Shunt portosistémico, una causa poco frecuente de hepatitis colestásica en neonatología. A propósito de un caso / Portosystemic shunt, a rare cause of neonatal cholestatic hepatitis. A case report

El shunt portosistémico congénito es una anomalía vascular venosa que comunica circulación portal y sistémica, por la que se deriva el flujo sanguíneo, salteando el paso hepático. Es una entidad poco frecuente, cuya incidencia varía entre 1/30 000 y 1/50 000 recién nacidos. Puede cursar de forma asintomática o presentarse con complicaciones en la edad pediátrica o, menos frecuente, en la edad neonatal. Ante el diagnóstico, se deberá definir la necesidad de intervención quirúrgica o intravascular para el cierre. Esta decisión depende de las características anatómicas de la malformación, de las manifestaciones clínicas y complicaciones presentes. Se presenta el caso de un paciente de un mes de vida derivado a nuestro centro para estudio de hepatitis colestásica neonatal, con diagnóstico de shunt portosistémico extrahepático. Se realizó cierre intravascular de la lesión con mejoría significativa posterior.

Congenital portosystemic shunt is a venous vascular abnormality that connects portal and systemic circulation, resulting in diversion of the blood flow, bypassing the hepatic passage. It is a rare malformation; its incidence varies from 1:30 000 to 1:50 000 newborns. It may be asymptomatic or present with complications in the pediatric age or, less frequently, in the neonatal age. Upon diagnosis, the need for a surgical or an intravascular intervention for closure should be defined. This decision depends on the malformation anatomical characteristics, clinical manifestations, and complications. We present the case of a 1-month-old patient referred to our center for the study of neonatal cholestatic hepatitis, with a diagnosis of extrahepatic portosystemic shunt. Intravascular closure of the defect was performed with significant subsequent improvement.

Síndrome de Stajano, Fitz-Hugh, Curtis. Descripción de un caso clínico y puesta al día de los conocimientos / Fitz-Hugh Curtis Syndrome. Description of a clinical case and knowledge update / Síndrome de Stajano, Fitz-Hugh, Curtis. Descrição de um caso clínico e atualização do conhecimento

El síndrome de Stajano, Fitz-Hugh, Curtis es una rara presentación clínica de las infecciones genitales altas, caracterizada por dolor en hipocondrio derecho, escasa sintomatología pelviana, y adherencias hepatofrénicas en forma de "cuerdas de violín". Esta rara presentación clínica lleva a frecuentes diagnósticos tardíos o erróneos, como colecistitis, apendicitis, urolitiasis o abscesos hepatofrénicos. A propósito de un caso clínico, se realiza una revisión histórica y cronológica de los conocimientos y publicaciones que se fueron sucediendo en el tiempo, de esta presentación clínica tan particular.

The Fitz-Hugh-Curtis syndrome is a rare clinical presentation of upper genital infections, characterized by pain in the right hypochondrium, few pelvic symptoms, and "violin strings" hepatophrenic adhesions. This unusual clinical presentation leads to frequent late or erroneous diagnoses, such as cholecystitis, appendicitis, urolithiasis or hepatophrenic abscesses. Based on the clinical case presented, a historical and chronological review of knowledge and publications over time, on this particular clinical presentation was conducted.

A síndrome de Stajano, Fitz-Hugh, Curtis é uma apresentação clínica rara de infecções genitais superiores, caracterizada por dor no quadrante superior direito, poucos sintomas pélvicos e aderências hepatofrênicas em forma de "cordas de violino". Esta rara apresentaçap leva a diagnósticos tardios ou errôneos, como colecistite, apendicite, urolitíase ou abscessos hepatofrênicos. Apresenta-se um caso clínico e uma revisão histórica e cronológica do conhecimento e das publicações ocorridas ao longo do tempo, desta apresentação clínica tão particular.

The synergism of hepatitis B and aflatoxicosis in hepatocellular carcinoma development: A mini-review

Hepatocellular carcinoma (HCC) is the twelfth most common cancer and the fifth leading cause of worldwide cancer related death. Chronic hepatitis B infection, caused by the hepatitis B virus (HBV) and exposure to aflatoxins is fundamental in the formation of HCC in developing countries. This review of scientific publications aims to establish the detrimental effects of aflatoxin-contaminated foods and highlights the correlation between aflatoxin and hepatitis B viral-associated hepatocellular carcinoma. Research has shown a significant increase in the occurrence of HCC in HBV-infected individuals exposed to fungal toxins. HBV demonstrates the ability to integrate and bind to p53 protein in the host DNA and propagate hepatocyte vulnerability through carcinogenic aflatoxin B1 (AFB1) damage. Although there has been clear evidence about the synergistic interaction of exposure to AFB1 and HBV infection in the induction of HCC, other literature has shown otherwise, mainly because incomplete and vague findings and hypotheses were made in regions where AFB1 and HBV pose a public health risk. Vaccination against hepatitis B and measures such as robust food safety systems to avoid hepatotoxicity and hepatocellular carcinogenesis induced by AFB1 is the most effective methods in the prevention of HCC induced by HBV and AFB1

Les risques de contamination infectieuse des praticiens dans les cabinets dentaires de Conakry: origine, conséquence et prévention / The risks of infectious contamination of practitioners in dental practices in Conakry: origin, consequence and prevention

INTRODUCTION: La pratique de la dentisterie implique un risque d'exposition à des microorganismes responsables de nombreuses maladies telles que l'Hépatite, la COVID-19, le VIH-SIDA. OBJECTIFS: Contribuer à l'étude des risques de contamination infectieuse des praticiens. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de type descriptive d'une durée de quatre mois allant de juin à septembre 2022. RÉSULTATS: Parmi les 100 praticiens interrogés, les chirurgiens-dentistes ont été les plus représentés avec un taux de 63%. Moins de la moitié des praticiens soit 46% avaient une expérience professionnelle compris entre 5 et 10 ans. Parmi nos enquêtés, 62% connaissaient les techniques de prévention d'hygiène. 76% ont été vaccinés contre la COVID-19 et 49% ont été vaccinés contre l'Hépatite B et 65% ont affirmé avoir été piqués ou coupés par un objet souillé. CONCLUSION: Il ressort de cette étude la nécessité de sensibiliser les praticiens sur les mesures de prévention contre les infections au cabinet dentaire.

INTRODUCTION: The practice of dentistry involves a risk of exposure to microorganisms responsible for many diseases such as Hepatitis, COVID-19, HIV-AIDS. OBJECTIVE: Contribute to the study of the risks of infectious contamination of practitioners. METHODOLOGY: This was a descriptive cross-sectional study lasting four months from June to September 2022. RESULTS: Among the 100 practitioners questioned, dental surgeons were the most represented with a rate of 63%. Less than half of the practitioners, or 46%, had professional experience of between 5 and 10 years. Among our respondents, 62% knew the hygiene prevention techniques. 76% had been vaccinated against COVID-19 and 49% had been vaccinated against Hepatitis B and 65% said they had been bitten or cut by a soiled object. CONCLUSION: This study shows the need to educate practitioners on preventive measures against infections in the dental office.

Vigilância epidemiológica hospitalar de Goiás: 1ª coletânea de boletins dos núcleos hospitalares de epidemiologia / Hospital epidemiological surveillance in Goiás: 1st collection of bulletins from hospital epidemiology centers

Coletânea de 13 boletins publicados no site da Secretaria de Estado da Saúde de Goiás, que se destacaram por descrever o perfil de morbimortalidade da unidade e apresentar temas relevantes para a população do Estado de Goiás. Trata-se de um estudo descritivo, realizado com dados do período de janeiro a março de 2023, com informações provenientes das declarações de óbitos e prontuário eletrônico do paciente

Collection of 13 bulletins published on the Goiás State Department of Health website, which stood out for describing the unit's morbidity and mortality profile and presenting relevant themes for the population of the State of Goiás. This is a descriptive study, carried out with data from January to March 2023, with information from death certificates and the patient's electronic medical record

Prophylactic vaccines for hepatitis type E / 中华肝脏病杂志

Over the past few years, hepatitis type E has been increasingly recognized as an underestimated global disease burden. Populations with severe infection-related injuries or deaths include pregnant women, patients with underlying liver disease, and the elderly. Vaccines are the most effective means to prevent hepatitis type E virus (HEV) infection. However, the development of inactivated or attenuated vaccines is not feasible due to the lack of an efficient HEV cell culture system, so researchers have conducted in-depth research on recombinant vaccines. The capsid protein (pORF2), which the virion's open reading frame 2 encodes, contains almost exclusively the HEV neutralization site. Several candidate vaccines based on pORF2 have demonstrated potential for primate protection, with two being well tolerated and highly effective in preventing hepatitis type E in adults. Hecolin® (HEV 239 vaccine), the world's first hepatitis type E vaccine, was approved for marketing in China in 2012.

Laboratory diagnosis of hepatitis type E / 中华肝脏病杂志

Hepatitis type E virus (HEV) infection is a common cause of acute viral hepatitis in China, and its etiological diagnosis relies on laboratory detection. Therefore, this article introduces the HEV RNA, HEV antigen, anti-HEV IgM, and IgG detection methods and their diagnostic application value. In addition, it also discusses the current international diagnostic standard and HEV infection presentation.

Biomarcadores convencionales y emergentes en hepatitis B / Conventional and emerging biomarkers in hepatitis B

A nivel mundial, 300 millones de personas están infectadas por el virus de la hepatitis B (VHB). A pesar de que existe una vacuna que previene la infección y se dispone de tratamiento antiviral que suprime la replicación del virus, no hay cura aún. El principal problema que evita la recuperación total del paciente, incluso para aquel que recibe tratamiento, es la persistencia de dos formas del genoma viral en los hepatocitos: el ADN circular covalentemente cerrado (ADNccc), el cual se encuentra en forma de episoma y tiene la capacidad de replicarse, y las secuencias lineales subge-nómicas que se integran en el genoma humano, con potencial oncogénico. Hasta el momento se dispone de unos pocos biomarcadores para monitorear o predecir la progresión de la enfermedad y la respuesta al tratamiento. Estos biomarcadores se detectan durante la infección, y son la base para la monitorización de la enfermedad y hacer un diagnóstico de la fase clínica de la infección. Recientemente han surgido nuevos biomarcadores como el antígeno relacionado con el core del virus de la hepatitis B (HBcrAg) y la detección del ARN del VHB, que parecen correlacionarse con los niveles transcripcionales del ADNccc, además, durante el tratamiento parecen ayudar a predecir la respuesta y podrían identificar aquellos a quienes se les puede suspender la terapia sin riesgo de recaída. En esta revisión, se describe la utilidad de los principales biomarcadores convencionales en hepatitis B, y se abordan los dos biomarcadores emergentes más estudiados que prometen evaluar el curso de la infección, al igual que determinar la progresión de la enfermedad y la respuesta al tratamiento.

Globally, 300 million people are infected with hepatitis B virus (HBV). Although there is a vaccine that prevents infection and antiviral treatment that suppresses the replication of the virus, there is still no cure. The main problem that prevents the total recovery of the patient, even for those who recei-ve treatment, is the persistence of two forms of the viral genome in hepatocytes: covalently close circular DNA (cccDNA), which is in the form of an episome that has the ability to replicate, and linear subgenomic sequences that are integrated into the human genome, with oncogenic potential. Few biomarkers are currently available to monitor or predict disease progression and response to treatment. These biomarkers are detected during infection and are the basis for monitoring the di-sease and making a diagnosis of the clinical phase of the infection. New biomarkers have recently emerged, such as hepatitis B core-related antigen (HBcrAg) and HBV RNA detection, which seem to correlate with cccDNA transcriptional levels while during treatment seem to help predict response, and could identify those for whom therapy can be discontinued without risk of relapse. In this review, the usefulness of the main conventional biomarkers in hepatitis B is described, and the two most studied emerging biomarkers are mentioned, which promise to evaluate the course of the infection, as well as to determine disease progression and treatment response.

Vigilancia de Hepatitis virales y de etiología desconocida / Surveillance of viral hepatitis and unknown etiology

Se presenta brevemente la situación mundial y regional de hepatitis virales y de hepatitis de etiología desconocida, con su correspondiente análisis de los casos residentes en la Ciudad de Buenos Aires durante el período 2020-2021. Describe la cobertura de vacunación en los años 2018-2021.

Acute Hepatitis in a Pediatric Patient with COVID -19: Case Report / Hepatitis Aguda en un paciente pediátrico con COVID-19

COVID-19 typically courses with mild clinical manifestations; however, a pediatric patient might get severe sequelae and complications when there is an infection. There is no information about liver complications due to COVID-19 in children in Mexico. This case report will set a precedent about timely diagnosis for hepatitis as a complication for COVID-19 disease in young patients in Mexico. Clinical case: A 12-years-old man has intermittent generalized abdominal pain misdiagnosed and treated for irritable bowel syndrome 3 days prior. The abdominal pain stayed, and a day after the patient vomited 3 times (each one after every meal). The patient started with orangish urine, weakness, fatigue and hyporexia 1 day prior to admission. The day of the admittance, a COVID-19 RT-PCR test was performed, giving a positive result. Once he was admitted, laboratory tests were made, showing an increase of liver enzyme levels, showing liver disease as a complication for the viral infection. Conclusion: Pediatrics patients might get Hepatitis due to COVID-19. In a patient with abdominal pain or other liver disease symptoms while coursing with the virus or even after the infection, further investigation must be made.

El COVID-19 típicamente cursa con manifestaciones clínicas leves, sin embargo, un paciente pediátrico puede presentar secuelas y complicaciones graves cuando existe una infección. No hay información sobre complicaciones hepáticas por COVID-19 en niños en México. Este reporte de caso sentará un precedente sobre el diagnóstico oportuno de hepatitis como complicación de la enfermedad COVID-19 en pacientes jóvenes en México. Caso clínico: Varón de 12 años con dolor abdominal generalizado intermitente mal diagnosticado y tratado por colon irritable 3 días antes. El dolor abdominal se mantuvo, y al día siguiente el paciente vomitó 3 veces (cada una después de cada comida). El paciente comenzó con orina anaranjada, debilidad, fatiga e hiporexia 1 día antes de su ingreso. El día del ingreso se le realizó una prueba de RT-PCR de COVID-19 dando positivo. Una vez que ingresó, se realizaron exámenes de laboratorio que mostraron un aumento de los niveles de enzimas hepáticas, lo que mostró una enfermedad hepática como complicación de la infección viral. Conclusión: Los pacientes pediátricos pueden contraer hepatitis por COVID-19. En un paciente con dolor abdominal u otros síntomas de enfermedad hepática mientras cursa con el virus o incluso después de la infección, se debe realizar una investigación adicional.

Nonalcoholic steatohepatitis: An emerging cause of cirrhosis in Colombia / La esteatohepatitis no alcohólica: una causa emergente de cirrosis en Colombia

Abstract Introduction: Cirrhosis of the liver is a significant cause of morbidity and mortality in Latin America; the increased prevalence of metabolic syndrome in our population could be changing the epidemiological profile of patients with advanced chronic liver disease. Aim: To characterize a group of patients with cirrhosis of the liver at an outpatient hepatology care center in Cartagena de Indias, Colombia, and determine the contribution of nonalcoholic steatohepatitis (NASH) as an etiological factor in this population. Materials and methods: Retrospective, cross-sectional, analytical study. All patients who attended the hepatology follow-up with a diagnosis of cirrhosis of the liver were in the six-monthly follow-up protocol that included screening for hepatocellular carcinoma (HCC) and esophageal varices. Results: 346 patients were included, most were women (54.3 %). The first and second causes of cirrhosis were cryptogenic (35 %) and NASH (30.9 %), respectively, followed by viral hepatitis (17 %) and autoimmune diseases (9 %). Of these patients, 87.4 % were within categories A and B of the Child-Turcotte-Pugh score, and only 12.5 % (33 patients) were in stage C. Also, 60 % had at least one clinical decompensation, 38 % a history of variceal hemorrhage, and 4 % a diagnosis of HCC; 80.6 % of patients with NASH cirrhosis had diabetes, and 46.7 % were overweight. Conclusion: NASH cirrhosis is an emerging cause of advanced chronic liver disease in Colombia.

Resumen Introducción: la cirrosis hepática es una importante causa de morbimortalidad en América Latina; el incremento de la prevalencia del síndrome metabólico en nuestra población podría estar cambiando el perfil epidemiológico de los pacientes con enfermedad hepática crónica avanzada. Objetivos: caracterizar un grupo de pacientes con cirrosis hepática y determinar la contribución de la esteatohepatitis no alcohólica (NASH) como factor etiológico de esta población en la ciudad de Cartagena de Indias, Colombia, en un centro de atención ambulatoria de hepatología. Métodos: estudio retrospectivo, transversal, analítico. Se incluyeron todos los pacientes que acudieron al seguimiento de hepatología con diagnóstico de cirrosis hepática que se encontraban en el protocolo de seguimiento semestral que incluía el cribado de hepatocarcinoma y várices esofágicas. Resultados: se incluyeron 346 pacientes. La mayoría fueron mujeres (54,3 %). La primera y segunda causa de cirrosis fue la criptogénica (35 %) y la NASH (30,9 %), respectivamente; seguidas de las hepatitis virales (17 %) y enfermedades autoinmunes (9 %). De estos pacientes, el 87,4 % se encontraba dentro de las categorías A y B de la escala pronóstica de Child-Turcotte-Pugh, y solo el 12,5 % (33 pacientes) en estadio C. El 60 % había presentado al menos una descompensación clínica, 38 % tenía antecedentes de hemorragia por várices y 4 %, diagnóstico de hepatocarcinoma. El 80,6 % de los pacientes con cirrosis NASH era diabético y el 46,7 % tenía exceso de peso. Conclusión: La cirrosis NASH es una causa emergente de enfermedad hepática crónica avanzada en Colombia.

Comunicado de risco: hepatite aguda grave de etiologia desconhecida em crianças / Risk statement: severe acute hepatitis of unknown etiology in children

A Comunicação de risco tem como objetivo apoiar na divulgação rápida e eficaz de conhecimentos às populações, parceiros e partes intervenientes possibilitando o acesso às informações fidedignas que possam apoiar nos diálogos para tomada de medidas de proteção e controle em situações de emergência em saúde pública. Na presente versão apresentaremos a situação epidemiológica e as medidas a serem adotadas mediante o aumento de casos de hepatite aguda grave de etiologia desconhecida em crianças, em diversos países do mundo

Risk communication aims to support the rapid and effective dissemination of knowledge to populations, partners and stakeholders, enabling access to reliable information that can support dialogues for taking protection and control measures in public health emergency situations. In this version, we will present the epidemiological situation and the measures to be adopted in view of the increase in cases of severe acute hepatitis of unknown etiology in children in several countries around the world