Frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes obesos / Frequency of fatty liver nonalcoholic diagnosed by abdominal ultrasound in patients obese

El hígado graso no alcohólico (HGNA) es una complicación asociada a la obesidad, debido a la acumulación excesiva de grasa en el hígado. Con el objetivo de determinar la frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes que asisten a la Unidad del Manejo Integral del Paciente Obeso del Hospital de Clínicas, FCM ­ UNA, se realizó un estudio observacional descriptivo retrospectivo que incluyó a 188 pacientes, de los cuales 146 fueron mujeres y 42 hombres, la edad media en los pacientes con diagnóstico de HGNA fue de 41,3±11,4 años con un rango de edad de 20 a 65 años. Los resultados señalan la frecuencia de HGNA con el 56,9% (n=107) por ecografía abdominal, siendo 39,9% (n=75) mujeres y 17% (n=32) hombres, mientras que 43,1% (n=81) presentó hígado de aspecto normal. El 43,9% (n=47) de los pacientes con HGNA exhibió obesidad grado III. Al comparar la circunferencia abdominal en los 107 pacientes con HGNA se obtuvo una media de 139,1±97,8 cm. Con respecto al grado de esteatosis el 43,1% (n=81) mostró grado 0, 31,9% (n=60) grado 1, 20,7% (n=39) grado 2 y 4,3% (n=8) grado 3. Se observaron en los datos de laboratorio elevación de las transaminasas GPT 35,5% (n=38), 25,2% (n=27) en la GOT y 24,3% (n=26) FA, se notó aumento en los valores de las bilirrubinas directa e indirecta, 65,4% (n=70) BD y 69,2% (n=74) BI, por otra parte el 47,7% (n=51) enseñó CT elevado, 49% (n=45,7) HDL disminuido, 36,4% (n=39) LDL elevado y 29% (n=31) con triglicéridos elevados. Se halló que el 69,1% (n=74) de los pacientes con HGNA tienen HTA. Al realizar la comparación de las variables mencionadas entre los pacientes con y sin HGNA, arrojó que las transaminasas GPT, GOT y triglicéridos estuvieron en niveles más altos en los pacientes con HGNA. Se evidenció que la obesidad es un factor determinante para el desarrollo de HGNA, la caracterización del perfil hepático y lipídico, asimismo la presión arterial constituyen puntos fundamentales para asociar el aumento de estos con la presencia de HGNA.

Nonalcoholic fatty liver disease (NAFLD) is a complication associated with obesity, due to excessive accumulation of fat in the liver. In order to determine the frequency of NAFLD diagnosed by abdominal ultrasound in patients attending the unit Comprehensive Patient Management Obese the Hospital of Clinics, FCM - UNA, a retrospective observational study involving performed in 188 patients, of which 146 were women and 42 men, average age in patients with NAFLD diagnosis was 41,3±11,4 years with an age range of 20 - 65 years. The results indicate the frequency of NAFLD with 56,9% (n=107) for abdominal ultrasound, being 39,9% (n=75) women and 17% (n=32) were men, while 43,1% (n=81) presented liver normal. 43.9% (n=47) of patients with NAFLD showed grade III obesity. By comparing the abdominal circumference in 107 patients with NAFLD an average of 139,1±97,8 cm was obtained. With respect to the degree of steatosis 43,1% (n=81) showed grade 0, 31,9% (n=60) grade 1, 20,7% (n=39) grade 2 and 4,3% (n=8) grade 3 were observed in laboratory data GPT transaminases elevation of 35,5% (n=38), 25.2% (n=27) in the GOT and 24,3% (n=26) FA, increased values of direct and indirect bilirubin, 65,4% (n = 70) BD and 69.2% (n=74) BI was noted, moreover 47,7% (n=51) CT taught high, 49% (n=45,7) decreased HDL, 36,4% (n=39) high LDL and 29% (n=31) with elevated triglycerides. It was found that 69,1% (n=74) of patients with NAFLD have hypertension. When comparing the variables mentioned among patients with and without NAFLD, he threw the GPT, GOT transaminases and triglycerides were at higher levels in patients with NAFLD. It was evident that obesity is a determining factor NAFLD development, characterization of liver and lipid profile, blood pressure also are key points to associate these increased with the presence of NAFLD.

Frecuencia de genes que codifican factores de virulencia en staphylococcus aureus aislados de niños que concurrieron al hospital general pediátrico niños de acosta ñú, durante el año 2010 / Frequency of gens that codify virulence factors in staphylococcus aureus isolated from children attending the niños de acosta ñú pediatric general hospital in 2010

Staphylococcus aureus es un microorganismo con habilidad de infectar diferentes tejidos celulares, por portar genes que le confieren resistencia a antibióticos, factores de virulencia y su plasticidad genética, que podrían contribuir a una progresión rápida y complicada de la enfermedad. El Paraguay no cuenta con datos epidemiológicos que indiquen los factores de virulencia que presentan las cepas de S. aureus, por lo que el objetivo del trabajo fue determinar un perfil de virulencia detectando los genes codificantes de: hemolisinas α y β,enterotoxinas A, B, C, D, H y toxinas exfoliativas A y B. Este estudio observacional descriptivo de corte transverso, con muestreo no probabilístico de casos consecutivos, incluyó 50 aislados de S. aureus obtenidos a partir de muestras clínicas de secreciones de piel, partes blandas o líquidos corporales de pacientes menores de 17 años que concurrieron al Hospital General Pediátrico Niños de Acosta Ñú durante el año 2.010. Las reacciones de PCR incluyeron la detección de los genes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed y seh. El 82% de los aislados provenía de niños que presentaron cuadros clínicos compatibles con infecciones de piel y partes blandas y el 18% de cuadros clínicos graves como sepsis, osteomielitis y neumonías. Los aislados contaban con datos de portación de Leucocidina de Panton-Valentine, el cual fue el factor de virulencia más frecuentemente detectado (58%), seguido de las hemolisinas alfa (16%) y beta (8%). Las enterotoxinas y las toxinas exfoliativas fueron menos frecuentes (0-2%), y no se detectaron genes codificantes de las enterotoxinas C y D.

Staphylococcus aureus is a pathogen that has the ability to successfully infect differenttissues, because it carries genes that confer antibiotic resistance, virulence factors and itshigh genetic plasticity, that could contribute to a quick and complicated diseaseprogression. Paraguay does not have epidemiological data indicating the virulence factorspresented in S. aureus strains. Therefore, the aim of this study was to determine thevirulence profile by molecular methods detecting the codifying genes of: α and β hemolysin, enterotoxins A, B, C, D, H and exfoliative toxins A and B. This descriptiveobservational study with non-probability sampling of consecutives cases, included 50 S.aureus isolates obtained from clinical specimens from skin secretions, soft tissue or bodyfluids of patients younger than 17 years who attended the Niños de Acosta Ñú PediatricGeneral Hospital in 2010. The PCR reactions included the detection of the followinggenes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed and seh. The 82% of the isolatescame from children skin and soft tissue infections and 18% came from invasive diseasessuch as sepsis, osteomyelitis and pneumonia. The Panton Valentine leukocidin, whichdata was previously obtained, was the most frequently virulence factor detected (58%),followed by alpha (16%) and beta (8%) hemolysins. Enterotoxins and exfoliative toxinswere less frequent (0-2%) and the enterotoxins C and D genes were not detected.

Altered frequency and phenotype of CD4+ forkhead box protein 3+ T cells and its association with autoantibody production in human immunodeficiency virus-infected paediatric patients.

The association between immune dysfunction and the development of autoimmune pathology in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is not clear. The frequency and phenotype of regulatory T cells, as well as the presence of autoantibodies, were evaluated in a paediatric cohort of HIV-infected patients without clinical evidence of autoimmune disease. Lower absolute counts but higher percentages of total CD4(+) forkhead box protein 3 (FoxP3)(+) T cells were recorded in children with severe immunosuppression than in those without evidence of immunosuppression. The frequencies of classical CD4(+) CD25(+) FoxP3(+) regulatory T cells were not altered, whereas CD4(+) FoxP3(+) CD25(-) T cells were found increased significantly in patients with severe immunosuppression. Like classical regulatory T cells, CD4(+) FoxP3(+) CD25(-) T cells display higher cytotoxic T-lymphocyte antigen 4 (CTLA-4) but lower CD127 expression compared with CD4(+) FoxP3(-) CD25(+) T cells. An improvement in CD4(+) T cell counts, along with a decrease in viral load, was associated with a decrease in CD4(+) FoxP3(+) CD25(-) T cells. The majority of the patients with severe immunosuppression were positive for at least one out of seven autoantibodies tested and displayed hypergammaglobulinaemia. Conversely, HIV-infected children without evidence of immunosuppression had lower levels of autoantibodies and total immunoglobulins. A decline in CD4(+) FoxP3(+) T cell numbers or a variation in their phenotype may induce a raise in antigen exposure with polyclonal B cell activation, probably contributing to the generation of autoantibodies in the absence of clinical autoimmune disease.

HLA class I diversity in Kolla Amerindians.

Human leukocyte antigen (HLA) class I polymorphism was studied within a population of 70 unrelated Kolla Amerindians from the far northwest of Argentina close to the Bolivian border. The results indicate that the HLA-A, -B, and -C alleles typical of other Amerindian populations also predominate in the Kolla. These alleles belong to the following allele groups: HLA-A*02, *68, *31, *24, HLA-B*35, *15, *51, *39, *40, *48, and Cw*01, *03, *04, *07, *08, and *15. For the HLA-A locus, heterogeneity was seen for HLA-A*02 with A*0201, *0211, and *0222; and for A*68 with *68012 and *6817, the latter being a novel allele identified in this population. Analysis of HLA-B identified heterogeneity for all Amerindian allele groups except HLA-B*48, including the identification of the novel B*5113 allele. For HLA-C heterogeneity was identified within the Cw*07, *04, and *08 groups with Cw*0701/06, *0702, *04011, *0404, *0803, and *0809 identified. The most frequent "probable" haplotype found in this population was B*3505-Cw*04011. This study supports previous studies, which demonstrate increased diversity at HLA-B compared with HLA-A and -C. The polymorphism identified within the Kolla HLA-A, -B, and -C alleles supports the hypothesis that HLA evolution is subject to positive selection for diversity within the peptide binding site.

Major histocompatibility complex class I diversity in a West African chimpanzee population: implications for HIV research.

Human immunodeficiency virus (HIV) poses a major threat to humankind. And though, like humans, chimpanzees are susceptible to HIV infection, they are considered to be resistant to the development of the acquired immune deficiency syndrome (AIDS). Little is known about major histocompatibility complex (MHC) class I diversity in chimpanzee populations and, moreover, whether qualitative aspects of Patr class I molecules may control resistance to AIDS. To address these questions, we assayed MHC class I diversity in a West African chimpanzee population and in some animals from other subspecies of chimpanzee. Application of different techniques allowed the detection of 17 full-length Patr-A, 19 Patr-B, and 10 Patr-C alleles. All Patr-A alleles cluster only into the HLA-A1/A3/A11 family, which supports the idea that chimpanzees have experienced a reduction in their repertoire of A locus alleles. The Patr-B alleles do not cluster in the same lineages as their human equivalents, due to frequent exchange of polymorphic sequence motifs. Furthermore, polymorphic motifs may have been exchanged between Patr-A and Patr-B loci, resulting in convergence. With regard to evolutionary stability, the Patr-C locus is more similar to the Patr-A locus than it is to the Patr-B locus. Despite the relatively low number of animals analyzed, humans and chimpanzees were ascertained as sharing similar degrees of diversity at the contact residues constituting the B and F pockets in the peptide-binding side of MHC class I molecules. Our results indicate that within a small sample of a West African chimpanzee population, a high degree of Patr class I diversity is encountered. This is in agreement with the fact that chimpanzees display more mitochondrial DNA variation than humans. In addition, population analyses demonstrated that particular Patr-B molecules, with the capacity to bind conserved HIV-1 epitopes, are characterized by high gene frequencies. These findings have important implications for evaluating immune responses in HIV vaccine studies and, more importantly, may help in understanding the relative resistance of chimpanzees to AIDS.

Characterization of the HLA class I genotypes of a Venezuelan Amerindian group by molecular methods.

We have characterized the HLA class I genotypes of the Yucpa, a tribe of Venezuelan Amerindians, using molecular methods. The study was carried out on DNA extracted from unrelated individuals using low resolution ARMS-SSP typing with sequence-specific primers, high resolution typing using reference strand conformation analysis (RSCA), and for some samples sequence-based typing (SBT). The following class I alleles were found to be present in this tribe: for the HLA-A locus A*0204, A*0212, A*0213, A*2402, A*3101 and A*6801; for the B locus B*1522, B*3512, B*3905, B*3909, B*4004 and B*52012, and for C locus Cw*0102, Cw*0302/ 4, Cw*0401, Cw*0702 and Cw*1503. This is the first time these alleles have been described in this group, although all of them have previously been reported as being present in other Amerindian tribes. The study confirmed the high frequency of HLA-B39 which was previously observed in serological analysis of this tribe, and indicated that two different B*39 alleles were present in this population. The identification of the class I alleles by molecular methods for this ethnic group confirms the restricted polymorphism of the MHC molecules previously obtained by serology and has allowed a more accurate definition of the different alleles present in this population.

Molecular histocompatibility typing in unrelated donor bone marrow transplantation.

Increasing numbers of bone-marrow transplants are being performed with marrow from unrelated donors. There is clear evidence that genetic disparity is a major cause of graft-versus-host disease. However, until very recently, typing methods did not have sufficient resolution to identify the majority of histocompatibility alleles. DNA-based typing methods have the potential to define alleles unequivocally, and this will help in the selection of better matched marrow donors. Also, a number of studies have indicated that patient and donor pairs that had previously been identified as matched can frequently be shown to have been mismatched at one or more locus. Consequently, it may become more difficult in future to find completely matched donors. There is also evidence that some genetic mismatching may not be deleterious to the patient and it may now be possible to analyse the histocompatibility data with greater confidence and identify those mismatches that are tolerated. This will allow a larger number of transplants to be performed using unrelated donors.

Factors influencing the outcome of bone marrow transplants using unrelated donors.

The use of unrelated donors for bone marrow transplantation (BMT) is associated with an increased morbidity and mortality when compared with HLA-identical donors, primarily due to an increased rate of graft-versus-host disease, but also to increased susceptibility to infections and graft failure. HLA matching for donors and recipients is the single most important factor influencing the outcome of BMT. However, unrelated donor selection generally relies on matching only for HLA-A, -B and -DR antigens without considering potential incompatibility for other HLA loci, such as HLA-C, -DQ and -DP. In addition, other factors that affect the outcome of BMT need to be taken into consideration in selecting the best unrelated donor. In this review, we will focus on the effects of HLA-associated factors in determining the result of a transplant procedure. We will also mention other relevant factors, drawing on our experience of laboratory studies performed at The Anthony Nolan Research Institute and clinical studies at the Hammersmith Hospital in London.

Complementary strand analysis: a new approach for allelic separation in complex polyallelic genetic systems.

We describe a method, complementary strand analysis (CSA), for separating alleles potentially from any heterozygous genetic locus. Locus specific PCR is performed generating two allelic products. The antisense strands are isolated and hybridised with a sense reference strand to form a chimeric DNA duplex for each allele which is then separated by non-denaturing PAGE. We demonstrate the application of CSA for separation of highly polymorphic HLA-A, -B and -Cw alleles and characterisation of HLA identity in related bone marrow donors and patients. CSA is capable of resolving one nucleotide differences in a DNA fragment nearly as large as a kilobase in length.

A novel method for simultaneous high resolution identification of HLA-A, HLA-B, and HLA-Cw alleles.

We describe a novel high resolution DNA based typing approach for HLA class I alleles, which identifies the recombinational motifs present in exons 2 and 3 of the HLA class I genes. Unique identification patterns for 201 known HLA-A, HLA-B, and HLA-Cw alleles were generated by the use of only 40 probes, which were targeted at these common motifs. The unambiguous identification of the alleles was achieved by the development of a new and powerful allelic separation technique that allows isolation of single alleles after amplification. To validate the method, we have used locus-specific primers to amplify exons 2 and 3 of HLA-A, HLA-B, and HLA-Cw loci from 22 heterozygous and 41 homozygous cell lines. After amplification, the allelic fragments from each locus were separated, blotted, and hybridized with the 40 probes. In all cases, the allelic products could be separated and 81 different class I alleles, 33 HLA-A, 30 HLA-B, and 18 HLA-Cw, were identified according to the predicted probe hybridization patterns.

Effect of finasteride on human testicular steroidogenesis.

We studied the testicular function and some androgen-mediated events in 22 males (16-30 years of age) with male pattern baldness that was treated with finasteride (10 mg once daily) for 2 years. Patients were evaluated every 3 months. Prostatic volume was determined in six subjects by endorectal ultrasound scans. Serum gonadotropin, prostate-specific antigen (PSA), and sex hormone levels were determined basally and periodically during the treatment period. Fourteen subjects underwent gonadal stimulation with human chorionic gonadotropin (hCG), and the gonadotropin response to gonadotropin releasing hormone (GnRH) was determined in eight subjects, prior to and after 2 years of therapy. Finasteride treatment resulted in an improvement in the male pattern baldness and prostatic shrinkage that was associated with an increase in serum testosterone levels (17.2 +/- 2.5 vs. 26.3 +/- 1.7 nmol/L) and a decrease in dihydrotestosterone (DHT) levels (1.45 +/- 0.41 vs. 0.38 +/- 0.10 nmol/L), causing a marked increase in that testosterone/DHT ratio. A significant increase in the serum levels of androstenedione (3.67 +/- 0.49 vs. 7.05 +/- 0.70 nmol/L) and estradiol (132 +/- 44 vs. 187 +/- 26 pmol/L) was also noted, whereas androstanediol glucoronide (33.3 +/- 6.4 vs. 10.7 +/- 4.5 pmol) and PSA (1.6 +/- 0.6 vs. 0.4 +/- 0.1 ng/ml) were significantly decreased. No changes in basal or stimulated levels of gonadotropin were observed. There was a significant increase in the testosterone response to hCG during finasteride therapy (delta: 16.7 vs. 35.5 nmol/L) that could be explained, at least in part, by the reduction of testosterone metabolism resulting from the blockage induced by finasteride. The decrease in the androstenedione to testosterone and estrone to estradiol ratios observed after hCG treatment, however, strongly suggests increased activity of the 17-ketosteroid reductase enzyme and an improvement of the testicular capacity for testosterone production.

Seizures in Alzheimer's disease: clinicopathologic study.

New-onset epileptic seizures occur in patients with Alzheimer's disease (AD), but the nature and underlying reasons for these seizures are unclear. We identified new-onset, nonsymptomatic seizures in 77 (17%) of 446 patients with uncomplicated, definite AD on autopsy. Among these seizure patients, 69 had generalized tonic-clonic seizures, and 55 had less than three total seizures. The seizure patients had a younger age of dementia onset than did the remaining AD patients; however, at seizure onset, they averaged 6.8 years into their AD and had advanced dementia. When further compared to 77 AD controls, matched for age of onset and duration, the seizure patients did not differ on medical illnesses, amount of medications, and degree of focal neuropathology. We conclude that a few unprovoked generalized seizures frequently occur late in the course of AD, and that AD patients with a younger age of dementia onset are particularly susceptible to seizures.

Relationship of seizure variables to personality disorders in epilepsy.

Among epileptic patients, personality disorders may be associated with specific seizure manifestations. In an epilepsy clinic, we identified 42 idiopathic epilepsy patients diagnosed with various DSM-III-R personality disorders, including borderline, atypical or mixed, explosive, and dependent. When compared with 42 age- and sex-matched epileptic control subjects on six seizure variables, the personality disorder group had more patients with epileptic auras (P = 0.001), particularly "cephalic" auras, and fewer with secondarily generalized tonic-clonic seizures (P < 0.05). These findings suggest that the experience of epileptic auras contributes to the development of personality disorders, especially when auras are not masked by secondarily generalized seizures.

Dynamics of elimination of the eggs of Fasciola hepatica (Trematoda, Digenea) in the faeces of cattle in the Porma Basin, Spain.

In order to contribute to the knowledge of the epizootiological conditions in which fasciolosis develops in the León mountains, the elimination of Fasciola hepatica eggs in 10% of the total number of cattle (1301 samples) at five locations in the Porma river basin was recorded at monthly intervals between March 1986 and March 1987. The parasite was found in cattle [29.5% prevalence, average of 51.6 +/- 4.5 eggs g-1 (e.p.g.) faeces] throughout the year. The main egg elimination period was winter-spring, with maximum prevalence in January and maximum e.p.g. in February-March. Prevalence of infection in cattle generally increased with the host's age, whilst the average e.p.g. varied between different age groups.

Teaching veterinary parasitology throughout the world.

In order to understand how the teaching of parasitology in veterinary schools and faculties in the world is carried out, a questionnaire was sent to all centres listed in the W.H.O. World Directory. A total of 91 replies were received. Additional information was obtained from the report of a symposium held in Hannover, Germany in 1978 and from the Education Committee of the American Association of Veterinary Parasitologists in 1981. The academic level, the place of parasitology in the veterinary curriculum, textbooks and practical instruction, evaluation techniques, teaching staff, institute organization and publications are discussed.

Pathogenesis of capsular opacification after extracapsular cataract extraction. An animal model.

Opacification of the posterior capsule is the most common post-operative complication of extracapsular cataract surgery. We studied the sequential changes in the posterior capsule of the aphakic cat and monkey after extracapsular surgery using light microscopy, scanning electron microscopy, and transmission electron microscopy. In the cat, but not the monkey, there was proliferation of a pigment-containing membrane arising from the iris root and ciliary body, and extending onto the residual lens capsule. In both animals there was transformation of residual lens epithelial cells to fibroblasts which contain contractile elements (myofibroblasts) and are associated with collagen deposition. In the cat, pigment epithelial cells from the iris or ciliary body, as well as the transformed lens epithelial cells, contributed to late opacification of the posterior capsule.