[Characteristics of Helicobacter pylori infection in a private hospital in Lima, 2019 experience and literature review]. / Características de la infección de Helicobacter pylori en un hospital privado de Lima, experiencia del 2019 y revisión de la literatura.

Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission.

INTRODUCTION & OBJECTIVES: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.

Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection.

INTRODUCTION AND OBJECTIVES: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. PATIENTS: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. RESULTS: Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). CONCLUSIONS: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

[Virological breakthrough in treating hepatitis B with entecavir: it means resistance?]. / Rebrote virológico en el tratamiento de hepatitis B con entecavir ¿resistencia?

A 45 year-old married man, with several sexual partners, initiated symptoms with nodosum erythema and in August 2008, is diagnosed of chronic hepatitis due to hepatitis B virus (HBV). Later he was diagnosed of Child A cirrhosis and hepatocarcinoma. He began HBV treatment with Entecavir 0.5 mg; then he underwent a V segment hepatectomy. In February 2009 he presented a relapse with a tumor of 14 mm on VI segment with AFP values of 68 ng/dl, so he underwent an ethanolization with good evolution. During the follow up, he has not presented evidence of relapse of hepatocarcinoma and continued with Entecavir 0.5 mg/d. In April 2010, after 72 weeks of therapy with good compliance, the patient presented a virological breakthrough (viral load 646 UI/dl) and Tenofovir was added to his therapy. Nowadays the patient is receiving double therapy for HBV and his last viral load, April 2012, was negative. This could be the first case in our country of a probable resistance to Entecavir; complementary tests are needed in order to rule out this suspicion.

Características de la infección de Helicobacter pylori en un hospital privado de Lima, experiencia del 2019 y revisión de la literatura / Characteristics of Helicobacter pylori infection in a private hospital in Lima, 2019 experience and literature review

RESUMEN Las enfermedades digestivas representan la cuarta causa de atención ambulatoria en los centros sanitarios peruanos, siendo la gastritis y las úlceras pépticas las más comunes. El presente es un estudio retrospectivo, de corte transversal, de tipo descriptivo, de análisis secundario de datos de historias clínicas, para evaluar la prevalencia de Helicobacter pylori en pacientes sometidos a endoscopia digestiva alta durante el año 2019 en la Clínica Delgado, Lima, Perú. Asociación entre el sexo masculino (PRa 1,27, IC95% 1,10-1,48, p <0,001), categorías de la edad y resultado de endoscopia digestiva alta (PRa 2,53, IC95% 2,16-2,97, p<0,001) fueron reportados. Se recomienda, a partir de estos hallazgos, determinar otras causas de gastritis, especialmente en las mujeres jóvenes con gastritis crónica profunda. Además, presentamos una revisión de la literatura científica del Perú sobre los factores asociados a la positividad de Helicobacter pylori en los resultados de la endoscopia digestiva superior.

ABSTRACT Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.

[Prognosis factors in acute hepatic insufficiency]. / Factores pronósticos en insuficiencia hepática aguda.

INTRODUCTION: Acute Hepatic Insufficiency (AHI) is a rare syndrome but has a high mortality rate. The purpose of this study was to determine the clinico-epidemiological characteristics of AHI. MATERIALS AND METHODS: Open study, prospective, descriptive of patients diagnosed with AHI in the Liver Unit of the Edgardo Rebagliati Martins State Hospital (HNERM) from February 1999 until January 2003. RESULTS: Fifteen (15) cases were studied. The average age was 63 (30-81), the M-F ratio was 2/1. The diagnosis was viral Hepatitis B (53.3%), toxic idiosyncratic reactions (20%), undetermined (20%) and Hepatitis A (6.7%). At the time of diagnosis 80% had Grade I encephalopathy and 20% Grade III encephalopathy; 13.3% did not have ascites and 86.7% had mild-moderate ascites; 53.3% had a history of chronic illness (diabetes, chronic renal insufficiency, cardiopathy and others). Average laboratory values were: albumin 2.5 gr./dl, bilirubin 25.9 mg/dl, prothrombin time 29 and Factor V 40.7%. The most frequent complications were sepsis and cerebral oedema. Global mortality was 80%. The average survival time was 16.6 days. CONCLUSIONS: In most cases the patients were over 60 years of age. The main cause of AHI was viral Hepatitis B, a disease which can be prevented with active immunisation. Infection and cerebral oedema were common causes of death. AHI, although rare, is a rapidly degenerative and fatal condition.

[Autoimmune hepatitis: clinical forms and related factors to their response to treatment]. / Hepatitis autoinmune: formas clínicas y factores relacionados con la respuesta al tratamiento.

Chronic liver disease is a clinical entity of different origins. It is most frequently caused by viral infection and alcohol consumption. The entities of immunological origin are listed in third place including autoimmune hepatitis, primary biliar cirrhosis, primary sclerosing cholangitis, as well as superposition syndromes. In Peru report of cases relating to autoimmune hepatitis are very few and its frequency is unknown. In 2002, autoimmune etiology represented 13% of all the cases admitted in the Hepathology Unit of Edgardo Rebagliati Martins National Hospital ("HNERM") for chronic hepatic disease. In this article, 30 cases of autoimmune hepatitis clinically and serologically diagnosed are reported. Biopsy was performed on 97% of the cases, of which 70% showed cirrhosis. The relationship F/M was 5/1, the average age was 48.59 years, and in 6.7% of the cases the initial picture was acute hepatic insufficiency. Antinuclear antibodies were found in 73.33%, smooth antimuscle antibodies in 43.33%, and antimitochondrial antibodies in 16.7%, with a coexistence of autoantibodies in 40%. The endoscopy performed revealed the presence of varices in 20% of the cases, but only one case of variceal hemorrhage. In most cases, therapy was initiated based on prednisone and azathioprine. Of 26 cases that were treated, 80% had an initial remission, 2 responded partially, and 3 did not respond. There were complications related to the treatment with immunosuppressants in 16.7% of the cases, and especially severe infections in 3 cases. In conclusion, autoimmune hepatitis is a substantial cause of chronic hepatic disease that has similar clinical characteristics to those reported in international medical journals. In most cases it responds to treatment with immunosuppressants. However, adequate follow-up is recommended to detect secondary complications in the treatment with immunosuppressants, especially in infections which represent a high risk of mortality in the immunosuppressed patient.

[Hepatotoxicity and pancreatitis associated with gold salts: case report]. / Hepatotoxicidad y pancreatitis por sales de oro: reporte de caso.

The case of a patient, 37 years old, born and resident of Lima, suffering rheumatoid arthritis who underwent treatment with prednisone, methotrexate, and chloroquine is reported. This therapy was substituted for gold salts one month before her admission. After the third dose she presented symptoms of abdominal pain and diarrhea, itching, and jaundice, associated with asthenia and a feverish sensation. Liver biochemistry demonstrated elevated transaminase, bilirubin, alkaline phosphatase, eosinophilia, inversion of the rate albumin/globulin, higher titer of immunoglobulin G, as well as an elevation of amylase and lipase. The anatomopathological study showed cholestasis, hepatocyte ballooning, spotty necrosis, predominantly in zone 3 of the acinus. These findings where found consistent with a toxic reaction.