y del personal de salud.

Sociodemographic characteristics and clinical features of patients with adult polycystic kidney disease undergoing hemodialysis

Aims:To analyze the socio-demographic and clinical characteristics of patients with adult polycystic kidney disease admitted to hemodialysis services in Northwestern Paraná state,Brazil. Methods: This was an observational, descriptive and retrospective longitudinal study. Medical records of patients with polycystic kidneys who initiated hemodialysis between 1995 and 2012, in four centers that treat patients of the coverage area of the 15th Regional Health Region of Paraná state where analyzed. Results:We found that 10.3% of hemodialysis patients had polycystic kidney disease as a leading cause of stage 5 of chronic kidney disease. The mean age of patients was 54.9±9.4 years (ranging between 27 and 74 years), with equal gender distribution and Caucasian predominance (72.9%). The average age of dialysis initiation was 50±10.2 years. The most common comorbidity was systemic hypertension (66.7%). Liver cyst was the main extra-renal manifestation (10.4%). Twenty-five percent of the patients required renal transplantation, and (22.9%) undergone nephrectomy. The most widely used classes of antihypertensive drugs were β-blockers (41.7%) and drugs that act on the renin-angiotensin system (31.3%), while 56.3% of patients were treated with recombinant human erythropoietin. Conclusions:This is a pioneering epidemiological study in Northwestern Paraná state. We found in this population a sociodemographic and clinical profile of adult polycystic kidney disease similar to that of North America and Europe, probably because the ethnic constitution of the sample was predominantly of Euro-descendants.

Autosomal dominant polycystic kidney disease in hemodialysis patients in southern Brazil

Introduction: Autosomal dominant polycystic kidney disease is the most common hereditary renal disease in humans. Objective: To examine the prevalence, clinical and laboratory characteristics of patients with polycystic kidneys and relate disease manifestations by gender. Methods: This was an observational and retrospective study. All the medical records of patients with polycystic kidneys who initiated hemodialysis between 1995 and 2012, in four centers that treat patients of the coverage area of the 15th regional health Paraná (Brazil), were analyzed. Results: The study included 48 patients with polycystic kidneys, the primary cause of stage 5 CKD. Disease prevalence was one in 10,912 people. The average age of dialysis initiation was 50.7 years and the follow-up time on dialysis until transplantation (36.5 months) was lower among men. Hypertension was the most frequent diagnosis in 73% of patients, predominantly in women (51.4%). The liver cyst was the most frequent extrarenal manifestations in men (60.0%). The death occurred in 10.4% of patients using hemodialysis, and 60% of men. The class of antihypertensive drug used was that acts on the renin-angiotensin system with higher frequency of use among women (53.3%). The post-dialysis urea was significantly higher in men. Conclusion: The prevalence of the disease is low among hemodialysis patients in southern Brazil. The differences observed between genders, with the exception of the post-dialysis urea, were not significant. The findings are different from those reported in North America and Europe.

An integrative model of amino acid metabolism in the liver of the lactating dairy cow

The objective of this work was to construct a dynamic model of hepatic amino acid metabolism in the lactating dairy cow that could be parameterized using net flow data from in vivo experiments. The model considers 22 amino acids, ammonia, urea, and 13 energetic metabolites, and was parameterized using a steady-state balance model and two in vivo, net flow experiments conducted with mid-lactation dairy cows. Extracellular flows were derived directly from the observed data. An optimization routine was used to derive nine intracellular flows. The resulting dynamic model was found to be stable across a range of inputs suggesting that it can be perturbed and applied to other physiological states. Although nitrogen was generally in balance, leucine was in slight deficit compared to predicted needs for export protein synthesis, suggesting that an alternative source of leucine (e.g. peptides) was utilized. Simulations of varying glucagon concentrations indicated that an additional 5 mol/d of glucose could be synthesized at the reference substrate concentrations and blood flows. The increased glucose production was supported by increased removal from blood of lactate, glutamate, aspartate, alanine, asparagine, and glutamine. As glucose Output increased, ketone body and acetate release increased while CO2 release declined. The pattern of amino acids appearing in hepatic vein blood was affected by changes in amino acid concentration in portal vein blood, portal blood flow rate and glucagon concentration, with methionine and phenylalanine being the most affected of essential amino acids. Experimental evidence is insufficient to determine whether essential amino acids are affected by varying gluconeogenic demands. (C) 2004 Published by Elsevier Ltd.

Net nutrient absorption and liver metabolism in lactating dairy cows fed supplemental dietary biotin

The effect of feeding supplemental biotin on net absorption and metabolism of nutrients by the portal-drained viscera (PDV; the gut, pancreas, spleen and associated fat) and liver of lactating dairy cows was measured. Three cows in early to mid-lactation catheterised for measurements of net nutrient absorption and metabolism by the PDV and liver were fed a total-mixed ration with or without supplemental biotin at 20 mg/day using a switch-back design (ABA v. BAB) with three 2-week periods. There were no effects of feeding biotin on dry matter intake (22.2 kg/day), milk yield (29.5 kg/day) or milk composition. There was also no effect of feeding biotin on net release of glucose by the liver, net liver removal of glucose precursors (propionate, alanine, lactate) or net liver release of p-hydroxybutyrate. Feeding biotin increased net PDV release of ammonia. Reasons for the response are not certain, but a numerical increase in net PDV release of acetate suggests that rumen or hindgut fermentation was altered. Results of the present study do not support the hypothesis that supplemental biotin increases liver glucose production in lactating dairy cows.

Short communication: Suppressor of cytokine signaling-2 mRNA increases after parturition in the liver of dairy cows

After parturition, the somatotropic axis of the dairy cow is uncoupled, partly because of reduced concentration of liver-specific GH receptor (GHR) 1A. Estradiol-17 beta (E-2) concentrations increase at parturition and E-2 upregulates suppressors of cytokine signaling-2 (SOCS-2) mRNA expression, potentially inhibiting GH signaling. Therefore, we hypothesized that SOCS-2 mRNA is upregulated after parturition. Multiparous Holstein cows (n = 18) were dried off 45 d before expected parturition and fed diets to meet nutrient requirements at ad libitum or limited dry matter intake during the dry period. All cows were fed the same diet ad libitum from calving until 4 wk after parturition. Blood samples were collected weekly and more frequently near parturition. Liver biopsies obtained at -21, -7, 2, and 28 d relative to parturition were assessed for SOCS-2 and GHR 1A mRNA by quantitative real-time reverse-transcription PCR. The relative amount of SOCS-2 mRNA increased after parturition with both treatments and was greater on d 2 for cows limit-fed during the dry period compared with cows fed at ad libitum dry matter intake. Plasma E2 concentrations increased on d -13, -5 and 1 relative to parturition and the increases were greater in limit-fed cows. Plasma GH concentration was greater for limit-fed cows and increased after parturition in all cows. The amount of GHR 1A mRNA did not differ between diets but decreased on d 2. In addition to reduced GHR 1A, increased SOCS-2 mRNA after parturition, perhaps because of increased E-2, may further uncouple GH signaling in the liver of the transition dairy cow.

Effects of schistosoma mansoni worms and eggs on circulating cholesterol and liver lipids in mice

It has previously been shown that experimental infections of the parasitic trematode Schistosoma mansoni, the adult worms of which reside in the blood stream of the mammalian host, significantly reduced atherogenesis in apolipoprotein E gene knockout (apoE(-/-)) mice. These effects occurred in tandem with a lowering of serum total cholesterol levels in both apoE(-/-) and random-bred laboratory mice and a beneficial increase in the proportion of HDL to LDL cholesterol. To better understand how the parasitic infections induce these effects we have here investigated the involvement of adult worms and their eggs on lipids in the host. Our results indicate that the serum cholesterol-lowering effect is mediated by factors released from S. mansoni eggs, while the presence of adult worms seemed to have had little or no effect. It was also observed that high levels of lipids, particularly triacylglycerols and cholesteryl esters, present in the uninfected livers of both random-bred and apoE(-/-) mice fed a high-fat diet were not present in livers of the schistosome-infected mice. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

The cytoprotective effect of alpha-tocopherol and daidzein against d-galactosamine-induced oxidative damage in the rat liver

We hypothesized that the hepatotoxicity that develops after the induction of oxidative stress (induced by d-galactosamine [GalN]) can be ameliorated by alpha-tocopherol (ATC) and the soy isoflavone daidzein. To test this, we ranked and assigned male Wistar rats into 6 groups, which involved pretreatment (ATC or daidzein) for 1 hour followed by treatment (GalN) for 23 hours. Histopathologic analysis showed that GalN administration induced marked necrosis (P < .001), steatosis (P < .001), both lobular and portal inflammations (P < .001), overall histopathologic score (P < .001), and activation of caspase-3 in the liver (P < .001). Immunohistochemical staining of malondialdehyde-protein adducts, a measure of oxidative stress, was increased in response to GalN (P < .001). Paradoxically, there were increases in total (P < .05) and cytosolic superoxide dismutase (P < .001) activities after GalN administration, indicative of an up-regulation of antioxidant defenses. The concentration of total protein (P < .001), albumin (P < .01), and globulin fractions (P < .001) in the plasma, as well as the activity of aspartate aminotransferase (P < .001), was significantly perturbed after GalN treatment, reflective of overall acute hepatic injury. Administration of daidzein showed a significant amelioration of the Ga1N-induced increase in malondialdehyde-protein adducts (P < .01) and cytosolic superoxide dismutase activities (P < .01) in the liver. However, all other variables were not significantly altered in response to daidzein. In response to ATC pretreatment, the total histopathologic score (P < .05), degree of necrosis (P < .05), and both lobular (P < .05) and portal (P = .05) inflammations were significantly ameliorated. To conclude, both daidzein and ATC protect the liver against oxidative damage possibly via different pathways.

Microgemma vivaresi n. sp (Microsporidia, Tetramicridae), infecting liver and skeletal muscle of sea scorpions, Taurulus bubalis (Euphrasen 1786) (Osteichthyes, Cottidae), an inshore, littoral fish

The ultrastructure of a new microsporidian species Microgemmia vivaresi n. sp. causing liver cell xenoma formation in sea scorpions, Taurulus bubalis, is described. Stages of merogony, sporogony, and sporogenesis are mixed in the central cytoplasm of developing xenomas. All stages have unpaired nuclei. Uninucleate and multinucleate meronts lie within vacuoles formed from host endoplasmic reticulum and divide by binary or multiple fission. Sporonts, no longer in vacuoles, deposit plaques of surface coat on the plasma membrane that cause the surface to pucker. Division occurs at the Puckered stage into sporoblast mother cells, on which plaques join up to complete the surface coat. A final binary fission gives rise to sporoblasts. A dense globule, thought to be involved in polar tube synthesis, is gradually dispersed during spore maturation. Spores are broadly ovoid, have a large posterior vacuole, and measure 3.6 mu m x 2.1 pint (fresh). The polar tube has a short wide anterior section that constricts abruptly, then runs posteriad to coil about eight times around the posterior vacuole with granular contents. The polaroplast has up to 40 membranes arranged in pairs mostly attached to the wide region of the polar tube and directed posteriorty around a cytoplasm of a coarsely granular appearance. The species is placed alongside the type species Microgemmia hepaticus Ralphs and Matthews 1986 within the family Tetramicridae, which is transferred from the class Dihaplophasea to the class Haplophasea, as there is no evidence for the occurrence of a diplokaryotic phase.

Daily consumption of an aqueous green tea extract supplement does not impair liver function or alter cardiovascular disease risk biomarkers in healthy men

Regular consumption of green tea polyphenols (GTP) is thought to reduce the risk of cardiovascular disease (CVD) but has also been associated with liver toxicity. The present trial aimed to assess the safety and potential CVD health beneficial effects of daily GTP consumption. We conducted a placebo-controlled parallel study to evaluate the chronic effects of GTP on liver function and CVD risk biomarkers in healthy men. Volunteers (treatment: n = 17, BMI 26.7 +/- 3.3 kg/m(2), age 41 +/- 9 y; placebo, n = 16, BMI 25.4 +/- 3.3 kg/m(2), age 40 +/- 10 y) consumed for 3 wk 6 capsules per day (2 before each principal meal) containing green tea extracts (equivalent to 714 mg/d GTP) or placebo. At the beginning and end of the intervention period, we collected blood samples from fasting subjects and measured vascular tone using Laser Doppler lontophoresis. Biomarkers of liver function and CVD risk (including blood pressure, plasma lipids, and asymmetric dimethylarginine) were unaffected by GTP consumption. After treatment, the ratio of total:HDL cholesterol was significantly reduced in participants taking GTP capsules compared with baseline. Endothelial-dependent and -independent vascular reactivity did not significantly differ between treatments. In conclusion, the present data suggests that the daily consumption of high doses of GTP by healthy men for 3 wk is safe but without effects on CVD risk biomarkers other than the total:HDL cholesterol ratio. J. Nutr. 139: 58-62, 2009.