Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals.

BACKGROUND AND AIM: Accurate information on the epidemiology of hepatitis C and B infection is mandatory to establish a national/regional plan. We aim to update the prevalence of hepatitis C and B infection in Catalonia using point-of-care tests to analyze the risk factors related and to implement a linkage-to-care circuit. METHODS: This is a community-based study. A random list of adult individuals was retrieved from censuses of primary care centers. Point-of-care tests for anti-hepatitis C virus (HCV) and HBV surface antigen (HBsAg) and a questionnaire for risk factor assessment were performed. Positive results were validated and a circuit for linkage-to-care was established. RESULTS: A total of 3328 individuals were included. The anti-HCV and HBsAg overall prevalence were lower than expected [1.02%, 95% confidence interval (CI) 0.65-1.39; and 0.52%, 95% CI 0.26-0.77, respectively]. Anti-HCV positive subjects were mostly (88%) autochthonous. The prevalence increased with age; only 12% were under age 40. The associated risk factors were drug use, blood transfusion, relative with HCV, and diabetes. Notably, the prevalence of active infection was only 0.49% (95% CI 0.23-0.74), 40% less than previously reported, reflecting the impact of direct acting antiviral therapy. Differently, HBsAg positive subjects were mostly foreign migrants (53%) with no other risk factors. Despite the implementation of a linkage-to-care circuit, one third of HBsAg positive subjects were lost. CONCLUSIONS: The prevalence of HCV infection was lower than previously reported, showing a strong impact of direct acting antiviral therapy in the last years. Because of hepatitis B universal vaccination, HBV infection in Catalonia is mainly associated with migrant population. Linkage-to-care in patients with hepatitis B was challenging and warrants additional efforts.

Autoantibodies to cytoplasmic rods and rings in patients with hepatitis C virus infection treated with direct-acting antivirals: The role of prior treatment with interferon plus ribavirin.

INTRODUCTION: The cytoplasmic rods-rings (RR) pattern is found in hepatitis C (HCV) patients treated with interferon-ribavirin when studied with ANA-IIF. Ribavirin aggregates/induces antigenic changes in IMPDH-2, an enzyme necessary for ribavirin action. PATIENTS AND METHOD: Prospective search for anti-RR autoantibodies (HEp-2, INOVA) in patients treated with direct-acting antivirals (DAAs) from October 2015 to June 2017. HCV-negative patients from up to June 2016 acted as controls. Anti-RR was analyzed at baseline and, mainly, during treatment and follow-up. The Chi-square test, Student's t-test and a logistic regression analysis were performed. RESULTS: Between October 2015 and June 2016, 1258 men and 2389 women who were HCV-negative and 137 men and 112 women who were HCV-positive patients were studied. Approximately 22.9% of HCV-negative and 13.2% of HCV-positive were ANA-IIF-positive (p<0.05). Three HCV-negative (0.08%) and 23 (9.2%) HCV-positive patients had anti-RR (p<0.001). A total of 122 patients received DAAs; 30 received DAA+RBV; 46 pre-treated with IFN-RBV received DAA; 31 pre-treated with IFN-RBV received DAA+RBV; 16 received IFNpeg-RBV; and 24 received IFN-RBV-DAA. None of the 122 DAA-treated patients showed anti-RR; anti-RR were identified in 14.8% of those treated with DAA-RBV; in 25.9% of those pre-treated with IFN-RBV receiving DAA; in 22.2% of IFN-RBV-pre-treated patients who received DAA+RBV; in 7.4% of those treated with IFNpeg-RBV and in 29.6% of those treated with IFNpeg-RBV-DAA. The multivariate analysis showed significant associations between anti-RR and "Exposure to IFN" and "Time of exposure to RBV". CONCLUSIONS: Anti-RR autoantibodies were detected only in patients with current or past treatments with RBV, even in cases in which only DAAs were later administered.

[Impacto psicosocial de la COVID-19 en los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña.] / Psychosocial impact of COVID-19 on the professionals of the Epidemiological Surveillance Services of Catalonia.

OBJECTIVE: Healthcare professionals were subjected to very demanding working conditions during the COVID-19 pandemic. The aim of this paper was to assess the level of risk of suffering a psychosocial disorder in the professionals of the Epidemiological Surveillance Services of Catalonia (EVS) during the sixth wave of the COVID-19 pandemic. METHODS: An epidemiological study of prevalence was carried out in SVE workers in Catalonia. The information was collected through a questionnaire of sociodemographic and occupational data and the Goldberg General Health Questionnaire (GHQ-28) from January to March 2022. A score equal to or greater than 7 on the GHQ-28 was considered positive and indicated a risk of suffering some disorder. The dependent variables were the score and positivity of the GHQ-28 test. The relationship between the GHQ-28 score and the rest of the independent variables of the study was studied with the Odds Ratio (OR) and its 95% confidence intervals (IC). RESULTS: The mean age of the population studied was 37 years (SD=±11.4) and 75% were women. 53.8% of the participants presented a positive result in the GHQ-28. The participants with the highest psychosocial risk were workers with a history of psychological problems (OR 2.8; IC95% 1.2-6.7). The risk was also higher in women (OR 1.8; IC95% 0.8-4.1), participants with health professions (OR 1.2: IC95% 0.6-2.5), those who were taking pharmacological treatment (OR 2.4; IC95% 0.6-9.7) or those who were undergoing psychological therapy (OR 1.5; IC95% 0.6-3.6) at the time of data collection and workers who did not had a perception of work support and recognition from their work teams (OR 1.8; IC95% 0.9-3.8), although some differences were not statistically significant. CONCLUSIONS: The professionals of the SVE professionals presented, during the sixth pandemic wave, a high risk of psychosocial disorder. As measures to be adopted, and with the aim of reducing psychosocial risk among its professionals, it is recommended to introduce organizational changes in surveillance services to prevent psychosocial disorders among its professionals.

OBJECTIVE: Los profesionales sanitarios estuvieron sometidos durante la pandemia de la COVID-19 a condiciones laborales muy exigentes. El objetivo de este artículo fue evaluar el nivel de riesgo de padecer algún trastorno psicosocial por parte de los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña (SVE) durante la sexta ola pandémica de la COVID-19. METHODS: Se realizó un estudio epidemiológico de prevalencia en trabajadores/as de los SVE de Cataluña. La información se recogió mediante un cuestionario de datos sociodemográficos, laborales y el Cuestionario de Salud General de Goldberg (GHQ-28) de enero a marzo de 2022. Una puntuación igual o mayor de 7 en el GHQ-28 se consideró positiva e indicaba riesgo de padecer algún trastorno. Las variables dependientes fueron la puntuación y la positividad del test GHQ-28. La relación entre la puntuación del GHQ-28 con el resto de las variables independientes del estudio se estudió con la Odds Ratio (OR) y sus intervalos de confianza (IC) del 95%. RESULTS: La edad media de la población estudiada fue de 37 años (DE=±11,4) y el 75% eran mujeres. El 53,8% de los participantes presentaron un resultado positivo en el GHQ-28. Los participantes con mayor riesgo psicosocial fueron los trabajadores con antecedentes de problemas psicológicos (OR 2,8; IC95% 1,2-6,7). El riesgo también fue superior en las mujeres (OR 1,8; IC95% 0,8-4,1), los participantes con profesiones sanitarias (OR 1,2: IC95% 0,6-2,5), los que estaban tomando tratamiento farmacológico (OR 2,4; IC95% 0,6-9,7) o los que estaban realizando terapia psicológica (OR 1,5; IC95% 0,6-3,6) en el momento de la recogida de datos y los trabajadores que no tuvieron una percepción de apoyo y reconocimiento laboral por parte de sus equipos de trabajo (OR 1,8; IC95% 0,9-3,8), aunque algunas diferencias no fueron estadísticamente significativas. CONCLUSIONS: Los profesionales de los SVE presentaron, durante la sexta ola pandémica, un elevado riesgo de trastorno psicosocial. Como medidas a adoptar, y con el objetivo de reducir el riesgo psicosocial entre sus profesionales, se recomienda introducir cambios organizativos en los servicios de vigilancia para prevenir los trastornos psicosociales entre sus profesionales.

Lichen planus of the esophagus: a case report.

Esophageal lichen planus (ELP) is an inflammatory disorder that affects the skin, cutaneous appendages and mucous membranes. The esophageal involvement is rare. We present the case of a 70-year-old woman with years of dysphagia and a history of erosive lichen planus involving the vulva, vagina, gingiva, and skin, who was eventually diagnosed with esophageal lichen planus. The patient's condition was refractory and progressed to the development of intraepithelial squamous neoplasia. We reviewed the literature on this condition.

A case report of gastrointestinal histoplasmosis in a patient treated with infliximab.

Histoplasmosis is an endemic mycosis in some areas of North and South America. This disease is usually asymptomatic, but it can result in severe and disseminated infection involving gastrointestinal tract, especially in immunocompromised individuals. We report a case of a 33-years-old Ecuadorian male treated with infliximab who developed disseminated histoplasmosis with gastrointestinal affection. Due to the non-specific presentation of gastrointestinal histoplasmosis, the diagnosis is often delayed and it causes poor outcomes. It is important to consider this diagnosis in immunocompromised patients with compatible symptoms, like patients on TNF inhibitors.