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clinical heterogeneity in autoimmune acute liver failure

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World Journal of Gastroenterology 2007年第12期13卷 1824-1827页

作者： norberto c chavez-tapia Julio Martinez-Salgado Julio Granados Misael Uribe Felix I Tellez-Avila Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City MexicoJulio Granados Department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico Department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico

AIM: To describe the outcome and prognosis in a cohort of patients with acute liver failure due to autoimmune hepatitis without liver transplantation. METHODS: A retrospective trial was conducted in 11 patients with acute liver failure due to autoimmune hepatitis who attended the Instituto Nacional de ciencias Médicas y Nutrición Salvador Zubiran. Demographic, biochemical and severity indexes, and treatment and outcome were assessed. RESULTS: Among the 11 patients, with a median age of 31 years, 72% had inflammatory response syndrome, and six patients received corticosteroids. The mortality rate within four weeks was 56%, and the one-year survival was 27%. In the survivors, severity indexes were lower and 83% received corticosteroids. cONcLUSION: We observed a relatively high survival rate in patients with acute liver failure due to autoimmune hepatitis. This survival rate could be influenced by severity of the disease and/or use of corticosteroids.

关键词： Autoimmune hepatitis Acute liver failure corticosteroids

Smoking is not associated with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2006年第32期12卷 5196-5200页

作者： norberto c chavez-tapia Javier Lizardi-cervera Oliver Perez-Bautista Martha H Ramos-Ostos Misael Uribe Departments of Gastroenterology and Internal Medicine. Medica Sur clinic and Foundation Mexico city Mexico

AIM： To analyze the relationship between smoking and nonalcoholic fatty liver disease （NAFLD）. METHODS： This is a cross-sectional study of a healthy population, carried out in a check-up unit of a university hospital in Mexico city. We enrolled 933 subjects, 368 current smokers （cases） and 565 persons who had never smoked （controls）. Demographic, metabolic and biochemical variables were measured in the two groups. NAFLD was determined by ultrasound and metabolic syndrome according to ATPⅢ. RESULTS： A total of 548 men （205 cases and 343 controls） and 337 women （114 cases and 223 controls） were included in the analysis. Statistical differences between cases and controls were observed only in high blood pressure prevalence （6.6% vs 11.3%, P〈0.05; cases and controls respectively）, high-density lipoproteins （1.00±0.26 vs 1.06±0.28 mmol/L, P 〈 0.005）, triglycerides （2.18±1.49 vs 1.84±1.1 mmol/L, P〈0.001）, and erythrocyte sedimentation rate （11.3±9.3 vs 13.5±11.9 mm/h, P〈0.001）. No differences were observed in the prevalence of NAFLD （22.27% vs 29.68%, P = NS） and metabolic syndrome （41.69% vs 36.74%, P = NS）. Univariate analysis showed that smoking was not a risk factor for NAFLD （OR = 0.89, 95% cI 0.65-1.21）. cONcLUSION： No differences in NAFLD prevalence were observed between current smokers and nonsmokers, and furthermore, no differences were observed in heavy smokers （more than 20 packs/year）, indicating that there js no relationship between smoking and NAFLD.

关键词： Smoking Nonalcoholic fatty liver disease Metabolic syndrome

Insulin sensitizers in treatment of nonalcoholic fatty liver disease:Systematic review

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World Journal of Gastroenterology 2006年第48期12卷 7826-7831页

作者： norberto c chavez-tapia Tonatiuh Barrientos-Gutierrez Felix I Tellez-ávila Francisco Sánchez-ávila Maria Antonieta Montao-Reyes Misael Uribe Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Zalvador Zubirán Mexico City Mexico The University of Texas School of Public Health Houston United States Instituto de Educación Media Superior Mexico City Mexico

AIM: To summarize the evidence available for the clinical effectiveness of insulin sensitizers in the treatment of nonalcoholic fatty liver disease (NAFLD) systematically. METHODS: Relevant articles were located using computer-assisted searches of Medline (1966-March 2006), EMBASE (1988-March 2006), cINAHL (1982-March 2003), Educational Resource Information center (1966-March 2006), Library, Information Science & Technology Abstracts (1967-March 2006), cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (1994-2006), dissertations in ProQuest and FirstSearch databases. Manual searches were made in the abstracts from meetings of the American Gastroenterological Association (1999-2006), and the American Association for the Study of Liver Diseases (2003-2005). Studies were retrieved using the following selection criteria: (1) clinical trials using insulin sensitizers in subjects with NAFLD, (2) adult patients, (3) published as full manuscripts or abstracts, and (4) English, Spanish, German, and French languages only. Data were abstracted independently by two reviewers following standardized procedures. A face-to- face comparison of data was conducted to ensure the completeness and reliability of the abstraction process. RESULTS: Nine studies were included, six using metformin and three using thiazolidinediones. Only two studies were placebo-controlled trials. The mediansample size for all studies was 18 subjects. In the placebo-controlled trials, metformin improved insulin resistance markers and liver function tests, but not histological scores. In the single-arm trials, metformin and thiazolidinediones improved insulin resistance markers and liver function tests, and beneficial histological changes were reported. There is limited high-quality information available from which to draw categorical conclusions about the clinical use of insulin sensitizers in ***: current information indicates that the use of insulin sensitizers

关键词： Steatohepatitis Evidence based medicine Systematic review

PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis

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World Journal of Gastroenterology 2010年第46期16卷 5869-5873页

作者： Mauricio Garcia-Saenz-de-Sicilia Francisco Sanchez-Avila norberto c chavez-tapia Gustavo Lopez-Arce Sandra Garcia-Osogobio Roberto Ruiz-cordero Felix I Tellez-Avila Department of Gastroenterology Instituto Nacional de Ciencias Medicas y Nutrición Salvador ZubiranMexico CityMexico Medica Sur clinic and Fundation Endoscopy Department Instituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico City14000Mexico

AIM:To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal ***:Patients with cirrhosis and endoscopic findings related to portal hypertension,receiving or not receiving proton pump inhibitor (PPI) therapy,were included *** assigned patients to two groups:group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI ***:One hundred and five patients with a median age of 58 (26-87) years were included,57 (54.3%) of which were *** varices were found in 82 (78%) patients,portal hypertensive gastropathy in 72 (68.6%) patients,and gastric varices in 15 (14.3%) *** therapy was used in 45.5% of patients (n=48).Seventeen (16.1%) patients presented with upper gastrointestinal bleeding;in 14/17 (82.3%) patients,bleeding was secondary to esophageal varices,and in 3/17 patients bleeding was attributed to portal hypertensive *** related to portal hypertension according to PPI therapy occurred in 18.7% (n=9) of group 1 and in 14% (n=8) of group 2 (odds ratio:0.83,95% confidence interval:0.5-1.3,P=0.51).cONcLUSION:Portal hypertension bleeding is not associated with PPI *** findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.

关键词： Drug prescription Liver cirrhosis Portal hypertension Proton pump inhibitors Upper gastrointestinal bleeding

Metabolic syndrome as a risk factor for gallstone disease

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World Journal of Gastroenterology 2005年第11期11卷 1653-1657页

作者： Nahum Méndez-Sánchez norberto c. chavez-tapia Daniel Motola-Kuba Karla Sanchez-Lara Guadalupe Ponciano-Rodríguez Héctor Baptista Martha H. Ramos Misael Uribe Departments of Biomedical Research and Gastroenterology and Liver Unit

AIM: To establish an association between the presence of metabolic syndrome and the development of gallstone disease. METHODS: We carried out a cross-sectional study in a check-up unit in a university hospital in Mexico city. We enrolled 245 subjects, comprising 65 subjects with gallstones (36 women, 29 men) and 180 controls (79 women and 101 men without gallstones). Body mass index, waist circumference, blood pressure, plasma insulin, and serum lipids and lipoproteins levels were measured. Insulin resistance was calculated by homeostasis model assessment. Unconditional logistic regression analysis (univariate and multivariate) was used to calculate the risk of gallstone disease associated with the presence of at least three of the criteria (Adult Treatment Panel Ⅲ). Analyses were adjusted for age and sex. RESULTS: Among 245 subjects, metabolic syndrome was present in 40% of gallstone disease subjects, compared with 17.2% of the controls, adjusted by age and gender (odds ratio (OR) = 2.79; 95%cI, 1.46-5.33; P= 0.002), a dose-dependent effect was observed with each component of metabolic syndrome (OR=2.36, 95%cI, 0.72-7.71; P= 0.16 with one component and OR = 5.54, 95%cI, 1.35-22.74; P = 0.02 with four components of metabolic syndrome). Homeostasis model assessment was significantly associated with gallstone disease (adjusted OR = 2.25; 95%cI, 1.08-4.69; P= 0.03). cONcLUSION: We conclude that as for cardiovascular disease and diabetes mellitus, gallstone disease appears to be strongly associated with metabolic syndrome.

关键词： Obesity Metabolic syndrome Gallstones Insulin resistance

Serum leptin levels and insulin resistance are associated with gallstone disease in overweight subjects

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World Journal of Gastroenterology 2005年第39期11卷 6182-6187页

作者： Nahum Méndez-Sánchez Luisa B Bermejo-Martínez Yolanda Vi(n|~)als norberto c chavez-tapia Irina Vander Graff Guadalupe Ponciano-Rodríguez Martha H Ramos Misael Uribe Departments of Biomedical Research and Gastroenterology and Liver Unit Medica Sur clinic and Foundation Mexico CityMexico clinical Research center National Institute of Perinatology.Mexico city Mexico Departments of Biomedical Research and Gastroenterology and Livei Unit Medica Sur clinic and Foundation Mexico CityMexico Faculty of Medicine National Autonomous University of Mexico (UNAM).Mexico city Mexico

AIM: To establish an association between the serum leptin levels and the development of gallstone disease (GD).METHODS: We carried out a non-matched case-controlled study in a university hospital in Mexico city. Two hundred and eighty-seven subjects were included: 97 cases with gallstones and 190 controls. Body mass index (BMI), fasting plasma leptin, insulin, serum lipid, and lipoprotein levels were measured. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Unconditional logistic regression analysis (univariate and multivariate)stratified by BMI was used to calculate the risk of ***: The multivariate conditional regression analysis revealed a model for those patients with BMI ＜30. The selected variables in the model were HOMA-IR index with OR = 1.31, P= 0.02 and leptin higher than median with OR = 2.11, P= 0.05. In the stratum of BMI ≥30, we did not find a useful ***: We concluded that insulin resistance and the development of GD appears to be associated with serum leptin levels in subjects with overweight, but not in obese subjects with similar metabolic profiles.

关键词： Obesity Leptin Gallstones, cholesterol Insulin resistance

Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis

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World Journal of Gastroenterology 2008年第30期14卷 4771-4775页

作者： Felix I Tellez-Avila Francisco Sanchez-Avila Mauricio García-Saenz-de-Sicilia norberto c chavez-tapia Ada M Franco-Guzman Gustavo Lopez-Arce Eduardo cerda-contreras Misael Uribe Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (cc) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with cc, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis c, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with cc were analyzed. Disease controls consisted of 81 patients with chronic hepatitis c, 33 with alcohol abuse and 20 with AIH. The median age of patients with cc was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were child A, 65 (48.5%) child B, and 16 (11.9%) were child c cirrhosis. The prevalence of MS (29.1% vs 6%; P cc patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. cONcLUSION: The prevalence of MS, obesityand T2DM were higher in patients with cc than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in cc.

关键词： cryptogenic chronic hepatitis Metabolic syndrome Obesity Diabetes mellitus

Very-early-stage Hepatocellular carcinoma,Are We at Long Last on Route for Achieving Better Patient Outcomes?

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Journal of clinical and Translational Hepatology 2021年第2期9卷 141-142页

作者： Paulina Vidal-cevallos norberto chavez-tapia Obesity and Digestive Disease Unit Medica Sur Clinic and FoundationMexico CityMexico

Hepatocellular carcinoma(Hcc)represents∼90%of the primary liver cancer cases,and 90%of Hcc cases occur in patients with chronic liver disease.1 It also represents the sixth most common cancer(4.7%)and the third leading cause of cancer-related death globally(8.3%).2 More troubling,the global incidence and mortality rates have been increasing since 1990.3 In the United States,the highest average annual percentage change(known as AAPc)reported between 2000 and 2012 involved individuals between 55 and 59 years of age(AAPc:8.9%;95%confidence interval:7.1–10.7%).

关键词： carcinoma mortality cancer

Gut microbiota in preterm infants receiving breast milk or mixed feeding

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World Journal of clinical Pediatrics 2024年第2期13卷 135-145页

作者： Sandra Gabriela Sánchez-González Bárbara Gabriela cárdenas-del-castillo Elvira Garza-González Gerardo R Padilla-Rivas Isaías Rodríguez-Balderrama consuelo Treviño-Garza Fernando Félix Montes-tapia Gerardo c Palacios-Saucedo Anthony Gutiérrez-Rodríguez Manuel Enrique de-la-O-cavazos Department of Pediatrics Hospital Universitario“Dr.JoséEleuterio González”Universidad Autónoma de Nuevo LeónMonterrey 64460Nuevo LeónMéxico Departamento de Bioquímica y Medicina Molecular Universidad Autónoma de Nuevo LeónMonterrey 64460Nuevo LeónMéxico Department of Biochemistry and Molecular Medicine Universidad Autónoma de Nuevo LeónMonterrey 64460Nuevo LeónMéxico Department of Pediatric Surgery Hospital Universitario"Dr.JoséEleuterio González"Monterrey 64460Nuevo LeónMéxico

BAcKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several *** milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and *** To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or *** An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital ***éEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June *** samples were collected before they were introduced to any feeding *** full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene *** variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric ***,evenness,equitability,Margalef’s index,Fisher’s alpha,chao-1 index,and Shannon’s diversity index were also *** No significant differences were observed at the genus level between the *** comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(Pcounts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(Pcteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most ***,no significant differences were

关键词： Gut microbiota Human milk Preterm infant Proteobacteria Very low birth weight 16S rRNA