RESUMO
The present descriptive, retrospective and longitudinal study was designed to determine the epidemic profile of patients infected by hepatitis C virus and chronic hepatitis, as well as to describe the eligibility criteria for treatment with pegilated interferon plus ribavirina and its early virological answer to the treatment. We studied 20 patients treated at Gastroenterology Service of Carlos Seguín Escobedo Hospital of EsSalud between 2004 and 2006. The diagnosis of HVC infection was confirmed by detection of viral RNA with PCR, and the viral load by counting number of RNA copies. The eligibility criteria for antiviral treatment were determined, and also the METAVIR score to determine hepatic fibrosis. After 12 weeks of treatment the patients with eligibility criteria and received treatment were evaluated, and the effectivity of treatment was evaluated with a new determination of viral load. There were more female (15; 75%) than male patients (5; 25%), with ages between 50 and 59 years. The more frequent risk antecedent was blood transfusion (45%), surgery (35%), and traffic accident (10%). The hematological, hepatic, renal and hormonal parameters were in normal range; and the viral load at the moment of diagnosis was of 580 thousand copies mean (between 4100 to 2 millions copies). The most frequent viral genotypes were 1a and 1b. Up to 40% of patients did not fulfilled eligibility criteria for treatment. Nine of 12 patients with eligibility criteria received treatment (75%), 6 of them were evaluated for early virologic response and of them 100,0% had an early virologic response with decrease of post-therapeutic viral load in all but one cases until non-detectable levels. In conclusion our study described the profile of patients infected by HCV with chronic hepatitis in gastroenterology ward of our hospital, and it has been determined that is suggestive that antiviral treatment is highly effective in patients with eligibility criteria for treatment, related to early virologic response.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adolescente , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Interferon alfa-2 , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes , Estudos RetrospectivosRESUMO
Se realizó el presente estudio descriptivo retrospectivo y longitudinal para determinar el perfil epidemiológico de los pacientes infectados por virus de hepatitis C con hepatitis crónica, así como la evaluación de sus criterios de legibilidad para recibir tratamiento con Interferón Pegilado más Ribavirina y su respuesta virológica temprana al tratamiento. Se estudiaron 20 pacientes atendidos en el Servicio de Gastroenterología del Hospital Carlos Seguín Escobedo de EsSalud entre los años 2004 y 2006. El diagnóstico de infección por HVC se confirmó mediante la detección de DNA viral mediante PCR, y de la carga viral mediante el conteo de número de copias. Se determinaron los criterios de legibilidad para tratamiento antiviral; se empleó además el score METAVIR para determinar la presencia de fibrosis hepática. Luego de 12 semanas de tratamiento se evaluó a los pacientes que cumplieron criterios de elegibilidad y que accedieron al tratamiento y se evaluó su efectividad mediante una nueva determinación de la carga viral. Hubo más pacientes mujeres (15; 75 por ciento) que varones (5; 25 por ciento), con edades entre 50 y 59 años. El antecedente de riesgo más frecuente fue transfusión sanguínea (45 por ciento), cirugía (35 por ciento), y accidentes de trabajo (10 por ciento). Los valores de parámetros hematológicos, renal y hormonal estuvieron dentro de límites normales, los parámetros de función hepática (bilirrubinas, aminotransferasas, fosfatasa alcalina y gamaglutamil transpeptidasa) estuvieron por encima de lo normal; la carga viral al momento del diagnóstico fue en promedio de 580 mil copias (entre 4100 a 2 millones de copias). Los genotipos virales más frecuentes fueron 1a y 1b. Hasta 40 por ciento de pacientes no tuvieron criterios de elegibilidad para recibir tratamiento antiviral. Sólo 9 a 12 pacientes que tuvieron criterios de tratamiento lo recibieron (75 por ciento), en 6 de ellos se evaluó la respuesta virológica temprana y de ellos...
The present descriptive, retrospective and longitudinal study was designed todetermine the epidemic profile of patients infected by hepatitis C virus and chronic hepatitis, as well as to describe the eligibility criteria for treatment with pegilated interferon plus ribavirina and its early virological answer to the treatment. We studied 20 patients treated at Gastroenterology Service of Carlos Seguín Escobedo Hospital of EsSalud between 2004 and 2006. The diagnosis of HVC infection was confirmed by detection of viral RNA with PCR, and the viral load by counting number of RNA copies. The eligibility criteria for antiviral treatment were determined, and also the METAVIR score to determine hepatic fibrosis. After 12 weeks of treatment the patients with eligibility criteria and received treatment were evaluated, and theeffectivity of treatment was evaluated with a new determination of viral load.There were more female (15; 75 per cent) than male patients (5; 25 per cent), with ages between 50 and 59 years. The more frequent risk antecedent was blood transfusion (45 per cent), surgery (35 per cent), and traffic accident (10 per cent). The hematological, hepatic, renal and hormonal parameters were in normal range; and the viral load at the moment of diagnosis was of 580 thousand copies mean (between 4100 to 2 millions copies). The most frequent viral genotypes were 1a and 1b. Up to 40 per cent of patients did not fulfilled eligibility criteria for treatment. Nine of 12 patients with eligibility criteria received treatment (75 per cent), 6of them were evaluated for early virologc response and of them 100,0 per cent had an early virologic response with decrease of post-therapeutic viral load in all but one cases until non-detectable levels. In conclusion our study described the profile of patients infected by HCV with chronic hepatitis in gastroenterology ward of our hospital, and it has been determined that is suggestive that antiviral treatment is highly...
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Antivirais , Carga Viral , Hepacivirus , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/terapia , Interferons/uso terapêutico , Ribavirina/uso terapêutico , Epidemiologia Descritiva , Estudos Longitudinais , Estudos RetrospectivosRESUMO
The investigation was performed in the Carlos Alberto Seguín Escobedo National Hospital of Essalud-Arequipa, in 194 patients that were submitted to Colonic Endoscopic Polypectomy from January of 1999 to December of 2004. This study is observational, retrospective and transverse. The clinical histories, endoscopies reports and pathological anatomy reports were reviewed, taking the personal data, clinical symptoms, endoscopic and pathologic characteristics of the polyps; colonoscopies associate findings; surgical technique of polypectomies, complications and complementary treatment of post-polypectomy. The colonic endoscopic polypectomy was performed in 194 patients from 1380 colonoscopies (14.05 %), with more frequency in the sixth decade of life, and corresponding most to the masculine sex. Most of the patients did not have previous symptoms, and of those who had clinical manifestations the more frequent were the bleeding lost and changes in the intestinal rhythm. The polyps endoscopic characteristics found that the sessile were the more frequent and were located in rectum--sigmoid zone. The preponderant size was from 5 to 10mm, and mostly unique. The histopathology type of the polyps was adenoma, frequently with some grade of dysplasia. The surgical techniques for the colonic endoscopy polypectomy were with cold pincer and electric cut. The complications were rare. The complementary treatment after polypectomy was injectotherapy and surgery. Finally, our results were discussed and compared with other similar studies, and then we elaborated the conclusions and recommendations, with whom we expect to contribute to a better knowledge of the Colonic Endoscopy Polypectomy in our country.
Assuntos
Pólipos do Colo/cirurgia , Colonoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas Angiogênicas , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos RetrospectivosRESUMO
El presente trabajo se realizó en el Hospital Nacional Carlos Alberto Seguín Escobedo-EsSalud-Arequipa en los 194 pacientes que fueron sometidos a Polipectomía Endoscopía Colónica en el periodo comprendido entre Enero de 1999 a Diciembre del 2004. El método empleado es el observacional, retrospectivo y transversal, se estudió las historias clínicas, informes de endoscopía y de anatomía patológica, teniendo en cuenta datos de filiación, cuadro clínico, características endoscópicas y anatomopatológicas de los pólipos, hallazgos colonoscópicos asociados, técnica de polipectomía, lógicas complicaciones de la polipectomía y tratamiento complementario postpolipectomía. Se encontró que la polipectomía endoscópica colónica se realizó en 194 pacientes, del total 1380 colonoscopías (14.05 por ciento), con más frecuencia en la sexta década de la vida, y correspondiendo la mayor parte al sexo masculino. En el cuadro clínico la mayoría de pacientes no tuvieron sintomatología previa, y de los que tuvieron alguna manifestación clínica las más frecuente fueron las pérdidas hemáticas y cambios en el ritmo defecatorio. En cuanto a las características endoscópicas de los pólipos, los sésiles fueron los más frecuentes, se localizaron en su mayoría en la zona recto-sigmoidea, el tamaño preponderante fue de 5 a 10mm, y su presentación generalmente fue única. El tipo histológico de los pólipos predominante son los adenomas, asimismo presentan con frecuencia algún grado de displasia. Las técnicas de polipectomía endoscópica colónica empleadas fueron con pinza fría y la de asa, las complicaciones fueron raras. El tratamiento complementario post-polipectomía recibido fue inyectoterapia y cirugía. Finalmente, se comentó y comparó nuestros resultados con otros estudios similares, elaborando conclusiones y recomendaciones, con lo que esperamos contribuir a un mejor conocimiento de la polipectomía endoscópica colónica en nuestro país.
The investigation was performed in the Carlos Alberto Seguín Escobedo National Hospital of Essalud-Arequipa, in 194 patients that were submitted to Colonic Endoscopic Polipectomy from January of 1999 to December of 2004. This study is observational, retrospecttive and transverse. The clinical histories, endoscopies reports and pathological anatomies reports were reviewed, taking the personal data, clinical symptoms, endoscopic and pathologic characteristics of the polyps; colonoscopies associate findings; surgical technique of polipectomies, complications and complementary treatment of post-polipectomy. The colonic endoscopic polipectomy was performed in 194 patients from 1380 colonoscopies (14.05 percent), with more frequency in the sixth decade of life, and corresponding most to the masculine sexo Most of the patients did not have previous symptoms, and of those who had clinical manifestations the more frequent were the bleeding lost and changes in the intestinal rhythm. The polyps endoscopic characteristics found that the sessile were the more frequent and were located in rectum -sigmoid zone. The preponderant size was from 5 to 10mm, and mostly unique. The histopathology type of the polyps was adenoma, frequently with so me grade of dysplasia.The surgical techniques for the colonic endoscopy polipectomy were with cold pincer and electric cut. The complications were rare. The complementary treatment after polipectomy was inyectotherapy and surgery. Finally, our results were discussed and compared with other similar studies, and then we elaborated the conclusions and recommendations, with whom we expect to contribute to a better knowledge of the Colonic Endoscopy Polipectomy in our country.
Assuntos
Humanos , Masculino , Feminino , Colonoscopia , Pólipos do Colo , Estudos Retrospectivos , Estudos Transversais , Hospitais EstaduaisRESUMO
UNLABELLED: The serum levels of antibodies against the Hepatitis B virus, in employees of the Case-Essalud National Hospital of Arequipa, who have been vaccinated, were determined in order to evaluate the immunoresponse that the vaccination produces in them and the factors that may be involved in the said response. In this way the protection level that is being achieved may be known. MATERIAL AND METHODS: The study was carried out on 165 health employees of the Case-Essalud National Hospital of Arequipa who were administered the recombinant vaccination against the Hepatitis B Virus (HBV), via intramuscular injection in the deltoid region, applying the rapid scheme 0, 1, 2 months. A 1 ml (30 microg of antigen) dose was administered. The serum concentrations of anti-HBs (in mUI/ml) were found in the third month of the third dose, by the enzyme immunoassay method, AXSYM System of Abbot Laboratories. In accordance with the facts established, seroprotection levels were defined to be serum concentrations of anti-HBsAg antibodies greater than 10 mUI/ml. RESULTS: The results evidenced that the vaccine applied to the employees being studied, produced seroprotection levels >10 mUI/ml in 94.54% of the employees. Besides, a lesser seroprotection response (p>0.01) was seen in male employees, in those older than 40 years of age, in those with high TGP levels and in tobacco consumers. Whereas, no significant relation (p>0.05) was observed between the immunogenic response and the pathological history of the employees vaccinated. CONCLUSIONS: It may be concluded that the recombinant vaccine against the Hepatitis B Virus (HBV) produces an adequate measure of protection in a significant percentage of employees in Peru and that the response is significantly lesser in male employees, in those older than 40 years of age, in those with high TGP levels and in tobacco consumers.
Assuntos
Anticorpos Anti-Hepatite B/biossíntese , Vacinas contra Hepatite B/imunologia , Recursos Humanos em Hospital/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Especificidade de Anticorpos , Comorbidade , Estudos Transversais , Feminino , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vacinas contra Hepatite B/efeitos adversos , Hospitais Públicos/estatística & dados numéricos , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controle , Ocupações , Peru , Estudos Retrospectivos , Fumar/imunologia , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/imunologiaRESUMO
Se determinaron los niveles séricos de anticuerpos contra el virus de la hepatitis B en trabajadores vacunados del Hospital Nacional CASE-ESSALUD de Arequipa, con el objetivo de evaluar en ellos la inmunorespuesta que produce la vacuna y los factores que podrían estar involucrados en dicha respuesta y de ese modo conocer el grado de protección que se está consiguiendo. MATERIAL Y METODOS: El estudio se llevo a cabo en 165 trabajadores de salud del Hospital Nacional CASE-ESSalud de Arequipa, a los que la vacuna recombinante contra el virus de la hepatitis B se les había administrado por vía intramuscular en la región deltoidea, aplicando el esquema rápido 0, 1, 2 meses. La dosis fue de 1 ml (20 ug de antígeno). En ellos se determinó las concentraciones séricas de anticuerpos anti-HBs (en mUl/ml al tercer mes de la tercera dosis, por el método Enzimoinmunoensayo AXSYM System de Laboratorios ABBOT. En concordancia con lo establecido, se consideraron como niveles de seroprotección las concentraciones séricas de anticuerpos anti-HBsAg superiores a 10 mUl/ml. RESULTADOS: Los resultados evidenciaron que la vacuna aplicada a los trabajadores en estudio produjo niveles de seroprotección (>10 mUl/ml) en el 94.54 por ciento. además, mostraron una menor respuesta de seroprotección (p<0.01) en trabajadores del sexo masculino, en los mayores de 40 años de edad, en los que presentaron mayores niveles de TGP y en los que consumen tabaco; en cambio no evidenciaron relación significativa (p>0.05) entre la respuesta inmunogénica los antecedentes patológicos de los trabajadores vacunados. CONCLUSIONES: Se concluye que la vacuna recombinante contra el virus de la hepatitis B en un importante procentaje de trabajadores de nuestro medio produce una adecuada tasa de protección y que dicho tipo de respuesta es significativamente menor en los trabajadores de sexo masculino, en los mayores de 40 años de edad, en los que tienen niveles elevados de TGP y en los que consumen tabaco.