Techniques for bone assessment and characterization: porcine hard palate case study.

The hard palate plate has an important structural function that separates the nasal cavity and the nasopharynx. Incomplete regeneration of palatal fistulae in children with a cleft palate deformity after primary palatoplasty is a relatively common complication. To date, the information about the physicochemical bone features of this region is deficient, due to the low availability of human samples. Swine and human bone share anatomical similarities. Specifically, pig bones are widely used as experimental animal models in dental, orthopedic, or surgical techniques. The aim of this study was to show different techniques to evaluate and characterize alternative properties of pig hard palate bone, compared to commercial hydroxyapatite, one of the most used biomaterials for bone tissue regeneration. Chemical analyses by Energy dispersive spectroscopy (EDS) and X-ray fluorescence (XRF) showed calcium and phosphate ions as the main constituents of bone, while magnesium, iron, sodium, potassium, and zinc ions were minor constituents. The calcium phosphate molar ratio (Ca/P) in the bone was low (1.1 ± 0.2) due to the very young specimen sample used. The FTIR spectrum shows the presence of phosphates ions (PO4 3-) and the main characteristics of collagen type I. The XRD results showed that the hard palate bone has a mixture of calcium, octacalcium dihydrogen phosphate (OCP), and apatite, where OCP is the predominant phase. Besides, this research demonstrated that the young bone has low crystallinity and small crystal size compared with commercial hydroxyapatite (HA). The palatine process of maxilla density and porosity data reported, suggest that the palate bone is getting closer to the compact bone with a 52.78 ± 2.91% porosity and their mechanical properties depend on the preparation conditions and the area of the bone analyzed.

Comparing Articaine brands: A randomized non-inferiority controlled trial.

INTRODUCTION: The substitution of reference drugs for similar, new or existing drugs in the market is a dilemma present in daily dental procedures. In order to decide whether or not to adopt a new drug in relation to the reference, a clinical trial can provide the necessary evidence. METHODS: A total of 179 healthy volunteers (18-25 years) requiring extraction of mandibular third molars completed the study. Subjects were randomized into 4 groups: right, left, Arteek-SP and Septanest. Allocations consisted of 4% Articaine hydrochloride with 1:10000 epinephrine. The primary aim of this randomized controlled trial was to determine whether the test drug Arteek-SP was noninferior by a margin of 10% in the proportion of patients with total absence of pain, compared to the reference drug Septanest in the extraction of mandibular third molars using inferior alveolar nerve blocks. Secondary outcomes included, hemodynamic parameters, volume (mL), pain scores assessed during one visit and reported postoperative discomfort assessed during 8 days. Noninferiority was declared if total absence of pain for both groups was equal to 0.9, with a significance level of 5% (P < 0.05) and power at 90% (ß = 0.1) at 95% confidence level. RESULTS: Arteek-SP was applied during the first surgery to 90 volunteers (50.28%) and Septanest was applied to 89 subjects (49.72%). Less than 10% difference was identified, in the proportion of patients with total absence of tooth pain P < 0.05 and in the gum P < 0.1, at 95% CI, when Arteek-SP was applied first in comparison with Septanest, establishing noninferiority. CONCLUSION: The clinical performance of the test drug Arteek-SP is noninferior to the reference drug Septanest. They can be considered interchangeable in terms of cost or convenience. REGISTRATION: ClinicalTrials.org, number NCT4166890.

Technical basis for using passive sampling as a biomimetic extraction procedure to assess bioavailability and predict toxicity of petroleum substances.

Solid-phase microextraction fibers coated with polydimethylsiloxane (PDMS) provide a convenient passive sampling format to characterize bioavailability of petroleum substances. Hydrocarbons absorb onto PDMS in proportion to both freely dissolved concentrations and partitioning properties of the individual constituents, which parallels the mechanistic basis used to predict aquatic toxicity in the PETROTOX model. When deployed in a non-depletive manner, combining SPME with thermal desorption and quantification using gas chromatography-flame ionization creates a biomimetic extraction (BE) procedure that has the potential to simplify aquatic hazard assessments of petroleum substances since the total moles of all hydrocarbons sorbed to the fiber can be related to toxic thresholds in target lipid of aquatic organisms. The objective of this work is to describe the technical basis for applying BE measurements to predict toxicity of petroleum substances. Critical BE-based PDMS concentrations corresponding to adverse effects were empirically derived from toxicity tests on different petroleum substances with multiple test species. The resulting species sensitivity distribution (SSD) of PDMS effect concentrations was then compared and found consistent with the previously reported target lipid-based SSD. Further, BE data collected on samples of aqueous media dosed with a wide range of petroleum substances were highly correlated to predicted toxic units derived using the PETROTOX model. These findings provide justification for applying BE in environmental hazard and risk evaluations of petroleum substances and related mixtures.

Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica / High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff

Objetivo: Determinar la prevalencia e índice de infestación (II) por Demodex spp. en pacientes con blefaritis en distintos grupos etarios y evaluar su asociación con la presencia de caspa cilíndrica (CC). Materiales y métodos: Estudio prospectivo que incluye a pacientes de la Fundación Oftalmológica Los Andes (Chile), con diagnóstico clínico de blefaritis con compromiso de la lámina posterior entre 2013 y 2015, sin tratamiento acaricida previo. Cuatro pestañas de cada párpado fueron extraídas al azar para la detección del ectoparásito y determinación del II, calculado como el cociente entre el número observado de especímenes de demodex y la totalidad de las pestañas extraídas. Además, se realizó una determinación semicuantitativa de la presencia de CC. Resultados: Se incluyó a 178 pacientes, de los cuales el 51,3% eran hombres. La edad promedio fue de 58,49 ± 20,66 años. El 83,7% de los pacientes resultaron infestados por demodex, con un II promedio de 0,96 ± 0,84 ácaros/pestaña. El II fue significativamente mayor en pacientes sobre los 50 años (p<0,0001). La edad de los pacientes y el II presentaron un coeficiente de correlación lineal de Pearson (R2) de 0,12 (p<0,0001). El 71,4% de los pacientes presentaron CC, con valores significativamente más altos en pacientes mayores de 50 años. Se observó una correlación positiva entre la cantidad de CC y el II (R2=0,33; p<0,0001). Conclusiones: Existe una elevada prevalencia de infestación por demodex en pacientes con blefaritis posterior. El II por Demodex folliculorum se correlaciona positivamente con la edad de los pacientes y con la presencia de CC en el borde palpebral (AU)

Objective: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). Materials and methods: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. Results: A total of 178 patients (91 men, 87 women), with a mean age of 58.49 ± 20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96 ± 0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). Conclusions: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border (AU)

High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff. / Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica.

OBJECTIVE: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). MATERIALS AND METHODS: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. RESULTS: A total of 178 patients (91 men, 87 women), with a mean age of 58.49±20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96±0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). CONCLUSIONS: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border.

Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados / Conjunctival impression cytology in patients with normal and impaired OSDI scores

OBJETIVO: Describir la graduación de Nelson y la densidad de células caliciformes en distintas áreas de la superficie ocular usando citología de impresión conjuntival (CIC), en pacientes con valores Ocular Surface Disease Index (OSDI©) normales y alterados. MATERIALES Y MÉTODOS: Los pacientes (n = 166) en evaluación por ojo seco, reclutados entre 2011 y 2012, fueron clasificados según el cuestionario OSDI en 4 categorías (normal y alteradas). Se evaluó citología (CIC con tinción Papanicolaou) aplicando el sistema de graduación de Nelson, con modificaciones en la determinación de la estadificación, y recuento de células caliciformes en zonas nasal, temporal, superior e inferior de la superficie conjuntival. RESULTADOS: El grado de Nelson fue significativamente mayor en pacientes con valores OSDI severos, variando desde 0,86 ± 0,09 en pacientes normales a 1,41 ± 0,14 en OSDI severo (p < 0,01). La densidad de células caliciformes disminuyó desde 497,31 ± 50,07 células por muestra en pacientes normales a 310,24 ± 56,24 células por muestra en pacientes con OSDI severo (p < 0,001). La conjuntiva bulbar no fotoexpuesta presentó un número de células caliciformes significativamente mayor (p < 0,0001) que la zona fotoexpuesta en pacientes con OSDI leve (p < 0,01) y moderado (p < 0,001). CONCLUSIÓN: La densidad de células caliciformes es menor y la clasificación de Nelson es mayor en pacientes con OSDI severo. La densidad de células caliciformes es mayor en la conjuntiva bulbar no fotoexpuesta

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n = 166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41 ± 0.14) compared to normal patients (0.86 ± 0.09) (P<0.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24 ± 56.24 cells per sample) compared with normal subjects (497.31 ± 50.07 cells per sample) (P<0.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<0.01) and moderate (P<0.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva

[Conjunctival impression cytology in patients with normal and impaired OSDI scores]. / Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados.

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n=166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41±0.14) compared to normal patients (0.86±0.09) (P<.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24±56.24 cells per sample) compared with normal subjects (497.31±50.07 cells per sample) (P<.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<.01) and moderate (P<.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva.

Imbalance of p75(NTR)/TrkB protein expression in Huntington's disease: implication for neuroprotective therapies.

Neuroprotective therapies based on brain-derived neurotrophic factor (BDNF) administration have been proposed for Huntington's disease (HD) treatment. However, our group has recently reported reduced levels of TrkB in HD mouse models and HD human brain suggesting that besides a decrease on BDNF levels a reduction of TrkB expression could also contribute to diminished neurotrophic support in HD. BDNF can also bind to p75 neurotrophin receptor (p75(NTR)) modulating TrkB signaling. Therefore, in this study we have analyzed the levels of p75(NTR) in several HD models, as well as in HD human brain. Our data demonstrates a p75(NTR)/TrkB imbalance in the striatum of two different HD mouse models, Hdh(Q111/111) homozygous knockin mice and R6/1 mice that was also manifested in the putamen of HD patients. The imbalance between TrkB and p75(NTR) levels in a HD cellular model did not affect BDNF-mediated TrkB activation of prosurvival pathways but induced activation of apoptotic cascades as demonstrated by increased JNK phosphorylation. Moreover, BDNF failed to protect mutant huntingtin striatal cells transfected with p75(NTR) against NMDA-mediated excitotoxicity, which was associated with decreased Akt phosphorylation. Interestingly, lack of Akt activation following BDNF and NMDA treatment correlated with increased PP1 levels. Accordingly, pharmacological inhibition of PP1 by okadaic acid (OA) prevented mutant huntingtin striatal cell death induced by NMDA and BDNF. Altogether, our findings demonstrate that the p75(NTR)/TrkB imbalance induced by mutant huntingtin in striatal cells associated with the aberrant activity of PP1 disturbs BDNF neuroprotection likely contributing to increasing striatal vulnerability in HD. On the basis of this data we hypothesize that normalization of p75(NTR) and/or TrkB expression or their signaling will improve BDNF neuroprotective therapies in HD.

Plan de formación y docencia en un centro integral de cáncer: estrategia e implementación / Continuing education and teaching plans in a comprehensive cancer centre: strategy and implementation

Introducción. El Institut Català d’Oncologia (ICO) puso en marcha la Unidad de Formación y Docencia (UFiD), en el año2006, con el objetivo de potenciar el desarrollo profesional, la difusión del conocimiento y la calidad de la atención oncológica. En el presente artículo se describe el proceso de puesta en marcha de la UFiD, los resultados del estudio de las necesidades formativas realizada por los profesionales y colectivos de la institución, las acciones formativas organizadas, y en el área de docencia, los resultados de la reorganización de las trayectorias docentes de los diferentes servicios, así como el apoyo de nuevas iniciativas. Materiales y métodos. Durante el periodo 2008-2009, se implantaron acciones formativas y docentes en concordancia con los resultados del estudio de necesidades y con las líneas estratégicas de la institución. Se realizaron un total de 71actividades formativas, con 898 participantes de todas las categorías profesionales, con una tasa de satisfacción de los participantes de 7,8 sobre 10. En el apartado de docencia, durante el mismo periodo se realizaron 3 másteres, 3 posgrados,59 cursos de actualización con metodología semipresencial y 19 cursos con metodología online, todos ellos con acreditación académica. La satisfacción media fue de 8 sobre 10.Resultados y conclusiones. La actividad llevada a cabo por la UFiD ha permitido, por una parte, articular la formación continuada en base al estudio de las necesidades de los profesionales, lo que ha contribuido a promover el desarrollo profesional y la calidad asistencial de éstos, y por otra parte, dar soporte a las actividades docentes ya existentes y promover nuevas iniciativas para favorecer la difusión de conocimientos en el área oncológica, lo que ha posicionado al ICO como un centro absolutamente comprometido con la formación oncológica (AU)

Introduction. The Oncology Catalonian Institute (ICO) launched the training and education unit (UFiD) in 2006, in order to enhance professional development, dissemination of knowledge and quality of the oncology care. Here are described the tune-up of this process and the results of the training needs survey carried out among the professionals and collectives of the centre. Materials and methods. Training and educational actions deployed during 2008 and 2009 and its evaluation results are presented. A total of 60 training activities were carried out in which 719 students of all professional categories participated, and with a score of participant’s satisfaction of 7.8 out of 10. In the area of education, the paths of the different services were reorganized and new initiatives were supported. A total of 3 masters, 3 post-graduate degrees, 59 update courses with semi-presential (blended learning) methodology and 19 on-line methodology courses, all of them with academicaccreditation were imparted with a satisfaction average score of 8 out of 10.Results and conclusions. The activity carried out by the UFiD during this period, has made possible to articulate the continuing training based on the study of the professionals needs. This has allowed promoting the professional development and the quality of the care. Supporting existing training activities and promoting new initiatives encourage the dissemination of knowledge in the area of oncology and has positioned us as a centre committed to oncology training (AU)

Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

OBJECTIVE: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). METHODS: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" RESULTS AND RECOMMENDATIONS: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

Prevalence of hemochromatosis in the Puerto Rico veteran population

BACKGROUND: Hereditary hemochromatosis (HH) is a disorder of iron storage that results in iron overload. It's prevalence in Puerto Rico (PR) is unknown and the condition frequently undiagnosed. PURPOSE: Determine the prevalence of HH in the PR Veteran population. METHODS: Patients attending the San Juan VA Medical Center Laboratory for routine tests were invited to participate. Basic demographic data, symptoms related questionnaire, fasting samples for unbound iron binding capacity (UIBC) and serum iron were obtained. Transferrin saturation (TS) > or =45% was considered as iron overload. Patients with elevated TS had a second test done to confirm iron overload. Genetic testing was performed to patients with sustained elevated TS. RESULTS: Data from 521 of the 559 recruited patients was available for analysis. 59 patients had TS > or =45%. Iron overload was confirmed in eleven patients. Two patients were lost to follow up; one had secondary causes for iron overload. Eight patients underwent genetic testing. Genetic mutations associated with hemochromatosis were found in four patients. CONCLUSION: The estimated prevalence of confirmed iron overload in our population is 2%, similar to one in the United States, while the prevalence of genetic mutations associated to hemochromatosis is 0.76%, which is slightly higher. Both genetic mutations (C282Y, H63D) are equally seen in the evaluated population which is different from reports elsewhere. Physician awareness of the prevalence of HH in PR may result in increased screening and early identification of the condition.

Hepatocellular carcinoma: ten years experience among veterans in Puerto Rico

PURPOSE: The aim of our study is to determine the characteristics of hepatocellular carcinoma (HCC) as well as risk factors, demographics, survival rates and the use of diagnostic and therapeutic modalities among veteran patients in Puerto Rico. METHODS: A retrospective study of 114 patients with Hispanic background and biopsy-proven HCC diagnosed at the VA Caribbean Healthcare System from 1992 to 2002 was performed. Demographics data, Child-Turcotte-Pugh (CTP) score, presence of cirrhosis, viral serology, alcohol and/or other liver diseases history, diagnostic modalities, lesion size, therapy, and overall survival were examined. RESULTS: The mean age was 66.6 years old. 82% had known underlying cirrhosis. 60% had alcoholic liver disease (ALD), 33% positive serology for hepatitis C (HCV) and 21% both. 5.3% had chronic hepatitis B virus (HBV) infection. Additional causes were not present. CTP classification was: A (42%), B (44%) and C (14%). Abdominal CT scan demonstrated most of the lesions, while ultrasound only 57%. Alfa-fetoprotein was diagnostic in 32%. Mean survival was 10.3 months, better for those with CTP score A. Only 42% of the patients received any kind of therapy. CONCLUSIONS: ALD is the principal underlying liver disease in our HCC patients, closely followed by chronic HCV infection. Less than half of our patients received treatment mainly due to advanced disease for which the over survival was less than a year. HCC continues to be a dreadful disease with poor prognosis for which aggressive screening should be considered for all patients with cirrhosis and advanced liver disease regardless of the cause.

Primary duodenal signet-ring cell carcinoma presenting as gastric outlet obstruction

Small bowel tumors occur rarely. We present an unusual case of a 68 year old man with gastric outlet obstruction secondary to a non-ampullary primary duodenal signet ring cell carcinoma. A review of the literature of small bowel malignant tumors is presented along with the case.

Anaplastic T-cell lymphoma presenting as fatal acute liver failure

Acute liver failure (ALF) is an uncommon manifestation of liver disease and constitutes a medical emergency for which early identification is necessary. Hepatic involvement by hematologic malignancies although frequent, rarely causes severe hepatic dysfunction. Even more, acute hepatic failure as the first manifestation of a hematologic malignancy is extremely uncommon, although some cases have been reported in the literature. We describe the case of a 61 y/o puertorrican veteran who developed acute hepatic failure secondary to massive infiltration of the liver by a recurrent non-Hodgkin's lymphoma.

Does Silybum marianum play a role in the treatment of chronic hepatitis C?

OBJECTIVES: The recent boom in patient education on chronic hepatitis C has resulted in a worldwide increase in the diagnosis of this condition. Available treatment is expensive and associated with significant side effects; therefore, many patients seek for alternative medicine. Silybum marianum is a natural herb known to mankind for over 2,000 years that has been used as a liver-protecting agent due to its antioxidant properties. The objective of this study is to evaluate the safety profile and the effects of this herb, using a commercially available extract; in the liver chemistry and viral load of hepatitis C in chronically infected patients. METHODS: Patients aged 21-65 years old with a diagnosis of chronic hepatitis C who were not using antiviral therapy were asked to participate. Patients were randomized to treatment with S. marianum 160 mg orally three times a week for four weeks or to no-treatment (control). Blood tests for viral load and liver enzymes (ALT and AST) were done at randomization and at the end of treatment. Paired-t test was used to measure differences between baseline and week 4 values for ALT, AST and viral load. The percent change for ALT, AST and viral load of both groups was analyzed using the Mann Whitney statistical test. RESULTS: 34 patients were enrolled. Men and women were equally distributed. Mean age was 50 years old. Mean baseline measurements of AST, ALT and viral load in the treatment group were 85 +/- 12.41 IU/ml, 120 +/- 20.57 IU/ml and 8.77 +/- 4.12 copies x 10(6)/ml while for the no-treatment group were 71 +/- 9.46 IU/ml, 97 +/- 15.35 IU/ ml and 1.8 +/- 0.62 copies x 10(6)/ml respectively. For treated subjects the mean values of AST, ALT and viral load demonstrated a decrease from baseline values, but this difference was not statistically significant. For control patients the values of ALT (p= .049), AST (p = .005) and viral load (p = .005) showed a statistically significant increase at week 4. Week 4 measurement chang...

Response to combination therapy of interferon alfa-2b plus ribavirin in Hispanics with chronic hepatitis C

OBJECTIVE: To evaluate the response rate of Hispanics with chronic hepatitis C to combination therapy of interferon alfa-2b plus ribavirin and to assess its adverse events. BACKGROUND: Hepatitis C virus may lead to chronic infection and multiple complications. Response to combination therapy of interferon plus ribavirin has been studied in many populations. African Americans have been found to have a lower response rate than Caucasians. However, little data exist for Hispanics. METHODS: Hispanic patients from Puerto Rico with chronic hepatitis C were eligible for the study between November 1997 and February 2000. The Institutional Review Boards of the participating institutions approved the study. Written informed consents were obtained. Combination therapy was given for 48 weeks and patients were followed for 24 weeks after treatment. Analysis of response to therapy was performed in an intention-to-treat basis. RESULTS: The most frequent adverse event was anemia (89%), associated to ribavirin. Sustained response was 23% for naive patients, 45% for relapsers, and 8% for non-responders to previous interferon monotherapy (p < 0.001). Data to analyze response was not available in 27% of patients. Hispanic patients had a low response rate to combination therapy. CONCLUSIONS: Response rates to combination therapy for Hispanic naive and previously non-responder patients are lower than in other reported populations. This may be due to a high prevalence of genotype 1 in Puerto Rico, which is associated to poor response. The higher response rate of relapsers, similar to those reported previously, was expected since these patients showed a previous response to interferon monotherapy. Ethnic factors may play a role in the response to therapy and should be further studied to determine proper treatment strategies for this population.

Steatosis as a predictive factor for treatment response in patients with chronic hepatitis C

BACKGROUND: Hepatic steatosis has been described in 31-72% of chronic hepatitis C virus (HCV) liver biopsies. Steatosis has been related to disease progression and suggested as a predictor of treatment response in chronic HCV. This study aims to evaluate the presence and degree of steatosis in liver histology of patients with chronic HCV prior to combination therapy with interferon (INF) and ribavirin (RBV), and how it influences treatment response. METHODS: The medical charts of patients with chronic HCV who received treatment at the San Juan Veterans Affairs (VA) Medical Center from 1998 to 2002 were reviewed. Selected patients completed therapy, had a pre-treatment liver biopsy, genotype determination, and pre and post treatment HCV-RNA levels. Patient's age, sex and body mass index (BMI) were determined. Pre-treatment liver biopsy slides were reviewed and graded for steatosis by a hepatopathologist blinded to the treatment outcome. Steatosis was graded by the presence of fat in total biopsy area as: mild (<33%), moderate (33-66%), severe (>66%) or absent. Treatment response was defined as virological clearance measured by HCV RNA at the end of treatment and 24 weeks after completion of treatment. The presence of steatosis was compared to BMI, HCV genotype and treatment response. RESULTS: 46 patients met the inclusion criteria. All patients were male of Hispanic origin. Mean age: 52.7 years (range: 40-68). Mean BMI: 27.5 kg/m2 (range: 21.1-35.9). HCV genotype 1 was present in 67% of patients. 82.6% (38/46) of the patients had hepatic steatosis: 29 (63%) mild, 7 (15%) moderate and 2(4%) severe. 16.6% (8/46) of the biopsies did not show steatosis. Overall, the response rate for those with steatosis was 31.6% (12/38): 10/29 (34.5%) mild, 1/7 (14.3%) moderate and 1/2 (50%) of severe. 75% (6/8) of those without steatosis responded to treatment. This difference (31.6% vs. 75%) was statistically significant (p=.042). The mean BMI of both groups was similar (27.7)...

Prevalence of chronic hepatitis C virus genotypes among patients between 21 to 65 years old in Puerto Rico

OBJECTIVES: This is the first study done in Puerto Rico to estimate the prevalence of hepatitis C virus (HCV) genotype distribution in patients with chronic infection and to determine the statistical association between the genotype and variables such as age, sex, HCV risk factors, and viral load. METHODS: Chronic HCV infected patients diagnosed with ELISA, RIBA or PCR from 1990 to 2002 who were under follow up with members of the Puerto Rico Gastroenterological Association were asked to participate. Eligible patients were those without evidence of HIV or other viral hepatic infection; had no previous antiviral treatment or if previously treated, therapy ended at least six months prior to their participation in the study; had no history of organ transplant and were willing to participate. All study subjects completed a study questionnaire and had blood samples taken to determine HCV genotype and viral load. RESULTS: 500 patients were recruited. Most of the study subjects were males (68%); 70% were 45 to 65 years old. The principal reported risk factors were: surgeries (75.5%), drug use (46.8%), sexual relationships with intravenous/intranasal drug users (30.3%), blood transfusions (30.2%), multiple sex partners (28.9%), tattoos (22.0%), needle accidents (12.7%), and sexual relationships with an HCV infected partner (9.0%). Most patients had multiple risks factors for infection, only 3.4% (17/500) reported a single risk factor whereas 2.0% (10/500) reported none. 33% of the patients were previously treated (non-responders or relapsers) while 67% were naive. In general, 82% of the HCV patients had genotype 1, while 18% had non-1 genotypes. Among genotype 1 subtypes, genotype la (39.8 %) was more common than 1b (27%). The most common non-1 genotype was genotype 2 of which 2b represented 9.8% of the study population. Similar distribution was observed within the categories of the HCV risk factors, with the exception of those who reported sex with an infected partn...