Infección por el virus de la hepatitis E: clínica y epidemiología / Clinical and Epidemiology of Hepatitis E Virus Infection

Resumen El virus de la hepatitis E es un patógeno hepatotrópico que se transmite por el agua y alimentos contaminados, y uno de los principales agentes etiológicos de hepatitis viral aguda de transmisión enteral en el mundo. La infección por el virus de la hepatitis E usualmente es autolimitada; sin embargo, se han descrito casos de infección crónica en pacientes inmunocomprometidos. La infección autolimitada no requiere tratamiento; por el contrario, la infección crónica debe tratarse debido al riesgo de progresión a cirrosis o a alguna de las manifestaciones extrahepáticas reportadas. En Colombia, la infección por el virus de la hepatitis E no hace parte del diagnóstico rutinario de hepatitis virales, a pesar de que existe evidencia de la circulación del virus en el país. El presente artículo de revisión tiene como objetivo describir las generalidades del virus de la hepatitis E, así como la historia natural de la infección y los estudios realizados en Colombia que evidencian su presencia en el país. La revisión se realizó mediante una búsqueda de literatura en la base de datos PubMed, SciELO y ScienceDirect, de trabajos originales y revisiones de tema publicados entre el período 1983-2017.

Abstract The hepatitis E virus, a hepatotropic pathogen transmitted by water and contaminated food, is one of the main etiological agents on the planet of enteral transmission of acute viral hepatitis. Hepatitis E infections are usually self-limiting, but cases of chronic infection have been described in immunocompromised patients. While self-limiting infections do not require treatment, chronic infections should be treated because of risk of progression to cirrhosis and/or extra-hepatic manifestations. In Colombia, hepatitis E infections are not included in the routine diagnosis of viral hepatitis, despite evidence of its presence in the country. The objective of this review is to provide a general description of the hepatitis E virus and the natural history of infections and to highlight studies carried out in Colombia showing its presence in the country. The review was carried out through a search in the PUBMED, SCIELO and ScienceDirect databases for of original papers and subject reviews published between 1983 and 2017.

An evaluation of the impact of urban air pollution on paint dosimeters by tracking changes in the lipid MALDI-TOF mass spectra profile.

We evaluated the impact of urban air pollution on egg yolk tempera paint dosimeters (binary mixture samples made with historic artist´s blue, red and white pigments) by tracking changes over time in their lipid matrix-assisted laser desorption ionization time-of-flight mass spectra (MALDI-TOF-MS) profiles. We studied triacylglycerols (TGs), phospholipids (PLs) and their oxidation by-products from paint dosimeters that had been exposed outdoors for six months to the polluted atmosphere in the city center of Granada (Spain). Four types of chickens' eggs were also analyzed to find out whether their lipid mass spectra (lipid fingerprints) varied significantly. The ultimate goal of this research is to provide a precise analytical protocol to show whether the changes in the egg yolk identified in paint dosimeters are due to pigment-binder interactions. The Bligh-Dyer (BD) method was optimized for the extraction of the lipids. This innovative procedure included a washing-step prior to the mass spectrometric analysis, which proved crucial for obtaining higher quality lipid fingerprints. A novel interpretation of the results is proposed by applying the BD method, which suggests that transesterification processes occurred in the lipid fractions that were catalyzed by the pigments in the paint dosimeters. In blank dosimeters specific ions produced by oxidative cleavage of PLs and/or TGs may be used as markers of the presence of egg yolk binders. The composition and structure of the specific lipid compounds are also tentatively proposed. In aged dosimeters the intact content of the TGs and PLs decreased; however, we propose that short-chain oxidative products arising from TGs and PLs are present in all the samples, except for the white lead based dosimeter. We end with a new explanation as to why this dosimeter behaves differently from the others.

Alcohol, cirrosis y predisposición genética / Alcohol, Cirrhosis, and Genetic Predisposition

La cirrosis hepática es la tercera causa de muerte alrededor del mundo que es atribuible al consumo de alcohol. Más del 80% de los consumidores crónicos de alcohol desarrollan esteatosis y entre el 20% al 40% presentan otras complicaciones como fibrosis, hepatitis alcohólica y cirrosis; sin embargo, no todos los individuos con consumo crónico de alcohol desarrollan cirrosis, en parte debido al componente genético de cada individuo. El grado de actividad de las enzimas que metabolizan el alcohol está influenciado por polimorfismos presentes en los genes que codifican para estas enzimas, y corresponde a uno de los factores determinantes para el desarrollo de una hepatopatía terminal en respuesta al consumo de alcohol. Entre las enzimas implicadas en el metabolismo del alcohol están la alcohol deshidrogenasa (ADH), el citocromo P450 2E1 (CYP2E1) y la acetaldehído deshidrogenasa (ALDH), de las cuales se ha reportado que la mayor actividad de ADH y CYP2E1 y la menor actividad de ALDH pueden conferir riesgo en algunas poblaciones por la acumulación de acetaldehído, el cual es tóxico para el organismo. Se realizó una revisión en la literatura de los principales aspectos del metabolismo del alcohol y polimorfismos (genotipos) de enzimas que intervienen en el metabolismo del alcohol como factor de riesgo. Esto se hizo mediante la búsqueda de material bibliográfico a través de la base de datos PubMed desde 1990 hasta el 2013 utilizando las palabras claves alcohol liver disease, ADH, ALDH, CYP2E1 y polymorphism.

Liver cirrhosis is the third most common cause of death attributable to alcohol consumption throughout the world. More than 80% of chronic drinkers develop steatosis, and 20% to 40% develop other complications such as fibrosis, alcoholic hepatitis and cirrhosis. However, not everyone who chronically consumes alcohol develops cirrhosis. This is partly because of the genetic component of each individual. The level of activity of the enzymes that metabolize alcohol is influenced by polymorphisms of the genes that coding for these enzymes. This is one of the determining factors in the development of terminal liver disease in response to alcohol consumption. Among the enzymes involved in alcohol metabolism are alcohol dehydrogenase (ADH), cytochrome P450 2E1 (CYP2E1) and acetaldehyde dehydrogenase (ALDH). It has been reported that higher levels of activity of ADH and CYP2E1 and lower levels of activity of ALDH may be risk factors in some populations for accumulation of acetaldehyde which is toxic for the organism. This literature review covers the most important aspects of alcohol metabolism including polymorphisms (genotypes) of enzymes involved in the metabolism of alcohol as a risk factor. A search through the PubMed database from 1990 to be held 2013 was conducted using the keywords alcoholic liver disease, ADH, ALDH, CYP2E1, and polymorphism.

Infección por el virus de la hepatitis B en individuos con factores de exposición en Quibdó y Apartadó, Colombia / Hepatitis B Infections in Individuals with Exposure Factors in Quibdo and Apartado, Colombia

Antecedentes: Colombia presenta un patrón de prevalencia heterogéneo para la infección por virus de la hepatitis B (VHB) con regiones de alta, moderada y baja prevalencia. Objetivo: identificar los casos de infección por VHB y caracterizar los genotipos virales en población con factores de exposición en las ciudades de Quibdó y Apartadó, Colombia. Materiales y métodos: la población del estudio correspondió a 768 individuos asintomáticos con factores de exposición a la infección por VHB. El primer análisis fue la detección del antígeno de superficie del VHB (HBsAg) por prueba rápida. En las muestras de individuos positivos para esta prueba, se confirmó la presencia del HBsAg por ELISA y se detectó el genoma del VHB por reacción en cadena de la polimerasa (PCR). El genotipo viral fue determinado por secuenciación y análisis filogenético. Resultados: se identificaron 17/768 individuos con infección por VHB (2,2%) según la detección del HBsAg por prueba rápida y por ELISA. Los análisis filogenéticos permitieron la identificación de los genotipos F, (subgenotipos F3 y F1a) y A en las muestras. Conclusiones: se reporta por primera vez la circulación del subgenotipo F1a en Colombia y se confirma la circulación del subgenotipo F3 y el genotipo A.

Introduction: Colombia has a varied geographical pattern of prevalence of hepatitis B virus (HBV) infections with regions of high, moderate and low prevalences. Objective: The objective of this study was to identify cases of HBV infection and characterize viral genotypes in population with factors of exposure in the cities of Quibdo and Apartado, Colombia. Materials and Methods: The study population included 768 asymptomatic individuals with factors of exposure to HBV infections. An HBV surface antigen (HBsAg) rapid detection test was the first test used. Samples from individuals who tested positive were tested with ELISA to confirm the diagnosis and with PCR to detect the HBV genome. Viral genotypes were determined by sequencing and phylogenetic analysis. Results: Seventeen individuals (17/768, 2.2%) were diagnosed with HBV infections by both the Rapid Test and Elisa. Phylogenetic analyses allowed identification of genotypes F (F3 and Subgenotype F1a) and A in the samples. Conclusions: We report for the first time the presence of the F1a subgenotype in Colombia and confirme the presence of subgenotype F3 and genotype A.

Infección por el virus de la hepatitis C en individuos transfundidos antes de 1994 en Antioquia, Colombia / Hepatitis C Infections among Individuals who Received Transfusions prior to 1994 in Antioquia, Colombia

Introducción: la infección por el virus de la hepatitis C es un problema de salud pública. Según datos de la Organización Mundial de la Salud, se estiman 184 millones de casos de infección por VHC en el mundo. El principal factor de riesgo en países en desarrollo corresponde a la transfusión de componentes sanguíneos. En Colombia, en 1993, se reglamentó el tamizaje serológico en los bancos de sangre para diferentes agentes infecciosos, incluido el VHC; sin embargo, los datos de infección por VHC en la población transfundida antes de esta fecha es limitada. Objetivo: describir la frecuencia de infección por el VHC en una población de individuos transfundidos antes de 1994 en Antioquia. Materiales y Métodos: un total de 166 individuos transfundidos antes de 1994 aceptaron participar en el estudio. A partir de las muestras de suero se realizó la detección de anticuerpos totales contra el VHC (anti-VHC) mediante prueba de ELISA y en las muestras positivas se determinó la presencia del genoma viral por RT-PCR de la región no codificante 5’. Resultados y conclusiones: en el población de estudio se encontró una frecuencia de anticuerpos anti-VHC de 6,6% (11/166) y presencia del genoma del VHC en 7/11 de las muestras; el genotipo 1 se identificó en 4 de las muestras. No se encontró asociación de otros factores de riesgo diferentes a transfusión en los individuos con marcadores de infección por el VHC. Este estudio aporta datos a la epidemiología de la infección por el VHC en Colombia.

Introduction: Infection with the hepatitis C virus is a public health problem. According to the World Health Organization there are an estimated 184 million cases of HCV infection around the world. The main risk factor in developing countries is transfusion of blood components. In 1993, Colombian regulations began requiring serological screening by blood banks for infectious agents including HCV. Nevertheless, data about HCV infections in the population transfused before this date is limited. Objective: The objective of this study is to describe the frequency of HCV infection in the population of individuals transfused before 1994 in Antioquia. Materials and Methods: A total of 166 individuals transfused before 1994 agreed to participate in the study. ELISA tests for antibodies to HCV were performed on these patients’ serum samples. Samples that were positive were tested for the presence of the viral genome by RT-PCR of non-coding region 5. Results and Conclusions: The frequency of anti-HCV antibodies in study population was 6.6% (11/166) while the HCV genome was present in seven of these eleven individuals. Genotype 1 was identified in four of the samples. No associations of different risk factors for transfusion in individuals with markers of HCV infection were found. This study provides data on the epidemiology of HCV infection in Colombia.

Study of the GC-MS determination of the palmitic-stearic acid ratio for the characterisation of drying oil in painting: La Encarnación by Alonso Cano as a case study.

The correct identification of drying oils plays an essential role in providing an understanding of the conservation and deterioration of artistic materials in works of art. To this end, this work proposes the use of peak area ratios from fatty acids after ensuring that the linear responses of the detector are tested. A GC-MS method, previously reported in the literature, was revisited to its developed and validated in order to identify and quantify of eight fatty acids that are widely used as markers for drying oils in paintings, namely myristic acid (C(14:0)), palmitic acid (C(16:0)), stearic acid (C(18:0)), oleic acid (C(18:1)), linoleic acid (C(18:2)), suberic acid (2C(8)), azelaic acid, (2C(9)) and sebacic acid (2C(10)). The quaternary ammonium reagent m-(trifluoromethyl)phenyltrimethylammonium hydroxide (TMTFAH) was used for derivatization prior to GC-MS analysis of the oils. MS spectra were obtained for each methyl ester derivative of the fatty acids and the characteristic fragments were identified. The method was validated in terms of calibration functions, detection and quantification limits and reproducibility using the signal recorded in SIR mode, since two of the methyl derivatives were not totally separated in the chromatographic run. The proposed method was successfully applied to identify and characterise the most widely used drying oils (linseed oil, poppy seed oil and walnut oil) in the painting La Encarnación. This 17th century easel painting is located in the main chapel of the cathedral in Granada (Spain) and was painted by the well-known artist of the Spanish Golden Age, Alonso Cano (1601-1667).

Determination of tramadol, metamizole, ropivacaine, and bupivacaine in analgesic mixture samples by HPLC with DAD detection.

A high-performance liquid chromatography-diode array detection method was developed and validated to simultaneously determine tramadol (TMD), metamizole (MTZ), ropivacaine (RPV), and bupivacaine (BPV) in the presence of 4-methylaminoantypirine (4-MAA), the metabolite of MTZ, in analgesic mixtures samples used in Patient Controlled Analgesia (PCA). Chromatographic separation is achieved with a C-18 column using a mixture of ACN-methanol-water adjusted to pH 3.0 with NaH(2)PO(4) 0.05M (10:25:65 v/v) in an isocratic mobile phase at a flow rate of 0.8 mL/min. 0.5 mg/mL of Na(2)SO(3) in the water of the mobile phase was necessary to prevent the fast MTZ hydrolysis process to 4-MAA. Ultraviolet-diode array detection was used and chromatograms were registered at the wavelength of 230 nm. The method was linear in the range of 2.2-80.0 mg/L for TMD, 4.1-140.0 mg/L for MTZ, 2.3-40.0 mg/L for RPV, and 2.9-40.0 mg/L for BPV. Validation of the method was made in terms of accuracy, intra- and interday precision, as well as quantification and detection limits. The hydrolysis of MTZ to 4-MAA was studied and verified by mass spectrometry. The developed method was used successfully to evaluate the chemical stability of binary analgesic TMD mixtures with MTZ, RPV, or BPV. The mixtures were tested at standard concentrations used in PCA and in different storage conditions. When mixtures contained MTZ, a chromatographic peak from the metabolite 4-MAA was always detected in the chromatograms.

Preliminary study of UV ageing process of proteinaceous paint binder by FT-IR and principal component analysis.

This work presents a preliminary study on the ageing process of proteinaceous binder materials used in painting under UV light. With this aim, two sets of model samples were prepared: samples prepared using a single protein material and complex samples prepared in a similar way to the sequence of layers in a real painting from lowest to highest complexity (protein, drying oils, pigment and varnish). The study focuses on acquiring information about the possible degradation process of proteinaceous binders due to ageing and how this process be affected by the presence of characteristic non-proteinaceous painting materials, such as lipids from linseed oil, terpenic compounds from varnish and inorganic pigments. Samples simulated the accelerated ageing process, as did the UV light exposition. The FT-IR spectra were recorded after 100, 500, 1000 and 1500 h of exposition. The study of the accelerated ageing process was performed by means of principal component analysis (PCA) using the FT-IR spectra obtained. Loadings from the significant principal components were analysed to find the FT-IR frequency (cm(-1)) involved in the degradation process. The study showed the lack of any relevant modification on the proteins in the single model samples. On the contrary, the complex model samples showed the ageing process. The accelerated ageing process can be explained by a principal component from PCA. The most affected IR region was 2900-3600 cm(-1), where the amide band was included.

La visión integradora biopsicosocial como estrategia ante el paciente con enfermedad renal crónica (ERC). Requisito contemporáneo / the biospsychological integrating view as a strategy for the patient with chronic renal failure (CRF). A contemporary requisite

No disponible

No disponible

Improvement in LC-MS calibration by addition of fragment signals.

Liquid chromatography-mass spectrometry has become a powerful analytical tool, with high selectivity and sensitivity. Usually in this technique, the calibration function is estimated from the molecular peak signal. This report describes the improvement in sensitivity when the signals from several fragments in addition to the molecular peak are used to establish the calibration function. The influence of the dwell time has also been analysed as an important instrumental parameter that influences the signal range, and consequently, the sensitivity. The calibration function obtained by adding fragment signals was used to estimate the instrumental detection limit using three different procedures, comparing and discussing the results obtained.

Determination of five nitroimidazoles in water by liquid chromatography-mass spectrometry.

A rapid liquid chromatography-mass spectrometric method for the determination of five nitroimidazoles in water from different sources is described. The extraction procedure was based on HLB solid-phase extraction with acetonitrile followed by an evaporation step. Ternidazol, another nitroimidazole, was used as the internal standard. The liquid chromatographic separation was made on a C18 bonded silica column applying a gradient with an ammonium acetate buffer solution and acetonitrile. Following electrospray ionisation, the protonated molecular ions [M+H]+ were obtained. Quantification for each nitroimidazole was carried out by monitoring its molecular ion. Calibration functions, quantification and detection limits, intra- and inter-day reproducibility and accuracy were estimated. For the confirmatory assay, several fragment ions from each nitroimidazole were obtained and monitored. The method was applied successfully to determine and identify nitroimidazoles in water from different sources at a level of 0.2 microg l(-1).

High-performance liquid chromatography determination of Zn-bacitracin in animal feed by post-column derivatization and fluorescence detection.

A sensitive and selective method is presented for the determination of Zn-Bacitracin in adulterated animal feed by reversed-phase ion-pair high-performance liquid chromatography and post-column derivatization with o-phthalaldehyde prior to fluorescence detection. The calibration function was estimated to be between 8.0 and 65.0 mg l(-1) of Zn-BC. The detection and quantification limits of the chromatographic method were 2.5 and 7.5 mg 1(-1), respectively. Using the extraction procedure of Zn-Bacitracin from the feedstuff that we recently proposed and applying this new chromatographic method, it was possible to detect this antibiotic at levels below 5 mg kg(-1) in different kinds of feedstuffs with a standard deviation less than 6.0%.

Extraocular muscle ultrastructural pathology in the paraneoplastic phenomenon associated with retinoblastoma.

Extraocular muscle biopsies were obtained during enucleation because of advanced intraocular retinoblastoma in four patients admitted to the Service of Ophthalmology at the Caracas University Hospital. Slight limitations of ocular movements and strabismus were present in all cases. The electron microscopical analysis showed muscle fibres with slight to severe atrophy exhibiting myopathic structures as nemaline, filamentous and zebra bodies. Fibre necrosis was also observed characterized by sarcomeric hypercontraction, autophagia, sarcolemmal disruption, and mitochondrial swelling. Capillary alterations included endothelial proliferation with intraluminal infoldings and, in some cases, capillary degeneration and necrosis. A mononuclear cell infiltration formed by macrophages and scarce mast cells located next to atrophic fibres and altered capillaries was observed. Additionally, neutrophils were found around capillaries and in their wall. Cancer cells invading muscle tissue were not seen. Two different ethiopathogenic mechanisms for muscle damages seem to be present. Because of the similarity between the microvascular changes we observed and those found in the muscle compromise of several autoimmune diseases, an autoimmune component in the ethiopathogenesis of the observed capillary alterations is proposed. On the other hand, abnormalities observed in muscle fibres are very similar to those in neurogenic atrophy. This study represents the first report on an extraocular muscle paraneoplastic phenomenon associated with orbital tumours.

Ecosonografía hepática normal y patológica / Normal and pathological hepatic ecography

La ecosonografía ha ampliado el campo de estudio de las técnicas exploratorias hepáticas, siendo un método inocuo no invasivo y de gran fiabilidad, situándose como primer método o técnica de estudio rutinario hepático. Aunado a esto, nos permite realizar y guiar métodos intervencionistas como la obtención de biopsias, canalizar vías biliares dilatadas o ramas portales. Por estas razones y por la facilidad con la cual se puede entonces realizar evaluaciones hepáticas rápidas y de gran especificidad y sensibilidad, este trabajo presenta una revisión detallada de la representación imagenológica ecográfica de las patologías hepáticas, proporcionando al profesional de la salud bases generales para realizar diagnósticos a través de este método

Rapid ultraviolet spectrophotometric and liquid chromatographic methods for the determination of natamycin in lactoserum matrix.

Two rapid and simple methods were developed for the determination of natamycin in lactoserum matrix by ultraviolet (UV) spectrophotometry and liquid chromatography (LC) with diode-array detection. The methods involve protein precipitation with methanol, followed by centrifugation. No cleanup is necessary. The applicable concentrations of natamycin in lactoserum range from 2 to 500 mg/L for samples analyzed by both methods. The detection and quantitation limits are 0.07 and 0.23 mg/L, respectively, for the UV spectrophotometric method and 0.1 and 0.32 mg/L, respectively, for the LC method. The methods were applied satisfactorily to the determination of natamycin in various commercial lactosera. Both methods were validated independently by standard additions and Youden methodologies, which verified their accuracy. Once the 2 proposed methods were validated independently, the validation of one method was carried out with the other.

Resolution of mixtures of three nonsteroidal anti-inflammatory drugs by fluorescence using partial least squares multivariate calibration with previous wavelength selection by Kohonen artificial neural networks.

A spectrofluorometric method for the quantitative determination of flufenamic, mefenamic and meclofenamic acids in mixtures has been developed by recording emission fluorescence spectra between 370 and 550 nm with an excitation wavelength of 352 nm. The excitation-emission spectra of these compounds are deeply overlapped which does not allow their direct determination without previous separation. The proposed method applies partial least squares (PLS) multivariate calibration to the resolution of this mixture using a set of wavelengths previously selected by Kohonen artificial neural networks (K-ANN). The linear calibration graphs used to construct the calibration matrix were selected in the ranges from 0.25 to 1.00 mug ml(-1) for flufenamic and meclofenamic acids, and from 1.00 to 4.00 mug ml(-1) for mefenamic acid. A cross-validation procedure was used to select the number of factors. The selected calibration model has been applied to the determination of these compounds in synthetic mixtures and pharmaceutical formulations.

Determination of bisphenol A in water by micro liquid-liquid extraction followed by silylation and gas chromatography-mass spectrometry analysis.

A method for the determination of bisphenol A according to the European Union guideline, which establishes a limit of 0.1 ng/mL for organic pollutants in water, is proposed. The method involves a micro liquid-liquid extraction using dichloromethane followed by a silylation step. Identification and quantitation are performed with gas chromatography-mass spectrometry, using an HP-5MS column. The retention time is 7.02 min. Quantitation is carried out using single-ion monitoring (SIM) at m/z 73, 357, and 372. A clean-up is not necessary using SIM mode. Deuterated anthracene (2H10-anthracene) is used as an internal standard. The method is applied to the determination of bisphenol A at very low concentration levels (10.0-250.0 ng/L) in different types of natural water samples. The detection limit obtained is 0.4 ng/L. Recovery efficiencies are close to 100% in all cases.

[Pancreatic pseudocyst. A review of 10 years]. / Pseudoquiste pancreático. 10 años de revisión.

In the hope of finding those patients whose pancreas pseudocyst resolution were spontaneous, we undertook a retrospective review of such cases admitted at the Hospital Central de San Cristobal y Hospital Patrocinio Peñuela Ruiz (from IVSS), with the diagnosis of acute pancreatitis. From 619 patients with pancreatitis, 40 developed a pseudocyst (5.78%). The most frequent ethiology was biliary disease (47.5%) and abdominal pain in 87.5%, the most common symptom. Abdominal ultrasonography was the best diagnostic aid. Spontaneous resolution occur in 24 cases (60%) in juntion with the normalization of seric and urinary amylases values, the size of the cyst in these patients was less than 5 cms. Sixteen patients needed surgery, in 8 of them the seric amylase value remained high and in 3 cases this value was normal but with a cyst size more than five cms. Internal drainage in 11, external in 4 and surgical resection in one. There was no deaths in this review.