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In recent decades, natural fibers have emerged as an alternative to synthetic fibers due to their renewable nature, lower environmental impact, and comparable strength properties. Agave bagasse, a byproduct of agave juice extraction in Mexico, stands out for its potential in various industrial applications, notably biocomposite production. Bagasse is rich in cellulose, along with hemicellulose and lignin. Cellulose is the most suitable to be converted into valuable products, and it is versatile, renewable, and biodegradable. An effective pre-treatment is crucial to enrich its fraction. This study aims to determine the optimal pre-treatment conditions for the agave bagasse. Three different pre-treatments were tested, acid (H2SO4), enzymatic (Cellic® HTec2 enzymatic preparation), and sequence of acid-enzymatic (sulfuric acid and Cellic® HTec2), to determine which pre-treatment got the optimal cellulose fraction increase. The acid pre-treatment was conducted over three time ranges (5, 10, and 15 min) at different acid concentrations (1%, 1.5%, and 2%). Enzymatic reactions were conducted over 24 h, testing three different enzyme concentrations (1.5%, 3%, 4.5%). The sequential pre-treatment utilized the optimal conditions derived from the acid experiments (1.5% H2SO4 for 10 min), followed by enzymatic reactions carried out over three different durations (6, 12, and 24 h). The findings revealed that a 1.5% acid concentration applied for 10 min was the most efficient pre-treatment method. This pre-treatment resulted in a 1.9-fold increase in the cellulose fraction while reducing hemicellulose content by 30%. The hemicellulose reduction was confirmed through Fourier Transform IR spectroscopy (FTIR) analysis, complemented by scanning electron microscopy (SEM) observations highlighting physical alterations in the fiber structure. Furthermore, thermogravimetric analysis (TGA) demonstrated improved thermal stability, suggesting potential use in biocomposites. Future research should evaluate the environmental impact of optimized pre-treatment methods for agave bagasse.

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Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.

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Blood extraction is extremely important for the development of scientific research; however, the existing methods for amphibian´s blood sampling are invasive, mainly leading to the euthanasia of the animal. Therefore, less intrusive methods that allow the obtention of multiple samples from the same individual, are needed as an alternative to the common methods available. Hence, the aim of this study was to propose a minimally invasive method for obtaining blood from the hind leg of Xenopus laevis, that allows continuous sampling without compromising the wellbeing of the organisms. With this method, it was possible to extract blood and plasma from adults and juveniles, and the amount of sample was enough to perform biochemical and molecular assays to assess the viability of the blood. The results also revealed that this method is a convenient alternative to obtain blood without affecting the welfare of the experimental organisms, avoiding the cull of the animals, and the samples are viable for their use in follow up studies.

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Bovines infected by bovine leukemia virus (BLV) are characterized by presenting low proviral load (LPL) or high proviral load (HPL). It is reported that animals with HPL in peripheral blood mononuclear cells (PBMCs) present a decrease in apoptosis, an increase in viability and the proliferation rate, while animals that maintain an LPL have an intrinsic ability to control the infection, presenting an increased apoptosis rate of their PBMCs. However, there is little information on the effect of BLV on these mechanisms when the virus infects somatic milk cells (SC). This study investigates the mechanisms underlying apoptosis in milk and blood from BLV-infected animals with HPL and LPL. Relative levels of mRNA of tumor necrosis factor-α (TNF-α), TNF receptor 1 (TNF-RI), TNF receptor 2 (TNF-RII), anti-apoptotic B-cell lymphoma 2 protein (Bcl-2), and pro-apoptotic Bcl-2-like protein 4 (Bax) were measured in SC and PBMCs using quantitative reverse transcription-polymerase chain reaction (RT-qPCR) assay. A significant decrease in the expression of TNF-α in SC from HPL animals vs non-infected bovines was observed, but the infection in SC with BLV did not show a modulation on the expression of TNF receptors. A significant increase in TNF-RI expression in PBMCs from HPL bovines compared to LPL bovines was observed. No significant differences in PBMCs between HPL and LPL compared to non-infected animals concerning TNF-α, TNF-RI, and TNF-RII expression were found. There was a significant increase of both Bcl-2 and Bax in SC from LPL compared to non-infected bovines, but the Bcl-2/Bax ratio showed an anti-apoptotic profile in LPL and HPL bovines compared to non-infected ones. Reduced mRNA expression levels of Bax were determined in the PBMCs from HPL compared to LPL subjects. In contrast, BLV-infected bovines did not differ significantly in the mRNA expression of Bax compared to non-infected bovines. Our data suggest that the increased mRNA expression of Bax corresponds to the late lactation state of bovine evaluated and the exacerbated increase of mRNA expression of Bcl-2 may be one of the mechanisms for the negative apoptosis regulation in the mammary gland induced by BLV infection. These results provide new insights into the mechanism of mammary cell death in HPL and LPL BLV-infected bovine mammary gland cells during lactation.

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Corncob (CC) based solar evaporators were employed to desalinize seawater brought from the Vallarta coast in Mexico. The pure CC produced an evaporation-rate and evaporation-efficiency of 0.63 kg m-2 h-1 and 38.4%, respectively, under natural solar light. Later, the CC was coated with carbonized CC (CCCE evaporator) or was coated with graphene (CCGE evaporator). Those evaporators were used for the desalination of seawater and obtained higher evaporation rates of 1.59-1.67 kg m-2 h-1, and higher evaporation efficiencies of 92-94% (under natural solar light). The desalination experiments were repeated under artificial solar light and the evaporation-rates/evaporation-efficiencies slightly decreased to 1.43-1.52 kg m-2 h-1/88-92%. The surface analysis of the evaporators by FTIR, XPS and Raman revealed that the CCGE evaporator had on its surface a lower content of defects and a higher amount of OH groups than the CCCE evaporator. Therefore, the CCGE evaporator had higher evaporation-rates/evaporation-efficiencies in comparison with the CCCE evaporator. Furthermore, we purified water contaminated with three different herbicides (fomesafen, 2-6 dichlorobenzamide and 4-chlorophenol at 30 ppm) by evaporation and using natural solar light. Interestingly, the CCCE and CCGE evaporators also removed the herbicides by physical adsorption with efficiencies of 12-22.5%. Moreover, the CCGE evaporator removed vegetable oil from contaminated water by adsorption and its maximum adsorption capacity was 1.72 g/g. Overall, our results demonstrated that the corncob-based evaporators studied here are a low-cost alternative to obtain clean water under natural solar light and this one was more effective for the desalination of seawater than the artificial sunlight (Xe lamp).

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Introducción. Blastocystis sp es un protozoo parásito que se encuentra en el tracto intestinal del hombre y algunos animales, se estima que infecta a más de 1.000 millones de personas en el mundo. El presente trabajo tuvo como Objetivo determinar los genotipos de Blastocystis sp asociados a diferentes fuentes de transmisión en zona rural del departamento del Quindío. Materiales y Métodos. Se obtuvieron 42 muestras coprológicas de niños entre 0 y 14 años, 17 de heces de animales, 17 de alimentos, 28 de superficies inertes ,15 de suelo, 18 de agua de red domiciliaria y 3 de fuente hídrica. Se realizó extracción de ADN y amplificación por PCR para Blastocystis sp usando como blanco el gen SSADNr. Las secuencias fueron alineadas con ClustalW y se realizaron árboles filogenéticos el programa (MEGA11). Resultados. De las 140 muestras recolectadas entre coprológicos de población infantil y matrices ambientales, se encontró una prevalencia de Blastocystis sp del 23,5 % en alimentos, 22,2% en red domiciliaria y del 4,75 % en la población infantil, no hubo evidencia estadística que implicara una asociación entre la presencia de este protozoo y las variables sociodemográficas. Se encontró el subtipo 2 asociado a población infantil y el subtipo 3 asociado a matrices ambientales (agua y alimentos) y población infantil. Conclusiones: Se reporta la presencia de Blastocystis sp en tomate y zanahoria, en la red domiciliaria y población infantil en una zona rural del departamento del Quindío donde los subtipos asociados fueron el subtipo 2 y 3.

Introduction. Blastocystis sp is a parasitic protozoan found in the intestinal tract of man and some animals, and it is estimated that it infects more than 1,000 million people in the world. In the national parasitism survey, it was reported with a prevalence of 52% in the northern Andean region. The aim of this study was to determine the genotypes of Blastocystis sp associated with different sources of transmission in rural areas of the department of Quindío. Materials and Methods. Forty-two coprological samples were obtained from children between 0 and 14 years of age, 17 from animal feces, 17 from food, 28 from inert surfaces, 15 from soil, 18 from household water and 3 from water sources. DNA extraction and PCR amplification were performed for Blastocystis sp using the SSADNr gene as target. The sequences were aligned with ClustalW and phylogenetic trees were performed with the program (MEGA11). Results. Of the 140 samples collected between coprological samples of children and environmental matrices, we found a prevalence of Blastocystis sp of 23.5% in food, 22.2% in the home network and 4.75% in the child population, there was no statistical evidence implying an association between the presence of this protozoan and sociodemographic variables. Subtype 2 was found associated with infant population and subtype 3 associated with environmental matrices (water and food) and infant population. Conclusions: We report the presence of Blastocystis sp in tomato and carrot, in the home network and infant population in a rural area of the department of Quindío where the associated subtypes were subtype 2 and 3.

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Plastic accumulation in the world amounts to approximately 8300 million tons. Polyurethanes (PU) account for 7.7 % of total plastics production worldwide, and their diverse chemical composition makes them highly recalcitrant to biodegradation. Several works have reported polyurethane-degrading microbial communities. However, it is still necessary to learn more about the chemical, biochemical, and genetic bases linked to the polyurethanolytic phenotype and the microbial taxonomic determinants responsible for metabolizing the PU polymer and its associated chemical additives. To shed light on this problem, we applied physical, chemical, biochemical, metagenomic, and bioinformatic analyses to explore the biodegradation capability and related biochemical and genetic determinants of the BP6 microbial community that can grow in PolyLack, a commercial coating containing a polyether polyurethane acrylate (PE-PU-A) copolymer and several additives, as sole carbon source. We observed complete additives (isopropanol, N-methyl-2-pyrrolidone, 2-butoxyethanol, alkyl glycol ethers) biodegradation and the appearance of released polymer components (toluene diisocyanate (TDI) and methylene diphenyl diisocyanate (MDI) derivatives), and multiple degradation products since early cultivation times. The Hi-C metagenomic analysis identified a complex microbiome with 35 deconvolved Metagenome-Assembled Genomes (MAGs) - several new species - and biodegradation markers that suggest the coexistence of hydrolytic, oxidative, and reductive metabolic strategies for degrading the additives and the PU copolymer. This work also provides evidence of the metabolic capability the BP6 community has for biodegrading polyether polyurethane foams. Based on these analyses, we propose a novel metabolic pathway for 4,4'-methylenedianiline (MDA), an initial biodegradation intermediate of MDI-based PU, encoded in the complex BP6 community metagenome and suggest that this community is a potential biotechnological tool for PU bio-recycling.

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Introduction: Spider venoms are a unique source of bioactive peptides, many of which display remarkable biological stability and neuroactivity. Phoneutria nigriventer, often referred to as the Brazilian wandering spider, banana spider or "armed" spider, is endemic to South America and amongst the most dangerous venomous spiders in the world. There are 4,000 envenomation accidents with P. nigriventer each year in Brazil, which can lead to symptoms including priapism, hypertension, blurred vision, sweating, and vomiting. In addition to its clinical relevance, P. nigriventer venom contains peptides that provide therapeutic effects in a range of disease models. Methods: In this study, we explored the neuroactivity and molecular diversity of P. nigriventer venom using fractionation-guided high-throughput cellular assays coupled to proteomics and multi-pharmacology activity to broaden the knowledge about this venom and its therapeutic potential and provide a proof-of-concept for an investigative pipeline to study spider-venom derived neuroactive peptides. We coupled proteomics with ion channel assays using a neuroblastoma cell line to identify venom compounds that modulate the activity of voltage-gated sodium and calcium channels, as well as the nicotinic acetylcholine receptor. Results: Our data revealed that P. nigriventer venom is highly complex compared to other neurotoxin-rich venoms and contains potent modulators of voltage-gated ion channels which were classified into four families of neuroactive peptides based on their activity and structures. In addition to the reported P. nigriventer neuroactive peptides, we identified at least 27 novel cysteine-rich venom peptides for which their activity and molecular target remains to be determined. Discussion: Our findings provide a platform for studying the bioactivity of known and novel neuroactive components in the venom of P. nigriventer and other spiders and suggest that our discovery pipeline can be used to identify ion channel-targeting venom peptides with potential as pharmacological tools and to drug leads.

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Resumen La proteína precursora del β- Amiloide (β-APP) es una glicoproteína de membrana y un componente habitual de las neuronas. Tiene funciones en el crecimiento y la adhesión celular tras un traumatismo. Es transportada mediante transporte rápido axonal anterógrado y se acumula dentro de las neuronas cuando se daña citoesqueleto. Este proceso es activo, es decir consume energía. El β-APP no es específico de los traumatismos. Se acumula en cualquier circunstancia en la que se dañen los axones, tal como la hipoxia, alteraciones metabólicas, y cualquier otra causa de edema cerebral y aumento de la presión intracraneal que puedan conducir a un daño axonal difuso (DAI) En el presente estudio estudiamos la expresión de esta proteína en casos de traumatismo cráneo-encefálico con diferente evolución cronológica El daño del citoesqueleto producido por la proteólisis, junto con la alteración de las quinasas y las fosfatasas, aumentan la permeabilidad de la membrana, lo que provoca la entrada de calcio en la célula que, a su vez, activa la calmodulina que hace que los neurofilamentos se compacten, los microtúbulos desaparezcan y se rompa la espectrina. Esta disrupción del citoesqueleto tiene como consecuencia que las sustancias que se transportan a su través, se acumulen, sobre todo en las zonas afectadas por el DAI. Al final de todo este proceso, los axones se rompen, lo que se conoce como axotomía secundaria. El estudio de la acumulación del β-APP es útil para valorar la extensión del DAI y para determinar el tiempo de supervivencia tras el traumatismo o cualquier otro daño cerebral.

Abstract β-Amyloid Precursor Protein (β-APP) is a membrane glycoprotein and a common component of neurons. It is involved in adhesion and cell growth processes after traumatic events. It is carried by anterograde fast axonal transport, and it accumulates inside neurons when the cytoskeleton is damaged. This is a vital biochemical process that consumes energy. β-APP is not specific of traumatic events. It accumulates in any case of axonal damage, whatever its cause may be, like hypoxia, metabolic disorders, and any other circumstances that lead to brain swelling and intracranial pressure rising and in consequence to Diffuse Axonal Injury (DAI). In this study we review the expression of this protein in cases of traumatic brain injury with different chronological evolution. The damage of cytoskeleton due to proteolysis in addition to the disturbance of kinases and phosphatases increase the permeability of the membrane. Calcium gets into the cell and activates calmodulin, thus neurofilaments compact, microtubules disappear and spectrin breaks. This disruption of the cytoskeleton has as consequence that the transported substances accumulate in the most affected areas by DAI. At the end of this process axon breaks, which is known as secondary axotomy. The study of the accumulation of β-APP is useful to assess the extent of DAI and to determine the time elapsed after trauma or another insult to CNS.

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Calodium hepaticum is a zoonotic nematode with a worldwide distribution. Although the host range of C. hepaticum includes a wide spectrum of mammals (including humans), this parasite is predominantly associated with the families Muridae and Cricetidae. Several Sigmodontinae species from Argentina were found to be infected by C. hepaticum, with a high prevalence in Akodon azarae. The present study focuses on C. hepaticum eggs from natural infection of three species of sigmodontine rodents from Argentina. Eggs were genetically characterized (intergenic 18S rRNA region). The objectives of this work are: (i) to propose a new analytical methodology; and (ii) to morphologically characterize C. hepaticum eggs, from three Sigmodontinae species (A. azarae, Calomys callidus and Oligoryzomys flavescens). Analyses were made by the Computer Image Analysis System based on the new standardized measurements and geometric morphometric tools. The resulting factor maps clearly illustrate global size differences in the parasite eggs from the three Sigmodontinae species analysed. The degree of similarity between egg populations was assessed through pairwise Mahalanobis distances, showing that the largest distances were detected between parasite eggs from C. callidus and O. flavescens. Herein, the phenotypical plasticity of C. hepaticum eggs is shown. Significant positive correlations were obtained between each egg parasite principal component 1 and rodent corporal characteristics: weight; liver weight; rodent length; and rodent body condition. The usefulness of the geometric morphometric analysis in studies of the relationship between C. hepaticum and its host must be highlighted. The high prevalence observed in A. azarae, associated with the wide size range of the parasite eggs evidenced by principal component analysis, suggests A. azarae to be the Sigmodontinae host species that plays the most important role as reservoir host for C. hepaticum in the New World.

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Recurrent positivity in a patient with COVID-19 may be due to various reasons, not necessarily reinfection. There is concern about the occurrence frequency of reinfection. Five databases and a preprint/preprint repository were searched. All case reports, case series, and observational studies were included. Bias was assessed for each study with the Newcastle-Ottawa Scale tool and reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA-2020). After eligibility, 77 studies were included for qualitative synthesis (52 case reports, 21 case series, and four case-controls; 1131 patients included). Of these, 16 studies described a second contact with the SARS-CoV-2 positive case, five studies described healthcare profession-related infection, ten studies described that the source of reinfection was likely to be from the community, one study described travel-related infection, nine studies described vulnerability-related infection due to comorbidity. The mean number of days from discharge or negative test to reinfection ranged from 23.3 to 57.6 days across the different included studies. The risk of bias for all case report/series studies was moderate/high. For observational studies, the risk of bias was low. Reinfection of patients with COVID-19 occurs between the first and second month after the first infection, but beyond, and 90 days have been proposed as a point to begin to consider it. The main factor for reinfection is contact with COVID-19 positive cases.

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Resumen La otitis media constituye una de las consultas médicas más comunes en la población infantil. Se caracteriza por la inflamación del oído medio en presencia de exudado en la cavidad timpánica, abarcando un amplio espectro de formas clínicas, dentro de las que destacan la otitis media aguda, con efusión y crónica. La hipoacusia de conducción es una de las complicaciones de la otitis media, por lo que es lógico pensar que algunas habilidades del lenguaje y cognición infantil podrían verse afectadas secundariamente. Sin embargo, la evidencia en torno al tema no es concluyente y se aprecian opiniones contrapuestas; asimismo, no existe actualmente una revisión de la literatura que agrupe las investigaciones existentes en torno al tema. Por ello, el presente estudio pretende identificar y analizar la evidencia científica disponible sobre el efecto de la otitis media en el desarrollo de la cognición y lenguaje infantil. Se realizó una revisión de la literatura guiada por protocolo PRISMA en bases de datos de acuerdo a términos claves. Fueron analizados 8 artículos que cumplieron con los criterios de inclusión. Los resultados recabados sugieren, por una parte, que la otitis media afecta el lenguaje en sus distintas dimensiones, el vocabulario comprensivo y la longitud media del enunciado; mientras que, por otra parte, no se encontró efecto directo de la otitis media o hipoacusia sobre la comprensión del lenguaje. Se concluye que las investigaciones analizadas presentan gran variabilidad de resultados y conclusiones. No existen reportes sobre su impacto en otros dominios de la cognición.

Abstract Otitis media is one of the most common medical consultations in children. It is characterized by inflammation of the middle ear in the presence of exudate in the tympanic cavity, covering a wide spectrum of clinical forms, among which acute otitis media, otitis media with effusion and chronic otitis media are the most outstanding. Conductive hearing loss is one of the complications of otitis media, so it is logical to think that some language and cognitive skills in children could be affected. However, the evidence on this matter is not conclusive and there are conflicting opinions; likewise, there is currently no review of the literature that compile the existing research on this topic. Therefore, the present study aims to identify and analyze the available scientific evidence on the effect of otitis media on the development of children's cognition and language. A review of the literature, guided by PRISMA protocol, was conducted in databases according to key terms. Eight articles that met the inclusion criteria were analyzed. The results suggest, on the one hand, that otitis media affects language in its different dimensions, comprehensive vocabulary and average sentence length; while on the other hand, no direct effect of otitis media or hearing loss on language comprehension was found. In is concluded that the research that were analyzed present great variability of results and conclusions. There are no reports on its impact on other domains of cognition.

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Full-thickness macular hole is a rare complication of macular telangiectasia type 2, and its treatment is still controversial. A patient with a full-thickness macular hole secondary to macular telangiectasia type 2 underwent vitreoretinal surgery with a plasma rich in growth factors membrane in the macular hole. At the sixth month of follow-up, anatomical and functional improvements were achieved, with no adverse effects. Plasma rich in growth factors is a new option, with advantages due to its biological properties that achieves good results in terms of safety and effectiveness in the surgical treatment of macular hole.

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Resumen La hiperacusia corresponde a la excesiva sensibilidad auditiva o intolerancia a ciertos sonidos cotidianos que para la mayoría de las personas parecerían habituales. Considerando los mecanismos fisiológicos involucrados en el origen de la hiperacusia, es lógico pensar que su presencia podría afectar algunas habilidades del procesamiento auditivo central, sin embargo, la evidencia en torno al tema es escasa y no existe actualmente una revisión de la literatura que agrupe las investigaciones sobre esta temática. Por ello, el presente estudio pretende identificar y analizar la evidencia científica disponible sobre la relación entre hiperacusia y desorden del procesamiento auditivo central. Se realizó una revisión de la literatura guiada por protocolo PRISMA en las bases de datos Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library y Scielo de acuerdo con términos claves. Fueron incluidos artículos originales de investigación, revisiones sistemáticas y metaanálisis, publicados desde el año 2010, realizados en animales y humanos, escritos en idiomas inglés, español y portugués. Se encontraron 323 estudios relacionados con los términos claves utilizados, de los cuales 13 cumplieron con los criterios de inclusión y fueron analizados. Se puede concluir que la evidencia científica en torno al tema es escasa e incipiente. Estructuras de la vía auditiva central como núcleos cocleares, lemnisco lateral, colículos inferiores, cuerpo geniculado medial y corteza auditiva primaria estarían relacionadas con la hiperacusia, así como también habilidades de procesamiento auditivo de figura/fondo, ordenación temporal y transferencia interhemisférica se verían afectadas.

Abstract Hyperacusis has been defined as the excessive auditory sensitivity or intolerance to certain everyday sounds that seem common for most people. Considering the underlying physiological mechanisms of hyperacusis, it is reasonable to think that it could affect some abilities involved in the central auditory processing. However, there is lack of evidence about this topic, and there is no literature review that gathers all the existing research. Therefore, the current study intends to identify and analyze the available scientific evidence regarding the relationship between hyperacusis and central auditory processing disorder. The review of the literature followed the PRISMA protocol, using key words in Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library and Scielo databases. Original research articles, systematic reviews and meta-analyses of studies made with human and animals that have been published since 2010 in English, Spanish and Portuguese were included. Among them, 323 studies were related to the key terms, out of which 13 met the inclusion criteria and were analyzed. It is possible to conclude that there is little and incipient scientific evidence on the topic. Structures of the central auditory pathway such as cochlear nuclei, lateral lemniscus, inferior colliculi, medial geniculate body and primary auditory cortex seem to be related to hyperacusis; auditory processing skills such as figure/ground discrimination, temporal ordering and interhemispheric transfer appear to be affected as well.

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The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

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INTRODUCTION: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. METHODS: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. RESULTS: Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. CONCLUSION: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.

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Introducción: El método de referencia para diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es la polisomnografía, esta no es diagnóstica en otros trastornos respiratorios del sueño, por lo que es necesario la implementación de puntajes predictivos para diferenciar aquellos pacientes que tienen más riesgos de padecer SAHOS y necesiten de una polisomnografía. El objetivo de este estudio fue validar el puntaje NoSAS y la escala de Berlín frente a la polisomnografía tipo 1 en pacientes con sospecha de SAHOS. Materiales y métodos: Estudio de pruebas diagnósticas. A 264 pacientes se les realizó una polisomnografía basal, la aplicación del puntaje NoSAS y la escala de Berlín; luego, se hizo el análisis de las pruebas diagnósticas y se calculó el rendimiento de cada una en relación con el índice de apnea hipopnea (IAH). Resultados: La sensibilidad del puntaje NoSAS para un IAH ≥ 20 fue 88,57% con intervalo de confianza (IC) 95% 80,4-96,74; especificidad 56,70 %; IC 95% 49,47-63,93 y valor predictivo negativo (VPN) de 93,22, IC 95% 91,70- 99,82. Para la escala de Berlín, la sensibilidad fue de 81,43%, IC 95% 71,60-91,25; especificidad de 58,76%, IC 95% 51,58-65,95 y VPN 89,76%, IC 95% 89,08-98,32. Conclusión: Se demostró que el puntaje NoSAS y la escala de Berlín tienen una buena sensibilidad para descartar a las personas con un menor riesgo de SAHOS. Un paciente clasificado de bajo riesgo probablemente está sano o tiene bajo riesgo para SAHOS moderado a severo y no requeriría de una polisomnografía inicial.

Introduction: The gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS) is the polysomnography, and it is not a diagnostic tool for another sleep breathing disorders, so that it is necessary to implement predictive scores to differentiate those patients who have more risk of suffering OSAHS, therefore they need a polysomnography. The aim to this study was to validate the NoSAS score and Berlin scale in relation to the polysomnography type 1, in patients who have the clinical suspicion of OSAHS. Material and methods: Diagnostic tests study. 264 patients underwent polysomnography, and the NoSAS score and Berlin scale were applied to them. After that, the diagnostic tests analysis was done and the performance of each one of them was calculated in relation to the apnea- hypopnea index (AHI). Results: The sensitivity of the NoSAS score for an AHI ≥ 20 was 88.57%, confidence interval (CI) 95% (80.4-96.74), specificity 56.70 %, CI 95% (49.47-63.93), and the negative predictive value (NPV) was 93.22, CI 95% (91.70-99.82). For Berlin scale the sensitivity was 81.43%, CI 95% (71.60-91.25), specificity 58.76%, CI 95% (51.58-65.95) and NPV 89.76%, CI 95% (89.08-98.32). Conclusions: It was shown that NoSAS score and Berlin scale have a good sensitivity to rule out people who have less OSAHS risk. A patient classified as low risk, probably is healthy or at low risk for moderate to severe OSAHS and would not require an initial polysomnography.

Assuntos

RESUMO

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

Assuntos

RESUMO

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.