Cirrosis hepática: medidas preventivas de algunas de sus complicaciones / Liver cirrhosis: some complications preventive measures

Cirrosis hepática es una enfermedad prevalente en el mundo. Su diagnóstico y tratamiento debe ser dominio de todo médico general e internista. En los últimos años han ocurrido notables avances en el diagnóstico, fisiopatología, tratamiento y en la identificación de factores pronósticos de cirrosis y de sus complicaciones mayores. Particular atención ha existido en desarrollar medidas preventivas de sus complicaciones como por ejemplo: hemorragia por várices esofágicas, peritonitis bacteriana espontánea, síndrome hepatorrenal. Estas medidas preventivas han influido de forma muy favorable en el pronóstico de los pacientes cirróticos. En este artículo se discuten las diversas estrategias preventivas que han demostrado su efectividad en cirrosis hepática

Liver cirrhosis is a prevalent disease around the world. Its diagnosis and treatment must be in the knowledge of every general physicians and internist.Over the last years, there have been notorious advances in the diagnosis, pathophysiology, treatment and the identification of prognosis factors for cirrhosis major complications.There has been particular attention to the development of preventive measures for its complications, such as variceal bleeding, spontaneous bacterial peritonitis, hepatorenal syndrome. These preventive measures have had a favorable influence on the prognosis of cirrhotic patients. This article discusses several preventive strategies that have proven its effectiveness in hepatic cirrhosis

Seguimientos de anticuerpos contra hepatitis A y E en una cohorte de niños de bajo nivel socioeconómico / Hepatitis A and E virus antibodies in Chilean children of low socioeconomic status. A one year follow-up study

Background: The seroprevalence of antibodies against hepatitis A virus (HAV) is decreasing in many Latin American countries, along with improvements in sanitary standards. However, there is no information available about low socioeconomic status (LSE) populations. Aim: To assess the evolution of hepatitis A and E virus antibodies in a cohort of LSE Chilean children. Material and methods: One hundred sixty eight children aged four years, 97 males, coming from public primary care clinics, were studied. Two blood samples were obtained with an interval of one year. Anti-HAV and anti-hepatitis E virus (HEV) antibodies, were detected by ELISA using Abbott kits. Results: Anti-HAV was positive in 19 children (11.3%). After one year of follow-up, only 10 children had sustained reactivity (52.6%). Fourteen children, initially negative, became positive during the follow up (9.4%). Antibody titers to HAV were significantly higher in samples that remained positive, compared with those that lost reactivity. Anti-HEV was found positive in two children (1.2%). One remained positive and the other became negative. Conclusions: In this cohort of LSE Chilean children, the prevalence to antibodies against HAV and HEV is low. Follow-up detected loss of reactivity to HAV in nearly one half of the children, probably related to lower antibody levels.

Hepatitis aguda por virus A, E y no A-E en adultos chilenos a fines de los años 90 / Acute hepatitis caused by virus A, E and non A-E in chilean adults

Background: Sanitary and socioeconomic changes and the identification of new causative virus, have changed the epidemiology of hepatitis in Chile. Aim: To study the natural history of acute hepatitis caused by virus A, E and non A-E in Chilean adults. Patients and methods: A special study protocol was followed for patients with a clinical picture of acute hepatitis. Anti HAV IgM, anti HBc IgM, anti HEV IgG and IgM and Anti HCV antibodies were determined by ELISA. Results: Fifty nine patients (30 male), aged 15 to 58 years old were studied. Eighty nine percent had jaundice and 50 to 70 percent had malaise and abdominal pain. Virus A was positive in 80 percent, virus E in 7 percent. In 14 percent of patients, all viral markers were negative. The evolution was typical in 78 percent, biphasic in 14 percent and cholestatic in 5 percent. One patient had a prolonged and one a fulminant course. Mean ALT was 1148 U/l and mean total bilirubin was 5.5 mg/dl. Seventy three percent of cases occurred during early winter and spring and 27 percent during summer and early autumm. Conclusions: The main etiology of acute viral hepatitis in Chile is virus A and most cases occur during the rainy season. Clinical features of hepatitis non A-E are similar to enteral transmission forms

Prevalencia de anticuerpos del virus hepatitis E en donantes de bancos de sangre y otros grupos de población en la X región, Chile / Prevalence of hepatitis E virus antibodies in blood donors and other population groups at X region, Chile

Little is known about hepatitis E virus (HEV) prevalence in South American countries. AntiHEV was studied in 1,773 subjects from 1,360 blood donors of 3 cities in Chile, 72 in health care workers, 241 inmates in state jails and in 100 Araucarian indians. Anti-HEV was detected in 109 out of 1,360 (8.0 percent) total donors (6.3 percent, 6.1 percent and 18.8 percent from the cities of Valdivia, Osorno and Puerto Montt respectively); 9 out of 72 (12.5 percent) health care workers; 18 out of 241 (7.5 percent) inmates and 17 out of 100 (17 percent) Araucarian indians. Prevalence of anti-HEV was not related to age and sex. Hepatitis E is an endemic infection in some population groups of Southern Chile, associated to environmental pollution, crowding and low socioeconomic level

Virus hepatitis C: resultados de detección en algunos grupos de riesgo en la X región de Chile / Hepatitis C virus: results on detection in some risk groups in X region of Chile

The aim of this study was to determine the prevalence of hepatitis C virus antibodies in high rosk patients coming from Valdivia, Osorno and Puerto Montt. Fiftysix patients in hemodialysis, 51 renal grafts recipients, 42 cirrhotic and 14 patients with acute non A non B hepatitis were studied. Antibodies were detected with a second generation ELISA technique and positive cases were confirmed with RIBA. All hemodialysis patients and renal grafts recipients were negative for hepatitis C virus antibodies. In one non alcoholic patient with cirrhosis, a positive ALISA was confirmed with RIBA. Six patients with acute hepatitis had a positive ALISA tests but none was confirmed with RIBA. It is concluded that the prevalence of hepatitis C virus antibodies in this region of Chile is very low

Infecciones bacterianas en la cirrosis hepática / Bacterial infections in hepatic cirrhosis

The aim of this work was to study the prevalence of bacterial infections in hospitalized patients with liver cirrhosis and to compare clinical, bacteriological and evolution features of patients with (group 1) and without bacterial infection (group 2). 132 hospitalized patients with liver cirrhosis were prospectively studied and 61 episodes of bacterial infections were diagnosed in 52 (27 spontaneous bacterial peritonitis (44.3 per cent) 16 urinary tract infections (26.2 per cent), 10 pneumonias (16.4 per cent), 3 spontaneous bacteremias (4.9 per cent) and 5 miscellaneous infections (8.2 per cent)). 26 per cent of infections were nosocomial. Child-Pugh score was 12 ñ 2 in group 1 vs 10 ñ 2 in group 2 (p=0.047). 65 per cent of identified microorganisms were gram negative and 61.5 per cent of these were E. coli. Hospital mortality of group 1 was 29 per cent and that of group 2 was 9 per cent (p=0.002). It is concluded that there is a high prevalence of bacterial infections in hospitalized cirrhotic patients, that is associated to a high mortality

El riesgo quirúrgico en la cirrosis hepática / Surgical risk in hepatic cirrhosis

Los pacientes con enfermedades hepáticas tienen un alto riesgo de presentar complicaciones y de morir, luego de la cirugía. Este riesgo está relacionado con la gravedad de la enfermedad subyacente y en la cirrosis se correlaciona con la clasificación de Child. La cirugía de urgencia y abdominal también aumenta el riesgo quirúrgico. La morbimortalidad operatoria es especialmente elevada en los pacientes con cirrosis descompensada. Por tanto, en estos pacientes la indicación de cirugía debe ser cuidadosa