Manifestaciones gastrointestinales y hepáticas de COVID-19 en niños / Gastrointestinal and hepatic manifestations of COVID-19 in children

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.

Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.

Impacto del COVID-19 en las enfermedades hepáticas y la salud pública en el Perú / Impact of COVID-19 on liver disease and the public health in Peru

RESUMEN La pandemia declarada por la OMS originada por el COVID-19 (enfermedad infecciosa originada por el virus SARS-CoV2), desde su aparición en Wuhan, China en diciembre 2019; esta diseminándose rápidamente y de manera inesperada por todo el mundo originando millones de casos y miles de muertes, afectando más de 120 países y desde el 06 marzo 2020 al Perú, distribuyéndose rápidamente por todo el país, originando crisis y colapso del sistema de servicios de salud, especialmente de las atenciones en emergencia, hospitalizaciones y unidades de cuidados intensivos abarrotadas; sin tener aún un tratamiento específico ni la posibilidad de una vacuna a corto plazo. Se sabe actualmente que COVID-19, es una enfermedad sistémica que puede afectar múltiples órganos y tejidos y que puede ser fatal. El objetivo de esta revisión es mostrar lo descrito en los recientes estudios publicados a nivel mundial incluido nuestro país, que han reportado sus manifestaciones clínicas, esbozando posibles mecanismos de disfunción hepática relacionados a COVID-19 y sus repercusiones, en especial sobre el aparato digestivo; analizando y discutiendo el potencial impacto sobre ellas y las enfermedades del hígado, enunciando las recomendaciones de expertos y organizaciones científicas respecto a medidas de prevención, control y manejo, además de esbozar algunas estrategias de salud pública en nuestro país para la adecuada atención de estos pacientes en tiempos de crisis generalizada.

ABSTRACT The pandemic of COVID-19 (an infectious disease caused by the SARS-CoV2 virus), declared as such by the WHO, is spreading since its appearance in Wuhan (China) in December 2019, rapidly and unexpectedly throughout the world, causing millions of cases and thousands of deaths and has affected more than 120 countries. It was officially acknowledged in Peru on March 6th, 2020, and has spread rapidly throughout the country, causing first the crisis and then the collapse of the healthcare system, especially emergency care, admissions, and overcrowded intensive care units, not having a specific treatment or the foreseeable possibility of a short-term vaccine. COVID-19 is currently known for being a systemic disease that can affect multiple organs and tissues and can be fatal. The goal of this review is to present what has been described in recent studies, published worldwide and including our country, that have reported clinical manifestations, outlining possible mechanisms of liver dysfunction related to COVID-19 and its repercussions, especially on the digestive system. These studies analyze and discuss the potential impact on liver diseases, offering recommendations of experts and scientific organizations regarding prevention, control and management measures, outlining also some public health strategies in our country for the proper care of COVID-19 patients in times of widespread crisis.

Occult Hepatitis B virus infection among Egyptian hepatitis C virus seropositive and seronegative hemodialysis patients in Sohag government, Upper Egypt

Background: Hepatitis B virus [HBV] and hepatitis C virus [HCV] Infections are important and common causes of liver disease in end-stage renal failure [ESRF] in patients on haemodialysis [HD]. HBV is less endemic than HCV in Egypt [ranges from 2%-7%]. Although, the prevalence of HBV in haemodialysis patients has decreased significantly due to HBV vaccine and screening of blood donors, the immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Haemodialysis patients are more risky to develop occult hepatitis B infection [OBI] due to an increased number of blood transfusions, frequent invasive procedures, difficulty in diagnosis of occult hepatitis B infection [OBI] and immunosuppression. Occult hepatitis B infection [OBI] is defined by the presence of HBV DNA in serum or liver tissue in the absence of HBsAg

Objective: to study the prevalence of occult HBV infection in HCV-positive and HCV negative patients on regular hemodialysis from Upper Egypt

Methodology: One Hundred hemodialysis patients with negative HBsAg were included in the study. These patients were divided into two groups: HCV positive and HCV negative, based on the results of anti-HCV by ELISA and HCV-RNA by PCR. HBV-DNA was studied using the real-time PCR method in both groups

Results: HBV DNA was detected in 7 of the 100 patients [7%] and HBcAb was detected in 22 patients [22%]. There were no statistically significant differences in the age, sex, duration of hemodialysis, biochemical parameters, HBcAb, or HBV DNA between patients with and without HCV infection

Conclusion: The prevalence of occult HBV infection [OBI] among Egyptian hemodialysis patients is 7% with no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV infection and we suggest screening of all HD patients for OBI by testing anti-HBc and HBV DNA

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study / Avaliação das alterações clínicas e hepáticas em pacientes adultos com dengue: estudo prospectivo em um período de dois meses

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

INTRODUÇÃO: Analisar prospectivamente a disfunção hepática e a evolução dos sinais e sintomas em pacientes adultos com dengue durante um período de dois meses. MÉTODOS: Realizamos um estudo prospectivo em Campos dos Goytacazes, Rio de Janeiro, Brasil, de janeiro a julho de 2008. Foi avaliada a evolução das manifestações clínicas e laboratoriais em 90 pacientes adultos com dengue, em um período de dois meses. Vinte controles foram arrolados para análise da função hepática. Em ambos os grupos foram realizadas coletas de dados e sangue nos primeiros cinco dias da doença, e aos 8, 15, 30 e 60 dias após o início da doença. Foram excluídos pacientes com hepatite B, hepatite C, gestantes e aqueles sabidamente soropositivos para HIV. RESULTADOS: No final do segundo mês do início da dengue, 33,3% (30/90) dos pacientes apresentaram persistência de pelo menos um sinal ou sintoma. Estavam presentes no final do segundo mês 57,7% (15/26) dos sinais ou sintomas. Os maiores percentuais de persistência foram: artralgia, adinamia, fraqueza, fadiga, anorexia, alteração do paladar e queda de cabelo. A infecção prévia pelo vírus da dengue (DENV) não predispôs a uma maior duração dos sintomas. Da função hepática, observamos alterações relevantes somente nos níveis das transaminases, que em alguns casos permaneceram elevados até o final do segundo mês. Os níveis de ALT ultrapassaram os de AST na convalescença. Homens apresentaram níveis mais elevados de transaminases quando comparados aos de mulheres. CONCLUSÕES: Dengue apresenta grande número de sintomas e transaminases elevadas no final do segundo mês de doença.

Clinical and laboratory findings in patients with dengue associated with hepatopathy / Achados clínicos e laboratoriais em pacientes com dengue associada à hepatopatia

INTRODUCTION: Hepatic disorders caused by dengue infection may progress to severe manifestations, including mortality and morbidity. Cytokines are involved in it, such as the migration inhibitory factor of macrophages (MIF), tumor necrosis factor (TNF), natural killer cells (NK), B lymphocytes, and macrophages. METHODS: This study was carried out from January to April 2007 at a public hospital from the Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Sixty-eight patients were studied concerning hepatic alterations, with 56 reported having classic dengue, 6 with hemorrhagic dengue grade I, and 6 with hemorrhagic dengue grade II. RESULTS: Among the 56 with classic dengue, 83.3 percent had aspartate aminotransferase (AST) alterations, and 69.6 percent had altered alanine aminotransferase (ALT). For those with hemorrhagic dengue grade I, 100 percent had AST alterations, and 83.3 percent had altered ALT. All the patients with hemorrhagic dengue grade II had AST and ALT alterations. AST variations reached 22.0 and 907.0, with an average value of 164.6. For ALT, we found variations between 25.0 and 867.0, with an average value of 166.07. There had been statistical significance between dengue clinical shapes and hepatic function markers. CONCLUSIONS: We conclude that the infection was predominant in adults, females, and in those with low income and education. The liver enzymes were of larger amount in hemorrhagic dengue, but there was weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, severe pain behind the eyes, and rashes.

INTRODUÇÃO: Afecções hepáticas causadas pela infecção da dengue podem evoluir para quadro grave, incluindo mortalidade e morbidade. O mecanismo de lesão do fígado está relacionado com a exacerbação da resposta imune. As citocinas estão envolvidas nele como fator inibidor da migração de macrófagos (MIF), fator de necrose tumoral (TNF), células natural killer (NK), B linfócitos e macrófagos. MÉTODOS: Este estudo foi realizado em um hospital público da Universidade Federal do Mato Grosso do Sul. As alterações hepáticas pelo dengue podem evoluir com quadros graves e potencialmente letais. Foram avaliados exames de 68 pacientes atendidos e confirmados com dengue, onde 56 foram classificados como dengue clássico, seis, como dengue hemorrágico grau I e seis como dengue hemorrágico grau II. RESULTADOS: Do dengue clássico, 83,3 por cento tiveram alterações de aspartato aminotransferase (AST) e 69,6 por cento alterações para alanino aminotransferase (ALT). No dengue hemorrágico grau I, AST elevou-se 100 por cento e para ALT 83,3 por cento. No dengue hemorrágico grau II observou-se 100 por cento de alterações tanto para AST, quanto para ALT. A variação de AST ficou entre 22,0 e 907,0 com média de 164,6. A alanino aminotransferase variou entre 25,0 e 867,0 com média de 166,07. Houve significância entre formas clínicas do dengue e marcadores de função hepática. CONCLUSÕES: Conclui-se que a infecção predominou em adultos do sexo feminino, de baixa renda e escolaridade. As enzimas hepáticas elevam-se mais no dengue hemorrágico, fraca evidência estatística entre as manifestações clínicas e as transaminases. Os mais prevalentes sinais/sintomas clínicos foram febre, cefaléia, mialgia, artralgia, fraqueza, dor retrorbitária e exantema.

Prevalence of hepatitis-C virus infection in Khairpurnathan Shah and Shahdakot: a city based screening program

The world health Organization estimates that approximately 3% of the world population is infected with hepatitis-C virus [HCV] and there are more than 170 million individuals with chronic HCV infection who are at risk of developing liver cirrhosis, decompensated liver disease and hepatocellular carcinoma while in Pakistan according to a safe estimate, approximately 10 million people are infected with HCV. To observe the prevalence of HCV infection in our remote areas and to find out the possible causes for the spread of HCV infection, among the individual of Khairpur Nathan Shah and Shahdadkot. One day city based HCV screening program was conducted in the two cities i.e. Khairpur Nathan Shah and Shahdadkot. Cable and papers were used to invite subjects to come in for free HCV screening. The over all seropositivity among 406 subjects was 30.29%. The prevalence of HCV infection was higher in males [76.1% as compared to females [23.9%] and it was highest in subjects between 31-40 years of age [34.2%]. In this city based screening program, we found a high prevalence of HCV infection among the residents of Khairpur Nathan Shah and Shahdadkot. Broader based studies for HCV screening program are suggested in the remote areas of Pakistan

Frequency of hepatitis C and D super infection in patients with hepatitis B related complex liver disorders

To determine the frequency of super infection of hepatitis C and D in patients with hepatitis B related complex liver disorders and the distribution of HBV genotypes in these patients. Descriptive study. The Gastroenterology Unit of PMRC in JPMC, Karachi, from July 2006 to June 2007. All patients registered for HBV associated infections were selected. Blood was drawn from 180 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, and findings at abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma [HCC] were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum, and subjected to a nested PCR using the type specific primers for HBV genotype. Descriptive statistics were used for frequency and mean determination. The 129 patients finally selected for statistical analysis included 108 [84%] males and 21 [16%] females. The age ranged from 6- 68 years [mean=31.5 +/- 12.39 years]. There were 70 [54.2%] patients of non-cirrhotic, chronic hepatitis [CLD], 38 [29.4%] carriers, 12 [9.3%] cirrhotics and 9 [6.9%] HCC patients. Among the 129 patients, 45 [34.9%] were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers, 4 [3.1%] patients were positive for double infection with HCV including one with CLD, 2 with cirrhosis and one with HCC. Triple infection with HBV/HDV/HCV was present in 4 [3.1%] patients who had CLD. Approximately 59% [n=76] patients were not coinfected, though 9 had developed HCC. The genotype distribution of HBV was observed as D in 98 [76%] patients, A in 24 [18.6%], and AD mix in 7 [5.4%]. Genotypes B, C, E or F were not found. Accordingly, genotype D strains were the predominant strains among all categories. The frequency of super infection of hepatitis C and D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease [non-cirrhotics] and carriers. Genotype D of hepatitis B virus was found dominant in all hepatitis B related complex liver disorders

Hepatitis C virus infection in Saudi Arabian recipients of renal transplantation

Studies of recipients most of whom had been infected prior to transplantation, had yielded conflicting conclusions in regard to the clinical impact of hepatitis C virus [HCV] infection. We determined the frequency of new HCV infection and assessed its effect on patient - and graft - survival and occurrence of chronic hepatitis in renal transplant recipients. We studied 54 Saudi recipients [37 males and 17 females; mean age [SD]; 38.2 [17.1] years] they were anti-HCV negative at the time of transplantation and followed for 3 to 19 years [mean = 8.1]. The prevalence of anti-HCV at the time of censorship was compared with the rates in 99 hemodialyzed patients, 400 healthy volunteers and 113 hospitalized patients. The period prevalence of anti-HCV in recipients was 37% [20 of 54], compared to hemodialyzed patients 1%], hospital patients [1.8%] and healthy volunteers [2.3%]. [P < 0.01]. Seroconversion to anti-HCV positivity occurring from 2 to 11 years [mean =7.8] after transplantation and was not influenced by age, gender or source of donor kidney. Cumulative frequency of HBsAg was 14.8%. Graft loss occurred in 1 HCV positive recipient. Serum aminotransferase was abnormal [>2 - fold elevation] in 2 anti-HCV positive recipients transiently. No deaths occurred among the recipients. The acquisition of new HCV infections had a relatively high frequency among renal transplant recipients in the study. The course of the infection was benign in the medium term, with no discernible progression to clinically recognized chronic liver disease. Further studies are required to determine cost- benefit of antiviral therapy in such patients

Aspectos patológicos, imunológicos e propriedades moleculares do TT vírus / Pathological and immunological aspects and molecular properties of TT virus

O TT vírus (TTV) foi primeiramente descrito no Japão, em 1997, por T. Nishizawa, no soro de pacientes com hepatite, pós-transfusão, não-A-G. Tem sido intensivamente investigado, desde então, como uma possível adicão à lista dos vírus indutores de hepatite. O TTV é um vírus DNA não-envelopado, de fita simples. Uma considerável variabilidade genética tem sido demonstrada por parte do TTV, o que tem levado pesquisadores a agrupar isolados do vírus em inúmeros genótipos e subtipos. No entanto a significância clínica da infeccão por TTV permanece desconhecida. Ele é freqüentemente detectado em fluidos corporais e seu componente mais bem elucidado atualmente é o genoma. Conhecimentos relacionados ao TTV têm aumentado constantemente, porém vários aspectos fundamentais permanecem obscuros. Esta revisão apresenta algumas das propriedades moleculares do TT vírus.

Programa de hepatopatias do Hospital da Fundação Santa Casa de Misericórdia do Pará: infra-estrutura e epidemiologia clínica em 10 anos de atendimento / The liver diseases program of the Hospital Santa Casa de Misericórdia do Pará: infrastructure and clinical epidemiology in 10 years of attendance

O Programa de Hepatopatias do Hospital da Fundação Santa Casa de Misericórdia do Pará surgiu pela necessidade de prestar assistência a hepatopatas na região amazônica priorizando assistência qualificada, identificação das etiologias, seguimento clínico, e tratamento direcionado. Este trabalho visa descrever dados relativos à epidemiologia clínica, fatores etiológicos e análise histopatológica. Dos 1469 pacientes avaliados, através de exames clínicos, laboratoriais, endoscópicos e de imagem e/ou histopatológico, foram considerados hepatopatas crônicos 935 (63,6%). Nesta casuística, a média de idade foi 50 anos, 666 (71,2%) do sexo masculino e maior procedência de Belém. Os agentes etiológicos mais prevalentes foram alcoolismo (53,7%) e hepatites virais (39,1%). Biópsia hepática realizada em 403/935 (43,1%), demonstrou hepatite crônica (34%) e cirrose (34%) na maioria das amostras. Conclui-se, portanto, que a doença hepática crônica na região é mais prevalente no sexo masculino, sendo o alcoolismo a principal etiologia e mais da metade dos casos se encontravam em fase avançada no momento do diagnóstico.

The Liver Diseases Program of the Hospital Santa Casa de Misericordia do Pará was create because of the need to attend patients with liver diseases of the Amazônia area, taking as priority to attend with quality, diagnosis of aetiologies, clinical following and specific treatment. This study aim to describe dates related to epidemiology, aetiologics agents and histopathologic analisys. One thousand sixthy nine patients were evaluated through medical, laboratory, endoscopic, ultrasound or computadorized tomography and histopathologic examination. Nine hundred thirty five (63,6%) patients within 1469 patients were diagnose as chronic liver disease. The average age was 50 year, 666 (71,2%) were male, and the most patients lived in Belem, state of Pará. The aetiologic agents most prevail were alcoholism (53,7%) and viral hepatitis (39,1%). Hepatic biopsy were done in 403 (43,1%) within the 935 patients and the results showed chronic hepatitis (34%) and chirrosis (34%). In sumary the chronic liver disease in the amazon region is more prevail in male than female, the alcoholism is the principal aetiologie, and the most of these cases were diagnose in the severe phase.

Hepatitis C seropositivity among chronic liver disease patients in Hazara, Pakistan

Hepatitis C is rapidly emerging as a major health problem in developing countries including Pakistan. The present study was conducted to document the frequency of Hepatitis C seropositive individuals reporting for hepatitis testing at a referral laboratory. Serum samples were collected from 614 people [436 males and 178 females] referred for chronic liver disease from all parts of Hazara division during the period July 2000 to July 2002. Hepatitis tests were performed by DOT immuno-chromatographic method for anti HCV antibodies. A total of 251 [40.8%] sera tested positive for anti HCV antibodies, including 184 males [73.3%] and 67 females [26.7%]. Of 436 males, 184 [42.2%] tested positive, while among females, 67/178 [37.6%] tested positive; this difference is not statistically significant. However the male/female ratio referred for testing was 2.4:1. There is a high frequency of HCV seropositive individuals of both sexes among patients referred for chronic liver disease. The frequencies obtained for Hazara division compare well with figures from other parts of Pakistan as well as developing countries. The male/female ratio could simply be a reflection of more males coming for treatment and testing in our setting

Hepatitis B seropositivity among chronic liver disease patients in Hazara division Pakistan

Hepatitis B virus infection is one of the major health problems in the developing countries including Pakistan. The present study was conducted to document the frequency of Hepatitis B seropositivity in patients with chronic liver disease in the Hazara Division. Serum samples were collected form 893 patients suffering from chronic liver disease [CLD] from all parts of the Hazara Division during period July 2000 to July 2002. Hepatitis HBsAg was detected by the immunochromatographic method. A total of 271 [30.35%] tested positive for HBsAg including 199 males [73.43%] and 72 females [26.56%]. There is a high frequency of HBV seropositive individuals of both sexes among patients referred for chronic liver disease. These frequencies obtained for Hazara Division compare well with figures from other parts of Pakistan as well as developing countries

High prevalence of transfusion-transmitted virus infection in patients with chronic liver diseases in an endemic area of hepatitis B and C virus

To determine the prevalence and clinical impact of transfusion-transmitted virus [TTV] DNA in patients with chronic liver diseases in the Southeast Anatolia region of Turkey where hepatitis B and C viral infections are endemic. Subjects and Patients diagnosed with chronic liver disease by clinical, biochemical and histologic means were enrolled in the study. Serum samples of 60 patients [19 males, 41 females] with chronic liver diseases, and of 45 healthy volunteer blood donors as a control group were collected. The chronic liver disease group consisted of 11 patients with hepatitis B, 44 with hepatitis C and 5 with chronic liver disease of unknown etiology. Presence of TTV DNA was investigated by the polymerase chain reaction. Using a scoring system histological grading of inflammation and staging of fibrosis were performed only in the chronic hepatitis C group. TTV DNA was detected in 47 [78%] patients with chronic liver disease and 5 [11%] volunteers in the control group. The difference was statistically significant [p < 0.001]. Ten of the 11 [91%] patients with hepatitis B, 32 of 44 [73%] of those with hepatitis C-related chronic liver disease, and 5 of 5 [100%] of the patients with cryptogenic liver disease were positive for TTV DNA. TTV is highly prevalent in patients with chronic liver diseases in Southeast Anatolia, Turkey but no pathogenic effect attributable to TTV infection was detected

Hepatits C virus serotypes in chronic liver disease

To determine the HCV sero-types in patients with chronic liver disease, secondary to chronic hepatitis C in Northern Pakistan. Patients with clinical features of chronic liver disease, elevated ALT, positive anti-HCV, and HCV RNA positive by PCR underwent HCV sero-type determination. Out of 148 patients there are 95 [64.1%] patients who had HCV sero-type III. The second and third most common categories were untypable and HCV sero-type I. Females out numbered males. Patients with chronic liver disease due to HCV infection in this part of Pakistan had predominantly HCV sero-type III

Hepatitis C y alteraciones en la biometría hemática / Blood count changes in hepatitis C

Es bien conocido que los virus causantes de hepatitis son pantrópicos y lo mismo afectan el hígado, el intestino, el riñón y la médula ósea; inclusive, en diversas publicaciones se les señala como causante de anemia aplásica, y es relativamente común hallar alteraciones en la biometría Hématica (BH) de pacientes con hepatitis C. por ello se decidió realizar un estudio observacional, longitudinal, abierto, comparativo, retro y prospectivo con 19 pacientes portadores de hepatitis C en que se registraron al menos en dos ocasiones durante su evolución: hemoglobina, leucocitos y plaquetas, además de pruebas de funcionamiento hepático y otros estudios complementarios. A todos los parámetros se les calculó media, desviación estándar y el análisis estadístico se realizó mediante la t de Student. Los resultados muestran una disminución significativa en la cuenta plaquetaria (p=0.001) en ambas determinaciones del grupo problema cuando se compararon con el grupo control, y lo mismo con las cifras de hemoglobina a su ingreso (p= 0.02) pero no durante su evolución (p= 0.10); por lo contrario, no se detectó diferencia significativa en la cuenta leucocitaria. Solamente en seis pacientes se demostraron várices esofágicas grado III o IV y/o hiperesplenismo por lo que en los 13 restantes no hay razón alguna que explique los cambios en la BH y se concluye que sí existe una relación entre estas alteraciones y el virus de la hepatitis C

Immunopathology of liver diseases

Esta revisión resume los conocimientos actuales de la copatogénesis inmunopatológica de las principales enfermedades hepáticas, incluyendo la hepatitis viral, hepatitis autoinmune, rechazo de trasplante, reacción del huésped hacia el injerto y otras. El trabajo se refiere principalmente a las implicaciones de los datos para el diagnóstico de la práctica clínica y en menor grado a los datos de las más recientes investigaciones, por lo que está dirigido principalmente al hepatólogo y al patólogo en ejercicio. Los autores desean que la lectura de este trabajo sirva como referencia práctica para el diagnóstico diferencial de las enfermedades hepáticas cada vez más frecuentes

Dermatologic disorders associated viral hepatitis in Egypt

Subjective: Viral hepatitis can present with a wide variety of cutaneous manifestations. Of all bloodborne infections, hepatitis has the greatest chance for accidental transmission through breaks in the skin during surgical procedures, needle pricks, etc. The aim of this work is to study the cutaneous manifestations of viral hepatitis in Egypt. Also to booster the dermatologist awareness of the various associations, so that an early diagnosis of and precautions against such a serious disorder could be undertaken. Patients and Hepatitis patients were taken at random from the inpatient and outpatient clinics of the university hospitals and liver institute in Egypt. The patients had complete history taking, physical and dermatological examination. Hepatitis serology, blood chemistry for liver functions, lipids, diabetes, and kidney function, skin biopsy, bacterial and mycological culture were done for the patients as indicated. 900 hepatitis patients [520 males, 380 females] were examined. Of them, 500 had Hepatitis C virus [HCV] and 400 had Hepatitis B virus [HBV] infection. 60% were patients residing in rural regions, and 55.5% were workers and farmers infested with Bilharzia. 15% gave different histories of blood transfusion, [27.7%] I.V. drug administration specially for Bilharziasis, and 5.5% were in contact with other hepatitis patients. Skin manifestations of liver disease as a whole comprised 48.1% of the total, and 6.1% had skin manifestations of hepatitis. 80% had skin manifestations with HCV, and 20% with HBV infection. The most prevalent diseases were lichen planus, urticaria, erythema multiforme, psoriasis, leucocytoclastic vasculitis, and erythema nodosum. Viral hepatitis is a prevalent infectious disease in Egypt, the commonest types being HCV and HBV most probably as a result of repeated I.V. treatment of Bilharzial patients. Male workers outnumbered females. Skin diseases occurred more with HCV patients. Not all types of the reported skin associations were found in this study, and there has not been a previous report about the prevalence of associated skin disorders in Egypt for comparison. However, a wider scale study is required for a more precise evaluation. Dermatologists should be aware of the various cutaneous associations of such a serious disease

Seroprevalence of hepatitis B surface antigen [HBS Ag] in patients with liver disease

One hundred and eight liver dysfunction patients, either admitted as indoor patients or attending the hospital as outdoor patients were included in the present study, to investigate the prevalence of Hepatitis B surface antigen [HBsAg]. Among the studied patients 22.22% were found positive for HBsAg. Of these positive patients, five had received blood transfusion and six gave a positive history of surgery. One hundred control population was also tested for HBsAg. Out of this, 5% were found positive for HBsAg; most of them were hospital employees. Of the 24 patients found positive for HBsAg, 44% could be attributed to known sources of transmission. The remaining HBsAg positive patients, most of them males, the infection of HBV could not be attributed to any of the conventionally reported sources, who belonged to very low income group. This fact brings to mind the possibility of infection through the percutaneous route. Further studies are necessary to investigate the role of this route in the causation of HBV infection in Pakistan