Beyond conventional physical examination in hepatology: POCUS.

Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient's bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures. POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists.

A satellite DNA evolutionary analysis in the North American endemic dioecious plant Rumex hastatulus (Polygonaceae).

We studied the evolution of RAE180 satellite DNA family in the North American endemic dioecious plant Rumex hastatulus. In this species, the Texas race is characterized by a single XX/XY sex chromosome system, whereas the North Carolina race has evolved a derived complex XX/XY(1)Y(2) sex chromosome system. RAE180 repeats were autosomic and poorly represented (2 × 10(-4)% of the genome) with no differences between individuals of different genders or different races of R. hastatulus. In fact, the sex chromosomes of the North Carolina race are still euchromatic, and they have not accumulated satellite DNA sequences, which contrasts with that occurring in the rest of dioecious XX/XY(1)Y(2) Rumex species. In R. hastatulus, we detected the existence of three RAE180 subfamilies. Notwithstanding, while in the Texas race the TX1/NC1 subfamily is the most frequent, the TX2/NC2 subfamily is the most abundant in the North Carolina race. Additionally, the third, less represented subfamily (TX3/NC3) appears currently as relict sequences in both genomes. A common feature of RAE180 satellite is the sudden replacement of one sequence variant by another in different species (or populations as in R. hastatulus races). Thus, the phylogenetic analysis of RAE180 repeats from six dioecious Rumex species supports the "library" hypothesis. According to this hypothesis, we assume that a set of divergent RAE180 variants were present in the ancestral genome of dioecious Rumex species, from which novel tandem arrays originated by the amplification of different variants in different lineages. Differential levels of RAE180 satellite DNA amplification in each lineage, at different evolutionary times, and in different chromosomal positions gave rise to differential patterns of sequence evolution.

Hepatitis B reactivation and current clinical impact.

Hepatitis B virus (HBV) reactivation results from increased viral replication in inactive carriers or patients with prior infection with HBV. Reactivation may occur spontaneously or secondary to immunomodulating or immunosuppressive chemotherapy. Reactivation may manifest with no symptoms but on occasion results in acute or even severe acute hepatitis. Prevention is the best management approach, hence HBV screening using serology should be performed for all patients undergoing any immunomodulating, immunosuppressive or chemotherapeutic treatment. Antiviral prophylaxis has proven effective in inactive carriers and in some patients with former infection with HBV undergoing selected immunosuppressive therapies.

Reactivación de la hepatitis B y su impacto clínico actual / No disponible

La reactivación del virus de la hepatitis B se debe a un aumento de la replicación del virus en pacientes portadores inactivos o con infecciones pasadas de VHB. La reactivación puede producirse espontáneamente o de manera secundaria a tratamientos de quimioterapia, inmunomoduladores o inmunosupresores. La reactivación puede manifestarse de manera asintomática pero en algunos casos puede causar hepatitis agudas e incluso hepatitis agudas graves. El mejor tratamiento es la prevención por lo que se debe realizar un cribado del VHB mediante una serología a todos los pacientes que vayan a someterse a cualquier tratamiento inmunomodulador, de quimioterapia o inmunosupresor. El tratamiento profiláctico antiviral ha demostrado ser eficaz en los pacientes portadores inactivos y en algunos pacientes con infecciones pasadas de VHB sometidos a ciertos tratamientos inmunosupresores(AU)

Nuevos tratamientos para la infección por virus de la hepatitis C / New treatments for hepatitis C virus infection

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Hemorragia digestiva alta: etiología y procedimientos diagnósticos / High digestive tract hemorrhage: etiology and diagnostic approaches

Las causas más frecuentes de hemorragia digestiva alta (HDA) son la úlcera péptica y la hipertensión portal de la que no se trata en esta revisión. La úlcera péptica constituye el 37-50% de las causas, siendo más frecuente la duodenal que la gástrica. Los factores principales que influyen en su aparición son la infección por Helicobacter pylori y la administración de antiinflamatorios no esteroideos. Las lesiones agudas de la mucosa gástrica constituyen el 20% de las causas de HDA y se asocian a la toma de AINE, alcohol, o estado crítico del enfermo con ventilación mecánica, coagulopatía, lesiones neurológicas graves, politraumatizados, etc. La esofagitis, síndrome de Mallory-Weiss, lesiones vasculares, neoplasias esofagogástricas, fístula aortoentérica y hemobilia son causas menos frecuentes. Los procedimientos diagnósticos disponibles son la anamnesis y exploración física, hemograma, bioquímica, estudio de coagulación, colocación de sonda nasogástrica y lavados, panendoscopia oral, radiología baritada, angiografía, gammagrafía con sulfuro coloidal o hematíes marcados y la laparotomía exploradora. Se discute cada uno de ellos, resaltando la importancia de la panendoscopia oral (AU)

Peptic ulcer disease and portal hypertension are the most frequent etiology of high digestive tract hemorrhage (HDTH). Peptic ulcer disease accounts for 37-50% of all HDTH, being duodenal ulcer disease more frequent compared to gastric ulcer disease. Main determinants for the presence of HDTD are infection for Helicobacter pylori and use of non-steroidal antiinflammatory drugs (NSAID). Acute injuries of gastric mucose account for 20% HDTH and they are associated to NSAID or alcohol ingestion, critical state of the patient in mechanical ventilation, patients with coagulopathies or severe neurological and politraumatism injuries, etc. Less frequent causes of HDTD are esofagitis, Mallory-Weiss syndrome, vascular injuries, gastroesophagic cancer, aortoenteric fistula and hemobilia. The diagnostic procedures available currently are anamnesis and physical exploration, hemogram, blood biochemistry, study of coagulation, nasogastric probe and washes, oral panendoscopy, barium radiology, angiography, labelled eritrocyte or colloidal sulphur scintigraphy and exploratory laparotomy. Every approach is discussed, stressing the significance of oral panendoscopia (AU)

Alteraciones pulmonares en los pacientes cirróticos: actualizaciones de un problema conocido / Hepatopulmonary syndrome and old problems revisited

No disponible

Utilidad del pantoprazol intravenoso en Urgencias / Efficacy of intravenous pantoprazol at the Emergency Department

Los inhibidores de la bomba de protones son los fármacos disponibles más eficaces en el control e inhibición de la secreción gástrica. En España sólo existen dos para administración intravenosa: omeprazol y pantoprazol. El segundo tiene ventajas sobre el primero por la ausencia de interacciones farmacológicas, lo que le convierte en el ideal para enfermos polimedicados y con afecciones asociadas, como ocurre frecuentemente en Urgencias. La administración intravenosa consigue una inhibición más rápida y potente de la secreción ácida, o que puede ser importante en el tratamiento de la enfermedad por reflujo gastroesofágico y sus complicaciones, enfermedad ulcerosa péptica, hemorragia digestiva alta, obstrucción gástrica, síndromes de hipersecreción, profilaxis y tratamiento de la lesión por AINEs y en profilaxis de la úlcera de estrés y de la neumonía aspirativa (AU)

A phylogenetic analysis of Doronicum (Asteraceae, Senecioneae) based on morphological, nuclear ribosomal (ITS), and chloroplast (trnL-F) evidence.

A phylogenetic analysis of the Old World genus Doronicum (26 species, 4 subspecies) based on sequence data of the internal transcribed spacer (ITS) region of the nuclear ribosomal DNA, the chloroplast spacer trnL-F, and morphology is presented. Congruence among the three data sets was explored by the computing of several indices, all of which suggest homogeneity between only the two molecular matrices. We argue that the morphological data set contains poor phylogenetic signal and advocate simultaneous analysis of the three data sets (total evidence approach) so that morphological characters are tested for homology by congruence with molecular data. The resulting phylogenetic hypothesis allows several well-supported conclusions including the placement of a Corsican endemic (D. corsicum), sister to the remainder of the genus, and the inference that an early southern European or Mediterranean diversification took place in the genus. Shifts in morphological characters (e.g., homocarpy to heterocarpy) are confirmed to have evolved several times. Results from comparative studies of sequence data of the chloroplast gene ndhF support inclusion of Doronicum in tribe Senecioneae.

Chromosome studies: Mexican Compositae.

Chromosome observations reported here from 70 collections representing 65 species from 40 genera of Compositae (mostly Heliantheae) provide taxonomically useful information. First counts for 28 species, including the first count for Psacaliopsis, may prove to be especially interesting in relation to phyletic and taxonomic alignments of the taxa. Of special interest among first reports is 2n = 5 II for Stevia lita; other stevias have x = 11, 12, or 17. Thirteen of our counts differ from prior reports and may also be of particular interest in phyletic and taxonomic contexts.

Phylogenetic analysis of Silphium and subtribe Engelmanniinae (Asteraceae: Heliantheae) based on ITS and ETS sequence data.

The phylogenetic relationships of Silphium and subtribe Engelmanniinae were examined using DNA sequence data. The internal transcribed spacer (ITS) region and the external transcribed spacer (ETS) region were sequenced for 39 specimens representing the six genera of subtribe Engelmanniinae (Berlandiera, Chrysogonum, Dugesia, Engelmannia, Lindheimera, and Silphium), plus five additional genera identified as closely related to the Engelmanniinae by chloroplast DNA restriction site analysis, and three outgroups. Phylogenetic analysis supported the monophyly of Silphium with Lindheimera as sister. Silphium can be divided into two sections based upon two well-supported clades that correspond to root type and growth form. These results also supported the expansion of subtribe Engelmanniinae to include Balsamorhiza, Borrichia, Rojasianthe, Vigethia, and Wyethia. We hypothesize that subtribe Engelmanniinae originated in Mesoamerica and later radiated to the United States. We suggest that the cypsela complex, which is present in Berlandiera, Chrysogonum, Engelmannia, and Lindheimera, arose only once and was subsequently lost in Silphium.

Molecular evidence for multiple origins of woodiness and a new world biogeographic connection of the Macaronesian island endemic Pericallis (Asteraceae: senecioneae).

The prevalence of woody species in oceanic islands has attracted the attention of evolutionary biologists for more than a century. We used a phylogeny based on sequences of the internal-transcribed spacer region of nuclear ribosomal DNA to trace the evolution of woodiness in Pericallis (Asteraceae: Senecioneae), a genus endemic to the Macaronesian archipelagos of the Azores, Madeira, and Canaries. Our results show that woodiness in Pericallis originated independently at least twice in these islands, further weakening some previous hypotheses concerning the value of this character for tracing the continental ancestry of island endemics. The same data suggest that the origin of woodiness is correlated with ecological shifts from open to species-rich habitats and that the ancestor of Pericallis was an herbaceous species adapted to marginal habitats of the laurel forest. Our results also support Pericallis as closely related to New World genera of the tribe Senecioneae.

Phylogenetic relationships of subtribe Ecliptinae (Asteraceae: Heliantheae) based on chloroplast DNA restriction site data.

Phylogenetic analysis of chloroplast DNA restriction site data for 76 of the 302 genera of Heliantheae sensu lato using 16 restriction endonucleases reveals that subtribe Ecliptinae is polyphyletic and that its genera are distributed in four different lineages. The ecliptinous genera Squamopappus, Podachaenium, Verbesina, and Tetrachyron (of the Neurolaeninae), along with other members of subtribe Neurolaeninae are the basalmost clades of the paleaceous Heliantheae. The mostly temperate species of subtribe Ecliptinae (exemplified by Balsamorhiza, Borrichia, Chrysogonum, Engelmannia, Silphium, Vigethia, and Wyethia) are strongly nested in a clade with the Mesoamerican monotypic genus Rojasianthe as basal. The genera characterized by marcescent ray corollas traditionally classified in subtribe Zinniinae constitute a strongly supported group sister to Acmella, Spilanthes, and Salmea. The largest clade of ecliptinous genera is the most recently derived group within Heliantheae sampled. This large group of mostly Neotropical lowland genera (variously characterized by their winged cypselae, foliaceous phyllaries, and opposite phyllotaxy and exemplified by Perymenium, Wedelia, and Zexmenia) has been and continues to be the most challenging group from a taxonomic standpoint. The study provides new insights as to their relationships that will have a positive impact in future monographic studies of the group. The genera of the Espeletiinae form a monophyletic clade and are sister to members of the Milleriinae and Melampodiinae. This result is consistent with their traditional taxonomic placement with genera such as Smallanthus with which they share a tendency for functionally staminate disc flowers. The phylogenetically enigmatic genus Montanoa is sister to Melampodium. Members of subtribe Galinsoginae are clustered in two main lineages that correspond to the traditional division of the subtribe based on pappus characteristics. There is no support for the monophyly of subtribe Galinsoginae, and the same results indicate some of its genera are paraphyletic.