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1.
Ann Hepatol ; 29(3): 101489, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38403068

RESUMO

INTRODUCTION AND OBJECTIVES: Different patterns of liver injury have been reported in association with the SARS-CoV-2 vaccines. The aim of this study was to describe a nationwide cohort of patients with SARS CoV-2 vaccine-induced liver injury, focusing on treatment and the evolution after further booster administration. PATIENTS AND METHODS: multicentre, retrospective-prospective study, including subjects who developed abnormal liver tests within 90 days after administration of SARS-CoV-2 vaccination. RESULTS: 47 cases were collected: 17 after prime dose and 30 after booster. Age was 57 years, 30 (63.8 %) were female, and 7 (14.9 %) had a history of prior autoimmune hepatitis (AIH). Most cases were non-severe, though 9 (19.1 %) developed acute liver injury or failure (ALF). Liver injury tended to be more severe in those presenting after a booster (p=0.084). Pattern of liver injury was hepatocellular (80.9 %), mixed (12.8 %) and 3 (6.4 %) cholestatic. Liver biopsy was performed on 33 patients; 29 showed findings of AIH. Forty-one (87.2 %) patients received immunosuppressants, mostly corticosteroids (35/41). One required liver transplantation and another died due to ALF. Immunosuppression was discontinued in 6/41 patients without later rebound. Twenty-five subjects received at least one booster and 7 (28.0 %) relapsed from the liver injury, but all were non-severe. Recurrence was less frequent among patients on immunosuppressants at booster administration (28.6 % vs. 88.9 %, p=0.007). CONCLUSIONS: SARS CoV-2 vaccine-induced liver injury is heterogeneous but mostly immune-mediated. Relapse of liver injury after re-exposure to vaccine is frequent (28.0 %) but mild. Immunosuppression at booster administration is associated with a lower risk of liver injury.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Recidiva , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Vacinas contra COVID-19/efeitos adversos , Estudos Retrospectivos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estudos Prospectivos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , SARS-CoV-2 , Idoso , Adulto , Imunização Secundária , Fatores de Risco , Transplante de Fígado , Imunossupressores/efeitos adversos
2.
Rev Esp Enferm Dig ; 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38305672

RESUMO

Hepatic focal lesions are a heterogeneous group of lesions that can be either benign or malignant in nature. They are typically diagnosed through ultrasound in all cases needing to rule out a metastatic nature. We present the case of a 51-year-old male from Morocco diagnosed with hepatic SOLs in the context of abdominal pain and constitutional syndrome.

3.
Rev Esp Enferm Dig ; 115(5): 223-224, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37114390

RESUMO

Gastrointestinal (GI) Endoscopy is a basic competence for the management of gastrointestinal diseases. However, it should not be regarded as an independent training technique. Rather it is a part of a continuous and accredited process that requires clinical knowledge from the gastroenterologist to keep skills up-to-date in a constantly evolving medical subspecialty. Thus, the only official accredited way for training in GI endoscopy is through the Specialized Health Training program in the Management of the Digestive Diseases administered by the Spanish Ministry of Health.


Assuntos
Gastroenterologistas , Gastroenteropatias , Humanos , Endoscopia Gastrointestinal/métodos , Currículo , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/terapia , Competência Clínica
4.
Rev Esp Enferm Dig ; 115(3): 128-132, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36514974

RESUMO

Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.


Assuntos
Hepatite C , Hepatopatia Gordurosa não Alcoólica , Humanos , Hepacivirus , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Nível de Saúde
5.
Rev Esp Enferm Dig ; 113(10): 704-708, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33906366

RESUMO

INTRODUCTION: immigrants from areas of high endemicity for hepatitis C represent a relevant risk group. The goal of this study was to analyze the characteristics of these patients in a high-immigration health care area, and to analyze the impact of promoting diagnosis and referral by means of training sessions in the primary care setting. MATERIALS AND METHODS: a retrospective study in immigrant patients with HCV monoinfection treated with direct-acting antiviral agents in Almería between 2015 and 2020. Epidemiological and clinical variables were collected, as well as the impact of a micro-elimination approach. RESULTS: a total of 175 immigrant patients were enrolled, most of them from eastern Europe (52.5 %), followed by sub-Saharan Africa (21.1 %) and the Maghreb (14.8 %). Patients from sub-Saharan Africa and eastern Europe were younger (p = 0.002) and sub-Saharan subjects predominantly exhibited genotypes 2 and 3, whereas genotype 1 predominated in the rest of patients (p < 0.001). Of all the patients, 156 attained SVR (ITT-SVR, 89.1 %). The modified ITT rate was 96.9 %. Patients with SVR had spent more time in Spain (12.7 vs 6.1 years; p = 0.006). CONCLUSIONS: the immigrant population with HCV infection in our health care area exhibits homogeneous clinical and epidemiological characteristics. The efficacy of antiviral therapy is similar to that reported in the non-immigrant population, with higher rates of losses to follow-up and dosage errors, particularly in those who have been in the country for less time.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Emigração e Imigração , Hepacivirus , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Humanos , Estudos Retrospectivos
7.
Emergencias ; 36(1): 25-32, 2024 Jan.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-38318739

RESUMO

OBJECTIVES: The prevalence of active hepatitis C virus (HCV) infection in Spain is estimated to be 0.2%, but a large number of persons are unaware of their infection status. Additional approaches to early diagnosis of HCV infection in vulnerable populations with scarce contact with the national health care system are therefore needed. Our aim was to evaluate the impact of an opportunistic screening program to detect HCV-infected patients attended in our university hospital emergency department (ED). MATERIAL AND METHODS: Opportunistic screening was implemented from August 2021 to April 2023 in ED patients aged 18 to 69 years. The test was ordered if HCV screening had not been done in the last year and blood extraction for testing was indicated for any reason as part of routine ED care. RESULTS: A total of 110 267 patients were seen; 22 712 of them (20.6%) were eligible for screening. Serology for HCV was done for 11 368 of the eligible patients (50.1%). Forty-three cases (in 0.4% of tested samples) of active HCV infection (viremia) were found. In 24 of these cases (56%) the patients had not been aware that they were infected. Their mean (SD) age was 57 (6) years, 34 (79.1%) were men, and 5 (11.6%) were citizens of countries other than Spain. No risk factors related to HCV infection could be found for 22 of the patients (51.2%), and 41 (95.3%) could have been diagnosed during previous contact with the health care system. Of the 18 patients evaluated by transient elastography (FibroScan), 7 (38.8%) had signs of cirrhosis at the time of diagnosis. Thirty-three of the patients with active infections (77%) were subsequently able to access care. CONCLUSION: The rate of active HCV infection in the screening program was higher than the prevalence estimated for the general population. Opportunistic screening for HCV during ED visits is useful for increasing the number of diagnoses and should be considered as a tool for eradicating this disease.


OBJETIVO: Se estima que la prevalencia de infección activa por el virus de la hepatitis C (VHC) en España es de un 0,2%, pero un gran número de personas desconocen su estado de infección. Por ello, se requiere aumentar las estrategias de diagnóstico precoz dirigidas a población vulnerable y con escaso vínculo con el sistema sanitario. El objetivo es evaluar el impacto de un programa de cribado oportunista del VHC en los pacientes atendidos en el servicio de urgencias (SU) de un hospital universitario. METODO: Se realizó un cribado oportunista entre agosto de 2021 y abril de 2023 a los pacientes de 18 a 69 años atendidos en el SU que no se habían realizado la prueba del VHC el año anterior, y que requerían un análisis de sangre dentro de la práctica clínica habitual por cualquier motivo. RESULTADOS: Durante el periodo de estudio se atendieron 110.267 pacientes en el SU, fueron candidatos a realizar el cribado 22.712 (20,6%), y finalmente se realizó una serología frente al VHC a 11.368 pacientes (50,1%). Se identificaron 43 casos (0,4% de los test efectuados) de infección activa por VHC (viremia), de los cuales, 24 (56%) desconocían previamente su estado. La media de edad del total de pacientes virémicos fue de 57 (DE: 6 años), 34 (79,1%) eran hombres y 5 (11,6%) tenían nacionalidades distintas a la española. No se identificaron factores de riesgo relacionados con la infección por VHC en 22 (51,2%) de los pacientes, y 41 (95,3%) habían tenido oportunidades de diagnóstico en visitas previas al sistema de salud. De los 18 pacientes analizados mediante elastografía transitoria, 7 (38,8%) presentaban cirrosis en el momento del diagnóstico. Se logró vincular a la atención médica posterior a 33 (77%) de los pacientes con infección activa. CONCLUSIONES: Las tasas de infección activa por VHC detectadas en el programa de cribado fueron más altas que la prevalencia estimada en la población general. El cribado oportunista de VHC en los SU puede ser de utilidad para aumentar el diagnóstico y debe ser considerado como una herramienta para la eliminación de la hepatitis C.


Assuntos
Hepacivirus , Hepatite C , Masculino , Humanos , Feminino , Espanha/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Fatores de Risco , Serviço Hospitalar de Emergência
9.
Gastroenterol Hepatol ; 36(7): 450-6, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-23850511

RESUMO

BACKGROUND: Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. METHODS: From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. RESULTS: A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. CONCLUSIONS: The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.


Assuntos
Fosfatase Alcalina/sangue , Hepatopatias/sangue , Hepatopatias/enzimologia , Fígado/enzimologia , Transaminases/sangue , gama-Glutamiltransferase/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Adulto Jovem
10.
Gastroenterol Hepatol ; 33(9): 629-32, 2010 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-20850907

RESUMO

Toxic-induced liver disease is uncommon, although the true proportion of cases of hepatotoxicity is unknown, as this entity is underdiagnosed and underreported. The main reasons why toxic-induced liver disease goes unnoticed is the lack of pathognomonic data and the lack of spontaneous reporting by doctors and pharmacists. In some cases, the toxic substance can leave its «signature¼ in the form of clinical semiology suggestive of an underlying toxic cause. We present a case of hepatotoxicity induced by drinking water (chlorinated), which produced a reactive metabolites syndrome (trihalomethanes from the reaction of chlorine with organic products). Although the clinical presentation was typical, the case posed a diagnostic challenge for the various professionals involved.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Cloro/toxicidade , Água/efeitos adversos , Doença Aguda , Adulto , Humanos , Masculino
11.
Cir Esp ; 84(6): 313-7, 2008 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-19087776

RESUMO

INTRODUCTION: Non-alcoholic fatty liver disease has a high prevalence among obese patients. It has been difficult to identify clear predictors of chronic liver damage, which could help in selecting patients for liver biopsy and therapeutic options. The aim of the study is to describe the liver damage in these obese patients and identify predictors of liver damage progression. PATIENTS AND METHOD: 76 obese patients submitted to bariatric surgery were included. Liver biopsies were taken at the time at the time of the surgery. Clinical and biochemical variables were analyzed. RESULTS: 67 patients (88.1%) were found to have non-alcoholic fatty liver disease; 41 (61.2%) had simple steatosis, and 26 (38.8%) had non-alcoholic steatohepatitis. Patients with non-alcoholic steatohepatitis had significantly higher values of GGT. Non-alcoholic steatohepatitis was associated with diabetes (p < 0.01) in these patients. CONCLUSIONS: Non-alcoholic fatty liver disease is highly prevalent in morbidly obese patients. Non- alcoholic steatohepatitis seems to be associated with diabetes and high values of GGT in obese patients.


Assuntos
Cirurgia Bariátrica/métodos , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/fisiopatologia , Obesidade/epidemiologia , Obesidade/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco
12.
Eur J Hosp Pharm ; 25(3): 132-137, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-31157007

RESUMO

OBJECTIVES: Anaemia is the most common side effect associated with ribavirin (RBV). This study intended to assess its incidence and determine its predictive factors in patients with hepatitis C virus on RBV plus direct-acting antiviral agents (DAAs). METHODS: A retrospective study of patients receiving RBV+DAA was conducted. Serum haemoglobin (Hb) was determined at baseline and monitored 4 weekly. Anaemia was defined as a single occurrence of Hb <10 g/dL. Bivariate and multivariate logistic regression analyses were conducted to assess the relationship between the occurrence of anaemia and the following factors: age, gender, FibroScan score, viral load, cirrhotic status (yes/no), RBV dose, glomerular filtration rate (GFR), alanine amino transferase, albumin, treatment duration (12 vs ≥12 weeks), baseline Hb, and Hb% drop (weeks 0-2). RESULTS: 152 patients were included, of which 15.1% experienced anaemia. The analysis revealed that estimated GFR (eGFR), baseline Hb, 12-week treatment duration and Hb% drop (weeks 0-2) were significantly associated with the likelihood of developing anaemia (p<0.05). Two mathematical models were subsequently developed to predict patients at risk of anaemia: a pretreatment model (positive predictive value 86.6%) which included eGFR, baseline Hb and 12-week treatment duration and an intratreatment model (positive predictive value of 90.48%) which in addition included the Hb% drop (weeks 0-2). CONCLUSION: Anaemia was found to be less significant in this cohort compared with studies on RBV plus pegylated interferon, telaprevir or boceprevir combinations, but higher than those on newer DAAs. Baseline Hb, eGFR, 12-week treatment duration and Hb% drop (weeks 0-2) significantly predicted the risk of anaemia and were used to construct two predictive models.

14.
Cir Esp ; 86(2): 94-100, 2009 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-19560754

RESUMO

INTRODUCTION: Non-alcoholic fatty liver (NAFL) is highly prevalent in obese patients. The aim of this study is to look at the development of the histological lesions in these patients that we treated using biliopancreatic diversion. MATERIAL AND METHODS: A liver biopsy was performed on 76 obese patients who were operated on using bariatric surgery. Another liver biopsy was performed on 39 of them between 12 and 24 months after the surgery. The clinical and analytical variables at the time of the surgery, and at 18 months were analysed. RESULTS: A total of 67 patients (88.1%) had NAFL at the time of the operation. Simple steatosis was seen in 41 (61.2%) patients and 26 (38.8%) had non-alcoholic steatohepatitis (NASH). An improvement was seen in both the associated pathology and the analytical evaluations. A significant improvement was observed in the degree of steatosis as well as the NASH in the second biopsy performed on 39 patients. There were no deteriorations in the lesions in any of the patients. CONCLUSIONS: There is a high prevalence of NAFL among obese patients. Bariatric surgery (Scopinaro) leads to weight loss which is associated to an improvement in the pathology associated with obesity, as well as a significant decrease in the liver function values. After weight loss, almost all our patients showed an improvement in the histological hepatic lesions, and in particular, that NASH disappeared in 85% of them.


Assuntos
Cirurgia Bariátrica/métodos , Fígado Gorduroso/patologia , Fígado/patologia , Obesidade Mórbida/cirurgia , Adulto , Algoritmos , Biópsia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos
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