ADDITIONAL INDEX WORDS. mature, index, fat content, dry matter, weather conditions SUMMARY. 'Hass' avocado (Persea americana) is a fruit in high demand in international markets, and Colombia is expanding its export to the United States. Avocado quality and shelf life are related to its harvest time. However, there is not enough information on harvest indicators in Colombia that allow producers to adequately harvest fruit to comply with market requirements. Therefore, the aim of this study was to estimate maturity indicators during two harvest periods. We harvested fruit between the years 2016 and 2017 in eight farms distributed in three regions of the Department of Antioquia, Colombia, and selected those in the postanthesis stages. We assessed variables such as fruit color, weight, dimensions, oil content (OC), and dry matter (DM). The results were analyzed using simple and multiple regressions as well as by principal component analysis (PCA). The results showed a high linear relation between DM and OC (R 2 ‡ 78.88) and a significant relation between OC, rainfall, fruit development time, and environmental temperature. Nondestructive indicators that allow the establishment of DM in the field (R 2 ‡ 73.57) varied according to the region and included fruit color (L*, b*), volume (P £ 0.05), and fruit development time. These indicators could reduce maturity heterogeneity during the harvest period.

Patient: Male, 14Final Diagnosis: Lysosomal acid lipase deficiency (LAL-D)Symptoms: Dyslipidemia • isolated hepatomegalyMedication: —Clinical Procedure: Genetic sequencingSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Lysosomal acid lipase deficiency is a rare genetic metabolic lipid storage disease, with a high morbidity, and mortality, in children and adults. It is characterized by a mutation in the LIPA gene that causes an alteration of lipid metabolism, resulting in deposits of cholesterol esters and triglycerides in organs such as the liver, blood vessels, and gastrointestinal tract. Lysosomal acid lipase deficiency is predominantly caused by the mutation c.894G>A, seen in approximately 50–70% of patients. Our objective is to report the first pediatric case of lysosomal acid lipase deficiency in a pediatric patient in Colombia.Case Report:The patient is a 14-year-old boy with isolated hepatomegaly since 6 years of age without a family history of dyslipidemia. In the pediatric control, laboratory exams revealed dyslipidemia, and a hepatic biopsy was performed, revealing severe fibrosis with septation and grade 3 microvesicular steatosis (>75%). He was referred to our center and was suspected to have lysosomal acid lipase deficiency. Enzymatic activity was measured, showing absent activity. Confirmatory diagnosis with genetic sequencing showed a pathological homozygous mutation of c.894G>A.Conclusions:Lysosomal acid lipase deficiency can manifest as early- or late-onset, with variable and severe signs and symptoms. The late-onset form has a broad spectrum of manifestations with mild symptoms, leading to under-diagnosis, which increases the actual disease burden. Early diagnosis is essential to initiate enzyme replacement therapy, since the natural disease course can be changed. More studies should be conducted in Latin America to evaluate the prevalence of the disease.

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Hepatitis A virus (HAV) causes an acute infection and is usually asymptomatic in children. When clinical manifestations appear, these include choluria, jaundice, and abdominal pain. Although infrequent, extra-hepatic manifestations related to HAV have been described, affecting the heart, bone marrow, blood vessels, and other tissues.A 10-year-old boy from a rural area presented with a 15-day history of malaise, fever, and jaundice; laboratory examinations were compatible with HAV infection. The patient turned encephalopathic and was remitted to our center, where laboratory examinations showed a medullary aplasia and fulminant hepatitis requiring a liver transplant that was performed 72 hours after admission. At 24 hours post transplant, the patient developed a cardiomyopathy secondary to HAV, and intravenous immunoglobulin was administered. The patient is still alive and attending his medical check-ups.Although rare, extra-hepatic manifestations of HAV infection have been described in 14% of cases. The groups of patients affected are usually aged and present with high bilirubin levels. Acquired aplastic anemia and myocarditis caused by HAV are uncommon, and its pathophysiology has not yet been elucidated.HAV infection is usually asymptomatic in children, although extra-hepatic manifestations can appear requiring early detection and management.

Palabras clave: trasplante; trasplante de órganos; selección de donante; obtención de tejidos y órganos; muerte encefálica.

Case seriesPatient: Male, 38 • Male, 48Final Diagnosis: En-bloc transplantation (liver, kidney, pancreas)Symptoms: Encephalopathy • adynamia • ascites • astheniaMedication: —Clinical Procedure: En-bloc transplantationSpecialty: TransplantologyObjective:Unusual setting of medical careBackground:En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages.This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique.Case Report:The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent.Conclusions:En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control.

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Invasive pulmonary aspergillosis in children with hepatic transplant: a survivorAspergilosis pulmonar invasora en pacientes pediátricos con trasplante hepático, a propósito de una sobreviviente AbstractIntroduction: Mycotic infections due to Aspergillus spp, are the main mycotic associated infections in liver transplant patients, with mortality rates up to 90% of the cases. Almost 50% of patients will develop an infection during the first months after transplantation, of which 10% are associated with opportunistic agents. Objective: To describe the diagnosis and management of an Invasive Pulmonary Aspergillosis (IPA) episode in a liver transplant patient. Case report: 11-months-old patient with liver transplant due to a biliary atresia who developed severe pneumonia associated with mechanical ventilation. The bronchoalveolar lavage showed high levels of galactomannan and positive culture for Aspergillus fumigatus leading to an IPA diagnosis. This episode was treated with antifungal with a favorable outcome. Conclusion: The IPA is an opportunistic infection in liver transplant patients, with high mortality rates, that must be suspected in this group of patients since an early diagnosis and treatment reduce mortality.