Inhibición de la absorción intestinal de colesterol. Una nueva estrategia para el tratamiento médico de la litiasis biliar de colesterol

La litiasis biliar o colelitiasis es muy frecuente en los continentes Americano y Europeo. En los países de esos continentes la litiasis biliar puede representar un problema de salud pública debido la morbilidad que induce. Los cálculos biliares de colesterol son los más frecuentes en México y en países de occidente. Su fisiopatología es multifactorial, pero uno de los factores de riesgo más importantes es la dieta rica en colesterol, la cual puede inducir bilis litogénica. El ezetimibe inhibe la absorción de colesterol de la dieta a nivel intestinal. En esta breve revisión abordaremos los mecanismos de producción de bilis litogénica y su inhibición mediante ezetimibe, la cual puede ser considerada como una nueva estrategia para tratar y prevenir la litiasis biliar de colesterol

Nuclear Receptors in Nonalcoholic Fatty Liver Disease

Nuclear receptors comprise a superfamily of ligand-activated transcription factors that are involved in important aspects of hepatic physiology and pathophysiology. There are about 48 nuclear receptors in the human. These nuclear receptors are regulators of many hepatic processes including hepatic lipid and glucose metabolism, bile acid homeostasis, drug detoxification, inflammation, regeneration, fibrosis, and tumor formation. Some of these receptors are sensitive to the levels of molecules that control lipid metabolism including fatty acids, oxysterols, and lipophilic molecules. These receptors direct such molecules to the transcriptional networks and may play roles in the pathogenesis and treatment of nonalcoholic fatty liver disease. Understanding the mechanisms underlying the involvement of nuclear receptors in the pathogenesis of nonalcoholic fatty liver disease may offer targets for the development of new treatments for this liver disease

The impact of the COVID-19 pandemic on patients with chronic liver disease: Results from the Global Liver Registry

Patients with preexisting chronic liver disease (CLD) may experience a substantial burden from both coronavirus 2019 (COVID-19) infection and pandemic-related life disruption. We assessed the impact of the COVID-19 pandemic on patients with CLD. Patients enrolled in our Global Liver Registry were invited to complete a COVID-19 survey. As of June 2021, 2500 patients (mean age ± SD, 49 ± 13 years; 53% men) from seven countries completed the survey. Of all survey completers, 9.3% had COVID-19. Of these patients, 19% were hospitalized, 13% needed oxygen support, but none required mechanical ventilation. Of all patients including those not infected with COVID-19, 11.3% reported that the pandemic had an impact on their liver disease, with 73% of those reporting delays in follow-up care. The Life Disruption Event Perception questionnaire confirmed worsening in at least one area (food/nutrition, exercise, social life, vocation/education, financial situation, housing, or health care) in 81% and 69% of patients with and without a history of COVID-19, respectively (p = 0.0001). On a self-assessed Likert health score scale (range, 1-10; 10 indicates perfect health), patients with a COVID-19 history scored lower (mean ± SD, 6.7 ± 2.2 vs. 7.4 ± 2.2, respectively; p \u3c 0.0001) despite reporting similar health scores if there was no pandemic (mean ± SD, 8.5 ± 1.4 vs. 8.4 ± 1.6, respectively; p = 0.59). After adjustment for country of enrollment, liver disease etiology and severity, age, sex, body mass index, diabetes, and history of psychiatric comorbidities, COVID-19 was found to be independently associated with lower self-assessed health scores (beta = -0.71 ± 0.14; p \u3c 0.0001). The COVID-19 pandemic resulted in a substantial burden on the daily life of patients with CLD

Nuclear receptors in nonalcoholic Fatty liver disease

Nuclear receptors comprise a superfamily of ligand-activated transcription factors that are involved in important aspects of hepatic physiology and pathophysiology. There are about 48 nuclear receptors in the human. These nuclear receptors are regulators of many hepatic processes including hepatic lipid and glucose metabolism, bile acid homeostasis, drug detoxification, inflammation, regeneration, fibrosis, and tumor formation. Some of these receptors are sensitive to the levels of molecules that control lipid metabolism including fatty acids, oxysterols, and lipophilic molecules. These receptors direct such molecules to the transcriptional networks and may play roles in the pathogenesis and treatment of nonalcoholic fatty liver disease. Understanding the mechanisms underlying the involvement of nuclear receptors in the pathogenesis of nonalcoholic fatty liver disease may offer targets for the development of new treatments for this liver disease

thrombosis of the portal venous system in cirrhotic patients

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Formation of engineering thinking at school during the lesson-game "solar system"

This paper describes the structure, conduct, and the main stages of the interdisciplinary lesson-game. Some data on the principles of educational technology are given. Methodical recommendations for conducting the lesson, as well as examples of didactic tasks are given. The proposed lesson carries the task - to build a model of the solar system. But this is not a simple design and construction but a deep didactic analysis. The results will be the construction of a model of the solar system, as a result of the application of engineering thinking skills in life, as well as the transfer of the project modeling algorithm from theory to practice

Lean non-alcoholic fatty liver disease patients from the global NASH registry

Background and aims: Although vast majority of patients with NAFLD are overweight and obese, NAFLD can be seen among lean individuals. The aim was to assess prevalence of lean NAFLD in different regions of the world. Method: The Global NASH Registry enrolled patients with an established diagnosis of NAFLD from real-world practices in 18 countries (Australia, China, Cuba, Egypt, Greece, Hong Kong, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Pakistan, Russia, Spain, Taiwan, Turkey, USA) in 6 out of 7 Global Burden of Disease (GBD) super-regions. Clinical and patient-reported outcomes (PRO) data (CLDQ-NASH, FACIT-F,WPAI) were collected. Lean NAFLD was defined as NAFLD in patients with BMI/m2, or 23 kg/m2 for patients of East Asian origin. Results: There were 6096 NAFLD patients included (as of November 10, 2021): 48% from High-Income super-region, 24% Middle East and North Africa (MENA), 12% Southeast Asia, 7% Latin America, 6% from Eastern Europe and Central Asia, and 3% South Asia super-region. Of these, 7.3% were lean. The rates of lean NAFLD were the highest in Southeast Asia (12%) and South Asia (31%), the lowest in Eastern Europe and Central Asia ( Conclusion: Lean NAFLD patients seen in real-world practices across the world have different clinical and PRO profiles in comparison to NAFLD patients who are overweight or obese

Use of albumin infusion for cirrhosis-related complications: An international position statement

BACKGROUND & AIMS: Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy. METHODS: Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications. RESULTS: Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion. CONCLUSIONS: Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated. IMPACT AND IMPLICATIONS: Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion

Severe impairment of patient-reported outcomes in patients with chronic hepatitis C virus infection seen in real-world practices across the world: Data from the global liver registry

Cure of chronic hepatitis C (CHC) can lead to improvement of health-related quality of life and other patient-reported outcomes (PROs). While extensive PRO data for CHC patients who were enrolled in clinical trials are available, similar data for patients seen in real-world practices are scarce. Our aim was to assess PROs of CHC patients enrolled from real-world practices from different regions and to compare them with those enrolled in clinical trials. CHC patients seen in clinical practices and not receiving treatment were enrolled in the Global Liver Registry (GLR). Clinical and PRO (FACIT-F, CLDQ-HCV, WPAI) data were collected and compared with the baseline data from CHC patients enrolled in clinical trials. N = 12,171 CHC patients were included (GLR n = 3146, clinical trial subjects n = 9025). Patients were from 30 countries from 6 out of 7 Global Burden of Disease (GBD) super-regions. Compared with clinical trial enrollees, patients from GLR were less commonly enrolled from High-Income GBD super-region, older, more commonly female, less employed, had more type 2 diabetes, anxiety and clinically overt fatigue but less cirrhosis (all p  0.05). In conclusion, hepatitis C patients seen in the real-world practices have PRO impairment driven by fatigue and psychiatric comorbidities.Peer reviewe