El síndrome de fatiga crónica en el curso de la hepatitis C. Presentación de un caso / Chronic fatigue syndrome in the course of Hepatitis C

RESUMEN Se supone que aproximadamente 80 millones de personas a nivel mundial están infectadas con el virus de la hepatitis C. Un aproximado del 60 % de dichos pacientes aqueja síndrome de fatiga crónica. Se presentó un paciente portador de hepatitis crónica de tipo C, con manifestaciones clínicas de síndrome de fatiga crónica por más de dos años. Se han reportado estudios internacionales que han demostrado la relación existente entre el desarrollo de la respuesta inmune y el daño que ocasiona en el tejido cerebral la infección por virus de hepatitis C. Este trabajo tiene como objetivo la presentación del primer caso que se tiene referencia (AU).

ABSTRACT It is believed that almost 80 million persons are infected with the Hepatitis C virus around the world, and 60 % of them suffer the chronic fatigue syndrome. For that reason we present the case of a patient who is a carrier of the chronic fatigue syndrome for more than two years. Reports of international research have showed the relation between the immune answer and the damage caused by the infection of the hepatitis C virus in the brain tissues. The aim of this work is presenting the first case reported in Cuba (AU).

Rheumatological manifestations associated with viral Hepatitis B or C

Abstract INTRODUCTION Rheumatological findings and rheumatic diseases may be associated with hepatitis virus infection. This study assessed the frequency of these manifestations in a reference unit in Acre, Brazil. METHODS This was a cross-sectional study with a convenience sample of patients having their first consultation at the rheumatology outpatient clinics of a referral unit in Rio Branco, Acre, from March to November 2017. Sociodemographic, clinical, laboratory, and imaging data registereds using a standardized questionnaire form. RESULTS Among the 600 patients with rheumatic complaints, 3.0% were newly diagnosed with hepatitis B virus (HBV) or hepatitis C virus (HCV), and 8.7% were previously diagnosed with hepatitis. Among the 70 patients with hepatitis, 54.3% were carriers of HBV and 45.7% of HCV. For patients infected with HBV and HCV, arthralgia was the most prevalent rheumatic manifestation in 97.4% and 90.6%, followed by myalgia in 81.6% and 65.6%, and arthritis in 26.3% and 40.6% of patients, respectively, according to the descriptive analysis performed using the Statistical Package for the Social Sciences software. In comparative analyses using the chi-squared test, despite the fact that fibromyalgia was the most prevalent rheumatic disease only the Rheumatoid Arthritis there were differences in distribution between the carriers of HCV (18.8%) and HBV (2.6%). According to the Fisher's exact test, hypothyroidism was the most frequent comorbidity in patients with HCV (21.9%). CONCLUSIONS An increased frequency of musculoskeletal manifestations, better than those reported in the medical literature, in patients infected with HBV and HCV was observed.

Impact of alcohol consumption among patients in hepatitis C virus treatment / Impacto do consumo alcoólico entre pacientes em tratamento da hepatite C

ABSTRACT BACKGROUND: Recent studies have questioned the recommendation of abstinence from alcohol for at least 6 months for alcoholic patients to be treated for hepatitis C. OBJECTIVE: The present study aimed to assess the impact of alcohol consumption among patients undergoing hepatitis C treatment. METHODS: In this cross-sectional study, 121 patients [78 (64.5%) men; 28-70 years] were evaluated. They were divided as follows: patients who consumed <12 g of ethanol/day throughout life (Group 1), 12-59 g/day (Group 2) and ≥60 g/day (Group 3). Patients were treated with pegyla­ted-interferon plus ribavirin. RESULTS: These three groups could not be distinguished in terms of the severity of liver fibrosis and frequency of HCV genotype-1 infection. In Group 3, treatment discontinuation (32.4%) was higher than in the Group 1 (9.4%) or Group 2 (0%), it was higher among patients who drank during treatment (66.7% vs 21.4%) and among those who had not been abstinent for at least 6 months (72.7% vs 15.4%). Moderate alcohol drinkers showed good adherence and did not discontinue the treatment. The frequencies of sustained viral response among patients in Group 3 (44.4%) were similar to those in Group 1 (61%) and Group 2 (68.4%). CONCLUSION: Heavy drinkers more often discontinued treatment for hepatitis C, but those that received this treatment had acceptable sustained viral response rates. These results suggest that heavy drinkers should not be systematically excluded from the treatment, but they should be monitored to avoid drinking and abandoning treatment, mainly those who have not been abstinent for at least 6 months.

RESUMO CONTEXTO: Estudos recentes têm questionado a recomendação de abstinência do álcool por pelo menos 6 meses para pacientes alcoolistas serem tratados para hepatite C. OBJETIVO: Este estudo objetivou avaliar o impacto do consumo de álcool entre pacientes submetidos ao tratamento para a hepatite C. MÉTODOS: Neste estudo transversal, avaliou-se 121 pacientes [78 (64,5%) homens; 28-70 anos). Eles foram divididos em três grupos: pacientes que consumiam <12 g de etanol/dia na vida (Grupo 1); 12-59 g/dia (Grupo 2) e ≥60 g/dia (Grupo 3). Pacientes foram tratados com interfe­ron-peguilado mais ribavirina. RESULTADOS: Os três grupos não puderam ser distinguidos em relação à gravidade da fibrose hepática e das frequências de infecção pelo genótipo-1 do HCV. No Grupo 3, descontinuação do tratamento (32,4%) foi maior do que no Grupo 1 (9,4%) ou Grupo 2 (0%), foi maior entre pacientes que beberam durante o tratamento (66,7% vs 21,4%) e entre aqueles que não estavam em abstinência por pelo menos 6 meses (72,7% vs 15,4%). Pacientes do Grupo 2 tiveram boa aderência e não descontinuaram o tratamento. As frequências de resposta virológica sustentada entre pacientes do Grupo-3 (44,4%) foi semelhante àquelas do Grupo 1 (61%) e do Grupo 2 (68,4%). CONCLUSÃO: Bebedores pesados mais frequentemente descontinuaram o tratamento da hepatite C, mas aqueles que foram tratados tiveram aceitáveis taxas de resposta virológica sustentada. Esses resultados sugerem que bebedores pesados não deveriam ser sistematicamente excluídos do tratamento, mas sim serem monitorados para evitar beber e abandonar o tratamento, principalmente aqueles que não estão abstinentes por pelo menos 6 meses.

Cúrcuma em combinação com os regimes de terapia tríplice melhora o estresse oxidativo e as alterações histopatológicas em gastrite crônica associada à infecçäo por Helicobacter pylori / Curcumin in combination with triple therapy regimes ameliorates oxidative stress and histopathologic changes in chronic gastritis-associated helicobacter pylori infection

ABSTRACT BACKGROUND Helicobacter pylori (H. pylori) gastric infection is a main cause of inflammatory changes and gastric cancers. OBJECTIVE The aim of this study was finding the effects of curcumin on oxidative stress and histological changes in chronic gastritis associated with H. pylori. METHODS In a randomized clinical trial, patients were divided into two groups: a standard triple therapy group and triple therapy with curcumin group. Endoscopic and histological examinations were measured for all patients before and after 8 weeks. RESULTS Triple therapy with curcumin treatment group significantly decreased malondialdehyde markers, glutathione peroxides and increased total antioxidant capacity of the gastric mucosa at the end of study compared to baseline and triple regimen groups. In addition, the oxidative damage to DNA was significantly decreased in triple therapy with curcumin group at the end of study compared to baseline and compared to triple therapy (P<0.05 for both). Triple therapy group in combination with Curcumin significantly decreased all active, chronic and endoscopic inflammation scores of patients compared to the baseline and triple therapy group (P<0.05 for both). The eradication rate by triple therapy + curcumin was significantly increased compared to triple therapy alone (P<0.05). CONCLUSION Curcumin can be a useful supplement to improve chronic inflammation and prevention of carcinogenic changes in patients with chronic gastritis associated by H. pylori.

RESUMO CONTEXTO A infecção gástrica pelo Helicobacter pylori (H. pylori) é principal causa de alterações inflamatórias e de câncer gástrico. OBJETIVO O objetivo deste estudo foi encontrar os efeitos da cúrcuma no estresse oxidativo e as alterações histológicas na gastrite crônica associada ao H. pylori. MÉTODOS Em um estudo randomizado clínico experimental, pacientes foram divididos em dois grupos: um grupo de terapia tríplice padrão e outro com terapia tríplice com e cúrcuma. Exames endoscópicos e histológicos foram analisados para todos os pacientes antes e depois de 8 semanas de tratamento. RESULTADOS A terapia tríplice com grupo de tratamento de cúrcuma diminuiu significativamente os marcadores de malondialdeído, de peróxidos de glutationa, com aumento da capacidade antioxidante total da mucosa gástrica ao final do estudo em comparação com grupos de regime basal e tríplice. Além disso, o dano oxidativo ao DNA diminuiu significativamente em terapia tríplice com grupo de cúrcuma no final do estudo em comparação com a linha de base e comparado à terapia tríplice (P<0,05 para ambos). No grupo de terapia tríplice em combinação com cúrcuma houve diminuição significativa de todas os escores ativos de inflamação crônica e endoscópica dos pacientes em relação ao grupo de terapia de base e tríplice (P<0,05 para ambos). A taxa de erradicação por terapia tríplice + cúrcuma aumentou significativamente em relação à terapia tríplice isolada (P<0,05). CONCLUSÃO A cúrcuma pode ser um complemento útil para melhorar a inflamação crônica e prevenção de alterações cancerígenas em pacientes com gastrite crônica associada ao H.pylori.

Interaction of Gender and Hepatitis C in Risk of Chronic Renal Failure After Liver Transplantation

ABSTRACT Background. Chronic renal failure (CRF) is a significant cause of morbidity and mortality in post-liver transplantation (LT) recipients. The risk factors associated with the development of renal dysfunction are not clearly elucidated. Objectives. To examine the risk factors in the development of CRF in these patients. Material and methods. Retrospective case-cohort of liver transplant patients without baseline kidney dysfunction who developed chronic renal failure during their follow-up. Results. Of 370 patients, 254 met the inclusion criteria. 30% (76) of these patients had CRF of which 57% (43) were male. Age, estimated glomerular filtration rate (eGFR) at discharge, and HCV infection were found to be risk factors for CRF post-LT. The odds ratio of developing CRF was 1.4 (0.6-3.3) in males with HCV, 1.6 (0.7-3.9) in females without HCV and 4.4 (1.5-13.2) among females with HCV when compared to men without HCV. Conclusions. In this cohort of LT receipients of a major Canadian city, age, eGFR, and HCV infection were risk factors for CRF. Female gender and HCV increased this odds by a factor of more than 4.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

Introduction Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. Methods We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. Results HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. Conclusions These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection. .

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections. .

Borderline tuberculoid leprosy and type 1 leprosy reaction in a hepatitis C patient during treatment with interferon and ribavirin / Hanseniase boderline tuberculoide e reacao hansenica do tipo 1 em paciente com hepatite C durante tratamento com interferon e ribavirina

Hepatitis C is an inflammatory disease of the liver caused by a single-stranded RNA virus belonging to the Hepacivirus genus in the Flaviviridae family, called the hepatitis C virus. After initial infection, 70% to 85% of the patients develop chronic hepatitis C with hepatic fibrosis. In addition to specific liver changes, various extrahepatic manifestations have been associated with the hepatitis C virus infection or with medications used to treat the condition. We report the case of a patient with chronic hepatitis C who presented with the signs and symptoms of borderline tuberculoid leprosy and type 1 reaction four months after the start of treatment with a pegylated interferon/ribavirin combination.

A hepatite C é uma doença inflamatória fígado causada por um vírus RNA de fita simples, pertencente ao gênero Hepacivirus e à família Flaviviridae, denominado de vírus da hepatite C. Após infecção inicial 70 a 85% dos pacientes infectados evoluem para hepatite C crônica, com fibrose progressiva. Além das alterações hepáticas específicas, várias manifestações extra-hepáticas têm sido relacionadas à infecção pelo vírus da hepatite C ou às medicações utilizadas no seu tratamento. Nesse trabalho, apresenta-se caso de paciente portador de hepatite C crônica, que manifestou um quadro hanseníase boderline tuberculóide e reação hansênica do tipo I, quatro meses após início do tratamento com interferon peguilado associado à ribavirina.

Seroprevalence of Hepatitis C and factors associated with this in crack users / Soroprevalência da Hepatite C e fatores associados em usuários de crack / Seroprevalencia de la Hepatitis C y factores asociados en usuarios de crack

OBJECTIVE: to investigate the seroprevalence of hepatitis C in crack users in Piauí. METHOD: seroepidemiological survey, undertaken in the Psycho-Social Care Centers for Drugs and Alcohol (CAPS AD) in Piauí in the period December 2011 to May 2012. A questionnaire was administered and blood samples were collected for serological research. Fisher's exact test and the Mann-Whitney test were used, with a level of significance of (p<0.05). RESULTS: the prevalence of Anti-HCV was 05 (1.4%) and 04 (1.1%) for the RNA-HCV. There was a statistically significant association between hepatitis C (serological marker RNA-HCV) and age, being resident at home, length of use of crack, interruption of the use of crack, and the habit of sharing the crack pipes. CONCLUSION: the findings support the need to implement health policies aimed at crack users, due to the accelerated process of physical and psychological deterioration to which these are subject. .

OBJETIVO: investigar a soroprevalência da Hepatite C em usuários de crack do Estado do Piauí. MÉTODO: trata-se de um inquérito soroepidemiológico, desenvolvido nos Centro de Atenção Psicossocial Álcool e Drogas do Piauí, nos meses de dezembro de 2011 a maio de 2012. Aplicou-se formulário e coletou-se amostra sanguínea para pesquisa sorológica. Utilizou-se o teste exato de Fisher e de Mann-Whitney com nível de significância p<0,05. RESULTADOS: a prevalência do Anti-HCV foi de 05 (1,4%) e 04 (1,1%) para o RNA-HCV. Houve associação estatisticamente significativa entre Hepatite C (marcador sorológico RNA-HCV) e idade, residentes no domicílio, tempo de uso do crack, interrupção do uso do crack e hábito de compartilhar os cachimbos. CONCLUSÃO: os achados reforçam a necessidade de implementação de políticas de saúde voltadas para os usuários de crack, devido ao acelerado processo de deterioração física e psíquica à qual estão sujeitos. .

OBJETIVO: investigar la seroprevalencia de la Hepatitis C en usuarios de crack del estado de Piauí. Método: se trata de una investigación seroepidemiológico, desarrollado en los Centros de Atención Psicosocial Alcohol y Drogas de Piauí entre diciembre del 2011 y mayo del 2012. Fue aplicado formulario y colectada muestra sanguínea para investigación serológica. Fue utilizado el test exacto de Fisher y de Mann-Whitney con nivel de significancia (p<0,05). RESULTADOS: la prevalencia del Anti-HCV correspondió a 05 (1,4%) y 04 (1,1%) para el RNA-HCV. Fue encontrada asociación estadísticamente significativa entre Hepatitis C (marcador serológico RNA-HCV) y edad, residentes en domicilio, tiempo de uso del crack, interrupción del uso del crack y hábito de compartir las pipas. CONCLUSIÓN: los hallazgos refuerzan la necesidad de implementación de las políticas de salud dirigidas a los usuarios de crack, debido al acelerado proceso de deterioro físico y psíquico a que están sujetos. .

Hepatitis b, c nnd hiv co-infections seroprevalence in a northeast Brazilian center / Soroprevalencia da co-infeccao hepatite B, C e HIV em um centro no Nordeste do Brazil

Context The occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification. Objectives The present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil. Methods Retrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected. Results A total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs. Conclusion The study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread. .

Contexto A ocorrência da associação de HIV com a hepatite por vírus B (HVB) e C (HVC) é preocupante visto que os pacientes coinfectados tendem a ter uma resposta pior à terapia antiviral e uma chance maior de progredirem para a cronificação da doença hepática e suas complicações. No Brasil, os estudos publicados sobre a prevalência dessas coinfecções ainda são escassos e, muitos deles, com resultados conflitantes entre si. Além disso, muitos pacientes coinfectados são portadores assintomáticos dos vírus das hepatites o que causa um atraso no seu diagnóstico, com consequente subnotificação de casos. Objetivos Este estudo objetiva determinar a prevalência da infecção pelo HVB e HVC em pacientes recém-diagnosticados com HIV no Ceará/Brasil. Métodos Coorte retrospectivo com pacientes >18 anos, diagnosticados HIV+ de 2008-2010. Foram coletados dados referentes ao primeiro ano de acompanhamento desses pacientes através de revisão de prontuário: fatores de risco para HIV, HBV e HCV e resultados de provas sorológicas para esses vírus. Resultados Foram acompanhados 1291 pacientes HIV+. Testes sorológicos para HBV foram realizados em 52% dos casos: 23% apresentavam hepatite B prévia e 3,7% eram coinfectados. Apenas 25,4% tinham testes sorológicos para HCV: 1,5% tinham hepatite C prévia e 5,4% eram coinfectados. A maioria dos pacientes HBV/HIV referia ter múltiplos parceiros sexuais em um ano. Homossexualismo e bissexualismo estavam presentes em 28% e 20% respectivamente. No grupo HCV/HIV 38,8% referia múltiplos parceiros sexuais em um ano e o uso de drogas endovenosas ocorreu em 22,2% dos casos. Conclusão O estudo reforça a necessidade de um treinamento dos profissionais de saúde e de facilitação do acesso do paciente ...

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1 %), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1 %), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis / Fatores de risco para esteatohepatite não-alcoólica na cirrose criptogênica

CONTEXT: In about 10% of patients with chronic liver disease, it is not possible to identify an etiologic factor. These cases are called cryptogenic cirrhosis. Currently, nonalcoholic steatohepatitis (NASH) is being considered as a possible etiologic factor for a significant segment of patients that presents with cryptogenic cirrhosis. OBJECTIVE: To estimate the prevalence of risk factors for NASH in patients with cryptogenic cirrhosis, in order to verify if there is a causal relationship between them. METHOD: Cross-sectional study, with evaluation of the demographic and laboratorial data of patients with cryptogenic cirrhosis. They were compared with data obtained from a group with NASH and a group with alcoholic and/or hepatitis C (HCV) cirrhosis. RESULTS: Forty seven patients with cryptogenic cirrhosis were evaluated, 47 with NASH and 196 with HCV and/or alcoholic cirrhosis. The mean age of patients with cryptogenic cirrhosis was 52 years, while in those with NASH it was 46.4 years (P = 0,041). The group with cryptogenic cirrhosis had 23 female and 24 male patients. Of the patients who presented with NASH, 68.1% were female. Of the patients who presented with alcoholic/HCV cirrhosis, 64.8% were male. There were no statistically significant differences between the groups. In cryptogenic cirrhosis patients, the following prevalences could be observed: impaired fasting glycemia - 68.2%; obesity - 27.5%; total hypercholesterolemia - 27.9%; low HDL levels - 58.1% (women - 81%; men - 36.4%); hypertriglyceridemia - 16.3%. The results seen in cryptogenic cirrhosis patients showed statistical similarity with the results of the NASH group regarding fasting glycemia (62.8%) and male HDL levels (53.8%). The comparison with the alcoholic/HCV cirrhosis group showed statistical differences regarding fasting glycemia (45.2%), hypercholesterolemia (13.3%) and female HDL levels (50.8%). CONCLUSIONS: It is not possible to establish a causal relationship between cryptogenic cirrhosis and NASH. Only data related to fasting glycemia and HDL levels in male patients showed statistical similarities between both groups of patients.

CONTEXTO: Em aproximadamente 10% dos pacientes com doença hepática crônica não é possível identificar um fator etiológico, sendo então rotulados como tendo cirrose criptogênica. Atualmente a esteatohepatite não-alcoólica (EHNA) tem sido considerada como provável etiologia em parcela significativa desses pacientes. OBJETIVO: Estimar a prevalência de fatores de risco para EHNA em pacientes com cirrose criptogênica com o intuito de verificar uma possível relação causal entre as duas doenças. MÉTODOS: Estudo transversal em que foi avaliado o registro de dados demográficos e laboratoriais de pacientes com cirrose criptogênica com a finalidade de compará-los com aqueles obtidos de um grupo de pacientes com EHNA e de um grupo controle composto de cirróticos por hepatite C (HCV) e/ou álcool. RESULTADOS: Foram avaliados 47 pacientes com cirrose criptogênica, 47 com EHNA e 196 com cirrose por HCV e/ou álcool. A média de idade dos pacientes com cirrose criptogênica foi 52 anos, enquanto a daqueles com EHNA foi 46,4 anos (P = 0,041). No grupo com cirosse criptogênica havia 23 mulheres e 24 homens. Naqueles com EHNA predominou o gênero feminino (68,1%) e nos cirróticos por HCV e/ou álcool predominou o gênero masculino (64,8%), sem diferença estatística entre os grupos. Naqueles com cirrose criptogênica, a prevalência de glicemia de jejum alterada foi 68,2%; obesidade, 27,5%; hipercolesterolemia total, 27,9%; baixos níveis de HDL, 58,1% (81% nas mulheres e 36,4% nos homens); e hipertrigliceridemia, 16,3%. A comparação com dados observados nos pacientes com EHNA mostra semelhança estatística entre o perfil glicêmico (62,8%) e níveis de HDL nos homens (53,8%). A comparação com os cirróticos relacionados ao HCV e/ou álcool mostra diferença estatística no perfil glicêmico (45,2%), colesterol total (13,3%) e HDL nas mulheres (50,8%). CONCLUSÃO: Não foi possível estabelecer uma relação causal entre a EHNA e a cirrose criptogênica. Apenas o perfil glicêmico e os níveis de HDL colesterol nos pacientes masculinos apresentaram semelhanças estatísticas entre os dois grupos de doentes.

Hepatitis C and cutaneous alterations / Hepatite C e alterações cutâneas

While most of those infected with hepatitis C virus (HCV) are asymptomatic or only develop liver manifestations, a significant percentage evolves with autoimmune and lymphoproliferative disorders, resulting in a clinical condition called HCV syndrome. This work involving case studies of six patients with hepatitis C and varied skin manifestation aimed to report skin lesions occurring with HCV infection and its treatment. Skin manifestations in hepatitis C have been based on epidemiological studies. This justifies the need for studies that correlate HCV infection and its treatment with skin manifestations.

A maioria dos infectados pelo vírus da hepatite C (VHC) é assintomática ou apresenta somente manifestações hepáticas, porém uma significativa porcentagem evolui com desordens autoimunes e linfoproliferativas resultando na síndrome da hepatite C. Este trabalho envolve seis estudos de casos de pacientes com hepatite C e várias manifestações cutâneas, visando relacionar lesões dermatológicas ao VHC e ao seu tratamento. Manifestações dermatológicas na hepatite C têm sido baseadas em estudos epidemiológicos. Isto justifica a necessidade de estudos que correlacionem infecção pelo VHC e seu tratamento com as manifestações dermatológicas.

To study the correlation between carrier status of nasal Staphylococcus aureus in patients on haemodialysis with hepatitis C, hepatitis B and their sociodemographic features / Estudiar la correlación entre el portador del Estafilococo dorado nasal en pacientes de hemodiálisis con hepatitis C, hepatitis B y sus características sociodemográficas

AIM: To study the correlation of nasal Staphylococcus aureus carrier status in patients on haemodialysis, infected by hepatitis C virus (HCV), hepatitis B virus (HBV), and their sociodemographic features. SUBJECTS AND METHODS: A survey, including patients ' sociodemographic features, was applied to patients by physicians in face to face interviews. Medical records regarding their serologic data were recorded from haemodialysis centres. Nasal swab samples of 2 cm depth from both nostrils of patients were obtained for nasal culture. Samples were inoculated in 5% sheep blood agar and incubated in an incubator at a temperature of 37ºCfor 24 hours. The results were studied by the same microbiologist. RESULTS: A total of 185 patients were enrolled in the study. According to culture results, 14.1% of patients (n = 26) had methicillin sensitive Staphylococcus aureus (MSSA) and 1.1% (n = 2) had methicillin resistant Staphylococcus aureus (MRSA). Status of viral hepatitis was 3.8% (n = 8), 10.8% (n = 20) for HBV and HCV, respectively. Forty per cent (n = 8) of patients with HBV (+) had MSSA carrier status. Statistically significant positive correlation between MSSA and HCV carrier was detected (r = 0.325, p = 0.001) but not between HBV carrier and MSSA (p = 0.255). CONCLUSION: In the present study, significant positivity was detected between MSSA carrier status and HCV in patients on haemodialysis and who have lived together with < 2 family members at home. Particularly, statistically significant correlation between HCV (+) and MSSA carrier was observed.

OBJETIVO: Estudiar la correlación entre el portador del Estafilococo dorado (Staphylococcus aureus) nasal en pacientes de hemodiálisis infectados por el virus de la hepatitis C (VHC), el virus de la hepatitis B (VHB), y sus características sociodemográficas. SUJETOS Y MÉTODOS: Una encuesta que incluía características sociodemográficas de los pacientes fue aplicada a pacientes por médicos en entrevistas cara a cara. Historias clínicas contentivas de sus datos serológicos, fueron registradas a partir de los centros de hemodiálisis. Muestras defrotis nasales de 2 cm de profundidad de ambas fosas nasales, fueron obtenidas para un cultivo nasal. Se inocularon muestras en agar de sangre de oveja al 5%, e incubadas en una incubadora a una temperatura de 37ºC por 24 horas. Los resultados fueron examinados por el mismo microbiólogo. RESULTADOS: Un total de 185 pacientes fueron enrolados en el estudio. Según los resultados del cultivo, 14.1% pacientes (n = 26) tenían estafilococo dorado sensible a la meticilina (MSSA) y 1.1% (n = 2) tenían estafilococo dorado resistente a la meticilina (MRSA). El estatus de las hepatitis virales fue 3.8% (n = 8), y 10.8% (n = 20) para HVB y HVC respectivamente. Cuarentapor ciento (n = 8) de los pacientes con HVB (+) eran portadores del MSSA. Estadísticamente, se detectó una correlación positiva significativa (r = 0.325, p = 0.001), entre MSSA y el portador de VHC, no así entre el portador del VHByMSSA (p = 0.255). CONCLUSIÓN: En el estudio presente, se detectó una positividad significativa entre el estatus de; portador de MSSA y los pacientes de VHC en hemodiálisis, que vivían junto con [= dos o menos de dos] miembros de la familia en casa. En particular, se observó una correlación estadísticamente significativa entre HCV (+) y el portador MSSA.

Hepatitis viral C / Hepatitis C virus infection

El virus de la hepatitis C se trasmite por contacto directo con la sangre de la persona infectada. La mayoría de los pacientes no presenta síntomas en la fase aguda o crónica de la hepatitis. Dos a tres décadas después, algunos pacientes progresan a la cirrosis compensada, que también es asintomática. En un examen de sangre, los anticuerpos se presentan como una sorpresa, porque no se les relaciona con un episodio de contagio. Un embarazo ocasiona la posibilidad de efectos negativos de la infección en la madre o el niño. El tratamiento actual no ofrece la certeza de cura, dependiendo del genotipo viral, y presenta efectos adversos que pueden ser severos. La cirrosis descompensada causa la mayoría de muertes relacionadas con esta infección; algunos de estos pacientes desarrollan carcinoma hepatocelular. La reproducción viral causa partículas virales diferentes del virus original, característica que ha impedido el desarrollo de una vacuna. Actualmente, la prevención consiste en evitar el contacto con sangre infectada. Este artículo revisa la infección con el virus de la hepatitis C, incluyendo los últimos progresos en tratamiento. Es necesario educar a la comunidad acerca de los efectos de este virus en la salud pública.

Hepatitis C virus is transmitted by direct contract with blood of an infected person. Most patients do not present symptoms during the acute or chronic phases. After two or three decades some patients progress to compensated cirrhosis, still asymptomatic. Antibodies in a blood test often come as a surprise because there is no association with the episode of contagion. Pregnancy brings the possibility of adverse effects to the mother or child. Current therapy does offer certainty of cure, depending on the viral genotype, and provokes adverse effects that might be severe. Decompensated cirrhosis causes most of the deaths associated with this infection; few patients develop hepatocellular carcinoma. Viral reproduction causes viral particles different from the original, characteristic that has prevented the development of vaccines. Current prevention consists in avoiding contact with infected blood. This article reviews infection with hepatitis C virus including the most recent progress in treatment. There is need to educate the general public about the effects of this virus on public health.

Correlation of hepatitis C and prostate cancer, inverse correlation of basal cell hyperplasia or prostatitis and epidemic syphilis of unknown duration

PURPOSE: The accuracy of prostate specific antigen (PSA) to detect prostate cancer has not yet been determined. Autopsy evidence suggests one-third of men have evidence of prostate cancer. Correlation between prostate cancer and sexually transmitted infection is indeterminate. MATERIALS AND METHODS: A retrospective database was created of all men who underwent transrectal ultrasound guided prostate biopsy over 3 years. Men were 49 percent African or African Caribbean, and 51 percent Central or South American. Information about prostate specific antigen, cholesterol, hepatitis A, B and C, human immunodeficiency virus, syphilis, tuberculin skin testing and histology were collected. RESULTS: Hepatitis C antibody detection correlated with prostate cancer OR 11.2 (95 percent CI 3.0 to 72.4). The odds of prostate cancer increased annually (p = 0.0003). However, no correlation was found between prostate cancer and the following: PSA, biopsy date, repeat biopsy, more than 12 cores at biopsy, total cholesterol, high density lipoprotein, triglycerides, low density lipoprotein, risk measure reported with free and total PSA, hepatitis B surface antibody, high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. Histologic prostatitis and basal cell hyperplasia were inversely correlated with prostate cancer. Syphilis of unknown duration occurred in 17 percent of men with indeterminate correlation to prostate cancer. CONCLUSION: In inner city men of African and African-Caribbean, or Central and South American descent, prostate specific antigen levels did not correlate with prostate cancer. Hepatitis C antibody detection correlates significantly with prostate cancer. One prostate biopsy is sufficient to diagnose statistically significant prostate cancer. Histologic prostatitis and basal cell hyperplasia decrease odds of prostate cancer. Atypical small acinar proliferation may not correlate to prostate cancer and is pending further investigation. Men should be screened for epidemic syphilis of unknown duration.

¿Qué sabemos de hepatitis en Venezuela? / What is known about hepatitis in Venezuela?

Cada vez es más reconocido el problema de salud pública que representa la Hepatitis Viral Crónica B y C en todo el mundo, no escapando nuestro país a ésta situación. Ambas pueden conducir a largo plazo a cirrosis hepática y aumentar el riesgo de cáncer de hígado. Dado que las hepatitis virales son patologías de origen infecto contagioso, la Sociedad Venezolana de Gastroenterología, llevó a cabo una encuesta a nivel nacional con el objeto de conocer la información que se maneja en la comunidad sobre éstas enfermedades. Para ello se entrevistaron 1.109 personas, de todos los estratos sociales, 581 de sexo femenino y 528 masculinos, con edades comprendidas entre 18 y 70 años en 8 regiones del país. El 51% de la población encuestada reconoce que tiene poca información sobre la enfermedad. El 57.36% de los encuestados no conocía las diferencias entre los distintos tipos de hepatitis. Más del 80% de las personas desconocían como se adquiere la Hepatitis B y la hepatitis C y casi el 60% de la población no sabe cómo prevenirlas. Al preguntar si tomaban algunas medidas para evitar la hepatitis el 80% de la población NO lo hace. Del 20 % que toma alguna previsión sólo el 36% se vacuna. Cuando se interrogó sobre conocimiento del tratamiento, el 67.09% no sabía que se utiliza para ello. El 24.71% de la población encuestada refirió haberse realizado la prueba diagnóstica. En vista de los resultados recogidos es necesario incrementar la educación de las comunidades en relación a todo lo relacionado con la hepatitis viral...

It is increasingly recognized the worldwide public health problem that represents the Chronic Viral Hepatitis B and C; not escaping our country to this situation. Both can lead, in long-term, to liver cirrhosis and increase the risk of liver cancer. Given that viral hepatitis is an infectiouscontagious disease, the Venezuelan Society of Gastroenterology conducted a nationwide survey in order to know the information that communities have about these diseases. The survey was made to 1109 persons, of all social strata, having 581 female and 528 male, aged between 18 and 70 years in 8 regions of the country. 51% of the population surveyed acknowledged having little information about the disease. 57.36% of respondents did not know the differences between different types of hepatitis. Over 80% of people were unaware of how to get the Hepatitis B and Hepatitis C and nearly 60% of the population does not know how to prevent them. When they were asked if they took some measures to prevent hepatitis, 80% of the population answered they did not. Of the 20% that took some sort of provision only 36% were vaccinated. When they were questioned about knowing any treatment, 67.09% did not know what was used to attack hepatitis. 24.71% of the surveyed population said that they had taken a diagnostic test. In view of the results is necessary to increase the education of communities in everything related to viral hepatitis...

Epidemiology of HIV/HCV coinfection in patients cared for at the Tropical Medicine Foundation of Amazonas

The association of HIV infection and hepatitis C virus (HCV) infection often occurs because both viruses share the same transmission routes, increasing the possibility of HIV/HCV coinfection. World prevalence greater than 30 percent of coinfected cases is estimated, and it can reach 90 percent depending on the transmission route. With the aim of determining the frequency and profile of HIV/HCV coinfected patients, a descriptive analysis was carried out with patients with HIV/AIDS whose serology was positive for hepatitis C virus (HCV), cared for at the Fundação de Medicina Tropical do Amazonas from 2000 to 2007. In the present study, of the 2,653 AIDS cases notified in SINAN, 1,582 patients underwent serology test for hepatitis C, and a frequency of 4.42 percent (n = 70) of HIV/HCV coinfected patients was identified in the period studied. The most frequent infection route was sexual transmission (84.3 percent), 68.6 percent among heterosexual individuals. Most patients were males (72.9 percent), aged between 25 and 40 years (60.1 percent), of low income (50 percent earning up to one minimum wage), and low educational level (80 percent had completed only middle school). A high percentage of deaths were observed during the study (34.3 percent). The results indicate a low seroprevalence of HIV/HCV coinfection in this population, in which sexual transmission, characterized by sexual promiscuity among heterosexual individuals, is the major transmission route of the virus rather than the use of injection drugs, as shown in world statistics.

Alterações dermatológicas na hepatite C / Dermatological alterations in the hepatitis C

JUSTIFICATIVA E OBJETIVOS: A infecção pelo vírusda hepatite C (VHC) está associada a um amplo espectro de manifestações clínicas: hepáticas, sistêmicas e cutâneas. O objetivo deste estudo foi destacar as principais manifestações cutâneas presentes na hepatite C, pois estas podem representar um sinal precoce da instalação da doença. CONTEÚDO: A hepatite C é uma doença causada pelo VHC, que é transmitido por via sanguínea. Esta é uma importante causa de doença hepática crônica e cirrose hepática. As manifestações cutâneas são muitas vezes os primeiros sinais da infecção pelo VHC. Os médicos devem estar atentos a estas manifestações, pois o diagnóstico precoce é importante para o sucesso terapêutico. Deve-se suspeitar de contaminação pelo VHC em pacientes que apresentem: vasculite leucocitoclástica (púrpura palpável), crioglobulinemia, livedo reticular, líquen plano, síndrome de Sjõgren, prurido inespecífico, porfiria cutânea tarda, poliartrite nodosa e urticária crônica. Nestes casos deve-se solicitar a pesquisa do VHC por Elisa. Em pacientes que vão iniciar terapia com metotrexato e com fármacos potencialmente hepatotóxicos, a pesquisa do vírus também deve ser efetivada. CONCLUSÃO: Podendo ser as lesões cutâneas uma das primeiras manifestações da hepatite C, faz-se necessário por parte do corpo médico, treinamento no reconhecimento das lesões elementares em Dermatologia para que seja aventada a hipótese de coinfecção entre o VHC e doenças dermatológicas.

Hepatitis C virus and human T-lymphotropic virus coinfection: epidemiological, clinical, laboratory and histopathological features / Coinfecção vírus da hepatite C-vírus linfotrópico de células T humanas: aspectos epidemiológicos, clínicos, laboratoriais e histopatológicos

Twenty-four hepatitis C virus patients coinfected with human T-lymphotropic virus type 1 were compared with six coinfected with HTLV-2 and 55 with HCV alone, regarding clinical, epidemiological, laboratory and histopathological data. Fischer's discriminant analysis was applied to define functions capable of differentiating between the study groups (HCV, HCV/HTLV-1 and HCV/HTLV-2). The discriminant accuracy was evaluated by cross-validation. Alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with intravenous drug users were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported abdominal pain or a sexual partner with hepatitis. Coinfected patients presented higher platelet counts, but aminotransferase and gamma-glutamyl transpeptidase levels were higher among HCV-infected subjects. No significant difference between the groups was seen regarding liver histopathological findings. Through discriminant analysis, classification functions were defined, including sex, age group, intravenous drug use and sexual partner with hepatitis. Cross-validation revealed high discriminant accuracy for the HCV group.

Compararam-se 24 pacientes coinfectados pelos vírus da hepatite C/vírus linfotrópico de células T humanas do tipo 1 com 6 coinfectados por VHC/HTLV-2 e 55 infectados pelo VHC, no tocante a dados clínico-epidemiológicos, laboratoriais e histopatológicos. A análise discriminante de Fischer foi utilizada para definir funções capazes de diferenciar os grupos de estudo (VHC, VHC/HTLV-1 e VHC/HTLV-2). A acurácia discriminatória foi avaliada pelo por validação cruzada. O uso de álcool, drogas endovenosas, cocaína inalatória e a parceria sexual com UDEV foram mais freqüentes no grupo VHC/HTLV-2, enquanto queixa de dor abdominal e parceiro sexual com hepatite predominaram no grupo VHC. Os coinfectados apresentaram número maior de plaquetas, enquanto as aminotransferases e a gamaglutamiltranspeptidase foram mais altas no grupo VHC. Não houve diferença entre os grupos à análise histopatológica do fígado. Por análise discriminante definiram-se funções classificatórias, incluindo as variáveis sexo, faixa etária, uso de drogas endovenosas e parceiro sexual com hepatite, com acurácia discriminante alta para o grupo VHC.