Evolución y pronóstico de la infección por el virus de la hepatitis C en pacientes monoinfectados y coinfectados por VIH en una unidad de enfermedades infecciosas: análisis retrospectivo del periodo 1992-2005 / Progression and prognosis of hepatitis C virus infection in a cohort of HIV-co-infected and non-co-infected patients in an infectious diseases unit between 1992-2005

Introducción. La coinfección por VIH en la hepatitis C crónica supone un factor de peor pronóstico, con mayor lesión hepática y progresión a cirrosis y hepatocarcinoma. Material y métodos. Análisis retrospectivo de 52 pacientes con hepatitis C crónica atendidos en una unidad de enfermedades infecciosas durante el periodo 1992-2005. Se valora: evolución de la hepatopatía crónica por VHC en pacientes coinfectados y no coinfectados por VIH, factores relacionados con el pronóstico de la enfermedad hepática, tasa de supervivencia y probabilidad de evolución a cirrosis en ambos grupos. Resultados. Hubo 29 pacientes coinfectados, con edad inferior (31 [4] vs. 35 [25], p<0,05) y con mayor incidencia de uso de drogas parenterales (26 [91,3] vs. 11 [64,4], p<0,04). No se encontraron diferencias significativas respecto a la respuesta global a los tratamientos entre ambos grupos. Cinco pacientes desarrollaron cirrosis (2 coinfectados y 3 monoinfectados), observándose un mayor riesgo en aquellos con un grado inicial de fibrosis severo (HR 8,30, IC 95% [1,13-60,65], p<0,05). La tasa global de evolución a cirrosis fue de 1,6/100 pacientes/año, reduciéndose a 1,19/100 pacientes/año al incluir a los respondedores al tratamiento. Fallecieron 13 pacientes (25%), sin diferencias en mortalidad, por causas mayoritariamente no hepáticas (64,4%). La probabilidad de supervivencia fue del 55,9% en coinfectados frente al 66,6% en monoinfectados (NS). Conclusiones. El grado de fibrosis hepática se asoció a peor evolución y desarrollo de cirrosis. La decisión de tratar redujo la tasa de progresión a cirrosis. No se observaron diferencias respecto a mortalidad ni factores relacionados con una mayor supervivencia (AU)

Introduction: HIV co-infection in chronic hepatitis C is a poor prognosis factor and accelerates liver damage and progression to cirrhosis and hepatocarcinoma. Material and methods: Retrospective analysis of 52 cases with chronic hepatitis C between 1992 and 2005. We performed an analysis of: outcome of chronic HepC liver disease in co-infected and non-co-infected individuals, factors related to prognosis of hepatic disease, survival ratio and cirrhosis-ratio in both groups. Results: A total of 29 patients were co-infected, with differences in age (31 [4] vs 35 [25], p < .05) and use of parenteral drugs (26 [91.3] vs 11 [64.4], p < .04). There were no differences in overall response to therapies in both groups. Five patients developed cirrhosis, with a higher risk in those who had severe hepatic fibrosis (HR 8.30, 95% CI [1.13-60.65], p < .05). Overall cirrhosis-progression ratio was 1.6/100 patients/year, and 1.19/100 patients/year, taking into account the treatment-responders. Thirteen patients (25%) died, with no differences in mortality between groups due to non-hepatic causes (64.4%). Survival ratio was 559% in co-infected versus 66.6% in non-co-infected (NS). Conclusions: Hepatic fibrosis was related to a worse prognosis and hepatic cirrhosis. Treatment reduced cirrhosis-progression ratio. There were also no differences in the mortality ratio or for related survival factors (AU)

[Acalculous cholecystitis: an uncommon form of presentation of Q fever]. / Colecistitis alitiásica: una forma infrecuente de presentación de fiebre Q.

Acute acalculous cholecystitis is a very rare clinical presentation of Q fever. We report the case of a 38-year-old man who presented with fever associated with elevation of liver enzyme levels and thickening of the gallbladder wall on abdominal ultrasonography and who was initially diagnosed with acute acalculous cholecystitis. Due to the persistence of fever and transaminase elevation despite antibiotic treatment, a liver biopsy was performed. Characteristic "doughnut" epithelioid granulomas were observed, suggesting a diagnosis of granulomatous hepatitis caused by Q fever, which was confirmed by serological methods. Treatment with doxycycline was commenced and the patient subsequently showed rapid clinical improvement, with disappearance of fever and normalization of liver enzyme levels. We review 8 cases of acute cholecystitis associated with Q fever published in the literature and stress the importance of liver biopsy in the etiological diagnosis of patients with prolonged fever and abnormal liver function tests.

Colecistitis alitiásica: una forma infrecuente de presentación de fiebre Q / Acalculous cholecystitis: an uncommon form of presentation of Q fever

La colecistitis aguda alitiásica es una forma infrecuente depresentación de la fiebre Q. Se expone el caso clínico de unpaciente varón de 38 años con un síndrome febril asociado aalteraciones en las pruebas de función hepática y un engrosamientode la pared vesicular en la ecografía abdominal,que permitió establecer un diagnóstico inicial de colecistitisalitiásica. La falta de respuesta al tratamiento habitual, juntocon la persistencia de la fiebre e hipertransaminasemia,motivó la realización de una biopsia hepática que mostró lapresencia de granulomas de células epitelioides «en rosquilla» típicos de la hepatitis granulomatosa por fiebre Q. Eldiagnóstico se confirmó posteriormente mediante serología.El tratamiento con doxiciclina fue altamente efectivo, conrápida desaparición de la fiebre y normalización de laspruebas de función hepática.Además, se realiza una revisión de los 8 casos de colecistitisaguda asociada a fiebre Q descritos en la bibliografía y sesubraya el papel de la biopsia hepática en el diagnósticoetiológico de los cuadros de fiebre prolongada asociada a alteracionesen el perfil hepático

Acute acalculous cholecystitis is a very rare clinical presentationof Q fever. We report the case of a 38-year-old manwho presented with fever associated with elevation of liverenzyme levels and thickening of the gallbladder wall on abdominalultrasonography and who was initially diagnosedwith acute acalculous cholecystitis. Due to the persistence offever and transaminase elevation despite antibiotic treatment,a liver biopsy was performed. Characteristic «doughnut epithelioid granulomas were observed, suggesting adiagnosis of granulomatous hepatitis caused by Q fever,which was confirmed by serological methods. Treatmentwith doxycycline was commenced and the patient subsequentlyshowed rapid clinical improvement, with disappearanceof fever and normalization of liver enzyme levels.We review 8 cases of acute cholecystitis associated with Q feverpublished in the literature and stress the importance ofliver biopsy in the etiological diagnosis of patients with prolongedfever and abnormal liver function tests

[Assessing the use of low-molecular-weight heparins fo venous thromboembolism prophylaxis in internal medicine patients]. / Evaluación de la utilización de heparinas de bajo peso molecular como profilaxis de tromboembolismo venoso en pacientes de medicina interna.

BACKGROUND: Sufficient evidence exists to recommend routine thromboembolic disease prophylaxis for medical inpatients with risk factors --with low-molecular-weight-- heparins being (LMWH) the most suitable treatment option. The objective is to determine the thromboembolic risk level of Internal Medicine patients with LMWH prophylaxis, prescription habits and their adequacy to hospital's standards, as well as prevalence of non-treated patients at risk. MATERIAL AND METHODS: Descriptive and prospective study of internal medicine patients for 2 months. Patients with prophylactic LMWH prescription were chosen, and their thromboembolic risk level and suitable LMWH dose was determined according to the hospital's "thromboembolic disease prevention standards". On the other hand, patients with no LMWH prophylaxis were analysed in order to judge their candidacy. RESULTS: 30% of patients had a prophylactical LMWH prescription, with 43.5% of these prescriptions being adequate to the risk level. The main risk factors were: age, bed-stay, hypertension, cardiopathy with risk factors, diabetes mellitus, dislipemias and COPD. Chi2(0.05) test between risk level and prescribed LMWH revealed no association. 72% of patients without LMWH prescription had a moderate or high risk level. CONCLUSIONS: 1. A high proportion of the patients studied have a considerable thromboembolic risk level. 2. There is not a statistical relationship between thromboembolic risk level and LMWH prescription. 3. There is a high percentage of patients with no LMWH prophylaxis which could be eligible for it. 4. A pharmaceutical intervention would be useful to approach pharmacological prophylaxis to each patient's risk.