Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement.

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

The Mexican consensus on alcoholic hepatitis. / Consenso Mexicano de hepatitis alcohólica.

Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resulting in 37 recommendations. Alcohol-related liver disease covers a broad spectrum of pathologies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and its complications. Severe alcoholic hepatitis is defined by a modified Maddrey's discriminant function score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21. There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyperbilirubinemia (> 3 mg/dL), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide the diagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone of treatment. Steroids are indicated for severe disease and have been effective in reducing the 28-day mortality rate. At present, liver transplantation is the only life-saving option for patients that are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colony stimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patient survival.

Effect of culture conditions on production of butter flavor compounds by Pediococcus pentosaceus and Lactobacillus acidophilus in semisolid maize-based cultures.

Two series of 120 h mixed cultures of Pediococcus pentosaceus MITJ-10 and Lactobacillus acidophilus Hansen 1748 were grown in semisolid maize-based media, applying an orthogonal factorial design in order to establish the most adequate parameters to get compounds related to butter-like flavor. Conditions of maize pre-treatment established in the first series were hot lime-treatment for 20 min, grinding and sieving to 0.0165 in., partial defatting and cooking for 25 min. While the culture conditions established for the second series were the addition of yeast extract (0.2% w/w), and culture starting with 2x10(6) CFU g(-1) and a ratio of P. pentosaceus and L. acidophilus, 3:1. The fermentation profile was studied in a last culture. Lactic acid bacteria (LAB) prevailed over the native microorganisms, with a specific growth rate of 0.47 h(-1). Diacetyl production correlated (r2=0.9972) with the 12 h exponential growth phase of LAB. The concentration of diacetyl at that time was 779.56 mg kg(-1). The contents of lactic acid and volatile fatty acids were low at 12 h, 665 and 1312 mg kg(-1), respectively. During the long stationary phase, they increased up to 4800 and 1886 mg kg(-1), respectively. This procedure might be useful to prepare naturally aromatized raw materials for the food industry.