Family practitioners, nurse-midwives, obstetricians, gynaecologis

Family practitioners, nurse-midwives, obstetricians, gynaecologists

and community health clinics will increasingly be strategic and central to WFH outreach efforts, in addition to serving as new care partners important to the multidisciplinary model of care. Africa is the second most populous continent. With 53 countries and nearly one billion people the challenges are indeed great. Africa is the most underrepresented geographical area within the WFH. Within Africa, at present, only 15 nations (less than one-third of those in Africa) have NMOs within the WFH national membership. In North Africa, Algeria, Egypt, Morocco and Tunisia are members. Within the three regions of sub-Saharan Africa, WFH has 11 NMOs: West Africa – Cameroon, Ivory Coast, Nigeria and Senegal; East Africa – Eritrea, Kenya and Sudan; Southern Africa – Botswana, Lesotho, South Africa and Zimbabwe (see Fig. 3). During the http://www.selleckchem.com/pharmacological_MAPK.html 2010 WFH Congress, three additional African countries are expected to be accredited as members of the WFH – Ethiopia, Ghana and buy SB203580 Tanzania. There are wide-ranging and disparate needs across the sub-Saharan region. The goal of developing care for people with bleeding disorders must be considered in context with other disease burdens in Africa,

such as HIV/AIDS, malaria, tuberculosis, and malnutition. To maximize the results of WFH work in Africa, WFH is encouraging countries to network with each other and organize programmes on a regional level. Integral to the approach to achieving Treatment for All is building a centre of core expertise within each African region. This then serves as a hub for further regional development activities, as well as 5FU a model for what can be achieved.

WFH experience has shown that culturally appropriate training that occurs in a setting resembling the level of care within a country maximizes the opportunity for practical learning and achieving sustainable care. Equally important, it is extremely beneficial to have regional role models when communicating with Ministries of Health and cultivating healthcare professionals. To date, WFH regional programming has been primarily based in Senegal (West African region), Kenya (East African region) and South Africa (Southern African region). In both the East and West African regions, the WFH started by improving diagnosis through regional laboratory training workshops (e.g. West Africa in 2008 and East Africa in 2009) and by encouraging the development of national patient registries. Five of the 11 sub-Saharan African countries now have patient registries [1]. Diagnosis of Haemophilia and Other Bleeding Disorders, the WFH Laboratory Manual [27], soon to be published in a new and expanded edition, and Guide to Developing a National Patient Registry [28] serve as the primary training tools.

This is the first report of infection in mulberry trees

b

This is the first report of infection in mulberry trees

by HSVd. “
“Commercial parsley plants in Safranbolu were found with symptoms of decline, stunting, yellowing and many galls in the roots, symptoms typical of infestation by root knot nematodes. Morphological, biochemical and molecular methods were used learn more to identify the causal root knot nematode species. Morphological characteristic and perineal patterns of the females and isoenzyme phenotypes matched the description of Meloidogyne arenaria. Polymerase chain reaction with the M. arenaria species-specific Far/Rar primer set also produced a 420-bp fragment, the same as obtained with a positive control population of M. arenaria. Results, therefore, confirm that the root knot nematodes isolated from parsley roots were M. arenaria. This is the first report of M. arenaria infecting parsley in Turkey. “
“Although the tobacco N gene, which confers resistance to Tobacco mosaic virus (TMV), is transcriptionally induced by infection with TMV, the regulatory mechanism has not previously been elucidated. We found that a 5′-flanking region of the N gene

exhibits TMV-inducible promoter activity and that the region from −290 to −271 includes a cis-acting this website element in response to infection. The activity required N protein and signal components of N-mediated resistance. These results suggest that transcription of the N gene is positively regulated by N-mediated resistance signalling. “
“Mallotus japonicus with witches’ broom disease were observed in Jeollabuk-do, Korea. A phytoplasma from the infected leaves was identified, based on the 16S rDNA, 16S-23S intergenic spacer region, and fragment of rp operon and tuf gene sequences. The 16S rDNA sequences exhibited maximum (99.7%) similarity with Iranian lettuce phytoplasma, the rp operon sequences exhibited 100% similarity with Goldenrain stunt phytoplasma, and the tuf gene sequences exhibited 99.8% similarity with Japanese Cell press spurge yellows phytoplasma. Results of the sequence analysis and phylogenetic studies confirmed that the phytoplasma

associated with M. japonicus in Korea was an isolate of Aster Yellows group (subgroup16SrI-B). “
“Plant viruses can cause serious crop losses. Calcium homoeostasis is involved in the movement of animal viruses. We have examined whether intracellular calcium flux can interfere with spread of virus in plants. The calcium channel blocker verapamil, applied to Nicotiana tabacum cv. Xanthi-nc plant leaves, interfered with Tobacco mosaic virus infection in treated and untreated leaves, reducing TMV lesion number by 68 and 71%, respectively. Verapamil interfered with calcium homoeostasis of leaf cells, evident by increased calcium efflux from leaf segments. This is a first effort to use calcium channel blockers as an inducer of systemic virus resistance in plants.

We then explored the molecular mechanism underlying modulation of

We then explored the molecular mechanism underlying modulation of CD151 in MMP9 expression in HCCLM3 cells through the zone-by-zone blockade of the PI3K/Akt/glycogen synthase kinase 3β (GSK-3β)/Snail

signal. We further explored the role of CD151 in tumor-associated neoangiogenesis and metastasis in vitro and in vivo. Finally, we evaluated the combined expression of CD151, MMP9, and MVD as a prognostic marker in HCC patients. AFP, alpha-fetoprotein; AKT, protein kinase B; bFGF, basic fibroblast growth Metformin factor; CDC42, cell division control protein 42 homologue; CI, confidence interval; ELISA, enzyme-linked immunosorbent assay; ERK, extracellular signal-regulated kinase; FAK, focal adhesion kinase; GAPDH, glyceraldehyde 3-phosphate dehydrogenase; learn more GSK, glycogen synthase kinase; H&E, hematoxylin and eosin; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HR, hazard ratio; HUVEC, human umbilical vein endothelial cell; LY294002, 2-morpholin-4-yl-8-phenylchromen-4-one; MAPK, mitogen-activated protein kinase; MMP, matrix metalloproteinase; mRNA, messenger RNA; MVD, microvessel density; NA, not adopted; NS, not significant;

OS, overall survival; PI3K, phosphatidylinositol-3-kinase; qRT-PCR, quantitative real-time polymerase chain reaction; RT-PCR, reverse transcription polymerase chain reaction; shRNA, short hairpin RNA; siRNA, small interfering RNA; TNM, tumor node metastasis; U0126, 1,4-diamino-2,3-dicyano-1,4-bis(2-aminophenylthio)butadiene; VEGF, vascular endothelial growth factor. A highly metastatic human HCC

cell line (HCCLM3), low-metastatic human HCC cell lines (MHCC97-L, PLC/PRF/5, Hep3B, and HepG2; American Type Culture Collection),6, 18, 19 and human umbilical vein endothelial cells (HUVECs; American Type Culture Collection) were used in this study. Male, athymic BALB/c nude mice (8 weeks old; Shanghai Gemcitabine cost Institute of Material Medicine, Chinese Academy of Science, Shanghai, China) were raised under specific pathogen-free conditions. Animal care and experimental protocols were in accordance with the guidelines established by the Shanghai Medical Experimental Animal Care Commission. Specimens taken from areas next to the margins of tumors were collected from 327 consecutive patients with HCC who underwent curative resection between 1997 and 2000 at the Liver Cancer Institute of Fudan University (Shanghai, China). The histopathological diagnosis was based on the World Health Organization criteria.20 The histological grade of tumor differentiation was determined according to the classification proposed by Edmondson and Steiner.21 Liver function was assessed by the Child-Pugh scoring system. Clinical tumor typing was performed according to the sixth edition of the tumor node metastasis (TNM) classification system of the Union Internationale Contre le Cancer. Ethical approval was obtained from the research ethics committee of Zhongshan Hospital, and written, informed consent was obtained from each patient.

We then explored the molecular mechanism underlying modulation of

We then explored the molecular mechanism underlying modulation of CD151 in MMP9 expression in HCCLM3 cells through the zone-by-zone blockade of the PI3K/Akt/glycogen synthase kinase 3β (GSK-3β)/Snail

signal. We further explored the role of CD151 in tumor-associated neoangiogenesis and metastasis in vitro and in vivo. Finally, we evaluated the combined expression of CD151, MMP9, and MVD as a prognostic marker in HCC patients. AFP, alpha-fetoprotein; AKT, protein kinase B; bFGF, basic fibroblast growth DMXAA molecular weight factor; CDC42, cell division control protein 42 homologue; CI, confidence interval; ELISA, enzyme-linked immunosorbent assay; ERK, extracellular signal-regulated kinase; FAK, focal adhesion kinase; GAPDH, glyceraldehyde 3-phosphate dehydrogenase; selleck chemicals GSK, glycogen synthase kinase; H&E, hematoxylin and eosin; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HR, hazard ratio; HUVEC, human umbilical vein endothelial cell; LY294002, 2-morpholin-4-yl-8-phenylchromen-4-one; MAPK, mitogen-activated protein kinase; MMP, matrix metalloproteinase; mRNA, messenger RNA; MVD, microvessel density; NA, not adopted; NS, not significant;

OS, overall survival; PI3K, phosphatidylinositol-3-kinase; qRT-PCR, quantitative real-time polymerase chain reaction; RT-PCR, reverse transcription polymerase chain reaction; shRNA, short hairpin RNA; siRNA, small interfering RNA; TNM, tumor node metastasis; U0126, 1,4-diamino-2,3-dicyano-1,4-bis(2-aminophenylthio)butadiene; VEGF, vascular endothelial growth factor. A highly metastatic human HCC

cell line (HCCLM3), low-metastatic human HCC cell lines (MHCC97-L, PLC/PRF/5, Hep3B, and HepG2; American Type Culture Collection),6, 18, 19 and human umbilical vein endothelial cells (HUVECs; American Type Culture Collection) were used in this study. Male, athymic BALB/c nude mice (8 weeks old; Shanghai Mephenoxalone Institute of Material Medicine, Chinese Academy of Science, Shanghai, China) were raised under specific pathogen-free conditions. Animal care and experimental protocols were in accordance with the guidelines established by the Shanghai Medical Experimental Animal Care Commission. Specimens taken from areas next to the margins of tumors were collected from 327 consecutive patients with HCC who underwent curative resection between 1997 and 2000 at the Liver Cancer Institute of Fudan University (Shanghai, China). The histopathological diagnosis was based on the World Health Organization criteria.20 The histological grade of tumor differentiation was determined according to the classification proposed by Edmondson and Steiner.21 Liver function was assessed by the Child-Pugh scoring system. Clinical tumor typing was performed according to the sixth edition of the tumor node metastasis (TNM) classification system of the Union Internationale Contre le Cancer. Ethical approval was obtained from the research ethics committee of Zhongshan Hospital, and written, informed consent was obtained from each patient.

Integrative transcriptome analysis revealed common traits enriche

Integrative transcriptome analysis revealed common traits enriched for stemness-associated genes, although each individual CSC gene expression signature exhibited activation of different oncogenic pathways (e.g., EGFR, RO4929097 concentration SRC, and MYC). The common CSC

signature was associated with malignant progression, which is enriched in poorly differentiated tumors, and was highly predictive of prognosis in liver and other cancers. Conclusion: Epigenetic modulation may provide a tool for prospective isolation and in-depth analysis of CSC. The liver CSC gene signatures are defined by a pernicious interaction of unique oncogene-specific and common stemness traits. These data should facilitate the identifications of therapeutic tools targeting both unique and common features of CSCs. (HEPATOLOGY 2011;) It is increasingly recognized that many solid tumors contain a subset of cells that possess functional properties ascribed to normal stem cells, such as self-renewal, unlimited proliferative capacity and pluripotency, leading to a hierarchical model of cancer with a cancer stem

cell (CSC) population at the apex of tumor formation.1 The CSC hypothesis posits that CSCs are responsible not only for tumor initiation but also generation of metastasis and local recurrence after therapy.2 The existence of CSCs (also referred to as tumor-initiating cells) has been shown in a variety of solid tumors, including liver cancer.3, 4 However, CSCs have highly variable antigenic and functional properties even when derived from the same tumor BMN 673 molecular weight type, thus highlighting DOK2 heterogeneity as a cardinal problem in CSC biology. It is conceivable that the CSC phenotype may be corrupted by distinct oncogenic events and influenced by various factors, including tissue microenvironment, resulting in an assortment of CSCs.5 Therefore, defining both unique and common CSC properties is essential for both understanding CSC biology and effective therapeutic

translation. Currently, most studies focusing on liver CSCs rely on cell surface markers, primarily single markers. This approach identified stem-like cancer cells with clonogenic and tumorigenic capacity, strongly supporting the existence of CSCs in hepatocellular carcinoma (HCC).6-8 Nonetheless, antigenic approaches have several shortcomings, including cross-reactivity, lack of specificity, and antibody-dependent toxicity.9, 10 Furthermore, it has been shown recently that the primary tumor oncogenotypes can influence the marker phenotypes of CSCs, raising questions regarding the use of single markers in molecularly diverse malignancies.5, 11 Alternatively, the side population (SP) approach, which is based on the functional property of CSCs to exclude Hoechst-33342-dye via ABCG2-transporters, might have certain advantages for prospective isolation and characterization of CSCs from liver and other cancers.

Integrative transcriptome analysis revealed common traits enriche

Integrative transcriptome analysis revealed common traits enriched for stemness-associated genes, although each individual CSC gene expression signature exhibited activation of different oncogenic pathways (e.g., EGFR, www.selleckchem.com/products/BIBW2992.html SRC, and MYC). The common CSC

signature was associated with malignant progression, which is enriched in poorly differentiated tumors, and was highly predictive of prognosis in liver and other cancers. Conclusion: Epigenetic modulation may provide a tool for prospective isolation and in-depth analysis of CSC. The liver CSC gene signatures are defined by a pernicious interaction of unique oncogene-specific and common stemness traits. These data should facilitate the identifications of therapeutic tools targeting both unique and common features of CSCs. (HEPATOLOGY 2011;) It is increasingly recognized that many solid tumors contain a subset of cells that possess functional properties ascribed to normal stem cells, such as self-renewal, unlimited proliferative capacity and pluripotency, leading to a hierarchical model of cancer with a cancer stem

cell (CSC) population at the apex of tumor formation.1 The CSC hypothesis posits that CSCs are responsible not only for tumor initiation but also generation of metastasis and local recurrence after therapy.2 The existence of CSCs (also referred to as tumor-initiating cells) has been shown in a variety of solid tumors, including liver cancer.3, 4 However, CSCs have highly variable antigenic and functional properties even when derived from the same tumor Palbociclib nmr type, thus highlighting Casein kinase 1 heterogeneity as a cardinal problem in CSC biology. It is conceivable that the CSC phenotype may be corrupted by distinct oncogenic events and influenced by various factors, including tissue microenvironment, resulting in an assortment of CSCs.5 Therefore, defining both unique and common CSC properties is essential for both understanding CSC biology and effective therapeutic

translation. Currently, most studies focusing on liver CSCs rely on cell surface markers, primarily single markers. This approach identified stem-like cancer cells with clonogenic and tumorigenic capacity, strongly supporting the existence of CSCs in hepatocellular carcinoma (HCC).6-8 Nonetheless, antigenic approaches have several shortcomings, including cross-reactivity, lack of specificity, and antibody-dependent toxicity.9, 10 Furthermore, it has been shown recently that the primary tumor oncogenotypes can influence the marker phenotypes of CSCs, raising questions regarding the use of single markers in molecularly diverse malignancies.5, 11 Alternatively, the side population (SP) approach, which is based on the functional property of CSCs to exclude Hoechst-33342-dye via ABCG2-transporters, might have certain advantages for prospective isolation and characterization of CSCs from liver and other cancers.

43 Its correlation with the HVPG has not been studied to date Se

43 Its correlation with the HVPG has not been studied to date. Several investigations have demonstrated that the degree of portal hypertension is correlated with the severity of cirrhosis assessed by the Child-Pugh classification or the presence of ascites.2, 44 For example, low serum albumin levels and elevated prothrombin times are associated with the presence of severe portal hypertension but have not been correlated with the degree of portal hypertension.45 In one study, patients with low serum albumin levels, which were associated with low platelet counts and

large portal vein diameters, were more likely to have severe portal hypertension and varices.46 However, liver tests are not accurate enough to evaluate the presence and severity of portal hypertension and thus cannot be used to assess portal hypertension. The clinical diagnosis of severe portal hypertension by a physical examination is MLN8237 research buy not difficult in patients with cirrhosis who have collateral circulation of the abdominal wall, ascites, and peripheral edema. Hepatic encephalopathy Kinase Inhibitor Library is rarely the first sign of portal hypertension. Splenomegaly is frequent but is not always present in patients with portal hypertension. The relationship between the portal pressure and the spleen size remains unclear.47 The main result of splenomegaly is hypersplenism, which corresponds to a reduction

in some blood elements and most frequently a low platelet count with normal bone marrow function. The presence of hepatopulmonary syndrome or portopulmonary syndrome may reveal severe portal hypertension.48 Finally, an episode of gastrointestinal

hemorrhaging may also reveal portal hypertension and cirrhosis. There are two types of noninvasive methods that evaluate the clinical consequences of portal hypertension: techniques that evaluate the presence of varices and those that evaluate modifications in the splanchnic circulation and vessels (including hepatic veins). In patients with cirrhosis, the presence of esophageal varices indicates severe portal hypertension. In the absence of varices, moderate or severe portal hypertension may be present.13 No correlation exists between the degree of portal hypertension and the presence and PTK6 size of varices above a certain HVPG level (10-12 mm Hg).13, 14 Several methods exist for detecting esophageal varices, the degree of portal hypertension, and the presence and size of varices.7 At present, upper gastrointestinal endoscopy is the gold standard for determining the presence of varices.49, 50 This technique is uncomfortable and invasive for patients and is costly and time-consuming, Moreover, up to 50% of patients may not have developed varices 10 years after the diagnosis of cirrhosis. This proportion is likely to increase with the widespread use of noninvasive methods for detecting cirrhosis, which results in the detection of larger numbers of patients with compensated cirrhosis.

So should we abandon cyclosporine in favor of infliximab? The jur

So should we abandon cyclosporine in favor of infliximab? The jury is out while we

wait the results of two prospective randomized, controlled trials, which click here are currently underway, that compare cyclosporine and infliximab for the treatment of steroid-refractory, severe UC. The Study Comparing Cyclosporine With Infliximab in Steroid-refractory Severe Attacks of Ulcerative Colitis is now complete, but is yet to be published in full.12 Preliminary reports suggest that cyclosporine and infliximab are equivalent at preventing colectomy at 90 days. Meanwhile, a British study comparison of infliximab and ciclosporin in steroid resistant ulcerative colitis: a trial continues to recruit patients.13 While rescue therapy remains important, and the results of the above studies are eagerly awaited, one should not forget the importance of performing the basics well when dealing with these very sick patients with UC. First of all, patients should be educated so as to know what to do when they are unwell in order that they seek medical attention early so that infections (e.g. cytomegalovirus and Clostridium

difficile) can be excluded, and a treatment plan established. Patient education, treatment plans, general practitioners, and IBD nurses can play an important role in expediting Staurosporine clinical trial appropriate treatment. Second, patients requiring admission must be appropriately examined and investigated to diagnose severe disease (tachycardia, hypotension, peritonitis, raised C-reactive protein, low serum albumin), and imaged by plain abdominal radiology to exclude complications, such as toxic megacolon and perforation. Fluid resuscitation should be timely, and attention should be paid to the prevention of venous thromboembolism by using low molecular-weight heparin.14 Non-steroidalanti-inflammatory and opioid drugs should be avoided.

Finally, and most importantly, decisions regarding rescue therapy and surgery should be made in a timely fashion, and preferably within the first 3 days of intravenous steroid treatment by the patient, with guidance from both a gastroenterologist and colorectal surgeon, preferably conferring together. Patients with severe colitis who fail to respond to intravenous steroids in hospital continue to be a major clinical challenge. Attention must be paid to doing the basics well, but it is now pleasing to see that there are Cepharanthine two rescue therapies available that might avert the need for colectomy. At this stage, it is not clear whether infliximab has usurped cyclosporine, but having a choice is likely to lead to improved outcomes for patients. “
“Although the incidence of bleeding from gastric varices is relatively low (10%–36%), the bleeding is massive once it has occurred and it increases the patient’s mortality. The management of esophageal variceal bleeding is highly differentiated with several effective treatments available. In contrast, bleeding from gastric varices continues to be a therapeutic challenge.

The natural history of RBDs is characterized by a lifelong bleedi

The natural history of RBDs is characterized by a lifelong bleeding tendency. Clinical presentation is highly variable, ranging from mild or moderate forms to severe forms with serious or life-threatening bleeding episodes. The bleeding Z-VAD-FMK research buy risks in affected individuals may, therefore, be difficult to assess [1, 32]. In contrast to haemophilia, in which FVIII or FIX levels <1% are usually associated with spontaneous and frequent joint bleeding episodes whereas patients with levels >5% remain largely asymptomatic,

there is a heterogeneous association between residual plasma coagulant factor activity and clinical bleeding severity in the various RBDs. The assays and reagents used to measure coagulation factor levels should be taken into consideration because there are often significant interlaboratory differences in factor assay results [10, 32]. Despite research efforts into RBDs, knowledge gaps remain, and randomized controlled studies may be difficult to conduct due to limitations in sample size and length of follow-up. These limitations underline the need to develop an accurate data collection tool, available to centres around the world, which would enable longitudinal and follow-up data collection. Patient registries, both national and international,

click here are powerful tools with considerable potential for rare disease research [33]. The European Network of Rare Bleeding Disorders (EN-RBD) was established to bridge the gap between knowledge and practice in the care of patients with RBDs [11]. The EN-RBD project, coordinated by the University of Milan,

Urocanase has involved 13 European treatment centres from 11 countries. Analyses of data from 489 patients registered in the EN-RBD were reported [11]. Abnormal bleeding episodes from mucous membranes (oral cavity bleeding, epistaxis and menorrhagia) are the most frequent bleeding manifestations in RBDs [10]. Abnormal bleeding from the skin and prolonged bleeding following trauma, an invasive procedure or surgery are also frequent symptoms [10]. The most severe bleeding symptoms, with a relatively high frequency of spontaneous major bleeding in joints and muscles, are found in patients with afibrinogenemia, FX deficiency and FXIII deficiency. Gastrointestinal tract bleeding and central nervous system bleeding are relatively rare for all disorders, except for FX deficiency [9]. Umbilical cord bleeding, typical of afibrinogenemia and FXIII deficiency, are relatively frequent also in individuals with FII, FV and FX deficiencies [10]. Results of the EN-RBD project demonstrate that it is not appropriate to use a single classification criterion for all types of RBDs [10]. A strong association between coagulation factor activity level and clinical bleeding severity was observed for fibrinogen, FX and FXIII deficiencies [10, 11].

The nodules were located in the VII and VIII segments and had dia

The nodules were located in the VII and VIII segments and had diameters of 24 and 39 mm, respectively. For characterization and staging, CEUS and contrast-enhanced computed tomography were performed. Both techniques showed intense and homogeneous arterial enhancement (Fig. 1A,B) followed by washout in the portal and delayed phases (Fig. 1D,E). In order to complete the genetic and immunochemical study protocol, biopsy was performed on both nodules. The lesion in the VIII segment http://www.selleckchem.com/HIF.html was revealed

to be well-differentiated ICC (Fig. 1C), whereas the other lesion showed features of well-differentiated HCC (Fig. 1F). This case clearly demonstrates the risk of accepting imaging findings as conclusive for HCC in the setting of liver cirrhosis and the risk of considering the largest of multiple nodules to be representative of all others. The AASLD guidelines should be amended with respect to the possible misdiagnosis of lesions whose imaging simulates HCC but that are due to different diseases (e.g., ICC or non-Hodgkin’s lymphoma) and with respect to synchronous nodules occurring in patients with cirrhosis. In conclusion, our case and the results of Vilana et al.1 confirm that aimed biopsy is the most accurate option for a confident diagnosis JQ1 research buy of liver nodules.4 The AASLD diagnostic

criteria increasingly seem to display evidence of low sensitivity and specificity, and this suggests the need for redefinition. Giorgia Ghittoni M.D.*, Eugenio Caturelli M.D.†, Sandro Rossi M.D.*, * Medicina VI, Ecografia Interventistica, Istituto di Ricovero Protein kinase N1 e Cura a Carattere, Scientifico Policlinico San Matteo, Pavia, Italy, † Unità Operativa di Gastroenterologia, Ospedale Belcolle,

Viterbo, Italy. “
“We read with interest the study by Solà et al.,1 who found that 39 patients (67%) had a very alarming decrease in their serum sodium levels ≥ 5 mEq/L during terlipressin treatment for acute variceal bleeding (AVB). We, however, feel that some of their observations may require a closer look by the readers. Terlipressin for AVB has been evaluated in a number of studies, but hyponatremia has not been mentioned, has not been found significant, or has not been examined in most. Escorsell et al.2 observed hyponatremia in 4 of 105 patients (3%) treated with terlipressin; similarly, Feu et al.3 observed 5 cases of hyponatremia among 80 patients (6%) with AVB. At our center, 47 patients were treated with band ligation along with terlipressin (2 mg every 6 hours for the first 48 hours and then 1 mg every 6 hours for the next 3 days) over the last 12 months [age = 50.4 ± 11.9 years, hemoglobin level = 8.1 ± 2.1 g %, median total bilirubin level = 2.3 mg % (range = 1.0-27.0 mg %), serum sodium level = 132.2 ± 6.3 mmol/L, serum albumin level = 2.5 ± 0.5 g %, median serum creatinine level = 0.