Drug-induced liver injury: Relation between the R ratio and histopathology.

INTRODUCTION AND AIM: Drug-induced liver injury (DILI) is a diagnosis based on the ruling out of potential liver diseases and consolidated by establishing causality through the temporal relation between a potentially hepatotoxic substance and altered liver biochemistry. Incidence fluctuates greatly worldwide, with very few reports of causal agents of DILI in Colombia. A retrospective study on patients treated at the Centro de Estudios en Salud (CES), within the time frame of January 2015 and June 2020, was conducted to document the causal substances of DILI in patients with liver biopsy and to correlate the types of histologic patterns with the biochemical pattern of liver injury (R ratio). RESULTS: Of the 254 adult patients with liver biopsy and no tumor etiology, 20 patients were identified as cases of DILI (7.87%). The two most frequently found causal substances were efavirenz, in three HIV-positive patients, and Moringa oleifera (moringa), in two patients. There was a statistically significant association between cholestatic patterns (p = 0.037) and mixed patterns (p = 0.031), in the comparison of the histopathologic categories and the R ratio. CONCLUSION: To the best of our knowledge, there are no reports on DILI secondary to Moringa oleifera (moringa). The R ratio could be a useful tool, in relation to the histologic pattern of injury, in cases of mixed and cholestatic patterns.

Arbovirus studies in the Guajira region of Venezuela: activities of eastern equine encephalitis and Venezuelan equine encephalitis viruses during an interepizootic period.

Repeated outbreaks of Venezuelan equine encephalitis (VEE) in humans and equines in the Guajira region of Venezuela suggested a sylvatic focus of an epizootic subtype of VEE virus. A surveillance system was established, and virus isolations were attempted from 67,760 mosquitoes as well as sentinel hamsters. Sixteen isolates of eastern equine encephalitis (EEE) and a strain of Itaqui virus were recovered from mosquitoes, and 60 isolates of EEE, two of VEE, and two of Itaqui viruses were recovered from tissues of sentinel hamsters. The VEE virus isolates were shown to be closely related antigenically to prototype VEE ID and the EEE virus isolates were shown to be more closely related to the South American than the North American variety of EEE virus. Evidence for the presence of VEE and EEE viruses in small wild vertebrates was obtained from serologic testing. This study showed, for the first time, the enzootic presence of both VEE ID and EEE viruses during a nonepizoodemic period in the Guajira region.

Arbovirus studies in southwestern Venezuela during 1973-1981. II. Isolations and further studies of Venezuelan and eastern equine encephalitis, Una, Itaqui, and Moju viruses.

Increasing utilization of arable land in southwestern Venezuela has led to a potential increase in human exposure to arbovirus infections. Since previous studies in the Catatumbo region of this area documented the presence of eastern equine encephalitis (EEE) and Venezuelan equine encephalitis (VEE) viruses, an attempt was made to study the transmission and maintenance of these viruses from 1973 to 1981. Isolations of EEE, VEE ID strains, Una, Itaqui , and Moju viruses were repeatedly obtained from mosquitoes, mostly Culex ( Melanoconion ) spp. and sentinel hamsters. The results indicate that these viruses constitute a potential hazard to public health in the area. Further, the strategic location of the Catatumbo region, between enzootic tropical foci of arboviruses, may provide circumstances and conditions for study of both enzootic maintenance and movement of these viruses.

Studies of arboviruses in Southwestern Venezuela: I. Isolations of Venezuelan and Eastern Equine Encephalitis viruses from sentinel hamsters in the Catatumbo region.

The purpose of this report is to describe isolations of Venezuelan (VEE) and Eastern (EEE) Equine Encephalitis virus made in the lowland moist tropical forest of the Catatumbo region on the southwestern part of the State of Zulia, Venezuela. We have isolated four strains of EEEV from sentinel hamsters exposed at Caño Mocho and Madre Vieja sites in 1973 and 1974, and three strains of EEEV in Hacienda (Hda.) Las Nubes in 1975. Both viruses were recovered during silent interepidemic periods and we believe these viruses are maintained in this region in sylvatic conditions. The recovered virus strains were detected within 24 to 48 hours, both in SMB and Vero Cell monolayer cultures and the sentinel hamsters yielded virus infectivities up to 10(4) PFU ml. Our VEEV isolate (IVIC PAn 23645-47), recovered during the silent interepizodemic period had an elution profile on the hydroxylapatite column corresponding to that of a I-D (VEEV-3880) or a I-E (VEEV-63A216) 'enzootic' subtype. However, considering other in vitro criteria (KHI; HA pH 5.8-6.0; small plaque size in Vero monolayers with suitable overlay media), this later and other previous isolates had some very distinct properties of the 'epizootic' strains. Thus, the evidence suggests that in Venezuela the VEEV cycle in nature is maintained either by the so called 'enzootic' and/or 'epizootic' virus types, or the virus population of the isolates have particular in vitro properties which do not correlate to the virulence markers in vivo. We consider this important question must be further clarified, and in addition, the isolation of three strains of EEEV are reported; this is the first report of the presence of this virus in Venezuela. Although the EEEV isolates may be of the South American type, they must be considered as potentially dangerous in the case of outbreaks.