Cylotoric T lymphocytec have bacn shown IO ha HLA Class 1 restricted. IPN amplyfies the display o... more Cylotoric T lymphocytec have bacn shown IO ha HLA Class 1 restricted. IPN amplyfies the display of these antigens on membranes of virus-infcclcd cells.-increasing cytotoxic T cell activity. We studied the effect of rlPN alpha-2b on serum B2 M9. a 12 KD subunit of HLA Class I amigens. levels in 22 pallcnls with chronic active C hepaitis treated (5 MU day/2 mo. 3 MU liwl4 mo. and 1 MU tiwl6 mo) over 1 y-r. Renal funcnelian was nomul in all patienti 82 MG serum levels were muswed by RIA (B-2 micro RIA. Pharmacia Diagnoslics AB. Uppsalr. Sweden), being 3 mu the normal upper limit. S~udaatS t test was used for sutiaial analysis. Prior 10 IFN lrcaunent, in serum the mean ALT levels was 231.9 ? 84.9 UR. and Ihe mean B2 MG levels was 2.7 rt 0.9 mg& ix prticmr (27%) had high basal levels of B2 MG. Afler four weeks of Vemmen, with 5 MUI day of IPN. the ma,, 82 MO level significamly rose 10 6.2 + 2.8 rnfl fpc 0.001) and 20 patients (91%) had high levels of BZ MG; lhis coincided whh a significant decrease of the mean ALT levels 10 74.4 A 41.8 fpcO.001). Mean BZ MO levels decreased during lxumenl: 4.1 + 1.2 mg.8 m 12 weeks. 3.0 '+ 1.6 mg,l at 24 weeks. 3.3 2 1.0 rnpn m 36 weeks, and 25 + 0.6 mgil finalizing ~ealment. There was no difference in B2 MG levels amanS pmienls who nomxdized ALT ad thosa who wcrc only partial rcspondar-. We concluded that rlPN alpha-2b significantly increased 82 MO swam levels in patients with chronic amivc C hepadtis in early phpXs of LIaaMCa1. This finding suggests that rlFN alpha-2b increases tic expression of HLA Class I vltlgaas on membranes of virusinfected hcpatocytes.
The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of o... more The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of oral, non-absorbable disaccharides. Theoretically, the inhibition of intestinal disaccharidases should induce malabsorption of disaccharides and increase delivery of undigested carbohydrates to the colon, thus stimulating the effects of lactulose and other non-absorbable disaccharides (that is, lactitol and lactose). AO-128 is an N-substituted derivative of valeolamine, an aminocyclitol that selectively inhibits intestinal disaccharidases. This study was performed to investigate whether AO-128 could be used as adjuvant therapy for the treatment of mild PSE in cirrhotic patients. A double-blind, randomized, controlled trial was performed in 35 cirrhotic patients with PSE. Patients were given a 2-week treatment consisting of AO-128 (2 mg three times daily) or an identical placebo. The following features of PSE syndrome were assessed in a semiquantitative fashion before and after I and 2 weeks of therapy: mental state, asterixis, number connection test (NCT), venous blood ammonia concentration, electroencephalogram (EEG), and overall PSE index (PSEI). More patients receiving AO-128 than patients receiving placebo showed >40% improvement in the PSEI (83% versus 35%; P < 0.05). The mean stool pH decreased from 5.8+/-0.3 to 5.5+/-0.3 (P < 0.004) after AO-128 treatment, whereas no changes were observed in the placebo group. The EEG and nitrogen balance did not show significant changes in any of the two groups. A significant improvement was seen in the NCT performance after AO-128 (from grade 2.0+/-1.04 to grade 1.25+/-0.87; P < 0.05). Seven patients treated with AO-128 developed diarrhea, as compared with none in the placebo group (P < 0.05). These results suggest that AO-128 may be useful in the treatment of PSE, although further studies are required to establish the benefit of AO-128 and determine adequate individual doses.
Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrho... more Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrhosis One hundred and eight patients with cirrhosis (23 grade A, 46 grade B and 39 grade C, according to Pugh's classification) underwent hemodynamic studies and plasma catecholamine concentration measurements. Blood samples were withdrawn from the pulmonary artery (n = 108), the hepatic vein (n = 108). the azygos vein (n = 59), the right renal xin (n = 66). the right jugular vein (n = 34) and the femoral vein (n = 33). Plasma roradrenaline concamations in the pulmonary artery and the hepatic vein were mere elevated in grade B (607 f 52 and 402 + 42 pgiml, respectively) and C patients (63X3 + 59 and 475 t 53 pg/ml, respectively) than in grade A patients (411 f 51 and 243 i 40 pglml, respectively). Plasma noradrenaline concentrations from these two vessels wem negatively correlated with indacyanine green clearance. These results indicate that hoth overall and splanchnic sympathetic activities are dependent on altered hepaiic function. Significant correlations were found between the wedged hepatic venous pressure and plasma noradrenaline concentrations from either the pulmonary artery, the hepatic vein or the azygos vein. Thew correlations Indicate that bath overall and splanchnic sympathetic activiries are dependent on the degree of portal hypertension. Moreover, significant correlations were found between hepatic venous plasma ncradrenaline concentrations and systemic hemodynamic values, suggesting that splanehnic sympathetic nervous activity could either play a role in Ihe systemic hyperkinetic syndrome or be a consequence of this hyperkinetic syndrome. Net release of noradrenaline uas higher in the kidneys (106 + 20 ng/min) than in the azygos vein territory (19 C 8 n&in). Net splanchnic extraction of noradrenaline did not depend on the severity of liver disease. Net distributions of the central nervous system and the limbs to circulating noradrenaline were very poor. This study shows that although the splanchnic contribution to circulating noradrenaline is not predominant, due to high extraction in the liver, splanchnic sympathetic activity is highly related with both the severity of liver disease and the hemodynamic changes in cirrhosis.
The altered response to ischemia was more marked in Child B patients and in those with ascites. C... more The altered response to ischemia was more marked in Child B patients and in those with ascites. Conclusions: The vascular reserve of the lower limbs is reduced in cirrhosis.
The hemodynamic responses to terbutalinea selective p,-adrenoceptor agonistwere studied in consci... more The hemodynamic responses to terbutalinea selective p,-adrenoceptor agonistwere studied in conscious normal rats and in conscious rats with secondary biliary cirrhosis. Compared with those of normal rats, dose-response curves in cirrhotic rats indicated significantly decreased reactivity in arterial pressure and heart rate. Half-maximal effective dose was not significantly different between the two groups. Terbutaline induced significant, dose-dependent decreases in portal pressure in both normal rats (9.3%) and cirrhotic rats (13.8%). In normal rats, terbutaline administration (32 pg * min-* kg-l bodywt) increased both cardiac output and portal tributary blood flow, thus mimicking hemodynamic changes in cirrhotic rats. In cirrhotic rats, despite a significant increase in portal tributary blood flow (from 19.9 f 1.7 mllmin to 22.7 & 1.5 ml/min), terbutaline decreased portal pressure from 17.4 k 1.0 mm Hg to 15.0 2 0.8 mm Hg. This study indicates that increased p,-adrenoceptor stimulation in cirrhotic rats may be involved in hyperdynamic circulation. The association of a decreased portal pressure and increased splanchnic blood flow suggests that p,-adrenoceptor stimulation may modulate hepatic and portal collateral vascular resistance. (HEPATOLOGY 1992;15:459-463.) p-adrenergic antagonists reduce the risk of gastrointestinal bleeding in patients with cirrhosis (1-3). This beneficial effect depends at least in part on reduction of portal pressure and reduction of blood flow into the superior portal systemic circulation (4). The mechanisms of action of P-blockers on the splanchnic circulation have not been, however, entirely elucidated. Nonselective p-blockers, however, are known to induce more profound splanchnic effects than cardioselective p-blockers (5). Thus it is thought that nonselective
Background/Aims: Thymalfasin has shown efficacy in the treatment of chronic HCV infection. The ai... more Background/Aims: Thymalfasin has shown efficacy in the treatment of chronic HCV infection. The aim of this study was to evaluate the efficacy and tolerability of triple therapy with thymalfasin, peginterferon α α α α α-2a (PEG-IFN α α α α α-2a), and ribavirin in Hispanic patients with chronic viral hepatitis C who were nonresponders to prior treatment with interferon alfa (IFN-α α α α α)/ribavirin. Methods: In this open-label study, 40 subjects received thymalfasin (1.6 mg twice a week), PEG-IFN α α α α α-2a (180 µg once a week), and ribavirin (800-1,000 mg/ day) for 48 weeks. All patients had positive HCV RNA by PCR analysis, abnormal levels of ALT, compensated hepatic disease, and liver biopsy with chronic damage. Results: Viral response was observed in 52.5% patients at week 12 and 50% at week 24. Of the per protocol group, 52.6% showed an end-of-treatment response at week 48 and 21.1% achieved an SVR at week 72. Among genotype 1 patients, 23.5% achieved an SVR at week 72. A reduction of the dose of PEG IFN α α α α α-2a and ribavirin was required. Thymalfasin was well tolerated without dose reduction. Conclusion: Triple therapy with thymalfasin, PEG IFN α α α α α-2a, and ribavirin is an effective treatment option for difficult-to-treat HCV patients who are refractory to prior conventional treatment, with adequate tolerability.
Background. There is no treatment for septic acute kidney injury (sAKI). The anti-inflammatory ac... more Background. There is no treatment for septic acute kidney injury (sAKI). The anti-inflammatory activity of prolonged-release pirfenidone (PR-PFD) could be beneficial in this clinical setting. Methods. This study was a double-blind randomized clinical trial in sAKI patients with nephrology consultation at the Civil Hospital of Guadalajara, in addition to the usual treatment of AKI associated with sepsis; patients were randomized to receive either PR-PFD at 1,200 mg/day (group A) or 600 mg/day (group B) or a matched placebo for 7 consecutive days. The primary objective was the decrease in serum creatinine (sCr) and increase in urinary volume (UV); the secondary objectives were changes in serum electrolytes, acid-base status, and mortality. Results. Between August 2016 and August 2017, 88 patients were randomized. The mean age was 54 (17 ± SD) years, and 47% were male. The main site of infection was the lung (39.8%), septic shock was present in 39.1% of the cases, and the mean SOFA sco...
Background: In the last decades it has been suggested that the main cause of liver cirrhosis in M... more Background: In the last decades it has been suggested that the main cause of liver cirrhosis in Mexico is alcohol. Currently in Western countries hepatitis C virus (HCV) infection is one of the leading causes of endstage liver disease and liver transplantation. In Mexico, we have no data relative to the etiology of liver cirrhosis. The aim of this study was to investigate the main causes of liver cirrhosis in Mexico. Methods: Eight hospitals located in different areas of the country were invited to participate in this study. Those hospitals provide health care to different social classes of the country. The inclusion criteria were the presence of either an histological or a clinical and biochemical diagnosis of liver cirrhosis. Results: A total of 1,486 cases were included in this study. The etiology of liver cirrhosis was alcohol in 587 (39.5%), HCV 544 (36.6%), cryptogenic 154 (10.4%), PBC 84 (5.7), HBV 75 (5.0%) and other 42 (2.8). There was not statistical difference between alcohol and HCV. Conclusions: We conclude that the main causes of liver cirrhosis in Mexico are alcohol and HCV.
AIM: To evaluate the prognostic value of percentage of 13 C-phenylalanine oxidation (13 C-PheOx) ... more AIM: To evaluate the prognostic value of percentage of 13 C-phenylalanine oxidation (13 C-PheOx) obtained by 13 C-phenylalanine breath test (13 C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13 C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13 C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13 C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of 13 C-PheOx obtained by 13 C-PheBT is a strong predictor of survival in patients with chronic liver disease.
The clinical suspicion of hereditary spherocytosis (HS) must be confirmed at the clinical laborat... more The clinical suspicion of hereditary spherocytosis (HS) must be confirmed at the clinical laboratory. The osmotic fragility test (OFT) and the autohemolysis test (AHT) are the worldwide accepted assays to establish a definite diagnosis of HS; however, they have some disadvantages. We describe herein our experience with the cryohemolysis test (CHT) as a tool to confirm the HS diagnosis. We included four groups of subjects, namely, patients with clinical HS, patients with mechanical heart valve prosthesis, malignant hematological diseases and healthy blood donors. CHT was carried out in all the groups, while OFT and AHT only in the HS patients and healthy individuals. OFT and AHT were performed according to previously described techniques. CHT was performed using red blood cells incubated in a hypertonic solution, preheated for 10 min and then transferred to an ice bath for an additional 10 min. The resulting cryohemolysis was determined measuring the free hemoglobin in the sample. Th...
Cylotoric T lymphocytec have bacn shown IO ha HLA Class 1 restricted. IPN amplyfies the display o... more Cylotoric T lymphocytec have bacn shown IO ha HLA Class 1 restricted. IPN amplyfies the display of these antigens on membranes of virus-infcclcd cells.-increasing cytotoxic T cell activity. We studied the effect of rlPN alpha-2b on serum B2 M9. a 12 KD subunit of HLA Class I amigens. levels in 22 pallcnls with chronic active C hepaitis treated (5 MU day/2 mo. 3 MU liwl4 mo. and 1 MU tiwl6 mo) over 1 y-r. Renal funcnelian was nomul in all patienti 82 MG serum levels were muswed by RIA (B-2 micro RIA. Pharmacia Diagnoslics AB. Uppsalr. Sweden), being 3 mu the normal upper limit. S~udaatS t test was used for sutiaial analysis. Prior 10 IFN lrcaunent, in serum the mean ALT levels was 231.9 ? 84.9 UR. and Ihe mean B2 MG levels was 2.7 rt 0.9 mg& ix prticmr (27%) had high basal levels of B2 MG. Afler four weeks of Vemmen, with 5 MUI day of IPN. the ma,, 82 MO level significamly rose 10 6.2 + 2.8 rnfl fpc 0.001) and 20 patients (91%) had high levels of BZ MG; lhis coincided whh a significant decrease of the mean ALT levels 10 74.4 A 41.8 fpcO.001). Mean BZ MO levels decreased during lxumenl: 4.1 + 1.2 mg.8 m 12 weeks. 3.0 '+ 1.6 mg,l at 24 weeks. 3.3 2 1.0 rnpn m 36 weeks, and 25 + 0.6 mgil finalizing ~ealment. There was no difference in B2 MG levels amanS pmienls who nomxdized ALT ad thosa who wcrc only partial rcspondar-. We concluded that rlPN alpha-2b significantly increased 82 MO swam levels in patients with chronic amivc C hepadtis in early phpXs of LIaaMCa1. This finding suggests that rlFN alpha-2b increases tic expression of HLA Class I vltlgaas on membranes of virusinfected hcpatocytes.
The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of o... more The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of oral, non-absorbable disaccharides. Theoretically, the inhibition of intestinal disaccharidases should induce malabsorption of disaccharides and increase delivery of undigested carbohydrates to the colon, thus stimulating the effects of lactulose and other non-absorbable disaccharides (that is, lactitol and lactose). AO-128 is an N-substituted derivative of valeolamine, an aminocyclitol that selectively inhibits intestinal disaccharidases. This study was performed to investigate whether AO-128 could be used as adjuvant therapy for the treatment of mild PSE in cirrhotic patients. A double-blind, randomized, controlled trial was performed in 35 cirrhotic patients with PSE. Patients were given a 2-week treatment consisting of AO-128 (2 mg three times daily) or an identical placebo. The following features of PSE syndrome were assessed in a semiquantitative fashion before and after I and 2 weeks of therapy: mental state, asterixis, number connection test (NCT), venous blood ammonia concentration, electroencephalogram (EEG), and overall PSE index (PSEI). More patients receiving AO-128 than patients receiving placebo showed &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40% improvement in the PSEI (83% versus 35%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The mean stool pH decreased from 5.8+/-0.3 to 5.5+/-0.3 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.004) after AO-128 treatment, whereas no changes were observed in the placebo group. The EEG and nitrogen balance did not show significant changes in any of the two groups. A significant improvement was seen in the NCT performance after AO-128 (from grade 2.0+/-1.04 to grade 1.25+/-0.87; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Seven patients treated with AO-128 developed diarrhea, as compared with none in the placebo group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). These results suggest that AO-128 may be useful in the treatment of PSE, although further studies are required to establish the benefit of AO-128 and determine adequate individual doses.
Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrho... more Regional sympathetic activity, severity of liver disease and hemodynamics in patients with cirrhosis One hundred and eight patients with cirrhosis (23 grade A, 46 grade B and 39 grade C, according to Pugh's classification) underwent hemodynamic studies and plasma catecholamine concentration measurements. Blood samples were withdrawn from the pulmonary artery (n = 108), the hepatic vein (n = 108). the azygos vein (n = 59), the right renal xin (n = 66). the right jugular vein (n = 34) and the femoral vein (n = 33). Plasma roradrenaline concamations in the pulmonary artery and the hepatic vein were mere elevated in grade B (607 f 52 and 402 + 42 pgiml, respectively) and C patients (63X3 + 59 and 475 t 53 pg/ml, respectively) than in grade A patients (411 f 51 and 243 i 40 pglml, respectively). Plasma noradrenaline concentrations from these two vessels wem negatively correlated with indacyanine green clearance. These results indicate that hoth overall and splanchnic sympathetic activities are dependent on altered hepaiic function. Significant correlations were found between the wedged hepatic venous pressure and plasma noradrenaline concentrations from either the pulmonary artery, the hepatic vein or the azygos vein. Thew correlations Indicate that bath overall and splanchnic sympathetic activiries are dependent on the degree of portal hypertension. Moreover, significant correlations were found between hepatic venous plasma ncradrenaline concentrations and systemic hemodynamic values, suggesting that splanehnic sympathetic nervous activity could either play a role in Ihe systemic hyperkinetic syndrome or be a consequence of this hyperkinetic syndrome. Net release of noradrenaline uas higher in the kidneys (106 + 20 ng/min) than in the azygos vein territory (19 C 8 n&in). Net splanchnic extraction of noradrenaline did not depend on the severity of liver disease. Net distributions of the central nervous system and the limbs to circulating noradrenaline were very poor. This study shows that although the splanchnic contribution to circulating noradrenaline is not predominant, due to high extraction in the liver, splanchnic sympathetic activity is highly related with both the severity of liver disease and the hemodynamic changes in cirrhosis.
The altered response to ischemia was more marked in Child B patients and in those with ascites. C... more The altered response to ischemia was more marked in Child B patients and in those with ascites. Conclusions: The vascular reserve of the lower limbs is reduced in cirrhosis.
The hemodynamic responses to terbutalinea selective p,-adrenoceptor agonistwere studied in consci... more The hemodynamic responses to terbutalinea selective p,-adrenoceptor agonistwere studied in conscious normal rats and in conscious rats with secondary biliary cirrhosis. Compared with those of normal rats, dose-response curves in cirrhotic rats indicated significantly decreased reactivity in arterial pressure and heart rate. Half-maximal effective dose was not significantly different between the two groups. Terbutaline induced significant, dose-dependent decreases in portal pressure in both normal rats (9.3%) and cirrhotic rats (13.8%). In normal rats, terbutaline administration (32 pg * min-* kg-l bodywt) increased both cardiac output and portal tributary blood flow, thus mimicking hemodynamic changes in cirrhotic rats. In cirrhotic rats, despite a significant increase in portal tributary blood flow (from 19.9 f 1.7 mllmin to 22.7 & 1.5 ml/min), terbutaline decreased portal pressure from 17.4 k 1.0 mm Hg to 15.0 2 0.8 mm Hg. This study indicates that increased p,-adrenoceptor stimulation in cirrhotic rats may be involved in hyperdynamic circulation. The association of a decreased portal pressure and increased splanchnic blood flow suggests that p,-adrenoceptor stimulation may modulate hepatic and portal collateral vascular resistance. (HEPATOLOGY 1992;15:459-463.) p-adrenergic antagonists reduce the risk of gastrointestinal bleeding in patients with cirrhosis (1-3). This beneficial effect depends at least in part on reduction of portal pressure and reduction of blood flow into the superior portal systemic circulation (4). The mechanisms of action of P-blockers on the splanchnic circulation have not been, however, entirely elucidated. Nonselective p-blockers, however, are known to induce more profound splanchnic effects than cardioselective p-blockers (5). Thus it is thought that nonselective
Background/Aims: Thymalfasin has shown efficacy in the treatment of chronic HCV infection. The ai... more Background/Aims: Thymalfasin has shown efficacy in the treatment of chronic HCV infection. The aim of this study was to evaluate the efficacy and tolerability of triple therapy with thymalfasin, peginterferon α α α α α-2a (PEG-IFN α α α α α-2a), and ribavirin in Hispanic patients with chronic viral hepatitis C who were nonresponders to prior treatment with interferon alfa (IFN-α α α α α)/ribavirin. Methods: In this open-label study, 40 subjects received thymalfasin (1.6 mg twice a week), PEG-IFN α α α α α-2a (180 µg once a week), and ribavirin (800-1,000 mg/ day) for 48 weeks. All patients had positive HCV RNA by PCR analysis, abnormal levels of ALT, compensated hepatic disease, and liver biopsy with chronic damage. Results: Viral response was observed in 52.5% patients at week 12 and 50% at week 24. Of the per protocol group, 52.6% showed an end-of-treatment response at week 48 and 21.1% achieved an SVR at week 72. Among genotype 1 patients, 23.5% achieved an SVR at week 72. A reduction of the dose of PEG IFN α α α α α-2a and ribavirin was required. Thymalfasin was well tolerated without dose reduction. Conclusion: Triple therapy with thymalfasin, PEG IFN α α α α α-2a, and ribavirin is an effective treatment option for difficult-to-treat HCV patients who are refractory to prior conventional treatment, with adequate tolerability.
Background. There is no treatment for septic acute kidney injury (sAKI). The anti-inflammatory ac... more Background. There is no treatment for septic acute kidney injury (sAKI). The anti-inflammatory activity of prolonged-release pirfenidone (PR-PFD) could be beneficial in this clinical setting. Methods. This study was a double-blind randomized clinical trial in sAKI patients with nephrology consultation at the Civil Hospital of Guadalajara, in addition to the usual treatment of AKI associated with sepsis; patients were randomized to receive either PR-PFD at 1,200 mg/day (group A) or 600 mg/day (group B) or a matched placebo for 7 consecutive days. The primary objective was the decrease in serum creatinine (sCr) and increase in urinary volume (UV); the secondary objectives were changes in serum electrolytes, acid-base status, and mortality. Results. Between August 2016 and August 2017, 88 patients were randomized. The mean age was 54 (17 ± SD) years, and 47% were male. The main site of infection was the lung (39.8%), septic shock was present in 39.1% of the cases, and the mean SOFA sco...
Background: In the last decades it has been suggested that the main cause of liver cirrhosis in M... more Background: In the last decades it has been suggested that the main cause of liver cirrhosis in Mexico is alcohol. Currently in Western countries hepatitis C virus (HCV) infection is one of the leading causes of endstage liver disease and liver transplantation. In Mexico, we have no data relative to the etiology of liver cirrhosis. The aim of this study was to investigate the main causes of liver cirrhosis in Mexico. Methods: Eight hospitals located in different areas of the country were invited to participate in this study. Those hospitals provide health care to different social classes of the country. The inclusion criteria were the presence of either an histological or a clinical and biochemical diagnosis of liver cirrhosis. Results: A total of 1,486 cases were included in this study. The etiology of liver cirrhosis was alcohol in 587 (39.5%), HCV 544 (36.6%), cryptogenic 154 (10.4%), PBC 84 (5.7), HBV 75 (5.0%) and other 42 (2.8). There was not statistical difference between alcohol and HCV. Conclusions: We conclude that the main causes of liver cirrhosis in Mexico are alcohol and HCV.
AIM: To evaluate the prognostic value of percentage of 13 C-phenylalanine oxidation (13 C-PheOx) ... more AIM: To evaluate the prognostic value of percentage of 13 C-phenylalanine oxidation (13 C-PheOx) obtained by 13 C-phenylalanine breath test (13 C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13 C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13 C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13 C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of 13 C-PheOx obtained by 13 C-PheBT is a strong predictor of survival in patients with chronic liver disease.
The clinical suspicion of hereditary spherocytosis (HS) must be confirmed at the clinical laborat... more The clinical suspicion of hereditary spherocytosis (HS) must be confirmed at the clinical laboratory. The osmotic fragility test (OFT) and the autohemolysis test (AHT) are the worldwide accepted assays to establish a definite diagnosis of HS; however, they have some disadvantages. We describe herein our experience with the cryohemolysis test (CHT) as a tool to confirm the HS diagnosis. We included four groups of subjects, namely, patients with clinical HS, patients with mechanical heart valve prosthesis, malignant hematological diseases and healthy blood donors. CHT was carried out in all the groups, while OFT and AHT only in the HS patients and healthy individuals. OFT and AHT were performed according to previously described techniques. CHT was performed using red blood cells incubated in a hypertonic solution, preheated for 10 min and then transferred to an ice bath for an additional 10 min. The resulting cryohemolysis was determined measuring the free hemoglobin in the sample. Th...
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Papers by Jorge Luis Poo