Guadalupe Ponciano-Rodríguez

Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease

Background and Aim: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes.

Prevalence of gallstone disease in Mexico : a necropsy study

The prevalence of gallstone disease in Mexico was investigated by studying a sample of 21,446 necropsies performed at the Department of Pathology of the General Hospital of Mexico City during a 35-year period (1953–1988). For each decade, 1000 necropsy cases were randomly selected. The crude prevalence of gallstone disease was 14.3%, 8.5% for males and 20.4% for females. The age groups ranged from 20 to more than 80 years old; the age-standardized prevalence for males was 5.6% and for females 16.2%. These rates are intermediate between those found in Chile and some African countries, comparable to some European studies, and less than those found in Mexican-Americans. No significant trend in the prevalence of gallstone disease was found when the different decades were compared.

Gallstones are associated with carotid atherosclerosis.

Background/Aims: Gallstone disease (GD) and cardiovascular disease (CD) are common diseases worldwide with considerable economical impact and they are strongly associated. Carotid atherosclerosis is an excellent marker of risk for CD like stroke and myocardial infarction. The aim of this study was to assess the association between gallstones and carotid atherosclerosis.

Prevalence of hepatitis C infection in a population of asymptomatic people in a checkup unit in Mexico city.

Hepatitis C virus (HCV) infection has an estimated prevalence of 3% around the world. Unfortunately, many persons with HCV infection are asymptomatic. The aim of this study was to determine the prevalence of hepatitis C Virus infection in asymptomatic persons. This study was carried out in a population-based cross-sectional study in the Checkup Unit of University Hospital in Mexico City. Patients with two or more HCV risk factors were studied. Serum specimens from all patients were screened for HCV RNA by qualitative polymerase chain reaction (PCR). HCV RNA-positive serum was also screened by quantitative PCR and for HCV genotype. Three hundred asymptomatic people were included, 194 men and 106 women, with a mean age of 46.8 ± 11.9. Six (2%) of the 300 people were positive and viremic. The most common risk factors in positive patients were manicures or pedicures with a nonpersonal instrument and more than three sexual partners. We concluded that hepatitis C is frequent in asymptomatic people, and those people are often viremic. In addition, this study suggests that the spectrum of liver disease in asymptomatic and newly diagnosed HCV-positive persons is broad.

Viral hepatitis infection and insulin resistance: A review of the pathophysiological mechanisms

Viral hepatitis is a common cause of morbidity in Mexico. Insulin resistance (IR) is related to the liver damage caused by some viral infections, especially chronic infections. Chronic viral infection is an important risk factor for the development of type 2 diabetes mellitus, disease that is currently among the 10 main causes of morbidity and the most common cause of mortality. Although several studies have reported an association between IR and hepatitis B virus or hepatitis C virus (HCV) infection, the pathophysiology has been studied thoroughly only for the association between IR and HCV infection. It is thought that HCV infection causes direct damage through the action of the core proteins, which induces an inflammatory state characterized by secretion of proinflammatory cytokines that interfere with normal insulin signaling and disturb glucose, lipid and protein metabolism. This review summarizes the mechanisms by which viral infection is thought to induce IR.

The Efficacy of Adipokines and Indices of Metabolic Syndrome as Predictors of Severe Obesity-Related Hepatic Steatosis

The aim of this study was to investigate adiponectin, leptin, and metabolic syndrome as predictors of the severity of obesity-related steatosis. By ultrasonography steatosis-positive (cases) subjects (n=141) were compared with controls (n=111). Demographic and anthropometric data and serum concentrations of adiponectin, leptin, and insulin were measured. The impact of several criteria of metabolic syndrome, serum adiponectin concentrations, and serum leptin concentrations were tested using a multivariate logistic regression analysis. The frequency of metabolic syndrome was higher in cases (44.0% versus 9.2%; P < .0001). Cases were older and had higher insulin resistance, waist circumference, and lower concentrations of adiponectin (all P < .001). The upper adiponectin quartile was associated with a lesser grade of steatosis. Metabolic syndrome and adiponectin concentrations were independently associated with the probability of steatosis. In conclusion, adipokines and metabolic syndrome are useful indices for the prediction of the severity of obesity-related steatosis.

Early Changes in the Components of the Metabolic Syndrome in a Group of Smokers After Tobacco Cessation

AIM We aimed to examine the prevalence of early changes in some components of metabolic syndrome after smoking cessation. METHODS Forty-eight heavy smokers from the Tobacco Cessation Clinic (24 women/24 men), average age of 49.4 years, were included in this study. They smoked a mean of 19.92 cigarettes per day and had smoked 33.23 packages per year during 33.4 years. Participants were included in a treatment group based on cognitive behavior therapy (CBT); 16 participants received varenicline and the other 16 nicotine replacement therapy (NRT). The target quit day was scheduled for week 3 through abrupt cessation. Abstinence was confirmed with exhaled carbon monoxide (CO) levels. Blood pressure, body mass index (BMI), and waist circumference (WC) were evaluated weekly. Glucose, triglycerides, high density lipoproteins (HDL-C), and insulin to determine the homeostasis model assessment (HOMA) index were determined in blood samples at weeks 1, 4, and 10. As a control group 96 healthy nonsmokers were matched by age and sex. RESULTS The mean BMI in smokers was 26.94 kg/m(2) and in nonsmokers 26.23 kg/m(2). Smokers showed hypertension, hypertriglyceridemia, and lower levels of HDL-C than nonsmokers. Percentages of cessation in week 3 were 81% for NRT and 93% for CBT and varenicline. The mean weight increase at the end of the treatment was 1.09 kg in the CBT group, 1.06 kg in the NRT group, and 1.17 kg in the varenicline group. The prevalence of metabolic syndrome was 31.25% in week 1 and 29.16% at the end. There were reductions in the number of subjects with hypertension, glucose alterations, hypertriglyceridemia, and low HDL levels. CONCLUSIONS Benefits of quitting smoking exceeded by far the risks associated with the amount of weight gained.

Prevalence of hepatitis C virus infection among patients undergoing haemodialysis in Latin America.

Hepatitis C infection is a worldwide problem. The global prevalence of the hepatitis C virus (HCV) averages 3%. Moreover, its prevalence among patients undergoing haemodialysis (HD) varies worldwide, ranging from as low as 1% to up to 70%. There are few data on its prevalence in developing countries, and even less information is available on HD patients. A literature review revealed that the prevalence of HCV infection among patients undergoing HD in Latin America ranges from 4.2 to 83.9%, with most data stemming from Argentina, Brazil, Mexico, Peru, Chile, Venezuela and Cuba. The most common genotype was genotype 1, and subtype 1b was the most frequent. The risk factors associated with this condition were the duration of the HD treatment and blood transfusion before hepatitis C screening. In addition, HCV RNA detection by polymerase chain reaction is crucial for the diagnosis of HCV infection in HD patients. Trials using combinations of new oral antiviral drugs, such as sofosbuvir and combo (ombitasvir, paritaprevir, ritonavir and dasabuvir), should be the next step in the improvement of care among HD patients with HCV, because these therapeutic agents apparently do not require dose adjustment according to renal function. Finally, information on this subgroup of patients remains unavailable in some countries; therefore, additional studies are needed to determine the prevalence trend of HCV infection in these populations.

Reflexiones sobre oportunidades de intervención en tabaquismo en Latinoamérica

The tobacco epidemic is a huge public health problem affecting all Latin American countries. These countries have the characteristic of a wide base of the pyramidal population structure, with many young people who have been natural targets for the tobacco industry. Therefore in this region there is an urgent need to establish prevention and treatment strategies capable to reduce incidence and prevalence of tobacco smoking in the population and as a consequence modify the health effects of tobacco consumption. Treating nicotine addiction requires intervention strategies really effective to reduce the number of current smokers as well as giving them tools to avoid relapse and maintain abstinence. Currently poor and vulnerable groups, which represent 44% of the total population in Latin America, are the most susceptible to suffer the health consequences of smoking since they show the highest prevalence rates and have little or no access to health services. The Framework Convention on Tobacco Control (FCTC) and MPOWER, both strategies proposed by the World Health Organization against tobacco, define clear goals to achieve their purposes, nevertheless they are limited by the economic and human resources assigned by each country. The scientific community involved in the fight against tobacco must think about new ways to place this issue in the political agenda so there will be more opportunities to increase the resources and therefore to reduce tobacco consumption in all the groups of the population. In the fight against tobacco, this is the right time to consider primarily issues related to equity and social justice.

The urgent need to change the current medical approach on tobacco cessation in Latin America

Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers.