Osteopenia in Puerto Ricans with Crohn's disease

BACKGROUND: Osteopenia has been reported in association to Inflammatory Bowel Disease, and in particular Crohn's disease. The use of corticosteroids, resection of the ileum, malabsorption, poor calcium intake, and the effect of inflammatory cytokines have all been considered as contributing factors. As Crohn's disease is more prevalent in young people, when peak bone mass is achieved, the presence of osteopenia is especially significant. OBJECTIVES: The aim of this study was to evaluate the bone density of patients with Crohn's disease in the University of Puerto Rico IBD Clinic; to determine the prevalence of osteopenia in these patients and to correlate bone mineral density with risk factors for osteopenia. METHODS: Sixty-six patients, 30 males and 36 females were included. After informed consent, demographic, clinical and metabolic data was obtained. Serum albumin, calcium, inorganic phosphorus and alkaline phosphatase were measured. Body mass index (BMI) was calculated. Bone density was determined by DEXA of the lumbar spine and femur and expressed as the Z score (standard deviations from normal correlated with sex and age). Severe osteopenia was a Z score > or = -2 and osteopenia was Z < or = -1.99 or > or = 1.01. Results were expressed in means. Pearson correlation coefficient was used for quantitative variables and Pearson chi-square for categorical values. RESULTS: Osteopenia was present in the hip in 69 and in the lumbar spine in 68. Most patients had received steroids; the difference between treated and not treated patients was not significant. Osteopenia did not correlate with ileal resection, gender, BMI, disease characteristics or biochemical parameters. CONCLUSIONS: Low bone density was frequent in patients with Crohn's disease, but no specific risk factors could be identified. Bone density should be determined in patients with Crohn's disease in order to institute appropriate therapeutic measures.

Chronic hepatitis C: treatment comparison between 3 and 5 million units of interferon alpha-2b

Interferon (IFN) is the only drug that has been approved by the FDA for therapy of chronic hepatitis C. However, optimal dose and duration of therapy are still controversial. This study compares the effectiveness of treatment of chronic hepatitis C patients with 3 vs. 5 million units (MU) of recombinant alpha-interferon 2-b three times per week. We also evaluated the relapse rate with a shorter 12 week-course of therapy in those patients who had normalization of aminotransferases by week 12. Seventy-five patients were randomized to receive either 3 vs. 5 MU of IFN; seventy-two completed the study. A complete response was seen in 11/35 (31 per cent) of those treated with 5 MU vs. 13/37 (35 per cent) in the 3 MU dose (p = 0.74). Patients were followed after IFN was withdrawn and only 2 had persistently normal aminotransferases. Analysis of multiple variables was done to predict response to FN and only elevations of GGT, ferritin and alkaline phosphatase were found to be predictors of a poor response. Therefore, we recommend initial therapy with 3 MU of IFN for a longer period than 12 weeks in patients who show a response.

Hepatitis C viral RNA amplification by the polymerase chain reaction allows detection of false positive HCV ELISAs among patients with non-A, non-B hepatitis

Serum from patients which tested positive for hepatitis C virus (HCV) by Enzyme Linked Immunosorbent Assay (ELISA) were analyzed for the presence of HCV RNA by nested Polymerase Chain Reaction (PCR) and for anti-HCV antibodies by Recombinant Immunoblot Assay (RIBA II). Total RNA was extracted from whole blood by a new procedure and subjected to reverse transcription of HCV RNA employing primers to the conserved 5' non-coding region of the HCV genome. PCR performed on these samples uncovered several false positive ELISAs. Reciprocal confirmation between PCR and RIBA II results was observed. These results substantiate this variation of the HCV PCR assay as a reliable alternative for routine confirmation of HCV serological tests

Hepatitis C antibody in health puertorican blood donors: prevalence, hepatic functional and histological abnormalities

The prevalence of hepatitis C antibody by ELISA I in 45797 consecutive Puertorican blood donors was 1.41 percent. 67 of these donors were fully evaluated and 31 underwent liver biopsy. Risk factors for hepatitis C were present in 71.6 percent, and 45 percent had elevated ALT. Of the 31 donors that underwent liver biopsy, 16 had elevated ALT and all had significant histologic abnormalities, while only one with normal ALT had Chronic active hepatitis. RIBA II was performed in 37 and only 20 (54 percent) were positive. Of the 17 RIBA II positive donor that underwent biopsy, 88 percent had evidence of chronic liver disease. Of 530 donors positive for hepatitis C antibody by ELISA in whom RIBA II was performed, 282 were negative, making the percentage of false positives 53.2 percent. We conclude that Puerto Rico has a high rate of hepatitis C infection, and that RIBA II positive and elevated ALT predict the presence of significant liver disease.