Correlación entre la velocimetría Doppler de la vena porta y la escala de Child-Pugh en pacientes con cirrosis

“La hipertensión portal es la complicación más frecuente de la cirrosis y la primera causa de mortalidad asociada a dicha patología; recíprocamente, la cirrosis es responsable de un gran número de fallecimientos, representando la causa de muerte número 14 en todo el mundo. El aumento de la presión portal resulta de la obstrucción del flujo del sistema venoso correspondiente, como consecuencia de enfermedades hepáticas crónicas y trombosis de la vena porta. No obstante, existen otros trastornos de origen no cirrótico que cursan con hipertensión portal, que se explican fundamentalmente por el compromiso vascular del sistema portal. Una vez que la hipertensión portal se desarrolla, el compromiso intrahepático influencia los lechos vasculares extrahepáticos que aumentan los valores tensionales, al generar un síndrome de circulación hiperdinámica. En consecuencia, a todos los procesos de la dinámica vascular y sanguínea, se desarrollan várices esofágicas y otras complicaciones, que dan razón a la cirrosis hepática como la primera causa de hospitalización, muerte y trasplante hepático en el mundo. Actualmente se encuentran disponibles una serie de métodos diagnósticos para la evaluación de la hipertensión portal que influyen en la evaluación y seguimiento integral de los pacientes con hepatopatías crónicas y que finalmente prometen mejorar el pronóstico y la calidad de vida de ellos"

Mallado para simulaciones

Se dividieron los mallados en cinco tipos distintos debido a su método de generación: - Mallados estructurados - Mallados no estructurados - Mallados superficiales - Mallados multibloques - Mallados adaptativosCONACYT – Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Mallado para simulaciones

Comprender, cuantificar y analizar diferentes tipos de flujos mediante simulación numérica, identificando las cualidades y limitaciones de los diferentes simuladores hidráulicos a utilizar.CONACYT – Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Early alterations of B cells in patients with septic shock

Abstract Introduction It has recently been proposed that B lymphocytes are involved in sepsis pathogenesis. The goal of this study is to investigate potential abnormalities in a subset distribution and activation of circulating B lymphocytes in patients with septic shock. Methods This observational prospective study was conducted in a medical-surgical ICU. All patients with septic shock were eligible for inclusion. B-cell phenotypes (CD19+CD69+, CD19+CD23+, CD19+CD5+, CD19+CD80, CD19+CD86+, CD19+CD40 and CD19+CD95+) were assessed by quantitative flow cytometry upon admission to the ICU and 3, 7, 14 and 28 d later. Results Fifty-two patients were included. Thirty-six healthy volunteers matched for age and sex were used as controls. The patients had lymphopenia that was maintained during 28 d of follow-up. In patients with septic shock who died, the percentage of CD19+CD23+ was lower during the 7 d of follow-up than it was in survival patients. Moreover, the percentage of CD80+ and CD95+ expression on B cells was higher in patients who died than in survivors. Receiver operating characteristic curve analysis showed that a CD19+CD23+ value of 64.6% at ICU admission enabled discrimination between survivors and nonsurvivors with a sensitivity of 90.9% and a specificity of 80.0% (P = 0.0001). Conclusions Patients with septic shock who survive and those who don't have different patterns of abnormalities in circulating B lymphocytes. At ICU admission, a low percentage of CD23+ and a high of CD80+ and CD95+ on B cells were associated with increased mortality of patients with septic shock. Moreover, a drop in circulating B cells persisted during 28 d of ICU follow-up.This work was partially funded by grants from Fondo de Investigación de la Seguridad Social, Ministerio de Economia y Competitividad (MEC) (Spain), Consejeria de Educación, Comunidad de Madrid, MITIC-CM (S-2010/BMD-2502) and Instituto de Salud Carlos III, MEC (PI051871, CIBERehd).Peer Reviewe

A case report on choledochoduodenal fistula: how to suspect this unusual entity?

A choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum, which are associated with a history of problems in the common bile duct. It has appeared in 0.74% of patients submitted for biliary tract surgery. The most frequent symptoms of non-obstructive enteric biliary fistulas are: epigastric pain, cholangitis (80.91%), jaundice (54,.26%), fever (50.69%), nausea and/or vomiting (10.30%), abdominal distension (0.39%), asymptomatic (0.11%), and diarrhea (0.11%). Diagnostic imaging methods provide the data of greatest interest in revealing the presence of air in the bile duct. This method, as well as barium reflux under the biliary tree in contrasted studies and in ERCP, reveal the fistulous tract and its location. Neither the prevalence, nor the clinical characteristics that pertain to its presentation, are well known among our population. Possible treatments for this illness include conservative treatment with medication, endoscopic sphincterotomy, and surgical therapy

Fat Distribution and Differential Effects on Metabolic Liver Fat Infiltration in Young Mexicans in Reynosa, Mexico: A Collaborative Study across the U.S.-Mexico Border

Introduction: Metabolic-associated fatty liver disease (MAFLD) is a descriptive term for NAFLD (Non-alcoholic) physiopathology associated with obesity. The age of onset linked to body fat distribution is poorly studied. Therefore, we aimed to assess the body fat effect on liver fat infiltration and stiffness (LSt) mediated by insulin resistance (IR). Methods: After obtaining informed consent, five hundred freshmen from two universities in Reynosa, Mexico (UMAN & UAT) were enrolled in the study. They completed a questionnaire focused on familial cardiometabolic risk and provided anthropometric measurements. In a subset of N=200, we obtained blood samples for biochemical measurements, body fat percentage (BF%) by bioimpedance, LSt (kPa), and fat infiltration (Continued Attenuation Parameter, CAP) by elastography. We used mediation analysis with structural equation models (Stata v16.1) to determine the relationship between BMI, BF%, and abdominal obesity with IR and liver stiffness and fat infiltration. The term “-\u3e” means ‘explain’ or ‘cause’. Results: We found that AO-\u3eIR (standardized values b=0.53, p=0.005), AO-\u3eCAP (b=0.69, pIR (b=0.23, p=0.007). BMI did not have an effect on CAP or IR. Also, BMI-\u3eLS (b=0.47, p=0.05) but AO-\u3eLS was absent. Finally, there was a bidirectional relationship between LS and IR [LS-\u3eIR (b=0.18, p=0.001), and IR-\u3eLS (b=0.27, p=0.001)]. Conclusion: Our findings suggest the adipose tissue measured as AO or BMI showed different phenotypic effects on liver fat infiltration or stiffness. Visceral fat had a direct effect on IR, meanwhile, subcutaneous adipose tissue was associated with liver stiffness. Our findings suggest that early age interventions should be focused on reducing visceral fat deposition

Monocyte populations as markers of response to adalimumab plus MTX in rheumatoid arthritis

INTRODUCTION: The treatment of rheumatoid arthritis (RA) patients with anti-tumor necrosis factor alpha (TNFα) biological drugs has dramatically improved the prognosis of these patients. However, a third of the treated patients do not respond to this therapy. Thus, the search for biomarkers of clinical response to these agents is currently highly active. Our aim is to analyze the number and distribution of circulating monocytes, and of their CD14(+high)CD16(-), CD14(+high)CD16(+ )and CD14(+low)CD16(+ )subsets in methotrexate (MTX) non-responder patients with RA, and to determine their value in predicting the clinical response to adalimumab plus MTX treatment. METHODS: This prospective work investigated the number of circulating monocytes, and of their CD14(+high)CD16(-), CD14(+high)CD16(+ )and CD14(+low)CD16(+ )subsets, in 35 MTX non-responder patients with RA before and after three and six months of anti-TNFα treatment using multiparametric flow cytometry. The number of circulating monocytes in an age- and sex-matched healthy population was monitored as a control. RESULTS: Non-responder patients with RA show an increased number of monocytes and of their CD14(+high)CD16(-), CD14(+high)CD16(+ )and CD14(+low)CD16(+ )subsets after three months of adalimumab plus MTX treatment that remained significantly increased at six months. In contrast, significant normalization of the numbers of circulating monocytes was found in responders at three months of adalimumab plus MTX treatment that lasts up to six months. CX3CR1 expression is increased in monocytes in non-responders. At three months of anti-TNFα treatment the number of circulating monocytes and their subsets was associated with at least 80% sensitivity, 84% specificity and an 86% positive predictive value (PPV) in terms of discriminating between eventual early responders and non-responders. CONCLUSIONS: The absolute number of circulating monocytes and of their CD14(+high)CD16(-), CD14(+high)CD16(+ )and CD14(+low)CD16(+ )subsets at three months of adalimumab plus MTX treatment, have a predictive value (with high specificity and sensitivity) in terms of the clinical response after six months of anti-TNFα treatment in patients with RA

Randomized Clinical Trials of obesity treatments in Mexican population. Systematic Review and Meta-Analysis

Background: Mexicans and Mexican Americans share similar culture, genetic background, and predisposition for obesity and diabetes. Randomized clinical trials (RCT) assessing obesity treatments (ObT) are reliable to assess efficacy. To date, there is no systematic review to investigate ObT tested by RCT in Mexican adults. Methods: We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve ObT RCT from 1990 to 2019. The ObT included alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions. The analyzed RCT were at least three months of duration, and reported: BMI, weight, waist circumference, triglycerides, glucose and blood pressure. Results: We found 634 entries; after removal of duplicates and exclusions based on eligibility criteria, we analyzed 43 and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and did not have replications from other studies. The nutrition/behavioral interventions were difficult to blind, and most studies had medium to high risk of bias. Random effects meta-analysis of nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like plain water instead of sweet beverages decreased triglycerides and systolic blood pressure. Participants with obesity and hypertension had beneficial effects with antioxidants, and the treatment with insulin increased weight in those with T2D. Conclusions: The RCT’s in Mexico reported effects on metabolic components despite small sample sizes and lack of replication. In the future we should analyze ObT in population living on the U.S.-Mexico border; therefore, bi-national collaboration is desirable to disentangle cultural effects on ObT response

Random scenarios generation with minimun energy consumption model for sectoring optimization in pressurized irrigation networks using a simulated annealing approach

A pressurized irrigation network may operate in two ways, namely, on demand and organized under operating sectors. In the first case, the user decides when to irrigate, and the pumping station has to meet the discharge and pressure head requirements of the group of users that is demanding water at any time. In the second case, the operating hydrants at a given moment are previously established, which permits identification of scenarios related to lesser energy consumption. In this work, a new model was developed that identifies such scenarios. The optimization process is carried out by means of simulated annealing (SA). The model was applied to an example and the result obtained was compared with the same network operating on demand and sectorized using the criterion of hydrant elevation with respect to the pumping station. The scenario adopted for SA saved 11.8% and 15.5% in energy consumption compared with the two other scenarios, and decreased the installed power requirement by 38.3% and 21.6%, respectively.García Prats, A.; Guillem Picó, S.; Martínez Alzamora, F.; Jiménez Bello, MA. (2012). Random scenarios generation with minimun energy consumption model for sectoring optimization in pressurized irrigation networks using a simulated annealing approach. Journal of Irrigation and Drainage Engineering. 138(7):613-624. doi:10.1061/(ASCE)IR.1943-4774.0000452S613624138