Chronic hepatitis C infection: An independent risk factor for subclinical atheromatosis. / Infección crónica por el virus de la hepatitis C: un factor de riesgo independiente para la ateromatosis subclínica.

BACKGROUND: The association between subclinical atheromatosis and chronic hepatitis C virus (HCV) infection is unknown but is relevant now that antivirals are improving the survival of patients with the infection. OBJECTIVES: To determine whether HCV is an independent risk factor for subclinical atheromatosis and to analyse the changes in lipid profiles according to viral RNA levels and hepatic fibrosis. PATIENTS AND METHODS: We conducted an observational, cross-sectional study that included 102 HCV-positive patients and 102 HCV-negative patients with parity in terms of sex and age, with no history of cardiovascular or kidney disease or diabetes. Atheromatosis (the presence of atheromatous plaques) and the carotid intima-media thickness (CIMT) were assessed using ultrasonography of the carotid and femoral arteries. RESULTS: There was a greater presence of atheromatosis in any vascular territory in HCV-positive patients than in the patients without infection (58.8% vs. 28.4%, p<.0001). In the multivariate analysis, the factors significantly associated with atheromatosis included HCV infection (OR, 14.37 [5.5-37.3]; p<.001), age (OR, 1.12 [1.1-1.2]; p<.001), male sex (OR, 4.32 [1.9-9.5]; p<.001) and the triglyceride/HDL cholesterol coefficient (TG/HDL-indirect indicator of insulin resistance) (OR, 1.34 [1.1-1.6]; p=.007). The HCV-positive patients with atheromatous plaques had a higher TG/HDL coefficient but no significant differences in terms of the viral load or degree of hepatic fibrosis and with a 'low risk' lipid profile. CONCLUSIONS: HCV infection is an independent risk factor for subclinical atheromatosis. Systemic arterial ultrasonography for this population improves the cardiovascular risk assessment beyond lipid profile abnormalities and the risk calculation using SCORE tables.

A pilot experience launching a national dose protocol for vascular and interventional radiology.

The design of a national dose protocol for interventional radiology has been one of the tasks during the European SENTINEL Coordination Action. The present paper describes the pilot experience carried out in cooperation with the Spanish Society on Vascular and Interventional Radiology (SERVEI). A prospective sample of procedures was initially agreed. A common quality control of the X-ray systems was carried out, including calibration of the air kerma area product (KAP) meters. Occupational doses of the radiologists involved in the survey were also included in the survey. A total of 10 Spanish hospitals with interventional X-ray units were involved. Six hundred and sixty-four patient dose data were collected from 397 diagnostic and 267 therapeutic procedures. Occupational doses were evaluated in a sample of 635 values. The obtained KAP median/mean values (Gy.cm2) for the gathered procedures were: biliary drainage (30.6/68.9), fistulography (4.5/9.8), lower limb arteriography (52.2/60.7), hepatic chemoembolisation (175.8/218.3), iliac stent (45.9/73.2) and renal arteriography (39.1/59.8). Occupational doses (mean monthly values, in mSv) were 1.9 (over apron); 0.3 (under apron) and 4.5 (on hands). With this National experience, a protocol was agreed among the SENTINEL partners to conduct future similar surveys in other European countries.

Seroprevalence of bactericidal antibodies against serogroup B and C Meningococci in a University Hospital.

Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990's. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro's outbreak that occurred in the 1990's. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.

Seroprevalence of bactericidal antibodies against serogroup B and C Meningococci in a University Hospital

Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990’s. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro’s outbreak that occurred in the 1990’s. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.

Importance of dose settings in the x-ray systems used for interventional radiology: a national survey.

The purpose of this work was to investigate the differences in dose settings among the X-ray units involved in a national survey of patient doses in interventional radiology (IR). The survey was promoted by the National Society of IR and involved 10 centers. As part of the agreed quality control for the survey, entrance doses were measured in a 20-cm-thick acrylic phantom simulating a medium-sized patient. A standard digital subtraction angiography (DSA) imaging protocol for the abdomen was used at the different centers. The center of the phantom was placed at the isocenter of the C-arm system during the measurements to simulate clinical conditions. Units with image intensifiers and flat detectors were involved in the survey. Entrance doses for low, medium, and high fluoroscopy modes and DSA acquisitions were measured for a field of view of 20 cm (or closest). A widespread range of entrance dose values was obtained: 4.5-18.6, 9.2-28.4, and 15.4-51.5 mGy/min in low, medium, and high fluoroscopy mode, respectively, and 0.7-5.0 mGy/DSA image. The ratios between the maximum and the minimum values measured (3-4 for fluoroscopy and 7 for DSA) suggest an important margin for optimization. The calibration factor for the dose-area product meter was also included in the survey and resulted in a mean value of 0.73, with a standard deviation of 0.07. It seems clear that the dose setting for the X-ray systems used in IR requires better criteria and approaches.

Infección crónica por el virus de la hepatitis C: un factor de riesgo independiente para la ateromatosis subclínica / Chronic hepatitis C infection: an independent risk factor for subclinical atheromatosis

Introducción: Se desconoce la asociación entre ateromatosis subclínica e infección crónica por el virus de la hepatitis C (VHC), relevante ahora que los antivirales mejoran la supervivencia en los pacientes infectados. Objetivos: Conocer si el VHC es factor de riesgo independiente de ateromatosis subclínica y analizar las modificaciones del perfil lipídico según niveles de ARN viral y fibrosis hepática. Pacientes y métodos: Estudio observacional y transversal; incluye 102 pacientes VHC positivos y 102 sujetos VHC negativos con paridad de sexo y edad, sin antecedentes de enfermedad cardiovascular, renal ni diabetes. La ateromatosis (presencia de placas de ateroma) y el grosor íntima-media carotídeo (GIMc) se evaluó mediante ecografía de arterias carótidas y femorales. Resultados: La presencia de ateromatosis en cualquier territorio vascular fue mayor en pacientes VHC que en sujetos no infectados (58,8% frente a 28,4%, p<0,001). En el análisis multivariante, los factores significativamente asociados con ateromatosis incluyeron infección por VHC (OR=14,37 [5,5-37,3]; p<0,001), edad (OR=1,12 [1,1-1,2]; p<0,001), sexo masculino (OR=4,32 [1,9-9,5]; p<0,001) y el coeficiente triglicéridos/colesterol HDL (TG/HDL-indicador indirecto de insulinorresistencia) (OR=1,34 [1,1-1,6]; p=0,007). Los pacientes VHC con placas de ateroma presentaban mayor coeficiente TG/HDL, sin diferencias significativas en cuanto a la carga viral ni grado de fibrosis hepática con un perfil lipídico de «bajo riesgo». Conclusiones: La infección VHC es factor de riesgo independiente de ateromatosis subclínica. La ecografía arterial sistémica en esta población mejora la evaluación del riesgo cardiovascular más allá de las alteraciones del perfil lipídico y del cálculo de riesgo por tablas SCORE

Background: The association between subclinical atheromatosis and chronic hepatitis C virus (HCV) infection is unknown but is relevant now that antivirals are improving the survival of patients with the infection. Objectives: To determine whether HCV is an independent risk factor for subclinical atheromatosis and to analyse the changes in lipid profiles according to viral RNA levels and hepatic fibrosis. Patients and methods: We conducted an observational, cross-sectional study that included 102 HCV-positive patients and 102 HCV-negative patients with parity in terms of sex and age, with no history of cardiovascular or kidney disease or diabetes. Atheromatosis (the presence of atheromatous plaques) and the carotid intima-media thickness (CIMT) were assessed using ultrasonography of the carotid and femoral arteries. Results: There was a greater presence of atheromatosis in any vascular territory in HCV-positive patients than in the patients without infection (58.8% vs. 28.4%, p<.0001). In the multivariate analysis, the factors significantly associated with atheromatosis included HCV infection (OR, 14.37 [5.5-37.3]; p<.001), age (OR, 1.12 [1.1-1.2]; p<.001), male sex (OR, 4.32 [1.9-9.5]; p<.001) and the triglyceride/HDL cholesterol coefficient (TG/HDL-indirect indicator of insulin resistance) (OR, 1.34 [1.1-1.6]; p=.007). The HCV-positive patients with atheromatous plaques had a higher TG/HDL coefficient but no significant differences in terms of the viral load or degree of hepatic fibrosis and with a 'low risk' lipid profile. Conclusions: HCV infection is an independent risk factor for subclinical atheromatosis. Systemic arterial ultrasonography for this population improves the cardiovascular risk assessment beyond lipid profile abnormalities and the risk calculation using SCORE tables

Estado actual del tratamiento mediantefuentes de luz intensa pulsada y láser sobrelesiones varicosas de las piernas / We review lasers and intense pulsed light systems treatments of leg's varicose lesions actually, comparing therapeutic parameters and indications due to vessels characteristics

Hacemos una revisión de los tratamientos actuales de las lesiones varicosas de las piernas con láseres y fuentes de luz intensa pulsada, comparando parámetros terapéuticos e indicaciones según las características de los vasos (AU)