Viral hepatitis and Treponema pallidum prevalence in persons who underwent premarital blood tests in Argentina.

The objective of this study was to estimate the prevalence of different serological markers of hepatitis A, B and C viruses and Treponema pallidum among the adult population of Argentina. To achieve this, adults who attended health services for premarital exams (which are mandatory and includes screening for syphilis) were recruited. A cross-sectional study was designed with a cluster sampling strategy. Couples who attended selected health services for premarital screening between 2013 and 2014 in Buenos Aires, Cordoba, Mendoza and Santa Fe provinces were included. A total of 3833 individuals were recruited. Anti-HAV prevalence was 63.9%, anti-HCV 0.3%, anti-HBc (without HBsAg) 1.9%, HBsAg 0.3%, and T pallidum 0.8%. Anti-HAV was higher among older participants, foreigners and those from the lower strata. HBV increased with age and was higher among foreigners and those with lower formal educational level. Anti-HCV frequency increased with age. Premarital screening of viral hepatitis could constitute an instance of diagnosis, vaccination and inclusion in care of those in need. Results from this study will allow the national hepatitis programs to design public policies in order to diminish the impact of these infections on the population.

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis and the risk of developing malignancies. A large prospective study.

BACKGROUND/AIM: primary sclerosing cholangitis (PSC) is associated with ulcerative colitis (UC) and seems to be a risk factor for colon cancer. However, taking into account that no data are available in South American population, we analyzed the prevalence of PSC in 1,333 patients with UC and the risk for developing colon cancer. MATERIAL: patients with persistent increases of alkaline phosphatase were studied by cholangiography and liver biopsy. To assess the risk of colon cancer, each patient with PSC and UC was matched with two control patients with UC without PSC of the same age, gender, extent and duration of UC. RESULTS: the whole prevalence of PSC was 2.9% (39 patients) reaching 6.2% in extensive colitis. Seven (18%) out of 39 patients with PSC developed colorectal carcinoma compared with 2 out of 78 (2.6%) in the control group (p=0.006). The cumulative risk of colorectal carcinoma was 11% and 18% after 10 and 20 years in the PSC group compared with 2% and 7% in the control group, respectively (p=0.002). CONCLUSION: this is the first prospective study performed in Latin America showing that the prevalence of PSC in patients with UC is similar to that reported in the Anglo-Saxon population. Patients with UC and PSC have a high risk of colorectal cancer.

Características clínicas y urodinámicas de las mujeres con detrusor hipoactivo / Clinical and urodynamic features of the hypoactive detrusor in women

RESUMEN Objetivo : Determinar las características clínicas y urodinámicas en mujeres con detrusor hipoactivo (DU). Material y métodos : Estudio de serie de casos de corte transversal, retrospectivo, comparativo, entre 2 grupos de pacientes femeninos con síntomas del tracto urinario inferior (STUI). Grupo 1: pacientes con DU según criterios urodinámicos, presión del del detrusor en el flujo máximo de 30 cm H20 (PdetQmax30) o eficiencia del vaciado de la vejiga (BVE) y grupo 2: pacientes sin DU. Se utilizaron medidas de tendencia central y proporciones para la descripción de los datos y pruebas paramétricas para la comparación entre grupos. Resultados : Ciento cincuenta y cinco pacientes fueron incluidos, 44 con DU (grupo 1) y 111 sin DU (grupo 2), con una media de edad de 60,8 ± 16,3 y 55,7 ± 13,4 respectivamente (p=0,0468). La nicturia (p=0,0061) y el esfuerzo miccional (p=0,000) fueron las únicas variables clínicas que presentaron una diferencia significativa en el análisis bivariado. La media de watts factor (WF) fue 3,2 ± 1,0 y 6,0 ± 2,2 en el grupo 1 y 2 respectivamente (p=0,000), mientras que el promedio de la presión isovolumétrica proyectada 1 (PIP1) fue de 28,0 ± 7,5 y 45,9 ± 11,2 respectivamente (p=0,000).En el análisis multivariado, la edad > 60 años, la nicturia, el esfuerzo miccional, tuvieron asociación significativa con DU. Conclusión : Las variables urodinámicas como PIP1, índice de contracción vesical (BCI), BVE y WF mostraron una diferencia significativa en el análisis bivariado, siendo el WF <5 y BCI <80 las que mejor identifican la presencia de DU en mujeres.

SUMMARY Objective : To describe the clinical and urodynamic features of the hypoactive detrusor (DU) in women. Methods : Cross sectional comparative study between two groups of women with lower tract urinary symptoms. Group 1 were patients with Pdet Qmax 30 or with the bladder emptying efficiency (BVE) criteria, and Group 2 were patients without DU. Central tendency measures and proportions were used to report results and parametric tests were performed to compare groups. Results : 155 patients were included, 44 with DU (Group 1) and 111 without DU (Group 2); mean age was 60,8 ± 16,3 and 55,7 ± 13,4 respectively (p=0,0468). Nocturia (p=0,0061) and micturition effort (p=0,000) were the only variables identified in the bivariate analysis who achieved statistical significance. Mean Watts factor (WF) was 3,2 ± 1,0 y 6,0 ± 2,2 in Group 1 and 2, respectively (p=0,000), while mean projected isovolumetric pressure 1 (PIP1) was 28,0 ± 7,5 and 45,9 ± 11,2, respectively (p=0,000). The multivariate analysis identified age above 60 years, nocturia and micturition effort associated with DU. Conclusion : Urodynamic parameters such as PIP1, BCI, BE and WF showed significant difference in the bivariate analysis, WF<5 and BCI <80 are best predictors of DU.

Efficacy and safety of oral naltrexone treatment for pruritus of cholestasis, a crossover, double blind, placebo-controlled study.

BACKGROUND/AIMS: To assess the efficacy and safety of naltrexone for the short and long term treatment of pruritus of cholestasis. METHODS: Twenty patients with pruritus and cholestasis were included. A baseline pruritus score was obtained over 1 week. Patients were then randomized to receive 50 mg/day of naltrexone or placebo for 2 weeks. Subsequently, a 1-week washout period ensued and patients were crossed over to the other therapy for 2 additional weeks. Pruritus was assessed daily with a visual analogue scale (VAS) from 0 to 10. Patients whose pruritus decreased >50% of basal with naltrexone received naltrexone 50 mg/day for 2 additional months. RESULTS: Mean basal VAS was similar in both groups. VAS showed greater and more significant changes with naltrexone than with placebo (P<0.0003). In nine out of 20 patients (45%) receiving naltrexone, pruritus decreased >50% compared to basal value, including five whose pruritus disappeared completely. No significant changes were observed in serum biochemistry. Most of the adverse events that occurred during the first 48 h of naltrexone therapy were consistent with opioid withdrawal-like phenomena and spontaneously disappeared 2 days after starting treatment. CONCLUSIONS: Naltrexone can be considered as an alternative option to treat pruritus of cholestasis. In the current study, side effects were transient and did not require specific medication.

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis and the risk of developing malignancies: a large prospective study / Prevalencia de colangitis esclerosante primaria en pacientes con colitis ulcerosa y el riesgo de desarrollar malignidades: un extenso estudio prospectivo

Background/aim: primary sclerosing cholangitis (PSC) is associated with ulcerative colitis (UC) and seems to be a risk factor for colon cancer. However, taking into account that no data are available in South American population, we analyzed the prevalence of PSC in 1.333 patients with UC and the risk for developing colon cancer. Material: patients with persistent increases of alkaline phosphatase were studied by cholangiography and liver biopsy. To assess the risk of colon cancer, each patient with PSC and UC was matched with two control patients with UC without PSC of the same age, gender, extent and duration of UC. Results: the whole prevalence of PSC was 2.9% (39 patients) reaching 6.2% in extensive colitis. Seven (18 %) out of 39 patients with PSC developed colorectal carcinoma compared with 2 out of 78 (2.6%) in the control group (p=0.006). The cumulative risk of colorectal carcinoma was 11% and 18% after 10 and 20 years in the PSC group compared with 2% and 7% in the control group, respectively (p=0.002). Conclusion: this is the first prospective study performed in Latin America showing that the prevalence of PSC in patients with UC is similar to that reported in the Anglo-Saxon population. Patients with UC and PSC have a high risk of colorectal cancer.

Introducción/objetivos: la colangitis esclerosante primaria (CEP) se asocia a colitis ulcerosa (CU) y parece ser un factor de riesgo para cáncer de colon. Sin embargo, teniendo en cuenta que no existen datos disponibles en población de Sudamérica, nosotros analizamos la prevalencia de CEP en 1.333 pacientes con CU y el riesgo de desarrollar cáncer de colon. Material: los pacientes con fosfatasa alcalina persistentemente elevada fueron estudiados con colangiografía y biopsia hepática. Para determinar el riesgo de cáncer de colon cada paciente con CEP y CU fueron apareados con dos pacientes controles con CU sin CEP de la misma edad, sexo, extensión y duración de la CU. Resultados: la prevalencia total de CEP fue de 2.9% (39 pacientes), alcanzando una prevalencia del 6.2% en colitis extensa. Siete (18%) de 39 pacientes con CEP desarrollaron cáncer colorectal comparado con 2 de 78 en el grupo control (p=0.006). El riesgo acumulado de cáncer colorectal fue 11 y 18% después de 10 y 20 años en el grupo con CEP comparado con 2 y 7% en el grupo control, respectivamente (p=0.002). Conclusión: este es el primer estudio prospectivo realizado en Latinoamérica mostrando que la prevalencia de CEP en pacientes con CU es similar a la reportada en población anglosajona. Los pacientes con CU y CEP tienen un alto riesgo de cáncer colorectal.