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Morales-Olvera CG, Lanz-Zubiría L, Aguilar-Zamora E, Camorlinga-Ponce M, Aparicio-Ozores G, Aguilar-Zapata D, Chávez-Tapia NC, Uribe M, Barbero-Becerra VJ, Juárez-Hernández E. Clostridioides Difficile in Latin America: An Epidemiological Overview. Curr Microbiol 2023; 80:357. [PMID: 37768473 DOI: 10.1007/s00284-023-03475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/18/2023] [Indexed: 09/29/2023]
Abstract
Clostridioides difficile infection is one of the most significant causes of nosocomial diarrhea associated with antibiotic use worldwide. In recent years, the incidence of Clostridioides difficile infection in Latin American countries has increased due to the emergence and spread of epidemic Clostridioides difficile strains, such as RT027/NAP1/ST1, RT078/ST11, and RT017/ST37; additionally, endemic multi-drug-resistant strains have recently appeared due to the lack of heterogeneous diagnostic algorithms and guidelines for antibiotic use in each country. The aim of this review is to present the latest information regarding Clostridioides difficile and emphasize the importance of epidemiological surveillance of this pathogen in Latin American countries.
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Affiliation(s)
- Claudia G Morales-Olvera
- Translational Research Unit. Medica Sur Clinic & Foundation, Mexico City, Mexico
- Geriatric Service, PEMEX North Central Hospital and Postgraduate Studies Division, School of Medicine, UNAM, Mexico City, Mexico
| | - Lorena Lanz-Zubiría
- Infectious Diseases and Hospital Epidemiology Department, Médica Sur Clinic & Foundation. Medicine School Universidad Anáhuac, Mexico City, Mexico
| | - Emmanuel Aguilar-Zamora
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margarita Camorlinga-Ponce
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gerardo Aparicio-Ozores
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Daniel Aguilar-Zapata
- Infectious Diseases and Hospital Epidemiology Department, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - M Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Eva Juárez-Hernández
- Translational Research Unit. Medica Sur Clinic & Foundation, Mexico City, Mexico.
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2
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Bendersky J, Uribe M, Bravo M, Vargas JP, Villanueva J, Urrutia G, Bonfill X. Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery. Med Oral Patol Oral Cir Bucal 2023; 28:e116-e125. [PMID: 36806025 PMCID: PMC9985940 DOI: 10.4317/medoral.25530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/26/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. MATERIAL AND METHODS A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. RESULTS 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. CONCLUSIONS Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions.
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Affiliation(s)
- J Bendersky
- Americo Vepsucio Norte 2101 CP 7630595, Vitacura, Santiago, Chile
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3
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Shannon CL, Bartels SM, Cepeda M, Castro S, Cubillos L, Suárez-Obando F, Williams MJ, Gómez Restrepo C, Uribe M, Marsch L, Torrey WC. Perspectives on the Implementation of Screening and Treatment for Depression and Alcohol Use Disorder in Primary Care in Colombia. Community Ment Health J 2021; 57:1579-1587. [PMID: 33665738 PMCID: PMC8658743 DOI: 10.1007/s10597-021-00781-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Depression and alcohol use disorder (AUD) greatly contribute to the burden of disease worldwide, and have large impact on Colombia's population. In this study, a qualitative analysis evaluates the implementation of a technology-supported model for screening, decision support, and digital therapy for depression and AUD in Colombian primary care clinics. Patient, provider, and administrator interviews were conducted, exploring attitudes towards depression and AUD, attitudes towards technology, and implementation successes and challenges. Researchers used qualitative methods to analyze interview themes. Despite stigma around depression and AUD, the model improved provider capacity to diagnose and manage patients, helped patients feel supported, and provided useful prevalence data for administrators. Challenges included limited provider time and questions about sustainability. The implementation facilitated the identification, diagnosis, and care of patients with depression and AUD. There is ongoing need to decrease stigma, create stronger networks of mental health professionals, and transition intervention ownership to the healthcare center.
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Affiliation(s)
- C L Shannon
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - S M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, USA
| | - M Cepeda
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - S Castro
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - L Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, USA
| | | | - M J Williams
- Global Mental Health Research Program, Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, MD, USA
| | - C Gómez Restrepo
- Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | - M Uribe
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - L Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, USA
| | - W C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, USA
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4
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Díaz LA, López M, Sin P, Wolff R, González G, Muñoz MP, Uribe M, Ananias Á, Bezama I, Zañartu N, Buckel E, Innocenti F, Pattillo JC, Jarufe N, Martínez J, Guerra JF, Elgueta S, Gana JC. [Current situation of pediatric liver transplantation in Chile. Inequities associated with the MELD/PELD prioritization system]. Rev Med Chil 2021; 148:1261-1270. [PMID: 33399701 DOI: 10.4067/s0034-98872020000901261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Chilean allocation system for liver transplantation (LT) uses the MELD/PELD score to prioritize candidates on the waiting list. AIM To assess if the Chilean allocation system for LT is equitable for pediatric candidates compared to their adult counterparts. MATERIAL AND METHODS We used the Public Health Institute's registry between October 2011 and December 2017. We analyzed candidates with chronic hepatic diseases listed for LT. The primary outcome was the cadaveric liver transplantation (CLT) rate. Secondary outcomes were death or disease progression in the waiting list and living donor liver transplant (LDLT) rate. RESULTS We analyzed 122 pediatric and 735 adult candidates. Forty one percent of pediatric candidates obtained a CLT compared to 48% of adults (p = NS). Among patients aged under two years of age, the access to CLT on the waiting list there was 28% of CLT, compared to 48% in adults (p = 0.001). Fifty-seven percent of candidates aged under two years were listed for cholestatic diseases, obtaining a CLT in 18% and requiring a LDLT in 49%. The median time in the waiting list for CLT was 5.9 months in pediatric candidates and 5.1 in adults, while the median time to death in the waiting list was 2.8 and 5.6 months, respectively. The mortality rate at one year in candidates under two years old was 38.1% compared to 32.5% in adults. CONCLUSIONS Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marisol López
- Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Priscila Sin
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Mario Uribe
- Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Álvaro Ananias
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Bezama
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Zañartu
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Juan Carlos Pattillo
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Jorge Martínez
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington D.C., Estados Unidos de Norteamérica
| | | | - Juan Cristóbal Gana
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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5
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Hepp J, Beca JP, Moran S, Roessler E, Uribe M, Palacios JM. [A proposal of the Chilean Academy of Medicine to improve organ procurement and transplantation in Chile]. Rev Med Chil 2020; 148:381-386. [PMID: 32730383 DOI: 10.4067/s0034-98872020000300381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
The Chilean Academy of Medicine designated a group of specialists to evaluate the practice and to propose reforms for organ donation and transplantation, due to the general insufficiencies at the national level with these procedures. In the last six years the mean number of organ transplants in Chile was 340 cases per year while effective cadaveric donors ranged between 6 and 10 per million inhabitants. These averages remained stable during this period and are among the lowest in the region. Our analysis attributed these deficient results mainly to low organ donation and inefficient procurement due to lack of compliance with protocols and little accountability. The committee proposes several measures for improvement. These are a systematic and obligatory report of potential organ donors by all emergency and critical care centers, frequent evaluation of results, empowering of health authorities to correct insufficiencies in organ procurement, education programs for primary, secondary, technical and university students to improve their knowledge about the social significance and solidarity required for transplantation policies and specialized updated training of all health professionals involved. Organ donation and transplantation must be based on clear and fair ethical considerations in order to be accepted by the general public.
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Affiliation(s)
- Juan Hepp
- Academia Chilena de Medicina, Instituto de Chile, Chile
| | | | - Sergio Moran
- Academia Chilena de Medicina, Instituto de Chile, Chile
| | | | - Mario Uribe
- Academia Chilena de Medicina, Instituto de Chile, Chile
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6
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Riquelme F, Marinkovic B, Salazar M, Martínez W, Catan F, Uribe-Echevarría S, Puelma F, Muñoz J, Canals A, Astudillo C, Uribe M. Early laparoscopic cholecystectomy reduces hospital stay in mild gallstone pancreatitis. A randomized controlled trial. HPB (Oxford) 2020; 22:26-33. [PMID: 31235428 DOI: 10.1016/j.hpb.2019.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/21/2019] [Accepted: 05/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests. METHODS This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopic-endoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and re-admission. One year of follow-up was carried-on. RESULTS At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found. CONCLUSIONS E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications. TRIAL REGISTRATION clinicaltrials.gov (NCT02590978).
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Affiliation(s)
- Francisco Riquelme
- Department of Surgery, Hospital del Salvador, Santiago, Chile; University of Chile, Santiago, Chile.
| | - Boris Marinkovic
- Department of Surgery, Hospital del Salvador, Santiago, Chile; University of Chile, Santiago, Chile
| | - Marco Salazar
- Department of Surgery, Hospital del Salvador, Santiago, Chile
| | - Waldo Martínez
- Department of Surgery, Hospital del Salvador, Santiago, Chile
| | - Felipe Catan
- Department of Surgery, Hospital del Salvador, Santiago, Chile
| | | | - Felipe Puelma
- Department of Surgery, Hospital del Salvador, Santiago, Chile
| | - Jorge Muñoz
- Department of Surgery, Hospital del Salvador, Santiago, Chile
| | | | | | - Mario Uribe
- Department of Surgery, Hospital del Salvador, Santiago, Chile; University of Chile, Santiago, Chile
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Coronel-Castillo C, Contreras-Carmona J, Frati-Munari A, Uribe M, Méndez-Sánchez N. Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. Revista de Gastroenterología de México (English Edition) 2020. [DOI: 10.1016/j.rgmxen.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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8
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Coronel-Castillo CE, Contreras-Carmona J, Frati-Munari AC, Uribe M, Méndez-Sánchez N. Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. Rev Gastroenterol Mex (Engl Ed) 2020; 85:56-68. [PMID: 31836274 DOI: 10.1016/j.rgmx.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Hepatic encephalopathy is a frequent complication in patients with cirrhosis of the liver and is associated with a high mortality rate. Costs attributed to the management of patients with cirrhosis are especially high due to complications, such as hepatic encephalopathy, given that they increase the number of days of hospital stay. Different drugs are currently used to treat hepatic encephalopathy, and the main ones are lactulose, L-ornithine L-aspartate (LOLA), and certain antibiotics, especially rifaximin-α (RFX). Even though many of them have been shown to be effective to greater or lesser degrees, it is important to understand the differences between them, so that every patient receives individualized treatment and the best option is chosen, in accordance with the different clinical scenarios. Thus, the aim of the present study was to analyze the evidence on the advantages and disadvantages of the individual or combined use of the 3 main treatments for hepatic encephalopathy, specifically taking into consideration their different degrees of efficacy, their impact on quality of life, prophylaxis, and cost reduction.
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Affiliation(s)
- C E Coronel-Castillo
- Unidad de Investigación en Hígado, Fundación Clínica Médica Sur, Ciudad de México, México
| | - J Contreras-Carmona
- Unidad de Investigación en Hígado, Fundación Clínica Médica Sur, Ciudad de México, México
| | - A C Frati-Munari
- Departamento de Medicina Interna, Fundación Clínica Médica Sur, Ciudad de México, México
| | - M Uribe
- Unidad de Investigación en Hígado, Fundación Clínica Médica Sur, Ciudad de México, México
| | - N Méndez-Sánchez
- Unidad de Investigación en Hígado, Fundación Clínica Médica Sur, Ciudad de México, México; Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México.
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9
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Broon NJ, Palafox-Sánchez CA, Estrela C, Camarena DCS, Uribe M, Ceja I, Ramos CS, Cruz A. Analysis of Electronic Apex Locators in Human Teeth Diagnosed With Apical Periodontitis. Braz Dent J 2019; 30:550-554. [PMID: 31800748 DOI: 10.1590/0103-6440201902705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022] Open
Abstract
Electronic apex locators (EAL) have been used to establish the working length (WL) in root canal treatment. In teeth diagnosed with apical periodontitis, resorption of tooth apical structures can lead to difficulties to obtain an appropriate WL. The aim was to compare the capacity of three EAL's (Root ZX II, Raypex 6 and Endo-Eze Quill) to locate the tip of the K-file between 0 to -0.5 mm from the apical foramen (AF) on teeth diagnosed with asymptomatic apical periodontitis (AAP). Electronic working length was performed on 60 roots with AAP. A K-file #15 was inserted in the root canal until the apical foramen (AF) was located, and followed was re-adjusted to -0.5 mm through observation in EAL display. The K-file was fixed to the tooth with composite and teeth were extracted. The 4 apical millimeters were worn out until the K-file could be seen and were prepared and measured its distance to AF in a scanning electron microscope. Appropriate WL was when the tip of the K-file was located between 0 to -0.5 mm from AF. Results: Root ZX II showed significant difference (p<0.01) with the other two EALs. Root ZX II presented the better performance than Raypex 6 or Endo-Eze Quill in teeth with AAP.
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Affiliation(s)
- Norberto J Broon
- University Center of Health Sciences (CUCS), Universidad de Guadalajara, México
| | | | - Carlos Estrela
- Department of Stomatologic Sciences, UFG - Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Mario Uribe
- University Center of Health Sciences (CUCS), Universidad de Guadalajara, México
| | - Israel Ceja
- University Center of Exact Sciences and Engineering CUCEI, Universidad de Guadalajara, México
| | - Carlos S Ramos
- Roseman University of Health Sciences, South Jordan, UT, USA
| | - Alvaro Cruz
- Research Institute of Biomedical Sciences, CUCS, México
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Castro L, Nazal L, Silva G, Brahm J, Segovia R, Ferrario M, Buckel E, Uribe M, Puelma F, Regueira T, Reccius A, Fardella P, Rodríguez MDLÁ, Blamey R. MANEJO DE LA FALLA HEPÁTICA FULMINANTE: PROPUESTA DE PROTOCOLO EN CLÍNICA LAS CONDES. Revista Médica Clínica Las Condes 2019. [DOI: 10.1016/j.rmclc.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Uribe M, Uribe-Echevarría S, Mandiola C, Zapata MI, Riquelme F, Romanque P. Insight on ALPPS - Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy - mechanisms: activation of mTOR pathway. HPB (Oxford) 2018; 20:729-738. [PMID: 29571618 DOI: 10.1016/j.hpb.2018.02.636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND ALPPS procedure has been introduced to increase the volume of future liver remnant. The mechanisms underlying the accelerated regeneration observed with ALPPS are unknown. It was hypothesized that AMPK/mTOR is activated as an integrating pathway for metabolic signals leading to proliferation and cell growth. Our aim was to analyze increase in liver volume, proliferation parameters and expression of AMPK/mTOR pathway-related molecules in patients undergoing ALPPS. METHODS A single center prospective study of patients undergoing ALPPS was performed from 2013 to 2015. Liver and serum samples, clinical laboratory results and CT-scan data were obtained. ELISA, Ki-67 immunostaining and qRT-PCR were performed in deportalized and remnant liver tissue in both stages of the procedure. RESULTS 11 patients were enrolled. Remnant liver volume increased 112 ± 63% (p < 0.05) in 9.1 ± 1.6 days. Proliferation-related cytokines IL-6, TNF-α, HGF and EGF significantly increased, while higher Ki-67 immunostaining and cyclin D expression were observed in remnant livers after ALPPS. mTOR, S6K1, 4E-BP1, TSC1 and TSC2 expression were significantly increased in remnant livers at second stage, while AMPK and Akt increased only in deportalized liver samples. CONCLUSION Rapid liver regeneration with ALPPS might be associated with hepatocyte proliferation induced by mTOR pathway activation.
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Affiliation(s)
- Mario Uribe
- Department of Surgery, Hospital del Salvador, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sebastián Uribe-Echevarría
- Department of Surgery, Hospital del Salvador, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Carlos Mandiola
- Biomedical Sciences Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - María I Zapata
- Biomedical Sciences Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Francisco Riquelme
- Department of Surgery, Hospital del Salvador, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Pamela Romanque
- Biomedical Sciences Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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12
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Fluxá P, Rojas-Sepúlveda D, Gleisner MA, Tittarelli A, Villegas P, Tapia L, Rivera MT, López MN, Catán F, Uribe M, Salazar-Onfray F. High CD8 + and absence of Foxp3 + T lymphocytes infiltration in gallbladder tumors correlate with prolonged patients survival. BMC Cancer 2018; 18:243. [PMID: 29499656 PMCID: PMC5833069 DOI: 10.1186/s12885-018-4147-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/19/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gallbladder cancer (GBC), although infrequent in industrialized countries, has high incidence rates in certain world regions, being a leading cause of death among elderly Chilean women. Surgery is the only effective treatment, and a five-year survival rate of advanced-stage patients is less than 10%. Hence, exploring immunotherapy is relevant, although GBC immunogenicity is poorly understood. This study examined the relationship between the host immune response and GBC patient survival based on the presence of tumor-infiltrating lymphocytes at different disease stages. METHODS Tumor tissues from 80 GBC patients were analyzed by immunohistochemistry for the presence of CD3+, CD4+, CD8+, and Foxp3+ T cell populations, and the results were associated with clinical stage and patient survival. RESULTS The majority of tumor samples showed CD3+ T cell infiltration, which correlated with better prognosis, particularly in advanced disease stages. CD8+, but not CD4+, T cell infiltration correlated with improved survival, particularly in advanced disease stages. Interestingly, a < 1 CD4+/CD8+ T cell ratio was related with increased survival. Additionally, the presence of Foxp3+ T cells correlated with decreased patient survival, whereas a ≤ 1 Foxp3+/CD8+ T cell ratio was associated with improved patient survival. CONCLUSIONS Depending on the disease stage, the presence of CD8+ and absence of Foxp3+ T cell populations in tumor tissues correlated with improved GBC patient survival, and thus represent potential markers for prognosis and management of advanced disease, and supports testing of immunotherapy.
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Affiliation(s)
- Paula Fluxá
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
- Departamento de Cirugía Oriente, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Daniel Rojas-Sepúlveda
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - María Alejandra Gleisner
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Andrés Tittarelli
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Pablo Villegas
- Unidad de Anatomía Patológica, Hospital del Salvador, 7500922, Santiago, Chile
| | - Loreto Tapia
- Unidad de Anatomía Patológica, Hospital del Salvador, 7500922, Santiago, Chile
| | - María Teresa Rivera
- Unidad de Anatomía Patológica, Hospital del Salvador, 7500922, Santiago, Chile
| | - Mercedes Natalia López
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Felipe Catán
- Departamento de Cirugía Oriente, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Mario Uribe
- Departamento de Cirugía Oriente, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile
| | - Flavio Salazar-Onfray
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile.
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, 8380453, Santiago, Chile.
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Plascencia H, Díaz M, Moldauer BI, Uribe M, Skidmore E. Non-Surgical Endodontic Management of Type II Dens Invaginatus with Closed and Open Apex. Iran Endod J 2017; 12:534-539. [PMID: 29225655 DOI: 10.22037/iej.v12i3.10861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dens invaginatus (DI) is a developmental anomaly that poses a significant challenge to the clinician if endodontic treatment is required. The type II (as per Oehlers) form exhibits complex internal anatomy and is frequently associated with incomplete root and apex formation. The purpose of this study is to present two cases of type II DI in the maxillary lateral incisors. In the first case, non-surgical endodontic therapy was performed utilizing calcium hydroxide as an intracanal dressing, showing significant periapical healing of the apical radiolucent area at the six month follow-up. In the second case, the development of the root and apex were affected by pulp necrosis, and the revascularization procedure was performed. Complete resolution of the pre-existing apical radiolucency, apical closure, thickening of the root canal walls, and increase in root length, after 32 months was observed. Early detection of teeth with DI type II and proper exploration of their internal anatomy are key factors for their successful management. As demonstrated in this report, conservative non-surgical endodontic treatment should be the first line of treatment for these cases. The use of revascularization protocols in teeth that develop pulp necrosis and exhibit early stage of root development could be a better alternative than traditional apexification techniques.
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Affiliation(s)
- Hugo Plascencia
- Endodontic Postgraduate Program, CUCS-CUAltos, University of Guadalajara, México
| | - Mariana Díaz
- Endodontic Postgraduate Program, CUCS-CUAltos, University of Guadalajara, México
| | - Bertram Ivan Moldauer
- Adjunct Assistant Professor in Endodontics and Surgical Course Co-Director, Nova Southeastern University, College of Dental Medicine, Fort Lauderdale, Florida, USA
| | - Mario Uribe
- Endodontic Postgraduate Program, CUCS, University of Guadalajara, México
| | - Eddy Skidmore
- Department of Endodontics, Nova Southeastern Universitiy College of Dental Medicine, Fort Lauderdale, Florida, USA
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Gutiérrez-Grobe Y, Juárez-Hernández E, Sánchez-Jiménez B, Uribe-Ramos M, Ramos-Ostos M, Uribe M, Chávez-Tapia N. Less liver fibrosis in metabolically healthy compared with metabolically unhealthy obese patients with non-alcoholic fatty liver disease. Diabetes & Metabolism 2017; 43:332-337. [DOI: 10.1016/j.diabet.2017.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 02/07/2017] [Accepted: 02/15/2017] [Indexed: 12/14/2022]
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15
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Camargo JF, Tobón GJ, Fonseca N, Diaz JL, Uribe M, Molina F, Anaya JM. Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature. Lupus 2016; 14:315-20. [PMID: 15864918 DOI: 10.1191/0961203305lu2082oa] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU.
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Affiliation(s)
- J F Camargo
- Rheumatology Unit, Clínica Universitaria Bolivariana, Medellin, Colombia, South America
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16
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Stewart E, Wei R, Uribe M, May S, Amoaku W. Stimulation of TLR4 Increases Angiogenic and Anti-Angiogenic Gene Expression in Choroidal Endothelial Cells. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E. Stewart
- Academic Ophthalmology- Division of Clinical Neuroscience; University of Nottingham; Nottingham United Kingdom
| | - R. Wei
- Academic Ophthalmology- Division of Clinical Neuroscience; University of Nottingham; Nottingham United Kingdom
| | - M. Uribe
- Nottingham Arabidopsis Stock Centre- School of Biosciences; University of Nottingham; Nottingham United Kingdom
| | - S. May
- Nottingham Arabidopsis Stock Centre- School of Biosciences; University of Nottingham; Nottingham United Kingdom
| | - W. Amoaku
- Academic Ophthalmology- Division of Clinical Neuroscience; University of Nottingham; Nottingham United Kingdom
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17
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Uribe M, Alba A, Hunter B, González G, Godoy J, Ferrario M, Buckel E, Cavallieri S, Heine C, Rebolledo R, Auad H, Acuña C. Liver transplantation in children weighing less than 10 kg: Chilean experience. Transplant Proc 2014; 45:3731-3. [PMID: 24315011 DOI: 10.1016/j.transproceed.2013.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Orthotopic liver transplantation is the treatment of choice for most terminal liver diseases in children. In small children (≤ 10 kg), this procedure is challenging and has special considerations. The aim of this study is to describe the experience of a Chilean liver transplantation program in this subgroup of patients. METHODS The liver transplant database of Hospital Luis Calvo Mackenna and Clinica Las Condes was reviewed. All children less than 10 kg undergoing liver transplantation between January 1994 and July 2011 were included. Patient and graft outcomes and main complications were analyzed. RESULTS We have performed 230 pediatric liver transplantations, 49 of them in 41 patients weighing less than 10 kg. The first indication for transplantation was biliary atresia in 25 patients (61%). A living related donor was used in 23 cases (51%). Actuarial survival was 75.7% at 1 year and 67.1% at 5 years. The main cause of death was infection, and the leading cause of graft loss was vascular complication. DISCUSSION Our transplant program includes 2 centers that perform more than 90% of pediatric liver transplantations in Chile, including public health pediatric patients from all around the country. Patients weighing less than 10 kg represent the most challenging group in pediatric liver transplantation due to higher rates of vascular and biliary complications and postoperative infections.
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Affiliation(s)
- M Uribe
- Hospital Luis Calvo Mackenna, Santiago, Chile.
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18
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Uribe M, Alba A, González G, Hunter B, Heine C, Íñiguez R, Cavallieri S, Flores L, Soto P, Auad H, Zuleta R, Acuña C. Pediatric Liver Transplant Outcome Using Severe Hypernatremic Donors. Transplant Proc 2013; 45:3726-7. [DOI: 10.1016/j.transproceed.2013.08.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Alba A, Uribe M, Hunter B, Monzón P, Ferrada C, Heine C, Auad H. Health-related Quality of Life After Pediatric Liver Transplant: Single-Center Experience in Chile. Transplant Proc 2013; 45:3728-30. [DOI: 10.1016/j.transproceed.2013.08.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Martinez EA, Sanchez G, Lopez C, Baena A, Uribe M, Giraldo G, Quintero K. Human papillomavirus types in cases of squamous cell carcinoma of head and neck of colombia. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Sánchez-Valle V, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. Role of oxidative stress and molecular changes in liver fibrosis: a review. Curr Med Chem 2013; 19:4850-60. [PMID: 22709007 DOI: 10.2174/092986712803341520] [Citation(s) in RCA: 353] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/19/2012] [Accepted: 05/19/2012] [Indexed: 02/06/2023]
Abstract
Liver fibrosis represents a health problem with significant morbidity and mortality that affects 100 million people worldwide. It is a final pathway to several chronic liver diseases and is characterized by excess collagen and accumulation of extracellular matrix in response to chronic hepatocellular damage. Clinical and experimental data suggest that oxidative stress (OS) mediates the progression of fibrosis, and that OS-related molecules may act as mediators of molecular and cellular events implicated in liver fibrosis. The generation of reactive oxygen species (ROS) plays an important role in producing liver damage and initiating hepatic fibrogenesis. OS disrupts lipids, proteins and DNA, induces necrosis and apoptosis of hepatocytes and amplifies the inflammatory response. ROS also stimulate the production of profibrogenic mediators from Kupffer cells and circulating inflammatory cells and directly activate hepatic stellate cells, resulting in the initiation of fibrosis. Advances in understanding the mechanisms involved in fibrosis have identified new molecular targets with therapeutic potential for more targeted and personalized control of this disease. This review will highlight recent concepts in OS, antioxidants and the molecular pathways involved in hepatic fibrosis.
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Affiliation(s)
- V Sánchez-Valle
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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22
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J. Barbero-Becerra V, J. Santiago-Hernandez J, A. Villegas-Lopez F, Mendez-Sanchez N, Uribe M, C. Chavez-Tapia N. Mechanisms Involved in the Protective Effects of Metformin Against Nonalcoholic Fatty Liver Disease. Curr Med Chem 2012; 19:2918-23. [DOI: 10.2174/092986712800672094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/31/2012] [Accepted: 04/02/2012] [Indexed: 11/22/2022]
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Abstract
The species Rubus glaucus, also known as the Andean or "Castilla" blackberry, is one of nine edible species of this genus that grow naturally in Central and South America. In Colombia, this species is the most important of all Rubus species for agricultural and commercial purposes. We used 20 SSRs developed for other Rubus species to characterize 44 Colombian R. glaucus genotypes, collected from eight different departments, and to look for molecular differences between thornless and thorny cultivated blackberries. Eighty-two bands were obtained from 28 loci. The genotypes were classified into eight populations, corresponding to collection sites. The mean number of polymorphic alleles per locus in all populations and genotypes ranged from 1.857 to 2.393. Samples collected from Valle del Cauca, Quindío, Caldas, and Risaralda departments had the highest heterozygosity values. The finding of exclusive bands from R. glaucus genotypes from Valle del Cauca, Quindío, and Caldas demonstrates genetic and molecular differentiation between thorny and thornless Andean blackberries.
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Affiliation(s)
- M Marulanda
- Laboratorio de Biotecnología Vegetal, Facultad de Ciencias Ambientales, Universidad Tecnológica de Pereira, Pereira, Colombia.
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Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther 2011; 34:509-18. [PMID: 21707680 DOI: 10.1111/j.1365-2036.2011.04746.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. AIM To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. RESULTS Twelve trials (1241 patients) evaluating antibiotic prophylaxis against placebo or no antibiotic prophylaxis were included. Antibiotic prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63-0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19-0.97), bacterial infections (RR 0.35, 95% CI 0.26-0.47), rebleeding (RR 0.53, 95% CI 0.38-0.74) and days of hospitalisation (MD -1.91, 95% CI -3.80-0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. CONCLUSIONS Antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.
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Olaguíbel JM, Alvarez MJ, García B, Igartúa M, Uribe M. Inflammatory phenotypes in nonsmoking asthmatic patients. J Investig Allergol Clin Immunol 2011; 21:249-250. [PMID: 21548458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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26
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Uribe M, Alba A, Hunter B, Valverde C, Godoy J, Ferrario M, Buckel E, Cavallieri S, Rebolledo R, Herzog C, Calabrán L, Flores L, Soto P. Chilean experience in liver transplantation for acute liver failure in children. Transplant Proc 2010; 42:293-5. [PMID: 20172334 DOI: 10.1016/j.transproceed.2009.12.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results. PATIENTS AND METHODS Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted. RESULTS Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%. CONCLUSION We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.
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Affiliation(s)
- M Uribe
- Centro de Trasplante Clinica Las Condes and the Hospital Luis Calvo, Santiago, Chile.
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Zapata R, Uribe M, Martínez W, Andrade A, Leal JL, Gomez F. Severe novel H1N1 influenza A infection in the immediate postoperative period of a liver transplant patient. Liver Transpl 2010; 16:447-52. [PMID: 20205234 DOI: 10.1002/lt.22013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In 2009, the World Health Organization recognized the novel H1N1 influenza A virus as a pandemic infection. Since April 2009, thousands of cases of novel H1N1 influenza A infection have been reported worldwide, and they have resulted in thousands of deaths. South American countries were affected by this infection during their winter season, and Chile presented one of the highest incidence rates. We have recently managed a liver transplant patient who presented with a severe novel H1N1 influenza A infection in the early postoperative period and required prolonged mechanical ventilation. The early suspicion of this infection during the current pandemic influenza in Chile made possible a timely treatment with oseltamivir. We decided to report this case because no other cases of liver transplant patients affected by H1N1 influenza A have been reported so far. We intend to alert clinicians about this potentially devastating viral infection in view of the current pandemic scenario, and here we review some of the recommendations for its prevention, diagnosis, therapy, and possible complications.
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Affiliation(s)
- Rodrigo Zapata
- Liver Transplant Unit, University of Chile School of Medicine, Hospital del Salvador, Santiago, Chile.
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Gutiérrez-Grobe Y, Gavilanes-Espinar JG, Uribe M, Kobashi-Margáin RA, Méndez-Sánchez N. Pyloric gland adenoma: case report. Rev Gastroenterol Mex 2010; 75:360-362. [PMID: 20959193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pyloric gland adenoma (PGA), also called adenoma with gastric differentiation, is a rare neoplasm of the gastric mucosa that can appear as gastric heterotopia in several organs. A 49-year-old woman presented with gastric reflux and chronic elevation of liver enzymes. She had a history of type 2 diabetes mellitus, hypothyroidism and an unspecified allergy treated with deflazacor, and a family history of autoimmune diseases. A liver biopsy showed macro- and microvesicular steatohepatitis. Hepatitis B and virus serum tests were negative. Autoimmune hepatitis was suspected and investigated. As an evaluation for dyspeptic symptoms an upper gastrointestinal endoscopy was performed, showing diffuse gastroduodenitis. A few polyps were found and resected from the gastric fundus; histopathology revealed a pyloric gland adenoma. There is very few clinical data on this tumor type because it is frequently underdiagnosed and reported as dysplasia. Further research is needed on the pathophysiology of this disease.
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Affiliation(s)
- Y Gutiérrez-Grobe
- Liver Research Unit, Gastroenterology Department, Médica Sur Clinic and Foundation, Mexico City, Mexico
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Tanimoto MA, de la Mora-Levy JG, Uribe M. [Clinical images. Submucosa endoscopic dissection of poorly differentiated gastric signet cell adenocarcinoma]. Rev Gastroenterol Mex 2010; 75:187-188. [PMID: 20615788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- M A Tanimoto
- Departamento de Endoscopia, Instituto Nacional de Cancerología, México, D. F., Mexico.
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Uribe M, Adams S, Stringaris K, Chouchane L, Marincola F. 252-P: HLA and KIR in Tunisians with NPC. Hum Immunol 2009. [DOI: 10.1016/j.humimm.2009.09.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uribe M. The Annual Joint Chilean Congress of the Societies of Nephrology, Hypertension and Transplantation was held in Pucón, a city 800 kilometers south from Santiago, October 1 through 4, 2008. Preface. Transplant Proc 2009; 41:2651. [PMID: 19715993 DOI: 10.1016/j.transproceed.2009.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Castro L, Yarur A, Segovia R, Ponce R, Uribe M, Ferrario M, Buckel E, Iturriaga H. Fenómeno de acomodación inmunológica: Trasplante hepático ABO incompatible. Caso clínico. Rev Med Chil 2009. [DOI: 10.4067/s0034-98872009000800010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Castro L, Yarur A, Segovia R, Ponce R, Uribe M, Ferrario M, Buckel E, Iturriaga H. [Accomodation process: ABO-incompatible liver transplantation. Report of one case]. Rev Med Chil 2009; 137:1061-1065. [PMID: 19915771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accommodation opens the possibility of using ABO-incompatible organs as a definitive grafts.
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Affiliation(s)
- Lorena Castro
- Departamento de Medicina, Hospital San Borja-Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Yarur A, Castro L, Segovia R, Roblero JP, Uribe M, Ferrario M, Buckel E. [Small-for-size syndrome. Report of one case]. Rev Med Chil 2009; 137:918-922. [PMID: 19802420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.
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Affiliation(s)
- Andrés Yarur
- Departamento de Medicina, Hospital San Borja-Arriarán, Santiago de Chile
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Yarur A, Castro L, Segovia R, Roblero JP, Uribe M, Ferrario M, Buckel E. "Síndrome pequeño para su tamaño", (small-for-size), como complicación de un trasplante hepático con donante vivo adulto relacionado. Rev Med Chil 2009. [DOI: 10.4067/s0034-98872009000700009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dickson-Gonzalez S, Uribe M, Alfonzo R, Correnti M, Cavazza M, Rodriguez-Morales A. Prevalence of High-Grade Anal Intraepithelial Neoplasia (AIN) in Anal Lesions in HIV+Men Who Have Sex with Men (MSM) from a Venezuelan Private Medical Center. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Villagrán ME, Sánchez-Moreno M, Marín C, Uribe M, de la Cruz JJ, de Diego JA. Seroprevalence to Trypanosoma cruzi in rural communities of the state of Querétaro (Mexico): statistical evaluation of tests. Clin Biochem 2008; 42:12-6. [PMID: 19014924 DOI: 10.1016/j.clinbiochem.2008.09.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The detection of anti-Trypanosoma cruzi antibodies has become one of the priorities of the clinical establishments in the health sector, due both to the increase in positive cases found in transfusion centres as well as to the appearance of patients with characteristic Chagas cardiopathies that seek emergency treatment in the main hospitals of Querétaro (Mexico). DESIGN AND METHODS The present study seeks to establish for the first time the infection level of Trypanosoma cruzi, in the rural communities of this state and implement the preventive measures necessary to control and/or eradicate this infection. A transversal study was conducted, examining seriologically 1029 blood samples of the inhabitants of rural areas of the state of Querétaro, to detect anti-Trypanosoma cruzi antibodies. RESULTS The indirect serological diagnostic tests were indirect hemagglutination, enzymo-immunoenzymatic absorbent, recombinant ELISA, and indirect immunofluorescence. For the diagnostic evaluation of serological tests used, ELISA was considered the control test. CONCLUSIONS The first conclusion was that the two tests with the greatest serological reactivity were ELISA and recombinant ELISA, followed by IFA and IHA, respectively, with the final percentage of positives being 6.6%, far above the national mean of seroprevalence in Mexico (1.6%). On the other hand, the sensitivity, specificity, VP+, VP-, percentage of concordance and Kappa index of the recombinant ELISA tests, IFA, and IHA were determined against the control ELISA. It was found that ELISA and recombinant ELISA presented a greater sensitivity level, as well as the highest values for the different parameters studied.
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Affiliation(s)
- M E Villagrán
- Laboratorio de Tripanosomiasis Americana, Facultad de Química, UAQ, CHIVO I.S.S.S.T.E., México
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Uribe M, González G, Alba A, Godoy J, Ferrario M, Hunter B, Iñiguez R, Cavallieri S, Díaz V, Macho L, Ferrón S, Buckel E. Living Donor Liver Transplantation in Pediatric Patients With Acute Liver Failure: Safe and Effective Alternative. Transplant Proc 2008; 40:3253-5. [DOI: 10.1016/j.transproceed.2008.03.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hepp J, Zapata R, Buckel E, Martínez J, Uribe M, Díaz JC, Ferrario M, Sanhueza E, Pérez RM, Hunter B, Ríos G, Humeres R, Poniachik J, Oksenberg D, Arrese M. [General considerations, indications and contraindications for liver transplantation in Chile: a multicenter consensus development document]. Rev Med Chil 2008; 136:793-804. [PMID: 18769839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Liver transplantation is an excellent therapeutic option for terminal liver disease. During the last decades the results of liver transplantation have improved significantly with a patient survival rate of nearly 90% at one year and 80% at 5 years of follow-up. The main indications for liver transplantation include: end-stage liver disease associated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). The absolute contraindications for a transplant are less frequent than in the past, and include: severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepatic malignancy. This document presents a Consensus of the main groups performing liver transplantation in Chile, about its indications and contraindications. It also reviews general aspects of liver transplantation, including the selection and referral of liver transplant candidates, allocation of organs and the evaluation of severity of liver disease.
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Affiliation(s)
- Juan Hepp
- Unidad de Trasplante Hepático, Clínica Alemana de Santiago, Vitacura 5951, Santiago, Chile.
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Hepp J, Zapata R, Buckel E, Martínez J, Uribe M, Díaz JC, Ferrario M, Sanhueza E, Pérez RM, Hunter B, Ríos G, Humeres R, Poniachik J, Oksenberg D, Arrese M. Trasplante hepático en Chile: Aspectos generales, indicaciones y contraindicaciones (Documento de consenso). Rev Med Chil 2008. [DOI: 10.4067/s0034-98872008000600017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lizardi-Cervera J, Vázquez-Elizondo G, Becerra-Laparra I, Chávez-Tapia N, Noriega-Iriondo MF, Uribe M. [Comparative study of the clinical presentation and complications of acute colonic diverticulitis in patients older and younger than 65 years.]. Rev Gastroenterol Mex 2008; 73:153-158. [PMID: 19671502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIM Colonic diverticular disease has an incidence from 66 to 85% in population older than 65 years. Most of them remain asymptomatic;20% will be symptomatic and about 35%will present an episode of Acute Colonic Diverticulitis(ACD). To date, there are not studies to compare its presentation in elderly patients. The aim of this study was to compare the clinical presentation, diagnostic procedures, treatment and complications of acute colonic diverticulitis (ACD)in patients older and younger than 65 years. MATERIAL AND METHODS A retrospective review of patients diagnosed with ACD from January 2003 to May 2006. Exclusion criteria included patients with incomplete medical records and those who didn't complete the in hospital treatment. Demographic,clinical, laboratory, and radiological,prognostic variables as well as chosen treatment,presence of complications were evaluated. Descriptive and comparative statistic analysis was performed by the Fisher Exact Test for categorical variables and Student t-Test for continual variables considering a statistically significant difference for p <0.05. The analysis was made with SPSS/PC v12.0 software. RESULTS Of 126 patients, 69 were men and 57 women; 93 younger than 65 years and 33 older than 65 years. 20 patients were excluded by previously defined criteria. Significant statistical differences were found for presence of pain in the left inferior quadrant (73.2% vs. 48.5% p <0.01); mean hemoglobin level (14.6 vs. 13.2 g/dL p<0.01), presence of anemia (10.8% vs. 27.3% p <0.05) use of ultrasonography (24.7% vs. 6.1%,p < 0.05) and presence of hemorrhage (3.3% vs.21.3% p < 0.01) respectively. There was not mortality in the series. CONCLUSION This series demonstrates that elderly patients with ACD have a greater rate of lower gastrointestinal bleeding and greater degree of anemia than younger patients.
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Affiliation(s)
- J Lizardi-Cervera
- Departamento de Gastroenterología, Fundación Clínica Médica Sur. México.
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Gallardo-Wong I, Morán S, Rodríguez-Leal G, Castañeda-Romero B, Mera R, Poo J, Uribe M, Dehesa M. Prognostic value of 13C-phenylalanine breath test on predicting survival in patients with chronic liver failure. World J Gastroenterol 2007; 13:4579-85. [PMID: 17729409 PMCID: PMC4611830 DOI: 10.3748/wjg.v13.i34.4579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic value of percentage of 13C-phenylalanine oxidation (13C-PheOx) obtained by 13C-phenylalanine breath test (13C-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 13C-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 13C-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 13C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival.
CONCLUSION: Percentage of 13C-PheOx obtained by 13C-PheBT is a strong predictor of survival in patients with chronic liver disease.
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Affiliation(s)
- I Gallardo-Wong
- Laboratory of Gastrohepatology Research, Hospital de Pediatria, CMN, Siglo XXI, IMSS. Av Cuauhtemoc 330, Colonia Doctores, Delegacion Cuauhtemoc, Mexico
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Savani BN, Mielke S, Adams S, Uribe M, Rezvani K, Yong ASM, Zeilah J, Kurlander R, Srinivasan R, Childs R, Hensel N, Barrett AJ. Rapid natural killer cell recovery determines outcome after T-cell-depleted HLA-identical stem cell transplantation in patients with myeloid leukemias but not with acute lymphoblastic leukemia. Leukemia 2007; 21:2145-52. [PMID: 17673900 DOI: 10.1038/sj.leu.2404892] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Natural killer (NK) cells are the first lymphocytes to recover after allogeneic stem cell transplantation (SCT) and can exert powerful graft-versus-leukemia (GVL) effects determining transplant outcome. Conditions governing NK cell alloreactivity and the role of NK recovery in sibling SCT are not well defined. NK cells on day 30 post-transplant (NK30) were measured in 54 SCT recipients with leukemia and donor and recipient killer immunoglobulin-like receptor (KIR) genotype determined. In univariate analysis, donor KIR genes 2DL5A, 2DS1, 3DS1 (positive in 46%) and higher numbers of inhibitory donor KIR correlated with higher NK30 counts and were associated with improved transplant outcome. NK30 counts also correlated directly with the transplant CD34 cell dose and inversely with the CD3+ cell dose. In multivariate analysis, the NK30 emerged as the single independent determinant of transplant outcome. Patients with NK30 >150/microl had less relapse (HR 18.3, P=0.039), acute graft-versus-host disease (HR 3.2, P=0.03), non-relapse mortality (HR 10.7, P=0.028) and improved survival (HR 11.4, P=0.03). Results suggest that T cell-depleted SCT might be improved and the GVL effect enhanced by selecting donors with favorable KIR genotype, and by optimizing CD34 and CD3 doses.
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Affiliation(s)
- B N Savani
- Stem Cell Transplantation Section, Hematology Branch, National Institutes of Health, Bethesda, MD 20892-1202, USA
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Uribe M, Hunter B, González G, Jorquera M, Salazar G, Salas S, Ortíz B, Cavallieri S, Calabrán L, Campusano E. Family interactions of liver transplanted children: are they normal? Transplant Proc 2007; 39:615-6. [PMID: 17445558 DOI: 10.1016/j.transproceed.2006.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several psychosocial and behavioral problems have been reported in liver transplanted children. Most publications have focused on them, without considering their family environment. The aim of this study was to evaluate the interaction between liver transplanted children and their families, compared with a healthy control group. We selected liver transplanted children, between 8 and 12 years of age, with at least 6 months follow-up posttransplantation and in good clinical condition. Family structure also included 1 to 3 other children. Evaluable patients must have been living with their parents throughout the whole posttransplantation period. They were compared with a similar group of children without any chronic disease. A written informed consent was signed by both parents. All families were evaluated using a standard test consisting of different situations. The information was evaluated by 3 independent experts. Factors evaluated were limits (rules and limits of behavior), alliance-opposition (interaction between members to act), and hierarchy. Scoring was given to all observed acts. Statistical analysis was performed using chi-square tests with P < .05 considered significant. No statistical differences were found between groups in limits, alliance, and hierarchy. Our results showed that there were no differences in family structure and behavior between families of liver-transplanted and healthy children belonging to a similar socioeconomic level.
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Affiliation(s)
- M Uribe
- Liver Transplant Program, Hospital Luis Calvo Mackenna, Santiago, Chile.
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Uribe M, Buckel E, Ferrario M, Hunter B, Godoy J, González G, Cavallieri S, Iñiguez R, Calabrán L, Herzog C. Pediatric Liver Retransplantation: Indications and Outcome. Transplant Proc 2007; 39:609-11. [PMID: 17445556 DOI: 10.1016/j.transproceed.2006.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Liver transplantation is the only treatment for end-stage liver disease. Not all patients have a favorable outcome. Graft failure secondary to primary nonfunction, vascular complications, or chronic rejection among other problems may lead to retransplantation. Retransplantation represents 8% to 29% of liver transplantations in the pediatric population. The aim of this study was to present our experience with retransplanted children by analyzing the indications and the results. METHODS All patients were prospectively included in our database, including 125 children. We included the indications for retransplantation, complications, and mortality. Kaplan-Meier curves were used for survival analysis. RESULTS Since 1994, 125 patients were transplanted and 25 were retransplanted (20%), including 5 who received a third graft. Primary nonfunction represented 30% of the indications for retransplantation and hepatic artery thrombosis, 20%. Six of 25 patients who received a first retransplantation and 2 of 5 who received a second retransplantation died. The most frequent cause of death was multiorgans failure. The survivals at 1 and 5 years were 82% and 76% for children receiving a first retransplantation, and 60% at 1 and 5 years for those who received a second retransplantation. CONCLUSIONS Organ failure after liver transplantation was a common event in pediatric transplantation. Survival was similar between patients transplanted once and those who received one retransplantation. Survival decreased among patients who received a third graft but was maintained at 60%, which is better than most published results for first retransplanted patients. Retransplantation is a valid option with good results for selected pediatric cases.
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Affiliation(s)
- M Uribe
- Liver Transplant Program, Clínica Las Condes-Hospital Luis Calvo Mackenna, Santiago, Chile.
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Mendez-Sanchez N, Zamora-Valdes D, Pichardo-Bahena R, Barredo-Prieto B, Ponciano-Rodriguez G, Bermejo-Martínez L, Chavez-Tapia NC, Baptista-González HA, Uribe M. Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease. Liver Int 2007; 27:215-9. [PMID: 17311616 DOI: 10.1111/j.1478-3231.2006.01401.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIM Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes. AIM To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver. METHODS We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT-PCR in 26 frozen liver samples and the ratio CB2/beta-actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann-Whitney U-test. We considered as significant differences those with a P-value <0.05. RESULTS Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti-CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/beta-actin ratio of 0.001+/-0.01, steatosis 6.52+/-17.3 (P=0.05 vs normal) and NASH 6.49+/-12.2 (P=0.06 vs normal and P=0.6 vs steatosis). CONCLUSION CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.
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Affiliation(s)
- N Mendez-Sanchez
- Department of Biomedical Research, Gastroenterology & Liver Unit, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, Mexico.
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Fernández V, Castillo I, Tapia G, Romanque P, Uribe-Echevarría S, Uribe M, Cartier-Ugarte D, Santander G, Vial MT, Videla LA. Thyroid hormone preconditioning: protection against ischemia-reperfusion liver injury in the rat. Hepatology 2007; 45:170-7. [PMID: 17187421 DOI: 10.1002/hep.21476] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Recently, we reported that oxidative stress due to 3,3',5-triiodothyronine (T(3))-induced calorigenesis up-regulates the hepatic expression of mediators promoting cell protection. In this study, T(3) administration in rats (single dose of 0.1 mg/kg intraperitoneally) induced significant depletion of reduced liver glutathione (GSH), with higher protein oxidation, O(2) consumption, and Kupffer cell function (carbon phagocytosis and carbon-induced O(2) uptake). These changes occurred within a period of 36 hours of T(3) treatment in animals showing normal liver histology and lack of alteration in serum AST and ALT levels. Partial hepatic ischemia-reperfusion (IR) (1 h of ischemia via vascular clamping and 20 h reperfusion) led to 11-fold and 42-fold increases in serum AST and ALT levels, respectively, and significant changes in liver histology, with a 36% decrease in liver GSH content and a 133% increase in that of protein carbonyls. T(3) administration in a time window of 48 hours was substantially protective against hepatic IR injury, with a net 60% and 90% reduction in liver GSH depletion and protein oxidation induced by IR, respectively. Liver IR led to decreased DNA binding of nuclear factor-kappaB (NF-kappaB) (54%) and signal transducer and activator of transcription 3 (STAT3) (53%) (electromobility shift assay), with 50% diminution in the protein expression of haptoglobin (Western blot), changes that were normalized by T(3) preconditioning. CONCLUSION T(3) administration involving transient oxidative stress in the liver exerts significant protection against IR injury, a novel preconditioning maneuver that is associated with NF-kappaB and STAT3 activation and acute-phase response.
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Affiliation(s)
- Virginia Fernández
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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Uribe M. Anatomía funcional del hígado y su importancia en las resecciones hepáticas. Medwave 2006. [DOI: 10.5867/medwave.2006.08.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Méndez-Sánchez N, Chavez-Tapia NC, Zamora-Valdés D, Uribe M. Adiponectin, Structure, Function and Pathophysiological Implications in Non-Alcoholic Fatty Liver Disease. Mini Rev Med Chem 2006; 6:651-6. [PMID: 16787375 DOI: 10.2174/138955706777435689] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity is a major risk factor for the development of the metabolic syndrome, a cluster of diseases including insulin resistance, type 2 diabetes, dyslipidemia, hypertension, microalbuminuria, atherosclerosis, and non-alcoholic steatohepatitis. On the other hand, it is now generally accepted that adipose tissue acts as an endocrine organ producing a number of substances with an important role in the regulation of food intake, energy expenditure and a series of metabolic processes. Adiponectin is a recently discovered hormone produced exclusively by adipocytes. In fact, adiponectin is considered currently as a major factor in obesity-related insulin resistance and atherosclerosis. This new hormone differs from other adipocytokines in that its production and concentrations are actually decreased in insulin resistant subjects. The aim of this review is to summarize the current knowledge about the chemistry and physiology of adiponectin and to discuss its implications in the pathophysiology and potential treatment of insulin resistance and non-alcoholic fatty liver disease.
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Affiliation(s)
- N Méndez-Sánchez
- Liver Unit and Biomedical Research Department, Medica Sur Clinic and Foundation, Mexico City, Mexico.
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