Genetic variants associated with steatohepatitis and liver fibrosis in HIV-infected patients with NAFLD.

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is a common cause of liver damage in people living with HIV (PLWHIV). Several studies have investigated candidate genes for susceptibility to NAFLD and to steatohepatitis. PNPLA3, TM6SF2, and MBOAT7-TMC4 have been reported to be associated with elevated ALT levels and the histologic parameters of nonalcoholic steatohepatitis and severity of fibrosis. Our objective was to analyze the relationship between PNPLA3, TM6SF2, and MBOAT7-TMC4 and steatosis, steatohepatitis, and liver fibrosis in PLWHIV with NAFLD. Method: A cohort of PLWHIV with persistently elevated aminotransferase levels and suspected NAFLD who underwent liver biopsy and determination of genetic variants was assessed at two large centers in Spain. All participants included in the current study were genotyped for rs738409 (PNPLA3), rs58542926 (TM6SF2), and rs641738 (MBOAT7-TMC4). Results: The study population comprised PLWHIV who were on stable antiretroviral therapy [7.7% women; median age, 49.3 years (44-53.4)]. The median CD4 count was 829 (650-980), 60% had metabolic syndrome, and 18.5% were diabetic. The median BMI was 28.9 (25.5-30.8). Patients with liver steatosis (any grade) vs. nonsteatosis tended to harbor the PNPLA3 G allele variant [57.6% vs. 16.7% (p = 0.09)], but not TM6SF2 or MBOAT7-TMC4 variants. However, those with steatohepatitis vs. nonsteatohepatitis significantly more frequently had the PNPLA3 G allele variant [69.4% vs. 39.1% (p < 0.05)] and the MBOAT7-TMC4 A allele variant [75% vs. 42% (p < 0.05)]. In our cohort, the TM6SF2 gene variant was not associated with steatosis or steatohepatitis. The PNPLA3 G allele variant was associated with steatohepatitis [OR 4.9 (1.3-18); p 0.02] and liver fibrosis [OR 4.3 (1.1-17.4); p 0.04], and the MBOAT7-TMC4 A allele variant was associated with steatohepatitis [OR 6.6 (1.6-27.6); p 0.01]. Conclusion: The PNPLA3 G allele variant and MBOAT7-TMC4 A allele variant were associated with steatohepatitis and liver fibrosis in PLWHIV with persistently elevated aminotransferases and NAFLD. We recommend routine genotyping for PNPLA3 and MBOAT7-TMC4 in PLWHIV with NAFLD to identify those at higher risk of progression.

Assessment of Noninvasive Markers of Steatosis and Liver Fibrosis in Human Immunodeficiency Virus-Monoinfected Patients on Stable Antiretroviral Regimens.

Background: Nonalcoholic fatty liver disease (NAFLD) is a major nonacquired immune deficiency syndrome-defining condition for persons with human immunodeficiency virus (PWH). We aimed to validate noninvasive tests for the diagnosis of NAFLD in PWH. Methods: This is a cross-sectional study of PWH on stable antiretroviral therapy with persistently elevated transaminases and no known liver disease. The area under the receiver operating characteristic curve (AUROC) was calculated to compare the diagnostic accuracy of liver biopsy with abdominal ultrasound, transient elastography (TE) (including controlled attenuation parameter [CAP]), and noninvasive markers of steatosis (triglyceride and glucose index [TyG], hepatic steatosis index [HSI], fatty liver index [FLI]) and fibrosis ([FIB]-4, aminotransferase-to-platelet ratio index [APRI], NAFLD fibrosis score). We developed a diagnostic algorithm with serial combinations of markers. Results: Of 146 patients with increased transaminase levels, 69 underwent liver biopsy (90% steatosis, 61% steatohepatitis, and 4% F ≥3). The AUROC for steatosis was as follows: ultrasound, 0.90 (0.75-1); CAP, 0.94 (0.88-1); FLI, 0.81 (0.58-1); HSI, 0.74 (0.62-0.87); and TyG, 0.75 (0.49-1). For liver fibrosis ≥F3, the AUROC for TE, APRI, FIB-4, and NAFLD fibrosis score was 0.92 (0.82-1), 0.96 (0.90-1), 0.97 (0.93-1), and 0.85 (0.68-1). Optimal diagnostic performance for liver steatosis was for 2 noninvasive combined models of tests with TyG and FLI/HSI as the first tests and ultrasound or CAP as the second tests: AUROC = 0.99 (0.97-1, P < .001) and 0.92 (0.77-1, P < .001). Conclusions: Ultrasound and CAP performed best in diagnosing liver steatosis, and FLI, TyG, and HSI performed well. We propose an easy-to-implement algorithm with TyG or FLI as the first test and ultrasound or CAP as the second test to accurately diagnose or exclude NAFLD.

Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report. / Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso.

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.

Theoretical Insights into Unexpected Molecular Core Level Shifts: Chemical and Surface Effects.

A set of density-functional theory based tools is employed to elucidate the influence of chemical and surface-induced changes on the core level shifts of X-ray photoelectron spectroscopy experiments. The capabilities of our tools are demonstrated by analyzing the origin of an unpredicted component in the N 1s core level spectra of metal phthalocyanine molecules (in particular ZnPc) adsorbed on Cu(110). We address surface induced effects, such as splitting of the lowest unoccupied molecular orbital or local electrostatic effects, demonstrating that these cannot account for the huge core level shift measured experimentally. Our calculations also show that, when adsorbed at low temperatures, these molecules might capture hydrogen atoms from the surface, giving rise to hydrogenated molecular species and, consequently, to an extra component in the molecular core level spectra. Only upon annealing, and subsequent hydrogen release, would the molecules recover their nominal structural and electronic properties.

Servicio de Psiquiatría y Psicología infanto-juvenil/Salud mental del Hospital Sant Joan de Déu / Infant child psychology and psychiatry service/Mental Health of the Hospital Sant Joan de Déu

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Intervención asistida con animales para la estimulación cognitiva de niños y adolescentes en la Unidad de Primeros Episodios Psicóticos / Neurocognitive performance and functioning of an adolescent bipolar disorder cohort: outcome two years after diagno / Animal-assisted intervention for cognitive stimulation of children and adolescents in a First Episode Psychosis Unit

El déficit cognitivo está presente desde las primeras fases de los trastornos psicóticos de inicio en la infancia y la adolescencia, y es tan relevante en la evolución, pronóstico y funcionalidad de los pacientes que en la última década se ha planteado la necesidad de una evaluación y abordaje terapéutico del mismo como parte esencial en los planes de tratamiento. La estimulación o rehabilitación cognitiva es una intervención no farmacológica empíricamente validada, que se realiza en pacientes adultos con psicosis desde hace décadas, pero que se ha introducido en el tratamiento de niños y adolescentes más recientemente, por lo que aún no se dispone de programas eficaces y validados para esta población. Por otra parte, las intervenciones asistidas con animales han mostrado eficacia como instrumento en la intervención terapéutica con niños y jóvenes con distintos tipos de trastornos psiquiátricos o psicológicos. Uno de los aspectos más importantes de estas intervenciones en su elevado valor motivacional para la población infantil, además de otras ventajas sobre otro tipo de metodología de apoyo. En el presente trabajo presentamos un programa de intervención en rehabilitación cognitiva para niños y adolescentes con psicosis de inicio reciente, diseñado específicamentepara esta población y que resulta novedoso por incorporar en su metodología aspectos pedagógicos y motivacionales relevantes para superar las limitaciones de este tipo de intervenciones (AU)

Cognitive impairment is present from the earliest phases of psychotic disorders in childhood and adolescence and it is so relevant in the prognosis and functionality of patients that in the last decade has raised the need for its evaluation and treatment as an essential part of the therapeutic plans. Cognitive rehabilitation (or stimulation) is a non pharmacologic intervention empirically validated, that hasbeen conducted in adult patients with psychosis from many decades, but that has been introduced recently in the treatment of children and adolescents, so we don’t have effective and validated programs for this population yet. Moreover, animal assisted interventions have shown effectiveness as a tool in therapeutic intervention with children and youth with different types of psychiatric or psychological disorders. One of the most important aspects of these interventions is their high motivational value to the child population, in addition to other advantages over other methods of support. In this paper we present a program of cognitive rehabilitation / intervention for children and adolescents with recent onset psychosis, designed specifically for this population and new because of incorporating teaching and motivational aspects relevant to overcome the limitations of this type interventions (AU)

Hemorragia digestiva: papel de la radiología / Gastrointestinal bleeding: the role of radiology

La hemorragia digestiva (HD) supone un problema diagnóstico tanto en su forma de presentación aguda, que requiere una rápida localización del punto de sangrado, como en la crónica, que precisa de exploraciones repetidas para determinar su etiología. El diagnóstico y tratamiento se basa en estudios endoscópicos, aunque los estudios radiológicos mediante angiografía por tomografía computarizada (TC) en la hemorragia aguda y mediante TC enterografía en la crónica son cada día más utilizados en la práctica clínica, a pesar de no estar incluidos todavía en las guías clínicas de la HD. La TC puede ser una exploración diagnóstica de primera elección en la hemorragia aguda masiva, sustituyendo a la angiografía, y una exploración diagnóstica complementaria a la cápsula endoscópica y la gammagrafía en la hemorragia crónica o recurrente cuando se sospecha un origen en el intestino delgado. La angiografía es actualmente un método terapéutico complementario a la endoscopia en el manejo de esta afección (AU)

Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding (AU)

[Gastrointestinal bleeding: the role of radiology]. / Hemorragia digestiva: papel de la radiología.

Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.

Paroxetine-induced increase in LDL cholesterol levels.

Paroxetine is widely prescribed because it has the indication for multiple psychiatric disorders. Our objective was to assess the effect of short-term administration of paroxetine on low-density lipoprotein cholesterol (LDL-C) levels in both healthy controls (HCs) and in patients with panic disorder (PD). Blood samples for measurement of LDL-C were collected atbaseline, after 8 weeks of paroxetine administration and post-discontinuation in 24 male HCs and nine male patients suffering from PD, for a total of 33 subjects. Paroxetine treatment, both in HCs and PD patients, induced a mean 9% increase per subject in LDL-C that normalized post-discontinuation, suggesting causality. The National Cholesterol Education Program (NCEP) guidelines suggest that this paroxetine-induced increase in LDL-C is clinically significant but would not warrant therapeutic intervention in this population selected to be at low cardiovascular risk. However, the increase in LDL-C levels raised above the threshold of 2.7 mmol/L (100 mg/dL) in 36% of our low-risk subjects. The LDL-C increase in this subgroup would be associated with a minor increase in coronary heart disease (CHD) risk. A similar 9% paroxetine-induced increase in LDL-C observed in the large number of psychiatric patients suffering from comorbid established CHD would be detrimental from a cardiovascular perspective and would oppose the new NCEP therapeutic goals of decreasing LDL-C levels by 30-40% in high and moderately high-risk patients. It is possible that longer treatment duration and use of higher doses of paroxetine would lead to a greater increase in LDL-C.

Prosodia afectiva y reconocimiento facial y verbal de la emoción en la esquizofrenia / Affective prosody and facial and verbal recognition of emotion in schizophrenia

En el presente estudio se evalúa la capacidad de los pacientesesquizofrénicos para reconocer emociones a nivelverbal y facial, y para expresar emociones oralmente,comparándolos con pacientes bipolares y sujetos control.Las evaluaciones se realizan antes y después deltratamiento con diferentes antipsicóticos. Se examinaránun total de 75 pacientes esquizofrénicos y 75 sujetoscontrol (entre bipolares y sanos).Para llevar a cabo este objetivo se utilizara el análisiscomputarizado de la voz pruebas de reconocimiento facialy verbal de emociones y diversas escalas de valoraciónpsiquiátrica

In the present study we want to evaluate the ability ofschizophrenic patients to recognise emotions in verbaland facial tasks compared with normal subjects and withbipolar patients. But also, we will compare the ability ofschizophrenics to express emotions when talking, withbipolar patients and normal subjects. The evaluationswill be done before and after the treatment with differentantipsychotics.A total number of 75 schizophrenic patients and 75 controlsubjects (including normal subjects and bipolarpatients) will be examined.In order to this, different speech computerised tests, andfacial- verbal recognition tests of emotions will be used.And also, a wide range of psychiatric evaluation scales

Response of first attack of inflammatory bowel disease requiring hospital admission to steroid therapy.

INTRODUCTION: Corticoid administration is the usual treatment of Crohns disease (CD) and ulcerative colitis (UC) attacks. However, information available on response rates and their predictive factors is scarce. OBJECTIVE: To establish response to steroidal treatment in an homogeneous group of patients with CD or UC during their first admission to hospital. METHODS: Restrospective analysis of 86 patients who received systemic steroidal treatment for a severe flare-up during their first hospital admission between 1995 and 2000. Patients were treated per protocol with fluid therapy, absolute diet, IV 6-methyl-prednisolone 1 mg/kg/day, and enoxaparin at prophylactic doses. Clinical response at 30 days was considered good in case of complete remission, and poor in case of partial or absent remission. Univariate and multivariate analyses according to non-parametric statistics were performed for sociodemographic and biologic variables. RESULTS: 45 patients with CD and 41 with UC were included. Good response rates were 64.4% for CD and 60.9% for UC. The univariate analysis showed that patients with good response have shorter evolution times and fewer previous flare-ups (p < 0.05) regarding CD. However, the multivariate analysis showed that none of the analyzed variables had predictive value. CONCLUSION: The response rate of severe inflammatory bowel disease attacks to corticoids is around 60% in CD and UC. Data resulting from the current study cannot predict which patients will ultimately respond to therapy.

Cambios cognitivos en la esquizofrenia bajo tratamiento con olanzapina, risperidona o haloperidol / Cognitive changes in schizophrenic patients receiving olanzapine, rispridone or haloperidol

Se estudia el efecto diferencial de tres antipsicóticos (olanzapina, risperidona y haloperidol) sobre la semiología cognitiva de la esquizofrenia, tanto en el episodio agudo de la enfermedad como en los seis meses posteriores de evolución. Se plantea un diseño simple ciego con un número de 34 pacientes distribuidos aleatoriamente en tres grupos paralelos. Se evalúa la respuesta a través del cambio de las puntuaciones de una batería de tests cognitivos compuesta por el subtest clave de números del WAIS-R, el RAVLT, los tests del trazo A y B, el WCST, el TACP y el test del golpeteo rítmico. Estos tests se pasan en la visita basal, al alta del episodio psicótico agudo y a los 6 meses de evolución. El análisis estadístico se realiza mediante la prueba t de Student. Las dosis medias administradas son: olanzapina (14,6ñ9,4), risperidona (6,5ñ2,9) y haloperidol (18,7ñ8,3).De los resultados cabe destacar que en el grupo de pacientes tratados con olanzapina se producen, a los 6 meses, mejorías significativas del rendimiento en casi todos los tests, mientras que para risperidona solo mejora el rendimiento en el test del trazo A y para haloperidol no se producen variaciones significativas en ningún test. En la exploración correspondiente al alta la comparación entre los tres grupos farmacológicos resulta ventajosa para olanzapina, fenómeno que se repite, con mayor intensidad, a los 6 meses de evolución, no habiendo diferencias significativas entre risperidona y haloperidol (AU)

Cardiopatía isquémica aguda: ¿dónde estamos?

La atención a los síntomas del paciente y la observación son el punto de partida hacia el diagnóstico. Un paciente con dolor opresivo restrosternal, irradiado o no, acompañado de cortejo vegetativo es una orientación de hacia dónde se dirigirá nuestra investigación, sin olvidar la atipia del dolor e incluso su ausencia en los enfermos graves, mayores o diabéticos que pueden presentar como única manifestación dolor epigástrico o vómitos.Es importante recordar la presentación del infarto como un síncope, mareos o una inquietud no explicable e incluso como estado psicótico. El siguiente paso que se debe realizar, una vez en el centro hospitalario, es repetir el ECG y observar los cambios producidos con el registro realizado en el centro de atención primaria. Hay que tener en cuenta que los marcadores enzimáticos se deben solicitar en función del tiempo que ha transcurrido.En cuanto al tratamiento extrahospitalario es preferible empezarlo cuanto antes. Si se tienen los medios adecuados y un personal adecuadamente entrenado, se debe iniciar tratamiento trombolítico inmediatamente después de haber confirmado el diagnóstico. Si no es así, se debe facilitar el transporte lo más pronto posible hacia el centro hospitalario (AU)

Variantes normales en electrocardiografía

La importancia del electrocardiograma en el ejercicio práctico de la medicina es indudable. Ningún otro método puede sustituirle por limpio, sencillo y eficaz. En este trabajo queremos poner de manifiesto algunas alteraciones electrocardiográficas (variantes normales) que se observan a menudo y que pueden causar dudas y confusiones a la hora de interpretar un electrocardiograma (AU)

[Focal nodular hepatic hyperplasia. A report of a new case]. / Hiperplasia nodular focal hepática. A propósito de un caso.

Focal nodular hyperplasia is a benign liver tumor, that is rare during childhood. We report a new case, exceptional by the short age of the patient, and by the way of this we review the epidemiology, the actual diagnosis criterion and the treatment options.

Hiperplasia nodular focal hepática. A propósito de un caso / Focal nodular hyperplasia. A report of a new case

La hiperplasia nodular focal es una tumoración hepática benigna, de rara presentación en la infancia. Presentamos un nuevo caso, excepcional por la corta edad del paciente, y a propósito de él realizamos una revisión de la epidemiología, de los criterios diagnósticos actuales y de las opciones de tratamiento (AU)

Tratamiento de las heridas cavitadas esternales tras cirugía cardíaca con un nuevo apósito / Treatment of sternal cavitated lesions following cardiac surgery with a new dressing

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[The specific bronchial provocation test in the diagnosis of occupational asthma]. / La prueba de provocación bronquial específica en el diagnóstico del asma ocupacional.

Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agents present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique. We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.