Access to direct-acting antivirals for the treatment of hepatitis C in a country with limited resources. / Evaluación del acceso a antivirales para el tratamiento de la hepatitis C en un país con recursos limitados.

AIMS: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access. MATERIALS AND METHODS: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017. RESULTS: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09]). CONCLUSION: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system).

Urinary albumin excretion in elderly patients with white coat hypertension.

The so-called white coat effect occurs in about 42% of elderly patients. This phenomenon leads to several problems in treatment and may also cause renal disease. One of the most frequently controlled parameters is microalbuminuria, an index of renal damage. The present case-control study intended to evaluate the urinary excretion of albumin in elderly patients suffering from white coat hypertension, and comparing their data to those of normotensive subjects. In addition, the study searched for correlations between albuminuria and various clinical and ambulatory blood pressure values. A total of 258 patients were enrolled, but after screening, only 129 were considered; 13 of the latter were further excluded because of problems encountered during ambulatory monitoring of arterial blood pressure. Therefore, 116 hypertensive subjects were included in the study. This pool of hypertensive patients was compared to a normotensive group of 33 subjects. The results have shown the occurrence of white coat effect in 25% of cases, and the microalbuminuria of these patients was statistically not significantly different from that of the normotensive group of patients. The microalbuminuria correlated only with ambulatory systolic blood pressure measured during the day.

[Solitary primary cerebral echinococcosis. Report of a case]. / Echinococcosi cerebrale primaria solitaria. Descrizione di un caso.

INTRODUCTION AND AIMS: Echinococcosis is a widespread parasitic disease caused by Echinococcus granulosus. Hydatid cysts are mainly diagnosed in adults except for primary cerebral localisation which is electively observed in childhood owing to the early manifestation of signs and/or symptoms of the space-occupying mass. In July 1995 P.N., a 55-year-old woman, was referred to our attention. She complained of intense asthenia, cephalea not responding to NSAIDs and paroxysms of tremor. RESULTS: The anamnesis revealed close relationships with dogs since infancy and an attack of pleurisy of unknown etiology. The objective examination was negative except for an increased volume of the right-hand thyroid lobe. Hematochemical tests showed relative eosinophilia, a significant positivity of anti-thyroglobulin antibodies and antiperoxidase with normal thyroid function indices. Thyroid scan showed a multinodular goitre. Confirmation of eosinophilia suggested the performance of a parasitological examination of feces with negative results. ECG and EEG were normal. Persistent cephalea led to the performance of an encephalic CAT which revealed a cystic formation in the rolandic region, subsequently confirmed by encephalic MNR. The positivity of the Ghedini-Weinberg test led to the diagnosis of cerebral echinococcosis. Chest X-ray and hepatic scan excluded hydatid localisation in these organs. CONCLUSIONS: The case was diagnosed as solitary primary cerebral echinococcosis. Medical follow-up was commenced with albendazole for six months, after which a control encephalic CAT showed the unchanged size of the cysts. The patient consequently underwent surgical exeresis.

[When is the best time to perform upper digestive endoscopy to detect the presence of esophageal varices in patients with cirrhosis?]. / 'Cuándo sería más rentable realizar una endoscopia digestiva alta para establecer la presencia de varices esofágicas en pacientes con cirrosis?

INTRODUCTION: Variceal hemorrhage occurs in 25 to 35% of cirrhotic patients and is associated with significant morbidity and mortality and elevated hospital costs. Endoscopic exploration of gastroesophageal varices (GEV) in cirrhotic patients increases costs and involves a certain degree of invasiveness and discomfort for patients. The association between the presence of GEV and spleen size, liver function and platelet count is controversial. The aim of this study was to determine the correlation between liver function, evaluated by Child-Pugh (Ch-P) classification, platelet count (PC) and spleen volume index (SVI) with the presence of GEV in patients with cirrhosis managed in the outpatient setting. PATIENTS AND METHOD: Sixty-eight patients were included. In all patients, a medical history was taken and biochemical tests, mode B and Doppler abdominal ultrasonography, and upper digestive video-endoscopy were performed. RESULTS: A total of 76.47% of the patients were men and 23.53% were women. The median age was 52.8 12.4 years. More than half (54.41%) of the patients were Ch-P grade A, 41.18% were grade B and 4.41% were grade C. The most frequent causes of cirrhosis were alcohol in 52.95% and hepatitis C virus in 17.65%. Esophageal varices (EV) were found in 85.29% of the patients. The median SVI was 50.5 9.2 and the median PC was 150 26 x 109/L. A correlation was found between the presence of EV, SVI >or= 45 and PC < or= 100 x 109/L (r = 0.327; p = 0.006). No correlation was found between the presence of EV and Ch-P grade A. In the multivariate analysis, only the presence of EV was associated with SVI >or= 45 (OR 7.4; 95% CI, 1.30-77.7; p = 0.02). CONCLUSION: The presence of EV in cirrhotic patients managed in the outpatient setting was correlated with SVI >or= 45 and PC

[Acute liver failure: clinical-epidemiological characteristics]. / Insuficiencia hepática aguda: características clínico-epidemiológicas.

In order to ascertain the clinical and epidemiological features of acute liver failure (ALF), we analyzed the clinical histories of 22 patients from La Plata city, with the diagnosis of ALF (prothrombin level or factor V below 50%) seen between November 1996 and November 2000. Age, sex, hepatic encephalopathy, reason for consultation, etiology, hepatic biochemical tests, serum creatinine, glycemia, digestive hemorrhage, course and treatment variables were analyzed. What is remarkable is the high frequency of the toxic etiology and of infection by HDV, as well as the high prevalence of ascites and the low incidence of hepatic encephalopathy. We think that the high survival rate we found is due to the early diagnosis and early referral of the patients to the intensive care unit and to centers with programs for liver transplantation.

[Acute liver failure by diphenylhydantoin]. / Insuficiencia hepática aguda por difenilhidantoina.

Diphenylhydantoin is a anticonvulsivant and antiarrhythmic drug. We reported a less frequent case of diphenylhydantoin associated acute hepatotoxicity in a 18-year old woman who immediately after child birth presented generalized tonic-clonic seizures secondary to arachnoid cyst in the left temporal-lobe. The patient developed a mononucleosis like coinciding with previous descriptions. Histological features observed in the liver biopsy specimen showed compatible changes with toxic acute liver failure (ALF). In the few cases published of ALF for Diphenylhydantoin is not specifically pointed out the absence of hepatic encephalopathy as it happened to our patient.

[Sexual transmission of Hepatitis C virus]. / Transmisiòn sexual del virus de Hepatitis C.

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldn't be a direct transmission of HCV.

[Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use]. / Prevalencia de afectación hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedente de consumo de drogas.

UNLABELLED: Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.

[Anti HCV in hemodialyzed patients: reduction of the prevalence and association with epidemiological variables]. / Anti HCV en pacientes hemodializados: descenso de la prevalencia y asociación con variables epidemiológicas.

In order to establish the present prevalence of HCV in hemodialyzed patients (HD) from the city of La Plata, and to know the association between the prevalence and different variables, we have studied 217 hemodialyzed patients belonged to the Hemodialysis Unit of a Public Hospital and other 7 private Units. Serological reactivity to Anti HCV and Anti HBc IgG were investigated in all of them, as well as age, sex, number of transfusions, the time under dialysis treatment, the use of erythropoietin and hepatitis episodes were taken into account. We have found a prevalence of Anti HCV of 18.4% which was significantly superior to the blood donors' prevalence (P < 0.01) and significantly inferior to the one found in 1993 in HD patients of the same city (p = 0.002). We have found an association between the presence of Anti HCV and transfusions exposure, as well as more hemodialysis time. Our results may agree with the ones that suggest the aminotransferases are not good markers for hepatocellular injuries in Anti HCV (R) HD patients.

Disfunción hepática en el trasplante de celulas progenitoras hematopoyéticas: Impacto sobre la mortalidad / Liver dysfunction in recipients of hematopoietic stem cells: Impact on mortality

El compromiso hepático en receptores de transplante alogénico de células progenitoras hemotopoyéticas (TCPH) es una complicación muy frecuente y es responsable de la morbimortalidad precoz. La toxicidad por fármacos la enfermedad injerto versus huésped ( EICH) , la enfermedad venooclusiva (EVO) y las infecciones fúngicas, bacterianas y virales constituyen las principales etiologias. El objetivo de este estúdio retrospectivo fue estabelecer la prevalencia y etiología de la afectación hepática, evaluar el impacto en la mortalidad y analizar el valor predictivo de las transaminasas pré TCPH en la ocurrencia de EICH agudo, crônico y mortalidad. De un total de 236 pacientes transplantados, se evaluaron 82 sometidos a TCPH alogénico. El 88% de los pacientes tuvo afectación hepática: EICH agudo 40.2%, EICH crônico 15.9%, de causa indeterminada 9.8% sepsis 7.3%, toxicidad por fármacos 6.1%, EVO 3.7%, hepatitis aguda y recidiva de enfermedad 2.4%. La mortalidad evaluada al año fue 36.6%. La insuficiência hepática aguda (IHA) represento el 10% de las muertes. Las causas de IHA fueron: progresón de EICH agudo, recidiva de la enfermedad hematológica en el hígado, hepatitis herpética y EVO. El valor predictivo positivo de las transaminasas pré TCPH para EICH agudo, crônico y mortalidad fue 0.27, 0.14 y 0.43 respectivamente. No se hallaron diferencias significativas entre pacientes con pruebas bioquímicas hepáticas pré TCPH alteradas o normales en la ocurrencia de EICH agudo, crónico o mortalidad.

Insuficiencia hepática aguda: características clínico-epidemiológicas / Acute liver failure: clinical-epidemiological characteristics

Se analizaron las historias clínicas de 22 pacientes con IHA (Protrombina y/o factor V menor de 50 por ciento). La ictericia fue el motivo de consulta más frecuente (54.5 por ciento). Doce pacientes (54.5 por ciento) presentaron EH, sólo dos de los cuales la teníam en el momento del ingreso. Doce (54.5 por ciento) presentaron ascitis en algún momento de la evolución. Etiología desconocida en 6 (27.2 por ciento), fármacos 6 (27.2 por ciento), HBV 5 (22.7 por ciento) 2 de los cuales teníam además HDV y 3 (13.6 por ciento) autoimmune. Se halló una alta tasa de sobrevida.

Insuficiencia hepática aguda por difenilhidantoina / Acute liver failure by diphenylhydantoin

Presentamos un caso poco frecuente de insuficiencia hepática aguda por difenilhidantoína en una joven de 18 años. La paciente fue tratada con dicho fármaco inmediatamente después de un parto normal por presentar convulsiones clónicas secundarias a un quiste aracnoideo del lóbulo temporal izquierdo. La paciente presentó un "tipo mononucleosis like" tal como ha sido descripto previamente. La enferma mejoró su función hepática estando en lista de espera para transplante ortotópico hepático y se recuperó totalmente hasta alcanzar el alta definitiva de dos meses después sin haber presentado manifestaciones de encefalopatía hepática en ningún momento de la evolución. La ausencia de encefalopatía hepática, tal como ocurrió en nuestra paciente, no fue señalada en ninguno de los pocos casos de insuficiencia hepática por difenilhidantoína comunicados previamente. Nos estimulan a poner en conocimiento de la comunidad médica un nuevo caso de insuficiencia hepática aguda por difenilhidantoína: 1) La ausencia de encefalopatía hepática (comunicada por primera vez en un caso de insuficiencia hepática aguda por difenilhidantoína. 2) La baja frecuencia de insuficiencia hepática aguda por difenilhidantoína. 3) La forma típica de presentación como "Síndrome Mononucleosis like" con la posibilidad que ella convella de confundir esta entidad con una infección por virus de Ebstein Bar.

Transmisión sexual del virus de Hepatitis C / Sexual transmision of Hepatitis C virus

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldn't be a direct transmission of HCV

Prevalencia de afección hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedentes de consum / Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use

Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.

Anti HCV en pacientes hemodializados: descenso de la prevalencia y asociación con variables epidemiológicas / Anti HCV in hemodialyzed patients: reduction of the prevalence and association with epidemiological variables

Para estabelecer la prevalencia actual de infección por HCV en pacientes hemodializados (HD) de la ciudad de La Plata y determinar su asociación con diferentes variables se estudiaron 217 pacientes con Insuficiencia Renal Crónica de una Unidad de Hemodiálisis de un Htal público y de 7 Unidades del medio asistencial privado. En la totalidad de los pacientes se investigó la presencia sérica de anti-HCV y de anti-HBc y se valoró la edad, sexo, número de transfusiones, antigüedad del tratamiento hemodialítico, uso de eritropoyetina y episodios de hepatitis. Se halló una prevalencia de anti-HCV del 18,4 por ciento significativamente superior a la de los donantes de sangre (P<0,01) y significativamente enor a la hallada en pacientes HD de la misma ciudad en 1993 (P=0,002). También se encontró que la presencia de anti-HCV se asocia con el antecedente de haber recibido transfusiones y con mayor tiempo de ento hemodialítico. Nuestro resultados parecen coincidir con los que sugieren que las aminotransferasas en pacientes HD anti HCV © son un mal marcador de lesión hepatocelular.