Interferon-based therapy delays but metabolic comorbidity accelerates progression of chronic hepatitis C.

BACKGROUND: We compared mortality and complications of chronic hepatitis C between treated and untreated Mexican patients after long-term follow-up. We used a time-to-event analysis and identified the prognostic factors. MATERIAL AND METHODS: Seventy-four patients with chronic hepatitis C were studied. They were ≥ 18 years of age and had a molecular diagnosis of chronic hepatitis C and ≥ 6 months of follow-up. Patients with neoplasia or those infected with human immunodeficiency virus or hepatitis B Virus were excluded. Kaplan-Meier analysis, log-rank test, annualized incidence per 100 person-years, and stepwise discriminant analysis were used to analyse mortality and complications. RESULTS: The end-point of annualized incidence was lowest in sustained virological responders, intermediate in non-responders, and highest in untreated patients. The absence of treatment impacted adversely on cirrhosis development and the occurrence of portal hypertension and hepatic decompensation/hepatocellular carcinoma (logrank, p < 0.05). Diabetes impacted adversely on liver-related death/liver transplantation among untreated patients. Stepwise discriminant analysis showed that diabetes, high blood pressure, and no retreatment predicted cirrhosis development (eigenvalue ≥ 0.8; p < 0.05). A MELD score ≥ 18 and age ≥ 50 years predicted hepatic decompensation/hepatocellular carcinoma (eigenvalue < 0.8; p < 0.05). APRI ≥ 1.5 predicted mortality/liver transplantation and liver-related death/liver transplantation (eigenvalue < 0.8; p < 0.05). CONCLUSIONS: This is the first long-term study of chronic hepatitis C among Mexican patients. Treated patients showed less progression of liver disease. Treated patients showed less progression of liver disease; and older patients, those with metabolic comorbidities, with MELD score ≥ 18 and APRI ≥ 1.5 exhibited adverse effects.

Intoxicación crónica con el fruto maduro de karwinskia humboldtiana en ratas wistar: daño renal / Chronic intoxication with ripe fruit of karwinskia humboldtiana in wistar rats: renal damage

Karwinskia humboldtiana (Kh) es un arbusto venenoso responsable de numerosos casos de intoxicación accidental en humanos. En la literatura se ha descrito a la intoxicación crónica con Kh como uno polineuropatía sin describir si existen o no alteraciones en órganos distintos al SNC y SNP como lo es el riñón. El objetivo de este estudio fue evaluar la morfología renal en un modelo de intoxicación crónica con Kh. Se utilizaron 32 ratas Wistar, se dividieron en cuatro grupos (n=8) en donde 5 ratas de cada grupo fueron intoxicadas y 3 fueron control no intoxicadas. A las ratas intoxicadas se les administraron por vía oral 3,5 g/kg del fruto seco y molido de Kh fraccionados en 5 dosis de 1,5; 0,5; 0,5; 0,5 y 0,5 g/kg los días 0, 3, 7, 10 y 14 respectivamente. Las ratas control solo recibieron agua. Cada grupo fue sacrificado a diferentes tiempos según la evolución de la parálisis. Se obtuvieron muestras de riñón, se procesaron hasta obtener bloques de parafina y resinas epóxicas, se obtuvieron cortes y se tiñeron y contrastaron para su observación al microscopio de luz y electrónico de transmisión (MET) respectivamente. A microscopia de luz identificamos congestión vascular, necrosis de los túbulos contorneados y fibrosis de la cápsula de renal, en la etapa de parálisis se realizo un conteo de los glomérulos afectados en las muestras tratadas con Kh, a MET además de los hallazgos previamente descritos se identificó la presencia de abundantes depósitos de matriz extracelular en la membrana basal de la cápsula renal y en la barrera de filtración de todos los grupos intoxicados, siendo más evidentes en el grupo de recuperación, lo que demuestra que la intoxicación crónica con Kh es una intoxicación sistémica y no exclusiva del SNC y SNP.

Karwinskia humboldtiana (Kh) is a poisonous shrub causing a number a accidental intoxications in humans. In previous studies, damage has been reported to Peripheral and Central Nervous System. Main intoxication sign is the presence of paralysis. However, no studies have been documented about damage to other organs like the kidney. The objective of this research is to evaluate kidney histology during chronic intoxication. Thirty two (32) Wistar rats were divided into 4 groups (n=8). For each group, 5 rats were intoxicated with Kh and 3 received water only as a control. Intoxicated rats received 3.5 g/Kg body weight of dry powder of Kh fruit, fractionated in 5 doses as follows 1.5, 0.5, 0.5, 0.5, 05 on days 0, 3, 7, 10 and 14 respectively. Control rats received water only. Each group was euthanized at different times during paralysis evolution. Samples of kidney were obtained and processed by routine technique until paraffin embedding for light microscopy studies, and in epoxy resins for transmission electron microscopy. Sections were obtained and stained with H&E, Masson's trichrome, and treated for PAS with diastase reaction to demonstrate basal membranes. At the light microscopic level we observed blood vessel congestion, tubular necrosis and fibrosis of renal capsule. Both at Light microscopy and electron microscopy, it was identified a thickening of the filtration barrier and of renal capsule, in all intoxicated animals, especially in the recovery group. These findings demonstrate that Kh causes a systemic intoxication and not only of the nervous system, as has been considered up to now.