Colonic malignancy: always adenocarcinomas?

Colorectal lymphomas represent one of the lesions that can be found in a colonoscopy and whose appearance can be indistinguishable from any other type of tumour, so it is important to be aware of them and include them in the differential diagnosis of colonic neoformations.

Lenvatinib in severe hypoglycemia associated with hepatocellular carcinoma.

We present the case of a 24-year-old male with multicentric hepatocellular carcinoma (HCC) over HBV-related compensated liver cirrhosis, on treatment with sorafenib and tenofovir. He had multiple admissions in recent months for severe hypoglycemia episodes with neurological symptoms.

Ribavirin monotherapy for the treatment of chronic hepatitis E in an immunosuppressed patient.

We herein report the case of a 54-year-old male patient with a human immunodeficiency virus 1 (HIV-1) infection, usually with low viral loads and CD4 cells < 200-100/mm3 due to thymic exhaustion. He was referred to our clinic because of hypertransaminasemia and cholestasis of a duration of 58 months and liver cirrhosis on FibroScan® without esophageal varices. Nonspecific manifestations included weight loss. Liver disease stigmata and generalized amyotrophy were also present.

Experience in the treatment of hepatitis C with direct-acting antivirals in a foreign population at a high-immigration area.

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.

Chronic hepatitis B genotype E in African migrants: response to nucleos(t)ide treatment in real clinical practice.

BACKGROUND: Hepatitis B virus (HBV) genotype E is a poorly studied genotype that almost exclusively occurs in African people. It seems to harbour intrinsic potential oncogenic activity and virological characteristics of immune scape but a paucity of information is available on clinical and virological characteristic of HBV genotype E-infected patients as well as on the efficacy of anti-HBV drugs for such patients. The increasing flow of migrants from high endemic HBV sub-Saharan Africa, where genotype E is the predominant one, to Western countries makes improving such knowledge critical in order to deliver proper medical care. METHODS: Prospective observational study of naïve patients of sub-Saharan origin treated for chronic HBV genotype E infection at a Tropical Medicine clinic sited in Spain from February 2004 to January 2018. The aim of the study was to describe the response of chronic HBV genotype E infection to nucleos(t)ide analogues (NA), entecavir or tenofovir, in real clinical practice. RESULTS: During the study period, 2209 sub-Saharan patients were assisted at our Tropical Medicine Unit and 609 (27.6%) had chronic HBV (CHB) infection. Genotype information was available for 55 naïve patients initiating treatment with NA (entecavir or tenofovir), 43 (84.3%) of them being genotype E, although 15 were excluded because they did not meet study inclusion criteria. Thus, a total of 28 CHB genotype E patients were included and followed for 24 months at least. Twenty-one patients were in HBeAg-negative chronic hepatitis phase and 7 patients in HBeAg-positive chronic hepatitis phase. After one year of treatment, among those with good adherence, 89.4% (17/19) of the HBeAg-negative patients and 80% of the HBeAg-positive ones had undetectable viral loads. Response rates reached 100% in both groups after 15-18 months of follow-up. Out of the 7 HBeAg-positive patients, 6 (85.7%) presented HBeAg loss in a median time of 31.8 months. Neither serious adverse effects nor hepatocarcinoma cases happened during the study period. CONCLUSIONS: HBV genotype may influence disease progression and antiviral response. Our study provides precious information on the efficacy and safety of NA treatment for CHB genotype E infection, a fairly unknown genotype with and increasing epidemiological impact.