ABSTRACT
The aim is to describe the molecular epidemiology and perform a genomic characterization of hepatitis B virus (HBV) circulating in Mar del Plata and to identify the origin and diversification patterns of the most prevalent genotype. The S gene and the region encompassing the X gene, basal core promoter (BCP), and precore (preC) was analyzed in 56 samples. They were genotyped as: 80% F1b, 9% A2, 7% D3, and 2% D1. A recombinant F4/D2 genome was detected. The double substitution G1764A/A1762T at the BCP (reduced HBeAg expression) was found in 20% F1b, 2% A2, 2% D1, and 2% D3 samples. A unique D3 presented the G1896A substitution at the preC (HBeAg negative phenotype). A 13% of the samples showed mutations at the HBsAg "a" immunodeterminant (escape from neutralizing antibodies). Mutations at the polymerase (antiviral resistance) were found in 52% of the samples. Coalescent analysis of subgenotype F1b, the most prevalent in the city, showed that viral diversification in Mar del Plata started by year 2000. F1b was the most prevalent genotype detected, being a characteristic of actual HBV infections in Mar del Plata. Local HBV exhibit clinically relevant mutations, but a minority of them was shown to be associated to potential vaccination escape or antiviral resistance. Nevertheless, further studies are needed to determine whether any of these mutants could pose a threat to prevention, diagnosis, or treatment.
Subject(s)
Evolution, Molecular , Genotype , Hepatitis B virus/classification , Hepatitis B virus/genetics , Hepatitis B/virology , Adult , Aged , Argentina/epidemiology , Female , Hepatitis B Core Antigens/genetics , Hepatitis B Surface Antigens/genetics , Hepatitis B virus/isolation & purification , Humans , Male , Middle Aged , Molecular Epidemiology , Promoter Regions, Genetic , Trans-Activators/genetics , Viral Regulatory and Accessory Proteins , Young AdultABSTRACT
Incidence and etiology of hepatocellular carcinoma (HCC) are variable around the world, depending mainly on theprevalence ofchronic hepatitis B carriers in each region. No study has been published analyzing epidemiological features of patients with HCC in Argentina. The aim of this retrospective study was to describe demographical and etiological results in a series of 587 consecutive patients with HCC diagnosed in 15 Hepatology and Gastroenterology Units distributed all around our country. Seventy-two per cent of patients were male, the median age was 62 years (interquartile range 55-68 years), and 93% had cirrhosis. Regarding to etiological data (fully available in 551 cases), main etiologies were chronic alcoholism in 229 patients (41.6%) (the sole risk factor in 182, associated to HCVin 35 and to HBV in 12); hepatitis C in 223 patients (40.5%) (the sole risk factor in 181, associated to alcoholism in 35 and to HBV in 7); hepatitis B in 74 patients (13.4%) (the sole risk factor in 55, associated to alcoholism in 12 and to HCV in 7); cryptogenic cirrhosis in 51 patients (9.2%). There were significant differences in percentages of genders between main groups: males were highly predominant in alcoholic cirrhosis (93%), hepatitis B (87%) and HCV plus alcohol (94%), compared to 63% in cryp togenic cirrhosis and 49% in hepatitis C (p<0.01). There were no differences in age at presentation between the main etiologies. In conclusion, the main causes of HCC in Argentina are alcoholic cirrhosis and hepatitis C (76% of cases). A majority of patients with HCC in our country are cirrhotics, males, and in their 6th or -7th decades of life.
Subject(s)
Alcoholism/complications , Carcinoma, Hepatocellular/etiology , Hepatitis B/complications , Hepatitis C/complications , Liver Neoplasms/etiology , Adolescent , Adult , Age of Onset , Aged , Aged, 80 and over , Alcoholism/epidemiology , Argentina/epidemiology , Carcinoma, Hepatocellular/epidemiology , Carrier State , Chi-Square Distribution , Female , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Humans , Liver Neoplasms/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Young AdultABSTRACT
El monitoreo ambulatorio de presión arterial (MAPA) demostró utilidad en la evaluación pronóstica y terapéutica de la hipertensión arterial (HTA), no habiendo consenso aún en los valores de corte del MAPA para el diagnóstico de la HTA. Este estudio de diseño prospectivo doble ciego comparó la concordancia entre el diagnóstico clínico de HTA (según normas del Joint National Committee, ver referencia 7) como prueba de oro versus los distintos valores de corte dados para el MAPA por distintos autores (ver ref. 2,3,4) en 33 pacientes normotensos e hipertensos recién descubiertos de los consultorios externos de Clínica Médica y de Nefrología del Hospital Interzonal General de Agudos de Mar del Plata. Los valores de corte de 117/72 para el MAPA de 24 hs. del Meta-análisis 2 resultaron ser lo más concordantes para el diagnóstico de HTA con el diagnóstico clínico (87 por ciento) con respecto a la cifra sugerida por Palatini 4 de 121.6/80.4 (75,75 por ciento), y la propuesta por the Allied Irish Bank Study 3 de 134/84 (60,70 por ciento). Cuando se evaluó el riesgo relativo (RR) de ser hipertenso clínicamente, si se lo era por los valores de corte, tuvo ventaja importante la cifra del meta-análisis pero con un I.C. 95 por ciento muy amplio con respecto a las cifras de los otros estudios. (AU)
Subject(s)
Comparative Study , Humans , Blood Pressure , Monitoring, Ambulatory/statistics & numerical data , Hypertension , Clinical DiagnosisABSTRACT
El monitoreo ambulatorio de presión arterial (MAPA) demostró utilidad en la evaluación pronóstica y terapéutica de la hipertensión arterial (HTA), no habiendo consenso aún en los valores de corte del MAPA para el diagnóstico de la HTA. Este estudio de diseño prospectivo doble ciego comparó la concordancia entre el diagnóstico clínico de HTA (según normas del Joint National Committee, ver referencia 7) como prueba de oro versus los distintos valores de corte dados para el MAPA por distintos autores (ver ref. 2,3,4) en 33 pacientes normotensos e hipertensos recién descubiertos de los consultorios externos de Clínica Médica y de Nefrología del Hospital Interzonal General de Agudos de Mar del Plata. Los valores de corte de 117/72 para el MAPA de 24 hs. del Meta-análisis 2 resultaron ser lo más concordantes para el diagnóstico de HTA con el diagnóstico clínico (87 por ciento) con respecto a la cifra sugerida por Palatini 4 de 121.6/80.4 (75,75 por ciento), y la propuesta por the Allied Irish Bank Study 3 de 134/84 (60,70 por ciento). Cuando se evaluó el riesgo relativo (RR) de ser hipertenso clínicamente, si se lo era por los valores de corte, tuvo ventaja importante la cifra del meta-análisis pero con un I.C. 95 por ciento muy amplio con respecto a las cifras de los otros estudios.
