Redefining fatty liver disease: an international patient perspective.

Despite its increased recognition as a major health threat, fatty liver disease associated with metabolic dysfunction remains largely underdiagnosed and undertreated. An international consensus panel has called for the disease to be renamed from non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) and has suggested how the disease should be diagnosed. This Viewpoint explores the call from the perspective of patient advocacy groups. Patients are well aware of the negative consequences of the NAFLD acronym. This advocacy group enthusiastically endorses the call to reframe the disease, which we believe will ultimately have a positive effect on patient care and quality of life and, through this effect, will reduce the burden on health-care systems. For patients, policy makers, health planners, donors, and non-hepatologists, the new acronym MAFLD is clear, squarely placing the disease as a manifestation of metabolic dysfunction and improving understanding at a public health and patient level. The authors from representative patient groups are supportive of this change, particularly as the new acronym is meaningful to all citizens as well as governments and policy makers, and, above all, is devoid of any stigma.

Estado actual de la epidemiología, diagnóstico, tratamiento y control de la hepatitis C / Present status of epidemiology, diagnosis, treatment and control of hepatitis C

La hepatitis C, infección producida por el virus de la hepatitis C (VHC), que se transmite por sangre, es una causa principal de hepatitis crónica, cirrosis y cáncer del hígado a nivel mundial. La mortalidad, incidencia y prevalencia de las infecciones por VHC han ido en aumento, superando en muchos casos la de otras infecciones como el VIH. Más de 71 millones de personas en el mundo padecen hepatitis C crónica, pero el 80% desconoce que tiene la infección y solamente 1% ha recibido tratamiento, pese a que existen medicamentos que curan la infección en más del 90% de los casos y pueden disminuir el riesgo de las complicaciones que llevan a la muerte. En el 2016 los países miembros de la Organización Mundial de la Salud (OMS) acordaron la primera estrategia mundial del sector salud contra la hepatitis víricas 2016-2021, y para su implementación es necesario concienciar a todos los involucrados acerca de la magnitud de las hepatitis virales. Esta revisión aborda aspectos epidemiológicos, microbiológicos y clínicos con el propósito de presentar un panorama general de la situación actual de la hepatitis C a nivel mundial y nacional.

Hepatitis C, an infection produced by hepatitis C virus (HCV), is transmitted by blood and is a leading cause of chronic hepatitis, cirrhosis and liver cancer around the world. HCV infection mortality, incidence and prevalence have been increasing, in many cases exceeding other infections like HIV. Globally, more than 71 million people suffer from chronic hepatitis C but 80% are unaware that they are infected and only 1% have been treated even though there are medicines that can cure the infection in more than 90% of the cases and also can reduce the risk of complications that can lead to death. In 2016, countries belonging to the World Health Organization (WHO) adopted the first Global Health Sector Strategy on Viral Hepatitis 2016-2021, for its implementation, it is necessary to raise awareness among all concerning parties of the magnitude of viral hepatitis. This review addresses epidemiological, microbiological and clinical aspects with the purpose of presenting a general view of the current situation of hepatitis C at the national and global levels.

Vulnerabilidad al virus de la hepatitis B y prácticas preventivas en trabajadores de un hospital de Guatemala / Hepatitis B virus vulnerability and preventive practices among workers at a Guatemalan Hospital

La hepatitis B (HB) es un problema de relevancia mundial para la salud pública y ocupacional. Diferentes informes indican una seroprevalencia intermedia del altamente transmisible virus de la hepatitis B (VHB) en Guatemala, que impone un riesgo sobre los trabajadores de salud (TS). Este artículo describe la adherencia a prácticas preventivas, la seroprevalencia de anticuerpos contra el antígeno de superficie (anti-HBs) y el riesgo de accidente ocupacional punzocortante en TS del Hospital Nacional Pedro de Bethancourt de Guatemala. En 121 TS voluntarios, se estimó la prevalencia de exposiciones, prácticas preventivas, concentración de anticuerpos anti-HBs, utilizando Elisa, así como odds ratios (OR) de diferentes factores de riesgo para heridas punzocortantes. Tener contacto con pacientes (69%) y manipular material punzocortante (63%) o biológico (54%) fueron identificados como peligros de exposición al VHB. Los TS entrevistados indicaron respetar las normas de bioseguridad (75%),utilizar guantes (69%) y estar vacunados (48%). La prevalencia de anti-HBs fue del 43%. El riesgo de accidentes punzocortantes fue 9 veces mayor para médicos (OR, 8.9; IC 95% [1.7, 63]; p = .0017) y 3 veces mayor para enfermeros (OR, 3.2; IC 95% [1.15, 9.1]; p = .0121), que para el resto del personal. Las prácticas de bioseguridad e inmunización son deficientes entre los TS del hospital, a pesar de ser una población con riesgo de infección por el VHB. Se recomienda fortalecer las competencias sobre bioseguridad y el cumplimiento de medidas preventivas en el hospital, así como institucionalizar la vacunación contra VHB para todos los TS.

Hepatitis B is a major, global issue for both public and occupational health. Reports indicate an intermediate seroprevalence of the highly transmissible hepatitis B virus (HBV) in Guatemala, imposing a high risk for healthcare workers (HCWs). We describe the adherence to preventive practices, seroprevalence of surface antigen's antibodies (anti-HBs) and the risk of puncture-related occupational accidents with medical sharps among HCWs, at Guatemalan Pedro de Bethancourt National Hospital (PBNH). Prevalence of exposure and prevention practices was estimated in 121 volunteering HCWs, as well as serum concentrations of anti-HBs, using ELISA. Odds ratios (OR) of risk factors for puncture wounds with medical sharps were estimated. Contact with patients (69%), medical sharps (63%) and biological material (54%) were identified as a risk of exposure to HBV. Of all volunteersinterviewed, 75% reported compliance with biosafety standards, 69% use surgical gloves and 48% reported having been vaccinated. Seroprevalence of anti-HBs was 43%. The risk of injuries with medical sharps was 9-fold among physicians and 3-fold among nurses, as compared with the rest of the hospital staff (OR, 8.9, 95% CI [1.7, 63], p = .0017; OR, 3.2, 95% CI) [1.15, 9.1], p = .0121, respectively). Biosecurity and immunization practices are por among hospital HCWs, despite being a population at high risk for HBV infection. We recommend that biosecurity capacity building and compliance with preventive practices be ensured. A sustainable HBV vaccination program for all HCWs should be institutionalized.