Annals of hepatology最新文献

{"title":"Effect of Alternate day fasting over Metabolic dysfunction-associated steatohepatitis in adult offspring of dams exposed to cafeteria diet during pregnancy and lactation.","authors":"Martín G. García-Juárez,&nbsp;Tania G. Heredia-Torres,&nbsp;Daniel Arellanos-Soto,&nbsp;Blanca E. Álvarez-Salas,&nbsp;Alberto Camacho-Morales,&nbsp;Ana María G. Rivas-Estilla","doi":"10.1016/j.aohep.2025.101803","DOIUrl":"10.1016/j.aohep.2025.101803","url":null,"abstract":"<div><h3>Introductions and Objectives</h3><div>Metabolic dysfunction-associated steatohepatitis (MASH) is a liver disease characterized by lipid accumulation and inflammation that can be exacerbated by cafeteria diets (CAF) exposition during pregnancy and lactation, whereas Alternate day fasting (ADF) improves metabolic parameters. Evaluate the effect of ADF and CAF maternal programming on MASH-associated markers in the offspring.</div></div><div><h3>Materials and Patients</h3><div>To assess the effect of maternal programming, we elaborated a mice model using 8-week C57BL6 females exposed to a CAF (cafeteria) diet (39% carbs, 49% fats, 12% proteins and sodium 231.8 mg) during 3 weeks of mating, 3 weeks of gestation and 3 weeks of lactation. For maternal programming control, we fed females with a Chow or control diet (57% carbs, 13% fats, 30% proteins and sodium 105 mg) during 3 weeks of mating, 3 weeks of gestation and 3 weeks of lactation. After weaning, the offspring were fed a control diet until they were 8 weeks old. They were then divided into four groups (Control n=8, Control + ADF n=8, CAF n=8, CAF+ ADF n=8) and an alternate day Fasting (ADF) protocol was initiated for 5 weeks. At the end of the fasting protocol, plasma samples were taken and beta-hydroxybutyrate (BHB) concentration was measured; in addition, samples of the left lateral lobe of the liver were taken at slaughter to evaluate by qPCR the effect of intermittent fasting on the expression of metabolic function markers involved during MASH: fibrosis (TGFβ, Col1a1), steatosis (PLIN2, ApoB100, Mylcd, PPARPα) and inflammation (Mcp-1).</div></div><div><h3>Results</h3><div>Groups treated with ADF showed an increase in plasma BHB concentration of 400 μmol compared to non-fasted groups. However, no significant difference was found between the control +ADF and CAF + ADF groups, so no effect of maternal programming with CAF diet on BHB production was observed. Additionally, the relative expression of mRNA from fibrosis-associated markers such as Col1a1 showed an 84% decrease in the CAF maternal programming model, 80% in the Control + ADF group and 88% in the CAF + ADF model with respect to control. Levels of mRNA-Plin2, involved in lipid droplet formation, decreased by 57% in the CAF group, 48% in Control +ADF and 79% in CAF+ADF. On the other hand, mRNA-Mcp-1 levels (chemokine) showed a decrease of 14.36% in CAF, 46.42% in Control + ADF and 62.68% in CAF+ ADF with respect to control.</div></div><div><h3>Conclusions</h3><div>The model of alternate-day fasting (ADF) showed an increased plasma BHB, but we did not observe a maternal programming effect on the concentration of betahydroxybutyrate. Interestingly, maternal programming and ADF reduce the expression of MASH-associated markers involved in fibrosis, lipid droplet formation and inflammation in this mouse model.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101803"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large volume paracentesis: Is there a limit?","authors":"Alejandro Tovar-Duran,&nbsp;Carlos A. Campoverde-Espinoza,&nbsp;Fatima Higuera-De la Tijera,&nbsp;Jose L. Pérez-Hernández","doi":"10.1016/j.aohep.2025.101844","DOIUrl":"10.1016/j.aohep.2025.101844","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Ascites is observed in 5-10% of cirrhotic patients. Large volume paracentesis (LVP), where &gt;5 liters are drained, is safe. Albumin is essential to prevent post-paracentesis circulatory dysfunction (PPCD), with the literature indicating that its incidence increases when draining &gt;8 liters in one session, suggesting draining a smaller amount.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;An observational, analytical, and retrospective study was conducted, which included the clinical records of patients over 18 years of age admitted to the Gastroenterology service of the General Hospital of Mexico \"Dr. Eduardo Liceaga\" from January 2020 to March 2024 with a diagnosis of Grade II or III ascites, without criteria for acute kidney injury (AKI) according to the International Ascites Club (ICA) and with baseline creatinine available in the last 3 months before assessment. The amount of ascites that were drained was evaluated, with no limit of liters in a session, and the occurrence of AKI during the following 7 days after paracentesis as a manifestation of PPCD. The definition of AKI was according to the latest definition by KDIGO / ICA. We excluded patients admitted with a diagnosis of AKI or a history of chronic kidney disease (CKD) of any etiology, and those in whom it was not specified whether albumin was administered after paracentesis. Descriptive statistics were performed with measures of central tendency and dispersion. We used X2, Student's T test, and Mann-Whitney U test to compare the variables. A value of &lt;em&gt;P &lt; 0.05&lt;/em&gt; was considered statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We included 60 patients with a diagnosis of cirrhosis, administered for grade II and grade III ascites, 53.3% were men, with an overall mean age of 51.1 ±10.5 years. Regarding the etiology, 45% were due to alcohol, 21.7% to Fatty Liver Disease Associated with Metabolic Dysfunction (MASLD), as well as the etiology of no filiation; with MELD-Na 17.5 ± 5.7 points. Regarding ascites, 26.7% were grade II and 73.3% grade III, and up to 10% with refractory ascites. The average of liters of ascites drained per session was 8.5 ± 3.8 liters, with a minimum drainage of 5 liters and a maximum of 19.4 liters per session. Of the total patients evaluated, 5% (3) developed AKI after paracentesis, with an elevation of creatinine &gt; 0.3 mg/dl in 48 hours. When comparing groups regarding the presence of ACLF, Child-Pugh, or MELD-Na; Regarding the DPPC, 41.66% (0%) drained less than 8 liters vs 58.34% (8.57%) more than 8 liters, all with refractory ascites, with no significant difference in the development of AKI (p=&gt;0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;LVP is safe as long as the albumin dose is adequately replaced at a dose of 6-8 grams per liter of drained ascites in a single session, with caution in patients with refractory ascites, due to the advanced stage of portal hypertension.&lt;/div&gt;","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101844"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the progression of liver disease in male and female rats induced by TAA: considerations in the development of pharmacological therapies","authors":"Jesús Dorantes-Alvarez,&nbsp;Moisés Martínez-Castillo,&nbsp;Adrián Flores-Sánchez,&nbsp;Ángel García-López,&nbsp;Luz Castro-Hernández,&nbsp;Abigail Hernandez-Barragan,&nbsp;Marisela Hernández-Santillán,&nbsp;Gabriela Gutierrez-Reyes","doi":"10.1016/j.aohep.2025.101830","DOIUrl":"10.1016/j.aohep.2025.101830","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Thioacetamide (TAA) is a hepatotoxic agent that causes fibrosis, cirrhosis, and cancer. Various doses and regimens of TAA have been tested in different murine models to validate hepatoprotective compounds. To date, only two studies have reported differences in TAA susceptibility according to sex in murine models. To compare the progression of liver disease in male and female Wistar rats induced by TAA.</div></div><div><h3>Materials and Patients</h3><div>Male and female Wistar rats (250 g) were grouped into two conditions: treated with thioacetamide (TAA) and saline solution (CT) intraperitoneally. TAA group (n=12, males=6, females=6): dose 200 mg/kg/3 times per week for 6 weeks; CT group (n=12, males=6, females=6): rats treated with saline solution. Water and food were provided <em>ad libitum</em>, and the animals were monitored daily, with weight recorded weekly. At the end of the treatment, euthanasia was performed with pentobarbital, and an exploratory laparotomy and liver recovery were conducted, with photographic records and macroscopic descriptions for each rat. Statistical analysis and mortality curve were performed using a two-way ANOVA and Log-Rank test.</div></div><div><h3>Results</h3><div>TAA administration caused weight loss in female rats during the first 2 weeks of treatment, but they showed recovery and stabilization from the third week onwards, while males showed progressive weight gain. Unexpectedly, the mortality rate in males by the third week was 66.6%, which remained until the sixth week, compared to 0% mortality in females and control animals. Macroscopic analysis of TAA-treated animals showed no alterations in adjacent organs but revealed evident morphological changes in liver tissue in males, such as heterogeneous dark brown coloration, irregular edges, and tissue nodulation. In contrast, female rats showed more discreet morphological changes of damage after 6 weeks of treatment.</div></div><div><h3>Conclusions</h3><div>The TAA model in Wistar rats demonstrated greater susceptibility to damage in male rats than in female rats. These findings should be considered in future studies, such as exploring new pharmacological therapies and/or biomarker development.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101830"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorimetric test for early diagnosis of spontaneous bacterial peritonitis.","authors":"Claudia G. Solis-Hernandez,&nbsp;Marycamen Alegria-Ovando,&nbsp;Kenia M. Bastida-Guadarrama,&nbsp;F. Yael Duran-Vargas,&nbsp;Paola Zuñiga-Escobedo,&nbsp;Monica Garcia-Baca,&nbsp;D. Ernestina Espinoza-Lopez,&nbsp;Rodrigo Toledo-Galvan,&nbsp;Jessica Mejia-Ramirez,&nbsp;Maria F. Higuera de la Tijera,&nbsp;Jose L. Perez-Hernandez","doi":"10.1016/j.aohep.2025.101887","DOIUrl":"10.1016/j.aohep.2025.101887","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The diagnosis of spontaneous bacterial peritonitis (SBP) requires biochemical analysis that can sometimes take time, so having an effective and rapid method could shorten the time to start the antimicrobial and reduce the risk of complications. Objective: To validate the colorimetric test (reagent strips) in the diagnosis of SBP.</div></div><div><h3>Materials and Patients</h3><div>Observational, prolective, and analytical study of the colorimetric test for the diagnosis of PBE. Diagnostic paracentesis was performed in patients with suspected PBE, for the analysis of the fluid by means of the colorimetric scale of the Mission test strip and compared with the cytochemical analysis in the laboratory (polymorphonuclear ≥ 250 cells/mm³). To assess the test strip as a diagnostic test, a cut-off point of strip reading ≥15 leukocytes is used. A 2 × 2 table is used to compare the positives and negatives of PBE by both cytochemical and dipstick methods. S, E, PPV and NPV were calculated.</div></div><div><h3>Results</h3><div>42 patients with ascites and suspected SBP were included. Of these, 24 patients (57.14%) were in Child-Pugh stage C, 17 patients (40.27%) were in Child-Pugh stage B and only 1 patient (2.38%) was in Child-Pugh stage A. The causes of chronic liver disease were alcohol consumption in 17 patients (40.27%), MASLD in 15 patients (35.71%), autoimmune liver disease in 4 patients (9.52%), unaffiliated etiology in 4 patients (9.52%), infection secondary to hepatitis C virus in 2 patients (4.76%). Of the total, 23 patients (54.7%) were female with a mean age of 54 years (SD ± 12.06). Thirteen patients were diagnosed with PBE, 81% of them with grade II ascites. The sensitivity of the dipstick compared to the cytochemical method was 92.3%, its specificity 86.2%, its positive predictive value (PPV) 99.4%, and its negative predictive value (NPV) 98.6%.</div></div><div><h3>Conclusions</h3><div>Colorimetry (test strips) show adequate sensitivity and specificity, making them a low-cost, easy-to-use, but above all quick to interpret tool for early initiation of antimicrobial therapy in patients with ascites and spontaneous bacterial peritonitis. Although the sample is small, it shows an interesting trend that should be confirmed.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101887"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hepatic Effect of Sub-chronic Chronic Cadmium Exposure.","authors":"Jessica N. Jiménez-Fabián ,&nbsp;Karina Martínez-Flores ,&nbsp;Leticia Bucio-Ortiz ,&nbsp;Roxana U. Miranda-Labra ,&nbsp;Luis E. Gómez-Quiroz ,&nbsp;María C. Gutierrez-Ruíz ,&nbsp;Veronica Souza-Arroyo","doi":"10.1016/j.aohep.2025.101888","DOIUrl":"10.1016/j.aohep.2025.101888","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>MAFLD is an umbrella disease characterized by lipids storage. Epidemiological studies found that cadmium (Cd) exposure is related to the development of MAFLD. We're interested in evaluating the effect of Cd exposure on lipid accumulation in the liver.</div></div><div><h3>Materials and Patients</h3><div>Eight-week-old CD-1 mice were exposed to Cd (10mg/L) for one and three months, sub-chronic and chronic models, respectively; they were fed with a Chow diet, recording the weight of the animals periodically. Euthanasia was performed, and the liver was macroscopically inspected. Liver damage enzymes were assayed in serum. Liver sections were stained with H&amp;E for morphometric analysis, Sirius red for fibrosis, and Red Oil O (ORO) for lipids. By biochemical studies, we determined the triglycerides and cholesterol content in the liver. The protein content of MAPKs was evaluated by western blot.</div></div><div><h3>Results</h3><div>Cd consumption in both models did not affect the weight of the mice. However, it promoted intestinal inflammation during one month of exposure. Liver/body weight ratio was obtained, despite which Cd was not found to promote hepatomegaly at one and three months of exposure. By H&amp;E, we found that sub-chronic exposure to Cd favored hepatocyte proliferation, and chronic exposure triggered death after cell proliferation; despite this, liver damage enzymes did not increase in serum following sub-chronic and chronic exposure. Subsequently, we evaluated fibrosis in chronic treatment without finding that Cd promotes its accumulation of collagen in the liver. Likewise, we analyzed hepatic triglyceride and cholesterol accumulation without finding that Cd causes lipid accumulation after sub-chronic and chronic exposure. Finally, we evaluated the activation of MAPKs in our model. We found that Cd favors the activation of p38 and the repression of JNK in chronic exposure, suggesting a damage-repair mechanism.</div></div><div><h3>Conclusions</h3><div>Sub-chronic and chronic exposure to Cd (10 mg/L) does not affect physiological parameters; however, activation of p38 is observed, suggesting a liver damage/repair mechanism and possible repression of JNK, which could prevent lipid accumulation.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101888"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged release pirfenidone restores miRNA expression and CpG island methylation in patients with HCV sustained virological response and residual liver fibrosis","authors":"Eira Cerda-Reyes ,&nbsp;Ricardo de la Rosa-Bibiano ,&nbsp;Ana Sandoval-Rodriguez ,&nbsp;Rebeca Rosas-Campos ,&nbsp;Rebeca Escutia-Gutiérrez ,&nbsp;Ángel Vázquez-Esqueda ,&nbsp;Stefanny Cornejo-Hernández ,&nbsp;Alejandro Gutiérrez-Átemis ,&nbsp;Salvador Amezquita-Pérez ,&nbsp;Jorge Luis Poo ,&nbsp;Gildardo Agustin Garrido-Sanchez ,&nbsp;Juan Ramón-Aguilar ,&nbsp;Juan Armendáriz-Borunda","doi":"10.1016/j.aohep.2025.101889","DOIUrl":"10.1016/j.aohep.2025.101889","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Patients with residual liver fibrosis after hepatitis C virus-infection clearance represent an important challenge due to the risk of progression and hepatocarcinoma development. The primary end of this study was to evaluate epigenetic marks in DAA-responders HCV non-European patients presenting remaining fibrosis. The secondary aim was to assess the efficacy of 12 months of treatment with prolonged-release pirfenidone (PR-PFD) in liver fibrosis regression.</div></div><div><h3>Materials and Patients</h3><div>Forty-four DAA-responders HCV patients presenting remaining fibrosis (73% women) were enrolled in the study and received PR-PFD (1200 mg/day) for 12 months. Six patients dropped out. Liver biopsies and serum samples were analyzed at the beginning and end of treatment. Besides, six non-fibrotic controls were included to compare epigenetics marks.</div></div><div><h3>Results</h3><div>After 12 months of treatment, 28.94% of patients showed a reduction in at least 1 fibrosis stage based on liver biopsies, while 57.57% experienced fibrosis reversion according to transient elastography. Bilirubin, alkaline phosphatase, AST, INR, and APRI values significantly decreased, and only minor adverse events were reported. Profibrogenic miRNAs displayed a significant increase in expression in advanced fibrosis versus controls without fibrosis. Noteworthy, PR-PFD treatment induced their decrease and restored the expression of miR-34a, miR-16, miR-192, miR-200a and miR-122 correlating with the downgrade of fibrosis stage. Specific PDGFa CpGs exhibited hypermethylation in both cell-free-DNA and liver biopsies in both mild and advanced fibrosis. Interestingly, four CpGs in PPARd promoter were hypomethylated versus controls. PR-PFD treatment resulted in hypermethylation in three TGFb1-CpGs after 12 months, suggesting down-regulation of this profibrogenic cytokine.</div></div><div><h3>Conclusions</h3><div>These findings suggest, for the first time, that PR-PFD might exert its therapeutic effects in Hispanic patients with residual fibrosis by modulating the expression of miRNAs and methylation of specific CpG sites.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101889"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of antimicrobial resistance and susceptibility in patients with spontaneous bacterial peritonitis at the General Hospital of Mexico \"Dr. Eduardo Liceaga\"","authors":"Gabriela Rangel-Zavala,&nbsp;Paloma M. Diego-Salazar,&nbsp;Karina Cazarín-Chávez,&nbsp;José L. Pérez-Hernández,&nbsp;Fatima Higuera-de-de-Tijera","doi":"10.1016/j.aohep.2025.101862","DOIUrl":"10.1016/j.aohep.2025.101862","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients, with high morbidity and mortality. Antimicrobial resistance complicates treatment and increases complications. This study aims to determine resistance patterns in microorganisms in SBP to improve treatment efficacy.</div></div><div><h3>Materials and Patients</h3><div>A descriptive, observational, and retrospective study on patterns of antimicrobial resistance and susceptibility in patients with spontaneous bacterial peritonitis was conducted at the General Hospital of Mexico “Dr. Eduardo Liceaga” between January 2022 and January 2024. Clinical information was collected from the records of the Gastroenterology Service. Microbiological results were obtained from reports from the Microbiology Service. Patients diagnosed with hepatic cirrhosis and meeting the criteria for SBP were included. Clinical and microbiological data were collected, analyzing variables such as age, sex, etiology of liver disease, and associated decompensations, such as gastrointestinal bleeding and hepatic encephalopathy. Antimicrobial resistance patterns, as well as clinical and microbiological characteristics of patients with SBP, were examined. This analysis aims to contribute to the optimal management of SBP and the development of more effective antimicrobial treatment strategies.</div></div><div><h3>Results</h3><div>A total of 48 patients were included, 52.1% were men, with a mean age of 52.4 ± 12.7 years. The predominant etiology of cirrhosis was alcohol, present in 56.3% of cases. Among the isolated bacteria, Escherichia coli (56.25%), Klebsiella pneumoniae (12.5%), Enterococcus faecalis (6.25%), Streptococcus spp. (6.25%), Staphylococcus epidermidis (4.16%), Staphylococcus aureus (4.16%), Enterococcus gallinarum (4.16%), Staphylococcus marcescens (2.08%), Acinetobacter sobria (2.08%), and Staphylococcus haemolyticus (2.08%) were prominent. The sensitivity and resistance table to different antimicrobials are presented in Graph 1.</div></div><div><h3>Conclusions</h3><div>Antimicrobial resistance is increasing in patients with SBP, leaving few effective alternatives, where cephalosporins and quinolones, recommended treatments, are no longer sufficiently useful, which is dangerous in the context of empirical therapy given the high risk of therapeutic response failure.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101862"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Hepatitis and Cardiac Tamponade, a rare association.","authors":"María E. Hernández-Ortega,&nbsp;Viridiana Ramírez Villagrán,&nbsp;Thania B. Zurita-Cruz,&nbsp;Oscar J. Tercero-Colmenares","doi":"10.1016/j.aohep.2025.101866","DOIUrl":"10.1016/j.aohep.2025.101866","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction and Objectives&lt;/h3&gt;&lt;div&gt;Ischemic hepatitis transiently elevates aminotransferases due to reduced oxygen delivery to the liver. The most common cause is heart failure&lt;sup&gt;1&lt;/sup&gt;. Cardiac tamponade is an accumulation of pericardial fluid that can cause hemodynamic compromise&lt;sup&gt;2&lt;/sup&gt;. The association of both is unusual, which is why it is important to identify them.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Patients&lt;/h3&gt;&lt;div&gt;A 50-year-old patient with a history of type 2 diabetes, systemic arterial hypertension and chronic kidney disease, presented in November 2023 due to hypotension with data of low output during a hemodialysis session, adding dyspnea on minor exertion and abdominal pain located in the right hypochondrium. Upon admission with hemodynamic instability, it was decided to start vasopressor support. In laboratory studies, it presents elevated aminotransferases (Alanine aminotransferase at 1947 U/L and aspartate aminotransferase at 2649 U/L), lactate at 5 mmol/L, lactic dehydrogenase at 2166 U/L and elevated INR at 3.15. An ultrasound of the liver and bile ducts was performed, reporting parenchyma with increased echogenicity and pericardial effusion. An evaluation was requested by Cardiology, performing a transthoracic echocardiogram, showing severe pericardial effusion with a separation of up to 34 mm in the basal region. Pericardiocentesis was performed with the extraction of 850 milliliters of pericardial fluid. As part of the approach, viral and autoimmune etiology was ruled out as a cause of liver disease. PCR for Mycobacterium tuberculosis in the pericardial fluid was requested with a negative report and no malignancy data in the pericardial effusion approach. Patient with clinical improvement and progressive decrease in transaminase levels until normalization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Ischemic hepatitis has been associated with cardiovascular diseases. The pathogenesis of ischemic hepatitis appears to occur as a result of two mechanisms, when the liver that is at risk is subsequently exposed to systemic hypoperfusion and ischemia, ultimately resulting in a marked but transient elevation of aminotransferases&lt;sup&gt;3&lt;/sup&gt;. The diagnosis is largely clinical and uses three criteria, a clinical setting of cardiac, circulatory, or respiratory failure, transient increase in serum aminotransferase activity, and exclusion of other causes of liver cell necrosis, especially viral hepatitis or induced drugs hepatitis&lt;sup&gt;1&lt;/sup&gt;. Other abnormal laboratory findings may be found in patients with ischemic hepatitis, such as increased lactic dehydrogenase levels, reduced prothrombin activity, increased serum creatinine, serum bilirubin, and serum lactate levels, due to an abnormal hepatic clearance. Non-invasive imaging options, such as abdominal ultrasound, may aid in the diagnosis of ischemic hepatitis. Dilatation of the inferior vena cava and suprahepatic veins due to passive congestion suggests this. However, the","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101866"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hepatic Lymphoma Associated with HIV, Case Report.","authors":"Luz A. Torres-López,&nbsp;Mónica M. Santamaría-Chávez,&nbsp;Leonardo D. De la Torre-Carmona,&nbsp;Omar G. Blancas-Reyes","doi":"10.1016/j.aohep.2025.101871","DOIUrl":"10.1016/j.aohep.2025.101871","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary liver lymphoma (PLL) is a rare form of lymphoma. It represents 1% of all non-Hodgkin lymphomas and 0.4% of extra nodal lymphomas. Risk factors include infection with human immunodeficiency virus (HIV), hepatitis B and C, as well as chronic immunosuppression. Here, we present a case of PLL.</div></div><div><h3>Materials and Patients</h3><div>A 39-year-old male with HIV infection and recently diagnosed disseminated Kaposi's sarcoma was admitted due to abdominal pain, asthenia, adynamia, and a 10 kg weight loss. Physical examination revealed a painful abdomen, hepatomegaly of 3 cm below the costal margin, and no other abnormalities. An exophytic, violaceous palatine tumor was observed in the oral cavity. Laboratory studies showed: total bilirubin 1.3, direct bilirubin 1, aspartate aminotransferase 23, Alanine transaminase 20, alkaline phosphatase 519, Gamma-glutamyltransferase 392, lactate dehydrogenase 271. A CT scan reported multiple hypodense oval images in hepatic segments III to VIII with a hypodense center in the contrast phase and ring enhancement; an amorphous, irregularly bordered mass occupying the soft palate extending to the nasal cavity; no splenomegaly or lymphadenopathies. An ultrasound-guided liver biopsy revealed lymphocyte proliferation with severe atypia consistent with lymphoma, which immunohistochemistry confirmed as diffuse large B-cell lymphoma of germinal center origin with a double-expressor immunophenotype (C-MYC &gt; 40%, BCL2 &gt; 50%). A biopsy of the palatal lesion reported ulcerated Kaposi's sarcoma. Endoscopy and colonoscopy showed circumscribed mucosal elevations in the cecum and stomach; histopathology reported Kaposi's sarcoma.</div></div><div><h3>Results</h3><div>Extension studies were conducted with serology for hepatitis B and C viruses and cytomegalovirus, all of which returned negative results. The bone marrow biopsy showed no lymphomatous infiltration, and the lumbar puncture revealed no abnormalities. The dissemination study with computed tomography of the chest, abdomen, and pelvis did not reveal findings suggestive of supradiaphragmatic or infradiaphragmatic involvement. The diagnosis of primary hepatic double-expressor lymphoma was concluded, synchronous with diffuse Kaposi's sarcoma. Antiretroviral therapy was initiated for 2 weeks, followed by the first cycle of chemotherapy with the EPOCH-DA regimen. The patient experienced progressive deterioration that ultimately led to his death.</div></div><div><h3>Conclusions</h3><div>LHP is an uncommon entity, just as Kaposi's sarcoma are common neoplasms associated with HIV and immunodeficiencies. Synchronous presentation is poorly documented, with only isolated cases reported in the literature. Therefore, it is important to conduct a comprehensive approach for the identification and timely management of these conditions</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101871"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperonitinemia-Hyperammonemia-Homocitrullinuria syndrome. Neonatal presentation with acute liver failure.","authors":"César U. Amaro-Reynoso,&nbsp;Jose L. Flores-Castillo,&nbsp;Catherine N. Pineda-Cely,&nbsp;Rodrigo Vázquez-Frías","doi":"10.1016/j.aohep.2025.101792","DOIUrl":"10.1016/j.aohep.2025.101792","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Urea cycle defects occur in 1/35,000 live births and Hyperonitinemia-Hyperammonemia-Homocitrullinuria (HHH) syndrome represents 1-4% of this group of diseases, which represents an autosomal recessive defect due to variants of the SLC25A15 gene. The present work describes the first case of HHH syndrome reported in Mexico.</div></div><div><h3>Materials and Patients</h3><div>We present a 5-month-old female infant, daughter of the second pregnancy of non-consanguineous parents, originally from Quintana Roo, born at term with intrauterine growth restriction, presented early neonatal sepsis and required ventilatory and hemodynamic treatment, in the second week she presented Cholestasis with normal GGT, coagulopathy, which did not correct after treatment with vitamin K, and irritability with hyperammonemia up to 640umol/L, which led to the diagnosis of neonatal acute liver failure.</div><div>At the initial approach, infectious etiology was ruled out, with high suspicion of gestational alloimmune liver disease, due to the presence of elevations of alpha-fetoprotein 12,410ng/mL and ferritin 1,590ng/mL. Gaucher disease, Niemann Pick, and lysosomal acid lipase deficiency were ruled out. Metabolic screen with hyperornithinemia (435.79 mmol/L). The genetic study found a pathogenic variant in a homozygous state of the acceptor site of the splicing of intron 2 of the SLC25A15 gene.</div><div>Two doses of human immunoglobulin and supportive treatment for liver failure with menadione and ammonium binders were administered with a favorable therapeutic response; the liver failure was remitted 4 weeks after the established management.</div></div><div><h3>Results</h3><div>The present work describes the first case of HHH syndrome reported in Mexico, which presented with neonatal acute liver failure associated with two of the three biochemical characteristics described due to hyperammonemia and hyperornithinemia. Likewise, a homozygous variant was identified in SLC25A15 and classified as pathogenic.</div></div><div><h3>Conclusions</h3><div>This report highlights the first documented case of HHH syndrome in Mexico, emphasizing its association with neonatal acute liver failure, hyperammonemia, and hyperornithinemia. The identification of a pathogenic homozygous variant in the SLC25A15 gene reinforces the importance of genetic studies for early diagnosis and targeted management of urea cycle disorders.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101792"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}