The Mexican consensus on nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak. This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease.

[IL-6 and TNF-α gene expression in the rectal mucosal of patients with chronic idiopathic ulcerative colitis and controls]

BACKGROUND

It has been reported that pro-inflammatory cytokines levels like IL-6 and TNF-α can determine the degree of inflammation of ulcerative colitis (UC).

AIMS

To measure the gene expression of IL-6 and TNF-á in patients with UC and controls and to correlate with histological activity.

PATIENTS AND METHODS

We studied 36 patients with UC, 13 healthy controls and 11 with inflammation. After total ribonucleic acid (RNA) extraction, complementary deoxyribonucleic acid (DNA) was synthesized by polymerase chain reaction (PCR) and relative expression was determined through real-time PCR for IL-6 and TNF-á. Statistical analysis was performed using the Kruskal-Wallis test and Spearman correlation.

RESULTS

The expression of IL-6 increases in patients with active UC compared to controls (p = 0.004) as well as UC patients in remission (p = 0.014). There was no significant difference between patients with active UC and controls with inflammation. (p = 0.446). Gene expression of TNF-α was higher in biopsies from patients with UC activity compred with control subjects (p = 0.004), as well as those in remission (p = 0.001). The expression of IL-6 correlated significantly (p = 0.02) with histological activity.

CONCLUSIONS

The gene expression of IL-6 and TNF-α is increased in active UC. Interleukin 6 is better marker of bowel inflammation because its expression correlates with histological activity.

[The prevalence of hepatitis B and C in blood donors in a 3rd-level hospital of Mexico City]

OBJECTIVE

To investigate the prevalence of the hepatitis C virus (HCV) and B virus (HBV) in blood donors attending Médica Sur Hospital.

MATERIAL AND METHODS

A total of 9,099 blood donors were tested for hepatitis B and C viruses from 1994 to 1998. A questionnaire was used to collect data and HCV and HBV were detected in serum. We obtained percentages and assessed statistical significance using the chi 2 test.

RESULTS

The prevalence of HCV and HBV carriers was 0.47 and 0.11 per cent. The main risk factors were dental procedures (11.6% for HCV and 20%, for HBV), and unsafe sexual practices (20%) for HBV.

CONCLUSIONS

These results indicate a low prevalence of HCV and HBV infection in this population.

Case report of multiple myeloma and hypothyroidism in primary biliary cirrhosis

A 71-year-old female with primary biliary cirrhosis, multiple myeloma and hypothyroidism is reported. The liver biopsy showed stage II-III histologic damage according to Scheuer's classification and the multiple myeloma was IgG-lambda type, stage II-A at the time of diagnosis. Another three cases of primary biliary cirrhosis associated with multiple myeloma were found in the literature. As a group, the four cases had mild or moderate liver damage, extensive bone lesions and three of four cases had multiple myeloma IgG-lambda type. Although this association could be incidental, there is evidence that implies a pathogenic relationship. This information is summarized in this report.

In vitro and in vivo lactose and lactulose effects on colonic fermentation and portal-systemic encephalopathy parameters

Lactose intolerance occurs in the majority of human groups, excluding people from Northern Europe. Because its effect is similar to that of lactulose, lactose seems to be an alternative treatment for patients with portal-systemic encephalopathy (PSE) and lactase deficiency. The mechanism of action of lactose is similar to that of lactulose. In vivo, lactose improves PSE parameters and causes acidic diarrhea. We performed in vitro studies in a fecal incubation system to investigate the biochemical and bacteriological effects induced by different substances customarily used for the treatment of patients with PSE (lactose, lactulose and Neomycin). In vitro experiments showed that lactose and lactulose decreased aerobic flora counts and reduced the pH of fecal incubation. Both disaccharides reduced the ammonia concentration in the incubation system.

[Extracorporeal shockwave biliary lithotripsy. Physical basis and clinical application]

Extracorporeal shock waves lithotripsy is a new procedure discovered and applied in the present decade to treat urinary and biliary stones. Shock waves are acoustic waves similar to sonic waves which follow the acoustic laws and therefore the shock waves can be refracted or reflected depending on the medium interface. Due to the high water content, the human body can be crossed by shock waves which eventually may be focused on the target stone. There are several commercially available shock waves generators, i.e. the spark gap emisors which were the first ones, and the piezoceramic and electromagnetic emisors. To focus the shock waves on a biliary stone the machines are provided with fluoroscopic or ultrasound devices or with both in the most advanced machines. Using an electromagnetic emisor (Lithostar plus) our group has treated 78 patients with biliary stones without analgesia or anesthesia. Total stone fragmentation was achieved in 85% of the cases. In patients with cholesterol gallstones who undergo lithotripsy, an adjuvant treatment with oral cholesterol solvent is mandatory. Extracorporeal biliary lithotripsy is free of mortality, and the morbidity is less than 5%.