We conducted a prospective, descriptive study in the Clinica Anglo Americana, a prívate institution taking care of patients from a medium-high socioeconomic level in Lima. The goal of the study was to determine the frequency of histologic findings in liver biopsies performed by laparoscopy or percutaneously in patients with overweight (body mass index > 25 kg/m2) or obesity (body mass index > 30 kg/m2), and to evaluate the correlation with antropometric variables such as BMI, waist circumference, history of diabetes or hyperlypidemia, and biochemical variables like glycemia, lipid profile, aminotransferases and AST/ALT ratio. Between the years 2001 and 2006 50 patients were biopsied, 29 with overweight and 21 with obesity. Eighteen had simple steatosis and 22 had Non-alcoholic steatohepatitis (NASH)(44%), so 40 patients (80%) had some form of fatty liver. Five patients (10%) had cirrhosis confirmed by biopsy, and in all of them the finding of cirrhosis was completely incidental. Sixty four percent of patients with NASH were obese, like the 5 cirrhotics in our series. Herein we illustrate that in a relatively small sample of patients with obesity and overweight like ours, we found all the forms of the liver steatosis spectrum, from simple steatosis to cirrhosis, with a high frequency of NASH.

Condujimos un estudio prospectivo descriptivo en la Clínica Anglo Americana, una institución privada que atiende a pacientes de estrato socio económico medio-alto en Lima metropolitana. El objetivo del estudio era determinar la frecuencia de hallazgos histológicos en biopsias hepáticas obtenidas por laparoscopía ó punción percutánea en pacientes con sobrepeso (IMC > 25 kg/m2) u obesos (IMC > 30 kg/m2), y evaluar la correlación con variables antropométricas como Indice de Masa Corporal (IMC), perímetro de cintura, historia de diabetes o dislipidemia y variables bioquímicas como glicemia, perfil lipídico, aminotransferasas y relación AST/ALT. Entre los años 2001 y 2006 se biopsiaron 50 pacientes, 29 con sobrepeso y 21 con obesidad. Dieciocho tuvieron esteatosis simple y 22 tuvieron Esteatohepatitis No alcohólica (NASH) (44%), de modo que 40 pacientes (80%) en total tuvieron alguna forma de hígado graso. Cinco pacientes (10%) tuvieron cirrosis confirmada por biopsia, y en todos ellos el hallazgo de cirrosis fue totalmente incidental. Un 64% de los pacientes con NASH fueron obesos, como lo fueron los cinco cirróticos de nuestra serie. Ilustramos en nuestro trabajo que en una muestra relativamente pequeña de pacientes con obesidad y sobrepeso como la obtenida, se encuentran todas las formas del espectro de la esteatosis hepática, que va desde la esteatosis simple hasta la cirrosis, con una gran frecuencia de NASH.

The control of CD4 gene expression is essential for proper T lymphocyte development. Signals transmitted from the T-cell antigen receptor (TCR) during the thymic selection processes are believed to be linked to the regulation of CD4 gene expression during specific stages of T cell development. Thus, a study of the factors that control CD4 gene expression may lead to further insight into the molecular mechanisms that drive thymic selection. In this review, we discuss the work conducted to date to identify and characterize the cis-acting transcriptional control elements in the CD4 locus and the DNA-binding factors that mediate their function. From these studies, it is becoming clear that the molecular mechanisms controlling CD4 gene expression are very complex and differ at each stage of development. Thus, the control of CD4 expression is subject to many different influences as the thymocyte develops.