Autonomic evaluation of hepatitis C virus infected patients / Avaliacao autonomica de pacientes infectados pelo virus da hepatite C

There are few studies reporting the association between hepatitis C virus (HCV) infection and disautonomia. We have evaluated the autonomic cardiovascular function in 12 patients with sensory small-fiber polyneuropathy infected by HCV. The mean age was 49±13 years old. The mean infection time was 9.6 years in six (50%) patients. Thermal and pinprick hypoesthesia was observed in distal legs in all patients. Autonomic symptoms were referred by eight (66.7%) patients. Among patients with abnormal autonomic cardiovascular test, five (41.7%) showed abnormal results in two or more tests. Valsalva maneuver was abnormal in seven (58.3%) patients. We can consider that there is an association of both parasympathetic and sympathetic efferent cardiovascular dysfunction in this group of patients.

Existem poucos estudos que relatam a associação entre infecção pelo vírus da hepatite C (HCV) e disautonomia. Avaliamos a função autonômica cardiovascular em 12 pacientes com polineuropatia de fibras finas e infectados pelo HCV. A idade média foi de 49±13 anos. O tempo de infecção média foi de 9,6 anos em seis (50%) pacientes. Hipoestesia termoalgésica foi observada nos segmentos distais das pernas em todos os pacientes. Sintomas autonômicos foram relatados por oito (66,7%) pacientes. No teste autonômico cardiovascular, cinco (41,7%) apresentaram resultados anormais em dois ou mais testes. Manobra de Valsalva foi anormal em sete (58,3%) pacientes. Podemos considerar que há comprometimento de ambas as vias parassimpática e simpática cardiovasculares eferentes nesse grupo de pacientes.

Apoptosis and progression of hepatic fibrosis in hepatitis C patients

Hepatitis C is a worldwide endemic disease, affecting roughly 200 million people. It has a variable prognosis, depending on the progression to fibrosis. During the last five years, the importance of apoptosis for the pathogenesis of various diseases, including hepatitis, has been recognized. It has been suggested that an increase in T cell-apoptosis during a hepatitis C virus infection is the cause of impaired regulation of the immune cellular response, helping to maintain infection. Thus, the interest in discovering the probable mechanisms by which the hepatitis C virus perpetuates in the liver, and to determine the conditions that predispose for progression of this disease, makes investigation of apoptosis in hepatic injury of great interest. We have made an overview of the various mechanisms by which the cell, more specifically the hepatic cell, is affected by apoptosis, and how it interacts with the hepatitis C virus and the immune system.

Hepatitis C virus infection: an enigma continues

Hepatitis C, caused by hepatitis C virus [HCV], has emerged as a major health problem not only in developing world but also in developed countries. HCV infects approximately 170 million people worldwide. HCV is the most efficiently transmitted through percutaneous exposure to blood, intravenous drug abuse, haemodialysis, nosocomial incidents [colonoscopy], inadequately sterilised medical instruments, high-risk sexual behaviour, body piercing, tattooing and vertical transmission. Most patients with acute HCV infection develop persistent infection and 75-85% patients develop chronic hepatitis. Chronic hepatitis C predisposes patients to progression to fibrosis, cirrhosis and hepatocellular carcinoma. The diagnosis of HCV infection by serological, virological, molecular tools and biopsy is essential in the management of HCV infection. Pegylated interferon a combined with ribavirin has been the mainstay of treatment of HCV infection. Awareness of health care workers and general population is important to curb this silent epidemic. This review is presented as an overview of epidemiology, virology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of HCV infection

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

Púrpura palpable asociada con hepatitis C / Papable purpura related to hepatitis C

Entre las múltiples manifestaciones clínicas extrahepáticas asociadas con la hepatitis C descritas hasta el momento se encuentran las dermatológicas, síntomas que pueden ser de gran ayuda en el diagnóstico temprano de la enfermedad y, por ende, en la disminución de su morbilidad y mortalidad. La púrpura palpable es una de ellas. A continuación describimos el caso de una mujer con cirrosis hépatica asociada con púrpura palpable y hepatitis C

Aspectos evolutivos da hepatite C pós-transfusional: revisão de 175 casos / Evolutive aspects of post-transfusion hepatitis C: review of 175 cases

O vírus da hepatite C é o principal responsável pela hepatite pós-transfusional e sua progressão para hepatite crônica, cirrose e carcinoma hepatocelular é muito comum. A fim de avaliar frequência, tempo e fatores relacionados à progressão da hepatite C, estudamos 175 pacientes com hepatite C pós-transfusional. Estes foram divididos em 2 grupos com cirrose (n = 92) e sem cirrose (n = 83). O tempo médio de desenvolvimento de cirrose foi de 11 ± 6 anos. Pacientes com cirrose eram mais velhos à época da transfusão, apresentavam maior prevalência de alcoolismo e tinham tempo de evolução mais longo. O prognóstico foi pior no grupo com cirrose com 28,4% de mortalidade e 9,1% de carcinoma hepatocelular, comparados a 5,5% e 0% no grupo sem cirrose, respectivamente. Concluímos que a hepatite C pós-transfusional é uma doença progressiva, que se agrava com o passar do tempo, progridindo mais rapidamente em idosos e pacientes com outros fatores de agressão hepática.

Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to chronic hepatitis, cirrhosis and hepatocellular carcinoma is very common. The aim of this study was to evaluate the frequency, timing and factors related to progression of hepatitis C. One hundred seventy five patients with chronic post-transfusion hepatitis C were grouped in a cirrhosis group (n = 92) and a non-cirrhosis group (n = 83). The medium time of development to cirrhosis was 11 +/- 6 years. Patients with cirrhosis were older at the time they received transfusion, used more alcohol and had longer times of evolution. The prognosis was worse in the cirrhosis group with a mortality rate of 28.4% and 9.1% of evolution towards hepatocellular carcinoma, comparing with 5.5% and 0% in the non-cirrhosis group respectively. It is shown that post-transfusion hepatitis C is slowly developing progressive disease which progress is much more rapidly in elderly patients and patients with others factors of liver damage.

Systemic and portal hemodynamic response to propranolol in patients with portal hypertension due to hepatitis c virus

Propranolol, a -adrenergic blocker, has been reported to reduce portal pressure in patients with alcoholic cirrhosis and thereby might be useful in the prophylaxis of variceal bleeding. Since it is not known if the response of patients with portal hypertension due to hepatitis C virus is similar, systemic and portal hemodynamic response to propranolol was evaluated in 10 patients with portal hypertension and hepatitis C virus infection. Patients were studied before the intravenous infusion of 0.15 mg/kg propranolol, and 30 min after the infusion. Propranolol induced highly significant systemic hemodynamic effects, reducing heart rate from 65 +/- 6 to 57 +/- 5 [p < 0.0001] and cardiac output from 6.7 +/- 1.6 to 5.0 +/- 1.1 [liters/min, p < 0.0005]. The effect on the pulmonary circulation was a mild increase in diastolic pulmonary artery pressure. Propranolol induced a mild and insignificant decrease in wedged hepatic vein pressure [WHVP], from 32 +/- 6 to 29 +/- 5 mm Hg, and hepatic venous pressure gradient from 18 +/- 3 to 16 +/- 5 mm Hg [p > 0.05]. Decrease of WHVP of more than 5 mm Hg occurred only in 3 out of 10 patients. It is suggested that propranolol may be useful only in some patients with portal hypertension associated with hepatitis C virus infection

Study of the significance of percentage of peripheral CD4+ and CD8+ T cells and the hepatitis C virus genotypes in egyptian patients with chronic hepatitis C

Sequence comparison between isolates of hepatitis C virus [HCV] indicated that HCV can be classified into a series of distinct genotypes. The aim of this study was to determine the prevalence and clinical significance of HCV genotypes, to evaluate clinical relevance of percentage of CD4+ and CD8+ T cells in blood, and to find out predictors of response to interferon [IFN] therapy in Egyptian chronic hepatitis C [CHC] patients. The present study included 61 CHC patients who were subjected to HCV-RNA detection, HCV genotyping and determination of percentage of CD4+ and CD8+ T cells in blood before and after six months treatment with IFN. Also, 20 healthy adults were enrolled as control group. Results revealed that genotype 4a is the prevalent HCV-genotype [85%] in Egypt. Only 21% of cases responded to IFN. The percentage of CD4+ T cells was significantly reduced, while the percentage of CD8+ T cells was significantly increased in patients with CHC. After IFN therapy only the percentage of CD8+ T cells was significantly reduced in non responders. Both genotype and percentage of both CD4+ and CD8+ T cells failed to predict response to IFN. It was concluded that genotype 4a is the predominant genotype in Egypt. CHC is a disease of liver which may be induced by a suboptimal immune response. Selection of CHC patients for treatment with IFN is still a controversial issue

Conceptos actuales en hepatitis por virus B (VHB) y virus C (VHC) / Contemporary concepts on hepatitis due to virus B (VHB) and virus C (VHC)

Los conocimientos que en materia de hepatitis viral se han obtenido en los últimos veinte años son impresionantes, lo cual nos ha permitido conocer con más precisión la historia natural de la enfermedad, la etiopatogenia, el cuadro clínico, el tratamiento y hasta la prevención. Los estudios de tamizaje a las sangres de donadores ha permitido disminuir notablemente la transmisión de la hepatitis viral tipo B que se adquiría por la vía transfusional. Sin embargo, la carencia de marcadores serológicos para prevenir la transmisión por la sangre de la hepatitis no-A, no-B, que recientemente conocemos como hepatitis C, explica el porqué la mayor parte de las hepatitis postransfusión en la actualidad son debidas al virus C. En esta revisión se pretende destacar los aspectos más relevantes de la biología de los virus B y C, así como las implicaciones que en la clínica pueden tener, destacando lo complejo pero fascinante que resulta el estudio de microorganismos que son capaces de desequilibrar al organismo humano, llevándolo incluso hasta la muerte

Seroprevalencia de marcadores de hepatis B y C en trabajadores del área de salud

Introducción : La vía percutánea es una de las más frecuentes y efectivas formas de contagio con los virus B y C. Por lo tanto los trabajadores del área tienen un riesgo importante de contagio. El presente estudio se realizó para evaluar la seroprevalencia de marcadores de infección con estos virus, y para medir la frecuencia

Hepatitis C virus infection in hepatic schistosomiasis

Thirty patients with bilharzial liver fibrosis, splenomegaly and hepatocellular failure [jaundice, ascites, gynecomastia, spider nevi] were studied. Colonic swab showed Bilharzia ova and colonic bilharziasis in all of them. Upper endoscopy showed esophageal varices in 22 cases. Disturbed biochemical liver functions were present in all cases. 16 patients [53.3%] had positive anti-HCV antibodies by second generation ELISA test and 6 patients [20%] had positive HBsAg. Three cases had both anti-HCV and HVsAg. All cases were negative for antinuclear and antismooth muscle antibodies. Liver biopsy showed histological changes of cirrhosis in 20 cases [66.7%] and chronic active, chronic lobular hepatitis in the remaining cases. Bilharzial pigment and/or Schistosoma ova, granuloma were presented in all cases. 8 cases [16.7%] showed ground glass appearance with positive orcein stain characteristics of HBsAg. In conclusion, the presence of positive markers of HCV in patients with hepatic schistosomiasis may contribute to liver cell failure. However, it may reflect only a chronic carrier state of anti-HCV, in such cases liver biopsy can differentiate by the presence of histopathological changes characteristic of chronic hepatitis C

Gastric emptying time in bilharzial patients with and without hepatitis-C virus infection

Eighty one adult male Egyptian bilharzial patients were subjected to the study. Their ages ranged from 25 to 45 years. Their complains were nausea, vomiting, eructation and epigastric pain. Full clinical, laboratory examination, liver biopsies, upper endoscopy, ECG and barium meal, were done to every patient. They were divided into 3 groups. Group I, bilharzial patients who were negative for hepatitis- C, group II, bilharzial patients who were positive for hepatis-C, and group III, control group [normal persons]. Gastric emptying time was prolonged in group I, but was more prolonged in group II patients. There were strong positive correlations between symptoms and gastric emptying times