Hepatitis B and Celiac Disease: A Cause for Concern?

Some theories suggest that the development of the immune response to clear hepatitis B triggers the intestinal tissue damage seen in celiac disease in genetically predisposed individuals. Although the role of hepatitis B virus infection in the development of autoimmune diseases has been widely discussed in the literature, it remains a controversial topic. Our objective is to review whether there is an association between hepatitis B and celiac disease and the particularities of vaccination against hepatitis B in celiac patients.

Algunas teorías sugieren que el desarrollo de la respuesta inmunitaria para la eliminación de la hepatitis B desencadena el daño del tejido intestinal observado en la enfermedad celíaca en individuos genéticamente predispuestos. Aunque el papel de la infección por el virus de la hepatitis B en el desarrollo de enfermedades autoinmunes se ha discutido ampliamente en la literatura, sigue siendo un tema controvertido. Nuestro objetivo es revisar si existe una asociación entre la hepatitis B y la enfermedad celíaca y las particularidades de la vacunación contra la hepatitis B en pacientes celíacos.

Hepatitis aguda recurrente inducida por albendazol / Recurrent albendazole-induced acute hepatitis

Resumen El albendazol es un medicamento usado para tratar infecciones por helmintos y usualmente presenta pocos o ningún efecto secundario. A pesar de que hay un incremento transitorio de enzimas hepáticas luego de su uso, existe poca evidencia en la literatura en la que se reporte lesión hepática luego de automedicación con albendazol. En este informe, el paciente se presentó con hepatitis aguda luego de automedicarse con albendazol. El paciente cuenta además con una historia de episodios similares después de haber usado el fármaco. Se evaluada la causalidad con el método de evaluación de causalidad de Roussel Uclaf del Concejo para Organizaciones Internacionales de Ciencias Médicas, cuyo resultado fue un puntaje de 10, lo que indicó una alta probabilidad de lesión hepática inducida por albendazol al cabo de realizarse una investigación rigurosa y de excluir otras posibles causas de la condición física del paciente. En conclusión, aunque es ideal agilizar el proceso para combatir a los helmintos, es necesario intensificar la necesidad de monitorizaciones de calidad para evitar reacciones adversas como la hepatitis inducida por medicamentos. Asimismo, la automedicación de cualquier medicamento debe ser siempre evitada.

Abstract Albendazole is used to treat helminth infections and usually has minimal or no side effects. A transient increase in liver enzymes is common following its use, but little evidence of albendazole-induced liver damage has been reported in the literature. This study presents a patient who developed acute hepatitis following self-medication with albendazole. The patient also had a history of similar episodes in the past after using the drug. After a thorough investigation and exclusion of all other causes of the patient's clinical condition, the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences scale yielded a score of 10 points, indicating a high probability of albendazole-induced liver damage. In conclusion, expediting the process of combating helminths is ideal, but quality monitoring is required to avoid adverse reactions such as drug-induced hepatitis. Moreover, self-medication with any drug should always be discouraged.

Perfil microbiológico de la peritonitis bacteriana espontánea en una ciudad del sur de Brasil / Microbiological profile of spontaneous bacterial peritonitis in a Southern

Introducción: La peritonitis bacteriana espontánea (PBE) es una de las complicaciones infecciosas másfrecuentes que afectan a los pacientes con cirrosis y ascitis descompensadas, la cual presenta un alto índicede mortalidad. Objetivo: Identifi car los principales agentes causantes de la PBE en un Hospital Universitarioentre los años 2008 y 2011. Métodos: Se llevó a cabo un estudio transversal de resultados positivos decultivos de líquido ascítico. Se obtuvieron variables clínicas y de laboratorio de los registros médicos.Resultados: Se incluyeron 47 pacientes de 55,7 ± 15,5 años de edad con cultivos positivos de líquidoascítico, de los cuales 70,2% eran hombres y 53,6% presentaba cirrosis. Todos los pacientes cirróticos presentaronGASA ≥ 1,1 y conteo promedio de neutrófi los en el líquido ascítico de 3.260,8 ± 5.122,9 células. Elmicrobio encontrado más frecuentemente fue el Escherichia coli (25,5%), seguido por el Klebsiella (14,9%), elEnterococcus (8,5%) y el Streptococcus (8,5%). No se observaron diferencias signifi cativas cuando se compararonlos pacientes cirróticos con los no cirróticos respecto a la prevalencia del E. coli (19,2% vs. 33,3%;p= 0,270), Klebsiella (19,2% vs. 9,5%; p= 0,436), Enterococcus (7,7% vs. 9,5%; p= 1,000) y Streptococcus(15,4% vs. 0,0%; p= 0,117). La presencia de infección causada por dos o más microbios es más común entrelas personas sin cirrosis (11,5% vs. 38,1%; p= 0,047).Conclusión: El perfi l microbiológico de los cultivos de líquido ascítico de este hospital es similar al de otrosestudios relacionados con el PBE, con prevalencia de bacterias Gram negativas

experienced by patients with decompensated cirrhosis and ascites, has a high mortality rate. Objective:Our objective was to identify the main agents causing SBP at a University Hospital between 2008 and 2011.Methods: A cross-sectional study of positive results from ascitic fl uid cultures was carried out. Clinical andlaboratory variables were extracted from the medical records.Results: 47 patients with positive ascitic fl uid cultures were included. Average age was 55.7 years ± 15.5years, 70.2% were men, and 53.6% of patients presented cirrhosis. All cirrhotic patients presented GASA≥ 1.1 and mean neutrophil count in the ascitic fl uid of 3,260.8 ± 5,122.9 cells. The most frequent germsfound were Escherichia coli (25.5%), Klebsiella (14.9%), Enterococcus (8.5%) and Streptococcus (8.5%). Nosignifi cant differences were observed between cirrhotic and non-cirrhotic patients regarding the prevalenceof E.coli (19.2% vs. 33.3%; P=0.270), Klebsiella (19.2% vs. 9.5%; P=0,436), Enterococcus (7.7% vs. 9.5%;P=1.000) or Streptococcus (15.4% vs. 0.0%; P=0.117). The presence of infection by two or more germs wasmore common among individuals without cirrhosis (11.5% vs. 38.1%; P=0.047).Conclusion: The microbiological profi le of ascitic fl uid cultures showed a prevalence of gram-negativebacteria similar to other studies related to spontaneous bacterial peritonitis

Positive serology for viral hepatitis and donor self-exclusion in Southern Brazil

Introduction Despite the great advances in serological testing for transfusion-transmitted infections, the selection of blood donors by blood bank operators remains the only way to avoid transmission within the testing window period. Part of this selection is the self-exclusion form, on which the donors can exclude their blood from donation without any explanation. This study assessed the clinical and epidemiological characteristics related to positivity for viral hepatitis and to the use of the confidential self-exclusion (CSE) form. Methods This transversal study analyzed the data collected from blood donors' files in a hospital in Southern Brazil. Univariate and multivariate analyses identified the clinical and epidemiological variables related to positive serologies of viral hepatitis and to whether the donor was self-excluded. Results Of the 3,180 donors included in this study, 0.1% tested positive for HBsAg, 2.1% for anti-HBc, and 0.9% for anti-HCV. When the 93 donors with positive serologies for viral hepatitis were compared with those who were negative, a greater proportion of the positive serology group was found to have had a history of blood transfusions (OR=4.908; 95%CI=1.628 - 14.799; p<0.01), had repeatedly donated (OR=2.147; 95%CI=1.236 - 3.729; p<0.01), and used the CSE form for self-exclusion (OR=7.139; 95%CI=2.045 - 24.923; p<0.01). No variables were independently associated with self-exclusion. Conclusions A history of blood transfusion, repeated donations, and self-exclusion are factors that should be considered during viral hepatitis screenings in blood banks. .

Autoantibody profile in individuals with chronic hepatitis C

Introduction Autoantibodies are often produced during infection with chronic hepatitis C virus (HCV), but it remains controversial whether they influence the biochemical profile and histological features of this disease. Therefore, this current study sought to describe these autoantibodies and evaluate their impact on the clinical and histological presentation of hepatitis C. Methods This cross-sectional analytical study assessed patients with HCV (RNA+) from October 2011 to July 2012. Results This study included 66 patients, with a mean age of 53.2±10.5 years. Of these patients, 60.6% were male, and 54.3% presented with genotype 1. Non-organ-specific autoantibodies (NOSA) were detected in 24% of the patients; of these, 7.6% were anti-mitochondrial antibodies (AMA+), 26.7% were anti-smooth muscle antibodies (SMA+) and 6.8% were liver kidney microsomal type 1 antibodies (LKM1+). With respect to the thyroid autoantibodies, 7.4% were anti-peroxidase (ATPO+) antibodies, and none were anti-thyroglobulin (ATG+) antibodies. Regarding celiac disease autoantibodies, 5.8% were endomysial antibodies (EMA+), and no transglutaminase (TTG+) antibodies were detected. Cryoglobulins were found in 2.1% of patients. When NOSA+ individuals were compared to patients without the presence of NOSAs, they exhibited higher median alkaline phosphatase (0.7 vs. 0.6 xULN; p=0.041), lower median platelet counts (141,500.0 vs. 180,500.0/mm 3 ; p=0.036), lower mean prothrombin activity (72.6±11.5% vs. 82.2±16.0%; p=0.012) and an increased prevalence of significant fibrosis (E≥2) (45.5% vs. 18.2%; p=0.012). There was also a tendency for a greater proportion of NOSA+ cases to have marked periportal activity (APP≥3) (44.5% vs. 15.6%; p=0.087). Conclusions In addition to the high prevalence of autoantibodies associated with HCV infection, it was observed that NOSA ...