RESUMO
For years our efforts have been focused on vaccination during childhood. Today we know that this is not enough to ensure health in the rest of the life. Childhood is as important as any other stage and, therefore, vaccination must be permanent and differentiated, according to our age, throughout life. Introducing a life course perspective in vaccination programs, with emphasis on adult vaccination, particularly in older adults, offers us the opportunity to review the performance of health programs, actions, and services in the field of immunization, as well as strengthening health promotion actions. In this context, the first Mexican Consensus on Adult Vaccination was carried out in a joint effort of the National Institute of Geriatrics, bringing together a group of specialists who worked on three central objectives: establishing vaccination guidelines throughout the life course, with emphasis on new vaccines; defining priority groups according to their risk factors; and contributing to the effort to promote healthy aging.
Assuntos
Vacinação , Vacinas , Adulto , Humanos , México , Guias de Prática Clínica como AssuntoRESUMO
For years our efforts have been focused on vaccination during childhood. Today we know that this is not enough to ensure health in the rest of the life. Childhood is as important as any other stage and, therefore, vaccination must be permanent and differentiated, according to our age, throughout life. Introducing a life course perspective in vaccination programs, with emphasis on adult vaccination, particularly in older adults, offers us the opportunity to review the performance of health programs, actions, and services in the field of immunization, as well as strengthening health promotion actions. In this context, the first Mexican Consensus on Adult Vaccination was carried out in a joint effort of the National Institute of Geriatrics, bringing together a group of specialists who worked on three central objectives: establishing vaccination guidelines throughout the life course, with emphasis on new vaccines; defining priority groups according to their risk factors; and contributing to the effort to promote healthy aging.
Assuntos
Envelhecimento , Consenso , Vacinação , Adulto , Fatores Etários , Atitude Frente a Saúde , Humanos , Programas de Imunização , México , Fatores de Risco , Determinantes Sociais da Saúde , Vacinas/administração & dosagemRESUMO
In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.
Assuntos
Atletas , Desempenho Atlético , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/induzido quimicamente , Suplementos Nutricionais/efeitos adversos , Fígado/efeitos dos fármacos , Medicamentos sem Prescrição/efeitos adversos , Substâncias para Melhoria do Desempenho/efeitos adversos , Doença Aguda , Adolescente , Biomarcadores/sangue , Biópsia , Carnitina/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Colestase/sangue , Colestase/diagnóstico , Colestase/tratamento farmacológico , Creatina/efeitos adversos , Humanos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/patologia , Testes de Função Hepática , Imageamento por Ressonância Magnética , Masculino , UltrassonografiaRESUMO
BACKGROUND: It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations. OBJECTIVE: To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series. MATERIAL AND METHODS: The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded. RESULTS: A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH). CONCLUSION: The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology.
Assuntos
Cardiomegalia/epidemiologia , Cirrose Hepática/etiologia , Miocárdio/patologia , Adulto , Idoso , Autopsia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Feminino , Hepatite C Crônica/complicações , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/patologia , Cirrose Hepática/virologia , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
We present two cases of acute liver injury resulting from consumption of wild mushrooms. The first case was a male who developed acute hepatitis after ingestion of diverse mushrooms including Amanita species. His clinical course was favorable with complete recovery of liver function. The second case was a male who developed acute liver failure (ALF) after ingestion of Amanita bisporigera. He required MARS therapy as a bridge to liver transplantation but transplantation was not performed because he succumbed to multiorgan failure. There are few trials demonstrating the efficacy of the different treatments for mushroom poisoning. These cases demonstrate that the consumption of wild mushrooms without proper knowledge of toxic species represents a serious and under recognized health problem.
Assuntos
Hepatite/etiologia , Falência Hepática Aguda/etiologia , Intoxicação Alimentar por Cogumelos/complicações , Amanita , Evolução Fatal , Hepatite/diagnóstico , Hepatite/terapia , Humanos , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/terapia , Masculino , México , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Intoxicação Alimentar por Cogumelos/diagnóstico , Intoxicação Alimentar por Cogumelos/terapia , Resultado do TratamentoRESUMO
BACKGROUND: With only a third of Latinos achieving sustained virologic response (SVR), there is a need for enhanced HCV treatment. Amantadine has been proposed to improve response rates in addition to standard therapy with peginterferon alpha and ribavirin. Our objective is to evaluate whether triple therapy with amantadine improves SVR rates in this special population. METHOD: Treatment-naïve Latino subjects with HCV genotype 1 infection were randomized to receive peginterferon alpha-2a plus weight-based ribavirin for 48 weeks (double therapy) or the same regimen plus amantadine 200 mg daily (triple therapy). The primary endpoint was SVR. Predictors of liver fibrosis using APRI and Forns indices were also evaluated. RESULTS: We enrolled 124 patients with chronic hepatitis C genotype 1. Sixty-three received conventional therapy and 61 patients had triple therapy with amantadine. SVR at week 72 was achieved in 25 patients (39.7%) vs. 26 patients (42.6%) in the double and triple regimen, respectively (p=0.561). After multivariate analysis, advanced fibrosis, obesity, and low pretreatment ALT levels were associated with non-response in both groups (p=0.0234, p=0.0012, p=0.0249, respectively). APRI values delimited an area under the ROC curve (AUROC) of 0.724 and Forns index with AUROC of 0.733. There was no difference between both indices in predicting significant fibrosis (Knodell index: F3-F4). CONCLUSION: Our study demonstrates that the addition of amantadine to standard treatment of chronic HCV does not improve SVR rates in Latino patients with genotype 1. Further research to improve response rates in this special population is needed.
Assuntos
Amantadina/uso terapêutico , Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Amantadina/efeitos adversos , Antivirais/efeitos adversos , Biópsia , Distribuição de Qui-Quadrado , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/etnologia , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Fígado/patologia , Fígado/virologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/etnologia , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Polietilenoglicóis/efeitos adversos , RNA Viral/sangue , Proteínas Recombinantes , Ribavirina/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga ViralAssuntos
Antivirais/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Fatores Etários , Antivirais/efeitos adversos , Coinfecção , Consenso , Farmacorresistência Viral , Genótipo , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Hepacivirus/genética , Hepatite C Crônica/epidemiologia , Humanos , Transplante de Fígado/efeitos adversos , México/epidemiologia , Valor Preditivo dos Testes , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Hepatitis B virus (HBV) is a small DNA-containing virus with 4 genes, C, S, X and P. The S gene codes for the surface antigen (HBsAg), which contains the "a" determinant, the main region for induction of a protective humoral immune response. To compare the genotype and sequence of the "a" determinant between strains isolated from asymptomatic and symptomatic Mexican HBV carriers. RESULTS: 21 asymptomatic (blood donors) and 12 symptomatic (with clinical signs and with >1 year lamivudine treatment) HBV carriers were studied; all patients were positive for the HBsAg in serum. Viral load, genotypes, and subtypes were determined in plasma. A fragment of the S gene including the "a" determinant was PCR amplified and sequenced to determine genotype, subtype and to identify mutations. Mean viral load was 0.7965 x 104 copies/ml in asymptomatic carriers and 2.73 x 106 copies/ml in symptomatic patients. Genotypes H, C, and F were identified in asymptomatic individuals; whereas H was dominant in symptomatic patients. A fragment of 279 bp containing the "a" determinant was amplified from all 33 carriers and sequences aligned with S gene sequences in the GenBank. Mutations identified were Y100N, T126I, Q129H and N146K in the asymptomatic group, and F93I and A128V in the symptomatic group. CONCLUSION: Differences in genotype and in mutations in the "a" determinant were found between strains from asymptomatic and symptomatic HBV Mexican carriers.
Assuntos
Portador Sadio/virologia , Antígenos de Superfície da Hepatite B/genética , Vírus da Hepatite B/classificação , Vírus da Hepatite B/genética , Hepatite B Crônica/virologia , Adulto , Doadores de Sangue , Portador Sadio/fisiopatologia , DNA Viral/análise , DNA Viral/isolamento & purificação , Feminino , Variação Genética , Genótipo , Antígenos de Superfície da Hepatite B/química , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/fisiopatologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase , Carga ViralRESUMO
Hepatitis B and C virus infections constitute a significant health problem in Latin America. Approximately 400,000 new cases of hepatitis B per year and 10 million people infected with hepatitis C are estimated to occur. HBV and HCV genotype distribution may reflect the different patterns of migration to the Americas: Genotype F and H of HBV correspond to the Amerindian genotype. Overall, Genotype 1 is the most prevalent HCV genotype in the Caribbean and in South and Central America. Hepatitis B and C epidemiology needs to be considered in the context of dissimilar social and economic aspects among the countries of the region. Behaviors, cultural and ethical aspects, as well as environmental and organizational processes affect directly the way these diseases are approached in their diagnosis, treatment and prevention.
Assuntos
Hepacivirus/genética , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Feminino , Genótipo , Hepacivirus/imunologia , Hepacivirus/patogenicidade , Hepatite B/imunologia , Hepatite B/virologia , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/patogenicidade , Hepatite C/imunologia , Hepatite C/virologia , Humanos , América Latina/epidemiologia , Masculino , Epidemiologia MolecularAssuntos
Antivirais/uso terapêutico , Hepatite C Crônica/sangue , Hepatite C Crônica/tratamento farmacológico , Transaminases/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Genótipo , Hepatite C Crônica/etnologia , Humanos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Ribavirina/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Worldwide HCV studies have documented its large genetic variability; HCV has major genetic groups called genotypes that are designated from 1 to 6, as well as > 50 subtypes. This is very important considering that treatment response varies according to genotype. The purpose of this trial was to ascertain prevalence of HCV genotypes in a group of patients from 10 states in Mexico. METHODS: This study enrolled patients from 22 hospitals throughout the country. Patients tested positive to hepatitis C antibody and genotyping was preformed by Lipa method. To carry out a comparison, two regions were arbitrarily defined, the northern region embodied the cities of Culiacan, Torreón, Monterrey, Ciudad Obregón, and Tijuana, while the central-southern region embodied Mexico City, Guadalajara, León, Puebla, and Veracruz. RESULTS: The test was performed on a total of 421 patients. The most frequently found genotype was genotype 1, present in 70.55% of cases. The majority (40.1%) corresponded to genotype 1b, 17.81% to 1a, and genotype 2a/2c (11.64%). A total of 29.4% of samples corresponded to genotypes non-1. Genotype 1 was found in 72.34 (northern region) and 70.03% (central-southern) of the two regions, and genotypes non-1 in 27.66 and 29.97%, respectively. CONCLUSIONS: We conclude that the most frequent genotype in Mexico is 1b, followed by 1a, and, in third place 1b1a, for a total of 70.55%; the remaining 29.45% had genotypes other than 1.
Assuntos
Hepacivirus/genética , Genótipo , Humanos , MéxicoRESUMO
BACKGROUND: Steatorrhea represents the indirect sign of lipid maldigestion in chronic pancreatitis and even when the measurement of fecal fat is considered as a gold standard for the diagnosis of steatorrhea, this test is not commonly used within clinical practice because of the inconvenience related to sample collection. Although the use of breath test using mixted tryglicerides was initally validated as an indirect alternative for the assessment of exocrine pancreas reserve, only recently has used this method as a surrogate for the measurement of fat in feces. AIM: To evaluate fat digestion by means of the breath test with 13C labelled mixed triglycerides in patients with chronic pancreatitis. MATERIAL AND METHODS: Patients with chronic pancreatitis underwent clinical and biochemical evaluation. The latter included serum amylase, lipase, betacarotenes; fecal fat analysis and breath test using 13C-mixed tryglicerides. Breath test results are expressed as the percentage of 13C recovered in the breath sample. RESULTS: Seventeen patients (age: 45 +/- 5 years) were included, of which 7 had steatorrhea (fecal fat greater than 7 g/day). In patients with steatorrhea, the percentage of recovered 13C from breath was significantly lower (6 +/- 4%) than in patients without it (25 +/- 5%). CONCLUSION: Results suggest the uselfuness of breath test with 13C-mixed tryglicerides as an alternative for the assessment of lipid digestion in patients with chronic pancreatitis.
Assuntos
Isótopos de Carbono , Metabolismo dos Lipídeos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/metabolismo , Triglicerídeos , Testes Respiratórios , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Non-cardiac chest pain (NCCP) is defined by recurrent episodes of substernal chest pain non related to ischemic heart disease, it's origin being in many cases the gastrointestinal tract; however, it may be associated to psychosomatic disorder. OBJECTIVES: To investigate the main causes of NCCP and to evaluate associated psychiatric comorbidity. METHODS: Patients with NCCP referred by a cardiologist were assessed underwent an upper endoscopy, ambulatory pH monitoring and stationary esophageal manometry. NCCP was considered gastro esophageal reflux disease (GERD) positive when the endoscopy and/or ambulatory pH monitoring were abnormal. When all results were normal, the symptom was considered as a functional chest pain (FCP). Patients were assessed by the Psychiatry service and diagnosed in accordance to the Diagnostic and Statistics Manual of Mental Diseases, fourth edition (DSM-IV). Several other test were applied for the assessment of anxiety and depression. RESULTS: Thirty-four patients were included (25 women and nine men; average age: 46.2 +/- 11.56 years). Three patients were eliminated because of refusal of the psychiatric evaluation. In 21 (68%) patients, NCCP was GERD-positive and in 10 (32%) to FCP. The most common symptoms associated to chest pain were: heartburn in 23 (74%), regurgitation in 21 (68%) and dysphagia in 15 (48%) patients. Upper endoscopy was abnormal in four cases; ambulatory pH monitoring was abnormal in 21 (67.7%) patients. The frequency of psychiatric disorders related to NCCP was 52%, in 10 patients with GERD-positive (48%) and six patients with FCP (60%). Mayor depression was the most common diagnoses identified among both groups. CONCLUSION: The high frequency of GERD and psychiatric disorders found in NCCP supports the multidisciplinary approach to NCCP.
Assuntos
Dor no Peito/etiologia , Transtornos de Deglutição/complicações , Refluxo Gastroesofágico/complicações , Azia/complicações , Transtornos Mentais/complicações , Transtornos Psicofisiológicos/diagnóstico , Adulto , Idoso , Dor no Peito/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Manometria , Transtornos Mentais/diagnóstico , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the epidemiological situation of Chronic Hepatitis C (CHC) in our country. BACKGROUND DATA: Chronic Hepatitis C affects 170 million people worldwide, and about 0.7% of Mexican population. There is no enough epidemiological information about CHC in our country, and it is very probable that some cases are not even detected. METHODS: An investigation poll was performed. Age, gender, birthday, weight, race, residence and birth place, routes of transmission, ALT levels, histological, serological and molecular diagnosis, evidence of complications and previous treatments were recorded. A data recollection sheet was dispatched to different country provinces; they had 6 months to answer it, in order to recollect all information. RESULTS: 831 patients were analized (58.6% female and 41.4% male) with the following distribution in our country provinces: Aguascalientes 15, Chihuahua 12, Distrito Federal 495, Durango 10, Jalisco 89, Guanajuato 78, Yucatán 8, Querétaro 11, Sonora 40, Tabasco 15, Baja California 5, Veracruz 13, Tamaulipas 2 and 38 patients of Nuevo León. The highest incidence of CHC was found at fifth and sixth decade of life (28.5% y 26.7% respectively. The weight distribution was 36.2% < 65kg, 34.6% 65-75 kg and 29.2% > 75 kg. 86.5% had chronic hepatitis and 13.2% cirrhosis. The risk factors for HCV infection analysis showed that the main route of transmission was via contaminated blood (64.2%); when we excluded the patients that were exposed before 1995, the incidence was lowered to 4.5%. The higher incidence was showed between 1970 and 1990 (68%). The intravenous drug users were predominantly male and on those patients in the provinces near the north border line of our country. The predominant genotype was gen- 1 no matter the province (72.2%), in the intravenous drug users genotype 3 was found in 25%. The viral load was similar in all the provinces. 75% of the patients had have treatment and 22.5% had have two cycles, 50% of cirrhotic patients had have treatment whereas only 28% of the patients with late complications had have it. The most common treatment was pegylated alpha-2a interferon plus ribavirine. CONCLUSIONS: 1. The main route of transmission was blood transfusion. There is a marked decrease in the incidence of post-transfusional hepatitis since the introduction of anti-VHC antibody screening of blood donors (4.5%). 2. The time between the infection and diagnosis was 23 years for chronic hepatitis and 26 years for cirrhosis. 3. Intravenous drugs use was an important route of transmission in the north of our country. 4. The predominant genotype was gen-1. 5. Almost all the patients with chronic hepatitis received treatment, the most common used was pegylated interferon alpha-2a and ribavirin. 6.50% of the patients with CHC have late complications.
Assuntos
Hepatite C Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND AND AIMS: The IL28B single nucleotide polymorphism (SNP) rs12979860 is a major predictor of treatment outcomes in hepatitis C virus (HCV) infection, but its distribution widely varies among populations and ethnicities. We undertook this study to investigate the distribution of IL28B SNP rs12979860 in Mexican patients with HCV infection and to assess its usefulness in predicting response to pegylated interferon-alpha and ribavirin (PegIFN-α/RVB) therapy. METHODS: Three hundred and fifty patients with chronic HCV infection were studied. The frequency of sustained virologic response (SVR), non-responders and relapses following a course of standard therapy was longitudinally assessed in 295 of these patients. IL28B SNP rs12979860 was genotyped from genomic DNA using real-time RT-PCR. The number needed to treat (NNT) to achieve a SVR was calculated. RESULTS: Seventy six (22%) patients were CC homozygous, 210 (60%) were heterozygous and 64 (18%) showed TT homozygosity for the IL28B SNP rs12979860. After a standard course of PegIFN-α/RVB, 69% of patients with the CC genotype, 46% of the heterozygous group and 38% of those with the TT genotype (p = 0.001) achieved a SVR. Conversely, the percentage of non-responders was 15, 43, and 48% (p <0.0001), respectively. The NNT to achieve a SVR was strongly influenced by the IL28B rs12979860 genotype and ranged from 2-10. CONCLUSIONS: The IL-28B rs12979860 CC genotype was found in 22% of Mexican patients chronically infected by HCV. Genotyping IL28B SNP rs12979860 is useful to predict the response to a standard regimen with PegIFN-α/RVB, especially in those infected with HCV genotype 1.
Assuntos
Hepatite C Crônica/virologia , Interleucinas/genética , Idoso , Antivirais/uso terapêutico , Estudos de Coortes , Feminino , Variação Genética , Genótipo , Humanos , Interferons , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo ÚnicoRESUMO
Treatment with polyethylene glycol-modified interferon alfa-2a (peginterferon) alone produces significantly higher sustained antiviral responses than treatment with interferon alfa-2a alone in patients with chronic hepatitis C virus (HCV) infection. We compared the efficacy and safety of peginterferon alfa-2a plus ribavirin, interferon alfa-2b plus ribavirin, and peginterferon alfa-2a alone in the initial treatment of chronic hepatitis C. Thirty-two patients were randomly assigned to treatment, and received at least one dose of medication consisting of 180 microg of peginterferon alfa-2a once weekly plus daily ribavirin (1,000 or 1,200 mg, depending on body weight) (n = 14), weekly peginterferon alfa-2a plus daily placebo (n = 6), or three million units of interferon alfa-2b thrice weekly plus daily ribavirin for 48 weeks (n = 12). More patients who received peginterferon alfa-2a plus ribavirin had a sustained virologic response (defined as the absence of detectable HCV RNA 24 weeks after cessation of therapy) than patients who received interferon alfa-2b plus ribavirin (7/14 vs. 4/12) or peginterferon alfa-2a plus placebo (0/6). The overall safety profiles of the three treatment regimens were similar. In conclusion, for patients with chronic hepatitis C, once-weekly peginterferon alfa-2a plus ribavirin was tolerated as well as interferon alfa-2b plus ribavirin and produced significant improvements in the rate of sustained viral reduction compared with interferon alfa-2b plus ribavirin or peginterferon alfa-2a alone.
Assuntos
Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hepatite C Crônica/diagnóstico , Humanos , Injeções Subcutâneas , Interferon alfa-2 , Interferons , Cooperação Internacional , Masculino , México , Pessoa de Meia-Idade , Probabilidade , Proteínas Recombinantes , Valores de Referência , Medição de Risco , Resultado do TratamentoRESUMO
Current therapy for hepatitis "C" chronic infection in native patients is the combination of pegylated interferon plus ribavirin. In our country we have available two kinds of pegylated interferons of 12 and 40 kilodaltons, with these combination the response rates is from 50% to 80% in patients with genotype 1 or different to 1 respectively. The best predictors of response are the viral load and the genotype. 24 weeks of therapy is sufficient for patients with genotypes 2 or 3 and 48 weeks in patients with genotype 1. The optimal dose of ribavirin for use in combination with either form of peginterferon is not clear and it goes from 800 mg, to 1200 mg. The side effects with these interferons are the same than the standard interferon. liver biopsy is recommended prior to embarking upon a course of antiviral therapy.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Interferons/uso terapêutico , Ribavirina/uso terapêutico , HumanosRESUMO
Pneumocystis jirovecii pneumonia (PCP) is a potential complication of immunosuppression. Crohn's disease (CD) is an immune granulomatous disorder characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Its treatment is based on steroids and immunosuppressants but in non-responders, biologic compounds such as anti-tumor necrosis factor alpha (TNF) antibodies have been used. Neutralization of TNF causes a decrease in the inflammatory response but increases susceptibility to opportunistic infections such as fungal infections. We report a young male with chronic diarrhea, fever and weight loss who was diagnosed with CD and began conventional treatment with immunosuppressants, but due to lack of response after several weeks, biologic therapy with adalimumab was initiated. Seven weeks later he developed persistent fever and upper respiratory symptoms. After chest CT, bronchoscopy and bronchial lavage, P. jirovecii was identified by silver staining and confirmed by immunofluorescence. To our knowledge this is the second case of pneumocystosis associated with the use of adalimumab in CD and the first reported Mexican case confirmed by microbiological and immunological studies in this setting.