Autoimmune hepatitis and systemic sclerosis A rare overlap

Autoimmune hepatitis concomitant with other immune-mediated diseases is an increasingly recognized condition which is difficult to diagnose. We present the case of a 42-year-old woman with no significant medical history who consulted due to progressive growth of an abdominal mass in the right hypochondriac region and associated constitutional syndrome. The physical exam showed hepatomegaly, calcinosis and salt-and-pepper depigmentation of the skin, and Raynaud's phenomenon in the hands. Paraclinical tests reported elevated transaminases and IgM immunoglobulin, as well as positive antinuclear antibodies (ANAs) and smooth muscle antibodies (SMAs), along with imaging signs of portal hypertension. A liver biopsy was compatible with autoimmune hepatitis, and treatment was begun with corticosteroids, with an adequate response. Systemic sclerosis is one of the autoimmune diseases which can present in a patient with autoimmune hepatitis. Suspecting, diagnosing and following up these diseases in this type of patients is key in their comprehensive management. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2609).

BehÒ«et's disease: A diagnostic challenge

BehÒ«et's disease is a low prevalence disorder that is difficult to diagnose. Its forms of presentation are often confused with infectious processes that involve multiple treatments and prolonged hospital stays. This article presents the case of a 30-year-old man who consulted with non-specific symptoms that represented a diagnostic challenge for the medical team.

La enfermedad de BehÒ«et es una patología de baja prevalencia y difícil diagnóstico; sus formas clínicas de presentación suelen confundirse con procesos infecciosos que implican múltiples tratamientos y estancias hospitalarias prolongadas. Este artículo presenta el caso de un hombre de 30 arios quien consulta de manera repetitiva con síntomas inespecíficos, lo que representa un reto diagnóstico para el equipo médico.

Cardiovascular Biomarkers and Diastolic Dysfunction in Patients With Chronic Chagas Cardiomyopathy.

Background: Chronic Chagas Cardiomyopathy is a unique form of cardiomyopathy, with a significantly higher mortality risk than other heart failure etiologies. Diastolic dysfunction (DD) plays an important role in the prognosis of CCM; however, the value of serum biomarkers in identifying and stratifying DD has been poorly studied in this context. We aimed to analyze the correlation of six biochemical markers with diastolic function echocardiographic markers and DD diagnosis in patients with CCM. Methods: Cross-sectional study of 100 adults with different stages of CCM. Serum concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), high-sensitivity troponin T (hs-cTnT), soluble (sST2), and cystatin-C (Cys-c) were measured. Tissue Doppler imaging was used to measure echocardiographic parameters indicating DD. Multivariate logistic regression models adjusted by age, sex, BMI, and NYHA classification were used to evaluate the association between the biomarkers and DD. Results: From the total patients included (55% male with a median age of 62 years), 38% had a preserved LVEF, but only 14% had a normal global longitudinal strain. Moreover, 64% had a diagnosis of diastolic dysfunction, with most of the patients showing a restrictive pattern (n = 28). The median levels of all biomarkers (except for sST2) were significantly higher in the group of patients with DD. Higher levels of natural log-transformed NTproBNP (per 1-unit increase, OR = 3.41, p < 0.001), Hs-cTnT (per 1-unit increase, OR = 3.24, p = 0.001), NGAL (per 1-unit increase, OR = 5.24, p =0.003), and Cys-C (per 1-unit increase, OR = 22.26, p = 0.008) were associated with increased odds of having diastolic dysfunction in the multivariate analyses. Finally, NT-proBNP had the highest AUC value (88.54) for discriminating DD presence. Conclusion: Cardiovascular biomarkers represent valuable tools for diastolic dysfunction assessment in the context of CCM. Additional studies focusing mainly on patients with HFpEF are required to validate the performance of these cardiovascular biomarkers in CCM, allowing for an optimal assessment of this unique population.

Germination response to water availability in populations of Festuca pallescens along a Patagonian rainfall gradient based on hydrotime model parameters.

Sensitivity to water availability is a key physiological trait for grassland species located in arid and semiarid environments, where successful germination is closely related to rainfall dynamics. Festuca pallescens inhabits diverse environments along a steep precipitation gradient in North Patagonia, thus offering a suitable model for the study of germination behavior in response to water availability. By analyzing germination in nine populations using a hydrotime model approach, we aimed to find within-species variation. Seed population behavior was analyzed under different hydric conditions using hydrotime model parameters (hydrotime, mean base water potential and its standard deviation). We estimated the mean base water potential for F. pallescens (ψb(50) = - 2.79 ± 0.45 MPa), which did not differ significantly between populations. However, the hydrotime parameter (θH) varied markedly, suggesting physiological adaptation to local environments. Higher values of θH were found in populations located at the extremes of the distribution gradient, indicating that germination may be prevented or delayed in conditions that are suboptimal for the species. Since the variation in hydrotime model parameters did not follow a cline, micro-environmental cues may have the greatest influence on the physiological behavior of the species, rather than the macroscale rainfall gradient.

Landscape genetics in the subterranean rodent Ctenomys "chasiquensis" associated with highly disturbed habitats from the southeastern Pampas region, Argentina.

Studies of genetic differentiation in fragmented environments help us to identify those landscape features that most affect gene flow and dispersal patterns. Particularly, the assessment of the relative significance of intrinsic biological and environmental factors affecting the genetic structure of populations becomes crucial. In this work, we assess the current dispersal patterns and population structure of Ctenomys "chasiquensis", a vulnerable and endemic subterranean rodent distributed on a small area in Central Argentina, using 9 polymorphic microsatellite loci. We use landscape genetics approaches to assess the relationship between genetic connectivity among populations and environmental attributes. Our analyses show that populations of C. "chasiquensis" are moderately to highly structured at a regional level. This pattern is most likely the outcome of substantial gene flow on the more homogeneous sand dune habitat of the Northwest of its distributional range, in conjunction with an important degree of isolation of eastern and southwestern populations, where the optimal habitat is surrounded by a highly fragmented landscape. Landscape genetics analysis suggests that habitat quality and longitude were the environmental factors most strongly associated with genetic differentiation/uniqueness of populations. In conclusion, our results indicate an important genetic structure in this species, even at a small spatial scale, suggesting that contemporary habitat fragmentation increases population differentiation.

Gnatodinamometro y fuerza oclusal / Gnatodynamometer and oclusal force

Este trabajo hace parte de los intentos de consolidación del laboratorio de fisiología oral de la Universidad del Valle y tiene como objetivo el diseño, construcción y validación de un gnatodinamómetro; este aparato construido en acero inoxidable mide la fuerza de apretamiento oclusal, gracias a que se deforma al recibir cargas y esta deformación se mide con precisión por un sensor de deformación o strain gauge incluido en el diseño: está compuesto por dos vigas, triangulares en su anchura, unidas en uno de sus extremos -el extremo mas ancho-, el otro extremo se recubre con acrílico y poliestireno ya que es el sitio donde se ubican las estructuras dentarias. El espesor definitivo es de aproximadamente 9 mm. Todos los procesos de construcción del gnatodinamómetro se realizaron en la Universidad del Valle, y con él se midió la variable funcional de apretamiento oclusal. Se validó finalmente el equipo mediante la realización de mediciones en un grupo de 7 pacientes entre 8 y 12 años con características faciales y dentales diagnosticadas clínicamente como normales, encontrando valores promedio para la fuerza máxima de apretamiento oclusal de 369 NW. (37 Kg-F) que son compatibles con valores encontrados en otros estudios.