Hepatoprotective effect of ß-myrcene pretreatment against acetaminophen-induced liver injury.

Objective: In the present study, the hepatoprotective effects of ß-myrcene (MYR) on acetaminophen-induced hepatotoxicity were investigated. Materials and Methods: A total of 40 Balb/c mice were randomly divided into five groups as follows: 1) Normal control group which received only carboxymethylcellulose (CMC), the vehicle used to dissolve acetaminophen (N-acetyl-p-aminophenol, APAP, paracetamol) and MYR; 2) APAP group which received a single dose of acetaminophen (250 mg/kg) orally on day 7; 3) Silymarin group which received 200 mg/kg/day of silymarin; and 4 and 5) pretreatment groups in which, mice were treated with 100 or 200 mg/kg/day of MYR. Liver and blood samples were collected to analyze serum aminotransferases, inflammatory response, oxidative stress markers, and histopathological insults. Results: Our results showed that MYR pretreatment attenuated liver damage and restored liver cells function and integrity as it decreased the leakage of serum aminotransferases (alanine and aspartate aminotransferases (ALT and AST, respectively)) into the blood (p<0.01). MYR treatment also reduced levels of myeloperoxidase (MPO) activity and nitric oxide (NO) (p<0.001). In addition, MYR pretreatment demonstrated significant antioxidant activity by decreasing malondialdehyde (MDA), reactive oxygen species (ROS), and reduced glutathione (GSH) levels (p<0.001). Furthermore, it restored the hepatic level of superoxide dismutase (SOD), catalase (CAT), and oxidized glutathione (GSSG) (p<0.001). Conclusion: For the first time, our results showed that MYR treatment significantly improved liver function by reducing oxidative stress and the inflammatory response induced by APAP.

Clinical profiles and factors associated with mortality in adults with yellow fever admitted to an intensive care unit in Minas Gerais, Brazil.

BACKGROUND: Yellow fever (YF) is a viral hemorrhagic disease caused by an arbovirus from the Flaviviridae family. Data on the clinical profile of severe YF in intensive care units (ICUs) are scarce. This study aimed to evaluate factors associated with YF mortality in patients admitted to a Brazilian ICU during the YF outbreaks of 2017 and 2018. METHODS: This was a longitudinal cohort case series study that included YF patients admitted to the ICU. Demographics, clinical and laboratory data were analyzed. Cox regression identified independent predictors of death risk. RESULTS: A total of 114 patients were studied. The median age was 48 years, and 92.1% were males. In univariate analysis, jaundice, leukopenia, bradycardia, prothrombin time, expressed as a ratio to the international normalized ratio-(PT-INR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, lactate, arterial pH and bicarbonate, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score 3 (SAPS 3) severity scores, transfusion of fresh frozen plasma, acute renal failure (Acute Kidney Injury Network stage III (AKIN III)), hemodialysis, cumulative fluid balance at 72 h of ICU, vasopressor use, seizures and grade IV encephalopathy were significantly associated with mortality. In multivariate analysis, factors independently associated with YF mortality were PT-INR, APACHE II, and grade IV hepatic encephalopathy. CONCLUSIONS: In the large outbreak in Brazil, factors independently associated with death risk in YF were: PT-INR, APACHE II, and grade IV hepatic encephalopathy. Early identification of patients with YF mortality risk factors may be very useful. Once these patients with a poor prognosis have been identified, proper management should be promptly implemented.

Leucemia linfoblástica aguda con grave alteración hepática como manifestación inicial: presentación de dos casos y revisión de la literatura / Acute lymphoblastic leukemia causing hepatic failure: report of two cases

Hematological diseases may cause acute hepatic failure and are seldom sought. We report two cases illustrating this situation. A 16-year-old male presented with an acute liver failure: a bone marrow biopsy showed complete infiltration with lymphoid type blasts. A flow cytometry confirmed the presence of an acute lymphoblastic leukemia. The patient died days later. A 20-year-old female presented with acute liver failure: due to a pancytopenia, a bone marrow biopsy was performed, which confirmed the presence of an acute lymphoblastic leukemia. Chemotherapy was started immediately. The patient had a favorable evolution.

Intoxicación por fósforo blanco en pediatría / White phosphorus poisoning in pediatrics

La intoxicación por fósforo blanco es una patología que es frecuente en festividades navideñas y de fin de año debido al uso de la pólvora recreativa como las martinicas, elementos de fácil acceso para los niños, principalmente lactantes y preescolares, los cuales sin medir consecuencias se convierten en víctimas de intoxicaciones al llevarse estos elementos a la boca y en ocasiones ingerirlos. En esta revisión se describe el caso de una menor intoxicada al ingerir fósforo blanco, con el objetivo de dar a conocer los efectos de este tóxico y advertir a los adultos a cargo acerca de la letalidad de esta patología, con el propósito de derivar a partir de esta revisión políticas encaminadas principalmente hacia prevención del evento. Se describe el caso de una niña de 2 años de edad que ingiere cuatro martinicas, presentando todos los efectos nocivos que ocasiona este tóxico a nivel hepático; la paciente recibió medidas iniciales las cuales fueron insuficientes por lo que tuvo que ser llevada a la unidad de cuidados intensivos con evolución favorable que hasta el momento no ha requerido transplante.

White phosphorus’ poisoning is a frequent pathology during holydays and New Year’s Eve. Fire works such as “martinicas”, are accessible for children – especially toddlers and preschoolers – who can have poisoning when they bring these elements to their mouths and ingest them, by accident. This work describes the case of a minor who was poisoned when she ingested white phosphorus. Our purpose is to show white phosphorus’ toxic effects and warn adults about this lethal pathology, in order to create policies directed towards its prevention. A two years old girl ingested four “martinicas”, presenting with hepatotoxicity. The patient needed an ntensive care unit admission with a favorable outcome and without requiring liver transplant.