Rôle des cellules endothéliales dans l’immunité innée précoce induite lors d’infections par des coronavirus murins

Les cellules endothéliales (EC) constituent une première barrière physique à la dissémination de virus pléiotropiques circulant par voie hématogène mais leur contribution à la défense innée anti-virale est peu connue. Des dysfonctions des EC de la barrière hémato-encéphalique (BMEC) et des sinusoïdes hépatiques (LSEC) ont été rapportées dans des neuropathologies et des hépatites aiguës ou chroniques d’origine virale, suggérant que des atteintes à leur intégrité contribuent à la pathogenèse. Les sérotypes de coronavirus de l’hépatite murine (MHV), se différenciant par leur capacité à induire des hépatites et des maladies neurologiques de sévérité variable et/ou leur tropisme pour les EC, représentent des modèles viraux privilégiés pour déterminer les conséquences de l’infection des EC sur la pathogenèse virale. Lors d’infection par voie hématogène, le sérotype MHV3, le plus virulent des MHV, induit une hépatite fulminante, caractérisée par une réponse inflammatoire sévère, et des lésions neurologiques secondaires alors que le sérotype moins virulent, MHV-A59, induit une hépatite modérée sans atteintes secondaires du système nerveux central (SNC). Par ailleurs, le sérotype MHV3, à la différence du MHV-A59, démontre une capacité à stimuler la production de cytokines par la voie TLR2. Les variants atténués du MHV3, les virus 51.6-MHV3 et YAC-MHV3, sont caractérisés par un faible tropisme pour les LSEC et induisent respectivement une hépatite modérée et subclinique. Compte tenu de l’importance des LSEC dans le maintien de la tolérance hépatique et de l’élimination des pathogènes circulants, il a été postulé que la sévérité de l’hépatite et de la réponse inflammatoire lors d’infections par les MHV est associée à la réplication virale et à l’altération des propriétés tolérogéniques et vasculaires des LSEC. Les désordres inflammatoires hépatiques pourraient résulter d’une activation différentielle du TLR2, plutôt que des autres TLR et des hélicases, selon les sérotypes. D’autre part, compte tenu du rôle des BMEC dans la prévention des infections du SNC, il a été postulé que l’invasion cérébrale secondaire par les coronavirus est reliée à l’infection des BMEC et le bris subséquent de la barrière hémato-encéphalique (BHE). À l’aide d’infections in vivo et in vitro par les différents sérotypes MHV, chez des souris ou des cultures de BMEC et de LSEC, nous avons démontré, d’une part, que l’infection in vitro des LSEC par le sétotype MHV3, à la différence des variants 51.6- et YAC-MHV3, altérait la production du facteur vasodilatant NO et renversait leur phénotype tolérogénique en favorisant la production de cytokines et de chimiokines inflammatoires. Ces dysfonctions se traduisaient in vivo par une réponse inflammatoire incontrôlée et une dérégulation du recrutement intrahépatique de leucocytes, favorisant la réplication virale et les dommages hépatiques. Nous avons aussi démontré, à l’aide de souris TLR2 KO et de LSEC dont l’expression du TLR2 a été abrogée par des siRNA, que la sévérité de l’hépatite et de la réponse inflammatoire induite par le sérotype MHV3, dépendait en partie de l’induction et de l’activation préférentielle du TLR2 par le virus dans le foie. D’autre part, la sévérité de la réplication virale au foie et des désordres dans le recrutement leucocytaire intrahépatique induits par le MHV3, et non par le MHV-A59 et le 51.6-MHV3, corrélaient avec une invasion virale subséquente du SNC, au niveau de la BHE. Nous avons démontré que l’invasion cérébrale du MHV3 était associée à une infection productive des BMEC et l’altération subséquente des protéines de jonctions serrées occludine, VE-cadhérine et ZO-1 se traduisant par une augmentation de la perméabilité de la BHE et l’entrée consécutive du virus dans le cerveau. Dans l’ensemble, les résultats de cette étude mettent en lumière l’importance du maintien de l’intégrité structurale et fonctionnelle des LSEC et des BMEC lors d’infections virales aigües par des MHV afin de limiter les dommages hépatiques associés à l’induction d’une réponse inflammatoire exagérée et de prévenir le passage des virus au cerveau suite à une dissémination par voie hématogène. Ils révèlent en outre un nouveau rôle aggravant pour le TLR2 dans l’évolution de l’hépatite virale aigüe ouvrant la voie à de nouvelles avenues thérapeutiques visant à moduler l’activité inflammatoire du TLR2.

Studies on the Antiulcerogenic and Antihepatotoxic Potential of Chitosan and Glucosamine in Experimental Rats

The present study examined the antiulcer effect of glucosamine on mucosal antioxidant defense system in ibuprofen-induced peptic ulcer in male albino rats. The results of the present study indicate that the pre-oral administration of chitosan and glucosamine maintain near to the normal status the activities of the mucosal antioxidant enzymes and the level of GSH (Glutathione), which protect mucosa against oxidative damage by decreasing the lipid peroxidation and strengthening the mucosal barrier, and which are the first line of defense against exogenous ulcerogenic agents. In this study indicate that the oral pre-treatment of chitosan and glucosamine can prevent ibuprofen-induced peptic ulcer in rats.This study can be concluded that co-administration of chitsosan and glucosamine can effectively prevent the isonized and rifampicin induced hepatotoxicity in rats.Comparatively, chitosan was found to have better results than glucosamine in alleviating the hepatic disorders.

5-HT1A AND 5-HT2C RECEPTOR GENE EXPRESSION AND FUNCTIONAL REGULATION DURING RAT HEPATOCYTE PROLIFERATION AND APOPTOSIS

The work is an attempt to understand the role of 5-HT, 5-HT1A and 5-HT2C receptors in the regulation of liver cell proliferation using in vivo and in vitro models. The work also focuses on the brain serotonergic changes associated with hapatocyte proliferation and apoptosis to delineate its regulatory function. The investigation of mechanisms involving different models of hepatocyte proliferation contributes to our knowledge about serotonergic regulation of cell growth, apoptosis and carcinogenesis of liver. The study reveals that the alteration of the 5-HT1A and 5-HT2C receptor function and gene expression in the brain stem, cerebral cortex and hypothalamus play an important role in the sympathetic regulation of cell proliferation, neoplastic transformation and apoptosis. The functional balance between 5-HT1A and 5-HT2C receptor plays an important role in regulating hepatocyte proliferation, neoplastic transformation and hepatic apoptosis. The regulatory role of 5-HT1A and 5-HT2C receptor during neoplastic transformation and apoptosis could lead to possible therapeutic intervention in the treatment of cancers and have immense clinical importance.

Hypothalamic GABA receptor functional regulation and liver cell proliferation

GABAergic alterations in hypothalamus during compensatory hyperplasia after partial hepatectomy (PH), lead nitrate (LN) induced direct hyperplasia and N-nitrosodiethylamine (NDEA) induced neoplasia in liver were investigated. Serum GABA levels were increased in all 3 experimental groups compared with the control. GABA content decreased in hypothalamus of PH and NDEA treated rats, while it increased in LN treated rats. GABAA receptor number and affinity in hypothalamic membrane preparations of rats showed a significant decrease in PH and NDEA treated rats, while in LN treated rats the affinity increased without any change in the receptor number. The GABAB receptor number increased in PH and NDEA treated rats, while it decreased in LN treated rats. The affinity of the receptor also increased in NDEA treated rats. Plasma NE levels showed significant increase in PH and NDEA rats compared with the control while it decreased in LN treated rats. The results of the present study suggests that liver cell proliferation is influencing the hypothalamic GABAergic neurotransmission and these changes regulate the hepatic proliferation through the sympathetic stimulation.

Studies om the Antiulcerogenic and Antihepatotoxic Potential of Chitosan and Glucosamine in Eeperimental Rats

The present study examined the antiulcer effect of glucosamine on mucosal antioxidant defense system in ibuprofen-induced peptic ulcer in male albino rats. The results of the present study indicate that the pre-oral administration of chitosan and glucosamine maintain near to the normal status the activities of the mucosal antioxidant enzymes and the level of GSH (Glutathione), which protect mucosa against oxidative damage by decreasing the lipid peroxidation and strengthening the mucosal barrier, and which are the first line of defense against exogenous ulcerogenic agents. In this study indicate that the oral pre-treatment of chitosan and glucosamine can prevent ibuprofen-induced peptic ulcer in rats.This study can be concluded that co-administration of chitsosan and glucosamine can effectively prevent the isonized and rifampicin induced hepatotoxicity in rats.Comparatively, chitosan was found to have better results than glucosamine in alleviating the hepatic disorders

Biochemical Effects of Anionic, Cationic and Non Ionic Surfactants on a Tropical Teleost Oreochromis Mossambicus(Peters) and a Marine Cyanobacterium Synechocystis Salina Wislouch

The present work is a base line attempt to investigate and assess the toxicities of three surfactants viz. anionic sodium dodecyl sulfate (SDS), non ionic Triton X-1OO (TX-IOO) and cationic cetyl trimethyl ammonium bromide (CTAB). These compounds represent simple members of the often neglected group of aquatic pollutants i.e. the anionic alkyl sulfates, non ionics and the cationics. These compounds are widely used In plastic industry, pesticide/herbicide formulations, detergents, oil spill dispersants, molluscicides etc. The test organisms selected for the present study are the cyanobacterium Synechocystis salina Wislouch representing a primary producer in the marine environment and a fresh water adapted euryhaline teleost Oreochromis mossambicus (peters) at the consumer level of the ecological pyramid. The fish species, though not indigenous to our country, is now found ubiquitously in fresh water systems and estuaries. Also it is highly resistant to pollutants and has been suggested as an indicator of pollution in tropical region .

Studies On Some Aspects Of Biology Of Two Estuarine Fishes Megalops Cyprinoides And Scatophagus Argus

Based on the adaption of fishes to their habitat, they are divided into three ecological groups - marine, fresh water and estuarine or brackish water forms. Estuarine fishes inhabit the less saline region of the sea, estuaries and other inland waters. These fishes are more subjected to pollution than fresh water fishes or marine fishes as they encounter pollutants present in the outgoing river water and the incoming sea water during low and high tides respectively. So, the study of the biology of the estuarine fishes has become unavoidable to assess their suitability in aquaculture. The development of both capture and culture fisheries related to any brackish water system is dependent on the availability of scientific‘ data on the various biological factors in respect of the different species. Such a study on fishes will be helpful in formulating suitable schemes for the management of brackish water for capture and culture fisheries. It was therefore felt that a study of the biological and biochemical aspects of two estuarine fishes Megalops cyprinoides Broussonet and Scatophargus Bloch which are not fully exploited in aquaculture programmes, was worth undertaking. The present study is expected to advance our knowledge on the biology of the two fishes which are very desirable for brackish water fish farming

Petrochemistry related mineralization and genesis of the Ambalavayal granite and assoiated pegmatites, Wynad district, Kerala

The Kerala region which forms a significant segment of the south—western Indian shield, dominantly comprises charnockites, khondalites and migmatitic gneisses of Precambrian age. Recent investigations have revealed the occurrences of a number of younger granite and syenite plutons in this region, .spatially related to regional fault—lineaments. The granite of Ambalavayal in Wynad district of northern Kerala is a typical member of this suite of intrusives. The thesis is based on a comprehensive study in terms of geology, petrology, geochemistry and petrogenesis of the Ambalavayal granite, basement gneisses, associated pegmatites, quartz veins and related mineralization that together cover an area of about 90 sq km in wynad district of northern Kerala

Adrenergic and serotonergic function in dna synthesis during rat liver regeneration and in hepatocyte cultures

The adult mammalian liver is predominantly in a quiescent state with respect to cell division. This quiescent state changes dramatically, however, if the liver is injured by toxic, infectious or mechanic agents (Ponder, 1996). Partial hepatectomy (PH) which consists of surgical removal of two-thirds of the liver, has been used to stimulate hepatocyte proliferation (Higgins & Anderson 1931). This experimental model of liver regeneration has been the target of many studies to probe the mechanisms responsible for liver cell growth control (Michalopoulos, 1990; Taub, 1996). After PH most of the remaining cells in the renmant liver respond with co-ordinated waves of DNA synthesis and divide in a process called compensatory hyperplasia. Hence, liver regeneration is a model of relatively synchronous cell cycle progression in vivo. In contrast to hepatomas, cell division is terminated under some intrinsic control when the original cellular mass has been regained. This has made liver regeneration a useful model to dissect the biochemical and molecular mechanisms of cell division regulation. The liver is thus, one of the few adult organs that demonstrates a physiological growth rewonse (Fausto & Mead, 1989; Fausto & Webber, 1994). The regulation of liver cell proliferation involves circulating or intrahepatic factors that are involved in either the priming of hepatocytes to enter the cell cycle (Go to G1) or progression through the cell cycle. In order to understand the basis of liver regeneration it is mandatory to define the mechanisms which (a) trigger division, (b) allow the liver to concurrently grow and maintain dilferentiated fimction and (c) terminate cell proliferation once the liver has reached the appropriate mass. Studies on these aspects of liver regeneration will provide basic insight of cell growth and dilferentiation, liver diseases like viral hepatitis, toxic damage and liver transplant where regeneration of the liver is essential. In the present study, Go/G1/S transition of hepatocytes re-entering the cell cycle after PH was studied with special emphasis on the involvement of neurotransmitters, their receptors and second messenger function in the control of cell division during liver regeneration

Petrochemistry, related mineralization and genesis of the Ambalavayal granite and associated pegmatites. Wynad district, Kerala

The Kerala region which forms a significant segment of the south—western Indian shield, dominantly comprises charnockites, khondalites and migmatitic gneisses of Precambrian age. Recent investigations have revealed the occurrences of a number of younger granite and syenite plutons in this region, .spatially related to regional fault—lineaments. The granite of Ambalavayal in Wynad district of northern Kerala is a typical member of this suite of intrusives. The thesis is based on a comprehensive study in terms of geology, petrology, geochemistry and petrogenesis of the Ambalavayal granite, basement gneisses, associated pegmatites, quartz veins and related mineralization that together cover an area of about 90 sq km in wynad district of northern Kerala.

Investigation on key molecular targets responsible for antidiabetic properties of Symplocos cochinchinensis (Lour.) S. Moore

Diabetes mellitus is a heterogeneous metabolic disorder characterized by hyperglycemia with disturbances in carbohydrate, protein and lipid metabolism resulting from defects in insulin secretion, insulin action or both. Currently there are 387 million people with diabetes worldwide and is expected to affect 592 million people by 2035. Insulin resistance in peripheral tissues and pancreatic beta cell dysfunction are the major challenges in the pathophysiology of diabetes. Diabetic secondary complications (like liver cirrhosis, retinopathy, microvascular and macrovascular complications) arise from persistent hyperglycemia and dyslipidemia can be disabling or even life threatening. Current medications are effective for control and management of hyperglycemia but undesirable effects, inefficiency against secondary complications and high cost are still serious issues in the present prognosis of this disorder. Hence the search for more effective and safer therapeutic agents of natural origin has been found to be highly demanding and attract attention in the present drug discovery research. The data available from Ayurveda on various medicinal plants for treatment of diabetes can efficiently yield potential new lead as antidiabetic agents. For wider acceptability and popularity of herbal remedies available in Ayurveda scientific validation by the elucidation of mechanism of action is very much essential. Modern biological techniques are available now to elucidate the biochemical basis of the effectiveness of these medicinal plants. Keeping this idea the research programme under this thesis has been planned to evaluate the molecular mechanism responsible for the antidiabetic property of Symplocos cochinchinensis, the main ingredient of Nishakathakadi Kashayam, a wellknown Ayurvedic antidiabetic preparation. A general introduction of diabetes, its pathophysiology, secondary complications and current treatment options, innovative solutions based on phytomedicine etc has been described in Chapter 1. The effect of Symplocos cochinchinensis (SC), on various in vitro biochemical targets relevant to diabetes is depicted in Chapter 2 including the preparation of plant extract. Since diabetes is a multifactorial disease, ethanolic extract of the bark of SC (SCE) and its fractions (hexane, dichloromethane, ethyl acetate and 90 % ethanol) were evaluated by in vitro methods against multiple targets such as control of postprandial hyperglycemia, insulin resistance, oxidative stress, pancreatic beta cell proliferation, inhibition of protein glycation, protein tyrosine phosphatase-1B (PTP-1B) and dipeptidyl peptidase-IV (DPPxxi IV). Among the extracts, SCE exhibited comparatively better activity like alpha glucosidase inhibition, insulin dependent glucose uptake (3 fold increase) in L6 myotubes, pancreatic beta cell regeneration in RIN-m5F and reduced triglyceride accumulation in 3T3-L1 cells, protection from hyperglycemia induced generation of reactive oxygen species in HepG2 cells with moderate antiglycation and PTP-1B inhibition. Chemical characterization by HPLC revealed the superiority of SCE over other extracts due to presence of bioactives (beta-sitosterol, phloretin 2’glucoside, oleanolic acid) in addition to minerals like magnesium, calcium, potassium, sodium, zinc and manganese. So SCE has been subjected to oral sucrose tolerance test (OGTT) to evaluate its antihyperglycemic property in mild diabetic and diabetic animal models. SCE showed significant antihyperglycemic activity in in vivo diabetic models. Chapter 3 highlights the beneficial effects of hydroethanol extract of Symplocos cochinchinensis (SCE) against hyperglycemia associated secondary complications in streptozotocin (60 mg/kg body weight) induced diabetic rat model. Proper sanction had been obtained for all the animal experiments from CSIR-CDRI institutional animal ethics committee. The experimental groups consist of normal control (NC), N + SCE 500 mg/kg bwd, diabetic control (DC), D + metformin 100 mg/kg bwd, D + SCE 250 and D + SCE 500. SCEs and metformin were administered daily for 21 days and sacrificed on day 22. Oral glucose tolerance test, plasma insulin, % HbA1c, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total protein etc. were analysed. Aldose reductase (AR) activity in the eye lens was also checked. On day 21, DC rats showed significantly abnormal glucose response, HOMA-IR, % HbA1c, decreased activity of antioxidant enzymes and GSH, elevated AR activity, hepatic and renal oxidative stress markers compared to NC. DC rats also exhibited increased level of plasma urea and creatinine. Treatment with SCE protected from the deleterious alterations of biochemical parameters in a dose dependent manner including histopathological alterations in pancreas. SCE 500 exhibited significant glucose lowering effect and decreased HOMA-IR, % HbA1c, lens AR activity, and hepatic, renal oxidative stress and function markers compared to DC group. Considerable amount of liver and muscle glycogen was replenished by SCE treatment in diabetic animals. Although metformin showed better effect, the activity of SCE was very much comparable with this drug. xxii The possible molecular mechanism behind the protective property of S. cochinchinensis against the insulin resistance in peripheral tissue as well as dyslipidemia in in vivo high fructose saturated fat diet model is described in Chapter 4. Initially animal were fed a high fructose saturated fat (HFS) diet for a period of 8 weeks to develop insulin resistance and dyslipidemia. The normal diet control (ND), ND + SCE 500 mg/kg bwd, high fructose saturated fat diet control (HFS), HFS + metformin 100 mg/kg bwd, HFS + SCE 250 and HFS + SCE 500 were the experimental groups. SCEs and metformin were administered daily for the next 3 weeks and sacrificed at the end of 11th week. At the end of week 11, HFS rats showed significantly abnormal glucose and insulin tolerance, HOMA-IR, % HbA1c, adiponectin, lipid profile, liver glycolytic and gluconeogenic enzyme activities, liver and muscle triglyceride accumulation compared to ND. HFS rats also exhibited increased level of plasma inflammatory cytokines, upregulated mRNA level of gluconeogenic and lipogenic genes in liver. HFS exhibited the increased expression of GLUT-2 in liver and decreased expression of GLUT-4 in muscle and adipose. SCE treatment also preserved the architecture of pancreas, liver, and kidney tissues. Treatment with SCE reversed the alterations of biochemical parameters, improved insulin sensitivity by modifying gene expression in liver, muscle and adipose tissues. Overall results suggest that SC mediates the antidiabetic activity mainly via alpha glucosidase inhibition, improved insulin sensitivity, with antiglycation and antioxidant activities.

Effects of dietary lipid source on growth, digestibility and tissue fatty acid composition of Heterobranchus longifilis fingerlings

One of the major problems facing aquaculture is the inadequate supply of fish oil mostly used for fish feed manufacturing. The continued growth in aquaculture production cannot depend on this finite feed resources, therefore, it is imperative that cheap and readily available substitutes that do not compromise fish growth and fillet quality be found. To achieve this, a 12-week feeding trial with Heterobranchus longifilis fed diets differing in lipid source was conducted. Diets were supplemented with 6% lipid as fish oil, soybean oil, palm oil, coconut oil, groundnut oil and melon seed oil. Triplicate groups of 20 H. longifilis were fed the experimental diets two times a day to apparent satiation, over 84 days. Growth, digestibility, and muscle fatty acid profile were measured to assess diet effects. At the end of the study, survival, feed intake and hepatosomatic index were similar for fish fed experimental diets. However, weight gain, SGR and FCR of fish fed soybean oil-based diet was significantly reduced. Apparent nutrient digestibility coefficients were significantly lower in fish fed soybean, coconut and groundnut oil-based diets. Fillet and hepatic fatty acid compositions differed and reflected the fatty acid compositions of the diets. Docosahexaenoic acid (22:6n-3), 20:5n-3 and 20:4n-6 were conserved in vegetable oils-based diets fed fish possibly due to synthesis of HUFA from 18:3n-3 and 18:4n-6. Palm oil diet was the least expensive, and had the best economic conversion ratio. The use of vegetable oils in the diets had positive effect on growth and fillet composition of H. longifilis.

Evaluación de la variabilidad del tiempo de duración de la relajación neuromuscular del cisatracurium vs rocuronio en pacientes ancianos

Objetivo: Comparar la variabilidad en el tiempo de acción clínicamente efectivo (definido como el tiempo de aparición del T125% al estímulo por tren de cuatro) y la recuperación de la función neuromuscular luego de la administración de un bolo de 3 ED95 de cisatracurio o 2 ED95 de rocuronio en pacientes mayores de 65 años sometidos a cirugía. Materiales y Métodos: se incluyeron para este estudio pacientes mayores de 65 años de ambos sexos programados para cirugía electiva que requirieran de anestesia general, quienes durante la valoración preanestésica se incluyeran dentro de la clasificación de ASA 1, 2 o 3. Los pacientes requieren de haber firmado el consentimiento anestésicos, y no presentar alteración de la función renal, antecedente de disfunción hepática, enfermedad cardiovascular no compensada, enfermedad neurológica o neuromuscular, desequilibrio acido-base o estar bajo tratamiento con medicamentos que interactúen con los relajantes. Los pacientes fueron aleatorizados mediante un método de bloques permutados en dos grupos: GRUPO 1: Relajación muscular con cisatracurio 0.15 mg/kg IV y GRUPO 2: Relajación muscular con rocuronio 0.6 mg/kg IV. Se incluyeron 68 pacientes a los cuales se le cuantificaron mediante la utilización del dispositivo TOF-Watch SX los siguientes tiempos: T0, T125%, T4/T1=80% y T4/T1=90%. Con base en estas mediciones se obtuvieron las medidas de tendencia central y de dispersión, posteriormente se realizó un análisis de varianza y /o pruebas no paramétricas dependiendo de la distribución para determinar la variabilidad entre los tiempos obtenidos en cada grupo. Resultados: los grupos eran comparables desde el punto de vista de edad, sexo, número de pacientes (p>0.05). Se obtuvo como resultado final que el cisatracurio es menos variable que el rocuronio para cada una de las variables T0, T125%, T4/T1=80% y T4/T1=90% (p<0.01) en pacientes ancianos llevados a cirugía mayor de 90 minutos que requiera relajación neuromuscular. Conclusión: el cisatracurio es menos variable que el rocuronio cuando se utiliza en pacientes ancianos sometidos a cirugía mayor de 90 minutos que requiera relajación neuromuscular, pudiendo ser el cisatracurio un medicamento mas predecible en su tiempo de acción, con lo cual la probabilidad de asociarse a efectos por relajación neuromuscular residual es menor.

Determinación de predictores asociados a sangrado intraoperatorio y comportamiento transfusional durante transplante hepático en la Fundación Cardioinfantil

La identificación de factores asociados a mayores requerimientos transfusionales preoperatorios e intraoperatorios en pacientes llevados a trasplante hepático, ha sido preocupación de diferentes instituciones que realizan este tipo de procedimiento debido al sangrado excesivo con el que se asocian; Diferentes estudios de otros países han identificado algunas variables relacionadas con el sangrado tanto en preoperatorio como en el intraoperatorio. Demostrar estas variables o definir otras en los procedimientos realizados en nuestro medio es importante para optimizar el número de transfusiones en este tipo de pacientes. Este estudio se trata de una cohorte de tipo retrospectivo, observacional que pretende encontrar asociaciones entre factores preoperatorios e intraoperatorios con mayores requerimientos transfusionales. Los pacientes que cumplieron los criterios de inclusión fueron tabulados en una tabla de Excel tomando datos de las historias clínicas. El grupo fue dividido en 2, aquellos que requirieron 4 o más unidades de GRE (glóbulos rojos empaquetados) y menos de 4 unidades de GRE. Se realizo un análisis bivariado y con los factores estadísticamente significativos se diseño un análisis multivariado. La información fue tabulada teniendo en cuenta las variables identificadas en la literatura como asociadas con sangrado intraoperatorio e incluimos otras que nos pareció interesante evaluar como el efecto de los antifibrinoliticos y el impacto del uso de tromboelastografo (TEG). Los datos obtenidos al ser analizados demuestran que factores preoperatorios tales como niveles de hematocrito menor de 30 gm/dl y la albumina menor de 3mg/dl, se asocian con mayores requerimientos transfusionales de GRE en pacientes llevados a trasplante hepático. Así mismo se observa un índice transfusional bajo en este tipo de procedimiento en la Fundación Cardioinfantil al compararlo con los promedios encontrados en estudios similares de otras instituciones.

Utilidad de la escanografia multicorte en la detección de lesiones focales hepaticas en pacientes sometidos a trasplante hepatico comparada con el estudio histopatologico del higado explantado

El trasplante hepático es el estándar de tratamiento de las enfermedades hepáticas agudas irreversibles y crónicas. La escanografía multicorte (ECM) es una herramienta útil que se utiliza en la selección adecuada de los candidatos a trasplante. El propósito de este estudio es determinar la efectividad de la (ECM) en la detección de lesiones hepáticas en el hígado cirrótico. METODOLOGIA: Estudio de prueba diagnóstica retrospectivo que incluye pacientes del programa de trasplante hepático de la Fundación Cardioinfantíl a los cuales se les realizo ECM en la valoración pretrasplante, realizando comparación con el resultado de la patología del hígado explantado. RESULTADOS: El 9.5% de los pacientes estudiados por tomografía, fueron diagnosticados con hepatocarcinoma celular. La sensibilidad y especificidad en la detección de hepatocarcinoma fue del 50% y del 94.87% respectivamente. DISCUSION: La prevalencia de tumores hepáticos en pacientes llevados a trasplante hepático ha sido reportada como de más del 8%. Es este estudio encontramos una prevalencia para el hepatocarcinoma de 7.14% que demuestra baja incidencia en nuestro medio para el hepatocarcinoma en pacientes trasplantados, lo que se traduce en una alta posibilidad de sobrevida. En nuestro estudio la sensibilidad del TAC multicorte para la detección de lesiones focales en general fue de 41.17 %. La sensibilidad y especificidad en la detección de hepatocarcinoma fue del 50% y del 94.87% respectivamente.