Three-dimensional photographic analysis of the face in European adults from southern Spain with normal occlusion: reference anthropometric measurements.

BACKGROUND: Recent non-invasive 3D photography method has been applied to facial analysis, offering numerous advantages in orthodontic. The purpose of this study was to analyze the faces of a sample of healthy European adults from southern Spain with normal occlusion in order to establish reference facial soft tissue anthropometric parameters in this specific geographic-ethnic population, as well as to analyze sexual dimorphism. METHODS: A sample of 100 healthy adult volunteers consisting of 50 women (mean age, 22.92 ± 1.56 years) and 50 men (mean age, 22.37 ± 2.12 years) were enrolled in this study. All participants had normal occlusion, skeletal Class I, mesofacial pattern, and healthy body mass index. Three-dimensional photographs of the faces were captured non-invasively using Planmeca ProMax 3D ProFace®. Thirty landmarks related to the face, eyes, nose, and orolabial and chin areas were identified. RESULTS: Male displayed higher values in all vertical and transversal dimensions, with the exception of the lower lip height. Larger differences between sexes were observed in face, mandible, and nose. Male also had higher values in the angular measurements which referred to the nose. No sex differences were found in transverse upper lip prominence or transverse mandibular prominence. No differences were found in the ratio measurements, with the exception of intercantal width/nasal width, which was higher in women than in men. CONCLUSIONS: Reference anthropometric measurements of facial soft tissues have been established in European adults from southern Spain with normal occlusion. Significant sexual dimorphism was found, with remarkable differences in size between sexes.

Hepatitis C recurrence after liver transplantation: Viral and histologic response to full-dose PEG-interferon and ribavirin.

Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-alpha-2a (n = 4) or alpha-2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients > or =12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 +/- 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease > or =1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.

Viral kinetics and early prediction of nonresponse to peg-IFN-alpha-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus.

To evaluate, among 70 hepatitis C virus (HCV)-monoinfected and 36 human immunodeficiency virus (HIV)-coinfected naïve patients with genotypes 1/4 receiving weight-adjusted pegylated interferon-alpha-2b/ribavirin, viral kinetics and the feasibility to predict treatment failure measuring early HCV-RNA decreases. HCV-RNA was assessed at baseline, weeks 4, 12 and 24. Receiver operating characteristic (ROC) curves were calculated to determine the most sensitive cut-off values of viral decrease at week 4 predicting treatment failure. Baseline predictors of failure were evaluated by univariate and multivariate analyses. Despite similar baseline HCV-RNA (5.75 vs 5.72 log(10)IU/ml, P = 0.6), HCV monoinfection led to significantly lower HCV-RNA values at weeks 4 (3.7 vs 4.3 log(10)IU/ml, P = 0.01), 12 (2.3 vs 3.5 log(10)IU/ml, P = 0.01) and 24 (1.4 vs 3.3 log(10)IU/ml, P = 0.001) and a higher rates of viral clearance at weeks 24 (60%vs 36%, P = 0.02), 48 (46%vs 25%, P = 0.03) and 72 (37%vs 17%). The lack of achieving an HCV-RNA decrease of at least 1 log(10) at week 4 was highly predictive of treatment failure for HCV-monoinfected patients (Se 100%, Sp 50%, positive predictive value (PPV) 57%, negative predictive value (NPV) 100%, ROC curve area, 0.86 [95% confidence interval (CI) 0.77-0.95], but not for HCV/HIV-coinfected patients (cut-off, 0 log(10), Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0.71 (95% CI 0.49-0.93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1.08-8.04, P = 0.01). Thus the magnitude of HCV-RNA decreases at week 4 correlated with treatment response. Significant differences in viral kinetics and cut-off values predicting nonresponse suggest a slower HCV clearance rate in HIV coinfection, which was independently associated with treatment failure.

[Lamivudine and adefovir resistance in a patient with HBeAg negative chronic hepatitis B]. / Resistencia del virus de la hepatitis B a lamivudina y adefovir en un paciente con hepatitis crónica B y antígeno e negativo.

We have studied a 49-year-old patient with a HBeAg-negative chronic hepatitis B in whom, after 34 months of treatment with lamivudine and associated with an increase in the serum hepatitis B virus (HBV) DNA, the lamivudine resistance mutations M204I and L180V were detected. Lamivudine was substituted for adefovir dipivoxil and after 16 months of treatment, in the course of a study to investigate hepatitis B genotypes, the adefovir resistance mutation N236T was detected. HBV viral load in this sample was 3 yen 10(7) UI/ml. Adefovir is considered as the alternative treatment when lamivudine resistance is detected. Appearance of resistance to adefovir is very unusual and in Spain, no case has been communicated yet. However, we must be aware of the adefovir resistance in patients who do not respond to adefovir and it must be confirmed with a resistance study, if possible.

Prevalence of hepatitis E antibodies in immigrants from developing countries.

The aim of the present study was to investigate the prevalence of anti-hepatitis E virus (HEV) antibodies among indigenous Spanish blood donors and immigrants from developing countries in order to determine whether immigrants pose a significant risk for the transmission of HEV to the healthy Spanish population. The seroprevalence of HEV was determined in a cohort of 90 asymptomatic immigrants (mostly from countries in sub-Saharan Africa) who had recently arrived in Madrid, Spain, and in 863 blood donors, who represented the healthy Spanish population. The results showed that the prevalence of HEV antibodies was 1.9 times higher in the immigrants than in the blood donors (5.5% in immigrants, 95% CI 1.8-12.4; 2.9% in blood donors, 95% CI 1.9-4.2). Combined with the estimated population figures of 300,000 undocumented immigrants versus 39,000,000 Spaniards, these results indicate that sub-Saharan immigrants cannot currently be considered a major risk source for the transmission of HEV in Spain.

[Acute hepatitis E in Spain]. / Hepatitis aguda E en España.

Hepatitis E virus (HEV) is the worldwide leading cause of non-A non-B enterically transmitted hepatitis, and affects most commonly the population in developing countries. Cases outside this area, are nearly always imported, although apparent local acquisition has been occasionally reported. We assisted three patients with acute HEV hepatitis, confirmed by the presence of serum anti-HEV IgM. One of them did not report travelling outside of Spain in the previous years. HEV has to be included in the differential diagnosis of acute non-A non-B non-C hepatitis, even in cases in which an exposure in endemic areas cannot be recalled.

Hepatitis E virus: relevance in blood donors and risk groups.

BACKGROUND AND OBJECTIVES: Hepatitis E virus (HEV) infection usually causes acute self-limited disease. HEV is associated with faecal-contaminated drinking water, but other vectors, such as blood, are possible. The aim of this study was to investigate the prevalence of HEV in blood donors and in two groups at high risk for parenteral infections, namely, haemodialysis patients, and children infected with HCV via blood transfusion. MATERIALS AND METHODS: We investigated the prevalence of anti-HEV in 863 blood donors, 63 haemodialysis patients, and 42 children infected post transfusion with HCV. RESULTS: The prevalence rates were 2.8, 6.3%, and zero, respectively. CONCLUSIONS: (1) The incidence of HEV in Spain is similar to that in other Western European countries, and (2) HEV is probably not transmitted parenterally to children.

Hepatitis E virus: relevance in blood donors and other risk groups.

BACKGROUND AND OBJECTIVES: Hepatitis E virus (HEV) infection usually causes an acute self-limited disease. HEV is associated with feces-contaminated drinking water, but other vectors, such as blood, are possible. The aim of this study was to investigate the prevalence of HEV in blood donors and in two groups at high risk of parenteral infections, namely, hemodialysis patients and children infected with hepatitis C virus (HCV) via blood transfusion. MATERIALS AND METHODS: We investigated the prevalence of anti-HEV in 863 blood donors, 63 hemodialysis patients, and 42 children infected with HCV posttransfusion. RESULTS: The prevalence rates were 2.8, 6. 3%, and 0 respectively. CONCLUSIONS: (1) The incidence of HEV in Spain is similar to that in other western European countries, and (2) HEV is probably not transmitted parenterally to children.

Antibody level after hepatitis B vaccination in hemodialysis patients: influence of hepatitis C virus infection.

Seroconversion after hepatitis B vaccine has been estimated to occur when the level of anti-HBs is higher than 10 IU/1, but recently is has been considered that an antibody titer above 100 IU/1 is necessary to guarantee an efficacious protection. We prospectively studied the evolution of anti-HBs after primary vaccination (3 doses; Engerix B, 40 mu g each) in 56 seronegative and not previously vaccinated hemodialysis patients. Three months after vaccine administration, seroconversion (anti-HBs > 10 IU/1) was found in 43 patients (76.7%), but an adequate response (titer > 100 IU/1) was observed only in 30 (53.5%). At 1 year after vaccination only 1 (3.3%) of the 30 cases with an effective response had lost his anti-HBs, while 12 of the 13 patients (92.3%) with an inadequate response (anti-HBs between 10 and 100 IU/1) had no detectable antibodies (p < 0.01, chi2). Considering that an antibody titer above 100 IU/1 following vaccination is necessary in order to maintain that level of antibody 1 year later, we analyzed the factors which influenced obtaining this level of antibody. Age, time on hemodialysis, serum albumin, Kt/V and protein catabolic rate did not affect the response to the vaccine. Females had a better response than males, and interestingly we found that hepatitis C virus (HCV) infection influenced the level of immunity. 27 out of the 43 HCV-negative cases (62.7%) obtained anti-HBs levels greater than 100 IU/1, but only 3 out of the 13 HCV-infected patients (23%) had an anti-HBs above 100 IU/1 (p < 0.01, chi2). Our results suggest that after hepatitis B vaccine, an antibody titer higher than 100 IU/1 is necessary to maintain the antibody level 1 year later, and that HCV infection may reduce the effectiveness of hepatitis B vaccine in hemodialysis patients.