[Distribution of the genotypes of hepatitis C virus in intravenous drug addicts in Argentina]. / Distribución de los genotipos del virus de la hepatitis C en una población Argentina de drogadictos endovenosos.

Intravenous drug addiction (IVD) is an unfrequent risk factor in Argentina, representing less than 10% of patients (pts) with chronic HCV infection seen in our Unit. In order to study the genotypes (Gt) in IVD and compare them with a non drug addicted control population, 68 pts with a history of IVD were enrolled in this study and compared with 68 non drug addict (NDA) pts with chronic HCV, with similar age and gender distribution. In all pts a liver biopsy was performed. Genotyping was done by INNO LiPA (Innogenetics, Belgium). Mean age in both groups was 35 +/- 7.8 years and 50 were males. No difference was observed between both groups in the prevalence of Gt1a, Gt2a/c and in those with mixed infections. The prevalence of Gt1b in IVD was 19.1% and in NDA 38.2% (p = 0.0228). A highly significant difference was also observed in the prevalence of Gt3a, of 42.6% in IVD and only 11.8% in NDA (p = 0.0001). Gt1a was the second most frequent genotype in IVD pts (26.5%). Simultaneous HIV infection was present in 8 IVD pts (11.8%) and in none of NDA group. Liver biopsies showed a higher prevalence of mild chronic hepatitis in NDA (57.3%) than in IVD (32.4%) (p = 0.0058). Severe chronic hepatitis with advanced fibrosis or cirrhosis was more frequent in the Gt3 of the group with IVD when compared with Gt3 of the NDA group. It can be concluded that in accordance with other geographical areas, Gt3a is far more prevalent in intravenous drugs addicts than in the general population in Argentina where Gt1b is more frequent. Mild forms of chronic hepatitis are less frequent in IVD. In spite of the relatively small group with HCV co-infection with HIV, it seems important to note that 2/8 (25%) showed severe hepatitis C or cirrhosis.

Distribución de los genotipos del virus de la hepatitis C en una población Argentina de drogadictos endovenosos. / [Distribution of the genotypes of hepatitis C virus in intravenous drug addicts in Argentina]

Intravenous drug addiction (IVD) is an unfrequent risk factor in Argentina, representing less than 10

of patients (pts) with chronic HCV infection seen in our Unit. In order to study the genotypes (Gt) in IVD and compare them with a non drug addicted control population, 68 pts with a history of IVD were enrolled in this study and compared with 68 non drug addict (NDA) pts with chronic HCV, with similar age and gender distribution. In all pts a liver biopsy was performed. Genotyping was done by INNO LiPA (Innogenetics, Belgium). Mean age in both groups was 35 +/- 7.8 years and 50 were males. No difference was observed between both groups in the prevalence of Gt1a, Gt2a/c and in those with mixed infections. The prevalence of Gt1b in IVD was 19.1

and in NDA 38.2

(p = 0.0228). A highly significant difference was also observed in the prevalence of Gt3a, of 42.6

in IVD and only 11.8

in NDA (p = 0.0001). Gt1a was the second most frequent genotype in IVD pts (26.5

). Simultaneous HIV infection was present in 8 IVD pts (11.8

) and in none of NDA group. Liver biopsies showed a higher prevalence of mild chronic hepatitis in NDA (57.3

) than in IVD (32.4

) (p = 0.0058). Severe chronic hepatitis with advanced fibrosis or cirrhosis was more frequent in the Gt3 of the group with IVD when compared with Gt3 of the NDA group. It can be concluded that in accordance with other geographical areas, Gt3a is far more prevalent in intravenous drugs addicts than in the general population in Argentina where Gt1b is more frequent. Mild forms of chronic hepatitis are less frequent in IVD. In spite of the relatively small group with HCV co-infection with HIV, it seems important to note that 2/8 (25

) showed severe hepatitis C or cirrhosis.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4%7) and six in Group B(35.2%) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4

7) and six in Group B(35.2

) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Ictericia por metimazol / Jaundice due to methimazole

Se presentan 3 pacientes de sexo femenino que bajo tratamiento con metimazol instituido a raíz de hipertiroidismo presentaron un cuadro caracterizado por ictericia, intenso prurito e hipocolia. Ninguna de las pacientes presentó antecedentes de alcoholismo o ingesta de drogas potencialmente hepatotóxicas. El laboratorio se caracterizó en todos los casos por una elevación de la bilirrubina con un máximo de 14.5 mg% a predominio de la fracción conjugada, aumento de la fosfatasa alcalina y de la gamma glutamil transpeptidasa con una sola moderada movilización de las aminotransferasas no superando el nivel sérico de 10 veces su valor normal. Los marcadores virales fueron reiteradamente negativos para los virus A y B de hepatitis en las tres pacientes. La biopsia hepática reveló en todos los casos una intensa colestasis con reacción inflamatória de grado moderado en los campos portales. La ictericia apareció aproximadamente al mes de instituído el tratamiento y desapareció al cabo de la suspensión del mismo en forma lenta, demorando en un caso hasta un año

Ictericia por metimazol / Jaundice due to methimazole

Se presentan 3 pacientes de sexo femenino que bajo tratamiento con metimazol instituido a raíz de hipertiroidismo presentaron un cuadro caracterizado por ictericia, intenso prurito e hipocolia. Ninguna de las pacientes presentó antecedentes de alcoholismo o ingesta de drogas potencialmente hepatotóxicas. El laboratorio se caracterizó en todos los casos por una elevación de la bilirrubina con un máximo de 14.5 mg% a predominio de la fracción conjugada, aumento de la fosfatasa alcalina y de la gamma glutamil transpeptidasa con una sola moderada movilización de las aminotransferasas no superando el nivel sérico de 10 veces su valor normal. Los marcadores virales fueron reiteradamente negativos para los virus A y B de hepatitis en las tres pacientes. La biopsia hepática reveló en todos los casos una intensa colestasis con reacción inflamatória de grado moderado en los campos portales. La ictericia apareció aproximadamente al mes de instituído el tratamiento y desapareció al cabo de la suspensión del mismo en forma lenta, demorando en un caso hasta un año (AU)

[Jaundice caused by methimazole]. / Ictericia por metimazol.

Three female patients with cholestatic jaundice related to methimazole therapy are presented. The jaundice appeared after more or less 30 days of therapy. Markers for hepatitis A and B were negative in all. None of them had previous history of alcoholism or ingestion of potentially hepatotoxic drugs. Characteristically there was a marked elevation of alkaline phosphatase and gamma-glutamyltranspeptidase with only moderate increase of the aminotransferases. Liver biopsy performed in all showed intensive cholestasis with low degree of inflammatory reaction confined to the portal tracts. The three patients presented a prolonged duration of the liver injury in spite of the interruption of the drug lasting in one of them up to one year, but all ultimately resolved.

[Prevalence of antibodies against hepatitis C virus (anti HCV) in different populations with chronic liver disease using the first generation test]. / Prevalencia de anticuerpos anti virus de la hepatitis C (anti HCV) en diferentes poblaciones de hepatopatiás crónicas con una prueba de primera generación.

UNLABELLED: In order to evaluate the prevalence of antibodies IgG against the virus of hepatitis C (anti HCV) in different forms of chronic liver disease negative for virus B markers of alcoholism, we studied 148 patients (pts) divided into several groups. Group I: Composed of 35 pts. with chronic active hepatitis (CAH) with definite evidence of parenteral exposure to blood. Group II: included 39 pts. with CAH without immune markers or evidence of possible parenteral transmission. Group III: Included 37 pts. with the diagnosis of CAH of autoimmune type with positivity of antinuclear, anti smooth muscle or both antibodies with range of positivity of 1:80 or higher. Group IV: was composed of 31 pts. with the diagnosis of primary biliary cirrhosis (PBC). Finally group V included 6 pts. with an overlap syndrome between CAH and PBC. The prevalence of anti HCV in the different groups was as follows: [table: see text] Two of the pts. positive for anti HCV in group III and 1 in group IV revealed parenteral exposure to blood or blood product. CONCLUSIONS: The determinations of anti HCV in order to characterize the posttransfusional NANB chronic hepatitis is of value. Positivity of anti HCV is high in cryptogenic chronic hepatitis and rare in PBC. In CAH of autoimmune type and in the overlap syndrome the prevalence was higher than expected. The question if we are dealing with false positivity or an uncertain diagnosis of autoimmunity is raised.

Ictericia por metimazol. / [Jaundice caused by methimazole]

Three female patients with cholestatic jaundice related to methimazole therapy are presented. The jaundice appeared after more or less 30 days of therapy. Markers for hepatitis A and B were negative in all. None of them had previous history of alcoholism or ingestion of potentially hepatotoxic drugs. Characteristically there was a marked elevation of alkaline phosphatase and gamma-glutamyltranspeptidase with only moderate increase of the aminotransferases. Liver biopsy performed in all showed intensive cholestasis with low degree of inflammatory reaction confined to the portal tracts. The three patients presented a prolonged duration of the liver injury in spite of the interruption of the drug lasting in one of them up to one year, but all ultimately resolved.

Prevalencia de anticuerpos anti virus de la hepatitis C (anti HCV) en diferentes poblaciones de hepatopatiás crónicas con una prueba de primera generación. / [Prevalence of antibodies against hepatitis C virus (anti HCV) in different populations with chronic liver disease using the first generation test]

In order to evaluate the prevalence of antibodies IgG against the virus of hepatitis C (anti HCV) in different forms of chronic liver disease negative for virus B markers of alcoholism, we studied 148 patients (pts) divided into several groups. Group I: Composed of 35 pts. with chronic active hepatitis (CAH) with definite evidence of parenteral exposure to blood. Group II: included 39 pts. with CAH without immune markers or evidence of possible parenteral transmission. Group III: Included 37 pts. with the diagnosis of CAH of autoimmune type with positivity of antinuclear, anti smooth muscle or both antibodies with range of positivity of 1:80 or higher. Group IV: was composed of 31 pts. with the diagnosis of primary biliary cirrhosis (PBC). Finally group V included 6 pts. with an overlap syndrome between CAH and PBC. The prevalence of anti HCV in the different groups was as follows: [table: see text] Two of the pts. positive for anti HCV in group III and 1 in group IV revealed parenteral exposure to blood or blood product. Conclusions: The determinations of anti HCV in order to characterize the posttransfusional NANB chronic hepatitis is of value. Positivity of anti HCV is high in cryptogenic chronic hepatitis and rare in PBC. In CAH of autoimmune type and in the overlap syndrome the prevalence was higher than expected. The question if we are dealing with false positivity or an uncertain diagnosis of autoimmunity is raised.

[Acute non-A non-B viral hepatitis]. / Hepatitis viral aguda no A no B.

Thirty-one patients HBs Ag negative seen between january 1978 and june 1980 were studied. Twenty-four of them were males and seven females. Their age ranged between 13 and 58 years. All of them were anti-HAV IgM negative. Six patients presented simultaneously Anti HBc and Anti HBs in the two first weeks of the illness. This fact could be imputed to an acquired immunity due to a previous infection with virus B. None of the patients studied had evidence of infectious mononucleosis or cytomegalovirus. In view of the absence of the markers of recent infection due to virus A and B these patients were considered to have a non A non B hepatitis. Twelve patients had evidence of previous hepatitis, thirteen had acquired the infection by parenteral route; four were post-transfusional and in six cases there was an epidemic medium. Forty-five percent of the patients studied had a biphasic elevation of the aminotransferases, and twenty percent had a cholestatic form. Two of the patients turned into a chronic active hepatitis and another one died of submasive necrosis; in both cases the via of infection was parenteral.