Acute Hepatitis in a Pediatric Patient with COVID -19: Case Report / Hepatitis Aguda en un paciente pediátrico con COVID-19

COVID-19 typically courses with mild clinical manifestations; however, a pediatric patient might get severe sequelae and complications when there is an infection. There is no information about liver complications due to COVID-19 in children in Mexico. This case report will set a precedent about timely diagnosis for hepatitis as a complication for COVID-19 disease in young patients in Mexico. Clinical case: A 12-years-old man has intermittent generalized abdominal pain misdiagnosed and treated for irritable bowel syndrome 3 days prior. The abdominal pain stayed, and a day after the patient vomited 3 times (each one after every meal). The patient started with orangish urine, weakness, fatigue and hyporexia 1 day prior to admission. The day of the admittance, a COVID-19 RT-PCR test was performed, giving a positive result. Once he was admitted, laboratory tests were made, showing an increase of liver enzyme levels, showing liver disease as a complication for the viral infection. Conclusion: Pediatrics patients might get Hepatitis due to COVID-19. In a patient with abdominal pain or other liver disease symptoms while coursing with the virus or even after the infection, further investigation must be made.

El COVID-19 típicamente cursa con manifestaciones clínicas leves, sin embargo, un paciente pediátrico puede presentar secuelas y complicaciones graves cuando existe una infección. No hay información sobre complicaciones hepáticas por COVID-19 en niños en México. Este reporte de caso sentará un precedente sobre el diagnóstico oportuno de hepatitis como complicación de la enfermedad COVID-19 en pacientes jóvenes en México. Caso clínico: Varón de 12 años con dolor abdominal generalizado intermitente mal diagnosticado y tratado por colon irritable 3 días antes. El dolor abdominal se mantuvo, y al día siguiente el paciente vomitó 3 veces (cada una después de cada comida). El paciente comenzó con orina anaranjada, debilidad, fatiga e hiporexia 1 día antes de su ingreso. El día del ingreso se le realizó una prueba de RT-PCR de COVID-19 dando positivo. Una vez que ingresó, se realizaron exámenes de laboratorio que mostraron un aumento de los niveles de enzimas hepáticas, lo que mostró una enfermedad hepática como complicación de la infección viral. Conclusión: Los pacientes pediátricos pueden contraer hepatitis por COVID-19. En un paciente con dolor abdominal u otros síntomas de enfermedad hepática mientras cursa con el virus o incluso después de la infección, se debe realizar una investigación adicional.

Optimización del diagnóstico de hepatitis por citomegalovirus en receptores de trasplante hepático: diez años de experiencia / Cytomegalovirus hepatitis diagnosis optimization in liver transplant recipients: 10 years of experience

Resumen Introducción: Para los pacientes receptores de trasplante hepático (TH) la hepatitis por citomegalovirus (CMV) constituye una entidad de difícil diagnóstico. Nuestro objetivo fue determinar la real incidencia de hepatitis por CMV aplicando técnicas diagnósticas más específicas. Material y Métodos: Estudio retrospectivo/ prospectivo, en un centro de trasplante hepático. Período de estudio: años 2009 al 2019. Se incluyeron los TH que presentaron elementos sugestivos y/o específicos de CMV en la histopatología de la punción biopsia hepática (PBH), a los que se les realizó inmunohistoquimica (IHQ) en la PBH. Población control n = 17. Resultados: 41 casos cumplieron los criterios de inclusión. La IHQ fue positiva en n = 6 (14,6%). En la población control, la IHQ fue negativa en el 100% de los casos. Esto traduce un valor predictor negativo de 100% para la histopatología en el diagnóstico de hepatitis por CMV, con un valor predictor positivo de 14,6%. En 85% de los pacientes con IHQ negativa, hubo diagnósticos alternativos. La terapia antiviral en la fase retrospectiva se indicó en 48% y en la prospectiva en 21%. Conclusiones: Combinar la histopatología con la IHQ optimiza el diagnóstico de hepatitis por CMV; lo que permite la racionalización del uso de antivirales de alto costo y la búsqueda de etiologías diferenciales.

Abstract Background: Cytomegalovirus (CMV) hepatitis constitutes a challenging diagnostic entity in liver transplant (LT) recipients. Aim: To determine the real incidence of CMV hepatitis using more specific diagnostic tools as those currently used before. Methods: Retrospective/prospective study conducted in a hepatic transplant unit from 2009 to 2019. LT recipients with CMV specific or suggestive elements in histopathology of hepatic biopsies were included. Immunohistochemistry (IHQ) was performed in tissue samples of the studied cohort as well as in a control one. Results: 41 patients met the inclusion criteria. IHQ was diagnostic in 6 (14.6%), and was negative in 100% of the control population. The negative predictive value of the histopathology for CMV hepatitis diagnosis was 100% and the positive predictive value was 14.6%. 85% of patients in whom the IHQ was negative had alternative diagnosis Antiviral therapy in the retrospective analysis was indicated in 48% of patients and in 21% of the prospectively analyzed cohort. Conclusions: Histopathology and IHQ combination improves the diagnostic accuracy of CMV hepatitis which translates into a rational us of expensive antiviral therapy and to search for differential diagnosis

A Comparison of the Bleaching Effectiveness of Chlorine Dioxide and Hydrogen Peroxide on Dental Composite

This study was carried out to verify if composites could be bleached using chlorine dioxide as compared with hydrogen peroxide. 3M ESPE Filtek Z350 Universal Restorative discs were prepared (n=40), with dimensions 5 mm diameter x 2 mm thickness. The discs were divided into 4 groups of 10 discs each. Color assessment was performed by CIEDE2000. The discs were stained with coffee, tea, wine and distilled water (control) solutions for 14 days, 5 hours daily. Color assessment was repeated on stained discs and followed by bleaching of 5 discs from each group using chlorine dioxide and hydrogen peroxide in-office systems. Finally, a last color assessment was performed and compared statistically. DE2000 after bleaching was very close to baseline for both the bleaching agents, although chlorine dioxide showed better results than hydrogen peroxide. After staining, there was a clinically significant discoloration (∆E2000≥3.43) for the tea, coffee and wine groups, and discoloration (∆E2000) was seen more in the wine group as compared to tea and coffee. Overall, the control group (distilled water) had the least color change in the three intervals. After bleaching, the color in all specimens returned close to the baseline. The color differences between bleaching and baseline were less than 3.43 for all groups. The obtained results show that chlorine dioxide is slightly superior to hydrogen peroxide in the bleaching of composites, while maintaining the shade of the composite close to the baseline.

Este estudo foi realizado para verificar se resinas compostas podem ser clareadas com uso do dióxido de cloro, em comparação com peróxido de hidrogênio. Foram preparados discos com resina restauradora Filtek Z350 3M ESPE (n=40), com dimensões 5 mm de diâmetro × 2 mm de espessura. Os discos foram divididos em 4 grupos de 10 discos cada. A avaliação da cor foi realizada por meio do CIEDE2000. Os discos foram manchados com soluções de café, chá, vinho e água destilada (controle) por 5 h diárias durante 14 dias. A avaliação da cor foi repetida nos discos manchados e seguida por clareamento de 5 discos de cada grupo, utilizando dióxido de cloro ou peróxido de hidrogênio pela técnica de consultório. Finalmente, uma última avaliação da cor foi realizada e as técnicas comparadas estatisticamente. DE2000 após o clareamento foi muito próxima ao baseline, para ambos os agentes clareadores, embora o dióxido de cloro tenha mostrado melhores resultados do que o peróxido de hidrogênio. Após o manchamento, houve uma descoloração clinicamente significativa (ΔE2000≥3,43) para os grupos de chá, café e vinho, sendo que o clareamento (ΔE2000) foi melhor obtido com o grupo do vinho, em comparação com chá e café. No geral, o grupo controle (água destilada) teve a menor mudança de cor nos três intervalos. Após o clareamento, a cor em todos os espécimes voltou próxima ao baseline. As diferenças de cor entre o clareamento e o baseline foram inferiores a 3,43 para todos os grupos. Os resultados indicam que o dióxido de cloro é ligeiramente superior ao peróxido de hidrogênio no clareamento de resinas compostas, mantendo a cor próxima à escala do baseline.

Inhibitory effect of liposomal quercetin on acute hepatitis and hepatic fibrosis induced by concanavalin A

Immune response plays an important role in the development of hepatic fibrosis. In the present study, we investigated the effects of quercetin on hepatitis and hepatic fibrosis induced by immunological mechanism. In the acute hepatitis model, quercetin (2.5 mg/kg) was injected iv into mice 30 min after concanavalin A (Con A) challenge. Mice were sacrificed 4 or 24 h after Con A injection, and aminotransferase tests and histopathological sections were performed. Treatment with quercetin significantly decreased the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Consistent with this observation, treatment with quercetin markedly attenuated the pathologic changes in the liver. A hepatic fibrosis model was also generated in mice by Con A challenge once a week for 6 consecutive weeks. Mice in the experimental group were treated with daily iv injections of quercetin (0.5 mg/kg). Histopathological analyses revealed that treatment with quercetin markedly decreased collagen deposition, pseudolobuli development, and hepatic stellate cells activation. We also examined the effects of quercetin on the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and transforming growth factor beta (TGF-β) pathways by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). NF-κB and TGF-β production was decreased after treatment with quercetin, indicating that the antifibrotic effect of quercetin is associated with its ability to modulate NF-κB and TGF-β production. These results suggest that quercetin may be an effective therapeutic strategy in the treatment of patients with liver damage and fibrosis.

Clinical Features of Fitz-Hugh-Curtis Syndrome in the Emergency Department

PURPOSE: Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. MATERIALS AND METHODS: We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. RESULTS: During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. CONCLUSION: FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.

Nuevos tratamientos para el manejo de la Hepatitis B / New treatments for the management of Hepatitis B

El tratamiento de hepatitis B está en fase de experimentación en espera de obtener medicamentos con mayor eficiencia y menor resistencia. La mayoría de los medicamentos, en experimentación, son análogos de nucleósidos y nucleóticos que inhiben competitivamente la polimerasa HBV. La emtricitrabina es un medicamento que potencialmente se podría utilizar en pacientes coinfectados con HIV con el inconveniente de la resistencia cruzada a lamivudina. El tenofovir es un medicamento prometedor en los pacientes coinfectados con HIV tanto los Hbe Ag negativo como los resistentes a lamivudina. Prodrogas como el pradefovir se visualizan como medicamentos más efectivos y con menos efectos adversos que la droga original. La mayoría de estos medicamentos requieren de más estudios para definir su rol en el tratamiento de la hepatitis B crónica.

Hepatitis B treatment is in the experimentation stage expecting to obtain more effective and less resistant treatments. Most treatments under experimentation are nucleoside and nucleotide analogues that competitively inhibit HBV polymerase. Emtricitabine is a drug that could be used in con-infected HIV patients with the inconvenience of cross-resistance to lamivudine. Tenofovir is a promising drug for co-infected HIV patients, not only for the HbeAg negative but also for those resistant to lamuvidine. Pro-drugs such as pradefovir are considered more effective and with less adverse effects than the original drug. Most of these drugs require more studies to define its role in the treatment of chronic hepatitis B.

Hepatitis - control in dental practice

Hepatitis infection is a silent epidemic. It has high morbidity and mortality in different countries. It is a public health problem in developing countries with limited resources and health budgets. The aim of this review paper is to revisit the hepatitis infection, its epidemiology, its modes of spread, diagnosis, prevention, especially in relation to Pakistan. Special emphasis is laid on hepatitis infection in the dental, and medical practices. The recommendations have been highlighted in the light of latest developments, understanding of hepatitis infection, treatment modalities and need of cost effective preventive regimens to control the infectious disease. The observance and practice of "Universal Precautions" for infection control has been emphasized. It is hoped that the paper will be of great help to health care professionals, those who are active in rendering their services to improve the quality of life of their patients. Further, it would be helpful to dental practitioners to protect themselves, their team and the patients in general, and may minimize the risk with better understanding of the public health problem

Effects of N-acetylcysteine on oxidative stress in rats with non-alcoholic steatohepatitis.

OBJECTIVE: Prove the attenuated effects of N-acetylcysteine (NAC) on oxidative stress in rats with nonalcoholic steatohepatitis (NASH). MATERIAL AND METHOD: Male Sprague-Dawley rats were randomly divided into five groups. Group I (normal control) was fed regular dry rat chow (RC) for 6 weeks. Group 2 (NASH) was fed 100% fat diet for 6 weeks. Group 3-5 were fed 100% fat diet for 6 weeks, and then switched to RC alone (NASH + diet ; group 3), to RC + 20 mg/kg/day of NAC orally (NASH + diet + NAC20; group 4) or to RC + 500 mg/kg/day of NAC orally (NASH + diet + NAC500; group 5) for 4 weeks, respectively. They were sacrificed to collect blood and liver samples at the end of the present study. RESULTS: Levels of total glutathione (GSH), serum cholesterol, and hepatic malondialdehyde (MDA) were increased significantly in the NASH group compared with normal control. Liver histopathology from group 2 showed moderate to severe macrovesicular steatosis, hepatocyte ballooning, and necroinflammation. Treatment with diet or diet plus NAC reduced the levels of GSH, cholesterol, and hepatic MDA back to normal. Liver sections from group 3-5 showed a decrease in fat deposition and necroinflammation in hepatocytes. However, no differences on all variables existed between diet alone and diet plus NAC groups. CONCLUSION: Our data indicate that diet or diet plus NAC treatment could attenuate oxidative stress and improve liver histopathology of NASH. However the addition of NAC is not better than diet treatment alone.

Hepatite auto-imune / Autoimmune hepatitis

Os autores fazem revisäo da literatura médica a respeito da hepatite auto-imune, enfatizando os aspectos laboratoriais, clínicos e terapêuticos desta entidade. Discutem a importância dos auto-anticorpos, mostrando a proliferaçäo de novos marcadores imunológicos e detalhando a sua utilizaçäo no diagnóstico e terapêutica. Por fim, ressaltam a importância do diagnóstico acertado e precoce, já que se trata de uma doença em que a terapia imunossupressiva prolonga muito a sobrevida.

Treatment of corticosteroid-azathioprine resistant autoimmune hepatitis with cyclosporin A.

A 33-year-old woman with autoimmune hepatitis developed resistance to prednisolone-azathioprine treatment. A switch to cyclosporin A resulted in immediate remission which was maintained for more than one year. No significant side effect was encountered. Cyclosporin A may be an alternative treatment for patients with autoimmune hepatitis who are resistant to conventional treatment.

O ácido ursodesoxicólico (AUDC) no tratamento das hepatites crônicas e nas colestases / Ursodeoxycholic acid (UCDA) for the treatment of chronic hepatitis and cholestasis

Como poderá observar o leitor, este assunto está em ebuliçäo, necessitando de mais trabalhos, para nos mostrar onde e como empregar o AUDC. Achamos ser o mesmo eficaz nas colestases de qualquer etiologia, e estamos empregando-o nas hepatites crônicas e cirroses, esperando trazer, em breve, nossos resultados nestas patologias

Treatment of patients with chronic hepatitis using ursodeoxycholic acid.

We treated 82 patients of chronic hepatitis using 300 mg. of ursodeoxycholic acid (UDCA) daily and observed them for a mean of 10 mo before and 16 mo after UDCA administration. Seven liver function tests (AST, ALT, ALP, LAP, GTP, Ch-E and T-cholest) were assessed monthly. The values were compared before and after the administration of UDCA. The AST, ALT, LAP and GTP improved significantly in the UDCA treated patients, whereas ALP, Ch-E and T-cholest. did not show any change throughout the study. Amongst the liver function tests that improved, the serum--GTP level, in particular decreased markedly and rapidly in patients treated with UDCA. Although UDCA 600-mg daily was administered in patients who showed lack of improvement with 300-mg UDCA treatment, no significant improvement was obtained. Repeated liver biopsies were carried out in six of the 42 patients in whom liver biopsy had been performed before the administration of UDCA. We detected no histological changes during the UDCA treatment. There were no side effects related to therapy with UDCA. In conclusion, we confirmed that UDCA is a safe and effective drug for treating patients with chronic hepatitis and may help in prevention of progression of the disease, particularly in patients with a high serum--GTP level.

Bioactive glycosides from Chinese medicines

Glycosides are the bioactive components of many famous Chinese medicines. Here reported are some bioactive glycosides we discovered from Chinese medicines in recent years. (1) Pheolic glycosides from Chinese medicines: Gastrodia elata, acontium austroynanense and Helicia erratica, three bioactive phenolic glycosides were discovered and two of them have been developed into new drugs. (2) Terpenoidal glycosides: a) Monoterpenoid: the sweroside from Swertia mollensis has been developed intro an anti-hepatitis drug; b) Diterpenoid: Phlomis betonicoides contains sweet glycoides; c) Triterpenoid: many biologically active triterpenoid glycosides were isolated from Panax plants and Siraitia grosvenorii. (3) Steroidal glycosides: a) C21-steroid: Cynanchum otophyllum and C. atratrum contain anti-epilepsy and-tumor glycosides; b) C27-steroid Hemostatic saponins were found in Paris polyphylla.

Uso del IFN * leucocitario por vía intraperitoneal en humanos: aspectos farmacocinéticos / Intraperitoneal administration of leukocytic alpha-interferon in humans: pharmacokynetic aspects

Una posible vía de administración del IFN-*, no explorada hasta el momento en el tratamiento a enfermos de hepatitis asociada al virus B o a portadores asintomáticos, es la vía intraperitoneal. Por las posibilidades terapéuticas que ella puede brindar, hemos iniciado estudios mediante esta vía de administración en humanos. Se estudiaron aspectos farmacocinéticos del interferón leucocitario humano durante su administración a 25 portadores asintomáticos del antígeno de superficie del virus de la hepatitis B, empleando dosis simple intraperitoneal, peritoneoclisis y dosis simple intraperitoneal inicial más peritoneoclisis. Se administraron 4 x 106 U.l. y 8 x 106 U.l., cada 24 horas, quedando conformados cuatro grupos. Se determinó la actividad antiviral del IFN-* basal, no detectándose actividad en 13 de los estudiados, y el valor promedio fue de 2 U.l./ml. Se determinó la actividad horaria dentro de las primeras 8 horas a partir de iniciada la administración del IFN, observándose su incremento en suero, en relación con la dosis empleada. El incremento en la temperatura se corresponde con los niveles del IFN sérico en el período de tiempo estudiado. La actividad máxima del IFN-* en suero, en todos los grupos, se alcanzó al final de cada esquema de tratamiento, y el 50 % de este valor, a las 8 horas después de culminado éste. Se determinó la actividad del IFN-* en sangre intrahepática y venosa. No se observaron complicaciones determinadas por la vía de administración en ninguno de los pacientes estudiados. No se observaron efectos indeseables en cuanto a cifras de plaquetas, leucograma y actividad de transaminasa glutámico-pirúvica