Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d'Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. MATERIALS AND METHODS: The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. RESULTS: The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. CONCLUSION: The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

Stability analysis of silver nanoparticle suspensions by cyclic voltammetry.

We report the application of cyclic voltammetry and absorption spectroscopy to the characterization and study of the stability of silver colloids in water. The samples are prepared via chemical reduction and the reactions are catalyzed by irradiation with white light. The electrochemical response is related to the characteristic sample surface plasmon resonance (SPR) in the UV-visible absorption spectra. Cyclic voltammetry shows a characteristic reduction peak whose position is specific to each analyzed sample. Optical analysis of a colloid precursor during a 12 h time span, under low-power white-light irradiation, shows that nanoparticles undergo change in size and surface state (absorption bands splitting and inversion) to attain the "stable" colloidal form. While the absorption spectrum bands of the precursor return almost periodically to similar positions, the cyclic voltammogram characteristic reduction peak is displaced as a function of time. Finally, we follow the SPR changes of one "stable" colloid being subjected to electrolysis, heating, and sunlight irradiation, for environmental remediation purposes. Sunlight exposure produces the most significant SPR intensity drop, but the electrochemical technique shows itself promising as well.

Evaluation of the biocompatibility of a PVA/SA scaffold with a human gingival fibroblast (HGF) by using electrochemical impedance spectroscopy.

The biocompatibility of human gingival fibroblasts (HGF) was evaluated in different concentrations of poly(vinyl alcohol) and sodium alginate (PVA/SA) nanofibres (3.5 wt% 4 wt% and 5 wt%). The PVA/SA nanofibres were deposited on the surface of an electrode microchip by using the electrospinning technique. Electrochemical impedance spectroscopy (EIS) was applied to measure the dielectric properties of each system. In order to provide a detailed analysis as well as a right physical interpretation of the EIS results, the data was fitted with an electric equivalent circuit based on the EIS and the microscopic assessments. The results registered three different time constants (TCs) of the PVA/SA scaffold which indicated different layers at different depths of the scaffold. The TCs changed their dielectric properties depending on the PVA/SA concentration. The 4 wt% system showed the highest biocompatibility properties, given that its resistance and electrochemical capacitance show the formation of a mature-stage cell interaction of HGF. The EIS data offers an exhaustive analysis of the biological activity of the cell response in real time to determine its biocompatibility features. Fluorescence analysis demonstrated a heterogeneous growth of the HGF on the PVA/SA scaffold surface.

Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado / Vascular diseases of the liver. Clinical Guidelines from the Catalan Society of Digestology and the Spanish Association for the Study of the Liver

Las enfermedades vasculares hepáticas, a pesar de su relativamente baja prevalencia, representan un problema de salud importante en el campo de las enfermedades hepáticas. Una característica común a muchas de estas enfermedades es que pueden causar hipertensión portal, con la elevada morbimortalidad que ello conlleva. Con frecuencia estas enfermedades se diagnostican en pacientes jóvenes y el retraso en su diagnóstico y/o un tratamiento inadecuado pueden reducir de forma importante la esperanza de vida. El presente artículo revisa la evidencia actual en el síndrome de Budd-Chiari, la trombosis venosa portal en pacientes no cirróticos, la hipertensión portal idiopática, el síndrome de obstrucción sinusoidal, las malformaciones vasculares hepáticas en la telangiectasia hemorrágica hereditaria, la trombosis portal en la cirrosis, otras patologías vasculares menos frecuentes como las fístulas arterioportales, así como un apartado sobre el diagnóstico por imagen de las enfermedades vasculares hepáticas y su tratamiento desde el punto de vista hematológico (estudio de la diátesis trombótica y tratamiento anticoagulante). Las recomendaciones se han realizado de acuerdo a los estudios publicados extraídos de Pubmed. La calidad de la evidencia y la intensidad de las recomendaciones fueron graduadas de acuerdo al sistema Grading of Recommendations Assessment Development and Evaluation (GRADE). Cuando no existían evidencias suficientes, las recomendaciones se basaron en la opinión del comité que redactó la guía.

Despite their relatively low prevalence, vascular diseases of the liver represent a significant health problem in the field of liver disease. A common characteristic shared by many such diseases is their propensity to cause portal hypertension together with increased morbidity and mortality. These diseases are often diagnosed in young patients and their delayed diagnosis and/or inappropriate treatment can greatly reduce life expectancy. This article reviews the current body of evidence concerning Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia, cirrhotic portal vein thrombosis and other rarer vascular diseases including arterioportal fistulas. It also includes a section on the diagnostic imaging of vascular diseases of the liver and their treatment from a haematological standpoint (study of thrombotic diathesis and anticoagulation therapy). All recommendations are based on published studies extracted from PubMed. The quality of evidence and strength of recommendations were rated in accordance with the GRADE system (Grading of Recommendations, Assessment Development and Evaluation). In the absence of sufficient evidence, recommendations were based on the opinion of the committee that produced the guide.

High HCV subtype heterogeneity in a chronically infected general population revealed by high-resolution hepatitis C virus subtyping.

OBJECTIVES: This study aimed to characterize the chronically infected general hepatitis C virus (HCV) population in Barcelona using a highly sensitive subtyping method that can identify the 67 recognized HCV subtypes and diagnose mixed infection by various genotypes/subtypes in a single individual. The resulting information has implications for selecting optimal direct-acting antiviral (DAA) treatment for each patient and establishing public healthcare policies in our setting. METHODS: Consecutive HCV patients (treatment-naïve or interferon-based failures) attending Vall d'Hebron Hospital outpatient clinics from February 2015 to May 2016 (N=1473) were included in the study. Patient samples were characterized using HCV subtyping by next-generation ultra-deep pyrosequencing. RESULTS: The following genotypes (G) were found: G1 (1126/1473 (76.4%)), G4 (145/1473 (9.8%)), G3 (135/1473 (9.2%)), G2 (51/1473 (3.5%)), and G5 (1/1473 (0.1%)). Twenty-two subtypes were seen: 1b (790/1473 (53.6%)), 1a (332/1473 (22.5%)), 3a (133/1473 (9.0%)), 4d (105/1473 (7.1%)), 4a (29/1473 (2.0%)), and 2c (25/1473 (1.7%)), with 16 low-prevalence subtypes accounting for the remaining 3.0% (44/1473). There was a worrisome 1.0% (15/1473) of mixed infections. G2 (51/1473 (3.5%)) showed a high level of heterogeneity. Analyses by age groups showed a predominance of G1b over G1a (428/506 (84.6%) vs. 24/506 (4.7%)) in patients born before 1950 (N=506/1473), and similar percentages of these subtypes in those born between 1951 and 1975 (N=834/1473) (315/834, 37.8% vs. 266/834, 31.9%) and after 1976 (N=133/1473) (47/133, 35.3% vs. 42/133, 31.6%). CONCLUSIONS: Subtype distribution showed a higher level of heterogeneity than was expected, particularly for G2. Prevalence of mixed infections was around 1%. HCV subtype distribution related to patient age group suggested that patients born from 1936 to 1975 in our setting should undergo screening for the infection. Next-generation sequencing enabled better classification of candidates for DAA-based treatment.

Relación entre el volumen espiratorio máximo en un segundo, el índice BODE y la calidad de vida percibida por el paciente de enfermedad pulmonar obstructiva crónica / Relation between maximum expiratory volume in one section, BODE index and quality of life perceived by the chronic obstructive pulmonary disease patient

Objetivo: Evaluar la correlación existente entre la calidad de vida percibida por los pacientes y dos parámetros objetivos de gravedad: a) la gravedad de la obstrucción por el volumen espiratorio máximo en el primer segundo (FEV1), y b) el índice BODE (Body Mass Index, Airflow Obstruction, Dyspnea and Exercice Capacity). Material y métodos: Estudio observacional descriptivo de corte transversal, realizado en 40 pacientes diagnosticados de la enfermedad pulmonar obstructiva crónica (EPOC) y clasificados según la escala GOLD (Global initiative for chronic obstructive lung disease) en moderados o graves, a los que se entrevistó mediante el cuestionario respiratorio de St. George (SGRQ). Se calculó el índice BODE, previa medición de los parámetros que lo componen. También se recogieron datos antropométricos y demográficos de los pacientes. Resultados: De los 40 pacientes del estudio, 38 eran varones (95%), con una edad media ± desviación estándar (DE) de 76,15 ± 5,82 años. Las medias ± DE obtenidas en referencia a la variable subjetiva del cuestionario SGRQ fueron de 33,58 ± 18,14. En referencia a los datos conseguidos de las variables objetivas, obtuvimos del FEV1 una media ± DE de 49,05 ± 15,731, y del índice BODE de 2,33 ± 1,8 y de sus parámetros integrantes: test de los 6 minutos, 440 ± 87,9; escala Medical Research Council, 1,4 ± 0,6; índice de masa corporal, 28,16 ± 4,4. Según los valores obtenidos observamos la existencia de correlación entre SGRQ y el índice BODE, al igual que entre la actividad, como subescala de la SGRQ y el índice BODE. Conclusiones: El resultado del índice BODE se correlaciona débilmente con los resultados de la SGRQ de forma conjunta, por lo que un elevado índice BODE afecta negativamente a la calidad de vida de los pacientes con EPOC moderados o graves (AU)

Objective: To measure the correlation between perceived quality of life and two objective severity parameters: forced expiratory volume in one second (FEV1) and body mass, airflow obstruction, dyspnea and exercise capacity (BODE) index. Material and methods: Observational descriptive cross-sectional study involving 40 Chronic Obstruction Pulmonary Disease (COPD) patients. They were classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system into moderate or severe. The Saint George Respiratory Questionnaire (SGRQ) was carried out by interview and the BODE value was analyzed after measurement of the parameters included in it. Anthropometry and demography data were also collected. Results: A study including 40 patients, 38 of them men 38 (95%), with mean age 76.15 ± 5.82 was performed. The means obtained for the subjective variable of the SGRQ was 33.58 ± 18.14. Regarding the data obtained for the objective variables, the FEV1 had a mean of 49.05 ± 15.731, and the BODE index showed 2.33 ± 1.8. The parameters making it up were: 6-minute exercise test 440 ± 87.9, mean MRC score: 1.4 ± 0.6, and body mass index (BMI) 28.16 ± 4.4. According to the values obtained, we observed the existence of a correlation between SGRO and the BODE index and between the activity, and subscale of the SGRO and BODE index. Conclusions: The BODE index are weakly correlative with the results of the SGRO combined. High index BODE negatively affects the perceived quality of life of moderate/severe COPD patients (AU)

[Predicting very early rebleeding after acute variceal bleeding based in classification and regression tree analysis (CRTA).]. / Predicción de resangrado precoz en cirróticos con hemorragia variceal aguda. Función del análisis con árboles de clasificación y regresión (CART).

BACKGROUND: Variceal bleeding (VB) is the main cause of death among cirrhotic patients. About 30-50% of early rebleeding is encountered few days after the acute episode of VB. It is necessary to stratify patients with high risk of very early rebleeding (VER) for more aggressive therapies. However, there are few and incompletely understood prognostic models for this purpose. AIMS: To determine the risk factors associated with VER after an acute VB. Assessment and comparison of a novel prognostic model generated by Classification and Regression Tree Analysis (CART) with classic-used models (MELD and Child-Pugh [CP]). PATIENTS AND METHODS: Sixty consecutive cirrhotic patients with acute variceal bleeding. CART analysis, MELD and Child-Pugh scores were performed at admission. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the models. RESULTS: Very early rebleeding rate was 13%. Variables associated with VER were: serum albumin (p = 0.027), creatinine (p = 0.021) and transfused blood units in the first 24 hrs (p = 0.05). The area under the ROC for MELD, CHILD-Pugh and CART were 0.46, 0.50 and 0.82, respectively. The value of cut analyzed by CART for the significant variables were: 1) Albumin 2.85 mg/dL, 2) Packed red cells 2 units and 3) Creatinine 1.65 mg/dL the ABC-ROC. CONCLUSION: Serum albumin, creatinine and number of transfused blood units were associated with VER. A simple CART algorithm combining these variables allows an accurate predictive assessment of VER after acute variceal bleeding. Key words: cirrhosis, variceal bleeding, esophageal varices, prognosis, portal hypertension.

Alteraciones en el metabolismo hidrocarbonado en los pacientes con infección crónica por el virus de la hepatitis C / Glucose abnormalities in patients with chronic hepatitis C virus infection: epidemiology, pathogenic mechanisms and their influence on antiviral treatment

La infección por el virus de la hepatitis C (VHC) y la diabetes mellitus tipo 2 son importantes problemas de salud pública por su elevada prevalencia, cronicidad y capacidad de ocasionar graves complicaciones a largo plazo. En los últimos años han surgido trabajos que muestran una asociación entre ambos procesos, que se refl eja tanto en la mayor prevalencia de infección por el VHC entre los pacientes diabéticos como en el incremento de la prevalencia de diabetes en los pacientes infectados. Ante la ausencia de un factor epidemiológico que explique la elevada prevalencia de infección por VHC entre la población diabética, y los datos que sugieren que la infección precede a la aparición de diabetes, existe sufi ciente información para apoyar la hipótesis de que el VHC es un agente con capacidad diabetógena. Además, la eliminación del VHC con el tratamiento antiviral disminuye la incidencia de alteraciones hidrocarbonadas. La consecuencia más práctica de todo ello es la necesidad de cribar las alteraciones hidrocarbonadas en los individuos infectados, así como descartar la infección en los pacientes diabéticos con transaminasas elevadas. El incremento de la resistencia a la insulina, asociado tanto a esteatosis como al aumento de citocinas proinfl amatorias, tendría un papel crucial en la fisiopatología de la diabetes asociada al VHC. Finalmente, la resistencia a la insulina se ha identificado como un factor de riesgo para una mala respuesta al tratamiento antiviral, lo que se refl eja en la menor tasa de curación que presentan los individuos con alteraciones hidrocarbonadas antes de iniciar el tratamiento

Hepatitis C virus infection (HCV) and type 2 diabetes mellitus are two common disorders with a strong impact on worldwide health. In recent years, a number of studies have documented a high prevalence of HCV infection among diabetic patients. Moreover, a higher prevalence of diabetes has also been reported in HCV-infected patients, in comparison with those with other liver diseases. The absence of any particular epidemiologic factor for HCV infection among the diabetic population and the evidence suggesting that HCV infection antedates diabetes support the idea that HCV is a risk factor for the development of type 2 diabetes in infected individuals. In addition, eradication of HCV infection signifi cantly reduces the incidence of glucose abnormalities in chronic hepatitis C patients. The clinical consequences of this association are, on the one hand, that screening for glucose abnormalities is indicated in HCV infected subjects and, on the other hand, that testing for HCV infection in diabetic patients with abnormal liver function tests should be mandatory. The specifi c mechanisms by which HCV leads to type 2 diabetes are not fully understood, but it seems that an increase in insulin resistance associated with both steatosis and the overproduction of proinfl ammatory cytokines could play a crucial role. Finally, insulin resistance has been found to impair the virological response to combined therapy in chronic hepatitis C patients, a fact that has been corroborated by the evidence that glucose abnormalities adversely influence the rate of sustained viral response in HCV-infected patients treated with interferon and ribavirin

Familial amyloidosis in a large Spanish kindred resulting from a D38V mutation in the transthyretin gene.

BACKGROUND: Transthyretin amyloidosis, also known as familial amyloidotic polyneuropathy, is an autosomal dominant disorder that results from a mutation in the gene encoding plasma transthyretin (TTR). Distinct clinical presentations of the disease have been related so far to different point mutations, polyneuropathy being the predominant clinical feature in the majority of cases. Nevertheless, misdiagnosis of familial forms of amyloidosis is still common. MATERIALS AND METHODS: A 71-year-old man was admitted to our hospital for heart failure. He had been previously diagnosed of AL amyloidosis with predominant polyneuropathic, cardiac and laryngeal involvement on the basis of clinical data and amyloid deposition in tissue specimens. During admission, suspicion of transthyretin amyloidosis was raised due to the absence of renal involvement, monoclonal protein and plasma cell dyscrasia. Complete clinical evaluation and sequence analysis of the TTR gene of the patient and his family were performed. RESULTS: Gene sequence analysis revealed a rare A-to-T transition in exon 2 resulting in the substitution of aspartic acid by valine at position 38 (D38V) in the index case and in two other members of the family. Clinical study of the kindred showed a predominant late-onset heart involvement with variable polyneuropathy. CONCLUSIONS: Here we report a large pedigree from Spain with three members affected by a severe late-onset form of amyloidosis due to a rare D38V TTR mutation. The variations on the natural history of this form of amyloidosis may have important consequences on genetic counselling, follow-up, and therapeutic approaches for these patients.

Increased tumour necrosis factor alpha production in mesenteric lymph nodes of cirrhotic patients with ascites.

BACKGROUND: Cytokines produced in mesenteric lymph nodes of cirrhotic rats with bacterial translocation may participate in circulatory alterations of cirrhosis. AIM: To investigate whether cirrhotic patients present an increased local generation of cytokines in mesenteric lymph nodes. METHODS: Mesenteric lymph nodes from 26 cirrhotic and 10 control patients were assessed for tumour necrosis factor alpha (TNF) and interleukin 6 mRNA and protein expression by competitive reverse transcription-polymerase chain reaction, and by enzyme immunoassay and immunohistochemistry, respectively. RESULTS: Interleukin 6 levels were not different between cirrhotics and controls. Protein and mRNA TNF levels in mesenteric lymph nodes from cirrhotics were higher than in controls (p<0.05). Tissue expression of TNF by immunohistochemistry was more abundant in cirrhotics. Ascitic patients showed higher TNF levels (47 (34-54) pg/mg protein) than patients without ascites (18 (17-25) pg/mg protein) (p<0.001). Elevated TNF levels (>28 pg/mg protein) in cirrhotics were associated with a higher Child-Pugh score, the antecedent of ascites, a lower prothrombin rate, and higher bilirubin and blood TNF levels. The strongest association, confirmed by multivariate analysis, was with the presence of ascites (p<0.001). Bacterial infections after transplantation, mainly by enteric bacteria, were only detected in patients with high TNF levels in mesenteric lymph nodes (33% of patients; p=0.05). CONCLUSION: Patients with advanced liver cirrhosis, and especially with ascites, have increased local production of TNF in mesenteric lymph nodes that, in common with experimental cirrhosis, may also be induced by bacterial translocation.

Role of immunosuppression in the development of quinolone-resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis.

BACKGROUND: Norfloxacin decreases the incidence of spontaneous bacterial peritonitis in cirrhotics, but promotes the appearance of quinolone-resistant Escherichia coli. AIM: : To define the characteristics of quinolone-resistant E. coli spontaneous bacterial peritonitis. METHODS: E. coli-positive ascitic fluid cultures were identified during a 6-year period. Data on quinolone-sensitive and quinolone-resistant E. coli spontaneous bacterial peritonitis were compared. RESULTS: One hundred and two E. coli-positive ascitic fluid cultures were detected. Cirrhotics accounted for 67 cases. Spontaneous bacterial peritonitis was found in 47 of the 67 (70%) cases [35 (74%) caused by quinolone-sensitive and 12 (26%) caused by quinolone-resistant E. coli]. Norfloxacin prophylaxis was higher in the quinolone-resistant group (92% vs. 6%, P < 0.001). Compared with patients with quinolone-sensitive E. coli spontaneous bacterial peritonitis, those with quinolone-resistant E. coli spontaneous bacterial peritonitis showed a higher prevalence of associated immunosuppressive factors (immunosuppressive drugs, human immunodeficiency virus infection or cancer) (92% vs. 20%, P < 0.001). Steroid therapy was independently associated with quinolone-resistant E. coli spontaneous bacterial peritonitis (odds ratio, 49; 95% confidence interval, 3.4-699; P = 0.004). The Child-Pugh score (P = 0.03), immunosuppression (P = 0.02) and renal failure (P = 0.01) were independent predictors of E. coli spontaneous bacterial peritonitis-related mortality. CONCLUSIONS: Associated immunosuppression is an important co-factor for the development of quinolone-resistant E. coli spontaneous bacterial peritonitis and for E. coli spontaneous bacterial peritonitis-related mortality.

Peritonitis bacteriana espontánea por haemophilus influenzae / Spontaneous bacterial peritonitis due to Haemophilus influenzae

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Isosorbide mononitrate in the prevention of first variceal bleed in patients who cannot receive beta-blockers.

BACKGROUND & AIMS: Nonselective beta-blockers (beta-blockers) are very effective in preventing first variceal bleeding (FVB) in patients with cirrhosis. However, 15%-25% of patients have contraindications or develop severe side effects precluding its use. The present study evaluates whether isosorbide-5-mononitrate (Is-MN) effectively prevents variceal bleeding in patients with contraindications or who could not tolerate beta-blockers. METHODS: One hundred thirty-three consecutive cirrhotic patients with gastro-esophageal varices and contraindications or intolerance to beta-blockers were included in a multicenter, prospective, double-blind randomized controlled trial. Sixty-seven were randomized to receive Is-MN, and 66 to receive placebo. RESULTS: There were no significant differences in the 1- and 2-year actuarial probability of experiencing a FVB between the 2 treatment groups. Presence of variceal red signs at endoscopy was the only variable independently associated with an increased risk of variceal bleeding on follow-up (relative risk 3.4; P < 0.01). Survival and adverse events were similar in the 2 groups. There were no significant differences in the incidence of ascites or changes in renal function. CONCLUSIONS: Is-MN does not reduce the incidence of FVB in patients with cirrhosis and esophageal varices who cannot be treated with beta-blockers because contraindications or intolerance to these drugs, suggesting that Is-MN has no place in the primary prophylaxis of variceal bleeding.

Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates.

BACKGROUND: Portopulmonary hypertension is a severe complication of liver cirrhosis that carries a high risk for posttransplantation mortality. We aimed at evaluating the utility of Doppler echocardiography in screening for portopulmonary hypertension in liver transplantation candidates. METHODS: One hundred seven cirrhotic patients candidates for liver transplantation were studied by Doppler echocardiography and subsequently, by cardiac catheterization at transplantation. Two parameters were estimated by Doppler: systolic pulmonary arterial pressure (SPAP) derived from tricuspid regurgitation and the pulmonary acceleration time. Portpulmonary hypertension was suspected when SPAP was > or = 40 mm Hg and/or pulmonary acceleration time < 100 ms. RESULTS: Portpulmonary hypertension was suspected by Doppler study in 17 patients (15%). However, portopulmonary hypertension (mean pulmonary arterial pressure > or = 25 mm Hg and pulmonary vascular resistance > 120 dynes.s/cm5) was confirmed by the hemodynamic study in five patients (4.7%). Sensitivity and specificity of Doppler echocardiography for detecting portopulmonary hypertension was 100 and 88%, respectively, with a positive predictive value of 30%. The diagnostic accuracy of pulmonary acceleration time alone (96%) was better than pulmonary arterial pressure alone (90%). CONCLUSIONS: Doppler echocardiography, and especially the determination of pulmonary acceleration time, is a useful screening method for portopulmonary hypertension in patients with liver cirrhosis who are candidates for liver transplantation.

Islet cell and thyroid antibody prevalence in patients with hepatitis C virus infection: effect of treatment with interferon.

An increased prevalence of hepatitis C virus (HCV) infection in patients with diabetes and a higher prevalence of diabetes in HCV-infected patients have been reported. However, the relationship between these two conditions remains controversial. In addition, although the effect of interferon treatment on thyroid autoimmunity has been extensively reported, its influence on beta-cell autoantibodies has not been investigated. The aims of the study were (1) to evaluate whether autoimmune beta-cell damage could be involved in the development of diabetes mellitus in HCV-infected patients and (2) to determine whether interferon treatment influences the appearance of beta-cell and thyroid autoantibodies. The prevalence of islet cell autoantibodies (glutamic acid decarboxylase antibodies [GADAs], tyrosine phosphatase antibodies [IA-2s], islet cell antibodies [ICAs]) was assessed in 303 non-selected HCV-infected patients (277 non-diabetic and 26 type 2 diabetic patients) and in 273 sex- and age-matched control subjects. ICAs and thyroid autoantibodies were also determined before and 6 and 12 months after treatment with interferon for 24 weeks in a subgroup of 46 HCV-infected patients. GADAs were detected in 4 of 277 (1.4%) HCV-infected non-diabetic patients, 1 of 273 (0.3%) control subjects, and 0 of 26 (0%) HCV-infected patients with diabetes. Anti-IA2s and ICAs were negative in all subjects. Both GADAs and anti-IA2s were negative in all HCV-infected patients treated with interferon. After therapy, only thyroid antibodies became positive in 5 of 46 (10.9%) treated patients, disappearing in all but 1 of these at the 12-month follow-up. Our results suggest that beta-cell autoimmunity is not associated with HCV infection, thus making it unlikely that the increased diabetes mellitus prevalence among HCV-infected patients could be mediated by autoimmune mechanisms. In addition, interferon treatment induces a transient increase in thyroid autoantibodies but does not influence the appearance of beta-cell autoantibodies.

[Relationship between iron stores and diabetes mellitus in patients infected by hepatitis C virus: a case-control study]. / Relación entre los depósitos de hierro y la diabetes mellitus en pacientes infectados por el virus de la hepatitis C: estudio de casos y controles.

BACKGROUND: To investigate whether the high prevalence of diabetes observed in patients infected by the hepatitis C virus (HCV) is associated to iron stores. PATIENTS AND METHODS: Serum ferritin levels were determined in 123 patients infected by HCV (55 diabetic and 68 non-diabetic). RESULTS: Serum ferritin concentrations were higher in diabetic than in non-diabetic patients (205 ng/ml [14-861] vs. 58 ng/ml [15-494]; p < 0.0001). CONCLUSIONS: Serum ferritin levels are related with the presence of diabetes in patients infected by HCV.

Nitric oxide may contribute to nocturnal hemodynamic changes in cirrhotic patients.

OBJECTIVE: Patients with liver cirrhosis have a nocturnal worsening of hemodynamic parameters that has been associated with an increased risk of variceal bleeding at nighttime. The aim of this study was to investigate whether nitric oxide and cytokines are implicated in these hemodynamic changes. METHODS: Ten cirrhotic patients and eight controls were studied. Mean blood pressure, heart rate, plasma norepinephrine, tumor necrosis factor alpha and interleukin-6 levels, and serum nitrite + nitrate levels were determined at 0800, 1600, and 2400 h. All determinations were performed in supine rest and at least 4 h after meals. In a second study, nitrite + nitrate levels were assessed in 10 cirrhotic patients before and after eating a standard meal. RESULTS: Mean arterial pressure levels that were always lower in the patient group showed a nocturnal decrease in both groups of subjects. Heart rate values that were always higher in cirrhotic patients showed a nocturnal fall in controls, whereas cirrhotics maintained elevated values at nighttime. Norepinephrine levels were higher in cirrhotics and maintained similar values during the study, whereas controls had a significant nocturnal decrease. Nitrite + nitrate levels that were higher in cirrhotic patients showed a significant mean increase of 40% from morning (0800 h) to night (2400 h) in the patient group, whereas in controls no change was observed (p < 0.05). Tumor necrosis factor alpha and interleukin-6 levels did not change either in patients or controls during the entire period. Cirrhotic patients with or without ascites maintained a pattern of hemodynamic and biochemical changes similar to the pattern observed in the entire group of patients. Finally, no changes in serum nitrite + nitrate levels were observed in patients before and after eating the standard meal. CONCLUSION: An increased nocturnal nitric oxide production might contribute to the hemodynamic changes observed in cirrhotic patients during nighttime.