Juan Carlos Restrepo

Acute hepatitis due to shen-min: a herbal product derived from Polygonum multiflorum.

Shen-Min is a herbal product sold as a supplement for women to enhance hair growth. It is widely available across Asia, Europe, and the United States and sold without prescription as a hair nutritional supplement. We describe a case of acute liver injury in a 28-year-old white woman who developed symptomatic hepatitis 8 weeks after starting Shen-Min. All other potential causes of acute hepatitis including viral, hypoxic/ischemic, metabolic, and autoimmune etiologies were excluded. The liver injury slowly resolved over 3 weeks after discontinuing the herbal product. Although the mechanism of Shen-Min hepatotoxicity is unknown, we suspect an idiosyncratic reaction because the patient developed a fine maculopapular rash, mild eosinophilia, and did not overdose. Shen-Min is a Chinese herbal product with a mixture of several plants and vitamins including Polygonum multiflorum, a root that has been previously associated with hepatotoxicity. Nonetheless to our knowledge this is the first reported case of herbal-induced hepatotoxicity in a patient taking Shen-Min per se. Clinicians taking care of patients with acute hepatitis of unclear etiology should be aware that the consumption of Shen-Min, a hair supplement widely available in the United States and Western countries might cause acute hepatitis.

Large-volume lipoinjection for gluteal augmentation

BACKGROUND Although placement of silicone implants remains the standard technique for gluteal augmentation, lipoinjection of autologous fat obtained from lipoplasty is emerging as an alternative procedure. OBJECTIVE We report the results of large-volume lipoinjection of the gluteal region in a series of 96 patients. METHODS Lipoplasty was performed by using the wet-technique conventional method with previous infiltration of approximately 0.5 mL of solution for each mL of fat extracted. Autologous fat was injected through incisions from 5 to 8 mm long in the intergluteal fold and infragluteal groove of each side. Lipoinjection continued until the desired aesthetic contour was achieved or until the tension of the soft tissues became evident. Most patients received between 300 and 500 mL of autologous fat. RESULTS A durable increase of the gluteal regions was achieved in all patients; all but 2 patients were satisfied with the results. Complications included paresthesias, small irregularities or asymmetries that did not require special treatment or cause patient dissatisfaction, and 1 case of septic shock as a result of gluteal cellulitis. CONCLUSIONS Large-volume lipoinjection is an alternative to silicone implants for augmentation of the gluteal area that can provide greater volume increase while eliminating the risk of implant rupture and the need for follow-up surgery. (Aesthetic Surg J 2002;22:33-38.).

Hepatitis C virus seroprevalence in multi-transfused patients in Colombia

BACKGROUND Hepatitis C Virus (HCV) infection is a public health problem worldwide, with particular relevance in multi-transfused patients given that HCV is principally transmitted by exposure to infected blood. STUDY DESIGN Between February and September 2003 a cross-sectional study was carried out in four hospital centres in Bogotá and Medellin, Colombia, to determine the risk factors for HCV infection in 500 multi-transfused patients. RESULTS The study population was distributed in five groups: haemophilia, haemodyalsis, acute bleeding, ontological illnesses and sickle cell disease or thalassemia. Serum samples from patients were tested for HCV antibodies (Asxym, Abbott). An overall prevalence (9.0%; 95% confidence interval (CI): 6.4-11.6) (45/500) of HCV infection was found. Anti-HCV antibodies were detected in 32.2% of patients with haemophilia, 6.1% of patients undergoing haemodialysis, 7.1% of patients with sickle cell disease or thalassemia, 2.6% of patients with acute bleeding and 3.4% of patients with ontological or hematological diseases. The main risk factors associated with infection by HCV were: to be hemophilic (odds ratio, OR = 18.03; 95% Cl: 3.96-114.17), having received transfusions before 1995 (OR = 12.27; 95% Cl: 5.57-27.69), and having received more than 48 units of blood components (OR = 6.08; 95% CI: 3.06-12.1). In the multivariate analysis, only the year of transfusions (before 1995) remained significantly associated with risk of infection by HCV. CONCLUSIONS The data show a 3-fold reduction in the infection risk between 1993 and 1995, when the serological screening for HCV in blood donors was being introduced. A reduction greater than 90% was achieved by 1995 when the screening coverage reached 99%.

new Technique of Plication for Miniabdominoplasty

The authors present a new method of plication of abdominal fascia performed in 42 patients who underwent surgery for miniabdominoplasty between September of 1998 and February of 2000. The design consisted of a horizontal half-moon on the infraumbilical fascia with high lateral tension, similar to the one that is performed on the skin, achieving an improvement in the muscle-aponeurotic tension of the whole abdomen without requiring a supraumbilical dissection or undermining. All patients (n = 42) had a superficial and a deep conventional liposuction of the abdomen, flanks, and posterior trunk with the wet technique. The rate of minor complications was 59.5 percent. Twenty patients had seromas, three patients had dog-ears and one had cutaneous ischemia (cpidermolysis). There were no cases of major complications such as tissue necrosis, infections, deep venous thrombosis, pulmonary emboli, or fat embolus syndrome. Patients received follow-up examination between 6 months and 2 years after surgery (average, 15 months). The results were excellent, and the patients were e completely satisfied.

Molecular characterization of hepatitis c virus in multi-transfused Colombian patients

BackgroundHepatitis C virus (HCV) infects 170 million persons worldwide and is a public health problem. Considering that HCV is principally transmitted by exposure to infected blood, multi-transfused patients constitute one of the most important risk groups in developing countries. To explore the dynamics of this infection in Colombia, we performed a study to determine the genotypes of HCV in a cohort of multi-transfused patients.ResultsThe serum samples from patients positive for anti-HCV were evaluated for HCV RNA by nested-PCR of the 5’untranslated region (5’UTR). Viral genotype was determined by RFLP and/or automated sequencing. HCV subtype 1b was found in eight cases (66.7%) and subtype 1a in two cases (16.7%); seven isolates of subtype 1b were obtained from patients who had received the first transfusion before 1986. Either genotypes 2b (8.3%) or 3a (8.3%) were found in the remaining positive specimens.ConclusionsThis is the first HCV genotyping study developed in multi-transfused patients in Colombia where HCV subtype 1b was the most prevalent. The mutation G235A in the 5’UTR of three isolates generated an additional restriction site and an RFLP pattern different from those previously described for genotype 1.

Hepatitis B and Hepatitis C Infection Biomarkers and TP53 Mutations in Hepatocellular Carcinomas from Colombia

Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death worldwide. Globally, the most important HCC risk factors are Hepatitis B Virus (HBV) and/or Hepatitis C Virus (HCV), chronic alcoholism, and dietary exposure to aflatoxins. We have described the epidemiological pattern of 202 HCC samples obtained from Colombian patients. Additionally we investigated HBV/HCV infections and TP53 mutations in 49 of these HCC cases. HBV biomarkers were detected in 58.1% of the cases; HBV genotypes F and D were characterized in three of the samples. The HCV biomarker was detected in 37% of the samples while HBV/HCV coinfection was found in 19.2%. Among TP53 mutations, 10.5% occur at the common aflatoxin mutation hotspot, codon 249. No data regarding chronic alcoholism was available from the cases. In conclusion, in this first study of HCC and biomarkers in a Colombian population, the main HCC risk factor was HBV infection.

Monte Carlo study of the magnetic properties of Fe-rich Al-Fe disordered alloys

We present a simulational study of the magnetic properties of disordered Fe-rich Al–Fe alloys. Our study has been developed in the framework of a simple site-diluted Ising model with nearest-neighbor interactions and by using a Monte Carlo algorithm. From our results, it is concluded that, in agreement with previous experimental data, disordered Al–Fe alloys exhibit ferromagnetic behavior up to higher Al concentrations than the ordered ones.

Hepatitis E Virus Genotype 3 in Colombia: Survey in Patients with Clinical Diagnosis of Viral Hepatitis.

Background Hepatitis E virus is a major cause of outbreaks as well as sporadic hepatitis cases worldwide. The epidemiology of this enterically transmitted infection differs between developing and developed countries. The aims of this study were to describe HEV infection in Colombian patients and to characterize the genotype. Methods A prospective study was carried out on 40 patients aged over 15 with a clinical diagnosis of viral hepatitis, recruited from five primary health units in the city of Medellin, Colombia. Fecal samples obtained from the 40 consecutives cases were analyzed for HEV RNA using nested reverse transcription PCR for both ORF1 and ORF2-3. The amplicons were sequenced for phylogenetic analyses. Results Nine (22.5%) cases of HEV infection were identified in the study population. Three HEV strains obtained from patients were classified as genotype 3. No significant association was found between cases of Hepatitis E and the variables water drinking source, garbage collection system and contact with pigs. Conclusions This is the first prospective study of hepatitis E in Colombian patients. The circulation of the genotype 3 in this population is predictable considering the reports of the region and the identification of this genotype from pigs in the state of Antioquia, of which Medellin is the capital. Further studies are necessary to establish whether zoonotic transmission of HEV is important in Colombia.

Abdominoplasty with anchor plication and complete lipoplasty

BACKGROUND Combined abdominoplasty and lipoplasty is fequently performed to achieve improved body contour in a single surgical session. OBJECTIVE We describe a procedure that combines vertical and transverse plication of the abdominal fascia with lipoplasty of the anterior abdominal wall. METHODS Lipoplasty of the anterior abdominal wall was performed using a superwet technique. The amount of extracted fat ranged from 200 to 6000 mL. Abdominoplasty was performed using traditional methods. Plication of the abdominal fascia combined the traditional longitudinal method with a half-moon plication, located in the lower abdomen. RESULTS Seventy-six women ranging in age from 20 to 62 years underwent combined abdominoplasty and lipoplasty between January 2002 and January 2003. Patient satisfaction was rated as excellent in 74 cases. Patient satisfaction was rated as good in the other 2 cases, in which the only patient complaint was hypertrophy of the scar, which improved over time with the use of massage. Seromas developed in 8 patients (10.52%) and were treated successfully by syringe extraction. CONCLUSIONS Benefits of combining abdominoplasty with lipoplasty include reduction of abdominal flap volume, improvement in the final quality of the scar, and improved tissue contraction. The anchor plication reduces strain in the abdominal fascia and also diminishes the vertical abdominal diameter, facilitating the descent of the flap.

Magnetism of Fe–Al disordered alloys: An Ising–Monte Carlo approach

Using a model of atoms randomly distributed on a cubic lattice, we have simulated the atomic disorder induced in quenched binary alloys. Our study has been developed within the framework of a random site-diluted Ising model with nearest-neighbor interactions and used a Monte Carlo algorithm implemented with Metropolis kinetics for sampling states. After equilibration, ensemble and configurational averages for magnetization, magnetic susceptibility, and heat capacity were computed. We conclude that, in agreement with previous experimental Mossbauer data for which a comparison is carried out, Fe–Al disordered alloys exhibit room-temperature ferromagnetic behavior up to around 43 at. % Al, beyond which the system becomes paramagnetic. This result contrasts with that for alloys with atomic order, which exhibit ferromagnetism only up to 30 at. % Al.