Hepatic and Splenic Acoustic Radiation Force Impulse Shear Wave Velocity Elastography in Children with Liver Disease Associated with Cystic Fibrosis

Background. Liver disease associated with cystic fibrosis (CFLD) is the second cause of mortality in these patients. The diagnosis is difficult because none of the available tests are specific enough. Noninvasive elastographic techniques have been proven to be useful to diagnose hepatic fibrosis. Acoustic radiation force impulse (ARFI) imaging is an elastography imaging system. The purpose of the work was to study the utility of liver and spleen ARFI Imaging in the detection of CFLD. Method. 72 patients with cystic fibrosis (CF) were studied and received ARFI imaging in the liver and in the spleen. SWV values were compared with the values of 60 healthy controls. Results. Comparing the SWV values of CFLD with the control healthy group, values in the right lobe were higher in patients with CFLD. We found a SWV RHL cut-off value to detect CFLD of 1.27 m/s with a sensitivity of 56.5% and a specificity of 90.5%. CF patients were found to have higher SWC spleen values than the control group. Conclusions. ARFI shear wave elastography in the right hepatic lobe is a noninvasive technique useful to detect CFLD in our sample of patients. Splenic SWV values are higher in CF patients, without any clinical consequence

Gene signatures of early response to anti-TNF drugs in pediatric inflammatory bowel disease

T. Around a 20–30% of inflammatory bowel disease (IBD) patients are diagnosed before they are 18 years old. Anti-TNF drugs can induce and maintain remission in IBD, however, up to 30% of patients do not respond. The aim of the work was to identify markers that would predict an early response to anti-TNF drugs in pediatric patients with IBD. The study population included 43 patients aged <18 years with IBD who started treatment with infliximab or adalimumab. Patients were classified into primary responders (n = 27) and non-responders to anti-TNF therapy (n = 6). Response to treatment could not be analyzed in 10 patients. Response was defined as a decrease in over 15 points in the disease activity indexes from week 0 to week 10 of infliximab treatment or from week 0 to week 26 of adalimumab treatment. The expression profiles of nine genes in total RNA isolated from the whole-blood of pediatric IBD patients taken before biologic administration and after 2 weeks were analyzed using qPCR and the 2−∆∆Ct method. Before initiation and after 2 weeks of treatment the expression of SMAD7 was decreased in patients who were considered as non-responders (p value < 0.05). Changes in expression were also observed for TLR2 at T0 and T2, although that did not reach the level of statistical significance. In addition, the expression of DEFA5 decreased 1.75-fold during the first 2 weeks of anti-TNF treatment in responders, whereas no changes were observed in non-responders. Expression of the SMAD7 gene is a pharmacogenomic biomarker of early response to anti-TNF agents in pediatric IBD. TLR2 and DEFA5 need to be validated in larger studies.This work was funded by Instituto de Salud Carlos III (grants numbers PI16/00559 and PI19/00792), Consejería de Educación y Deporte de la Comunidad de Madrid (grant number PEJ16/MED/AI-1260), and by the Gregorio Marañón Health Research Institute (grant number PRE-2018-2), The study was cofunded by ERDF Funds (FEDER) from the European Commission, “A way of making Europe

Detección de marcadores precoces de enfermedad hepática asociada a fibrosis quística

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Fecha de lectura: 15 de Septiembre de 200

Estilo de vida de estudiantes de medicina chilenos durante la pandemia por covid-19: Lifestyle of chilean medical students during the covid-19 pandemic

Objective: To analyze the relationship of lifestyle and habits associated with health care and religiosity in Chilean Adventist medical students during the COVID-19 pandemic. Methods: Analytical and cross-sectional, census, non-experimental design. The population consisted of 72 Adventist medical students who attended or are in any year of the career in 2020 and 2021. The FANTASTIC instrument was applied, in its validated version, and an evaluation of habits associated with health care and religiosity. The work was approved by an ethics committee. Results: 55.6% are female. The mean age is 22.64. 43.1% of the students have some type of diet associated with vegetarianism. Tobacco use was not evidenced. 66.7% study the Bible and pray always or almost always. 77.8% of the students have a very good or fantastic lifestyle. When performing the Spearman correlation between the variable habits associated with health care and religiosity versus the total score of the FANTASTICO instrument, a statistically significant relationship is presented at the 0.01 level (p <0.00 r=0.48). Conclusions: Although some habits can be improved, in general most of the students have a very good lifestyle. It is appreciated that the scores of habits associated with health care and religiosity have a positive relationship with the scores obtained in the fantastic instrument.Objetivo: Determinar la correlación el estilo de vida y hábitos asociados al cuidado de la salud y religiosidad en estudiantes adventistas de medicina chilenos durante la pandemia por COVID-19. Métodos: Diseño de tipo analítico y de corte transversal, censal, no experimental. La población estuvo compuesta por 72 estudiantes de medicina de religión adventista que cursaron o cursan cualquier año de la carrera en 2020 y 2021. Se aplicó el instrumento FANTASTICO, en su versión validada y una evaluación de hábitos asociados al cuidado de la salud y religiosidad. El trabajo fue aprobado por un comité ético.  Resultados: Un 55,6% son de sexo femenino. La edad media es de 22,64. Un 43,1% de los estudiantes tiene algún tipo de alimentación asociada al vegetarianismo. No se evidenció consumo de tabaco. Un 66,7% estudia la Biblia y ora siempre o casi siempre. Un 77,8% de los estudiantes tiene un estilo de vida muy bueno o fantástico. Al realizar la correlación de Spearman entre la variable hábitos asociados al cuidado de la salud y religiosidad versus el puntaje total del instrumento FANTASTICO, se presenta una relación estadísticamente significativa en el nivel 0,01 (p<0,00 r=0,48). Conclusiones: A pesar de que algunos hábitos pueden ser mejorables, en general la mayoría de los estudiantes tiene un muy buen estilo de vida. Se aprecia que los puntajes de hábitos asociados al cuidado de la salud y religiosidad tienen relación positiva con los puntajes obtenidos en el instrumento fantástico

Esteatohepatitis no alcohólica y adenomatosis hepática: ¿asociación casual o causal?

RESUMEN La adenomatosis hepática es una enfermedad benigna definida por la aparición de múltiples adenomas en un hígado normal. Se trata de una entidad poco frecuente y de causa no conocida, de la que existen menos de un centenar de casos publicados en la literatura médica y que se ha relacionado con la toma de anticonceptivos orales o esteroides anabolizantes, con enfermedades por depósito y con mutaciones genéticas asociadas a la diabetes mellitus tipo MODY (maturity onset diabetes of the young). En los últimos años se ha comunicado la coexistencia de adenomatosis hepática con lesiones de esteatohepatitis no alcohólica en dos pacientes con síndrome metabólico, una asociación de interés por la creciente prevalencia de la enfermedad hepática grasa no alcohólica en los países desarrollados y por la posibilidad de que compartan un mecanismo causal. Comunicamos el caso de una mujer joven con fructosemia familiar y esteatosis hepática durante cuyo seguimiento aparecieron múltiples adenomas hepáticos asociados a lesiones de esteatohepatitis y discutimos el posible significado de dicha asociación

Hepatic and Splenic Acoustic Radiation Force Impulse Shear Wave Velocity Elastography in Children with Liver Disease Associated with Cystic Fibrosis

Background. Liver disease associated with cystic fibrosis (CFLD) is the second cause of mortality in these patients. The diagnosis is difficult because none of the available tests are specific enough. Noninvasive elastographic techniques have been proven to be useful to diagnose hepatic fibrosis. Acoustic radiation force impulse (ARFI) imaging is an elastography imaging system. The purpose of the work was to study the utility of liver and spleen ARFI Imaging in the detection of CFLD. Method. 72 patients with cystic fibrosis (CF) were studied and received ARFI imaging in the liver and in the spleen. SWV values were compared with the values of 60 healthy controls. Results. Comparing the SWV values of CFLD with the control healthy group, values in the right lobe were higher in patients with CFLD. We found a SWV RHL cut-off value to detect CFLD of 1.27 m/s with a sensitivity of 56.5% and a specificity of 90.5%. CF patients were found to have higher SWC spleen values than the control group. Conclusions. ARFI shear wave elastography in the right hepatic lobe is a noninvasive technique useful to detect CFLD in our sample of patients. Splenic SWV values are higher in CF patients, without any clinical consequence