Autoimmune hepatitis in children: progression of 20 cases in northern Mexico.

BACKGROUND: Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver with nonspecific clinical manifestations that causes greater liver damage in children than in adults. AIMS: To analyze the clinical progression, biochemical profiles, histopathologic changes, and treatment response in 20 children with AIH. MATERIAL AND METHODS: A retrospective study was carried out on the variables associated with clinical progression, diagnosis, and treatment response in children seen at the the Unidad Médica de Alta Especialidad (UMAE) No. 71 IMSS in Torreón, Coahuila, Mexico, from 1992 to 2012. RESULTS: Twenty patients were analyzed, 75% with type 1 AIH (AIH-1) and 25% with type 2 AIH (AIH-2). Girls predominated with a 3:1 ratio of girls to boys. The mean age was 10.07 ± 6.53 years for the AIH-1 cases and 6.75 ± 3.77 years for the AIH-2 cases. There was an association with immunologic diseases in 40% of the patients. The patients in the AIH-2 group had greater biochemical profile alterations and IgA deficiency. Anti-nuclear antibody and anti-smooth muscle antibody were positive in 100% of the patients with AIH-1, and anti-liver kidney microsomal type 1 antibody was positive in 100% of the AIH-2 patients. Liver biopsy revealed interface hepatitis in both groups. The AIH-2 group responded more quickly to treatment, but had a higher recurrence rate. CONCLUSIONS: Autoimmune hepatitis in the pediatric patient should be suspected in order to make an early diagnosis and thereby establish opportune treatment. Determining the type of AIH is necessary for making adequate diagnosis and for achieving a better outcome in relation to recurrence and complication rates.

Clinical outcomes and peritoneal histology in patients starting peritoneal dialysis are related to diabetic status and serum albumin levels.

Peritoneal morphological changes seem to be related to dialysis solutions bioincompatibility and to infections, but the uremic milieu per se may also contribute to peritoneal changes. The influence of diabetes and diabetes-associated comorbidities on peritoneal histological changes in the pre-dialysis stage have been insufficiently studied. The aim of this study is to analyze the effect of diabetes and serum albumin levels on peritoneal histology and certain clinical variables such as peritoneal permeability, technique failure, and general mortality in patients starting peritoneal dialysis (PD) treatment. Eighteen PD patients without diabetes (uremic non-diabetic group, U-ND) and 65 with diabetes (uremic diabetic group, U-D) were studied prospectively. Clinical and biochemical variables were registered, and a parietal peritoneum biopsy was obtained at the time of the peritoneal catheter placement. Peritoneal histology was evaluated by light microscopy and immunohistochemistry. A control group of 15 non-uremic, non-diabetic (NU-ND) patients who underwent non-complicated elective abdominal surgery was also studied and used as control. The proportion of patients with peritoneal morphological changes as evaluated by light microscopy was higher in the two groups of uremic patients than in the control. The U-D group had higher mesothelial loss (40.9 vs 29.4%), higher mesothelial basement membrane thickening (45.5 vs 23.5%), higher proportion of vascular wall thickening/sclerosis (39.7 vs 11.1%), and higher proportion of inflammatory infiltrate (45.4 vs 23.6%) than the U-ND group. Uremic patients had lower density of mesothelial cells and higher density of inflammatory cells than the control, as evaluated by immunohistochemistry. These changes were even more striking in the U-D group than in the U-ND group. On the other hand, inflammatory infiltration to the peritoneum, mesothelial cell loss, and mesothelial basement membrane thickening were associated with higher technique failure and mortality. However, when the serum albumin level was introduced into the model, the aforementioned associations became nonsignificant. In conclusion, uremia and diabetes were associated with important peritoneal histological changes before starting PD treatment. Diabetes associated with uremia was more strongly related to the peritoneal changes than uremia per se. Hypoalbuminemia and peritoneal inflammatory infiltrate were markedly associated with technique failure and mortality in patients starting PD treatment.

[Third case of human hepatic capillariasis in Mexico]. / Tercer caso de capilariasis hepática humana en México.

A case of hepatic capillariasis in a 54-year-old woman confined to a mental institution is reported. The patient was transferred to the Hospital General de México for terminal care of a breast cancer; she died 12 days after admission. Hepatomegaly was observed clinically and numerous Capillaria hepatica eggs were found at autopsy. The laboratory examinations did not show eosinophilia or other abnormalities. Twenty-six cases of human hepatic capillariasis have been recorded in the world literature. This is the third case reported in Mexico: the previous two in children. Since the patient had a psychiatric condition she may have had aberrant alimentary habits. The features of C hepatica eggs stained with Jone's silver methenamine, which allows the demonstration of an internal multilayered sheath and an external layer endowed with multiple radiated canaliculi, are described in this patient.